When parents and physicians are pursuing concerns about a child’s development, one crucial component is the audiological screening. This screening is particularly important for children suspected of having a communication or developmental disorder. Increasingly, routine audiological screenings are recommended for all newborn babies.

“It seems like she doesn’t hear me.”

“When I call his name, he doesn’t respond.”

“I can’t figure it out: sometimes it seems like he can’t hear, sometimes loud noises upset him. What’s going on?”

The relationship between a child’s hearing, communication, and overall development is complex: A child who appears to have a developmental delay may, in fact, have a hearing impairment. A child with a hearing impairment that goes undiagnosed may experience resulting delays in development and communication. A child with a communication or developmental disorder may also have related issues with sensitivity to sound. For parents, all of this may seem like a puzzle they can’t solve.

The solution is simple: when addressing concerns about a child, a developmental screening should be followed by audiological testing.

The term “audiological” takes its roots from the word “audio,” which means sound or hearing. A child’s ability to process sound has a profound impact on the child’s ability to understand and communicate.

When a child appears to have difficulty seeing, vision testing enables a physician to determine the nature and scope of the problem. Is the child nearsighted? Farsighted? Blind? Colorblind? Or are there other concerns?

Just as it is important to distinguish between different vision impairments, it is crucial to understand what “auditory,” or hearing and sound-related, issues might be present. This is sometimes referred to as a “differential diagnosis” process. There are many names for disorders of hearing and communication, depending on their cause and their effect. Some of these include: Central Auditory Processing Disorder; Hearing Impairment; Deafness; Pervasive Developmental Disorder.

Audiological testing often takes place at a hospital, and despite the clinical environment, the screening is designed to be child-friendly. Often, a young child will simply sit on his or her parent’s lap while a skilled professional will assess hearing through play, toys, and puppets.

Audiological testing can take many different forms, depending on the age of the child. Today, there is increasing interest in having hearing tests made standard for newborns. The American Academy of Pediatrics issued a policy paper stating, “Significant hearing loss is one of the most common major abnormalities present at birth and, if undetected, will impede speech, language and cognitive development.”

When a routine developmental screening raises concerns, or a child is at risk of atypical development or a communication disorder, the following types of audiological tests may be conducted:

• Otoacoustic emissions: This non-invasive screening is done with a small probe inserted into the ear canal.
• Auditory brainstem response: Electrodes are placed on the head, and brain wave activity in response to sound is recorded.
• Visual reinforcement audiometry: This is the method of choice for children between 6 months and 2 years of age. The child is trained to look toward (localize) a sound source. When the child gives a correct response, e.g., looking to a source of sound when it is presented, the child is “rewarded’ through a visual reinforcement such as a toy that moves or a flashing light.
• Conditioned play audiometry: The child is trained to perform an activity each time a sound is heard. The activity may be putting a block in a box, placing pegs in a hole, putting a ring on a cone, etc. The child is taught to wait, listen, and respond.
• Acoustic Immittance Screening: This test is often done if an otoacoustic emissions screening raises concerns. This screening may include tympanometry, acoustic reflex, and static acoustic impedance.

See the American Speech-Language-Hearing Association’s web site for more information about these procedures, and for general information about Audiological Screening.

(Source of definitions: ASHA)

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