State of Disgrace: The Need for Improved Hearing Health Screenings in Public Schools

failure school hearing screenings united states
June 22, 2023

Originally presented at the 2023 Future of Hearing Healthcare Conference, Dr. Jacque Scholl, Executive Director & Head of Audiology for Soundwrx and Head of Pediatrics for Tuned, discusses the motivation behind and solution for expanding a telehealth platform for pediatrics.

Despite several known barriers to learning in schools, such as hearing loss and mental health issues, no state screens for all of them. This leads to a failure in identifying and addressing these barriers early, hindering children’s academic success. Outdated screening methods and insufficient training further contribute to the problem.

Dr. Scholl emphasizes the urgent need for improved screening and intervention programs to support children with hearing loss and auditory processing disorders in schools.

Full Episode Transcript

Hello, and thank you for being here. My name is Dr. Jacque Scholl, and I am the executive director of Soundwrx, a nonprofit organization dedicated to finding all children with auditory pathway problems. In addition, I serve as the head of pediatrics for Tune Care.

I’m going to spend the next 30 minutes showing you some compelling statistics and information that may actually shock you. It did me. After selling my clinic three and a half years ago, I’ve discovered some stunning truths about things that are going on in our public schools and things that aren’t going on.

There’s strong evidence that many children in our schools have specific health barriers that prevent them from learning or being academically successful.

But in the entire country, there is no state that screens for all seven, even though we know that they are health barriers to learning. These seven health barriers to learning are vision and hearing deficits, uncontrolled asthma, mental and behavioral problems, dental pain, persistent hunger, and the effects of lead exposure.

All of these health barriers, if caught early and monitored on a regular basis,

can be mitigated and help these children learn better.

So I’m going to take a closer look at the one I’m most familiar with and probably the reason why you’re here today, which is hearing. Hearing loss actually goes from being one of the leading birth defects, which is why we screen at birth, to becoming a low incidence occurrence once a child starts school.

The CDC states in their research, even though it’s a little old at this point, but that approximately 15% of the kids sitting in our classrooms have some sort of hearing loss, whether it be temporary or fluctuating or permanent.

There is a portion of idea called Child Fined if you’re not familiar with that.

And Child Find

requires that each school district is responsible for finding these children that have a health barrier, hearing loss being one of them. And in that category, by the time a child begin school, that category is less than 2%. So.

If you’re watching, you’ll see that there’s a real discrepancy in the numbers. We go from being a leading birth defect, which is why we screen there’s an increase of numbers by the time they start school. And then once they start school, it’s a low incidence, less than 2%. Something doesn’t add up.


so what I did and I honestly don’t remember the moment, but what I did was when I had started the nonprofit, I was actually speaking to, I had been doing some outreach, and I was speaking to one of the outreach providers at the Oklahoma school for the deaf. She goes around there’s actually two, three, or maybe even four now, because what they were finding was that there was a huge need out in the public schools.

There were lots and lots of children out there on a waiting list to receive services and or get an IEP. In the state of Oklahoma, an educator of the deaf must sign off on the IEP. And she alluded to the fact that there was over 200 children at that time.

And I was like, 200 children? I said, well, do they all have current audiograms? And she said, no, not really. I said, well, are there any aided audiograms? Do you know what they’re hearing? Any verification of their amplification? And she said, not so much. So I kind of shook my head, and I’m like, I don’t understand.

I was so busy at our clinic seeing children, and what I realized was I was only scratching the surface. There are so many children that are out in our schools that have some form of hearing loss, and I’m just talking about peripheral hearing loss with hearing the the type you fit with hearing AIDS and or cochlear implants or FM systems.

And so what I realized was that we had possibly a big problem. So I started digging, and I started looking at the numbers, because they always say the numbers don’t lie. And this is what I found for the state of Oklahoma. And specifically, I looked at the year 2019, 2020.

I wanted to look at pre COVID numbers, because anything beyond that, people can brush off and say, oh, it’s COVID. Oh, it’s COVID. And what I was hearing was possibly a systemic problem that was pre COVID. So the first thing I did was I looked at our newborn hearing screening numbers, and we actually have a very effective of and pretty good newborn program in the state, as with.

With every program. Loss to follow up is the issue. But we were identifying in the five years before 2019, 2015, 19, about 1.7 children per thousand, which really runs on the average.


is interesting here is people talk about that average like it is set in stone, one to three kids per thousand. What we’re not looking at are the children with mild hearing loss who are not being picked up, or possibly a cookie bite hearing loss. And so really, if you think about it, that number is actually bigger.

The hopes is that we’ll find those kids when speech and language development, all those other things start happening by the time they start preschool, for sure.

