Language and Communication with Children Who Are Deaf + ASD

The issue


Though no longer considered a “core symptom” of autism spectrum disorder (ASD), language difficulties are common in children with ASD. Especially challenging for many children on the spectrum are the social uses of language (pragmatics), for example interpreting nonliteral language, sarcasm, irony, intonation, and facial expressions. Some hearing children with ASD have also been found to parrot what others say (echolalia) and/or mix up words like “you” and “me” (pronoun reversal). For reasons that are still unclear, a significant minority of children with ASD produce few or no words, though they may understand more than they can say.

Deaf and hard-of-hearing (DHH) children may be affected by ASD in unique ways. First, DHH children are generally at increased risk for language impairment due to limited access to speech or limited exposure to sign. DHH children with ASD who are only exposed to spoken language are likely to show a similar profile as hearing children with ASD, with the added challenge of not being fully able to perceive speech sounds. For those children exposed to sign, social deficits may also complicate access. Because signs are visual, children must be looking at the person producing signs in order to perceive them. This is unlike hearing children learning speech, who may overhear words without purposely attending to them. Thus, DHH children with ASD may receive less “incidental” language input than hearing children with ASD and this lesser exposure could slow language development. Furthermore, children with ASD often have difficulty with a number of social skills needed to learn sign, such as producing gestures, understanding and producing facial expressions, making eye contact, understanding others’ visual perspectives, and pointing. Finally, children with ASD often display comorbid impairment in their motor skills, which could also impact their ability to produce signs.

What we know

Few studies have been conducted on DHH children with ASD, so relatively little is known compared to hearing children with ASD. That said, 1 in 59 American DHH children has an ASD diagnosis. From the very few studies on the language abilities of such children, we know that some have very good ASL, but many appear to have at least some receptive and/or expressive language impairment, even when exposed to ASL from birth by their Deaf parents. Like hearing children, a significant minority appears to produce few or no signs and may require augmentative and alternative communication (AAC) strategies or devices. For children with ASD who can sign, a number of unique patterns have been identified. Some children with ASD sometimes reverse the direction of their palm while signing. They may also have difficulty with pointing signs such as pronouns, or use name signs instead of pronouns. DHH children with ASD sometimes echo signs just as some hearing children with ASD echo words. Finally, their signing may be slower, more disfluent, and jerky than typical signing children.

What we don’t know

We don’t know if the structure of ASL and other signed languages will pose special problems for children with ASD. For example, facial expressions are important for communicating various aspects of sign language, such as questions. We don’t know if children with ASD are fully able to use these facial expressions. Similarly, we don’t know if children with ASD will have special difficulty with signs that require an understanding of other people’s perspectives, such as directional verbs and classifiers. Conversely, we don’t know if exposure to sign could actually improve children’s social abilities by giving them frequent practice with challenging social skills.


Parents and educators of DHH children should know the signs and symptoms of ASD and be aware that existing instruments may be inadequate at properly identifying ASD. Given the diversity in language backgrounds of DHH children, parents should take a “kitchen sink” approach to communication with children with ASD. Visual communication is generally more accessible to DHH children than speech, but parents and educators should know that DHH children with ASD may have special challenges with ASL, and could also benefit from AAC devices if necessary. Finally, DHH children may be at increased risk for impoverished language exposure, especially if they have trouble looking at or paying attention to others. Increased attention to making sure that children have adequate exposure to an accessible form of language could help improve language outcomes for DHH children with ASD.

Posted on July 7, 2016 by
Aaron Shield
Department of Speech Pathology and Audiology
Miami University
shielda {at}

Further reading