Expert: Dr. Sharon A. Mitchell - 6/18/2010

Question
My step son was diagnosed with hearing imapirment when he was born. They say it is due to nerve damage. He has hearing aids and wears them all day every day at our home, but when he goes to his mothers (we have joint custody) he does not wear them but a couple hours a day. He is 3 years old. He has only mild hearing loss according to a test with both aids in. He can say probably 100 words but we can not get him to make 2 or more word sentences. He does not put words together. He does not pretend play at all. He will follow around the older children but when they stop and sit to play or color he will walk off by himself. He does not often play with other children. He does not play with toys. He will take them away from the other children then throw them down. He does not follow directions, he gets distracted very easily. He does not pay attention to anything for any amount of time. He throws tantrums. He is potty trained for the most part, but if we ask him if he needs to go he starts crying. He does not seem to enjoy anything except riding on his motorized fourwheelers. He hits, bites, and pinches other children. I do not know if all of this is due to his hearing loss or if I should talk to my husband about having him evaluated.

Answer
Good evening Demetra,

It's encouraging that while wearing his aids, his hearing loss is only considered mild. You are quite right that it is important for him to wear these aids as much as possible. These are the years when he is developing language and without the ability to hear properly, his skills at imitating speech are hampered. Not only does a hearing impairment impair his ability to acquire spoken language himself, but not being able to hear also interferes with his understanding of language. This has social implications as well as in the educational realm when he goes to school.

Between the ages of two and three, most children begin to put together two or more words. Kids who have a hearing impairment may have some delays in this area. This makes sense when you consider that they may have missed out on the first year or so while while other babies are listening to and mimicking the speech sounds of our language. You can read about normal development of toddlers here: http://www.asha.org/public/speech/development/23.htm

Language plays a large part in socialization. A child who cannot hear or has delays in receptive language may find it harder to enter into play with other children. He may also become upset when adults speak to him; he may know that you expect a response from him but he may not know how to reply.

Since your son already wears hearing aids, I assume that you are in close contact with a Speech Language Therapist. If an audiologist fitting your son's aids but you do not have a Speech Therapist, then I would suggest that you make this contact. In the United States and Canada you may use this search engine to find a therapist who lives near you: http://www.asha.org/proserv/

Speech Language professionals are trained in working with kids with hearing impairments. The also know a lot about language in general and the social implications of communication. Some of the observations you make about your son could be true of children with autism spectrum disorders, but they could also be found kids with hearing impairments. A Speech/Language Therapists can help you sort this out, refer you on if necessary and offer suggestions on how you can work with your son at home to enhance his development.

Best wishes,

Sharon A. Mitchell