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Disease & Conditions >>> Hearing Loss Articles & News
ADHD/ADD Or Hearing Loss?
By: Margie Littell Ulrich, Audiologist
When classroom teachers are confronted with children who ''will not listen,'' ''cannot sit still,'' ''does not finish classroom assignments,'' and ''creates problems for other children,'' hearing loss is not the first problem the teacher considers. Maybe it should be.
Research studies show that one out of three children have enough hearing loss to make learning difficult. Children in every school (public and private) are at risk for this silent epidemic.
Five million school-aged children, or 11.3% of all school children in the U.S.A. exhibit some degree of hearing impairment. This startling finding was reported by Fred Bess Ph.D., from the Department of Hearing and Speech Sciences, at Vanderbilt University Medical Center, in a recent issue of The Hearing Journal. Dr. Bess noted that many children have ''unrecognized'' hearing loss. The largest undetected hearing loss in children affects those considered to have ''minimal sensorineural hearing loss'' (MSHL). Dr. Bess found that the prevalence of MSHL in schools is 5.4%, or more than one of every twenty children.
Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood, estimated to affect three to five percent of school-age children. ADHD core symptoms include; developmentally inappropriate levels of attention, concentration, activity, distractibility, and impulsivity. Children with ADHD usually have functional impairment across multiple settings including home, school, and peer relationships. ADHD has been shown to have long-term adverse effects on academic performance, vocational success and social-emotional development, according to the National Institute of Health and the office of Special Education Programs.
The diagnosis of ADD/ADHD is often based on doctor, parent, and/or teacher observations of the child's behaviors.
Could these two problems (ADHD and MSHL) overlap, or perhaps be easily confused based on observations of children's behaviors?
Recently, an assistive listening device manufacturer compared the behavioral characteristics of children with ADD/ADHD, to children with mild hearing loss. They discovered extraordinary similarities among the two groups.
Both groups have academic difficulty and both give inappropriate responses to questions. Neither group completes assignments, they both exhibit trouble sustaining attention during oral presentations, and for both, following directions is problematic. Impulsiveness and acting out are common to both groups, as is a poor self concept. Both groups of children exhibited low self esteem, fewer social interactions with their peers, and greater stress. Members of both groups were more likely to drop out of school. Both groups tended to repeat grades imposing a significant financial burden on the schools, and of course, their families.
Could this mean that some children diagnosed with ADHD/ADD could actually have mild or minimal hearing loss?
In young children, the most common type of hearing loss is a ''conductive'' hearing loss. Conductive hearing loss is generally correctable through medical and surgical options. Conductive hearing losses include; broken ear drums, middle ear infections, swimmer's ear, and other ear problems that physically ''block'' the path of sound. Middle ear disease (otitis media) is the leading cause of visits to the pediatrician. Research studies have determined that 50% of the children between birth and five years of age will experience a conductive hearing loss.
Karen Anderson, in her 1995 American Academy of Audiology presentation in Dallas, noted that approximately 80% of elementary school students (ages 4 -10 years) suffer from temporary hearing loss at sometime during the school year. Those hearing losses were largely undetected by parents or teachers, and the typical hearing loss was determined to be 25 -30 dB, similar to the hearing loss that occurs when your ears are plugged with fingers.
Research suggests that some middle ear infections can lead to permanent hearing loss if left untreated and if unresolved. Noise-related hearing impairment is another cause of permanent hearing loss in children. In one school system, Anderson found 22% of high school students suffered from noised induced hearing loss.
Oddly enough, increased survival rates of premature ''at-risk'' infants may be contributing to milder forms and higher numbers of permanent hearing impairment in children.
Bess reported that 37% of children with hearing loss failed at least one grade, compared to a district norm of about 3%. The majority of learning problems in these children included; not understanding, trouble with vocabulary, word usage skills and story telling abilities. Children with minimal sensorineural hearing loss are 4.3 times more likely to experience trouble in communication, than children with normal hearing.
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