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Prevalence of additional disabilities with deafness:
A review of the literature
ContentsContents ............................................................................................................................2
Executive Summary ............................................................................................................3
Introduction .......................................................................................................................4
Aim ....................................................................................................................................5
Methods .............................................................................................................................5
Search Strategy ..............................................................................................................5
Selection Criteria ............................................................................................................6
Results ...............................................................................................................................8
Discussion ....................................................................................................................... 13
References ....................................................................................................................... 15
Appendix A: Excluded Papers ........................................................................................... 17
Executive Summary
With the advances in hearing screening methods, it is expected previous estimates of the prevalence of additional disabilities with hearing loss may no longer be accurate.
A thorough search of the published literature was conducted using a number of electronic databases. The search strategy clearly defined the search terms and parameters for accepting papers for review. The literature search identified 51 relevant papers, of which 39 papers were excluded from review as the data was not specific to the aims of this report. One abstract was excluded as at the time of the review the full paper had not been published in the journal. Altogether 12 papers were included in the review.
The findings from the current review are:
• The prevalence of additional disabilities in children with hearing loss identified three areas of published research:
o Visual impairment: range of prevalence= 4-57%
o Neurodevelopmental disorder: range of prevalence= 2-14%
o Speech Language Disorder: range of prevalence= 61-88%
• The prevalence of deafness in children with other disabilities identified three areas of published research:
o Autistic Spectrum Disorder (ASD): range of prevalence= 2-4.2%
o Cerebral Palsy: range of prevalence= 2-13%
o Pervasive Developmental Disorder (PDD): prevalence= 2%
• The literature search has highlighted the overall evidence of research on the prevalence of additional disabilities in children with deafness, and the prevalence of deafness in children with disabilities, is very low.
• More research is required in this area. A follow up study similar to the one conducted by Fortnum and Davis (1997) is much needed.
Introduction
The seminal work of Fortnum and Davis (1997) identified the prevalence rates of permanent childhood hearing impairment for children in the Trent region. The study identified 38.7% of the children were found to have another clinical or developmental problem and half of these children had at least two additional problems. Since then there have been major developments in the technology used to assess deafness, with objective measures in place allowing for hearing testing from birth. In England, the newborn hearing screening program (NHSP; www.hearing-screening.nhs.uk) offers 99.9% of babies born a hearing screening test within the first few weeks of birth. To date over 5 million children have undergone hearing screening in England. The high specificity and sensitivity rates of the objective measures employed for screening have resulted in children being identified much earlier with permanent childhood hearing impairment.
More recently, the Consortium for Research into Deaf Education (CRIDE) published a report detailing their findings from a UK wide survey on educational staffing and service provision for deaf children in the 2010/11 financial year (BATOD, 2011). The findings from this report highlighted around 19% of deaf children in the survey have some form of additional special educational need (SEN). There is a marked difference between the results from this report and the published results of Fortnum and Davis (1997). However there are two possible explanations for this difference. The first, being the research (Fortnum and Davis, 1997) used a wide definition of additional needs including, for example, eczema, whereas the CRIDE report (2011) focused on SEN, which refers to children with learning difficulty where special educational provision needs to be made for them. The second is the CRIDE report includes mild hearing loss in their definition of deafness, whereas the research (Fortnum and Davis, 1997) excluded mild hearing losses. Prevalence of additional disabilities maybe increased in children with moderate to profound hearing losses and may have been another factor in the lower prevalence rates described in the CRIDE report.
As a result the National Deaf Children’s Society (NDCS) as part of their remit to serve all deaf children requested a thorough search of the literature for any studies that may have explored the prevalence of additional disabilities with childhood deafness. The purpose of the current report was to identify literature published after 2002, to take into consideration newborn hearing screening, which has identified the prevalence of additional disabilities in children with hearing loss. Secondly, the report was to focus on identifying any published literature on the prevalence of deafness in children with other disabilities.
AimThe aim of this report is to review the published literature relating to the prevalence of additional disabilities with deafness.
The review will consider the prevalence of additional disabilities in the deaf paediatric population as well as the prevalence of deafness in the paediatric population with other disabilities.
Methods
Search Strategy
To identify relevant literature pertaining to the prevalence of deafness with additional disabilities in children, the following electronic databases were searched:
• Medline
• Embase
• PsycINFO
• Pubmed
• Science Direct
• Scopus
• Cochrane Database of Systematic Reviews.
The search terms used for deafness were deaf, deafness, hearing, hearing impairment, hearing loss and hard of hearing. A joint meeting and further correspondence with NDCS and specialist professionals working with deaf children helped finalise the search terms. The search terms of additional disabilities included were:
• Autistic spectrum disorder, autism
• Blind, visual impairment
• Cerebral Palsy
• Cytomegalovirus, CMV
• Complex needs
• Cystic Fibrosis
• Intellectual Disability
• Mental Retardation, mental
• Neurodevelopmental Disorder
• Pervasive Developmental Disorder
• Physical Disabilities
• Profound and multiple learning disabilities, PMLD
• Severe learning disabilities, severe learning difficulties, SLD
• Speech Language Disorder
• Special Educational Needs, SEN
The reference lists of included studies e.g. review papers, were used to identify other appropriate published papers.
Selection Criteria
Papers were included if they met the following criteria:
• Published after 2002: papers published prior to 2002 were excluded.
• Reported in the English language: translation facilities were not available.
• Data related to countries in North America, Western Europe, Australia and New Zealand as the prevalence data in these countries would be relevant to the UK.
• Data was related to the paediatric population: papers reporting prevalence of deafness with additional disabilities in adult populations were excluded.
• Data was reported with sufficient definition and precision to allow extraction and contribution to this review: papers not including data specific to the prevalence of deafness with additional disabilities, or where deafness data was merged with another disability when reporting prevalence, were excluded.
