Physical Health

May Is Better Hearing and Speech Month: Promoting Early Hearing Screening and the Use of Assistive Technology

May is Better Hearing and Speech Month. It is a time when the American Speech-Language-Hearing Association (ASHA) promotes the importance of communication development for young children, including those with disabilities. This year’s theme is "Communication for All." This includes:

  • Developing an understanding and awareness of the value and importance of having the ability to communicate
  • Actively nurturing and protecting that ability
  • Taking steps to restore that ability by seeking professional care or employing the use of assistive technology

The Office of Special Education Programs (OSEP) and the Offices of Head Start and Child Care are partnering to celebrate Better Hearing and Speech Month. Together, we want to promote the importance of hearing screenings and awareness about using assistive technology to support children’s communication development. Our goal is to ensure that all children receive the supports and services they need in a timely fashion.

Approximately one out of every 300 children in the U.S. is born with a significant hearing loss. As many as one in four children through the age of 5 are at risk for a developmental delay or disability, and permanent hearing loss is the most common birth defect in the United States. By school-age, the incidence has doubled. Early identification allows communities to intervene earlier. Early intervention leads to improved outcomes, which can have a positive impact on children’s development and learning when they enter school. Early screening also affords the option of introducing assistive technology. Even when used for short periods of time, assistive technology has proven to provide access to learning opportunities that may otherwise be missed.

The Individuals with Disabilities Education Act (IDEA) supports states in providing early intervention services for infants and toddlers with disabilities and their families (Part C) and special education and related services for preschool children with disabilities (Part B, Section 619). The state lead agency for Part C and the state education agency for Part B have an obligation to identify any child who may be eligible for special education and related services under the child find requirement. Under IDEA Part C, Child Find requires coordinated efforts with specific agencies, including the state agency responsible for administering the Child Abuse Prevention and Treatment Act (CAPTA), the State Early Hearing Detection and Intervention (EHDI) system, the home visiting program under Maternal and Child Health (MCH-Title V), child care programs, and the Children’s Health Insurance Program (CHIP).

Similarly, IDEA Part B requires the state to have policies and procedures to ensure that all children residing in the state who are in need of special education and related services are identified, located, and evaluated. As part of their comprehensive Child Find procedures, states may choose to include hearing screening and follow-up hearing evaluations where needed. Early care and education programs can partner at the state and local levels to support identifying children who may be eligible for IDEA services by administering screenings and referring families to Part C and Part B, Section 619, if there is a developmental concern.

The Child Care and Development Block Grant (CCDBG) provides federal funding to states, territories, and Tribes to administer child care programs. It includes provisions for developmental screenings for children at risk of cognitive or developmental delays.

Head Start Program Performance Standards require that a developmental screening be conducted within the first 45 days of entry into the program. Furthermore, Head Start programs must obtain from a health care professional a determination that each child is up-to-date on a schedule of age-appropriate preventive and primary health care, including medical, dental, and mental health. Programs must perform or obtain screenings to identify concerns related to hearing and speech. The schedule must incorporate the requirements of well-child care within the state Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. Programs also are required meet the latest immunizations schedule recommended by the U.S. Centers for Disease Control and Prevention (CDC) and state, tribal, and local authorities.

Frequent Developmental Screening

Children’s development should be observed, or monitored, on an ongoing basis in the home, child care settings, and anywhere else children spend their time. The American Academy of Pediatrics (AAP) recommends developmental screening using a standardized tool when a child is 9, 18, and 24 or 30 months of age, or more routinely if needed. These screenings may be done in early childhood settings, schools, community-based intervention programs, or in the child’s medical home. Although there are specific ages at which screening is recommended, it should be done at any age there is a concern about a child’s development.

