The first three years of life are a critical period for speech and language development as well as acquiring psychosocial skills. Hearing loss (HL) present at birth or acquired in early life can profoundly affect normal communication development. For this reason, early detection of hearing impairment and intervention are imperative.
Preschool and school-age children require normal hearing in at least one ear to develop normal language. However, even a mild HL in one ear can impact their developing communication skills and academic performance. In addition to permanent hearing impairment, temporary hearing loss is common among school-age children, mostly as a complication of otitis media (middle ear inflammation).
Therefore, monitoring hearing status of children is crucial.
Identification of Hearing Loss:
The Universal Newborn Hearing Screening (UNHS) has become the standard of care in the US. It was made federal law in 1999. Prior to this law, children were often not identified till age two or older.
Children with risk factors at birth, e.g. a stay in the NICU, will need to have routine pediatric audiological evaluations. Furthermore, even if a baby passes the UNHS, parents should watch for signs of hearing loss. For example, a one year old should react to loud noises and their name. At age two, they should imitate simple words and play with their voices. At age three, they should begin to understand simple phrases like “all gone”/”bye bye”). Many times unfortunately, a hearing loss can go unnoticed simply because the pediatricians dismiss parents’ concerns.
At least two events may trigger a parent or caregiver to bring a child to an Audiologist for evaluation: a failed hearing screening test at school or if the parent has noticed the child is not responding to sound in the same way as children with normal hearing.
Objective tests of Hearing:
The selection of how a HL can be identified is wide, but dependent on the child’s age & ability to participate in the evaluation. Once a HL has been identified, the child would be retested often.
Otoacoustic Emissions (OAEs) testing: OAEs will assess the integrity of hair cells in the organ of hearing, the cochlea or inner ear. This is purely an objective measure- the child does not have to respond but they need to be still and quiet while the test is running.
Auditory Brainstem Response (ABR): An ABR will track sound traveling from the child’s ear up to the brainstem. This is purely an objective measure- the child does not have to respond but they need to be still and quiet while the test is running.
Three behavioral tests: Behavioral/Observational Testing, the audiologist assesses the child in the sound booth as he/she presents tones or speech. Visual Reinforced Audiometry and Play Audiometry are similar test methods requiring more of the child’s attention and cooperation.
Early intervention in children begins as soon as a HL is identified. The goals of Early Intervention in children are to enhance their language development as well as social development (e.g., play), to minimize the possibility of developmental delay and to enhance the family’s ability to accommodate their needs.
Selection of a Communication Mode:
The type of Communication mode is one of the first decisions parents make about intervention. These options are geared toward children with more severe to profound hearing loss. Below are some examples of communication modes for parents or caregivers to choose from.
American Sign Language (ASL) is a manual system of communication that has different grammar than spoken English. Facial expression & body language are used to give a variety of meanings to the signs.
Manually Coded English (MCE) is a variety of visual communication methods expressed through the hands which attempt to represent the English Language. MCE can be used with Simultaneous Communication — speaking and signing at the same time. This is not possible with ASL, because it has a very different grammar (including word order) than English.
Total Communication aims to make use of several modes of communication such as signed, oral, auditory, written and visual aids, depending on the particular needs and abilities of the child.
Oral language is produced with the vocal tract, and is strictly spoken language.
Cued speech is a communication system that uses phonemically based hand gestures to supplement speech (lip) reading. The speaker speaks while simultaneously cueing the message. In the cued speech system eight different hand shapes are used to distinguish consonants and six locations on the face and neck are used to distinguish vowels.
Parents’ Experiences & Counseling: The Five Stages of Emotional Adjustment
Parents and caregivers require support after a HL diagnosis is made. There are five stages of emotional adjustment they may go through: Shock, denial, guilt, anger, and acceptance. It is crucial that parents receive proper counseling in order to fully participate in their child’s habilitation intervention plan.
Shock is a feeling of numbness and confusion. After a HL diagnosis, the parent may deny the HL exists or the enormity of its consequences.
Grief may occur next and it’s a normal healthy reaction. With time the grieving process can bring the family back into a balance and result in a resolve to move forward. Negative consequences of grief are fatigue and stress. There are ways for Audiologists to help parents resolve grief. Active listening and building parents self-esteem go a long way in this journey.
Guilt & Anger may follow denial as well because parents feel they might have done something in the past to be responsible for the HL. Guilt can cause a parent to overprotect the child so that the parents’ logic becomes: “I may have let the HL happen, but I’m not going to let anything else bad happen to you” or become super dedicated where their logic becomes: “I’m going to make this up to you”. Causes of parents’ anger may stem from parents expectations that their child would lead a normal life and the presence of HL violated that expectation or from feeling like they lost control. Anger may also be a façade to cover up fear and feelings of inadequacy.
Acceptance may set in as parents begin to accept that their child’s HL is a reality.
- Anderson, K., (November 2002). Parent Involvement: The Magic Ingredient in Successful Child Outcomes. The Hearing Review, Retrieved from http://www.hearingreview.com/issues/articles/2002-11_02.asp
- Ashmead, D., Rothpeltz, A., & Tharpe, A.M., (2002). Visual Attention in Children with Normal Hearing, Children with Hearing aids, and Children with Cochlear Implants. Journal of Speech, Language, and Hearing Research, 45, 403-413.
- Chasin, J. & Harris, M., (2005). Visual attention in deaf and hearing infants: the role of auditory cues. Journal of Child Psychology and Psychiatry, 46(10), 1116-1123.
- Clark, J & Martin, F., (2006). Introduction to Audiology 9th edition. Pearson Allyn & Bacon, Boston, MA. (chapter 13)