Intersecting Cultures in Deaf Mental Health: An Ethnographic Study of NHS Professionals Diagnosing Autism in D/deaf Children

Abstract

Autism assessments for children who are deaf are particularly complex for a number of reasons, including overlapping cultural and clinical factors. We capture this in an ethnographic study of National Health Service child and adolescent mental health services in the United Kingdom, drawing on theoretical perspectives from transcultural psychiatry, which help to understand these services as a cultural system. Our objective was to analyse how mental health services interact with Deaf culture, as a source of cultural-linguistic identity. We ground the study in the practices and perceptions of 16 professionals, who have conducted autism assessments for deaf children aged 0-18. We adopt a framework of intersectionality to capture the multiple, mutually enforcing factors involved in this diagnostic process. We observed that professionals working in specialist Deaf services, or with experience working with the Deaf community, had intersectional understandings of assessments: the ways in which cultural, linguistic, sensory, and social factors work together to produce diagnoses. Working with a diagnostic system that focuses heavily on 'norms' based on populations from a hearing culture was a key source of frustration for professionals. We conclude that recognising the intersectionality of mental health and Deaf culture helps professionals provide sensitive diagnoses that acknowledge the multiplicity of D/deaf experiences.

Diagnosing Autism Spectrum Disorders in Deaf Children Using Two Standardised Assessment Instruments: The ADIR-Deaf Adaptation and the ADOS-2 Deaf Adaptation

“…They allow us to combine important information from parents about their child’s development with information from direct play and interaction with the child. These tools for ASD assessment can be available for use with deaf participants, and given the large struggles experienced by parents seeking assessment [ 33 ] and by assessing clinicians [ 6 ], this is a step forward. Whilst these assessments may be used in specialist centres, with deaf and hearing clinicians working together [ 17 ], this research has opened up new assessment possibilities.…”

“…Beyond parent surveys, there are no community prevalence studies of ASD in deaf children. Several studies have reported that deaf children can be difficult to assess for ASD because of confusion about the causation of behaviours and symptoms [ 5 ], lack of confidence and expertise in clinicians, and lack of adequate assessment tools [ 6 ]. In particular, deaf children without ASD but with language deprivation, where children have reduced language learning opportunities in early years, commonly present with social and emotional developmental delays [ 7 ].…”

Mental Health Recovery in SDGs Through the Empowering Family Communication in Palmerah Community Jakarta

“…Brenman et al [3] also view the importance of intersecting cultures and mental health in the family, especially for children with disabilities. Therefore, his approach to ethnographic studies in children and adolescents' mental health services, the National Health Service in the United Kingdom, is based on transcultural psychiatry's theoretical perspective.…”

Modifying and validating the social responsiveness scale edition 2 for use with deaf children and young people

“…Some aspects of ASD can present differently in hearing children compared to deaf children, for example, pronominal reversal is seen in the former group, but not the latter [16]. These differences in ASD presentations in deaf children are not well known clinically [17]. Children may be considered to have traits of ASD if they seem unable to interact in groups; however, deaf children may experience significant interactional challenges in noisy group settings and this may be misunderstood by those observing them [18].…”

“…Children may be considered to have traits of ASD if they seem unable to interact in groups; however, deaf children may experience significant interactional challenges in noisy group settings and this may be misunderstood by those observing them [18]. These clinical complexities mean that clinicians in both child health and child mental health services may find the ASD diagnostic assessments and differential diagnoses of deaf children challenging [17]. Furthermore, there are only a limited number of professionals with expertise in both ASD and working with deaf people [19].…”