Gallaudet psychology expert raises awareness about autism in deaf children

When a deaf child has autism, it often goes undiagnosed for far too long, says Dr. Danielle Previ, G-’15 & PhD ’18, senior manager of the Gallaudet Psychology Clinic.

She first recognized the problem in 2017, when she became the first deaf psychology intern at Baltimore’s Kennedy Krieger Institute and Johns Hopkins School of Medicine. Previ was providing neuropsychological assessments to deaf and hard of hearing (DHH) children when she noticed a common pattern: Kids were coming to see her with a range of documented issues, but they had never been identified as possibly having autism. That’s despite the fact that research shows that rates of autism are much higher in the DHH population.

“At that time, it was still ambiguous what was the most effective way to assess and properly diagnose deaf children who may be on the spectrum,” Previ says.

Several indicators regularly used to diagnose hearing children, such as language delays, can be present in deaf children because of environmental factors. And the language barrier can pose a major problem, she adds. Even when hearing psychology providers can sign, or there are interpreters present, it can be easy for them to miss everything that children are trying to express.

“I have direct communication with deaf and hard of hearing kids. Non-verbal cues can be communication as well,” Previ says. That allows her to take note of subtle differences, like when children “mirror sign” toward themselves rather than to others. “Looking through a deaf lens, I document things differently,” she adds.

As Previ continued her clinical psychology work at Kennedy Krieger, psychologists and families reached out to her from across the country. During COVID, she was able to do many behavioral observations online, which allowed her to expand her reach. She also encouraged her trainees to bring their expertise to other regions. “We need to spread out,” she says.

Along with her colleagues, Previ published a guide to help clinical psychologists identify autism in deaf kids. “Approaching DHH on the spectrum requires a careful review of their medical and developmental history as well as separating the symptoms between deafness and autism spectrum disorders,” says Previ, who has offered workshops to raise awareness about this information, too.

Previ says the next area that needs to be addressed is treatment options. It’s helpful to have a diagnosis, but you can’t stop there. “Parents say, ‘Where am I supposed to go?’ Who do I refer them to? It’s hard for me to refer out because a lot of professionals can’t sign,” Previ says.

Although there are many programs designed for hearing children, she says they might not be as effective for deaf children, who could do better with a visual-focused approach. Previ also notes that some schools offer separate programs for deaf students and autistic students. “Parents ask, ‘Which should I prioritize?’” she says.

All of these issues were part of the conversation at the first National Conference on Autism in Deaf Education, held last October at the American School for the Deaf (ASD) in West Hartford, Connecticut. Previ, who delivered the keynote presentation, was honored to be a part of the program, which included sessions on how deaf children with autism acquire sign language, attending to the social interactive needs of children who are deaf and autistic, and positive behavioral interventions and supports.

She was impressed that the conference organizers were individuals with autism and the parents of deaf children with autism, and hopes that they have more opportunities to present about their personal experiences. What they have been through can be used to help the next generation.

“I see a lot of teenagers who are so nervous about their future,” says Previ, who would like schools to create more inclusive environments for students who are neurodivergent. She was impressed by ASD’s sensory room, which has dimmed lights and swings. “It would be nice if all deaf campuses had one,” she says.

Now that Previ is at Gallaudet, she can clearly see that this isn’t an issue that only affects kids. “There are a lot of adults coming in, wondering about autism,” she says. Many of them are learning that they are on the spectrum, which explains problems they have had for years. “They’re able to function in the world, but they struggle with friends and high level anxiety. Individuals with autism tend to be at high risk of being taken advantage of, and they’re not good at conflict resolution,” Previ says.

Recognition of their diagnoses can help them get their lives back on track. And Previ hopes it will continue to raise awareness in the deaf community that autism needs to be explored and addressed.