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Hearing loss and academic failure
Publ. Hlth, Lond. (1983) 97, 136-138
Hearing Loss and A c a d e m i c Failure J. K. Tweedie M.B., Ch.B., D.P.H., Dip.Aud.
Senior C//n/ca/ Med/ca/ Officer (Audio/ogy) St He/ens and Knows/ey Hea/th Authority
A study was made of 97 children in remedial classes to see if a connection could be demonstrated between academic failure and a past or present hearing loss. Twenty-seven were found to have current losses; and 17 of these, plus a further 33, had a recorded history of defective hearing. Examination of school medical records, taken at random, of 100 children not needing remedial teaching showed only 13 had a history of hearing loss. Tests of non-verbal ability in the remedial group showed that a large number of these children were above average. Introduction
According to Chomsky, the growth of language in the child's mind requires a certain "triggering" input in the early months and years. If, because of a hearing defect at this critical period, the input is impeded, development of vocabulary and auditory processing skills may be retarded, and never reach its full potential. Even the slightest hearing loss, if prolonged or frequently recurrent, can be damaging. Middle ear dysfunction is a c o m m o n cause of such mild recurrent impairment. This condition tends to be self-limiting, and as the child grows older and the hearing becomes normal we are left with what has been referred to as the " q u o n d a m " case - an educational problem that may be impossible to resolve fully. Early defective hearing is only one of the factors determining the need for remedial teaching, but as it can often be corrected, treatment where indicated should be implemented without delay. Methods
The school selected for the study was an Infant and Mixed Junior School with about 450 pupils. The head-teacher was interested and co-operative, the great need for remedial teaching in his school having always been a source of concern to him. His help was greatly appreciated. Children in this school are routinely identified as being in need of remedial teaching by a battery of tests, all verbally based, and administered by the staff at the age of 6½ or 7 years. One hundred and three were thus identified, and 97 of these were available for a preliminary screening by tympanography, which is an objective method of detecting middle ear dysfunction, the commonest, and eminently treatable, cause of defective hearing in children. A t y m p a n o g r a m was categorized as abnormal if it indicated immobility of the tympanic membrane, or a negative pressure in the middle ear of - 200 m m of water or more, in one ear or both ears. Children with abnormal t y m p a n o g r a m s were followed up by the followir~g. (1) Pure tone audiometry. A loss of 20 dB or more on any one of three frequencies in the better ear was taken to be significant. 0033-3506/83/030136+03 $02.00/0
© 1983 The Society of Community Medicine
137
Hearing Loss and Academic Failure
(2) A non-verbal test of ability. Raven's matrices were used. This is a test which depends on completing increasingly intricate patterns. Results
In the 97 remedial group children, findings were as follows. (la)
Abnormal tympanograms Significant hearing losses Smaller hearing losses (lb) Current hearing losses with a recorded history (lc) Normal hearing at present, but with a recorded history (2) Total number with recorded losses (3) Total number with past or present hearing losses (4a) Above-average non-verbal ability (4b) Below-average non-verbal ability
27 21 6 17 33 50 60 60 37
(51%) (62~) (62~) (38%)
For the non-remedial group children, examination of randomly selected medical records showed that the total percentage with recorded losses was 13 ~ compared with finding (2) above, where the total percentage of recorded losses for remedial children was 51 ~o. Discussion
Many papers, over a period of many years, have been published relevant to the subject of this study. 1-8 The relationship between hearing problems and academic problems is complex, partly because so many factors can be involved in the causation of learning difficulties. Some of these, such as poor intelligence, specific language disorders, and sensory impairments, are quantifiable; others, such as deprived social backgrounds and the effect of frequent absences from school, are not. The analysis of the interaction of some or all of these factors presents a formidable task. The general conclusion, however, seems to have been that a mild to moderate hearing loss does not, per se, cause academic failure, but can be a contributing factor with other adverse circumstances. In the present study, one of the most striking features is that 62 ~ of the children in the remedial group had current and/or past hearing problems. Fifty-one per cent had a recorded history of such problems, compared with 13 ~ in the control group. The children in the study were virtually all socially deprived, so that an additional handicapping factor could quite easily, for many of them, have made the difference between academic success and failure. The correlation in the general population between ability and attainment is not, of course, exact, but one would have expected, among the remedial group children, to find a higher proportion with poor ability than with good ability, perhaps in the ratio of 75: 25, though this depends on the actual tests used. The obser~eed findings show a ratio of 38:62- a striking reversal of expectation. Thus there are too many above-average children needing remedial teaching. When it is recognized that most of the children with hearing problems in the school are in t.he remedial group, and that these problems occur in children of all levels of ability, the message is clear that if these hearing problems had been not only recognized but also treated early enough, much of this waste of human potential and community resources might have been avoided. In our area, we have for several years been holding a weekly paediatric audiology clinic
138
J. K. Tweedie
for pre-school children, attended by a knowledgeable and sympathetic E.N.T. surgeon. He keeps a special waiting list for these children, so that treatment can be carried out without delay. It is too soon yet for us to assess the overall results of this arrangement, but they seem promising. We are now starting to screen for hearing loss all children identified as needing remedial teaching, in the hope of obtaining correction o f the hearing. This, however, can only be a patching-up procedure, since much of the educational damage will be irreparable.
