Development in hearing impaired.rev

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  • The prevalence of other disabilities in addition to hearing loss is approximately three times as large (30.2%) in the deaf or hard of hearing population as in the general school population. Some of this may be explained by the varying causes of hearing loss. Some of the current documented etiologies of childhood deafness include maternal rubella (2%), prematurity (5%), cytomegalovirus (1%), and meningitis (9%)(Moores, 1987). It is logical to assume that the population demonstrating a hearing loss is at a high risk for additional disabilities since the previously mentioned etiologies are also known to be associated with neurological involvements. The prevalence of several specific disabilities occurring with diminished hearing has been documented over time (Craig & Craig, 1993, 1983, 1973). The three additional disabilities most often reported in children who are deaf or hard of hearing are learning disabilities, intellectual disabilities, and emotional/ behavioral disabilities. The 1993 reference issue of the American Annals of the Deaf reports learning disabilities as the largest co-occurring disability at a prevalence of 9%. The prevalence of intellectual disabilities occurring with a hearing loss followed closely at 8%. The co-occurrence of emotional/behavioral disabilities was the least at a 4% occurrence rate.
  • The prevalence of other disabilities in addition to hearing loss is approximately three times as large (30.2%) in the deaf or hard of hearing population as in the general school population. Some of this may be explained by the varying causes of hearing loss. Some of the current documented etiologies of childhood deafness include maternal rubella (2%), prematurity (5%), cytomegalovirus (1%), and meningitis (9%)(Moores, 1987). It is logical to assume that the population demonstrating a hearing loss is at a high risk for additional disabilities since the previously mentioned etiologies are also known to be associated with neurological involvements. The prevalence of several specific disabilities occurring with diminished hearing has been documented over time (Craig & Craig, 1993, 1983, 1973). The three additional disabilities most often reported in children who are deaf or hard of hearing are learning disabilities, intellectual disabilities, and emotional/ behavioral disabilities. The 1993 reference issue of the American Annals of the Deaf reports learning disabilities as the largest co-occurring disability at a prevalence of 9%. The prevalence of intellectual disabilities occurring with a hearing loss followed closely at 8%. The co-occurrence of emotional/behavioral disabilities was the least at a 4% occurrence rate.
  • Development in hearing impaired.rev

