Hearing loss can impact children's speech and language development. The following is a research summary of the possible effects across the domains of language (Reading Rockets, 2023):

Vocabulary (Semantics) 

• Vocabulary develops slower in children who have hearing loss.

• Children with hearing loss learn concrete words like cat, jump, five, and red more easily than abstract words like before, after, equal to, and jealous. They also have difficulty with function words like the, an, are, and a.

• The gap between the vocabulary of children with normal hearing and those with hearing loss widens with age. Children with hearing loss do not catch up without intervention.

• Children with hearing loss have difficulty understanding words with multiple meanings. For example, the word bank can mean the edge of a stream or a place where we put money.

Sentence structure (Syntax) 

• Children with hearing loss comprehend and produce shorter and simpler sentences than children with normal hearing.

• Children with hearing loss often have difficulty understanding and writing complex sentences, such as those with relative clauses ("The teacher whom I have for math was sick today.") or passive voice ("The ball was thrown by Mary.")

• Children with hearing loss often cannot hear word endings such as -s or -ed. This leads to misunderstandings and misuse of verb tense, pluralization, nonagreement of subject and verb, and possessives.

Speaking (Speech)

• Children with hearing loss often cannot hear quiet speech sounds such as "s," "sh," "f," "t," and "k" and therefore do not include them in their speech. Thus, speech may be difficult to understand.

• Children with hearing loss may not hear their own voices when they speak. They may speak too loudly or not loud enough. They may have a speaking pitch that is too high. They may sound like they are mumbling because of poor stress, poor inflection, or poor rate of speaking.

Social functioning (Pragmatics)

• Children with severe to profound hearing losses often report feeling isolated, without friends, and unhappy in school, particularly when their socialization with other children with hearing loss is limited.

• These social problems appear to be more frequent in children with mild or moderate hearing loss than in those with severe to profound loss.

Academic achievement (Cognition and Learning) 

• Children with hearing loss have difficulty with all areas of academic achievement, especially reading and mathematical concepts.

• Children with mild to moderate hearing losses, on average, achieve one to four grade levels lower than their peers with normal hearing, unless appropriate management occurs.

• Children with severe to profound hearing loss usually achieve skills no higher than the third- or fourth-grade level, unless appropriate educational intervention occurs early.

• The gap in academic achievement between children with normal hearing and those with hearing loss usually widens as they progress through school.

• The level of achievement is related to parental involvement and the quantity, quality, and timing of the support services children receive.

SUGGESTED: Watch the CDC video [LINK HERE] and consider (1) why it's so critical that newborn's hearing is screened and then (2) why we continue to monitor hearing across the early childhood years

The previous summary illustrates the impact that undetected hearing loss in the early years (birth-early school years) can have on a child's speech and language development. Therefore, early identification is critical so that children can be supported to become effective communicators (communication choice). Most hearing losses are identified through a screening at birth. Some children are not diagnosed until later, when speech or language skills are not progressing. Earlier identification and management of hearing loss results in better outcomes for the child.

SUGGESTED: Review the NYS Early Intervention Program 'Clinical Clues of Possible Hearing Loss' summary [LINK HERE]

The National Institute of Health (Deafness and Other Communication Disorders) defines 'stuttering' as...

"Stuttering is a speech disorder characterized by repetition of sounds, syllables, or words; prolongation of sounds; and interruptions in speech known as blocks. An individual who stutters exactly knows what he or she would like to say but has trouble producing a normal flow of speech. These speech disruptions may be accompanied by struggle behaviors, such as rapid eye blinks or tremors of the lips. Stuttering can make it difficult to communicate with other people, which often affects a person’s quality of life and interpersonal relationships. Stuttering can also negatively influence job performance and opportunities, and treatment can come at a high financial cost.

Symptoms of stuttering can vary significantly throughout a person’s day. In general, speaking before a group or talking on the telephone may make a person’s stuttering more severe, while singing, reading, or speaking in unison may temporarily reduce stuttering.

Stuttering is sometimes referred to as stammering and by a broader term, "disfluent speech."

It is important to recognize, and differentiate, normal/expected disfluencies from those that present with a clinical concern. ASHA (2023) stresses the importance of differentiating typical disfluencies from stuttering. Review the chart [LINK HERE] differentiating the types of normal disfluency from those with greater clinical concern (stuttering moments). 

SUGGESTED: Read the article on 'Developmental Stuttering' [LINK HERE] and take note of the 3 figures within the article. 

