Why does the TV volume need to be so loud?
Why don’t you follow the direction the first time I said it?
Why is my child’s vocabulary not developing as fast as their siblings did?
These are all valid questions that parents ask themselves when their child is having difficulty hearing – and often they don’t know it, instead thinking their child instead has attention difficulties or learning delays. However, hearing loss during the early years of speech and language development can happen, and when they do, they can cause developmental delays that may initially seem like a different issue.
How Hearing Loss Impacts Speech and Development
According to the American Speech-Language-Hearing Association (ASHA), children with hearing loss are affected in four ways: they experience a delay in receptive and expressive language development (read more about language development here), and experience a reduction in academic achievement, social skills, and can be less engaged in activities that interest them. In short, it can be both impairing and socially isolating in the school setting when the condition is unrecognized.
Children with hearing loss typically have vocabulary that develops more slowly and that gap grows with age, in comparison to their average-hearing peers. Along those lines, they typically can pick up concrete wording but have difficulty with abstract vocabulary and multiple meaning words, especially when the sounds are hard for them to hear. For example, suffix endings are often dropped because they are unable to hear them, like the “s” or “-ed” ending on words, and at times they struggle to speak or write in simple sentences compared to their peers. They also have trouble with articulation since they are unable to fully hear the sound of their own voice, and the sound of quieter letters or combinations like “s,” “f,” “k,” “t,” and “sh.” These challenges leave school-aged children at a greater risk of failing a grade or scoring poorly on intelligence testing, and depending on the severity of the hearing loss, they may fall several grades behind if it isn’t caught early on.
The best way to avoid these delays is early intervention for children with hearing loss, and to help children affected by hearing loss quickly catch up with their peers. But to do so, you have to identify it first.
Types of Hearing Loss
There are two different categories of hearing loss that occur in children, congenital (occurring at birth) and acquired (occurring after birth). In these two categories, there are also different types of losses: sensorineural, conductive, and mixed.
Sensorineural hearing loss is damage that occurs in the inner ear (shown highlighted in yellow), the auditory nerve, or the brain. This type of hearing loss is most likely to be permanent. There are many causes, however the most common are: aging, head trauma, genetics, illness, reaction to medications, and exposure to loud noises.
Conductive hearing loss is what happens when sound is not efficiently directed through the middle ear bones (shown highlighted in green). This type of hearing loss is often able to correct through medical or surgical intervention. Common causes for a conductive loss are impacted earwax, perforated eardrums, ear infections, excessive fluid from colds and allergies, swimmer’s ear, foreign body trauma and malformation of the outer (the area in blue) and middle ear.
Mixed hearing loss is a combination of both a sensorineural loss and a conductive loss.
Determining Hearing Loss
When children are born an infant hearing screening is completed before they leave the hospital. If the infant does not pass their screening, parents should not worry as this often does not mean their child has a hearing loss. Generally, a second screen is completed after the first non-pass, and most infants do pass this screening. However, if the infant fails the second screening, parents are then referred to a pediatric audiologist for further investigation, diagnosis, and an action plan. These newborn hearing screenings are important since early intervention is key when it comes to combating delays with developmental milestones in speech and language development.
However, hearing loss isn’t always from birth. It’s also important to realize that it can also occur later in development, and much like the questions posed above, it is easy to mistaken it for other familiar childhood issues. Below is a list of signs a parent might see in their children if hearing loss is present:
Hearing Loss Signs in Babies:
- Does not startle at loud noises;
- Does not turn to the source of a sound after 6 months of age;
- Does not say single words, such as “dada” or “mama” by 1 year of age;
- Seems to hear some sounds but not others;
- Turns head when he or she sees you but not if you only call out his or her name. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
Hearing Loss Signs in Children:
- Speech is delayed;
- Speech is not clear;
- Does not follow directions. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss;
- Often says, “Huh?”
- Turns the TV volume up too high.
(source: CDC Facts about Hearing Loss)
If you see any of the previously mentioned patterns and have concerns, I urge you to address it through your pediatrician directly for a check-up and additional screenings if needed. Some children who attend preschool or elementary school are also given complete hearing screenings through their school’s nurse’s office, which is an extra layer of support that may reveal hearing loss at a later age. However, this isn’t always the case.
If you do see any of the behaviors listed above, getting your child’s hearing screened at your pediatrician’s office is a relatively routine task and easy to request. Asking other adults in your child’s life can also be useful in terms of gathering information – if your child is school aged, speak with their teachers to see if there are any concerns at school and then bring all that information to their pediatrician. Don’t be afraid to bring up your concerns. It’s a simple, non-invasive test and it gives you answers (and a plan to get on track) very easily. Hearing plays an integral part in speech and language development so the more quickly the better. Remember: early identification for intervention is key!