Hearing test was "perfect" but he guessed, so what now?

[CanadianAlison+3boys]

Forgive me if this isn't the right spot to post this. I'm not quite sure what to do to help my son. He's six years old, would be in K in public school because of January birthday but he's doing first grade at home.

 

He's very bright, and was my earliest talker. His speech has always been precocious but he's always had a hard time with some pronunciation of words and phrases. He has a significant tongue tie but since we were able to nurse through it when he was an infant (I was tandem nursing at the time, without that he wouldn't have been able to keep my supply up) I can't get anyone to do anything other than agree with me that it is there.

 

The pronunciation issues I feel are twofold. One I think is the tie, his tongue doesn't move easily and the letters he's had the most trouble with are the ones that need the tongue the most. Also he doesn't hear new words correctly the first time unless he's really focusing and watching the speaker. So if its something he's heard before he does a good job responding appropriately but if its a new word, or new phrase, or even a familiar word or phrase used in a new context he will get confused and repeat back what he heard and then need it slowly and clearly repeated (and explained if the concept is entirely new). After that he can confidently use it. He assimilates new ideas easily once he hears them properly.

 

So I asked for a hearing test which was done today. He was tested with beeps and then words into headphones. The audiologist said he got perfect. Then we leave and he says "I'm glad I trusted my gut when the voice said foot dog. I knew foot dog wasn't a thing so I guessed what I thought it meant and said hot dog." So I asked him if there were any others he guessed and he told me a few more.

 

So what now? Anything? He's frustrated when people don't understand him (which he's getting better at compensating for but still when he's excited or not focusing it slips, and of course mishearings that he repeats are a problem). The mishearing issues really came to a full light when he was in a French immersion class this past autumn. He was picking up language like crazy, he loves language, but he would mishear and then repeat words and phrases and even when I'd try and correct him sometimes I'd have to try multiple times and really get him to focus to hear it correctly, even if I broke it down by syllable.

 

Should I let it go and just keep correcting? Is there something else I should be doing? I'm starting to doubt myself when I say I think there is a problem and get told that he's compensating and will figure it out or that some six year olds have far smaller vocubularies than him so he's doing fine. For the vocabulary he has and the love of expression he has I feel this struggle to understand and be understood all the time is unfortunate for him. But maybe I should be focusing on just helping him work through his frustration?

 

A little lost over here. Thank you for any support or ideas.

[Tsuga]

On the one hand, it would be very difficult to get a perfect score just by guessing.

 

On the other hand, since he told you he was guessing, I might consider a more in-depth hearing exam.

 

As for French, it is not the best language to discern hearing issues with. It's very difficult to gauge his issues since many people have the issues you described. Still, I trust that since you were tutoring him, you are familiar with French and the normal mistakes people make.

 

He may have a processing disorder as well.

 

I would listen to your gut and go for further testing in auditory processing, and perhaps ask the doctor if there is a different kind of hearing test that can be administered. Did they listen to the issues he has, and take notes? I hate when doctors don't listen. All the textbooks in the world won't tell you one thing about my own kid's specific issue.

 

Good luck.

[Nart]

Did you get a copy of his audiogram or any of his test results where it says how many decibels he "passed" at and the frequencies? The speech discrimination test should have listed at how many decibels it was administered at. My son can "pass" a hearing screening done by a nurse at his pediatrician's office because it is set at 25 decibels but he can't pass at the audiologist's office because she doesn't consider 25 decibels to be acceptable for a young child.

[OneStepAtATime]

Agreed that the hearing test may not have been in depth or detailed enough and he may need screening for auditory processing issues.

 

And hugs OP. I know this is frustrating. Go with your gut. Keep asking questions.

[PeterPan]

My dd went to the audiologist yesterday too, and I think they used hot dog with her too!   :lol:  I can see your concern, but remember the audiologist did multiple measures, using them to confirm results.  So they probably had some kind of computer testing and the earphones and...  And when all those results line up (some of which he's just passive for), then that's a good sign.  Also, is it possible your audiologist was running some APD testing?  They ran the SCAN3 on dd yesterday.  That may have been when they used the words, because I know they used an audiotrack with a speaker.  I think the regular hearing part was just with a clicker response.  

 

So maybe call back, tell them your concerns, and ask what they test was and whether that would invalidate it if he was doing a lot of guessing?  