Communication screening must note instances of disfluency and consider whether or not they are consistent with developmental or typical disfluencies OR if they present greater clinical concern. The following are types of disfluencies, and associated behaviors, to take note of; if these are observed (or reported) children should be monitored or referred: 

• Sound and syllable repetitions at any point in the word (e.g., b-b-b-b-b-ball, wa-wa-wa-wa-want)

• Sound prolongations at any point in the word (e.g., sssssssssssssssss-ing, ffffffff-inger)

• Blocks (tense pauses where phonation/sound stops and tension is noted)

• Secondary behaviors such as blinking, grimacing, or other physical or verbal behaviors 

• Negative reactions, frustration or avoidance behaviors (withdrawing from verbal interactions) 

• Family history of stuttering 

SUGGESTED: Watch the National Stuttering Foundation's video [LINK HERE] on parent's perspective on their children's stuttering. Reflect on how the parents describe their child's stuttering and some of the strategies suggested to support children who stutter. 

Voice is produced when air from the lungs passes through the vocal folds (vocal cords) in the larynx (voice-box) causing the vocal folds to vibrate; this is our body's noise maker (vocal folds, voice-box). There are a number of factors that can impacts a child's voice which result in altered perceptions of vocal quality (e.g., hoarseness).  

Read the following article excerpts (Theis, 2010) and consider the reflection questions associated with each: 

EXCERPT #1: Why shouldn't we ignore concerns with children's vocal quality? What could be the longer-term implications for saying, "they will grow out of it?"

"Pediatric voice disorders typically have been blamed on vocally “abusive” behaviors, and many practitioners have tended not to provide intervention because they believed that children would “grow out of it.” However, changes in pitch, loudness, and overall vocal quality tend to interfere with communicative abilities. Recently, research has focused on pediatric voice disorders and the effects of a voice disorder on a child’s life. It has been reported that children and adolescents felt that their voice disorders resulted in negative attention and limited their participation in activities (Connor, Cohen, Theis, Thibeault, Heatley, & Bless, 2008).

Incidence rates of pediatric voice disorders range from 6% to 23% (Maddern, Campbell, & Stool, 1991), with more than 1 million children in the United States affected by chronic dysphonia (Gumpert, Kalach, Dupont, & Contencin, 1998). Childhood dysphonia is a broad condition and can be difficult to quantify and study; however, several studies have shown that voice disruptions negatively affect how children are perceived both by adults and by their peers (Ruscello, Lass, & Podbesek, 1988; Lass, Ruscello, Stout, & Hoffmann, 1991; Lass, Ruscello, Bradshaw, & Blankenship, 1991). Although voice disorders are common in the pediatric population and have recently been gaining more attention, there is still a lack of information available to clinicians regarding evaluation and treatment of pediatric voice disorders."

EXCERPT #2: What are some of the changing qualities of a developing child's voice?

"As the child grows, the larynx descends; the movement does not necessarily affect phonation, but it does affect the resonance of the vocal tract. As the infant’s vocal tract continues to grow, the frequency of the vocal tract formants decreases, as does the fundamental frequency (Gray, Smith, & Schneider, 1996). Therefore, one of the most important features in the developing pediatric voice is the change in pitch as children get older. The laryngeal structure also changes. It has been shown that laryngeal growth is related to overall body growth. This growth accelerates from birth to age 3, then decelerates, then enters a rapid growth phase during adolescence and puberty, particularly in boys (Gray, Smith, & Schneider, 1996). Until puberty, the larynx is similar in size for boys and girls, and voices do not differ greatly (Maddern, Campbell, & Stool, 1991)."  

EXCERPT #3: What are two [potential] causes of pediatric voice disorders?

Changes in the structure or function of the pediatric larynx can lead to dysphonia, and a child can present with a voice problem for a number of different reasons. A thorough review of pediatric voice disorders is beyond the scope of this article; in general, however, childhood dysphonia can be broadly classified into several categories: infectious, anatomic, congenital, inflammatory, neoplastic, neurologic, and iatrogenic (McMurray, 2003).

Vocal fold nodules are one of the most common forms of pediatric dysphonia (Maddern, Campbell, & Stool, 1991) and are considered inflammatory. Studies have estimated that the incidence of vocal fold nodules as the cause of pediatric dysphonia ranges from 38% to 78% (Gray, Smith, & Schneider, 1996). Vocal fold nodules are defined as swelling (usually bilaterally) in the mid-membranous portions of the true vocal fold that interferes with glottic closure and vocal fold vibration (Heman-Ackah, Kelleher, & Sataloff, 2002). Vocal nodules impede the normal vibratory pattern of the vocal folds and present what we hear acoustically as hoarseness. Vocal nodules are the most common—but not the only—cause of pediatric dysphonia; therefore, a thorough assessment and diagnosis are essential in the evaluation and treatment of pediatric voice disorders.

SUGGESTED: Review the Cincinnati Children's Hospital resource on voice disorders in children [LINK HERE] and reflect on the vocal qualities (signs and symptoms) you may note that could be of concern for a young child; further, consider the types of questions you might ask a parent/caregiver/teacher about a child's 'VOCAL HYGIENE' 

Quiz 3