December 17, 2010

Misdiagnosing Children With Hearing Loss

Some of you may have heard about how deaf and hard of hearing children have been misdiagnosed as having other disorders such as learning disabilities. Does this still happen? I would hope that today's diagnostic tools and assessments and knowledge of hearing loss has improved since a decade ago. From what I have read and heard, it seems as if misdiagnosing hearing loss for another disorder or disability was prevalent before and during the 1980s.

I sometimes wonder if some students of mine really have learning disorders or if it is a result of their hearing losses.

How do you properly assess a child with a hearing loss on whether or not they have a type of learning disability? How do you do this when a majority of them already struggle with comprehension and language due to their hearing loss? It seems as if most children with hearing loss can exhibit similar symptoms to certain communication, language, and  learning disorders.

Does anyone have any information about this? Anyone know of a deaf or hard of hearing individual who was misdiagnosed? If so, please contact me or leave a comment.



  1. I believe it still happens. Ask Gallaudet for some names of qualified educational psychologists having diagnostic experience with deaf children. Psychometrics is a field that focuses on testing which is a sadly understaffed area in deaf education.

    Children like this often blossom when they go to a dedicated school for the deaf because of the constant flow of visual information from peers and teachers using ASL. It might be good to consider this also because many of them have educational psychologists on staff. Their teachers may have special training in learning dysfunction since they appear more often among deaf children.

  2. Gallaudet University has a graduate program in School Psychology that has been around since the early 80s. (A clinical psychology program began in 1990 and is now accredited by APA.) There are currently about 200 or so school psych graduates working all over the world. Not all of them are still practicing school psychologists, but a good number are. State schools for the deaf are most likely to have a Gallaudet-trained school psychologist. Most state schools have a diagnostic center to which you can refer any deaf or hard of hearing students for an evaluation free of charge. the Indiana and Kentucky schools for the deaf come to mind.

    It's been my experience that deaf children are often wrongly classified with a secondary educational handicap of learning disabled by the local school or district's psychologist. Some say speech/language disorder, language processing, or even auditory processing. how dumb is that? But it's also true that some deaf children have language delays, in either sign or spoken language, beyond what may be expected in a student with a significant hearing loss. Even for a trained assessment professional, it's difficult to distinguish a true learning disability ("deaf plus")and what could be attributed to the effects of auditory and language deprivation.

    Immersion in an ASL environment does not guarantee that a student will blossom. Socially, perhaps, but not academically.

  3. This happens more frequently than you think. The State of Florida took a step to remedy future 'misdiagnoses'. It's Rule 6A-6.03018(1).

    Basicially, a broad interpretation of this rule means that a student who is identified as "Specific Learning Disabled" cannot also be identified as a "Deaf and Hard of Hearing", and vice-versa.

    The link is: Click on the "Final" MS Word Document and go to Section (1) - Definition. That pretty much sums it up.

  4. I think that it happens far less in the US than it used to. Thank goodness! But I have an international student who was diagnosed as "mentally retarded" (not really an acceptable term here, but I guess it was in Egypt) until he was four. Turns out he is brilliant but happens to be profoundly deaf, which resulted in language deprivation. That first label unfortunately has been hard for him to overcome--his family still thinks he's slow. If only they could communicate with him!

    The child began learning ASL about two years ago, which was just before he turned six, so his language is extremely delayed. Yet somehow he manages to be solidly on grade level in math now (first grade). MR? Please. He schools the hearing kids in the math class.

    On the other hand, I have several other students who have hearing loss and cognitive, learning, or emotional disabilities. It takes time to identify which learning difficulties result from hearing loss and which do not, because most of them have hearing families and are quite language delayed when they come to me for kindergarten. Yes, that includes the children with cochlear implants. I work for a regular old school district, not a school for the deaf.

    One of my kids was diagnosed as having apraxia... nope, he turned out to be a kid who just wasn't interested in people enough to start talking. And his visual impairment was worse than originally thought. That can be isolating.