 

It's normal to still be clarifying pronunciation and understanding at this age, even in very bright kids.  What you're saying there doesn't seem like such a concern.  I'd just call back and clarify what test that was.  If it in fact was an APD screening, then you might be seeing a relative weakness there, something where it's maybe not quite as strong as you'd expect for a bright child but not enough to get him flagged for a disorder.  That's what happened with dd.  She is *right on* the line for pass/fail, with a 29 score and a 28 cutoff.  They said relative weakness, not enough to get you sent over.  If that testing is what they did, they'll have ear dominance for you, and you can use that with earbuds (only listening through the weak ear) to try to improve processing.  In my dd's case she's left-ear dominant, right-handed, and I'm wondering if that mixed dominance is part of the problem?  She's also left-eye and the developmental optometrist didn't care about that.  

 

Mainly the audiologist told us relative weakness, don't put yourself in a position where you're in background noise as a career, move on, no diagnosis.  That's the story of her life, lol.  Not a low enough CTOPP score to get a dyslexia label, not a low enough SCAN3 to get a CAPD label (not that they would, but even to send on), not quite enough praxis to get her a dyspraxia label (so far).  But definitely the symptoms are there, definitely causing problems.  It's just there are cutoffs.  If he's even ABLE to guess through it, he's probably not gonna get that label, my guess.  Doesn't mean you're not seeing it, but it might be a relative weakness.

 

Has he been to a psych eval?  You have a hard time getting psych evals in Canada, right?  

 

And as far as the short frenulum, they just clip it, an outpatient service in the doctor's office.  Maybe go ahead and get that done and then do some speech therapy?

 

[merry gardens]

Look at LiPS. http://www.ganderpublishing.com/content/lips-overview.asp

 

Your son's intelligence can help compensate for difficulties and correct their understanding, such as the way he figured out "foot dog" didn't make sense so he chose an answer that made sense. Looking at what his initially said her heard, he heard "oo" instead of the short o, and an /f/ instead of /h/. The LiPS program teaches how all the sounds are made with the mouth, lips, vocal cords and tongue. Sometimes if they can't hear the difference, they can see and feel the difference--and if caught early enough that can help train their ears to hear the difference. For many children, this problem corrects over time without all the intervention, as it's certainly not uncommon for 6 year olds to mishear and mispronounce words. At what point you worry about it enough to correct it depends on the extent of the problem and how it affects his life.

 

I assume your son has been evaluated by a speech therapist. As you say he's hard to understand, someone could focus very specifically on how he pronounces his vowels and how he pronounces common words. Two different speech therapists seemed to have missed that my son was substituting non-English vowel sounds on several words because he also all the age-appropriate English sounds. Since your son is throwing French into the mix as you're in Canada, that's yet entirely different tongue and mouth movements! 

 

Some of these things tend to correct as children grow and learn to read, but not always. If your son is already reading, you can still work with him in a similar manner to what I'm going to describe.  My son had a terrible time learning to read and failed a screen for a dyslexia program, (Barton) which then referred us to LiPS. After getting through all the letter sounds and the vowel circle in LiPS, we went through common words for a few minutes each day with flashcards. My son's difficulty in learning to read words by sight caused us to work on common words hundreds of times each--and it was through that process of saying those common words each day with me helping him pronounce them correctly that his speech became easier for people outside the family to understand him. 

 

There are some speech sounds (like L, S, R's) that many speech therapists hold off on correcting until the child has reached a certain age, UNLESS the child is making an unusually large number of errors or unless the parents wish to pay for speech therapy out of pocket. Some children do correct those over time, as their teeth and mouth change as they grow. That's why healthcare and school districts won't pay for treatment until it's clearly indicated by their standards--which is far later than some of us wish. At a certain point, it's appropriate to intervene.  

 

 

[Crimson Wife]

Did the audiologist do the electronic in-ear measurements? If you've got a copy of the report it's called the DPOAE and should be noted as "present" (normal) or "absent" (abnormal). The kid can't fake his/her way through that part.

 

If the audiologist didn't do the electronic in-ear measurements, I would call them up and ask why.

 

I just got Linguisystems Contrasts for Auditory Speech Training (C.A.S.T.) and it would be a good program to use with a child who is having difficulty distinguishing between similar-sounding words. The program consists of cards with two pictures of similar-sounding words (like "ship" and "chip"). The parent/therapist says the words in series (ship, chip, ship, ship, chip, ship) and the child has to point to the correct picture as he/she hears the word. My little one's Applied Behavioral Analysis therapy team is going to be incorporating C.A.S.T. into her ABA program. That way she'll be getting the training from multiple people so hopefully it'll help with generalization.

[Julie of KY]

Trust your instinct - keep asking questions. I might pursue a speech evaluation.