Early Intervention for Children Who Are Hard Of Hearing

The issue

The term “hard of hearing” is a commonly used term for individuals with a mild to severe hearing loss, who often use spoken language and hearing aids. Hearing loss of any degree is likely to affect social interactions in a spoken language environment, and may affect children’s language development as well as cognitive and psychosocial development. Before universal newborn hearing screening, mild to severe hearing losses could be unattended for many years, which means that the children would not receive early intervention services such as amplification and family support.

With the implementation of newborn hearing screening in a growing number of countries, children who are hard of hearing have their hearing loss identified at an earlier age than before. When identified early, they can also receive intervention that supports their development. However, we know less about early intervention for children who are hard of hearing than we know about deaf children (those with greater hearing losses). Families sometimes find that professionals are uncertain, or differ in their opinions regarding the need for follow-up, and what type of follow-up is appropriate for their hard-of-hearing child.

What we know

Early access to sound is vital for spoken language development. For children with severe to profound hearing loss, early amplification with cochlear implants or hearing aids increases their chances of age-appropriate spoken language outcomes. For hard-of-hearing children, the need for early intervention such as amplification may not be as evident. In particular, children with mild or unilateral hearing loss do have access to some sound even without amplification, and they are less at risk for language delays.

However, even mild hearing losses cause problems when the listening conditions are not optimal, and difficulties with memory or attention can increase the burden. There is great variability of language outcomes among children who are hard of hearing; some have language skills comparable to their peers, whereas others lag behind and need more support. Children who receive hearing aids and early intervention at an early age and children who use their hearing aids all the time have smaller risks of language delays than children who get support late or who use their hearing aids less frequently.

Unlike studies of language development, studies of psychosocial development suggest that the risk of psychosocial difficulties does not depend on degree of hearing loss; children with mild hearing loss have the same risk of psychosocial difficulties as children with severe hearing loss, and the risk is present even for children with good language skills. Such difficulties include being more anxious or sad, attention difficulties, or having more problems with friends. Also in these areas, just like with language development, children with early diagnosis and early access to intervention have better outcomes than those who have late access to intervention.

What we do not know

Early intervention is not only about amplification and access to sound, it also includes family support such as information about the child’s hearing loss and interventions supporting the parent-child interaction. In most cases, the different types of early intervention such as family support and amplification are provided at about the same time, which makes it difficult to tell what part of early intervention is effective for hard-of-hearing children. Is it the improved access to sound, or is it the increased knowledge and competence of the parents? Most likely, both parent knowledge and access to sound are important aspects, but it is possible that the different parts of early intervention are of different importance depending on the child’s degree of hearing loss.


Early intervention should always be guided by the specific needs of the child and family, but also by current knowledge about the risks and the effectiveness of specific interventions. Parents of children with mild hearing losses have reported that both professionals and the parents themselves were uncertain about the need for hearing aids and the need for family support, and the impact of the hearing loss became more evident as the child grew older. In order to prevent difficulties before they become apparent, there is a need for more detailed knowledge concerning what types of intervention work for whom, but for a start, it is important to acknowledge that children who are hard of hearing benefit from early intervention, and parents should be encouraged to enter the programs that are provided.

Posted on Jan. 12, 2018 by
Nina Jakhelln Laugen
Regional Centre for Child and Youth Mental Health and Child Welfare
Department of Mental Health
Norwegian University of Science and Technology
nina.jakhelln.laugen {at} ntnu.no


Further reading

Fitzpatrick, E., Grandpierre, V., Durieux-Smith, A., Gaboury, I., Coyle, D., Na, E., & Sallam, N. (2016). Children with mild bilateral and unilateral hearing loss: Parents’ reflections on experiences and outcomes. Journal of Deaf Studies and Deaf Education, 21, 34-43. view details

Laugen, N. J., Jacobsen, K. H., Rieffe, C., & Wichstrøm, L. (2016). Predictors of psychosocial outcomes in hard-of-hearing preschool children. Journal of Deaf Studies and Deaf Education, 21, 259-267. view details

Moeller, M. P., Carr, G., Seaver, L., Stredler-Brown, A., & Holzinger, D. (2013). Best practices in family-centered early intervention for children who are deaf or hard of hearing: An international consensus statement. Journal of Deaf Studies and Deaf Education, 18, 429-445. view details

Sass-Lehrer, M., & Young, A. (2016). Evidence-based practice in early intervention: The proof of the pudding is in the eating. In M. Marschark, V. Lampropoulou, & E. K. Skordilis (Eds.), Diversity in Deaf Education (pp. 21-48). New York: Oxford University Press. view details

Yoshinaga-Itano, C. (2014). Principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. Journal of Deaf Studies and Deaf Education, 19, 143-175. view details