Academic journal article The Volta Review

Psychological Assessment of Children with Multiple Handicaps Who Have Hearing Loss

Academic journal article The Volta Review

Psychological Assessment of Children with Multiple Handicaps Who Have Hearing Loss

Article excerpt

This article discusses issues involved in psychological assessment of children with hearing loss who have additional disabilities or special needs. It provides recommendations for appropriate methods of assessment that accommodate the communication difficulties associated with hearing loss. This article includes assessment procedures for children who have cognitive disabilities, learning disabilities, visual impairments, attention deficits (ADHD), autism, sensory integration dysfunction, emotional and behavioral difficulties, and motor disabilities.


An estimated 40% of children with hearing loss have additional impairments that can affect education and adaptive development (Gallaudet Research Institute, 2003). These children should have comprehensive psychological assessments for several reasons. First, parents and educators require an accurate understanding of the child's cognitive abilities to develop appropriate expectations and goals based upon standardized methods of assessment. Second, an accurate differential diagnosis of the child's impairments provides guidance in design of educational and treatment programs, and provides a prognosis for long-term planning. Third, parents and medical staff know the child's level of comprehension to determine the child's ability to participate in decisions and to cooperate with procedures (e.g., the cochlear implant process). Fourth, suspected behavioral or emotional problems require adequate assessment to ascertain what impairments may interfere with educational programs and development of adaptive behaviors. Finally, a comprehensive psychological assessment can determine appropriate methods to adapt instruction and therapy to the specific abilities of a child who has cognitive, behavioral, or emotional differences.

Assessment of Cognitive Functioning

In the general population, 2% to 3% of children are mentally retarded, as defined by significant limitations in intellectual functioning and adaptive behavior (AAMR, 2002). A survey of school-aged children with hearing loss reported that approximately 9.3% have mental retardation (Gallaudet Research Institute, 2003). In addition, the survey indicated that another 10.2% are identified with learning disabilities. Of the approximately 50% of children who had a known etiology for their hearing loss, nearly 30% had hearing loss associated with problems during pregnancy or with postnatal injury. These conditions include cytomegalovirus (CMV), rubella, trauma associated with premature birth, meningitis, and ototoxic medications. Many of these etiologies are also associated with central nervous system (CNS) damage implicated in mental retardation and learning disabilities. Because children who are deaf or hard of hearing are at high risk for learning problems, it is important to provide them with appropriate cognitive assessment.

There are several reasons for intelligence testing of these children:

* to provide a standardized method of cognitive assessment;

* to derive a differential diagnosis;

* to advise families about a prognosis;

* to assist in the planning of treatment and education programs.

It is important to use standardized instruments to assess children who are deaf or hard of hearing so that their performance can be compared with the cognitive performance of children with normal hearing of their own age. When non-standardized methods of estimating a child's ability are used, there is the potential to over or underestimate the child's abilities. Often informal assessments are dependent on communicative interaction. Shy, apprehensive children may not show their best intellectual skills in this situation. On the other hand, sometimes children are socially engaging, initiating communication with adults, and amicably interacting with others. These children's cognitive skills are sometimes overestimated by informal methods, because of their friendliness. …

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