Deafness and autism
When children have more than one additional need, it’s important to consider both and also how they interact with each other. Because the signs of deafness are similar to the signs of autism, getting the right diagnosis can be a challenge. This page explains ways to identify deaf children with autism and how to get support.
Every time I went to the GP with questions, their response was always, "It’s because he’s deaf." He was 3-and-a-half when he was diagnosed as autistic. It was very obvious to everybody by that point and, thankfully, the National Deaf Child and Adolescent Mental Health Services (Deaf CAMHS) were involved in his diagnosis and have been brilliant the whole time.
Kate is mum to Xander (10) who's profoundly deaf and has autism and ADHD.
Understanding autism
Autism is a lifelong, developmental condition that affects the way a person communicates, interacts and processes information. Autism is a spectrum condition, which means that how much it affects someone will vary from person to person. Some autistic people may not need any help or support while others may have significant learning difficulties.
However, most people with autism share certain characteristics.
- Difficulties with social communication and interaction, for example avoiding eye contact, not drawing parents’ attention to objects or events, difficulty understanding other people’s feelings or emotions.
- Repetitive behaviours, activities and routines, for example fixating on particular things, or being resistant to change.
- An over- or under-sensitivity to sounds, touch, tastes, smells, light, colours, temperatures or pain, for example startling easily or appearing to find noise painful.
Find out more about possible signs of autism (National Autistic Society).
Diagnosing autism
Many children in the UK are identified as having a permanent hearing loss at birth through newborn hearing screening. Hearing children are rarely diagnosed with autism before the age of two. If a deaf child is also autistic, this will often be diagnosed later because some of the signs of deafness are similar to signs of autism.
These include:
- a delay in acquiring language
- appearing withdrawn
- appearing indifferent to other people
- playing alone.
Professionals need to be sure that these behaviours are due to autism, not deafness, before they can make a firm diagnosis. Autism often presents as a child having difficulties processing external sensory information, such as sound or light, as well as other sensory issues such as around food and eating.
Some parents find it helpful to track their child’s early development using resources such as our early years development tool, 'Success from the Start'. This helps them to share information about their child with the professionals who support them.
Things to look out for may include:
- poor eye contact
- not using common gestures such as pointing
- a delay in being able to pretend play
- poor body awareness and balance, for example bumping into things, rocking, spinning or moving the whole body to look at something
If you have any concerns, you should raise them with your GP, health visitor or Teacher of the Deaf, and ask for a referral for a possible diagnosis of autism.
Find out more about the process of being diagnosed with autism (National Autistic Society).
Research is currently underway to develop an assessment for autism in deaf children. You can find out more about this from the Child Oriented Mental Health Innovation Collaborative (COMIC).
Some doctors or other medical professionals may refer to autism as Autism Spectrum Disorder (ASD). This is the medical term for autism.
Parenting a deaf child with autism
Finding what works for your child will often be trial and error. Building on your child’s interests and strengths will make a big difference.
We’re still learning about the impact of both deafness and autism on children. Since autism is a spectrum condition and deafness will also affect children in different ways, there is no one approach which is right for every child.
Getting the diagnosis was great as it enables Oliver to get extra support for his autism, and not just through the Teacher of the Deaf or going to a school with a deaf hub/resource.
Maria is nanny to Oliver (10), who became deaf when he was three and wears hearing aids.
Promote communication
Be open and supportive of your child and allow them to communicate in whatever way they can. This may include sign language, spoken language, or using an assistive communication device.
Find out more about communication choices for children with additional needs.
Whatever method of communication your child uses, it should be used consistently – both at home and in education. A speech and language therapist and other professionals working with you will be able to provide support and advice.
Children with autism may struggle with eye contact and joint attention (when parents naturally draw their child’s attention to something, for example, by looking at it themselves or using gestures). This can make communication approaches often used by deaf children, such as lip-reading or sign language, more difficult.
Deaf children with autism may benefit from support such as visual schedules, calendars or cues for routine activities and objects of reference, to help them understand. These can be accompanied by programmes to help with interpreting facial expressions or learning how to use language in social situations.
Behaviour
All behaviour is a form of communication. Children with autism can display challenging behaviour that may be hard to understand or manage as a parent. It's important to remember that 'difficult' or 'challenging' behaviour, known as a meltdown, is actually the child expressing an unmet need, rather than them being badly behaved, having a tantrum or being naughty.
The National Autistic Society has a guide for family members and friends of people with autism to find out how to predict meltdowns, identify their causes and reduce how often they happen.
For deaf children with autism, this challenging behaviour can be due to frustration at not being able to express themselves because of difficulty communicating or because they’re feeling overwhelmed. It can be hard to know what’s causing certain behaviours, but it’s important to work with your child to try to find the cause so you can then act to reduce or remove it.
By being reflective, tracking and observing carefully, parents and professionals may be able to work out what’s causing the behaviour, including if it’s the result of a particular sensory issue.
To do this, it can be helpful to think ‘ABC’.
A: Antecedent — what happened before the meltdown?
- What was the child doing?
- Where was the child?
- Who was with the child?
- What was the environment like?
- Was there a possible sensory trigger, such as light, sound, smell?
B: Behaviour
- What was the child’s reaction/how are they behaving?
- How long did the behaviour last?
C: Consequence
- What did you or other people present do?
- What impact have your/their actions had or not had?
- What happens next?
You can use ABC to find any links between the behaviour and specific triggers, such as information or emotion overload or sensory issues like light levels, textures, sounds, and smells.
As children grow and develop more language, they may learn to share what they find stressful or frustrating and begin to recognise how their body and feelings change in these situations. This allows them to understand and process their feelings.
Our resource 'What are you feeling?' helps deaf children to identify their emotions and talk about their and others’ feelings.
Social stories are short descriptions of a situation, event or activity. They include information about what to expect in that situation and why. Social stories can help deaf children with autism understand what’s coming next and stay safe.
Education
Some deaf children with autism will have a plan. These are legal documents which set out your child’s special or additional needs, their school placement and the support that has been agreed.
Find out more about getting additional support in education in:
It’s important that the different professionals supporting your child work together to make sure your child’s needs are being met and frequently reviewed.
Depending on your child's needs, you may want to look for a school which can offer specialist support in both deafness and autism. It’s important that the school your child goes to gives them the opportunity to use their preferred language and communication approach.
Emotional health and wellbeing
Autism is not a mental health condition. However, deaf, neurodiverse children have a higher chance of developing problems with their emotional health and wellbeing than hearing children. Being aware of this risk can allow you and your child to take steps to develop emotional resilience and wellbeing.
Deaf Children and Adolescent Mental Health Services (Deaf CAMHS) can help if you have any concerns about your child’s mental health.
Full references for this webpage are available by emailing
informationteam@ndcs.org.uk