The search yielded 4,639 papers. All titles were reviewed and 3,709 references were excluded as not relevant to the research. The abstracts of the remaining 930 references were reviewed and a further 878 were excluded as the abstracts were not relevant. Of the remaining 52 references, full papers were sought but one could not be retrieved. This abstract was excluded as at the time of the review the full paper had yet not been published. After assessment of the 51 full papers, 39 full papers were excluded as they did not meet the inclusion criteria (Figure 1).
Figure 1: Literature review* 1 study included data for more than one disability.
4,639 papers identified by literature search
3,709 excluded as titles not relevant
930 selected for review of abstracts
878 excluded as abstracts not relevant
51 papers + 1 abstract analysed
Additional disabilities in deafness4 Blind + VI*
1 Neurodevelopmental Disorder1 Speech Language Disorder*
Deafness in additional disabilities2 Autistic spectrum disorder
4 Cerebral palsy1 Pervasive Developmental Disorder
39 papers excluded based on inclusion criteria. 1 abstract excluded as full paper
not available
12 papers reviewed
Res
ults
Dat
a on
the
prev
alen
ce o
f add
itio
nal d
isab
iliti
es in
the
paed
iatr
ic d
eaf p
opul
atio
n ar
e pr
esen
ted
in T
able
1. D
ata
on th
e pr
eval
ence
of d
eafn
ess
in
paed
iatr
ic p
opul
atio
ns o
f oth
er d
isab
iliti
es a
re p
rese
nted
in T
able
2.
Tabl
e 1:
Pre
vale
nce
of a
ddit
iona
l dis
abil
itie
s in
pae
diat
ric
deaf
pop
ulat
ion
Refe
renc
eTy
pe o
f pap
er
(Rev
iew
/St
udy)
Loca
tion
Hea
ring
loss
Dis
abili
ty d
escr
ipti
onA
ge ra
nge
in y
ears
(mea
n; s
tand
ard
devi
atio
n)
Num
ber
Prev
alen
ce (%
)
Blin
d an
d V
IFa
lzon
et a
l., 2
009
Stud
yD
ublin
, Ire
land
Seve
re-
Prof
ound
Ocu
lar a
bnor
mal
itie
s1.
4-16
(m:2
.4)
141
59 (4
1.8)
Guy
et a
l., 2
003
Stud
yD
erby
shir
e, U
KM
oder
ate-
Prof
ound
Oph
thal
mic
ab
norm
alit
ies
0.8-
16.8
110
48 (4
3.6)
Nik
olop
oulo
s et
al.,
200
6Re
view
Inte
rnat
iona
l st
udie
s O
phth
alm
ic d
isor
ders
Refr
acti
ve e
rror
s
Mus
cle
coor
dina
tion
Reti
nal a
bnor
mal
ity
54-9
6012
%-5
7%
27-5
7%
3-20
%
4-26
%W
iley
et a
l., 2
011
Stud
yCa
nada
& U
SA
Bila
tera
l M
od-
Prof
and
un
ilate
ral o
r m
ild
Eye
exam
Nee
d fo
r cor
rect
ive
lens
es
Sign
ifica
nt e
ye
prob
lem
s
0.1-
19.7
(5.9
)19
8
105
60 (5
7)
13(1
2)
Neu
rode
velo
pmen
tal D
isor
der
Chilo
si e
t al.,
201
0St
udy
Ital
ySe
v-Pr
of
Cogn
itiv
e
Mot
or
Beh
avio
ur-e
mot
iona
l
Perv
asiv
e D
D
Epile
psy
0.8-
16 (5
.7)
100
14 (1
4)
14 (1
4)
13 (1
3)
5 (5
)
2 (2
)
Spee
ch L
angu
age
Dis
orde
rW
iley
et a
l., 2
011
Stud
yCa
nada
& U
SA
Bi M
od-P
rof
Uni
or M
ild
Bi M
od-P
rof
Uni
or M
ild
Spee
ch e
valu
atio
n
Spee
ch d
elay
Aur
al re
habi
litat
ion
asse
ssm
ent
Ther
apy
requ
ired
0.1-
19.7
(5.9
)19
8
118
69 49 80 24
91 (7
7)
61 (8
8)
30 (6
1)
48 (6
0)
4 (1
7)
Tabl
e 2:
Pre
vale
nce
of d
eafn
ess
in p
aedi
atri
c po
pula
tion
wit
h ad
diti
onal
dis
abil
itie
sRe
fere
nce
Type
of p
aper
(R
evie
w/
Stud
y)
Loca
tion
Hea
ring
loss
D
isab
ility
des
crip
tion
Age
rang
e in
ye
ars
(mea
n)
Num
ber
Prev
alen
ce
(%)
Aut
isti
c sp
ectr
um d
isor
der
Clos
e et
al.,
201
2St
udy
Nat
iona
l Su
rvey
of
Child
ren’
s H
ealt
h, U
SA
Mod
erat
e/Se
vere
Curr
ent A
SD:
Past
but
not
cur
rent
(P
BN
C) A
SD:
3-5
( 4.1
4)
6-11
(8.3
8)
12-1
7 (1
4.41
)
3-5
(4.1
3)
6-11
(8.6
3)
12-1
7 (1
4.75
)
154
373
386
53 189
211
3 (2
.0)
10 (2
.7)
16 (4
.2)
1 (2
.0)
4 (2
.1)
12 (5
.7)
Sche
ndel
et a
l., 2
009
Stud
yA
tlan
ta, G
A,
USA
NR
Curr
ent A
SD3-
1061
79
(1.5
)
Cere
bral
Pal
syA
nder
sen
et a
l, 20
08St
udy
Nor
way
Seve
reCe
rebr
al P
alsy
Uni
late
ral
Bila
tera
l
Dys
kine
tic
Ata
xi
Not
cla
ssifi
ed
1.9-
10.2
(6.9
)26
8
90 128
17 14 19
12(4
)
2 (2
)
7 (5
)
1 (6
)
1 (7
)
1 (5
)H
imm
elm
an e
t al.,
201
2St
udy
Euro
peSe
vere
Dys
kine
tic
CPN
R. C
P co
nfirm
ed b
y ag
e 5
for a
ll ch
ildre
n
578
28 (6
)
Reid
et a
l., 2
011
Stud
y an
d Re
view
Stud
y:
Vict
oria
, A
ustr
alia
Revi
ew:
Dat
a fr
om
coun
trie
s in
sea
rch
stra
tegy
Mod
-Pro
f
Sev-
Prof
Any
hea
ring
lo
ss
Seve
re
Cere
bral
Pal
sy5.
