Expert: Dr. Sharon A. Mitchell - 10/4/2009

Question
Hi>  My daughter was diagnosed under the educational spectrum of autism.  Her doctor feel that my daughter problem is a central auditory processing disorder.  She has had intermittent hearing loss for about 13 months.  She is 3 years old.  I have a report from a audiologist requesting an evaluation for environmental hearing and individual speech therapy. The school finally acknowledge that there are "effect of intermittent hearing loss, but there are significant communication and socialization needs that are beyond that level of a child with a hearing loss or developmental delay".  She just recently got surgery and her hearing has returned since, June.  The school feels that they are unable to communicate with her so they decided to focus on autism and not language development.   
My daughter is able to function in the community, she has no stereo type behavior. She likes to be around other children and is starting to seek out children her own age.  I am concern about how much therapy she should get, what types of programs should she be in.  Right now she goes to school 2 days for two half hours. She receives speech therapy about 20 minutes a week. Can you give some information about types of programs that I should get her into.  I would appreciate some information about what I should do concerning hearing loss.

Answer
While some parents feel they have to work hard to receive services for three year olds from their school system, you are in the enviable position of already being connected with the school. Some parents also feel that no one listens to their concerns about the possibility of autism and that the school may downplay the symptoms. Your school seems to be acknowledging that there are difficulties and is willing to be involved.

Actually, it is more work for the school to work with a child with an autism spectrum disorder rather than just a hearing loss. The fact that the school looks at your daughter through an autism rather than solely a hearing loss lens demonstrates their level of concern and willingness to help. I would imagine that what they observe of your daughter in a group situation is more complex than is usually seen in a child with only an intermittent hearing loss. They sound like good partners for you and I think you should welcome their help.

If your little girl has had recurrent bouts of ear infections, it is likely she has had some degree of hearing loss, which would have affected her acquisition of language. It's great that she has now had surgery and hears better. Most young children who have suffered some hearing loss will benefit from extra help, such as your daughter is now receiving.

At the heart of autism, it is a communication and processing disorder. Most people with autism have characteristics similar to those with auditory processing difficulties such as:

- trouble picking out which things in the environment to pay attention to and which to ignore
- difficulties in understanding spoken language
- difficulties with multi-step oral directions
- they have a hard time processing what they hear amid confusion and background noise

The things that your speech therapist and the school will do to assist a child with central auditory processing disorder, a hearing loss and autism are similar. One of the main focuses when working with children with autism is communication and language. These are also things that we work on with kids with hearing impairments. I think your daughter will benefit, no matter what her official label may be.

The exact label is not as important as finding the strategies that work best for your child. It sounds like that is the goal of your school.

The American Speech/Language/Hearing Association has a chart that lists behaviors you would expect typical two-to-three years to have acquired. You can take a look at the link below and see how well this describes your child. The second link talks about language skills for three-to-four year olds. At the bottom of each page are a variety of suggestions that you can do at home.

2 - 3 year olds: http://www.asha.org/public/speech/development/23.htm

3 -4 year olds: http://www.asha.org/public/speech/development/34.htm

Here are some further suggestions you could try when you're at home with your daughter:

http://www.tr.wou.edu/perc/documents/INDIRECTLANGUAGESTIMULATION.pdf

The aim of early intervention is to provide help to a child at an early age so that she can advance as quickly as she is able. Your school sounds keen to provide some of this help. Your speech therapist will likely offer you other suggestions to try at home and may guide you in ways that you can actively encourage your little girl's communication.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., Ph.D. candidate
www.autismsite.ca