Between 1 to 2 of every 1,000 children are born deaf or hard of hearing (DHH) and, of those, 30–50% have additional disabilities, including Autism Spectrum Disorder (ASD). Most measures assessing ASD characteristics rely on some degree of behavioral response to sound (e.g., responding to name, listening response), and may not be appropriate for use with children who are DHH. Further, ASD specific measures do not provide information on a child’s functional abilities across developmental domains. We conducted a cross-sectional analysis comparing mean T-scores on a standardized multidimensional measure, the Behavior Assessment System for Children, Third Edition, Parent Rating Scale (BASC-3 PRS), across three groups matched for age and sex: children who are DHH and diagnosed with ASD (DHH + ASD; n = 16); children who are DHH without ASD (DHH-ASD; n = 16); and children who are typically hearing with ASD (H + ASD; n = 16). Analyses revealed statistically significant differences across scales of Attention Problems, Atypicality, Withdrawal, Behavioral Symptoms Index, Social Skills, Leadership, Functional Communication, Activities of Daily Living, Adaptive Skills, Autism Probability Indices, and Developmental Social Disorders. Pairwise comparisons showed DHH + ASD and H + ASD mean T-scores were statistically similar and distinct from DHH-ASD mean T-scores on all these scales except for Withdrawal, Leadership, Functional Communication, and Activities of Daily Living, where pairwise comparisons varied. The findings add to the literature on ASD and DHH children and call for further exploration of the BASC-3 as a tool for both evaluation of ASD and the development of individualized treatment plans in this unique population.
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American Psychological Association. (2021). Equity, Diversity, and Inclusion INCLUSIVE LANGUAGE GUIDELINES. https://www.apa.org/about/apa/equity-
Antshel, K. M., & Russo, N. (2019). Autism Spectrum Disorders and ADHD: Overlapping Phenomenology, Diagnostic Issues, and Treatment Considerations. Current Psychiatry Reports, 21(5), 34. https://doi.org/10.1007/s11920-019-1020-5
Benson, N. F., Floyd, R. G., Kranzler, J. H., Eckert, T. L., Fefer, S. A., & Morgan, G. B. (2019). Test use and assessment practices of school psychologists in the United States: Findings from the 2017 National Survey. Journal of School Psychology, 72, 29–48. https://doi.org/10.1016/j.jsp.2018.12.004
CDC. (2020). Summary of 2020 National CDC EHDI Data. https://digitalcommons.usu.edu/jehdi/vol4/iss2/1/
Dale, B. A., & Neild, R. (2020). The assessment needs of families with children who are deaf and hard of hearing referred for an autism spectrum disorder evaluation. Psychology in the Schools, 57(3), 475–484. https://doi.org/10.1002/pits.22328
De Reyes, A. L., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131(4), 483–509. https://doi.org/10.1037/0033-2909.131.4.483
Duncan, A. W., & Bishop, S. L. (2015). Understanding the gap between cognitive abilities and daily living skills in adolescents with autism spectrum disorders with average intelligence. Autism, 19(1), 64–72. https://doi.org/10.1177/1362361313510068
Gallaudet Research Institute. (2011). Regional and national summary of data from the 2009–10 annual survey of deaf and hard of hearing children and youth. GRI, Gallaudet University.
Gulati, S. (2019). Language Deprivation Syndrome. In N. S. Glickman & W. C. Hall (Eds.), Language Deprivation and Deaf Mental Health (pp. 24–53). Routledge.
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., & Duda, S. N. (2019). The REDCap consortium: Building an international community of software platform partners. In Journal of Biomedical Informatics (Vol. 95). Academic Press Inc. https://doi.org/10.1016/j.jbi.2019.103208
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Hodkinson, R., Phillips, H., Allgar, V., Young, A., Le Couteur, A., Holwell, A., Teige, C., & Wright, B. (2023). Comparison of Diagnostic Profiles of Deaf and Hearing Children with a Diagnosis of Autism. International Journal of Environmental Research and Public Health, 20(3), 2143. https://doi.org/10.3390/ijerph20032143
Humphries, T., Kushalnagar, P., Mathur, G., Napoli, D. J., Padden, C., Pollard, R., Rathmann, C., & Smith, S. (2016). Avoiding linguistic neglect of deaf children. Social Service Review, 589–619.
Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D. Z., Apkon, C. S., Davidson, L. F., Ellerbeck, K. A., Foster, J. E. A., Noritz, G. H., O’Connor Leppert, M., Saunders, B. S., Stille, C., Yin, L., Brei, T., Davis, B. E., Lipkin, P. H., Norwood, K., Coleman, C., Mann, M., … Paul, L. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1). https://doi.org/10.1542/PEDS.2019-3447
Kaufman, N. K. (2022). Rethinking “gold standards” and “best practices” in the assessment of autism. Applied Neuropsychology: Child, 11(3), 529–540. https://doi.org/10.1080/21622965.2020.1809414
Kind, A. J. H., & Buckingham, W. R. (2018). Making Neighborhood-Disadvantage Metrics Accessible — The Neighborhood Atlas. New England Journal of Medicine, 378(26), 2456–2458. https://doi.org/10.1056/NEJMp1802313
Lieu, J. E. C., Kenna, M., Anne, S., & Davidson, L. (2020). Hearing Loss in Children: A Review. In JAMA - Journal of the American Medical Association (Vol. 324, Issue 21, pp. 2195–2205). American Medical Association. https://doi.org/10.1001/jama.2020.17647
Lord, C., Charman, T., Havdahl, A., Carbone, P., Anagnostou, E., Boyd, B., Carr, T., de Vries, P. J., Dissanayake, C., Divan, G., Freitag, C. M., Gotelli, M. M., Kasari, C., Knapp, M., Mundy, P., Plank, A., Scahill, L., Servili, C., Shattuck, P., … McCauley, J. B. (2022). The Lancet Commission on the future of care and clinical research in autism. In The Lancet (Vol. 399, Issue 10321, pp. 271–334). Elsevier B.V. https://doi.org/10.1016/S0140-6736(21)01541-5
Lord, C., Rutter, M., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism Diagnostic Observation Schedule - 2nd Edition (ADOS-2). Western Psychological Corporation.