So if I looked at the CDC numbers, which was up to 15%, and I looked at what child fine numbers were, which was 2% or left, I took a very, very conservative number, which was 3%. And I looked at what would 3% of our school enrollment for 2019 2020 be, and 3% would be 20,818 children.

The 1.7 is located right above there. And that’s what our newborn hearing screening says. We’re picking up yearly would be 11,797. And if you took that number all the way to 15% and included those kids with fluctuating hearing loss, you’d have almost 105,000 children that have some sort of hearing loss in our schools.

What I found was that we identified 1539 children that year.

We are way off the mark. Way

so way off that I started thinking, well, I’m from Missouri. I’m sure we do it better in Missouri. No, do not do it better in Missouri.

Then I thought, Well, Texas, they’re known for all those things. And

looked at Texas. Nope, not any better. And then I got obsessed with it. I was like, oh my gosh, what is happening here? Where are all these children? And what I’m about to show you is pretty shocking. And I’ve had audiologists argue with me about this map. But when I ask, well, what are the real numbers?

If these aren’t the numbers, they don’t have a reply. And these numbers I’m going to tell you, I took directly off each state’s education. Educational website, and then I verified it with the national numbers, and they are correct.

Conservatively. Conservatively. We are missing 1.2 million children that have hearing loss sitting in our schools. And I’m just only talking to peripheral issue use. I’m not talking about auditory processing, not talking about anything like that. I’m talking about those children with mild to moderate hearing loss or kids that maybe were identified at birth and then lost.

We are doing our children a terrible disservice, and I’m going to talk more about that. But if you look at these numbers, look for your state.

Look for your state. There is not one state that’s doing a good job. Even the states that have mandates in place. Sorry, guys, you’re not catching them either. A couple of the states let’s see, iowa. And there was another one on here that they don’t even report numbers. Like, it’s not even important.

Okay. I was pretty shocked by these numbers. Just so you know,

there are still 14 states who don’t even require that when a child goes through their entire academic journey that they even have to have a hearing test. You can see these 14 states right here.

Mine right there in the middle, always at the bottom.

And what you always see with these 14 states is that they always end up around the bottom of all of the list. And I’m beginning to understand why.

Just so you know what you’re looking at there. The first number is

there’s a national average for reading, and this is for the fourth grade is the first number. You can see Alabama is the only one here that has a positive number, meaning that those children scored

two points above the national average. The rest of the numbers are all either flat or in the negative. And that means that the first number stands for the fourth grade, and the second number stands for the 8th grade where they fell. And you can see all of these schools are scoring negatively.

Okay? So I kind of alluded to part of the problem is that even for the states that are screening, we’re still using archaic technology.

We are not looking at the new research that’s going on in neurology and biology and all of the things that give us those biological markers that can show us a child old has a hearing loss. We are still using the raise your hand when you hear a beep. And not only that, we’re still in most cases, just screening at five one, two, and four, missing all high frequency hearing losses, which for those of us who see kids in clinics, we’re seeing a higher incidence of high frequency hearing loss.

And so what you see is that even those states that have programs in place are not doing very well because they’re still missing kids. Some of the programs are screening at 25 DB, which will still miss a kid with hearing loss. And they’ll say, well, it’s the ambient noise.

Well, I say, find a quieter room.

We’re not doing our kids any justice here. And what I find is that, yes, we have educational audiologists in a lot of states. We don’t have nearly enough. They are covered up, busy with the ones they have. They don’t have time to get in and do the screenings. And that is terribly unfortunate because the people that are doing the screenings and responsible for those are not trained in auditory problems.

They don’t know what they’re looking at all the time. The auditory system is very complex and we are missing kids left and right.

So here are some things. We had a relatively recent scorecard that came out from the Annie B. Casey, I think it was Annie B. Casey.


these numbers are frightening. These are frightening numbers. Over 50% of our first and second graders are at risk for reading problems. Over 50%,

71 and a half percent of our fourth graders are at a reading risk.

That’s a huge number. And then almost 75% are scoring poorly in math.

In the state of Oklahoma, where we have it’s the Wild, Wild West, and we have no rules, it is not uncommon that when a child will qualify for an Ie P, he’ll be screened by somebody who has. No experience on an audiometer and using an audiometer that may have not been calibrated seven, eight years.

I am not just throwing this out as, what ifs? This is what I’ve seen. I see this in our schools, and it is not okay?

It public.

So where are these kids? We know they’re in our schools, but where are they ending up?

I’m going to tell you a

story about one young man that I knew was a patient, and this story really is going to give you an idea of where I think these kids are going. His case is one in millions, but it’s one that really exemplifies where I think these kids go.

This is a story. I’ll call him Nick. Nick had significant sensory issues and allergies. He had his first ear infection when he was three months old. He had PE tubes by the time he was eight months old. And he had another set one year later with an adenoid. Nectomy adenoid.