Acknowledgements My thanks are due to Dr P. Hamilton, Head of Service for Hearing-Impaired Children, and to Mr R. D. LeMasurier, Principal Educational Psychologist, both of Knowsley Education Authority, for their valuable help.
References 1. Bennett, E. C., Ruuska, S. H. & Sherman, R. (1980). Middle ear dysfunction in learning-disabled children. Pediatrics 66, 254-9. 2. Bond, G. L. (1935). Auditory and Speech Characteristics of Poor Readers. Teachers' Contribution to Education No. 657, New York, Teachers' College, Columbia University. 3. Brooks, D. N. (1969). The use of the electro-acoustic impedance bridge in assessment of middle ear function. International Audiology 8, 563-9. 4. Burt, C. (1950). The Backward Child. London: London University Press. 5. Freeman, B. A. & Parkins, C. (1979). The prevalence of middle ear disease among learningimpaired children. Clinical Pediatrics 18, 205-12. 6. Gerwin, K. S. & Glorig, A. (1974). Detection of Hearing Loss and Ear Disease in Children. Springfield, Illinois: Charles C. Thomas. Pp. 5-10. 7. Kaplan, G. J., Fleshman, J. & Bender, T. (1973). Long-term effects of otitis media; a ten-year cohort study of Alaskan Eskimo children. Pediatrics 52, 577-85. 8. Zincus, P. W. & Gottlieb, M. (1980). Patterns of perceptual and academic deficits related to early chronic otitis media. Pediatrics 66, 246-52.
Hearing Loss and A c a d e m i c Failure J. K. Tweedie M.B., Ch.B., D.P.H., Dip.Aud.
Senior C//n/ca/ Med/ca/ Officer (Audio/ogy) St He/ens and Knows/ey Hea/th Authority
A study was made of 97 children in remedial classes to see if a connection could be demonstrated between academic failure and a past or present hearing loss. Twenty-seven were found to have current losses; and 17 of these, plus a further 33, had a recorded history of defective hearing. Examination of school medical records, taken at random, of 100 children not needing remedial teaching showed only 13 had a history of hearing loss. Tests of non-verbal ability in the remedial group showed that a large number of these children were above average. Introduction
According to Chomsky, the growth of language in the child's mind requires a certain "triggering" input in the early months and years. If, because of a hearing defect at this critical period, the input is impeded, development of vocabulary and auditory processing skills may be retarded, and never reach its full potential. Even the slightest hearing loss, if prolonged or frequently recurrent, can be damaging. Middle ear dysfunction is a c o m m o n cause of such mild recurrent impairment. This condition tends to be self-limiting, and as the child grows older and the hearing becomes normal we are left with what has been referred to as the " q u o n d a m " case - an educational problem that may be impossible to resolve fully. Early defective hearing is only one of the factors determining the need for remedial teaching, but as it can often be corrected, treatment where indicated should be implemented without delay. Methods
The school selected for the study was an Infant and Mixed Junior School with about 450 pupils. The head-teacher was interested and co-operative, the great need for remedial teaching in his school having always been a source of concern to him. His help was greatly appreciated. Children in this school are routinely identified as being in need of remedial teaching by a battery of tests, all verbally based, and administered by the staff at the age of 6½ or 7 years. One hundred and three were thus identified, and 97 of these were available for a preliminary screening by tympanography, which is an objective method of detecting middle ear dysfunction, the commonest, and eminently treatable, cause of defective hearing in children. A t y m p a n o g r a m was categorized as abnormal if it indicated immobility of the tympanic membrane, or a negative pressure in the middle ear of - 200 m m of water or more, in one ear or both ears. Children with abnormal t y m p a n o g r a m s were followed up by the followir~g. (1) Pure tone audiometry. A loss of 20 dB or more on any one of three frequencies in the better ear was taken to be significant. 0033-3506/83/030136+03 $02.00/0
© 1983 The Society of Community Medicine
137
Hearing Loss and Academic Failure
(2) A non-verbal test of ability. Raven's matrices were used. This is a test which depends on completing increasingly intricate patterns. Results
In the 97 remedial group children, findings were as follows. (la)