Ludwig, N. N., Jashar, D. T., Sheperd, K., Pineda, J. L., Previ, D., Reesman, J., Holingue, C., & Gerner, G. J. (2022). Considerations for the identification of autism spectrum disorder in children with vision or hearing impairment: A critical review of the literature and recommendations for practice. Clinical Neuropsychologist, 36(5), 1049–1068. https://doi.org/10.1080/13854046.2021.2002933
McFayden, T. C., Culbertson, S., DeRamus, M., Kramer, C., Roush, J., & Mankowski, J. (2023). Assessing Autism in Deaf/Hard-of-Hearing Youths: Interdisciplinary Teams, COVID Considerations, and Future Directions. Perspectives on Psychological Science. https://doi.org/10.1177/17456916231178711
Meinzen-Derr, J., Wiley, S., Bishop, S., Manning-Courtney, P., Choo, D. I., & Murray, D. (2014). Autism spectrum disorders in 24 children who are deaf or hard of hearing. International Journal of Pediatric Otorhinolaryngology, 78, 112–118. https://doi.org/10.1016/j.ijporl.2013.10.065
Miller, L. E., Perkins, K. A., Dai, Y. G., & Fein, D. A. (2017). Comparison of parent report and direct assessment of child skills in toddlers. Research in Autism Spectrum Disorders, 41–42, 57–65. https://doi.org/10.1016/j.rasd.2017.08.002
National Association of the Deaf. (2023). Community and Culture - Frequently Asked Questions. https://www.nad.org/resources/american-sign-language/community-and-culture-frequently-asked-questions/
Nordahl-Hansen, A., Kaale, A., & Ulvund, S. E. (2014). Language assessment in children with autism spectrum disorder: Concurrent validity between report-based assessments and direct tests. Research in Autism Spectrum Disorders, 8(9), 1100–1106. https://doi.org/10.1016/j.rasd.2014.05.017
Paul, R., Paatsch, L., Caselli, N., Garberoglio, C. Lou, Goldin-Meadow, S., & Lederberg, A. (2020). Current research in pragmatic language use among deaf and hard of hearing children. Pediatrics, 146. https://doi.org/10.1542/peds.2020-0242C
Phillips, H., Wright, B., Allgar, V., McConachie, H., Sweetman, J., Hargate, R., Hodkinson, R., Bland, M., George, H., Hughes, A., Hayward, E., De Las Heras, V. F. G., & Le Couteur, A. (2022). Adapting and validating the Autism Diagnostic Observation Schedule Version 2 for use with deaf children and young people. Journal of Autism and Developmental Disorders, 52(2), 553–568. https://doi.org/10.1007/s10803-021-04931-y
Reynolds, C. R., Kamphaus, R. W., & Vannest, K. (2015). Behavior Assessment System for Children, 3rd Edition (BASC-3). Pearson.
Sanislow, C. A., Pine, D. S., Quinn, K. J., Kozak, M. J., Garvey, M. A., Heinssen, R. K., Wang, P.S.-E., & Cuthbert, B. N. (2010). Developing constructs for psychopathology research: Research domain criteria. Journal of Abnormal Psychology, 119(4), 631–639. https://doi.org/10.1037/a0020909
Szarkowski, A., Mood, D., Shield, A., Wiley, S., & Yoshinaga-Itano, C. (2014). A Summary of current understanding regarding children with autism spectrum disorder who are deaf or hard of hearing. Seminars in Speech and Language, 35(4), 241–259. https://doi.org/10.1055/s-0034-1389097
Szymanski, C. A., Brice, P. J., Lam, K. H., & Hotto, S. A. (2012). Deaf children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(10), 2027–2037. https://doi.org/10.1007/s10803-012-1452-9
University of Wisconsin School of Medicine and Public Health. (2018). Area Deprivation Index v2.0. https://www.neighborhoodatlas.medicine.wisc.edu/
Walensky, R. P., Bunnell, R., Kent, C. K., Gottardy, A. J., Leahy, M. A., Martinroe, J. C., Spriggs, S. R., Yang, T., Doan, Q. M., King, P. H., Starr, T. M., Yang, M., Jones, T. F., Boulton, M. L., Carolyn Brooks, M., Virginia Caine, M. A., Fielding, J. E., David Fleming, M. W., Halperin, W. E., … Johnson, L. (2023). Morbidity and Mortality Weekly Report Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years-Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveillance Summaries, 72(2), 1–14. https://doi.org/10.15585/mmwr.ss7202a1
Zhou, X., Reynolds, C., & Kamphaus, R. W. (2022). Diagnostic utility of Behavior Assessment System for Children-3 for children and adolescents with autism. Applied Neuropsychology: Child, 11(4), 647–651. https://doi.org/10.1080/21622965.2021.1929232
The authors wish to acknowledge Christine MacDonald, AuD, CCC-A, PASC, CH-AP for her contributions reviewing the audiological variables in this manuscript.
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Spellun, A., Herlihy, M., Taketa, E. et al. Diagnostic Utility of Parent Ratings on the Behavior Assessment System for Children-Third Edition in Children who are Deaf and Hard of Hearing and Diagnosed with Autism Spectrum Disorder. Res Child Adolesc Psychopathol (2023). https://doi.org/10.1007/s10802-023-01115-3