Visual and hearing impairments
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Am interested in what ways hearing tests are modified for young people with learning difficulties?

toasttoast Member Posts: 46 Listener


  • toasttoast Member Posts: 46 Listener
    Hi Vicki

    Am interested in what ways hearing tests are modified for young people with learning difficulties. Is there much work/ research being done in this area specifically? From my own and other's experience audiology assessments have been somewhat difficult. I think my daughter's deafness went undetected for some time as it was felt that the problem was developmental -ie she wasn't responding to the drumming monkey in a box because she didn't have the cognition / interest in the test.

    Very interested to hear your thoughts
  • Natasha BrownNatasha Brown Member Posts: 112 Courageous
    hi toast, my son (15, SLD, ASD) is now under the "complex needs" clinic at the nuffield centre at the ENT hosp in london under dr lim - they have been trying very hard to use different approaches to get some idea of his hearing levels (probably mildly down on normal). he also is not reliable for the standard testing and has gone beyond the monkey in a box stage. not sure where you are but perhaps your team could speak to them and share ideas?
  • VickiKirwinVickiKirwin Member Posts: 69 Courageous
    Hi toast & natashailg,

    It should be possible to get hearing test results right from the time of birth and we do now screen the hearing of newborn babies. These types of tests are called 'objective' tests and they don't require the baby or child to respond to a sound as the results are recorded automatically from the hearing nerves. But as children grow up we're also interested in their responses to sound and we use 'behavioural' tests because this tells us a bit more about how the sound is heard, processed and responded to. The type of test done depends on the development stage of the child - earlier on we're looking for behavioural responses like looking for the source of a sound (such as the monkey in the box you mention) or maybe looking for eye movement or another physical response. You are right and children grow out of these tests as they no longer hold their interest and there are also babies and children who simply don't respond to electronic sounds. After the watching for responses stage we move on to actively involving the child in a game of some sort - perhaps throwing a ball into a bucket when they hear a sound. Children don't need to understand what they're doing and will often just copy if it is interesting for them and this is known as 'conditoning'. Sometimes conditioning can take lots of visits to audiology and some practice at home but my experience is that most children will get there eventually. It also seems to be something that isn't forgotten once they've done it and I've tested adults with learning disability who come in, sit down, put the headphones on, and do a hearing test with no instruction - they have obviously done it when they were kids! So when we're thinking about modifying tests for children or adults with learning disability then we may be looking to undertake testing that is more suitable for their developmental stage but needing to do this in a way that interests them. We can't just do the test in the same way that would have done for a baby. If they don't respond to the monkey in the box they may respond to human voice or to a different reward (favorite toys, sweets?) We may condition an adult with learning disabilities but we wouldn't usually teach them to move a toy, we would teach them to press a buzzer or clap their hands etc.

    Often behavioural testing is more successful if it's carried out by an experienced team who work with children and adults with complex needs a lot so it can be worth being referred to a specialist centre such as the Nuffield in London. If behavioural isn't possible then we may suggest using objective testing. In babies this is easier because you need to be very still and quiet for the tests (half hour+) and we can test them while they naturally sleep during the day. With older children and adults they may be be to cooperate in being very still when awake but inbetween times sedation or a light general anaesthetic may be required. This option has to be balanced with the need to get the results (are there significant concerns about the hearing that cannot be tested in another way) with any other health needs the child has and whether sedation would be appropriate etc. It may be possible to do the testing at the same time they have another operation if this is happening for some reason. This is another reason why a specialist team is a good idea but should mean that we can get accurate hearing levels on most people.

    Some ot the most interesting and exciting research going on at the moment is into a new type of objective testing that measures cortical responses in the brain in response to sound whilst the person being tested is awake and alert - watching TV or reading. It's not widely available yet but I think it has a lot of potential for testing what children can hear with their hearing aids at the brain level, as well as for testing those people who are not able to participate in traditional test techniques.


  • toasttoast Member Posts: 46 Listener
    (Belated!) Thankyou Natasha and Vicki for your helpful replies. Wish we were nearer london! Deafness was confirmed by ABR (?) test under anaesthetic. They are still trying with the behavioural ones now she has had implants to assess impact of them - with little success (although we can clearly see a big difference - as can school)
  • VickiKirwinVickiKirwin Member Posts: 69 Courageous
    The National Deaf Children's Society is about to start work developing guidance for special schools about hearing loss in children who have complex needs. We want to help staff in these schools recognise a potential hearing loss, understand the needs of children with hearing loss, use hearing aids and other technologies to their best advantage, and support children in their hearing and listening development. If you have any tips or recommendations to share based on your experiences I would love to hear them either here or email [email protected] Thank you!
  • April2018momApril2018mom Posts: 2,869 Member
    That’s exciting. Could you tell me more about the research being done? My mom’s friend’s daughter had hearing issues and they tried to see whether or not her ears were working properly or not. Any new research excites me greatly. 
  • VickiKirwinVickiKirwin Member Posts: 69 Courageous
    Hi @April2018mom

    This is the study I mentioned above:

    Its being tested with with infants who wear hearing aids as a way of telling us what the baby is hearing without the baby having to tell us. But other services are testing it out with older children who we struggle to get hearing test results for because of a range of complex needs. It’s not routinely available yet but is in some places. 

  • dolfrogdolfrog Member Posts: 440 Pioneering
    So when are UK audiologists going to be required to be trained and qualified to understand and carry out an Auditory Processing Disorder battery of tests, as a minimum requirement to be an audiologist. From our experience most UK audiologists are professionally negligent in this respect, and hbave no idea as even know what the various types of Auditory Processing Disorders are. Thye fail to provide the support and understanding that those who have Auditory Processing Disordrs require and fail to work as part of the Medical Research Councils recommened multi - discipline support team of Audiologists, speech and language pathologists, and psychologists.
  • dolfrogdolfrog Member Posts: 440 Pioneering
    edited June 2019
    The Temporal type of Auditory Processing Disorder (APD) is the main underlying cognitive cause of developmental dyslexia, what the dyslexia industry call a phonological processing deficit.
    The temporal type of APD is about the brain having problems processing the gaps between sounds, which can include the gaps between words in rapid speech. The Random Gap Detection Test is the clinical diagnostic test which attempts to identify the size of gap between sounds and individual can process. (When i did the test it did not include a GAP large enough for me to process.) 

    Dyslexia is a man made problem concerning decoding and recoding the visual notation of speech, or the graphic symbols society chooses to represent the sounds of speech.Dyslexia is language dependent.
    There are two types of dyslexia. Acquired Dyslexia, also known as Alexia, is caused by brain injury, stroke, atrophy, etc which is concerned with those loosing or have lost the previously acquired skills to decode and recode the visual notation of speech. 
    And Developmental Dyslexia which has a genetic causes. There are three cognitive subtypes of Developmental Dyslexia - Auditory, Visual and Attentional. Which means that an Auditory Processing Disorder, a Visual Processing Disorder, an Attention Deficit / Disorder, or any combination of these issues can cause the Dyslexic Symptom.

    So we need UK Audiologists, speech and language, psychologists, to get together, and catch up with  international research regarding these issues and stop living in the last century. 
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