INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Shubert Complex (Posters 1-60) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #58 A Case Series About Using the Childhood Autism Rating Scale-2 (CARS-2) when Assessing Autism Spectrum Disorder in Deaf/Hard of Hearing Children Samantha Hasenbalg, Boston Children's Hospital, Boston, United States Matthew Fasano-McCarron, Children's Hospital of Philadelphia, Philadelphia, United States Amber Graham, Boston Children's Hospital, Boston, United States Megan Herlihy, Boston Children's Hospital, Boston, United States Rachel Cozzens, Boston Children's Hospital, Boston, United States Peter Isquith, Boston Children's Hospital, Boston, United States Rachel Landsman, Boston Children's Hospital, Boston, United States Category: Autism Spectrum Disorders/Developmental Disorders/Intellectual Disability Keyword 1: autism spectrum disorder Keyword 2: assessment Objective: There are no instruments designed to identify ASD in deaf/hard of hearing (DHH) children in the US. While the Autism Diagnostic Observation Schedule- Second Edition was recently adapted for children using British Sign Language (Phillips, et al., 2022), it has not been adapted for American Sign Language (ASL; Hodkinson, et al., 2023). Current tools assume typical access to sound when assessing social behaviors (e.g. response to sound), complicating administration and interpretation for DHH children. ASD symptoms are often over- or under-attributed to hearing loss (HL), especially when there is delayed language access (Dale & Nield, 2022). Clinician-rated (e.g., CARS-2) and parent-rated (e.g., BASC-3; Spellun et al., 2023) measures of ASD symptoms show promise for differential diagnosis. We examined the utility of the CARS-2 for identifying ASD in DHH children as part of a multidisciplinary evaluation. Participants and Methods: The profiles of five participants (80% female and White; M_age=5.82 years) with sensorineural HL were compared. Etiologies were presumed hereditary (n=2) or unknown (n=3). Participants primarily used spoken English (n=3) and wore bilateral hearing aids (n=2) or cochlear implant/hearing aid combination (n=1). Participants using ASL (n=2) reported no hearing assistive technology (HAT). All completed a multidisciplinary evaluation with a neuropsychologist, speech-language pathologist, and/or developmental behavioral pediatrician within a tertiary hospital, consistent with best practice for ASD evaluation in DHH children (Ludwig et al., 2022). Clinicians jointly completed the CARS-2 as a guide to criteria for ASD diagnosis. Appropriate adjustments were made for differing hearing levels and language access. Caregivers also completed the BASC-3 PRS and profiles were compared to prior research and current CARS-2 results. Results: CARS-2 scores indicated mild-to-moderate ASD symptoms for 3 children and moderate-to-severe symptoms for 2 children. BASC-3 profiles were similar to patterns in DHH and hearing children with ASD with problems on Hyperactivity, Attention, Withdrawal, Atypicality, Social Skills, Activities of Daily Living, and Functional Communication scales. Conclusions: Ratings on the CARS-2 were congruent with ASD diagnoses based on multidisciplinary team evaluations in this small sample of DHH children with varying language access and modalities. The CARS-2 may be an appropriate measure to help guide diagnostic decisions when evaluating ASD in DHH children with important caveats. Verbal Communication ratings were only completed if a child had appropriate language access as determined by the clinical team. Clinicians altered items querying Verbal Communication by replacing “words'' with “signs” for children who used ASL. Listening Response ratings were not coded for any child with HL. Comparing clinician ratings with parent perspectives captured on the BASC-3 PRS increased diagnostic certainty with similar elevations in scales commonly associated with ASD for both hearing and DHH children. Clinical judgment in DHH ASD evaluations remains paramount. The CARS-2 can increase clinician confidence by capturing important areas of children’s functioning with caveats for Listening Response and Verbal Communication ratings.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Shubert Complex (Posters 1-60)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #58

A Case Series About Using the Childhood Autism Rating Scale-2 (CARS-2) when Assessing Autism Spectrum Disorder in Deaf/Hard of Hearing Children

Samantha Hasenbalg, Boston Children's Hospital, Boston, United States
Matthew Fasano-McCarron, Children's Hospital of Philadelphia, Philadelphia, United States
Amber Graham, Boston Children's Hospital, Boston, United States
Megan Herlihy, Boston Children's Hospital, Boston, United States
Rachel Cozzens, Boston Children's Hospital, Boston, United States
Peter Isquith, Boston Children's Hospital, Boston, United States
Rachel Landsman, Boston Children's Hospital, Boston, United States

Category: Autism Spectrum Disorders/Developmental Disorders/Intellectual Disability

Keyword 1: autism spectrum disorder
Keyword 2: assessment

Objective:

There are no instruments designed to identify ASD in deaf/hard of hearing (DHH) children in the US. While the Autism Diagnostic Observation Schedule- Second Edition was recently adapted for children using British Sign Language (Phillips, et al., 2022), it has not been adapted for American Sign Language (ASL; Hodkinson, et al., 2023). Current tools assume typical access to sound when assessing social behaviors (e.g. response to sound), complicating administration and interpretation for DHH children. ASD symptoms are often over- or under-attributed to hearing loss (HL), especially when there is delayed language access (Dale & Nield, 2022). Clinician-rated (e.g., CARS-2) and parent-rated (e.g., BASC-3; Spellun et al., 2023) measures of ASD symptoms show promise for differential diagnosis. We examined the utility of the CARS-2 for identifying ASD in DHH children as part of a multidisciplinary evaluation.

Participants and Methods:

The profiles of five participants (80% female and White; M_age=5.82 years) with sensorineural HL were compared. Etiologies were presumed hereditary (n=2) or unknown (n=3). Participants primarily used spoken English (n=3) and wore bilateral hearing aids (n=2) or cochlear implant/hearing aid combination (n=1). Participants using ASL (n=2) reported no hearing assistive technology (HAT). All completed a multidisciplinary evaluation with a neuropsychologist, speech-language pathologist, and/or developmental behavioral pediatrician within a tertiary hospital, consistent with best practice for ASD evaluation in DHH children (Ludwig et al., 2022). Clinicians jointly completed the CARS-2 as a guide to criteria for ASD diagnosis. Appropriate adjustments were made for differing hearing levels and language access. Caregivers also completed the BASC-3 PRS and profiles were compared to prior research and current CARS-2 results.

Results:

CARS-2 scores indicated mild-to-moderate ASD symptoms for 3 children and moderate-to-severe symptoms for 2 children. BASC-3 profiles were similar to patterns in DHH and hearing children with ASD with problems on Hyperactivity, Attention, Withdrawal, Atypicality, Social Skills, Activities of Daily Living, and Functional Communication scales.

Conclusions:

Ratings on the CARS-2 were congruent with ASD diagnoses based on multidisciplinary team evaluations in this small sample of DHH children with varying language access and modalities. The CARS-2 may be an appropriate measure to help guide diagnostic decisions when evaluating ASD in DHH children with important caveats. Verbal Communication ratings were only completed if a child had appropriate language access as determined by the clinical team. Clinicians altered items querying Verbal Communication by replacing “words'' with “signs” for children who used ASL. Listening Response ratings were not coded for any child with HL. Comparing clinician ratings with parent perspectives captured on the BASC-3 PRS increased diagnostic certainty with similar elevations in scales commonly associated with ASD for both hearing and DHH children. Clinical judgment in DHH ASD evaluations remains paramount. The CARS-2 can increase clinician confidence by capturing important areas of children’s functioning with caveats for Listening Response and Verbal Communication ratings.