1-10
.11
(8.1
)68
5
14 d
ata
sets
: 75
-621
6
88 (1
3)
48 (7
)
4-13
%
2-12
%
Surm
an e
t al.,
200
9St
udy
5 CP
re
gist
ers
in
the
UK
Sev-
Prof
All
MIG
1
MIG
2
MIG
3
NR
4566
3176
473
917
356
(8)
205
(7)
39 (8
)
112
(12)
Perv
asiv
e D
evel
opm
enta
l Dis
orde
rSt
urm
et a
l., 2
004
Stud
ySw
eden
Seve
rePe
rvas
ive
DD
5-12
(9.8
)10
12
(2)
Discussion
The prevalence of additional disabilities in children with deafness and the prevalence of deafness in children with additional disabilities, in the published studies reviewed, vary considerably depending on the disability and the specific definitions used by the researchers. The findings for additional disabilities in children with deafness highlighted three areas where published papers were present: visual impairment, neurodevelopmental disorders and speech and language disorders. The prevalence of visual impairment with deafness in children varied from 4-59%. This marked variance was highly dependent on the visual difficulties being reported. Previously, the Fortnum and Davis (1997) study reported 9.5% of deaf children were also reported to have visual problems. The findings from Wiley et al. (2011) were much closer to this reported figure at 12%. However this was specific to “significant eye problems”. Once the need for corrective lenses was taken into consideration the figure rose to 57%. The other reported studies also identified quite high prevalence of visual deficits in children with deafness. Future research would benefit from establishing if this high prevalence is disproportionately higher in deaf children compared to normal hearing children.
The prevalence of neurodevelopmental disorders ranged between 2-14% depending on the type of neurodevelopmental disorder. Fortnum and Davis (1997) found 7.7% of deaf children were reported to have neuro-motor problems. Chilosi et al. (2010) found approximately double the figures, with 14% of children reported to have neurodevelopmental motor disorders. The findings from Chilsoi et al. (2011) also identified 14% of children had cognitive neuro developmental problems and this finding was similar to the 13.9% reported by Fortnum and Davis (1997). The findings from Wiley et al. (2011) reported a very high prevalence of speech delays in children with bilateral moderate to profound hearing losses at 88%. A marked prevalence for speech delays in children with unilateral and mild hearing loss was also identified at 61%. These results highlight two important factors, the first being despite the advances in newborn hearing screening and early intervention a large group of children were still being identified with speech delays. Secondly, more attention needs to be given to the population of children with mild and unilateral hearing losses, as they are generally overlooked when it comes to intervention, yet a large percentage are still affected by speech delays.
The findings for the prevalence of deafness in children with additional disabilities identified three areas of research: ASD, cerebral palsy and PDD. The prevalence of deafness in children with ASD increased with age as identified by Close et al. (2012). The older age group (12-17 years) were found to have close to twice the prevalence of deafness (4.2%) compared to the younger groups of 3-5 years and 6-11 years who both had a 2% and 2.7% prevalence of deafness respectively. Interestingly, higher levels of prevalence were reported for the older group of children (12-17 years) identified as having past but not current ASD at 5.7%. Schendel et al. (2009) grouped all 3-10 year olds together and reported a similarly low prevalence of deafness in 1.5% of children with current ASD. The findings relating to the older children are interesting and should be explored further in future research. The studies exploring the prevalence of deafness in children with cerebral palsy consistently identified a prevalence rate of 2-13%. These findings are much higher than those reported by Fortnum and Davis (1997) when identifying aetiology of hearing loss, where the aetiology of hearing loss in 2 out of 653 children was attributed to cerebral palsy. Sturm et al. (2004) reported quite low prevalence of hearing loss in children with PDD at 2%. In comparison, Chilosi et al. (2010) reported slightly higher prevalence rates of PDD in children with deafness at 5%.
The current review has highlighted an important gap in the current research evidence base. Another study similar to that carried out by Fortnum and Davis (1997) would benefit by identifying the prevalence of additional disabilities in children with deafness and highlight any differences since the introduction of newborn hearing screening. The newborn hearing screening program in England is one of the most comprehensive databases of its kind in the world and may provide the initial foundations for carrying out such research.
The main conclusions for this report are:
Research focussing on prevalence of additional needs in deaf children has highlighted three main areas where published research currently exists: visual impairment, neurodevelopmental disorder and speech language disorder. It is important to note the prevalence of VI with deafness was highly varied at a prevalence rate of 3-57%. If the strictest interpretation was taken then recent research suggests 12% of children have “significant eye problems”. The prevalence of neurodevelopmental disorders ranged between 2-14% depending on the type of disorder. A high prevalence (88%) of speech disorders was identified in children with bilateral moderate to profound deafness. Interestingly, a high prevalence (61%) of speech delay was also identified in children with mild and unilateral hearing losses.
The research focussing on prevalence of deafness in children with additional needs has also highlighted three main areas where published studies were present: ASD, cerebral palsy and PDD. The prevalence of deafness with ASD ranged from 2-4.2%. It was interesting to note, the older children in the research were reported to have had a higher prevalence of deafness. The prevalence of deafness with cerebral palsy ranged between 2-13%. Finally, a low prevalence of deafness was identified for children with PDD (2%).
The findings of this review highlight the paucity of published research in this area. The overall evidence of research on the prevalence of additional disabilities with deafness is very low. With the developments in newborn hearing screening it would be expected that more research on this important area would have emerged. There is a growing need for robust published studies assessing the prevalence of additional needs in children with deafness.
