The need for early diagnosis and treatment of congenital hearing loss to facilitate cognitive development

Posted: 05/05/2022

The neonatal hearing screening programme was put in place because of the significant evidence that early intervention for hearing loss, during the first few months of life, is crucial for achieving the best outcome for a child in terms of their speech and language development, and their cognitive development. Better speech, language and cognitive development will facilitate better inclusion for deaf people. Inclusion within the community is the theme of the UKCoD’s (UK Council on Deafness) Deaf Awareness Week 2022 (#DAW2022 #InclusionDeafness).

The most intensive period of speech and language development is during the first 36 months of life. This is a period when the human brain is developing and maturing. Newborn babies recognise the sound of voices and, as they develop, they begin to recognise and sort out the words forming the building blocks of language. Babies will recognise the basic sounds of their native language at a few months of age.

Key speech and language skills develop best in an environment that is full of sounds, sights and exposure to the speech and language of others. During this critical period of speech and language development, the brain is best able to absorb language. The flipside is that the ability to learn a language will be more difficult if the critical period is passed without exposure to that language.

Studies over the years, for example by Lenneberg (1967), have indicated that the impact of early auditory deprivation during the critical period of sensitivity is detrimental to the acquisition of language. The development of speech and language feeds into cognitive development. Accordingly, the late diagnosis of a hearing impairment and delayed interventions may impact the development of abstract thinking and social communication.

Moeller (2000) studied the vocabulary skills of deaf and hard of hearing children and found that, statistically, those children who were enrolled on intervention programmes at an older age had poorer language outcomes. Those who were enrolled earliest, by eleven months of age, had better vocabulary and better verbal reasoning skills at the age of five years than the children enrolled later. A study by Dowell et al (1997) evidenced the positive impact of receiving early cochlear implants on speech perception, and later studies by Nicholas and Geers (2006 and 2007) stressed the importance of hearing in the first three years of a child’s life and the negative impact of not hearing during this period.

Their later study indicated that if a deaf child has not received cochlear implants by two and a half years old, they will not catch up with their hearing peers. Such children may have difficulties with processing language structures, acquiring new vocabulary and understanding what words mean, thereby impacting their ability to access the curriculum and progress at school and to fully engage with the world around them.

It is therefore clear how important the early diagnosis and treatment of congenital hearing loss is in terms of the development of a child’s speech and language and cognitive skills. Late diagnosis and interventions may not just have an impact during childhood, but may well impact that individual’s educational attainments and employment potential in later life. It is therefore vitally important that screening for hearing loss is undertaken properly so that those individuals who do have hearing loss are offered interventions, such as cochlear implants, to facilitate their speech and language and cognitive development at the crucial time in their lives, before three years of age.

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