Includes the following article: Children and Unresolved
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CHILDREN & UNRESOLVED HEARING LOSS
By Max Stanley Chartrand, M.A.,
Health & Human Services/Research in Communicative
Disorders
Hearing impairment in school age children is increasing,
yet continues to be overlooked as teachers, therapists,
and parents seek answers to children’s learning
disabilities and developmental delays. Because the
symptoms of a number of learning and developmental
disorders bear an unfortunate resemblance to uncorrected
hearing loss, these children run a high risk of being
misdiagnosed and ineffectively treated. Consequently,
many are set up at a very early age for failure. Across
demographic age groups, the psychological effects caused
by hearing impairment are nowhere more debilitative, yet
under-recognized and untreated, than in school-age
children.
Recognizing the difference between the effects of
uncorrected hearing impairment and the traditionally
understood symptoms of “learning disabilities” may prove
problematic for even the most adept professionals
without a thorough audiometric evaluation and case
history. Hearing health in often the last factor
considered in the equation.
Auditory developmental delays often superficially
comprise the symptoms of the other more recognized and
treated(learning) disabilities. Attention Deficit
Disorder (ADD), language delay, developmental dyslexia,
cognitive dysfunction, mild autism, and mental
retardation share remarkable similarities with those of
unaddressed hearing loss.
Even more disturbing is the prevalence of children with
mild hearing loss who have experienced auditory
deprivation as a result of middle ear infection (OME)
history. Too often, these children are assumed to be
mildly learning disabled or merely performing below
grade level. This is a travesty, which may have more
than a passing influence on the declining academic
performance of U.S. schools in cognitive skills.
This thesis correlates alarmingly with the notable
increase I young American children who suffer from
chronic inhalant allergy and anti-biotic resistant
strains of bacteria during their formative years.
Cognitive development is jeopardized, as chronic cases
can represent months or years of developmental delay in
neurological and auditory skills.
THREE SUBGROUPS
In looking at the larger picture of those who may be
affected educationally as a result of hearing
impairment, three subgroups emerge:
1. Students with a history of extensive middle ear
infections, numbering into the millions of compromising
up to 20-30% of primary school children. Repeated
episodes of the middle ear infection during the first
few years of life may cause developmental delays in
central auditory and attentional abilities, language
acquisition, and interhemispheric continuity. Typically,
children who have experienced the longest history of OME
show signs of ADD, language disorders, and developmental
dyslexia- especially males.
2. Children with mild transient or permanent hearing
impairments (usually 16 dB- 30dB puretone average
diagram). These cases comprise approximately 80 percent
of students with ongoing hearing impairment, yet rarely
qualify for special attention under section 504 of the
rehabilitation act or individuals with disabilities
education act. These children are often not identified
during the critical developmental period (prior to
school age). And even as they enter school, the losses
may continue to go undetected because testing in schools
is conducted at screening levels which allow for high
ambient noise, precluding the identification of hearing
losses of 20 dB or less.
3. Children officially recognized as hearing impaired or
deaf, compromising a little more than one percent of the
student population. Approximately 90 percent of the
funding and resources spent on children with hearing
impairments go to this group. Yet substantial
shortcomings still exists in most schools for properly
educating even these children.
WAKE-UP CALL
In the professional arena, much attention is now turning
to these issues. It is increasingly apparent that 1,000
well trained educational audiologists are only a small
fraction of the number needed to adequately serve the
nearly 16,000 school districts. This small army of
dedicated professionals is being called upon to
establish, provide, and monitor hearing health programs,
which potentially touch every American school child.
Because states establish their own standards for hearing
health programs, inconsistencies and inadequacies
abound. Most school districts do not have even one
audiologist on staff!
Add to this need for many times more audiology aides and
audiometric technicians to carry out the program under
the direction of the school district audiologists, and
the current staffing scenario stands as the tip of the
proverbial iceberg. According to the American
speech-language hearing association, to establish a
ratio of just one audiologists for every 12,000 students
would require a four-fold increase of school
audiologists. Even this estimate is over conservative
when considering the larger mild hearing loss population
that is suffering from misdiagnosis, erroneous
treatment, and academic delay.
FM systems, along with hearing instruments, cochlear
implants, and assistive technology, have made
mainstreaming of the above groups not only feasible but
also affordable. Compared to the enormous costs of
misdiagnosis and training these cases as attention and
learning disabilities- or just ignoring them, to the
detriment of the child’s academic performance-the cost
for adaptive technology and/or interpreters seems
paltry.
Most of these cases can be effectively addressed at much
lower educational cost by:
• Early Identification and referral, with the staff,
equipment, and facilities needed to find even the milder
loss cases, and to ascertain OME history.
