Adopted or Not, Hearing Health and Listening Comprehension Affect Our Children

There was a very interesting article posted on the ASHA Sphere Blog today. Written by Deborah Hwa-Froelich, PhD, CCC-SLP, the article titled Hearing Health and Development Following Adoption brings up a number of very important – and tightly linked – issues.

How a small amount of fluid buildup in the middle ear can affect balance and hearing acuity.

How, after seeking medical advice and completing impedance testing, she says that her results were in the low-normal range and that “most medical professionals would not treat a patient who exhibited these symptoms preferring to wait until the patient demonstrated consistent flat tympanograms or infection.” But, without exhibiting either of these conditions, she had significantly reduced hearing acuity, especially in noisy environments like the classroom. She wonders how children can focus and learn when they have fluid in the middle ear.

How children who have resided in orphanages around the world – who receive less than adequate medical care – may have untreated otitis media and become accustomed to the symptoms of ear pain, imbalance, and poor hearing acuity. And when parents who adopt these children they expect the child to exhibit and demonstrate certain behaviors of discomfort when the child is ill. However, because of the lack of attention to hearing health, the children do not show the typical symptoms of pain or lack of balance and thus the parents may not recognize – and then not seek – medical care.

Many orphanages do not provide the social interaction that children need to learn which sounds are meaningful to attend to or what certain sounds mean. And that some children, even years after they are adopted and have passed a hearing screening and audiological evaluation, did not alter to environmental sounds (whistles, knocks on the door, telephones, or their name being called). Some children have difficulty attending to and discriminating speech from noise. Undetected and undiagnosed hearing loss is also not uncommon.

I find these issues interesting, not only in their relationship to adoption (I have an adopted son, although not through an international adoption and without any orphanage stay) but how the same issues link to so many children – adopted or not.

Ear infections (Otitis media) is the most frequent reason that children are taken to the emergency room and account for over 24.5 million doctor visits each year. Ms. Hwa-Froelich indicated that her symptoms were not severe enough to warrant treatment, but they were severe enough to diminish her hearing acuity and her ability to discriminate speech from noise. In other words, her ability to listen – to understand spoken messages – was seriously compromised. As an educated adult, Ms. Hwa-Froelich was able to understand that her hearing loss was affecting her ability to understand the people with whom she was communicating with.

Children, regardless of being adopted or not, don’t have the contextual knowledge to understand whether they are hearing the phonetic stream – the verbal message – correctly. Their ability to listen effectively is reduced causing them to work harder at listening (tiring them out by the middle of the day) or frustrating them so much that they act out in the classroom (causing their teachers to wonder if the child is ADD/ADHD – since we don’t really consider this a symptom of hearing loss.

As our healthcare safety net dissipates for many, especially our poor, more and more students will be coming to school with untreated ear infections and hearing loss. The ultimate fact is that child is coming into the classroom without the ability to listen properly, without the ability to understand what the teacher is saying. It doesn’t take many days with a listening disorder to lose one’s academic pace.
Considering the fact that a child could have middle ear fluid buildup for several days prior to the symptoms becoming severe enough to warrant a doctor’s visit and then several more days after the symptoms subside, there can be an extended period of diminished hearing acuity that would most certainly stifle the child’s academic achievement.

It is therefore critical that both educators and parents be aware of their children’s hearing health – not only their ability to hear, but their ability to understand what is being said. Remember, hearing is about sounds – Listening is about understanding.