Is it ADD or hearing loss? In kids, it can be hard to tell

If your child is having difficulty focusing and completing school assignments, you may want to get them screened not just for attention-deficit disorder (ADD), but also childhood hearing loss. That's because the symptoms of these two common conditions mimic each other, and in some cases, a child may have both.

What is ADD?

ADD is a collection of behaviors without any known cause and has no definitive physical tests. Its symptoms can mimic other disorders such as hearing loss.

A child with ADD may be impulsive, struggle to pay attention in class, have poor organizational skills, avoid tasks that require sustained mental effort (such as homework), and get easily distracted compared to their peers.

A child with a very similar disorder—attention-deficit hyperactive disorder (ADHD)—may also seem unable to sit still, and try to tackle more than one task at a time, according to the American Speech-Language Hearing Association.

All children (and many adults) struggle with these skills, but if the person's behaviors are markedly worse than their peers, than it could be ADD or ADHD, the National Institute of Mental Health points out.

Hearing loss can be mistaken for ADD or a learning disorder

Even mild hearing loss can cause a child to miss up to 50 percent of what is said in the classroom.

The increase in the number of ADHD diagnoses in the past few decades means the likelihood of incorrect diagnoses or potential for overlap with hearing loss increases as well. According to hearing loss statistics, about 2 to 3 out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears. Even a mild hearing loss can cause a child to miss up to 50 percent of what is said in the classroom.

Some indicators of hearing loss that might be confused for ADHD include:

• Poor academic performance
• Inattentiveness
• Not responding when spoken to
• Acting out
• Inappropriate responses to questions 
• Low self esteem
• Difficulty with social interactions

These symptoms can also lead to the child being diagnosed with a learning disorder, when in reality it's hearing loss.

However, children with ADHD only tend to have normal speech language development on par with their peers, whereas a child with untreated hearing loss may also have delays in these areas. 

In some cases, a child is affected by both conditions, but it is important to accurately determine the reason behind a child’s poor school performance or inattentiveness to avoid a misdiagnosis of ADHD, unnecessary medication and to determine the best course of action to help a child succeed in school.

The good news: Treating hearing loss will dramatically help a child in school, regardless of whether they have ADHD or not.

Diagnosis is the key

Accurate diagnosis is key to a child’s successful academic performance, followed by appropriate intervention and treatment.

In kids with hearing loss and ADHD, the hearing loss tends to be diagnosed first, thanks to mandatory newborn infant hearing screening programs and observable behaviors obvious to astute parents. Testing for hearing loss and ADHD are different processes, and hearing loss is much easier to diagnose and quantify.

Some hearing tests don't require active participation from the patient and can still yield valuable information. ADHD, on the other hand, is diagnosed by observation of behavioral and psychological symptoms and answering a series of questions, and it can be somewhat subjective.

Speech and language delays in kids with hearing loss

Some children with hearing loss can have delays in speech-language development. Unless they have received early diagnosis, intervention and treatment in the form of pediatric hearing aids or cochlear implants, along with speech-language therapy, they often lag behind their peers in this area.

If a child can’t hear their teacher, they will have difficulty focusing, paying attention and completing assignments—all of which might incorrectly indicate ADHD.

In cases where hearing loss has already been diagnosed, it is important to note the effectiveness of programs put in place for intervention such as amplification, speech-language therapy programs and academic and classroom support. If the child's behavior and academic progress does not improve, it may then be appropriate to begin testing for ADHD to determine if there are further problems beyond the hearing loss. A speech-language pathologist can still be quite useful, by helping your child's social, organizational and speech skills. 

Whether a child has ADHD, hearing loss or both, the key to success is early and professional diagnosis and management by a team of qualified healthcare professionals. 

If you suspect hearing loss, see a hearing healthcare professional for a formal audiologic evaluation, diagnosis and treatment, and recommendations for management of educational goals. See a pediatrician or a psychologist for professional help if you suspect your child might have ADHD.