(a)

1. (1) Hearing disorders of varying types are prevalent in the preschool population.
2. (2) Studies have reported that up to eighty percent (80%) of children attending daycare centers may exhibit frequent ear infections and resulting hearing loss.
3. (3) A hearing screening program for the three-year-old to five-year-old population can assist in identifying the at-risk children.

(b)

1. (1) The following guidelines apply when establishing an early childhood hearing screening program.
2. (2) Initial screening of children ages three (3) to five (5) should be completed by appropriately trained personnel.
3. (3) Such personnel may include trained volunteers or school personnel.
4. (4) For assistance in establishing the hearing screening process, contact the Department of Health.

(c)

1. (1) Children who fail the initial screening should be rescreened in two (2) to four (4) weeks, due to the many false results of hearing screening that occur at this young age.
2. (2) This second screening should be completed by individuals with increased knowledge of hearing loss.
3. (3) These may include school nurses, speech language pathologists, area services consultants for the hearing impaired, etc.

(d)

1. (1)

   1. (A) Failure of the second screening constitutes an automatic referral for consideration for early childhood special education services.
   2. (B) Prior to the referral conference, informal observation of the child should be conducted with attention to the following presenting characteristics.
   3. (C) The area services consultant for the hearing impaired can provide assistance in this process.

2. (2) Behavior.

   1. (A) Frequently uses neutral response, smiling, saying “yes”, and periodically nodding in situations where he or she lacks understanding.
   2. (B) Has difficulty following verbal directions or does not respond.
   3. (C) Frequently asks to have statements repeated.
   4. (D) May appear hyperactive, if he or she is dependent upon monitoring the environment visually and tactually.
   5. (E) Is inattentive in group activities.
   6. (F) Appears to be confused, especially in noisy situations.
   7. (G) Gives inappropriate answers to simple questions.
   8. (H) Has complete or partial misunderstanding of conversation.
   9. (I) Is overly dependent on visual clues.
   10. (J) May have a low tolerance for frustration.
   11. (K) Often speaks too loudly or too softly.

3. (3) Communication abilities.

   1. (A) Language:

(i) Difficulty expressing ideas;

1. (ii) Words frequently omitted from sentences;

   1. (iii) Limited vocabulary;

      1. (iv) Incorrect sentence structure; and
      2. (v) Difficulty following directions.

   2. (B) Speech:

      1. (i) Voice quality harsh, breathy, nasal, and/or monotone; and
      2. (ii) Developmentally appropriate sounds distorted and/or omitted from words (i.e., “I caught a fish” may be spoken as “I cau-fi-”).

   3. (C) Auditory:

      1. (i) Turns head to one (1) side to hear better;
      2. (ii) Has difficulty in locating source of sounds or speech;
      3. (iii) Responds better to environmental noises than to voice; and
      4. (iv) Has problems understanding speech after a head cold subsides.

2. (4) Physical/medical.

   1. (A) History of frequent earaches or ear discharge, nasal obstruction with associated mouth breathing, or other nasal symptoms, such as frequent colds, sneezing, allergies, history of viral infections, high fever, etc.
   2. (B) Family history of hearing loss and/or ear diseases.
   3. (C) History of dizziness and balance problems.
   4. (D) Deformity of oral facial structure (i.e., cleft palate).