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Understanding Deaf Plus: The Likelihood and Impact of Other Disabilities Compounding Hearing Loss

6 min read
Liam, Clarke alum.
Clarke alum Liam, who has hearing loss and autism, is considered “deaf plus.”

While it’s often noted that more than 90% of children who are deaf or hard of hearing are born to parents with typical hearing, another important statistic frequently goes overlooked.

According to the Gallaudet Research Institute, approximately 40% of children who are deaf or hard of hearing experience additional challenges or disabilities co-occurring with their hearing loss. These children are often described as being “deaf plus.”

“When we use the term ‘deaf plus,’” says Barbara Hecht, PhD, Clarke’s national director of strategic initiatives and partnerships, “we’re generally referring to any type of deafness or hearing loss plus additional conditions or special education needs. Those additional conditions could be medical; they could be learning needs; they could be social-emotional needs. But they are needs that usually require an expanded team and an expanded skill set on the part of the child’s providers.”

Approximately 40% of children who are deaf or hard of hearing have co-occurring disabilities.

There is a very wide range of possible co-occurring conditions. In 2022 Clarke surveyed its itinerant teachers of the deaf who were serving more than 450 students who are deaf or hard of hearing in Massachusetts mainstream schools. Clarke teachers identified the most common co-occurring conditions experienced by their students to be ADHD, autism spectrum disorder (ASD), cognitive disabilities, fine/gross motor and sensory disabilities, learning disabilities, vision disabilities and apraxia.

For these students, establishing an interdisciplinary team is essential. We know that when a child presents with hearing loss and any other complex needs, the critical factor to their success is having a collaborative team of caregivers and professionals at their side.

Diagnostic Challenges and Interactions Among Conditions

Early identification of hearing loss can make a significant difference for a child’s success. And once a hearing loss is identified, starting early intervention as soon as possible is paramount. Not only will early intervention specialists help families create language-rich environments for their young children, but they also monitor children’s cognitive, social-emotional and physical development, allowing them to identify characteristics of other conditions that might warrant further assessment and intervention.

It can, however, be challenging to accurately diagnose conditions that co-occur with hearing loss. There can be overlapping symptoms, limitations in existing assessment tools and difficulty in obtaining accurate assessments for very young children.

For example, hearing loss and ASD share several early manifestations, including delayed speech and language and inattention to one’s name and other auditory cues.

Sarah, mother to 11-year-old Clarke alum Liam, describes her experience supporting her child who is deaf and on the autism spectrum.

Characteristics of a Successful Team for Children who are Deaf Plus
  • Recognizes and supports parents as key members of the team
  • Fosters a culture of flexibility and open communication
  • Encourages collaboration across disciplines and settings
  • Provides case management and frequent progress monitoring
  • Provides strengths-based instruction with high expectations
  • Embraces a Universal Design for Learning perspective (teaching to address the diverse needs of all learners)
  • Supports ongoing parent and professional learning
  • Modifies or changes course when necessary

“Liam’s hearing loss was identified at birth because he has microtia/atresia grade 3,” she says. “Then signs of ASD first became apparent at around age one. Liam’s monthly speech and language goals [established in collaboration with his Clarke support team] began to carry over into the following months without any progress. His frustration increased and that’s when we began signing the basics so that he could communicate his basic needs… Liam comprehended most of what people asked of him but he was unable to reciprocate the language and process it in real time.

“When Liam was diagnosed as mild-moderately autistic… I was apprehensive about the new/secondary diagnosis as a new mother. While the Clarke team was very kind and sensitive to my expecting condition [pregnant with Liam’s younger brother Miles], the place we went for [neuropsychological] evaluations was not. So, we had a hard time accepting what was to be our future as ASD parents with a child who is deaf.”

ASD and Hearing Loss diagram

The incidence of ASD has been increasing in the general population in recent years as well as in children who are deaf or hard of hearing. But because so many of the signs overlap with hearing loss, they can be missed or diagnosed later than they may have been without a diagnosed hearing loss. In fact, recent data suggest that ASD is diagnosed an average of one year later in children with hearing loss than in children with typical hearing.

“ASD and many other additional needs can often create complex challenges for the professionals who work with the children, the families and for the children themselves,” says Barbara Hecht.