References
Andersen G, Irgens L, Haagaas I, Skranes J, Meberg A and Vik T. (2008) Cerbral Palsy in Norway: Prevalence, subtypes and severity, European Journal of Paediatric Neurology, 12: 4-13
BATOD (2011) CRIDE report on 2011 survey on educational provision for deaf children in England. Available from: http://www.batod.org.uk/content/publications/survey/CRIDENI2011.pdf last accessed: 25/05/2012
Chilosi A, Comparini A, Scusa M, Berrettini S, Forli F, Battini R, Cipriani P and Cioni G (2010) Neurodevelopmental disorders in children with severe to profound hearing loss: a clinical study, Developmental Medicine and Child Neurology, 52: 852-862
Close H, Lee L, Kaufmann C, and Andrew W. (2012) Co-occurring Conditions and Change in Diagnosis in Autism Spectrum Disorders, Pediatrics, 129: e305-e316
Falzon K, Guerin M, Fulcher T and Viani L. (2009) Ophthalmological screening of a paediatric cochlear implant population: a retrospective analysis and 12-year follow-up, Eye, 24: 1031-1046
Fortnum and Davis (1997) Epidemiology of permanent childhood hearing impairment in Trent Region, 1985-1993, British Journal of Audiology, 1997,31,409-446
Guy R, Nicholson J, Pannu S and Holden R (2003) A clinical evaluation of ophthalmic assessment in children with sensori-neural deafness, Child: Care, Health & Development, 29: 377–384
Himmelman K, McManus V, Hagbeng G, Uvebrant P, Krageloh-Mann I and Cans C. (2012) Dyskentic cerebral palsy in Europe: trends in prevalence and severity, Arch Dis Child, 94: 921-926
NHSP (2012), Newborn hearing screening program. Available from: http://hearing.screening.nhs.uk/ last accessed 25/05/2012.
Nikolopoulos T, Lioumi D, Stamataki S and O’Donoghue G. (2006) Evidence-Based Overview of Ophthalmic Disorders in Deaf Children: A Literature Update, Otology & Neurotology, 27:S1–S24
Reid S, Modak M, Berkowitz R and Reddihough D. (2011) A population based study and systematic review of hearing loss in children with cerebral palsy, Developmental Medicine and Child Neurology, 1038-1045
Schendel D, Autry A, Wines R and Moore C. (2009) The co-occurrence of autism and birth defects: prevalence and risk in a population-based cohort, Developmental Medicine & Child Neurology, 51: 779–786
Sturm H, Fernell E and Gillberg, C (2004) Autism Spectrum disorders in children with normal intellectual levels: associated impairments and subgroups, Developmental Medicine and Child Neurology, 46: 444-447
Surman G, Hemming K, Platt M, Parkes J, Green A, Hutton J and Kurinczuk J (2009) Children with cerebral palsy: severity and trends over time, Paediatric and Perinatal Epidemiology, 23: 513-521.
Wiley S, Arjmand E, Meinzen-Derr J and Dixon M. (2011) Findings from multidisciplinary evaluation of children with permanent hearing loss, International Journal of Pediatric Otorhinolaryngology, 75:1040-1044
App
endi
x A
: Exc
lude
d Pa
pers
Tabl
e: re
sear
ch p
aper
s ex
clud
ed fr
om li
tera
ture
revi
ew
No.
Refe
renc
eLo
cati
onD
isab
ility
des
crip
tion
Reas
on fo
r exc
lusi
on
1Sc
hend
el, D
and
Kar
apur
kar B
hasi
n, T
. (20
08) B
irth
Wei
ght
and
Ges
tati
onal
Age
Cha
ract
eris
tics
of C
hild
ren
Wit
h A
utis
m,
Incl
udin
g a
Com
pari
son
Wit
h O
ther
Dev
elop
men
tal D
isab
iliti
es,
Pedi
atri
cs, 1
21: 1
155-
1164
Atl
anta
, G
eorg
ia, U
SALo
w b
irth
wei
ght +
ad
diti
onal
dis
abili
ties
Dat
a on
pre
vale
nce
of h
eari
ng lo
ss
wit
h lo
w b
irth
wei
ght p
rese
nted
. D
id c
ompa
re w
ith
auti
sm a
nd o
ther
di
sabi
litie
s bu
t did
not
pro
vide
sp
ecifi
c pr
eval
ence
of h
eari
ng lo
ss
wit
h ot
her d
isab
iliti
es.
2B
oyle
C, B
oule
t S, S
chie
ve L
, Coh
en R
, Blu
mbe
rg S
, Yea
rgin
-A
llsop
p M
, Vis
ser S
and
Kog
an M
. (20
11) T
rend
s in
the
Prev
alen
ce o
f Dev
elop
men
tal D
isab
ilit
ies
in U
S c
hild
ren,
Pe
diat
rics
, 127
: 103
4-10
42
Atl
anta
, G
eorg
ia, U
SAPr
eval
ence
of
Dev
elop
men
tal
Dis
abili
ties
Prev
alen
ce o
f hea
ring
loss
pre
sent
ed.
Dat
a on
pre
vale
nce
of h
eari
ng lo
ss
wit
h ot
her d
isab
iliti
es n
ot p
rese
nted
3Ce
ntre
for D
isea
se C
ontr
ols
and
Prev
enti
on (2
012)
Pre
vale
nce
of A
utis
m S
pect
rum
Dis
orde
rs —
Aut
ism
and
Dev
elop
men
tal
Dis
abil
itie
s M
onit
orin
g N
etw
ork,
14
Sit
es, U
nite
d S
tate
s, 2
008
, M
orbi
dity
and
Mor
talit
y W
eekl
y Re
port
, 61
(3):
1-1
9
Atl
anta
, G
eorg
ia, U
SAA
SDD
ata
on h
eari
ng a
nd v
isua
l im
pair
men
t wer
e pr
esen
ted
as a
jo
int d
isab
ility
. Pre
vale
nce
of h
eari
ng
loss
wit
h A
SD w
as n
ot p
rese
nted
se
para
tely
.