Abnormal tympanograms Significant hearing losses Smaller hearing losses (lb) Current hearing losses with a recorded history (lc) Normal hearing at present, but with a recorded history (2) Total number with recorded losses (3) Total number with past or present hearing losses (4a) Above-average non-verbal ability (4b) Below-average non-verbal ability
27 21 6 17 33 50 60 60 37
(51%) (62~) (62~) (38%)
For the non-remedial group children, examination of randomly selected medical records showed that the total percentage with recorded losses was 13 ~ compared with finding (2) above, where the total percentage of recorded losses for remedial children was 51 ~o. Discussion
Many papers, over a period of many years, have been published relevant to the subject of this study. 1-8 The relationship between hearing problems and academic problems is complex, partly because so many factors can be involved in the causation of learning difficulties. Some of these, such as poor intelligence, specific language disorders, and sensory impairments, are quantifiable; others, such as deprived social backgrounds and the effect of frequent absences from school, are not. The analysis of the interaction of some or all of these factors presents a formidable task. The general conclusion, however, seems to have been that a mild to moderate hearing loss does not, per se, cause academic failure, but can be a contributing factor with other adverse circumstances. In the present study, one of the most striking features is that 62 ~ of the children in the remedial group had current and/or past hearing problems. Fifty-one per cent had a recorded history of such problems, compared with 13 ~ in the control group. The children in the study were virtually all socially deprived, so that an additional handicapping factor could quite easily, for many of them, have made the difference between academic success and failure. The correlation in the general population between ability and attainment is not, of course, exact, but one would have expected, among the remedial group children, to find a higher proportion with poor ability than with good ability, perhaps in the ratio of 75: 25, though this depends on the actual tests used. The obser~eed findings show a ratio of 38:62- a striking reversal of expectation. Thus there are too many above-average children needing remedial teaching. When it is recognized that most of the children with hearing problems in the school are in t.he remedial group, and that these problems occur in children of all levels of ability, the message is clear that if these hearing problems had been not only recognized but also treated early enough, much of this waste of human potential and community resources might have been avoided. In our area, we have for several years been holding a weekly paediatric audiology clinic
138
J. K. Tweedie
for pre-school children, attended by a knowledgeable and sympathetic E.N.T. surgeon. He keeps a special waiting list for these children, so that treatment can be carried out without delay. It is too soon yet for us to assess the overall results of this arrangement, but they seem promising. We are now starting to screen for hearing loss all children identified as needing remedial teaching, in the hope of obtaining correction o f the hearing. This, however, can only be a patching-up procedure, since much of the educational damage will be irreparable.
Acknowledgements My thanks are due to Dr P. Hamilton, Head of Service for Hearing-Impaired Children, and to Mr R. D. LeMasurier, Principal Educational Psychologist, both of Knowsley Education Authority, for their valuable help.
References 1. Bennett, E. C., Ruuska, S. H. & Sherman, R. (1980). Middle ear dysfunction in learning-disabled children. Pediatrics 66, 254-9. 2. Bond, G. L. (1935). Auditory and Speech Characteristics of Poor Readers. Teachers' Contribution to Education No. 657, New York, Teachers' College, Columbia University. 3. Brooks, D. N. (1969). The use of the electro-acoustic impedance bridge in assessment of middle ear function. International Audiology 8, 563-9. 4. Burt, C. (1950). The Backward Child. London: London University Press. 5. Freeman, B. A. & Parkins, C. (1979). The prevalence of middle ear disease among learningimpaired children. Clinical Pediatrics 18, 205-12. 6. Gerwin, K. S. & Glorig, A. (1974). Detection of Hearing Loss and Ear Disease in Children. Springfield, Illinois: Charles C. Thomas. Pp. 5-10. 7. Kaplan, G. J., Fleshman, J. & Bender, T. (1973). Long-term effects of otitis media; a ten-year cohort study of Alaskan Eskimo children. Pediatrics 52, 577-85. 8. Zincus, P. W. & Gottlieb, M. (1980). Patterns of perceptual and academic deficits related to early chronic otitis media. Pediatrics 66, 246-52.