Additionally, the oft-cited national teacher shortage impacts the field of special education even more intensely. According to a Pew Research Center report, the number of students receiving special education services in the United States has doubled since the 1970s.

“I had a really hard time placing Liam in an appropriate setting,” says Sarah. “I went to every classification in pursuit of the right place for my son.” Sarah was fortunate to find a placement for Liam at an institute specializing in special education with integrated therapeutic services.

Because multiple disabilities can substantially impact each other, this expertise must be integrated and shared across specialties to evaluate how to best support each child. Collaboration is imperative.

Teaming Up with Families for Short- and Long-Term Success

Liam and his family worked with the team at Clarke for speech-language therapy, occupational therapy, physical therapy  as well as participating in family support groups that provided emotional support and the opportunity to build social connections with other families.

“Clarke taught me hearing-related specifics, like how to help Liam localize sound and they also helped me learn to communicate effectively with clinicians in order to advocate for my child,” says his mom, Sarah. “They taught my husband and myself that we were not only part of the team but that we were Liam’s team managers and if no one else, we were the team.”

The support team for a child who is deaf plus will vary, depending on the individual child’s needs, but might look like this:

  • Family/caregivers
  • Developmental pediatrician or neuropsychologist
  • Teacher of the deaf (TOD)
  • Board certified behavior analyst (BCBA)
  • Educational audiologist
  • Special education teacher
  • Speech-language pathologist
  • Occupational therapist (OT)
  • 1:1 classroom assistant

Interdisciplinary team members will have familiarity with their specific areas of expertise and typical patterns of development for each disability or condition, and the family brings their unique and vital perspective knowing the child as an individual. Working together, this group can customize a plan of care to best meet the academic and social needs of the student.

Barbara notes that the co-occurring needs of a child who is deaf plus doesn’t mean they won’t excel.

“There can be a tendency to underestimate the abilities of children with complex needs,” she notes. “The key is to put the family and child’s needs first and make collaboration and communication among team members a priority.”

A mom with her two children
Sarah, center, mother to Liam, left, and Miles, right. Liam is a Clarke alum who is considered “deaf plus,” as he has a hearing loss and autism.

Children do best when team members share their own expertise while remaining open to learning from each other. Even with a robust team of experts, much of the day-to-day and long-term work falls to the family; it is an enormous responsibility to wade through diagnoses, appointments, education, at-home learning, advocacy and more. “You will always be your child’s greatest advocate,” says Sarah. “Just because someone has letters after their name or a title before it, does not mean they have the final or only say.

“I read a lot, and I gained a lot of insight into the various neurodivergent markers and characteristics,” says Sarah. “Also, I took a variety of courses [offered through early intervention in our area] and became more knowledgeable about the processes and our rights as a family. I began to share and help other families as a result.”

Her efforts paid off again when she began noticing ASD behaviors in Liam’s little brother, Miles. “Had it not been for my experience with Liam, Miles’s characteristics could’ve possibly been solely attributed to his age.” Miles has since been diagnosed with ASD and ADHD.

Sarah advises other families to enjoy the journey as an advocate for their children.

“One thing I would like to share with other parents: Don’t look at your child like something is wrong with them, instead view this journey as a scenic detour,” she says. “You might not get directly to your destination, but you will encounter many things that will cause you to learn and grow with and for your child. We must understand that whether our children are neurotypical or neurodivergent, the journey is theirs and we are mere passengers riding alongside them. Like every good co-pilot, we have to make sure we stay on course but also notice all the beauty along the way.”

Liam, now a sixth grader, enjoys artistic pursuits, including dance, music, making figurines with pipe cleaners and telling stories. With memory retention and cognitive challenges, he experiences delays in processing and literacy skill development. “He is highly conceptual, empathetic and aware of his surroundings,” says Sarah. “Liam tells us he wants to either be a chef or a scientist when he gets older. He specifically would like to live above his restaurant by the sea.”

Working together across disciplines to help children like Liam reach their full potential is the goal at Clarke. And with a robust support system in place, including knowledgeable professionals and an engaged family, children who are deaf plus will have the resources necessary to reach their full potential.

To learn more, watch our webinar for professionals called “Deaf Plus: Addressing the Needs of Students with Hearing Loss and Additional Challenges.” You’ll also find resources and further reading below the recording. 

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