LM208 - Do Our Societal and Educational Systems Value Listening for Children Who Are Deaf and Hard of Hearing?

Abstract:
With the roll-out of universal newborn hearing screening, opportunities for deaf and hard children to listen using hearing technology exploded. Despite these access changes and the recognized importance of parents as effective teachers for their children, early intervention and educational systems do not consistently promote the opportunity afforded by hearing. Messaging to parents is complicated by inaccurate information from pediatricians. This presentation and facilitated discussion will review the diverse ways in which societal perspectives and the medical/professional communities impact family decisions on hearing assistance including US trends in utilization of hearing aids and cochlear implants for children.

Summary:
With the roll-out and expansion of universal newborn hearing screening some 20 years ago, opportunities for children with hearing loss to listen and talk using advanced hearing technology exploded. No longer would children with hearing loss typically be identified at age 2 or later—when their parents noticed that they weren’t talking. Instead, children were routinely detected within the first week of life, diagnosed, and referred for early intervention services by six months. Such services include the provision of hearing aids, cochlear implants, or bone-anchored solutions as well as access to parent-centered habilitation to maximize their spoken language and other learning. Families were also eligible for other services to address the unique needs of their children.

As CI criteria expanded to include younger ages, for the first time profoundly deaf children routinely developed age-appropriate spoken language and grade-level reading and writing skills. Children with lesser hearing loss were fitted with advanced hearing aids and remote microphone systems that provided ever-improving access to speech, music, and other environmental sounds.

Despite these important changes in early detection and follow-up including hearing technology access and recognition of the power of parents and families to be the effective first teacher for their child (similar to what parents do for their children with typical hearing), early intervention and educational systems still do not consistently promote the value of hearing. Messaging to parents is complicated by inaccurate and biased information that too often comes from medical professionals (i.e., pediatricians) and the early intervention and educational system.

A September 2023 Clinical Report by the American Academy of Pediatrics, “Hearing Assessments in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening”, provided inaccurate and incomplete information on pediatric hearing loss. The report included a recommendation that identified children should be referred to Early Intervention while referrals to medical specialties (i.e., audiology, otolaryngology, speech pathology) “may be appropriate.” Hearing care professionals were notably absent in the development of this influential report. Only one outside organization was consulted (National Association of the Deaf)—a group with a very specific approach to communication in children with hearing loss (ASL as a core value). The report minimized the benefits of technology and suggested that without ASL, children risked being “language deprived” if only using hearing aids or cochlear implants.

Negative perspectives about hearing technology have been perpetuated in diverse ways in our society. The popular film Sound of Metal provided an especially misleading portrayal of the process of cochlear implantation. Such coverage is all too common and contributes to misconceptions about the benefits of hearing and maximizing listening with technology. The link between listening, language, and literacy in children—with or without hearing loss—is well documented though often not shared with parents who are negotiating the best path forward for their child.

As part of this presentation and facilitated discussion, we will review the diverse ways in which societal perspectives impact family decisions relative to listening including US trends in utilization of hearing aids and cochlear implants for children.