In kids, hearing loss can mimic learning disorders, leading to misdiagnosis

During her years teaching, former Oklahoma teacher Bonnie Stone encountered several students who were flagged as having learning, language and behavioral challenges when in reality, they had hearing loss.

"I taught first grade and discovered six children in three years with hearing loss," Stone said. "One was a Spanish-speaking boy who was profoundly deaf, but his lack of oral speech was dismissed because 'he doesn’t know English.'"

Another student was about to undergo testing for learning disabilities when Stone suggested to the mom that her daughter get her hearing checked first.

"The next day, the mom comes in and tells me her daughter had impacted earwax in both ears and had them cleaned. By the end of the year, the girl tested in the top quartile for first grade," Stone said.

Misdiagnosis leads to real learning problems

When treated with pediatric hearing aids or cochlear implants, kids with hearing loss are just as capable as their peers. However, if childhood hearing loss is left undiagnosed and untreated, it can have an impact that's similar to a learning or behavioral disorder.

A child who can't hear well will struggle to keep up, may get restless and act out in class, or disengage from lessons. Unfortunately, this may lead to getting screened for other conditions, such as learning disabilities or ADD and ADHD. Eventually, this can affect their self-esteem, too, leading to behavioral problems.

"Hearing loss is a real and possible cause of behavioral and learning problems," she explained in a blog post about her experience. "ALWAYS assume hearing loss first and have the child screened."

How common is childhood hearing loss?

According to the CDC's Third National Health and Nutrition Examination Survey , about 15% of children ages 6 to 19 have hearing loss of at least 16 decibels in one or both ears. Around .1% have severe hearing loss.

Even hearing loss in only one ear has a tremendous impact on school performance; research shows anywhere from 25 to 35% of children with unilateral hearing loss are at risk of failing at least one grade level.

Hearing and learning are connected

Untreated hearing loss causes delays in the development of speech and language, and those delays then lead to learning problems, often resulting in poor school performance.

Even mild hearing loss can make it hard to keep up—yet mild hearing loss is the hardest to detect and diagnose, because kids learn quite early how to compensate for their hearing loss, and the milder it is, the easier it is to compensate. And parents may not realize that their child can hear but not understand. Over time, though, this catches up to them in school.

Untreated hearing loss leads to a very real learning gap

According to the American Speech-Language Hearing Association (ASHA), children who have mild to moderate hearing loss but do not get help are very likely to be behind their hearing peers by anywhere from one to four grade levels.

And for those with more severe hearing loss, intervention services are even more crucial; those who do not receive intervention usually do not progress beyond the third-grade level.

What are the reasons behind this education gap? It’s certainly not a question of intelligence; just because a child has hearing loss doesn’t mean he is any less capable of doing well in school than his hearing peers. Sometimes the classroom environment itself doesn’t support a child with hearing loss. A busy teacher who has many students to tend to, or a teacher with a poor understanding of hearing loss, often is unable to alter his teaching style or keep a student’s hearing loss in mind while teaching a lesson or assigning homework.

Speech, language and vocabulary development

For example, if a teacher turns his back on the students while teaching, his voice will be directed toward the blackboard, causing a student with hearing loss to miss part of the lesson. Oral changes to homework assignments, an unfamiliar accent or a teacher who talks too rapidly can all hinder the learning progress of a student with hearing loss.

In addition to the classroom environment, certain subjects are just intrinsically more difficult for a child with hearing loss. While the ability to hear affects all aspects of academic achievement, perhaps the areas most affected are those involving language concepts. Vocabulary, language arts, sentence structure and idiomatic expressions are extremely difficult for a child affected by hearing loss to grasp.

New vocabulary, language arts, sentence structure and idiomatic expressions are extremely difficult for a child affected by hearing loss to grasp.

Frustration and confusion can also play a big part in poor academic performance. Though he might have perfectly normal speech, a child with only mild hearing loss can still have trouble hearing a teacher from a distance or amid background noise. Imagine the difficulty and confusion of not being able to hear the high-frequency consonants that impart meaning in the English language (ch, f, k, p, s, sh, t and th) and you can begin to understand some of the academic struggles a child with hearing loss faces on a daily basis. "Chick" and "thick" may sound identical to a child with hearing loss, for example. 

Social struggles due to communication challenges

In addition to academic struggles in school, children with hearing loss can also experience trouble socially. Communication is vital to social interactions and healthy peer relationships; without the ability to communicate effectively they often experience feelings of isolation and unhappiness.

If a child with hearing loss is excluded from social interactions or is unwilling to participate in group activities due to fear of embarrassment, the result is that she can become socially withdrawn, leading to further unhappiness. Children with hearing loss are also slower to mature socially, which hinders peer relationships.

Hearing aids and other interventions make all the difference

The good news? Hearing aids help language development in kids with hearing loss.

Children who receive hearing aids or devices like cochlear implants can make great strides and perform just as well as their peers, according to research.

How to help hearing-impaired students in the classroom

Teachers are in a unique position to help learners with hearing impairments by arming themselves with the knowledge as to how a student with a hearing loss receives and understands information, as well as comprehensive knowledge of an individual student’s capabilities and level of comprehension. Since early intervention is key, signs teachers can watch for in the classroom include:

• Inattentiveness
• Inappropriate responses to questions
• Daydreaming
• Trouble following directions
• Speech problems

A child who is struggling in school, especially if she has a family history of hearing loss or has had recurring ear infections, should be seen by a hearing care professional for an evaluation.

Depending on the results a proper course of intervention and hearing loss student accommodations can then be recommended. Intervention is crucial because a child who is supported both at school and at home has the best chance of success, academic and otherwise.

If you believe your child is suffering from hearing loss, take her to a pediatrician or your local hearing healthcare professional today. Check out our hearing care directory for one near you.

Hearing loss is invisible and kids may not know they have it

Hearing loss in kids can be mistaken for many different problems, but is easily diagnosed with a hearing evaluation, either at school or with a doctor. Stone, the retired first grade teacher, can't stress doing this enough.

"Unlike vision, it cannot be recognized by a student who squints or tells you they can't see the board. Children with hearing loss may not even realize they aren't hearing properly," Stone, the former teacher, said. "So it is up to us, as their teachers and parents and caregivers, to be observant, educated, and aware of the signs. And to offer support and help."