4Ko
gan
M, B
lum
berg
S, S
chie
ve L
, Boy
le C
, Per
rin
J, G
hand
our
R, S
ingh
G, S
tric
klan
d B
, Tre
vath
an E
and
van
Dyc
k P.
(200
9)
Prev
alen
ce o
f Par
ent-
Rep
orte
d D
iagn
osis
of A
utis
m S
pect
rum
D
isor
der
Am
ong
Chil
dren
in th
e U
S, 2
007,
Ped
iatr
ics,
124
: 139
5-14
03
Atl
anta
, G
eorg
ia, U
SA
ASD
This
pap
er w
as in
clud
ed a
s pr
evio
us
pape
rs fr
om th
ese
auth
ors
incl
uded
da
ta o
n he
arin
g lo
ss w
ith
ASD
as
wel
l. H
owev
er a
fter
read
ing
the
pape
r no
data
on
hear
ing
loss
was
pre
sent
ed.
5Sz
yman
ski C
, Bri
ce P
, Lam
K a
nd H
otto
S. (
2012
) Dea
f Chi
ldre
n w
ith
Aut
ism
Spe
ctru
m D
isor
ders
, Jou
rnal
of A
utis
m a
nd
Dev
elop
men
tal D
isor
ders
, pg
1-11
Was
hing
ton,
D
C, U
SACu
rren
t ASD
Full
pape
r not
yet
ava
ilabl
e. A
ccep
ted
abst
ract
pre
sent
ed in
onl
ine
jour
nal.
6M
sall
M, A
very
R, T
rem
ont M
, Lim
a J,
Roge
rs M
and
Hog
an D
(2
009)
Fun
ctio
nal D
isab
ilit
y an
d S
choo
l Act
ivit
y Li
mit
atio
ns
in 4
1 30
0 S
choo
l-A
ge C
hild
ren:
Rel
atio
nshi
p to
Med
ical
Im
pair
men
ts, P
edia
tric
s,11
1: 5
48-5
53
Prov
iden
ce,
Rho
de Is
land
, U
SA
Med
ical
Impa
irm
ents
Alt
houg
h he
arin
g im
pair
men
t was
in
clud
ed in
the
stud
y it
was
gro
uped
w
ith
a nu
mbe
r of o
ther
impa
irm
ents
an
d th
e da
ta w
as p
rese
nted
und
er
the
broa
d ca
tego
ry o
f neu
rose
nsor
y im
pair
men
ts. T
he d
ata
on h
eari
ng
loss
wit
h ot
her d
isab
iliti
es w
as n
ot
pres
ente
d se
para
tely
.
7R
ice
C, S
chen
del D
, Cun
iff C
and
Doe
rnbe
rg N
(200
4) P
ubli
c H
ealt
h M
onit
orin
g of
Dev
elop
men
tal D
isab
ilit
ies
wit
h a
Focu
s on
the
Aut
ism
Spe
ctru
m D
isor
ders
, A
mer
ican
Jour
nal o
f Med
ical
G
enet
ics,
125
C: 2
2-27
.
Atl
anta
, G
eorg
ia, U
SAD
evel
opm
enta
l di
sabi
litie
s an
d A
SDN
o da
ta s
peci
fic to
pre
vale
nce
of
hear
ing
loss
wit
h A
SD p
rese
nted
.
8Ve
rnon
M a
nd R
hode
s A
(200
9) D
eafn
ess
and
Aut
isti
c Sp
ectr
um
Dis
orde
rs, A
mer
ican
Ann
als
of th
e D
eaf,
154:
5-1
4 Ja
ckso
nvill
e,
Flor
ida,
USA
Dea
fnes
s an
d A
SDN
o da
ta s
peci
fic to
pre
vale
nce
of
hear
ing
loss
wit
h A
SD p
rese
nted
.
9H
itog
lou
M, V
erve
ri A
, Ant
onia
dis
A a
nd Z
afei
riou
D, (
2010
) Ch
ildh
ood
Aut
ism
and
Aud
itor
y Sy
stem
Abn
orm
alit
ies,
Pe
diat
ric
Neu
rolo
gy, 4
2: 3
09-3
14
Thes
salo
niki
, G
reec
eA
SD w
ith
hear
ing
loss
No
data
spe
cific
to p
reva
lenc
e of
he
arin
g lo
ss w
ith
ASD
pre
sent
ed.
10J.
Bis
t, P
. Adh
ikar
i and
A. K
. Sha
rma
(201
0) O
cula
r m
orbi
dity
in
hea
ring
impa
ired
sch
oolc
hild
ren,
Chi
ld: c
are,
hea
lth
and
deve
lopm
ent,
37:
394
-397
Kath
man
du,
Nep
alO
cula
r mor
bidi
ty w
ith
hear
ing
loss
Rese
arch
out
side
of c
ount
ries
sp
ecifi
ed in
incl
usio
n cr
iter
ia.
11Ce
ntre
for D
isea
se C
ontr
ols
and
Prev
enti
on (2
006)
Pre
vale
nce
of
Four
Dev
elop
men
tal D
isab
ilit
ies
Am
ong
Chil
dren
Age
d 8
Yea
rs-
Met
ropo
lita
n A
tlan
ta D
evel
opm
enta
l Dis
abil
itie
s S
urve
illa
nce
Prog
ram
, 199
6 an
d 20
00, M
orbi
dity
and
Mor
talit
y W
eekl
y Re
port
, 55
(1):
1-9
Atl
anta
, G
eorg
ia, U
SAM
enta
l ret
arda
tion
Cere
bral
Pal
sy
Visu
al im
pair
men
t
Hea
ring
loss
No
data
spe
cific
to p
reva
lenc
e of
hea
ring
loss
wit
h ad
diti
onal
di
sabi
litie
s pr
esen
ted.
