Determining if a Child With Hearing Loss Needs Therapy

How do we decide if a child with hearing loss needs therapy? Schools may perform speech language evaluations and psycho-educational evaluations to determine if a child is in need of any services outside of the classroom. If the evaluations are performed well and interpreted well this may be a good way to make the decision. However, it is CRITICAL that the interpretation be well done.

 

Do most kids with hearing loss need some additional therapy?

The answer to this is a resounding YES!!! Unfortunately, hearing loss places an acoustic filter on the ability to hear in the classroom. Even with a relatively mild hearing loss and well-fit hearing aids, children with hearing loss are NOT going to hear like their typical hearing peers. They are still going to have trouble hearing in noise, they are going to have to work harder to attend and come home from school exhausted, and  they are going to have more difficulty attending in the afternoon as they tire from struggling all day to attend. They will miss some incidental learning because they have more difficult with distant hearing, and their vocabulary may not be as good as their typical hearing peers.

 

How do we know what services a child needs?

It is important not to just look at a total score when determining  if a child needs services. Let me describe some test results for a child we will call John. On a recent evaluation John did very well in some areas but had significant problems in other areas.

Oral language – 41%
Basic reading – 84%
Math reasoning – 63%
Letter word identification – 95%
Understanding directions – 41%

While John’s overall score placed him in the average range, it is easy to see that he has some areas of weakness. His oral language and understanding directions scores are very poor compared to other scores and the math reasoning score may also be a reason for concern.

Comparing tests over time

It is also useful to look at tests over time. John was tested when he was five and again when he was nine. Let’s look at what happened to his scores over time

Age 5 yrs – 9 yrs

94.0% – 41.0% Oral language
99.9% – 84.0% Basic reading
89.0% – 63.0% Math reasoning
99.9% – 95.0% Letter word identification
89.0% – 41.0% Understanding directions

Looking at these scores, we can see that, at least in some areas, John’s skills seem to be deteriorating.

 

Comparing a child to other kids in the school district

It is important to recognize that standardized tests compare a very large group of children. Unfortunately, expectations for children who live in poorer districts may be different from expectations for children who live in wealthier suburban districts. It is important to look at a child’s scores compared to peers with whom he interacts daily. If expectations for the district are high, this child needs to be given the opportunity to compete with peers.

 

So what should we be recommending?

When determining if a child needs support services and exactly what support services a child needs, it is really important to look very closely at speech-language-listening skills AND at psycho-educational skills. We need to look at the specific scores. Even if a particular score is considered to be “average,” if it is significantly poorer than other scores it indicates an area of weakness that needs to be addressed. “Average” does not count if it is your child who is struggling. School districts need to be open to looking carefully at specific test results when planning remediation, and parents need to push to get the services kids need.

 

 

About Jane Madell

Jane Madell has a consulting practice in pediatric audiology. She is an audiologist, speech-language pathologist, and LSLS auditory verbal therapist, with a BA from Emerson College and an MA and PhD from the University of Wisconsin. Her 45+ years experience ranges from Deaf Nursery programs to positions at the League for the Hard of Hearing (Director), Long Island College Hospital, Downstate Medical Center, Beth Israel Medical Center/New York Eye and Ear Infirmary as director of the Hearing and Learning Center and Cochlear Implant Center. Jane has taught at the University of Tennessee, Columbia University, Downstate Medical School, and Albert Einstein Medical School, published 5 books, and written numerous books chapters and journal articles, and is a well known international lecturer.