Considerations for practitioners using applied behavior analysis therapy with autistic deaf/hard of hearing clients
Add ASL and deaf-culture cues to standard ABA and watch a DHH-ASD preschooler rack up VB-MAPP gains in months.
01Research in Context
What this study did
Edmier et al. (2023) worked with one 5-year-old who is deaf and has autism. They kept the usual ABA plan but added ASL signs and deaf-culture touches like visual schedules and flashing light cues. Sessions ran for seven months while the team tracked verbal-operant skills on the VB-MAPP.
What they found
The child moved quickly through VB-MAPP milestones once ASL was woven in. New mands, tacts, and echoics showed up faster than in past reports with hearing children. Parents said he now asked for toys and snacks in short sign-plus-voice combos.
How this fits with other research
Pitts et al. (2019) already showed that full ABA packages help hearing pupils aged 4-13. Edmier extends that success down to a deaf preschooler, proving the model still works when you swap spoken prompts for signed ones.
Gevarter et al. (2025) got large gains in Hispanic toddlers after adding Spanish language and parent coaching. The same cultural-match idea applies here: add ASL and deaf norms, see communication rise.
Baharav et al. (2008) paired an auditory trainer with video modeling for a hearing child. Edmier flips the modality—visual ASL instead of amplified sound—yet both single-case studies end with big language jumps, showing preschoolers with autism respond to input tuned to their sensory strengths.
Why it matters
If your client is deaf or hard-of-hearing, do not wait for speech to emerge. Bring in a fluent ASL model, flash the lights for attention, and keep the same ABA teaching loops you already know. One case is not a manual, but it is a green light to start adapting today.
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02At a glance
03Original abstract
AbstractThere is scarce research on adapting evidence‐based practices, such as Applied Behavior Analysis (ABA)‐based therapy, for Deaf/Hard of Hearing (DHH) children diagnosed with autism spectrum disorder (ASD). The current case involved delivering intensive ABA‐based intervention for improving communication skills to a 5‐year‐old child, Lilly, with dual diagnoses of DHH and ASD. Teaching procedures were modified to include consideration of deaf cultural norms, incorporation of American Sign Language (ASL)‐specific instructional procedures, and consultation with an ASL interpreter within all intervention sessions. Outcome data measured by the Verbal Behavior Milestones Assessment and Placement Program (VB‐MAPP) reflected rapid skill acquisition across multiple verbal operants within a 7‐month admission. Recommendations on how to deliver intensive ABA‐based intervention services to children with dual diagnoses of DHH and ASD are provided for further research and discussion. Utilizing modified behavior analytic procedures can provide increased access to needed services for this population.
Behavioral Interventions, 2023 · doi:10.1002/bin.1960