Diagnostic Overshadowing: A Delayed Diagnosis Of Autism Spectrum Disorder In A Deaf Child

Diagnostic overshadowing occurs when a patient with a pre-existing diagnosis presents with symptoms that are attributed to the diagnosis, but actually reflect a separate issue. This diagnostic overshadowing can lead to delays in diagnosis, as well as disparities in health care and outcomes. The following case will provide an example in which diagnostic overshadowing contributed to the delay of an autism diagnosis in a child who is deaf. With at least 40 to 50% of children who are deaf or hard of hearing having at least one co-existing medical/developmental condition, and the current prevalence of autism at 1 in 36 children in the United States, the intersection of these conditions is substantial. Pediatricians, otolaryngologists, audiologists, and speech therapists are all likely to encounter young children who are deaf/hard of hearing and in the process of acquiring language, and interdisciplinary collaboration can support identification of children with coexisting conditions. Clinicians can benefit from increased familiarity with the presentation of deaf children who are neurotypical, and how it tends to differ from children with autism, to reduce the chance of delayed/incorrect diagnosis and formation of care plans.