    One of my kids was diagnosed as plain old deaf... nope, she has a significant cognitive impairment. Her brain did not fully develop.

    It's tough with such a diverse population, especially when you don't know their language background. Even if you ask about it, you never really know unless you witness the communication first hand.

    I guess it's important to know the expected developmental sequence. For example, a moderately hard of hearing child who is appropriately aided from a young age will be within the normal range for language and learning, or just below it. If I'm finding that a kiddo is struggling more, I'm going to look at other disabilities.

    When one of my severe/profound kids (whether they have hearing aids, implants, silence, whatever the parents have decided) is struggling, which is unfortunately a common scenario, the first thing I do is go for heavy duty ASL instruction, because very few deaf kids have had this before elementary school. If they pick up ASL quickly, I am frustrated that they didn't have it earlier but not so worried about concomitant disabilities. If they are slow to acquire ASL, I'm going to look at other disabilities. The SLP and school psych are very helpful with this. It often comes down to language being the main area where the child struggles, and that is an indicator of learning disabilities. But if it's just a matter of not having exposure to a completely accessible language, that's not a learning disability. That's language deprivation, which many would consider neglect.

    Sorry this is so long. One last thing to add... Dianrez, the comment about these kids blossoming when they go to the schools for the deaf is right on the mark. I see it often where the families really want them in mainstream settings, and the kids struggle all through elementary school. Then they end up in the nearby school for the deaf for middle school, and their worlds suddenly open up. Ignored in the corner of the cafeteria? Try center of attention! Chatting with the interpreter before the bell rings? Try chatting with a big group of friends! Stressed out and always a step behind? Try keeping up and feeling confident!

  5. Hearing loss most likely, why you think professional are pushing CI before the age of three? If you don't have the language, you're more likely play catch up for the rest of your life. Which why I don't like professional risking this by telling parents no ASL. You just never know the child aren't auditory wired for spoken language (or don't have the right hearing for it). Because it's hard to turn back the clock to fix it.

  6. I'd be interested in knowing what assessment tools were used in the diagnosis. A learning disability is assessed in four parts: achievement, cognitive ability (IQ), observation, and parent/teacher information. No child should be diagnosed on the basis of one test.

    When giving any test, it must be in the child's primary language or form of communication. Fortunately, there are non-verbal assessments out there, some more reliable than others. The child can have multiple disabilities, but really should have only ONE primary disability. For now, the primary disability could be the child's hearing loss.

    As the child's communication skills develop, reassessment is necessary to determine the primary disability as well as any, or if, other deficiencies are present.

  7. Thank you everyone for your information and thoughts on this.

  8. Some students do have an additional disability; however, it can be difficult to diagnose. It is like the chicken and the egg. Which came first: the hearing loss or the _______ (insert various behaviors). I work with a kinder student who is profoundly deaf and also has a tendency to be violent. Does he have EBD, a sensory disorder, ADHD, or is he simply frustrated because he can't communicate? He is obviously very bright and is picking up sign language quickly but his outbursts continue. He is truly a puzzle we have yet to figure out.

    The point is not what label he needs or doesn't need. What would another label do to change his services? He is served all day in my deaf education classroom. I am duel certified in special education as well. He is educated in a language rich environment. The only more restrictive environment would be a residential setting and that is not appropriate at this time. I feel that the education system should be careful how young children are diagnosed and really weigh the benefits of adding multiple labels to children.

  9. Yes, being misdisagnosed still happens. It has happened to my daughter. Now,5 years old, she is getting appropriate attention to her hearing-loss. My daughter failed the hearing at birth. We followed up with audiologists and they claimed she had 'moderate' hearing loss, but never did anyone suggest hearing aids until recently. Now my daughter's hearing loss has progressed to moderate to severe. However, with her diagnoses 'syndrome' it involves developmental delays. Time will tell if the hearing aids will help or maybe her cognitive skills are below?


Keep it civil.