Review Question - QID 105628

This child most likely has hearing impairment, as evidenced by poor language development, and inability to hear directions or his name when called.

Undetected hearing loss can lead to developmental and behavioral problems in children. Moreover, hearing impairment can make it seem like the child has a behavioral disorder, because the child appears inattentive and unwilling to follow directions. Children may be mislabeled with ADHD. This child's poor language development points more strongly towards hearing impairment as the cause of his inattentiveness.

Isaacson et al. review the diagnosis and treatment of hearing loss. In children, otitis media is the most common cause of conductive hearing loss. Middle ear effusion decreases tympanic membrane mobility, which can decrease hearing by 20-30dB. Diagnosis can be confirmed with tympanometry and audiometry.

Theunissen et al. systematically review psychopathology and hearing loss in children and adolescents. They report that hearing-impaired children were more prone to depression, aggression, oppositional defiant disorder, and conduct disorder. Levels of anxiety, somatization, and delinquency were elevated in some patients. Possible protective factors include earlier age of detection, and earlier intervention to restore the lost hearing.

Illustrations A and B are schematic representations depicting otitis media, the most common cause of hearing loss in children.

Incorrect answers:
Answer 1: Ignoring teachers, poor vocal skills, and not interacting with classmates is not normal behavior at this age.
Answer 2: The patient is friendly and interested in playing with siblings at home, and displays none of the features of autism. Autistic children have difficulties in reciprocal social interactions, and frequently display repetitive or stereotyped behavior.
Answer 4: The patient's inattentiveness is more likely explained by hearing loss in this context. The diagnosis of ADHD requires impairment in attention or hyperactivity, or both, and must occur in two-or-more environments.
Answer 5: The patient has not displayed any behaviors that would warrant this diagnosis. The diagnosis of conduct disorder requires behaviors that violate the basic rights of others.