My daughter, Julia, an eight-year-old second grader with moderate-severe hearing loss has trouble printing. After waiting more than a year for her to take pencil to paper and “work it out on her own” as numerous teachers predicted she might, we headed to an occupational therapist for an evaluation. I rattled off a list of complaints: messy printing, letter reversals with /b/ and /d/, pain when writing, and excessive movement especially when she is excited. As for her health history, I explained that Julia was diagnosed with hearing loss just before her third birthday and of course, now she’s having some of this sensory stuff. I presented them as two unrelated issues.
The occupational therapist sent us home with a list of helpful exercises and strategies. The visit also brought up a bunch of thought provoking, Google-able vocabulary like sensory integration, hypotonia and vestibular processing. Sloppy penmanship and excessive movement could be explained with these fancy terms as well as her propensity for spinning while simultaneously being prone to car sickness.
Suddenly aware of this broad range of sensory issues, I started noticing the slightly higher prevalence of sensory processing disorder (SPD) in kids with hearing loss. My totally unscientific observations revealed at least three moms who had identified and/or sought treatment for sensory issues for their children with varying levels of deafness. While hardly a randomized controlled trial, this number represents a high percentage of the kids I know with hearing loss. Could there be a link or am I just looking to pin this on the deaf scapegoat? Is it okay to blame hearing loss for something that is seemingly so unrelated and visual?
When I broached this subject with the occupational therapist after our next visit, she indicated it probably does have something to do with hearing loss, the brain, and things we don’t understand. I thought back to workshops I attended long ago when three-year-old Julia was first diagnosed. I remembered discussions about the pathways formed by auditory input and my fear that she’d be missing something after three years without access to sound.
Though not much formal research exists (at least not on Google), there is a definite link between hearing loss and SPD. The California Ear Institute (californiaearinstitute.com) explains it like this:
Children who have either partial or total hearing loss are especially vulnerable to sensory processing disorder. The inner ear affects the sense of balance and gravity which play a major part in the processing of the other senses. The cochlea also plays an important role in sensory integration. If hearing impairment affects sensory integration it can lead to learning disorders and emotional problems.
Auditory development plays an important role in cognitive function, and the brain’s ability to properly process sense data may be impaired because of a hearing loss problem. The loss of auditory sense stimulation can be compensated for by the same techniques used in treating sensory processing disorder.
One 2009 study says, “although the data are quite preliminary, they do suggest that some pediatric users of cochlear implants demonstrate SPD and atypical behaviors.” (Bharadwaj, S. V., Daniel, L. L., & Matzke, P. L. 2009 Brief Report - Sensory-processing disorder in children with cochlear implants. American Journal of Occupational Therapy, 63, 208–213.
My comprehension of decibels and listening bubbles is much stronger than my understanding of the link between SPD and hearing loss will ever be, but I’m convinced there is a link. Enough of a link that I think my old standby statement, “it’s just her ears” may have been an oversimplification. Ears play a bigger role than just processing sound and maintaining balance. Even if we, as parents, don’t fully understand the differences caused by hearing loss there are things we can be on the lookout for. The SPD Foundation (https://www.spdfoundation.net/) offers the following checklist to determine if an evaluation by an occupational therapist might be beneficial:
____ My child has difficulty being toilet trained.
____ My child is overly sensitive to stimulation, overreacts to or does not like touch, noise, smells, etc.
____ My child is unaware of being touched/bumped unless done with extreme force/intensity.
____ My child has difficulty learning and/or avoids performing fine motor tasks such as using crayons and fasteners on clothing.
____ My child seems unsure how to move his/her body in space, is clumsy and awkward.
____ My child has difficulty learning new motor tasks.
____ My child is in constant motion.
____ My child gets in everyone else's space and/or touches everything around him.
____ My child has difficulty making friends (overly aggressive or passive/ withdrawn).
____ My child is intense, demanding or hard to calm and has difficulty with transitions.
____ My child has sudden mood changes and temper tantrums that are unexpected.
____ My child seems weak, slumps when sitting/standing; prefers sedentary activities.
____ It is hard to understand my child's speech.
____ My child does not seem to understand verbal instructions.
___ My child is overly sensitive to stimulation, overreacts to or does not like touch, noise, smells, etc.
___ My child is easily distracted in the classroom, often out of his/her seat, fidgety
___ My child is easily overwhelmed at the playground, during recess and in class.
___ My child is slow to perform tasks.
___ My child has difficulty performing or avoids fine motor tasks such as handwriting.
___ My child appears clumsy and stumbles often, slouches in chair.
___ My child craves rough housing, tackling/wrestling games.
___ My child is slow to learn new activities.
___ My child is in constant motion.
___ My child has difficulty learning new motor tasks and prefers sedentary activities.
___ My child has difficulty making friends (overly aggressive or passive/ withdrawn).
___ My child ‘gets stuck' on tasks and has difficulty changing to another task.
___ My child confuses similar sounding words, misinterprets questions or requests.
___ My child has difficulty reading, especially aloud.
___ My child stumbles over words; speech lacks fluency, and rhythm is hesitant.
Julia is getting an hour of occupational therapy every other week to address her difficulty printing and constant movement. The OT gym is a wonderful place with trampolines, swings, and giant balls. The therapy is geared toward giving the brain and vestibular system a big sensory experience to cut down on her need to compensate with ever-present jumping and bouncing. In the future, therapeutic listening may be added to the mix. Progress seems harder to track than it was back in our speech therapy days, but I’m hopeful that in time my child will print with ease and that we’ll understand her underlying issues. If not, there’s always typing!
H&V Communicator - Winter 2014
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