    1. 1. Development in the Hearing Impaired Child Dr Varsha Atul Shah Associate Consultant Department of Neonatal & Developmental Medicine, SGH Visiting Consultant K K Hospital,Child Development Unit
    2. 2. Colorado Newborn Screening Program Per 100 000 birthsCongenital HL 260 (200 bilateral)Hypothyroidism 25PKU 7CF 50 Pediatrics Jan 1998
    3. 3. Classification of Severity of Hearing ImpairmentSeverity dBMild 27 - 40Moderate 41 - 55Moderately-severe 56 - 70Severe 71 - 90Profound ≥ 91 American National Standards Institute 1969
    4. 4. Hearing Impairment In InfancyEnvironmental Genetic Causes Causes (50%) (HHI) (50%) Syndromic Non Syndromic (30%) (70%)
    5. 5. Environmental Causes Perinatal infections  CMV, Rubella, other IUI Meningitis  bacterial Prematurity  multiple risk factors Hyperbilirubinaemia Ototoxicity  aminoglycosides, loop diuretics
    6. 6. Hereditary Hearing Impairment (HHI) Congenital HHI Delayed onset HHI Present at birth Develop later in lifeSyndromic: Non Syndromic:both conductive & SNHL most often SNHL
    7. 7. Syndromic HHI Chromosomal disorders  Down Syndrome  Trisomies Non Chromosomal disorders  Noonan’s syndrome  Craniosynostosis  Pendred Syndrome  Osteogenesis Imperfecta  Charcot-Marie Tooth  Waardenburg Syndrome
    8. 8. Non-Syndromic HHI: the genetics Gene mutation Genetic heterogeneity “DeaFNess” gene loci  AR (77%) DFNB loci (1-33)  AD (22%) DFNA loci (1-41)  X-linked (1%) DFN loci (1-8)  Mitochondrial (< 1%) maternal inheritance with susceptibility to aminoglycosides
    9. 9. Undetected Hearing Loss Hearing loss is a Screening hidden disability which has long termIdentification consequences on Follow up development if theIntervention appropriate intervention is not Outcome instituted early
    10. 10. The Importance of Hearing  Hearing is important for  Language development  especially in the first 5 years of life  Speech development  Speech perception  Speech production (including articulation, timing and prosody)
    11. 11. Unilateral or Mild Bilateral HL  Relatively minor disability  Speech recognition & understanding under adverse conditions (e.g. classroom noise) → Attention Behaviour Overall educational achievement  Psychosocial well being
    12. 12. Children with minimal sensorineural hearing loss: Poorer comprehension & communication Impairment in functional status 37% failed at least 1 grade Bess FH, Ear Hear Oct 1998
    13. 13. Moderate-profound HL Impairment of speech/language development Reduction of academic achievement Disturbance in social & emotional development
    14. 14. Problems faced by HI Children Hearing Impaired Children Language Non – Language Concomitant Issues Issues Disabilities
    15. 15. Language Related Issues1. When adults speak with the HI child  They tend to give less verbal praise and become less stimulating2. HI children have reciprocal communication issues  They use attention-seeking statements or methods to enter a conversation  They have difficulty deciding when to enter a conversation
    16. 16. Language Related Issues1. When HI children seek clarification,  They tend to repeat rather than revise3. HI children have limited vocabulary:  Vocabulary of the HI is 0 - 9 words at 18 months  Vocabulary of normally-hearing children = 20 – 50 words
    17. 17. Language Related Issues1. HI children have poor sentence structure Children with language difficulties face difficulty in  Learning new skills & concepts  Making sense of events around  Solving problems  Literacy – reading & writing skills
    18. 18. Non-Language Issues More physically–tired (more effort required) Emotional outcomes- Poor self-esteem, motivation3. Socialization skills  Difficulty in making friends & being accepted socially  Often feel rejected & isolated  Weaker play skills (especially those associated with language and social skills)
    19. 19. Non-Language Issues1. Behaviour problems  Aggression  Impulsivity  Immaturity  Inattention, frustration2. Family dynamics  Challenges in family adjustment (emotional, financial and time factors) will impact on the child and his/her family - child relationship
    20. 20. Assessment of Language Proper diagnostic hearing assessment Proper treatment i.e. aids / CI / AVT / sign Hearing Age important Appropriate non verbal and verbal language assessments:  Receptive language skills  Expressive language skills
    21. 21. Concomitant DisabilitiesSeveral disabilities occur more commonly in HIchildren Intellectual / cognitive disability (8%)  Based on generalized developmental delay with poor adaptive or functional skills Emotional / behavioural problems (4%)  Inappropriate, disruptive, aggressive behaviour
    22. 22. Concomitant DisabilitiesLearning disability (9%)  Diagnosis based on discrepancy between intellectual potential and achievement in reading and writing skills  Average / above average IQ with specific deficits in reading/writing (dyslexia)Neurological problemsVisual impairment
    23. 23. Hearing Impairment & Learning Previous studies showed that HI children have  Linguistic / language problems  Cognitive / thinking / learning problems Hearing impairment alone does NOT equate to low intellectual ability or inability to learn With early intervention, children can develop good language skills
    24. 24. Early intervention is essential  Neural circuits of auditory system rewired by external stimulations very early in life  If such stimulations not received at that time, circuits will not develop fully Pediatric Clinics of North America Feb 1999
    25. 25. ScreeningIdentification Breakdown at any stage Follow up jeopardizes entire effortIntervention Outcome
    26. 26. The UNHS programme was piloted at the Singapore General Hospital in 1998In 2002 the project become theNational UNHS programmeinvolving all public hospitals,polyclinics and some privatehospitals
    27. 27. Echocheck version 2.13.3ILO, Otodynamics(July 2000 - )
    28. 28. Echoport ILO 288, Otodynamics(Nov 1998 - )
    29. 29. Do not only hear mebut also listen to me…

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