A child’s speech and language development may be delayed by a hearing loss.
There are different types and severity of hearing loss: -
Conductive deafness
This is when sound cannot pass efficiently through the outer and middle ear to the cochlea and auditory nerve. The most common type of conductive deafness in children is caused by ‘glue ear’. Glue ear (or otitis media) affects about one in five children at any time.
Sensori-neural (or nerve) deafness
This is when there is a fault in the inner ear (most often because the hair cells in the cochlea are not working properly) or in the auditory (hearing) nerve. Sensori-neural deafness is permanent.
Children who have a sensori-neural deafness can also have a conductive deafness such as glue ear. This is known as mixed deafness.
Presenting difficulties
There are some common signs that might indicate a hearing loss: -
- The child does not respond when called.
- There is a delay in learning to speak.
- There is a lack of clarity in speech.
- Unstressed words in speech may be missed or misinterpreted.
- The child watches faces/lips intently.
- The child is reluctant to speak freely.
- The child displays inappropriate behaviour.
- There are difficulties in listening and attending to speech.
- Constantly asking for repetition.
- Failure to follow instructions straight away or misunderstanding/ignoring instructions.
- Requiring repeated explanations.
- Watches what others are doing before doing it themselves.
- Continues with an activity when the rest of the class has stopped.
- Inattentive and daydreaming.
- Doesn’t pick up information from overheard conversations.
- Attempts to control and dominate the conversation through talking.
- Becomes withdrawn.
- Shouts or talks too loudly.
- Makes little contribution to group or classroom discussions.
- Speaks very softly.
- Complains of not being able to hear.
- Frequently seeks help from peers.
(N. B. There can also be other reasons for a child having these difficulties that are not related to a hearing loss.)
Hearing assessment
The Newborn Hearing Screening programme means that now newborn babies are screened for a hearing loss. This has the advantage that a hearing loss may be identified at a very early age and appropriate management of the hearing loss can be arranged. This can help minimise the impact of the hearing loss on the child’s development of speech and language.
At other times when a hearing loss is suspected the child will be referred for a hearing assessment. A range of different hearing tests may be performed depending on the age of the child, their ability to co-operate in an activity and their individual needs. If a hearing loss is found the parents will be advised on how this can best be managed.
The Audiology Department and the Ear, Nose and Throat (ENT) department at the hospital will be involved. Where a hearing loss is likely to be permanent, hearing aids are usually fitted. Where appropriate children will referred on to be assessed regarding their suitability for a cochlear implant.
Intervention
Once a child has been identified as having a hearing loss then it will depend on the level of hearing loss and the level of need regarding their speech, language and communication as to the intervention they will receive. There may also be some variation as to when intervention will begin depending on when the hearing loss is identified.
In the case of a child with a sensori-neural loss, the hearing loss may be picked up soon after birth and as soon as it is appropriate, a teacher of the deaf will be involved to help support the family in understanding the hearing loss and in managing the hearing aids and the child’s development of language. The specialist speech and language therapist for hearing impairment will also be involved, when required, to offer advice and support as part of the multi-agency team supporting the family.
In the case of a child with a conductive loss or glue ear the child may be slow to develop their speech and language and their hearing loss may not be identified until there are concerns regarding their development. The health visitor may refer the child for a hearing assessment at the same time as referring to speech and language therapy. In some cases a referral for a hearing assessment may follow assessment by a speech and language therapist if there is any doubt or concern regarding a child’s hearing.
Intervention will be based upon the child’s level of need and may involve individual or group therapy, advice to pre-school or school. Sometimes it will be appropriate for the child’s needs to be met within the pre-school or school setting and speech and language therapy will not be indicated.
Strategies for good communication with a hearing impaired or deaf child: -
- Make sure that you have the child’s attention before starting to talk.
- Speak clearly and at your normal pace.
- When changing the topic of the conversation let the child know.
- Do not shout as this will distort your lip patterns.
- Keep your face clear and try not to cover it with your hands.
- Try to keep your hands free so that you can use natural gestures to support what you are saying.
To help a deaf child understand: -
- Repeat
- Re-phrase
- Explain
- Simplify
- Clarify