12M
oral
es A
ngul
o C,
Azu
ara
Bla
nco
N, G
allo
Ter
an J,
Gon
zale
z A
ledo
A a
nd R
ama
Qui
ntel
a J (
2006
) Sen
sori
-Neu
ral H
eari
ng
Loss
in C
ereb
ral P
alsy
, Act
a O
torr
inol
arin
gol E
sp, 5
7: 3
00-3
02
Cant
abri
a,
Spai
nCe
rebr
al P
alsy
Resu
lts
pres
ente
d w
ere
spec
ific
to a
dult
s. N
o da
ta o
n ch
ildre
n pr
esen
ted.
13Jo
hnso
n S,
Faw
ke J,
Hen
nese
y E,
Row
ell V
, Tho
mas
S, W
olke
D
and
Mar
low
N (2
009)
Neu
rode
velo
pmen
tal D
isab
ilit
y Th
roug
h 11
Yea
rs o
f Age
in C
hild
ren
Bor
n B
efor
e 26
wee
ks o
f ges
tati
on,
Pedi
atri
cs, 1
24: e
249-
e257
UCL
, Lon
don,
U
K,N
euro
deve
lopm
enta
l D
isab
iliti
esN
o da
ta s
peci
fic to
pre
vale
nce
of h
eari
ng lo
ss w
ith
addi
tion
al
disa
bilit
ies
pres
ente
d.
14Pe
ters
en M
, Kub
e D
and
Pal
mer
F (2
006)
Hig
h Pr
eval
ence
of
Dev
elop
men
tal D
isab
ilit
ies
in C
hild
ren
Adm
itte
d to
a G
ener
al
Pedi
atri
c In
pati
ent U
nit,
Jour
nal o
f Dev
elop
men
tal a
nd P
hysi
cal
Dis
abili
ties
, 18:
307
-318
Mem
phis
, Te
nnes
see,
U
SA
Dev
elop
men
tal
Dis
abili
ties
No
data
spe
cific
to p
reva
lenc
e of
hea
ring
loss
wit
h ad
diti
onal
di
sabi
litie
s pr
esen
ted.
15W
illia
ms
E, T
hom
as K
, Sid
ebot
ham
H a
nd E
mon
d A
. (20
08)
Prev
alen
ce a
nd c
hara
cter
isti
cs o
f aut
isti
c sp
ectr
um d
isor
ders
in
the
ALS
PAC
coho
rt, D
evel
opm
enta
l Med
icin
e, 5
0: 6
72-6
77
Bri
stol
, UK
ASD
No
data
spe
cific
to p
reva
lenc
e of
hea
ring
loss
wit
h ad
diti
onal
di
sabi
litie
s pr
esen
ted.
16D
e Vr
ies
J, Ko
rver
A, V
erke
rk P
, Rus
man
L, C
laas
E, L
oebe
r J K
roes
A
and
Vos
sen
A (2
011)
Con
geni
tal c
ytom
egal
ovir
us in
fect
ion
in
the
Net
herl
ands
: bir
th p
reva
lenc
e an
d ri
sk fa
ctor
s, Jo
urna
l of
Med
ical
Viro
logy
, 83:
177
-178
2
Leid
en,
Net
herl
ands
CMV
No
data
spe
cific
to p
reva
lenc
e of
he
arin
g lo
ss w
ith
CMV
pre
sent
ed.
17G
ross
e S,
Ros
s D
and
Dol
lard
S (2
008)
Con
geni
tal
cyto
meg
alov
irus
infe
ctio
n as
a c
ause
of p
erm
anen
t bila
tera
l he
arin
g lo
ss: a
qua
ntit
ativ
e as
sess
men
t, Jo
urna
l of C
linic
al
Viro
logy
, 41:
57-
62
Atl
anta
, G
eorg
ia, U
SACM
VD
ata
was
cal
cula
ted
thro
ugh
a pr
edic
tion
ass
essm
ent w
here
two
sets
of r
evie
ws
wer
e pr
oces
sed.
Doe
s no
t pro
vide
act
ual d
ata.
18N
ance
W, L
im B
and
Dod
son
M. (
2006
) Im
port
ance
of c
onge
nita
l cy
tom
egal
ovir
us in
fect
ions
as
a ca
use
for
pre-
ling
ual h
eari
ng
loss
, Jou
rnal
of C
linic
al V
irolo
gy, 3
5: 2
21-2
25
Engl
and,
UK
USA
dat
a us
ed fo
r ca
lcul
atio
ns.
CMV
Dat
a on
stu
dy d
esig
n an
d m
etho
ds
for r
etro
spec
tive
cal
cula
tion
s no
t cl
ear.
19M
ison
o S,
Sie
K, W
eiss
N, H
uang
M, B
oeck
h M
, Nor
ton
S an
d Yu
eh B
(201
1) C
onge
nita
l cyt
omeg
alov
irus
infe
ctio
n in
ped
iatr
ic
hear
ing
loss
, Arc
hive
s of
Oto
lary
ngol
ogy-
Hea
d an
d N
eck
Surg
ery,
137
: 47-
53
Was
hing
ton,
U
SACo
ngen
ital
Cy
tom
egal
ovir
usD
ata
high
light
ed 8
.9%
of h
eari
ng
loss
in c
hild
ren
in W
ashi
ngto
n ca
n be
att
ribu
ted
to C
MV
infe
ctio
n.
How
ever
, met
hods
for r
etro
spec
tive
ca
lcul
atio
ns n
ot c
lear
.
20M
arti
ns L
, Cam
argo
s P,
Bec
ker H
, Bec
ker C
and
Gui
mar
aes
R
(201
0) H
eari
ng L
oss
in C
ysti
c Fi
bros
is, I
nter
nati
onal
Jour
nal o
f Pe
diat
ric
Oto
rhin
olar
yngo
logy
, 74:
469
-473
Bra
zil
Cyst
ic F
ibro
sis
Rese
arch
out
side
of c
ount
ries
sp
ecifi
ed in
incl
usio
n cr
iter
ia.