Had his adenoids taken out? That’s hard to say.

He was constantly moving, constantly in the classroom, moving and rolling around. But if you asked Nick what the teacher said, he was always listening and could tell you he unsuccessfully completed handwriting with tears, with lots of tears. He loved his friends, hated school, loved all things boys, Star Wars.

I mean, he was very typical kid, really, in in most aspects. He could build any Lego that was 1012. Sometimes 13 years older than his age, but yet he couldn’t read.

His parents owned an extensive library. They read to him all the time. Four, five, six books a night. This was not a child who did not have resources.

Nick got a diagnosis of severe anxiety and ADHD.

He was put on medication, Abilify. And if you know anything about medications, it’s like the nuclear bomb. They put him on abilify. He didn’t take it very long because he told his mom it made him feel funny, and it didn’t make him any better. He still couldn’t focus,

and he couldn’t read. In the second grade, you.

Nick was, like most of these kids, held back a year in school. His his parents were told when they started asking more specific questions

that he was not gifted, that he really just had a lot of issues.

When he started first grade for the second time, his reading scores were ranging in early kindergarten, sounding outwards but not being able to blend them.

And Nick’s mom very

I did not give her any sort of indication that this would be something to do. But she enrolled him in horseback riding lessons because one of his most severe allergies was horses. And growing up in Oklahoma, even though they lived close to the city in a place called Midtown and there were no horses, horse dander is in the air because all the surrounding areas.

And she did not want him to struggle with allergies for the rest of his life. So he was kind of a needle flobe. So she enrolled him in horseback riding lessons also thinking it would help his sensory issues as well.

Also, within that same year,

the parents had Nick’s IQ tested. And he was not gifted. He was highly gifted. So

some strange things, weird things, kids that we see every day in our schools, highly intelligent kids, not reading, performing poorly in the schools. But something interesting happened.

Within six months of starting horseback riding lessons, nick’s reading went from he started let’s see, they started they started the horseback riding lessons that summer, like June, nick had his test in his first reading test when school started. So early kindergarten, by Christmas, Nick’s reading was

late second, early third grade, he went he shot off the charts. And the teachers could not they were like, we don’t know. He’s just he just got it. He just got it.

Nick didn’t just get it. Nick was getting something that many of our children need.

Because Nick is my son,

and I’d like to tell you that I am all that and a box of crack, but it was totally dumb luck.

Totally dumb luck.

Nick has one of the possibly worst auditory processing disorders that I’ve seen in the clinic. And Nick is my son at the age when he was 13. And trust me, struggled through school when he was 13. I was norming some new equipment and we were doing a 300, which is that late response.

And if you look here, if you look at Nick’s response, he has a perfectly normal left ear. But on the right ear, do you see that total inversion starting right.

He was attending, but he had no response on his right side.

I’m an audiologist. You don’t know what you don’t know. But I carry this around with me all the time to remind me that you cannot pick these children out and say, yes, it’s ADHD or yes, it’s a behavior problem. Oh, it’s dyslexia. Unless you have done the proper testing.

We missed it. I missed it. And the only reason why Nick flew off the reading charts is because he was getting sensory and timing input from riding that horse that allowed his auditory pathway to synchronize. That’s what happened.

Nick today is almost 22. It’s his dad looking very goofy there and what he’s doing. But if you notice, Nick wears this bud in his right ear. And I asked him about it not too long ago, he actually said that it is garbled on that side. So he’ll run like low music or Babbling on that side so that he can focus with his left ear.

He’s sort of

self adapted

to function well. Not going to lie,

we had a lot of issues. Nick went to military school. He almost dropped out. School was hard for him. Also found out not too long ago I was norming another testing that I do. It’s called acoustic. Pioneer. Nick still shows a deficit on his right ear. And interestingly, I have a mild deficit in my right ear.

Who knew? I had no idea.

The stakes are pretty high. Guys, we have to find these children. They are out there and they are not getting the intervention they need. Not getting the right diagnosis means not receiving the right intervention.

If we don’t find these kids, one in six will drop out of school. If two out of three lack proficient reading skills. By fourth grade and will end up in jail or on welfare. And 85% are functionally illiterate. Youth in the juvenile court system can’t read,

going to have some pretty big issues.

The majority of these kids will grow up and be welfare recipients that are high school dropouts with poor literacy skills. And 70% of our inmates in our US. Prisons cannot read above the fourth grade level.

Those statistics, if you think back to what you saw, 75% in the fourth grade, and now 70% of inmates can’t read above the fourth grade level. Think about the correlation.

So what do we do? How do we find these kids? First of all, we start using contemporary hearing screening methods. We stop using what we used 50 years ago. We pass standardized legislation in all states, and we use technology to reach more children.

