The Effect of Early Confirmation of Hearing Loss on the Behaviour in Middle Childhood of Children with Bilateral Hearing Impairment.

Children with hearing impairment frequently show behavioural problems.1–3 In terms of the type of behavioural difficulty associated with hearing impairment, difficulties related to attention have been specifically noted.4 For example, between one-third and one-half of children with hearing impairment have been reported as showing externalizing behavioural problems including difficulties with attention.5 Emotional problems are also a feature of children with hearing impairment.6,7 It has been suggested that speech and signing were a mediator of the effect of hearing loss on behaviour.1 The effect of hearing impairment on behaviour was less marked for children with better communication skills. These results parallel those from hearing children. There are well-replicated findings that, for a range of language related skills, poor development is linked with increased behavioural problems.8 As with hearing children, behavioural problems in young children with hearing impairment may be associated with a wide range of biological (e.g. preterm birth) and social (e.g. unresponsive parenting) factors.9 Moreover it is well established that children with physical disabilities and chronic illnesses have an elevated rate of behavioural and emotional difficulties.10 The factor of central interest in this paper is whether differences in the age at which permanent childhood hearing impairment (PCHI) is identified in children are related to the risk of behavioural problems. It has been suggested that enrolment in an intervention programme by the age of 9 months lessens the deficit of verbal ability compared with later intervention by as much as 19 points in the verbal ability quotient.11,12 We have shown previously, in the sample discussed in this paper, that behavioural problems are found more frequently in children with PCHI than in hearing children.2 We have also shown, in the same sample, that early confirmation of PCHI is followed by improved language (particularly receptive language) abilities at primary school age.13,14 It would therefore be expected that early confirmation would decrease the rate of behavioural problems in children with PCHI because language ability mediated the impact of PCHI on behaviour. This paper tests this hypothesis in children with hearing loss taking part in a follow-up of a cohort study of the outcome of universal newborn screening for hearing impairment.