Attention Deficit Disorder & Hearing Impairment

Introduction Many children (and some adults) in the United States have been diagnosed with ADHD (attention deficit hyperactivity disorder). It seems to be a prevalent condition, and one with a fair amount of controversy attached to it. It ss hard to define ADHD. It is not a disease. It is a collection of symptoms which can sometimes seem rather vague and could derive from a number of sources. ADHD does not have any known cause and has no definitive physical test. ADHD is a psychiatric condition which is defined in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) handbook, which is used to diagnose personality disorders. The symptoms of ADHD as defined by the DSM-IV include:

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Inattention:

• Fails to pay close attention to detail or makes careless mistakes in schoolwork or other activities
  
• Has difficulty sustaining attention in tasks or activities
  
• Does not appear to listen when spoken to
  
• Does not follow through on instructions and does not finish tasks
  
• Has difficulty organizing tasks and activities
  
• Avoids or dislikes tasks that require sustained mental effort (e.g. homework)
  
• Is easily distracted
  
• Is forgetful in daily activities

Hyperactivity:

• Fidgets with hands or feet or squirms in seat
  
• Does not remain seated when expected to
  
• Runs or climbs excessively when inappropriate
  
• Has difficulty playing quietly
  
• Is constantly on the move
  
• Talks excessively

Impulsivity:

• Blurts out answers before the question has been completed
  
• Has difficulty waiting for his or her turn
  
• Interrupts and / or intrudes on others

The DSM-IV states that at least six of the symptoms of inattention plus six symptoms of hyperactivity and impulsivity combined are required for a diagnosis of ADHD.

Confusion arises because many of these symptoms are common childhood behaviours that could have multiple causes. Bright children are often bored in school, and people who are bored are quite often fidgety. Children could be distracted or disturbed by their physical environment, or there could be outside problems like family stress which can cause ADHD-like symptoms. This article will address the overlap in symptoms between hearing impairment and ADHD.

ADHD and Hearing Loss

Could a child with an undiagnosed or improperly amplified hearing impairment be erroneously diagnosed with ADHD? Let’s look at some of the symptoms for inattention. “Fails to pay close attention to detail.” “Has difficulty sustaining attention.” “ Does not appear to listen.” “ Does not follow through on instructions.” All of the symptoms could be explained by a hearing loss.

When reviewing the symptoms for hyperactivity, “fidgets” and “does not remain seated” could result from a child has hearing instructions or understanding what is required. And finally, a child who interrupts others may simply be unaware of all the audio clues that somebody is speaking.

Given the highly subjective interpretations of ADHD symptoms, it is easy to see how symptoms of a hearing loss could be confused with symptoms of ADHD. It is of course, quite possible, for a child to have both hearing impairments and ADHD. Therefore, it is essential that professionals who are familiar with both issues be involved with diagnosis and treatment.

Central Auditory Processing Disorder

There is another medical condition that has many of the symptoms of ADHD. Central Auditory Processing Disorder (CAPD) is a disorder which can appear like a hearing impairment, even when no hearing loss is present. A person with CAPD has normal hearing, but their brain has difficulty in processing the sounds that they hear.

Someone with CAPD may have difficulty concentrating in a noisy environment. They may be unusually sensitive to sound, and may confuse similar sounding words. A child in a classroom setting would be overwhelmed by the constant influx of sound. Under such conditions a child would appear fidgety and unfocused. He would be unable to finish tasks, and would be easily distracted. Many of the symptoms of ADHD would fit a child with CAPD.

Before a child with CAPD starts going to school, the parent may have no suspicion that there is any kind of hearing problem. Usually the first indication of CAPD begins in a learning environment where the child is required to perform certain tasks. A noisy classroom makes it extremely difficult for child with CAPD to concentrate. Again, hearing impairment and CAPD can exist in a single individual. In the case of a child with a diagnosed hearing impairment, CAPD might manifest itself as the hearing impairment appearing behaviorally to appear more severe than it is.

Conclusion

Many people fear that ADHD is too quickly diagnosed for children who are difficult to handle in a classroom situation. Children are naturally active and have a lot of energy to burn. Put them in a classroom where they are expected to sit still for long periods of time and without question, some of them will naturally exhibit behaviors that seem like ADHD and CAPD.

Children who have been diagnosed with ADHD are frequently put on medication such as Ritalin. Also, like hearing impaired children, children with ADHD and CAPD do benefit from the use of FM systems in the classroom, which improve the ability to understand speech by reducing the amount of competing background noise. This makes it easier for them to concentrate and understand speech in the presence of environmental noise. However, a child who is simply hearing impaired or has CAPD will not benefit from any pharmaceutical solutions.

Given that one in nine individuals who is suspected to have ADHD is known to have an untreated hearing loss, or found to have an undiagnosed hearing loss, it is quite possible that undiagnosed or untreated hearing loss is masked under an ADHD diagnosis. Furthermore, since hearing impaired children are ten times more likely to be held back a grade than children with hearing within normal limits, it is essential that hearing losses be properly diagnosed and treated to minimize the potential impact on the child’s education.

State of the art diagnostics, combined with the selection of appropriate hearing aids and skilled, professional programming and fitting, like that provided by the audiologists at the Hearing Device Center of the California Ear Institute, combined with assistive listening devices and acoustical modifications may also necessary to creating the optimal listening environment for any hearing impaired student. Click here to make an appointment to improve your hearing today !