Attention Problems or Hearing Problems?

Undetected hearing loss is frequently confused by parents with possible Attention Deficit Disorder (ADD). The mistake is understandable because children with hearing loss can seem inattentive or unfocused. Children with untreated hearing loss frequently struggle in school. The Centers for Disease Control and Prevention (CDC) reported that, in 2008, about one in seven (14.9%) children between the ages of 6-19 years had some level of hearing loss. A 2010 article in The International Journal of Pediatric Otorhinolaryngology reported that 11.3 percent of children in a general school setting had mild hearing loss. These reports reflect the large number of children with hearing loss in one ear (unilateral hearing loss) and children with mild hearing loss in both ears (mild bilateral hearing loss). These children are often able to hear in most settings but struggle when background noise is present.

Unilateral and mild bilateral hearing loss among children is frequently not identified because the hearing loss may not have been present at birth, when they were initially screened. Many schools provide screening services once a year; however, the nurses conducting the screenings may not be trained in hearing loss or hearing testing. Inadvertently, the test may be given with a pattern of beeps instead of random beeping. Some children pick up on the pattern and may indicate they have heard the beep, when they did not. (Pediatric audiologists are trained to avoid patterns that can result in these false positives.)

When a screening does indicate a hearing loss, sometimes parents do not follow-up on recommendations for more evaluation because the child likely developed skills to compensate for the loss, including lip reading or turning the “good ear” near the speaker.  The parent, therefore, may not notice there is a problem when these skills are used and consequently may not seek further testing.

It is important to diagnose unilateral or mild bilateral hearing loss in children. Both of these types of hearing loss have been related to developmental delays, poor speech and academic difficulty.

Children with hearing loss also experience more symptoms of depression and anxiety. In an article summarizing published research findings, Dr. Anne Tharpe reported that speech delays are significantly greater in children with unilateral or mild bilateral hearing loss than in children without loss. One reviewed study found that 37 percent of children with minimal hearing loss are retained in a grade, rather than moving on with their peers, while another reported a delay in academic performance of more than one year among children with hearing loss. An increase in teacher reported behavior problems is common, as well. Struggling to communicate and keep up with peers can result in long-term mental health problems, including depression. To prevent these struggles, parents should be aware of steps to protect their child’s hearing as well as ways to decrease the negative effects, if the child does have a loss.

There are many causes of hearing loss; some are temporary and others are permanent. Impacted ear wax, foreign objects in the ears, fluid in the ears, and otitis media (ear infection) are common culprits.  These can usually be treated and hearing can be restored. Trauma to the ear and chronic ear infections are sources that can lead to more permanent hearing loss.  An experienced pediatric audiologist can provide a parent with information specific to their child’s hearing loss.

Tips for Parents:

  1. Have your child’s hearing screened each year. Most schools offer free vision and hearing screenings once a year. Keep in mind that these screenings are not always conducted by a nurse with experience in hearing loss or hearing testing, so if you suspect a problem that is not reported you should follow-up with your child’s doctor.
  2. Talk to your child’s doctor about concerns you may have. Get a referral to a pediatric audiologist if you think your child may have a hearing loss. You know your child best, so push for this referral, if needed.
  3. If your child does have a hearing loss, get him or her the accommodations and services he or she needs to succeed. This may include any of the following: hearing aids, sound field systems, preferential seating in the classroom, an Individualized Education Plan (IEP), monitoring by an itinerant teacher trained in hearing loss and deafness, and more. Work with your child’s audiologist, teacher, and school to determine the appropriate accommodations.
  4. Protect your child from future problems. Limit noise exposure, seek treatment for ear infections, and note differences in hearing abilities.

* This Evidence-Based Parenting article was supported by funds from the George Kaiser Family Foundation awarded to the Oklahoma State University Center for Family Resilience.  Joseph G. Grzywacz is the Kaiser Family Endowed Professor of Family Resilience and Director of the Center for Family Resilience.  He can be reached at or 918-594-8440.

Mary K. Chapman Speech and Hearing Clinic

The Mary K. Chapman Speech and Hearing Clinic at the University of Tulsa provides a variety of services by appointment. Services related to hearing include:

• Free speech-language and hearing screening tests for children
• Free hearing screenings for adults
• Speech-language assessment (evaluation)
• Hearing evaluation
• Speech-language therapy
• Audiologic rehabilitation (including cochlear implant)
• Augmentative communication

The clinic is open Monday – Friday from 8 a.m. to 5 p.m. For appointments, call 918.631.2504.

The Tulsa City-County Health Department provides:

  • Newborn Hearing Screening Follow-up Testing (birth – 5 months): For babies referred in the hospital or for those who have factors considered high risk for hearing loss.
  • Hearing Evaluation (6 months – 18 years old): Diagnostic behavioral hearing tests for those concerned about their child’s hearing or speech development. Hearing loss is one of the most common birth defects.
  • For more information, contact Child Guidance: Audiology, Central Regional Tulsa City-County Health Department, 315 S. Utica, Tulsa. 918.594.4720.
Categories: Little Ones