The link between ADHD and hearing loss
October is Attention Deficit Hyperactivity Disorder (ADHD) Awareness Month. If it seems like more and more kids suffer from ADHD, it is because diagnoses are, in fact, on the rise. In 2003, only 7.8 percent of American kids received an ADHD diagnosis, but by 2011 that number was up to 11 percent, says the CDC. One potential reason for the shift may be ever-increasing academic pressure on kids combined with a heightened focus on behaviors like executive function, which are related to a child's ability to keep track of time, make plans, apply learned principles and analyze ideas.
What is ADHD
ADHD is not a disease or medical condition. It is a collection of symptoms without any known cause and has no definitive physical tests. Its symptoms can mimic other disorders such as hearing loss. Unlike hearing loss, ADHD is a non-specific psychiatric condition which, as defined by the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) handbook, includes the following symptoms:
- 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
Can hearing loss in kids look like ADHD?
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. The increase in the number of ADHD diagnoses means the likelihood of incorrect diagnoses or potential for overlap with hearing loss increases as well. According to the Better Hearing Institute and the Center for Hearing and Communication, about 1.4 million people under the age of 18 in the U.S. have hearing loss, and 15 percent of kids between the ages of 6 and 19 have a measurable hearing loss in at least one ear. 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
- Not responding when spoken to
- Acting out
- Inappropriate responses to questions
- Low self esteem
- Difficulty with social interactions
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.
It is easy to see where the lines blur, especially when a child has already been diagnosed with one or the other. “It can be very difficult [for parents] to determine whether or not a child with hearing loss has ADHD,” Nanette McDevitt, PsyD, Med., with the Greater Minnesota Assessment Service (GMAS) reports to Minnesota Hands and Voices. “Hearing loss can be like trying to listen on a cell phone when it is cutting in and out. It is very hard to maintain your attention when you can’t get all of the information. It can be very hard to attend, and this can look like ADHD.”
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 vastly different processes, and hearing loss is much easier to diagnose and quantify. Some hearing tests, like otoacoustic emissions used in newborn screening programs, don't require active participation from the patient and 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.
We have looked at the similarities between ADHD and hearing loss, but it is important to remember that there are differences as well. For example, 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 hearing aids or cochlear implants, along with speech-language therapy, they often lag behind their peers in this area. In contrast, children with ADHD tend to have normal speech language development on par with their peers.
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.
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.