Monty, now
aged 11 with ASD, has an assistant who comes in the afternoon to run our
ABA-inspired home program, let’s call her Stella.
Stella is a
student training to be a teacher for deaf people, so her knowledge of ABA comes
from her time with Monty. Nobody here
uses ABA to teach the deaf.
Her latest
task was to try and teach 3 eight year old children to count to ten. The problem being that two of the children
are deaf and can only say “yes” and “no” and the third child is deaf, autistic
and non-verbal.
Using ABA
she managed to teach the two deaf children to count out loud to ten and to
match objects marked with each number. Very good and the regular teachers were very
impressed.
My comment
was that it was a pity nobody taught them to say something more useful. How about “hello”, “my name is Tom” etc.
What about
the deaf boy with autism? It turns out,
where we live, if you are deaf and have other “complex needs” you do not get a cochlear implant.
Cochlear implants, when
implanted while the deaf person is very young, can be hugely successful. About 400,000 people worldwide have received
them. You end up with a different kind
of sound than that experienced by non-deaf people, but it gives the brain
inputs which allow it to identify and process speech and other sounds.
A cochlear implant (CI) is a
surgically implanted electronic device that provides a sense of sound to a
person who is profoundly deaf or severely hard of hearing.
Cochlear implants may help provide hearing in
patients who are deaf because of damage to sensory hair cells in their cochleas. In those
patients, the implants often can enable sufficient hearing for better
understanding of speech. The quality of sound is different from natural
hearing, with less sound information being received and processed by the brain.
However, many patients are able to hear and understand speech and environmental
sounds. Newer devices and processing-strategies allow recipients to hear better
in noise, enjoy music, and even use their implant processors while swimming.
Cochlear implants for congenitally deaf
children are considered to be most effective when implanted at a young age,
during the critical period in which the brain is still learning to interpret
sound.
Hence they are implanted before the recipients can decide for themselves, on
the assumption that deafness is a disability.
Children with cochlear implants are more
likely to be educated orally, in the standard fashion, and without access to sign
language (Spencer et al. 2003). They are often isolated from other deaf
children and from sign language (Spencer 2003). Children do not always receive
support in the educational system to fulfill their needs as they may require
special education environments and Educational Assistants. According to
Johnston (2004), cochlear implants have been one of the technological and
social factors implicated in the decline of sign languages in the developed
world.
Cochlear Implants and Autism
Since people
with autism have various sensory issues, they are not considered suitable
candidates for the only therapy that could give them the ability to hear. At least that is the case in many countries.
The word is
that in the first year it is hard to adjust to a Cochlear Implant and this is
one reason why they have to be implanted while the person is very young. It takes the brain a while to adjust, and the
more plastic it is, the better it can adjust.
Since people
with autism are not exactly flexible at the best of times and they can be prone
to tantrums and violence, they are seen as a challenge too far.
This seems
rather cruel to me and very short sighted.
As Stella
said:- “for that first year, who is going to look after them?”
My response
would be “who is going to look after them for the next 60+?”
After all, would
you rather care for a sometimes violent toddler for 12 months during his adaptation to
hearing, or a sometimes violent, deaf autistic adult for life? I suppose they just drug the adults.
How common is deafness with autism?
According to some research, about 5% of people with deafness have autism and about 3.5% of
people with autism have deafness.
I think when
they say “autism” they mean serious autism, not the modern, all-inclusive, DSM 5 autism-lite.
What does the Research tell us?
As always, there is data on just about everything and this includes autism with deafness
and the efficacy of Cochlear Implants.
Rather as I
expected, it is not true that giving hearing to deaf people with autism is a
bad idea. The research actually shows
the opposite.
Just as
teaching deaf people to count aloud is possible, when you apply simple
behavioral techniques, so is giving hearing to deaf people with autism.
Results: Fifteen patients
with history of ASD and cochlear implantation were analyzed and compared with
15 patients who received cochlear implant and have no other disability.
Postoperatively, more than 67% of children with ASD significantly improved
their speech perception skills, and 60% significantly improved their speech
expression skills, whereas all patients in the control group showed significant
improvement in both aspects. The top 3 reported improvements after cochlear
implantation were name recognition, response to verbal requests, and enjoyment
of music. Of all behavioral aspects, the use of eye contact was the least
improved. Survey results in regard to improvements in patient interaction were
more subtle when compared with those related to sound and speech perception.
The most improved aspects in the ASD patients' lives after cochlear
implantation seemed to be attending to other people's requests and conforming
to family routines. Of note, awareness of the child's environment is the most
highly ranked improvement attributed to the cochlear implant.
Conclusion: Cochlear implants are effective and
beneficial for hearing impaired members of the ASD population, although
development of language may lag behind that of implanted children with no
additional disabilities. Significant speech perception and overall behavior
improvement are noted.
"Although the group of deaf children with complex needs is
overall a heterogeneous one, there are subgroups that would benefit from
further and detailed investigation in thinking about cochlear implantation, for
instance deaf children with Down’s syndrome, Children with Autistic Spectrum
Disorder, cerebral palsy."