I frequently get contacted for assistance by families who have concerns about their child’s performance, or by families whom I used to care for and who have either moved away or who have begun receiving their services from other professionals since I retired from full-time clinical work. In the last few weeks I received a phone call from one family who wanted assistance with getting extended time for a graduate school entrance exam, another from a family who was trying to get SSI benefits for a teenager, and a third from a parent who wanted extended time for her child’s high school entrance exam.
Two of the children involved were children I had worked with years ago, and a third was one whom I did not know. My first request was to ask that the families send me copies of all recent tests. I wanted to see recent hearing tests, recent speech-language evaluations, and recent educational evaluations (if available) and school reports. Parents are frequently surprised that I need to see that kind of information in order to write a recommendation. But if I do not know how a child is performing, how can I figure out what a child needs?
Why do we need current evaluations?
One of the children described above had not had a hearing evaluation in 5 years, one in 3 years, and one in 18 months. What parents state, when I ask, is that hearing is stable now so they did not think that current testing was critical. I understand that hearing is likely stable for many kids, and maybe you can make a case for not having hearing retested (I DO NOT MAKE THIS CASE SINCE HEARING CAN CHANGE, EVEN IF IT HAS BEEN STABLE FOR MANY YEARS) but there is NO excuse for not testing with technology. As one of my former colleagues used to say – if it is electric, it will break. We know that technology deteriorates over time. You may still hear sound, but it may develop some distortion that will result in reduced speech perception skills. If changes are gradual, you may not recognize the deterioration.
What does the hearing test tell us?
I am most interested in the information about how the child is performing with technology. Is she hearing at sufficiently soft levels (20-25 dB) throughout the frequency range from 500-8000 Hz? If not, we know that speech perception will be reduced because the child will not hear all the phonemes. If thresholds are at 30-35 dB or poorer, it means the child will not hear soft speech, which is at 30-35 dB.
What about speech perception?
Even more important is testing speech perception. We need to test speech perception at normal conversational levels (50 dBHL) to be sure that the child can hear when standing within a few feet of the talker. We need to test at soft conversational levels (35 dBHL) to be sure a child can hear when the talker is 10 feet away. (Soft speech is important because it permits incidental hearing or overhearing and the data indicates that children learn most of what they learn by overhearing.) And we need to test their ability to hear in competing noise (50 dBHL + 5 SNR) because the world is a noisy place and you need to be able to hear in noise to learn and communicate. We need to test using tests that are appropriate for the child’s chronological age and for their listening conditions. Tests that are too easy do not provide a realistic impression of how a child functions in every day listening conditions.
Interpreting test results
To make a case for additional services or extended test time we need to show that a child has poor performance. Typically hearing children have excellent speech perception at normal, and soft conversation in quiet and in noise. For children with hearing loss to compete, we would like them to have excellent hearing in all three situations, but many do not. If speech perception is poor then we can justify asking for additional services. If we don’t test, we cannot justify the request.
What happened to the three kids I described at the start of this blog?
One had a device what was so distorted that his speech perception was very poor. (He thought he just had to live with it.) He needed a device upgrade. One had a device that was intermittent and needed replacement. The third needed his device repaired.
How often do kids need to be tested?
In their early years I think kids need to tested with technology every 3 months. When they reach middle school we can move it to every 6 months. I would not want to move it to once a year until a child has completed school. Is it ever okay to test less often than once a year? I do not think so. Hearing is what keeps people connected with the world. Their technology needs to be working optimally all the time. If they are not hearing well their life choices and social opportunities are reduced.
In addition, technology is changing and improving almost by the moment. What was the best for someone at one point may no longer be the best in a year. Do not assume that a person with hearing loss will know when assistance is needed. Don’t assume that you need to live with poor performance. Go to an audiologist you are comfortable with, who has high expectations for what is possible, and go regularly. If you are not doing well, and someone says, “You have to live with this level of performance” get a second opinion.