What do I mean by a contemporary method? Well, first of all, we have to start out with temponometry and acoustic refluxes. We must be monitoring middle ear fluid. I’m working on some data right now, but we actually are showing that 30% to 40% of our kids in the schools that we’re testing here have middle ear pathology.

We do a functional hearing test. I’m using soundscouts. Soundscouts is the brainchild of Carolyn Me and Harvey Dillon in Australia. It tests speech and quiet, speech and noise, warble tones and noise. And just since I did this, I received a message from Carolyn saying that they’ve also added a pure tone screening because those in the US.

Must have their pure tones. And then we also need to be checking rhythm. We need to know if the auditory pathway is synchronized.

So here you see soundscout. Soundscouts. All you need is an iPad. We use Sennheiser HD, 300 headphones that are $50, and you can take the test. And it’s a very engaging, fun test. You’re not going to have any trouble with your kids not wanting to take this at all ages

for rhythm.

For rhythm, it’s a little bit

more difficult because you have to have something objective. It’s. Enough to sit and think. That your subjective take. If a child can keep rhythm is enough.

I have been using rhythmicity. It’s UCSF

one of their brainchilds.

You can set it up many different ways, but it will objectively measure

the ability to keep a beat and rhythm.

The thing about rhythmicity is the kids pretty much have to be around five,

sometimes depending on the kids, sometimes six. So it’s imperative that we find these little littles so that we can start intervention early so they don’t spend a lifetime on an IEP. In those cases, we have been using something called

interactive Metronome. And it’s a lot easier. You have these timers that are measuring and giving you objective information and assessments of that rhythm. And as you can see, this little boy here is playing a basketball game. Honestly, there’s no twisting arms for any of these. And it gives you really valuable information.

The last part of this is we have to reach them where they are. And trust me, folks, it’s not just in the state of Oklahoma, it’s everywhere. We have children out there sitting in classrooms with juicy noses and ears who’s not hearing. We have children who have hearing loss.

We have children with auditory pathway disorders. Our reading scores continue to plummet. And what I learned with my daughter, who is profoundly deaf, is that once the reading scores start to improve, the math scores naturally do too. The language is a very logical progression. Well, not the English language in all the cases, but it is a logical sequence and progression which will naturally spill over into math.

It doesn’t mean that you’re going to be great in math, but it’s just one relies on the other. And so we have to find these children. One of the things that I’ve been working on with Tuned, and I’m not trying to plug Tuned, but I want you to know what we’re doing because

it’s pretty new, hasn’t been out there. First, I want to say that nothing replaces face to face. Nothing. And nothing that we do via telehealth can be really diagnostic at this point. But these functional hearing screenings can give us a tremendous amount of information.

To help guide parents to find local resources to take that next step. Tell them where to go.

We have got to reach these children. Children who may never in their lifetime see an audiologist and working with the schools. This is a perfect platform to work as partners along with the schools. The other thing is that I think what you’re seeing with a modern and contemporary hearing screening platform you’re going to find not only hearing loss naturally, you’ll find that you’ll find auditory pathway problems too.

The auditory pathway is not just the ear, it is the pathway leading all the way to the brain.

So we should be launching this. It’s going to launch first for ages 13 to 18. Then we’ll drop it down to the next age group as we work out the kinks. But I’m pretty proud of being able to tell you that we will have something very soon for pediatrics.

Probably starting in June is when our launch is planned.

I want to thank you for sticking through these 30 minutes and I hope that

you are now enlightened on what is truly happening out in our public schools, which is sad. We must all take a stand. I would love to hear from you. Here is my contact information. This does not want to stay in my maybe I need a custom mold.

We’ve got to find these children. They are out there. We are missing them. I know that there’s been a lot going on in our profession with OTC and other things that are kind of clouding what performing up to

what our licenses will allow us. And I am asking that each and every one of you take a look at what’s happening in your own state and I’ll leave you with that and I hope you have a great day. Thanks for joining in. Bye.



Be sure to subscribe to the TWIH YouTube channel for the latest episodes each week, and follow This Week in Hearing on LinkedIn and Twitter.

Prefer to listen on the go? Tune into the TWIH Podcast on your favorite podcast streaming service, including AppleSpotify, Google and more.

About the Presenter

Jacqueline R Scholl, AuD, is the Executive Director & Head of Audiology for Soundwrx, a 501(C)3 organization, and Head of Pediatrics for Tuned Care. Prior to starting Soundwrx and Tuned Care, Scholl owned her own clinic. As founder and manager of The Scholl Center, she curated an impressive team of clinicians who changed the landscape for audiological care in Oklahoma. Dr. Scholl has been practicing hearing health care for 25 years and after selling her practice in 2019, she continues to blaze trails by changing policy and providing best practice services to children across the state of Oklahoma. She is a tireless advocate for those who don’t have a voice.


Leave a Reply