• Acoustic enhancement of the classroom, which in most
cases would call for FM systems to equalize the
teacher’s voice and improve signal to noise for all
students.
• Education and training for students and teachers in
communication and listening skills at the classroom
level, as well as how to utilize amplification and
assistive technology.
ADVOCACY & OUTREACH
Naturally, funding issues come into play. However,
funding comes only after addressing the glaring need to
better educate and inform parents, administrators,
educators, and school boards. They need to know the
damage that is unwittingly being done to our primary
school age children.
As Karen Anderson, ED.S., and Kristina M. English,
Ph.D., of the American Educational Audiology Association
recently stated:
“A significant and administratively unpopular, portion
of the educational audiologist’s role is to advocate for
the needs of all students with educationally significant
auditory disabilities to be accommodated appropriately
in their schools.”
We need to broaden indications of “educationally
significant auditory disabilities” to include the vast
numbers of children who struggle daily to keep up, but
whose auditory and developmental problems have been
previously unrecognized, misdiagnosed, or ignored.
A thorough auditory investigation must become a top
priority in the protocols of the developmental and
learning disability diagnostic battery. Moreover, those
in decision-making capacities must provide the staffing,
resources, and funding to bring the hearing health of
our children to the fore.
In doing so, far fewer children would be held back at
the early grade level; fewer would exhibit attentional,
behavioral, and socialization deficits; and more would
proceed successfully through high school graduation and
on to college and careers… alongside their peers.
13 FACTS: HEARING LOSS IN THE CLASSROOM
by Karen L. Anderson, Ed.S.
1. Our present hearing screening procedures identify
less than 50% of the children with significant hearing
problems.
2. Medically, a child is not considered to have abnormal
hearing until his/her hearing is worse than 25 dB. A 25
dB hearing loss is slightly worse than plugging your
ears with your fingers. We screen in school at 20-25 dB.
3. The typical ear infection causes a “plugged ear”
hearing loss. Two-thirds of preschoolers have at least
one episodes of ear problems, and 16% of preschoolers
have six or more episodes. One-half of all episodes of
ear problems go undetected by parents or teachers. Even
with good medical follow up, 10% of preschoolers
continue to have chronic ear problems during critical
language development years.
4. The difference between reading comprehension and
grade equivalencies for normal hearing children and
those with 25 dB hearing losses:
Grade 1 Grade 4
Normal Hearing 2.3 6.3
25 dB Loss 2.0 4.5
5. The difference between expected and actual
performance on language tests:
Degree of Hearing Loss Language Delay in Years
15-26 dB 1.2
27-40 dB 2.0
41-55 dB 2.9
56-70 dB 3.5+
6. Of the learning disabled population, as many as 38
percent have been found to have abnormal hearing
thresholds, indicating high incidence of history of ear
related problems. Sufficient data is available to
suggest that children with early, recurrent ear problems
are at the risk for developing delays in auditory,
language, and academic skills.
7. Eighty-nine percent of hyperactive children have had
three or more episodes of ear problems, and 74 percent
have had 10 or more. Of those receiving medication for
hyperactivity, 94 percent have had three or more
episodes of ear problems; 68 percent have had 10 or
more.
8. For the Down’s Syndrome population, the incidence of
hearing loss ranges from 23-90 percent, and 40-50
percent have hearing losses greater than 25 dB in both
ears.
9. When the special education population was considered
in two studies, one found that 75% and the other found
84% of these students had abnormal hearing levels.
10. Of children whose parents identified them as having
gifted characteristics via a short checklist, 66 % were
found to be on the gifted range on the Stanford Binet.
Seventy-five percent of those who fit the
characteristics, but tested below the gifted range, had
experienced chronic ear infections in infancy.
11. Children with hearing loss only in one ear (30 dB or
greater) have ten times the risk for failing a grade as
normal hearing children. Almost 50% of unilaterally
hearing impaired students have failed one or more grades
or receive support services in school.
12. Noise inducing hearing loss is a serious concern.
Only three percent of children in grades 1-3 were found
to have high pitch loss, presumably due to noise
exposure. The incidence in high school leaps to 22
percent of the student population.
13. The effectiveness of hearing instruments can become
reduced in the regular educational setting. In the
presence of typical classroom noise, a student’s ability
to understand may drop to sixty percent- or even as low
as 27 percent if there is no carpeting.
Karen Anderson, ED.S., is an educational audiologist.
She can be contacted at: 15610 121st AVE. Ct. E.,
Puyallup, WA 98374.
These facts were originally presented at the 1995
American Academy of Audiology Convention. Reprinted with
permission from hearing review, Vol.3, No. 9, 1996. |
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