Rethinking the Accessibility of Hearing Assessments for Children with Developmental Disabilities

Area of Science:

• Pediatrics
• Audiology
• Developmental Disabilities

Background:

• Gold-standard hearing assessments, including audiograms and auditory brainstem response (ABR) tests, are crucial for early detection of hearing loss in children.
• Children with developmental disabilities may face unique challenges in accessing timely and appropriate healthcare services, potentially impacting their hearing health monitoring.

Purpose of the Study:

• To determine the accessibility of gold-standard hearing assessments for children aged 0-18 years within the initial 3 months of healthcare.
• To compare the rates of accessing audiogram or ABR assessments between children with and without developmental disabilities.

Main Methods:

• Electronic health records of 131,783 children from three hospitals were analyzed.
• Children with developmental disabilities included diagnoses of autism, cerebral palsy, Down syndrome, or intellectual disability.
• Logistic regression models, controlling for age, race, ethnicity, sex, and site, were used to evaluate differences in assessment access based on disability status.

Main Results:

• Children with developmental disabilities (9.8% of the cohort) had a significantly higher rate of not receiving a gold-standard hearing assessment (24.4%) compared to typically developing children (9.3%).
• The relative risk of lacking a gold-standard assessment was elevated across all subgroups of developmental disabilities, with the highest risk observed for those with multiple diagnoses (RR=13.24) and intellectual disabilities (RR=11.52).
• Children with autism (RR=2.88), Down syndrome (RR=6.14), and cerebral palsy (RR=9.87) also faced significantly higher risks.

Conclusions:

• Children with developmental disabilities are at high risk for suboptimal hearing evaluations lacking gold-standard assessments, potentially leading to delayed or missed diagnoses of hearing loss.
• There is a critical need for closer monitoring of hearing health by healthcare providers for children with developmental disabilities.
• Advancements in hearing testing methods and updated clinical guidelines are necessary to improve access and ensure comprehensive hearing care for this vulnerable population.