Hearing Loss and Autism Spectrum Disorder

Hearing loss and Autism Spectrum Disorder can Exist Together. Amanda Rohde/Getty Images

Autism is a complex disorder that consists of behavioral differences, communication challenges, and difficulties with social interactions. It is estimated that 1 in 88 children are on the autism spectrum but that incidence jumps to 1 in 59 when looking at children with hearing loss. Hearing loss may mask some of the symptoms of autism, delaying diagnosis by a significant amount. The average hearing child is diagnosed with autism by age 3 years while the average age of autism diagnosis in a child with hearing loss is 5 ½ years of age.

Characteristics of Autism in a Child with Hearing Loss

  • Nonverbal communication: Children with hearing loss will have good eye contact and use facial expressions and gestures to convey information. Children on the autism spectrum will typically have less eye contact, may display flat affect, and have difficulties reading nonverbal cues of others.
  • Interactions with others and play: Children with hearing loss will attempt to initiate communication with others, will want to cooperate and share activities, and will play in an interactive manner. Children on the autism spectrum are not socially motivated, will have difficulties or lack of interest in playing with peers and are usually developmentally delayed in how they play (such as not engaging in imaginative play). A child on the autism spectrum may have stereotypical play behaviors such as lining up toys or spinning wheels on a toy repeatedly, which would not be seen in a child with hearing loss only.
  • Transitions: While children with hearing loss may prefer predictability, especially if they do not understand when or why a change may occur, they react in a developmentally appropriate way. Children with autism will display a much more rigid need for routine and dependable schedule.
  • Interests: All children will find topics that interest them. In a child with hearing loss, these interests are developmentally appropriate. In a child on the autism spectrum, these interests may become fixations and consume an inordinate amount of time and energy.
  • Sensory Behaviors: A child with hearing loss will respond to appropriate amplification and make progress with intervention. A child on the autism spectrum may have little response to amplification or have an adverse reaction to sounds, the tactile feel of the hearing aids, and/or have limited progress with appropriate interventions in place.

In any child with hearing loss, the first priority is to obtain adequate exposure to sound in order to facilitate speech and language development and develop the auditory brain pathways. For children with both autism spectrum disorder (ASD) and hearing loss, a multidisciplinary approach is critical. Early identification of ASD will allow for appropriate interventions. Members of the team will include an audiologist, speech-language pathologist, occupational therapist (especially if there are difficulties with sensory behaviors), psychologist, and educators.

Interventions for children with a dual diagnosis of hearing loss and ASD need to focus on functional behavior and functional communication. Communication can be verbal, manual (sign language), use of an augmentative communication board, or a combination of these strategies. Visual strategies and supports are important tools, such as using a picture book to illustrate an upcoming activity or schedule.


Gallaudet Research Institute (2011). Regional and national summary report of data from the 2009–2010 annual survey of deaf and hard of hearing children and youth. Washington, DC: GRI, Gallaudet University.

Worley JA, Matson JL, Kozlowski AM. The Effects of Hearing Impairment on Symptoms of Autism in Toddlers. Dev Neurorehabil 2011; 14(3): 171-6.

DeRamus, M. When it’s More Than Hearing Loss. The ASHA Leader, April 2015, Vol. 20, 10-11

Red Flags for Disabilities in Children who are Deaf/Hard of Hearing. The ASHA Leader, January 2007, Vol. 12, 8-29.

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