Periodic Hearing Screening

A young child’s hearing should be observed, monitored, and screened on a periodic basis beginning at birth and in subsequent early learning settings. Most newborns in the U.S. now receive an initial hearing screening before leaving the hospital. However, not all hearing loss can be identified at birth. Hearing loss can occur at any time in a child’s life as a result of illness, physical trauma, or environmental or genetic factors. Evidence-based hearing screening leads to early identification of children who may be at risk for hearing loss. When a hearing loss is identified early, this can significantly minimize, if not eliminate, delays that have historically been associated with hearing loss. As a result of early identification and access to various communication options, children who are deaf or hard of hearing are thriving in ways that used to be rare.

AAP recommends periodic hearing screening during early childhood because hearing is central to language development, communication, and learning. Relatively few health care providers have the equipment necessary to provide objective screening during well-child visits. This is why it is so valuable to have evidence-based hearing screening practices integrated into early care, education, and intervention settings.

Assistive Technology Consideration

Assistive technology, which includes services and devices, is required under Parts C and B of IDEA. Children may not be excluded from consideration for assistive technology for any reason (e.g., type of disability, age, cost, lowered expectations, or administrative concerns). Parents are an integral part of the process for determining the needs of their child. Parental participation is vital for the assessment, selection, implementation, and maintenance associated with their child’s use of assistive technology.

The complexity and specificity of assistive technology devices proceed along a hierarchy. Options ranging from off-the shelf to specialty should be considered. To neglect the assistive technology needs of a child may deprive them of the chance to engage with the world, participate in daily routines, and develop new skills. For example, while waiting to fit hearing aids, we should not deprive a child of valuable opportunities to develop critical communication skills. Along the same lines, delaying the introduction of pictures as a support for communication diminishes the chance for children to experience the power of communication in influencing their worlds. When children have only their behavior to communicate their wants, needs, feelings, and opinions, it can lead to frustration for the child, the family, and other caregivers.

Resources to Support Early Developmental Screening

Birth to 5: Watch Me Thrive! encourages healthy child development, universal developmental and behavioral screening for children, and support for the families and providers who care for them. Find resources designed to support families and providers in ensuring that all young children are screened early and frequently. It is a coordinated federal effort between the U.S. Departments of Education and Health and Human Services.

The Learn the Signs. Act Early. campaign aims to educate parents about childhood development and encourages developmental screening and intervention. It provides free resources to support your screening efforts. Learn the Signs. Act Early. is a public awareness campaign between the CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD), and a number of national partners.

Resources to Support Early Hearing, Speech, and Language Screening

The Early Childhood Hearing Outreach (ECHO) Initiative works to extend periodic hearing screening to infants, toddlers, and young children in a variety of health and education settings. Discover an array of resources and training and instructional materials for planning and implementing hearing screening and follow-up practices. The ECHO Initiative is part of the National Center for Hearing Assessment and Management (NCHAM) at Utah State University. NCHAM serves as the National Technical Resource Center for all state-based Early Hearing Detection and Intervention (EHDI) programs in the U.S.

The CDC is committed to hearing loss surveillance, research, and health education. Their goal is to help children reach their full potential by promoting and tracking early screening, diagnosis, intervention, and hearing loss prevention. CDC offers free materials to support hearing health education for parents, health care providers, and public health professionals.

Speech and Language Screening: Well-Child Health Care Fact Sheet describes the importance of speech and language screening tests. It also explains how they are conducted and what treatments may include. This fact sheet is useful for health managers, health staff, and disability coordinators in Head Start and child care programs. This T/TA resource was developed by the National Center on Early Childhood Health and Wellness.

Resources to Support Assistive Technology

Let’s Participate! offers many resources on assistive technology, including supports for early learning, communication, and participation. Materials include fact sheets, PowerPoint presentations, and tips for using assistive technology. Let’s Participate! is an OSEP-funded early childhood assistive technology model demonstration project.

Technology to Improve Kids’ Education Success (TIKES) explores how assistive technology, whether something as simple as a pencil grip or as complicated as a communication device, has the power to change lives and opens doors of opportunity for people with disabilities. TIKES is another OSEP-funded early childhood assistive technology model demonstration project.