21Pi
ltch
er O
, Tei
xeir
a V,
Oliv
eira
M, S
catt
olin
I an
d Pi
ltch
er S
(200
3)
The
prev
alen
ce o
f neu
rose
nsor
ial h
eari
ng lo
ss a
mon
g sy
stic
fi
bros
is p
atie
nts
from
Hos
pita
l de
Clin
icas
de
Port
o Al
egre
, In
tern
atio
nal J
ourn
al o
f Ped
iatr
ic O
torh
inol
aryn
golo
gy, 6
7: 9
39-
941
Spai
nCy
stic
Fib
rosi
sD
ata
rela
ted
to th
e ef
fect
s of
oto
toxi
c dr
ugs
(am
inog
lyco
side
s) ra
ther
than
pr
eval
ence
of h
eari
ng lo
ss in
cys
tic
fibro
sis
popu
lati
on in
gen
eral
.
22Ch
eng
A, J
ohns
ton
P, L
uz J,
Ulu
er A
, Flig
or B
Lic
amel
i G, K
enna
M
and
Jone
s D
(200
9) S
enso
rine
ural
hea
ring
loss
in p
atie
nts
wit
h cy
stic
fibr
osis
, Oto
lary
ngol
ogy
– H
ead
and
Nec
k Su
rger
y
Bos
ton,
MA
, U
SACy
stic
Fib
rosi
sD
ata
rela
ted
to th
e ef
fect
s of
oto
toxi
c dr
ugs
(am
inog
lyco
side
s) ra
ther
than
pr
eval
ence
of h
eari
ng lo
ss in
cys
tic
fibro
sis
popu
lati
on in
gen
eral
.
23Ch
arlo
t L, A
bend
S, R
avin
P, M
asti
s K,
Hun
t A a
nd D
euts
ch C
(2
011)
Non
-psy
chia
tric
hea
lth
prob
lem
s am
ong
psyc
hiat
ric
in-
pati
ents
wit
h in
tell
ectu
al d
isab
ilit
ies,
Jour
nal o
f Int
elle
ctua
l D
isab
ility
Res
earc
h, 5
5: 1
99-2
09
MA
, USA
Inte
llect
ual
disa
bilit
ies
Dat
a w
as re
late
d to
adu
lts
and
not c
hild
ren.
Dat
a re
late
d to
the
age
grou
p cl
uste
r 16-
25 w
as n
ot
pres
ente
d se
para
tely
.
24Pi
nbor
ough
-Zim
mer
man
J, S
atte
rfiel
d R
, Mill
er J,
Hos
sain
S a
nd
McM
ahon
W (2
007)
Com
mun
icat
ion
diso
rder
s: p
reva
lenc
e an
d co
mor
bid
inte
llec
tual
dis
abil
ity,
aut
ism
and
em
otio
nal/
beha
viou
ral d
isor
ders
, Am
eric
an Jo
urna
l of S
peec
h-La
ngua
ge
Path
olog
y, 1
6: 3
59-3
67
Uta
h, U
SACo
mm
unic
atio
n di
sabi
lity
Dat
a on
pre
vale
nce
of h
eari
ng lo
ss
wit
h co
mm
unic
atio
n di
sabi
lity
not
pres
ente
d.
25Ili
adou
V, B
amio
u D
, Kap
rini
s S,
Kan
dylis
D a
nd K
apri
nis
G
(200
9) A
udit
ory
Proc
essi
ng D
isor
ders
in c
hild
ren
susp
ecte
d of
Lea
rnin
g D
isab
ilit
ies-
A n
eed
for
scre
enin
g? In
tern
atio
nal
Jour
nal o
f Ped
iatr
ic O
torh
inol
aryn
golo
gy, 7
3: 1
029-
1034
Thes
salo
niki
, U
SAA
PD
Lear
ning
Dis
abili
ty
Dat
a on
pre
vale
nce
of h
eari
ng lo
ss
wit
h ad
diti
onal
dis
abili
ties
not
pr
esen
ted.
26B
oule
t S, S
chie
ve L
and
Boy
le C
(201
1) B
irth
wei
ght a
nd h
ealt
h an
d de
velo
pmen
tal o
utco
mes
in U
S c
hild
ren,
199
7-20
05,
Mat
ern
Child
Hea
lth
J, 15
: 836
-844
Atl
anta
, G
eorg
ia, U
SAD
evel
opm
enta
l ou
tcom
esD
ata
on p
reva
lenc
e of
hea
ring
loss
w
ith
addi
tion
al d
isab
iliti
es n
ot
pres
ente
d.
27M
cLeo
d S
and
McK
inno
n D
(200
7) P
reva
lenc
e of
com
mun
icat
ion
diso
rder
s co
mpa
red
wit
h ot
her
lear
ning
nee
ds in
14
500
prim
ary
and
seco
ndar
y sc
hool
stu
dent
s, In
tern
atio
nal J
ourn
al o
f La
ngua
ge a
nd C
omm
unic
atio
n D
isor
ders
, 42:
37-
59
Sydn
ey,
Aus
tral
iaCo
mm
unic
atio
n D
isor
ders
Dat
a on
pre
vale
nce
of h
eari
ng lo
ss
wit
h ad
diti
onal
dis
abili
ties
not
cle
ar
as a
ddit
iona
l dis
abili
ties
all
mer
ged
into
ove
rarc
hing
lear
ning
nee
d.
28U
love
c Z,
Sos
ic Z
, Skr
inja
ric
I, Ca
tovi
c A
, Civ
ljak
M a
nd S
ziro
vicz
a L
(200
4) P
reva
lenc
e an
d si
gnifi
canc
e of
min
or a
nom
alie
s in
ch
ildr
en w
ith
impa
ired
dev
elop
men
t, A
cta
Paed
iatr
, 93:
836
-84
0
Zagr
eb,
Croa
tia
Impa
ired
D
evel
opm
ent
Dat
a on
pre
vale
nce
of h
eari
ng lo
ss
wit
h ad
diti
onal
dis
abili
ties
not
pr
esen
ted.
29M
arch
isio
P, S
elic
orni
A, P
igna
taro
L, M
ilani
D, B
aggi
E,
Lam
bert
ini L
, Dus
i E, V
illa
L, C
apac
cio
P, C
erut
ti M
, Esp
osit
o S
and
Prin
cipi
N (2
008)
Oti
tis
med
ia w
ith
effu
sion
and
hea
ring
lo
ss in
chi
ldre
n w
ith
Corn
elia
de
Lang
e sy
ndro
me,
Am
eric
an
Jour
nal o
f Med
ical
Gen
etic
s, 1
46A
: 426
-432
Mila
n, It
aly
OM
ED
ata
on p
reva
lenc
e of
hea
ring
loss
w
ith
addi
tion
al d
isab
iliti
es n
ot c
lear
.
30M
orto
n R
, Sha
rma
V, N
icho
loso
n J,
Bro
deri
ck M
and
Poy
ser J
(2
002)
Dis
abil
ity
in c
hild
ren
from
dif
fere
nt e
thni
c po
pula
tion
s,
Child
: Car
e, H
ealt
h an
d D
evel
opm
ent,
28:
87-
93
Der
bysh
ire,
U
KSe
vere
ne
urod
isab
ility
Dat
a on
pre
vale
nce
of h
eari
ng lo
ss
wit
h ot
her a
ddit
iona
l dis
abili
ties
not
pr
esen
ted.
31H
utch
inso
n T
and
Gor
don
D (2
004)
Asc
erta
inin
g th
e pr
eval
ence
of
chi
ldho
od d
isab
ilit
y, C
hild
: Car
e, H
ealt
h an
d D
evel
opm
ent,
31
: 99-
107
Bat
h, U
KCh
ildho
od d
isab
ility
Des
crip
tion
of h
eari
ng lo
ss
subj
ecti
ve, a
udio
met
ric
mea
sure
s to
as
sess
hea
ring
not
use
d.
32D
amm
eyer
J (2
010)
Psy
chos
ocia
l Dev
elop
men
t in
a D
anis
h Po
pula
tion
of C
hild
ren
Wit
h Co
chle
ar Im
plan
ts a
nd D
eaf a
nd
Har
d of
Hea
ring
Chi
ldre
n, Jo
urna
l of D
eaf S
tudi
es a
nd D
eaf
Educ
atio
n, 1
5: 5
0-58
Cope
nhag
en,
Den
mar
kPs
ycho
soci
al
Dev
elop
men
tSt
udy
iden
tifie
d un
der s
earc
h te
rm
“men
tal”
. Res
ults
hig
hlig
hted
the
findi
ngs
wer
e re
late
d to
soc
io-
emot
iona
l diffi
cult
ies
and
not w
ithi
n th
e se
arch
term
par
amet
ers.
33Fe
lling
er J,
Hol
zing
er D
, Sat
tel H
, Man
fred
L a
nd G
oldb
erg
D
(200
9) C
orre
late
s of
men
tal h
ealt
h di
sord
ers
amon
g ch
ildr
en
wit
h he
arin
g im
pair
men
ts, D
evel
opm
enta
l Med
icin
e an
d Ch
ild
Neu
rolo
gy, 5
1; 6
35–6
41
Linz
, Aus
tria
Men
tal h
ealt
h di
sord
erSt
udy
iden
tifie
d un
der s
earc
h te
rm
“men
tal”
. Res
ults
hig
hlig
hted
the
findi
ngs
wer
e re
late
d to
soc
io-
emot
iona
l diffi
cult
ies
and
not w
ithi
n th
e se
arch
term
par
amet
ers.
34Fe
lling
er J,
Hal
zing
er D
and
Pol
lard
R (2
012)
Men
tal h
ealt
h of
de
af p
eopl
e, T
he L
ance
t, 3
79: 1
037-
1044
Vien
na,
Aus
tria
Men
tal h
ealt
hSt
udy
iden
tifie
d un
der s
earc
h te
rm
“men
tal”
. Res
ults
hig
hlig
hted
the
findi
ngs
wer
e re
late
d to
soc
io-
emot
iona
l diffi
cult
ies
and
not w
ithi
n th
e se
arch
term
par
amet
ers.
35H
inte
rmai
r M. (
2009
) Pre
vale
nce
of S
ocio
emot
iona
l Pro
blem
s in
Dea
f and
Har
d of
Hea
ring
Chi
ldre
n in
Ger
man
y, A
mer
ican
A
nnal
s of
the
Dea
f, 15
2: 3
20-3
30
Hie
delb
erg,
G
erm
any
Soci
oem
otio
nal
Prob
lem
sSt
udy
iden
tifie
d un
der s
earc
h te
rm
“men
tal”
. Res
ults
hig
hlig
hted
the
findi
ngs
wer
e re
late
d to
soc
io-
emot
iona
l diffi
cult
ies
and
not w
ithi
n th
e se
arch
term
par
amet
ers.
36St
efan
is N
, The
wis
sen
V, B
akou
la C
, Van
Os
J and
Myi
n-G
erm
eys
(200
6) H
eari
ng im
pair
men
t and
psy
chos
is: A
repl
icat
ion
in a
co
hort
of y
oung
adu
lts,
Sch
izop
hren
ia R
esea
rch,
85:
266
-272
Ath
ens,
G
reec
eSe
lf re
port
ed
psyc
hoti
c lik
e ex
peri
ence
s
Stud
y id
enti
fied
unde
r sea
rch
term
“m
enta
l”. R
esul
ts h
ighl
ight
ed th
e fin
ding
s w
ere
rela
ted
to p
sych
otic
like
ex
peri
ence
s an
d no
t wit
hin
the
sear
ch
term
par
amet
ers.
37Va
n El
dik
T, T
reff
ers
A, V
eerm
an J
and
Verh
ulst
F (2
004)
Men
tal
Hea
lth
Prob
lem
s of
Dea
f Dut
ch C
hild
ren
As
Indi
cate
d by
Pa
rent
s’ R
espo
nses
to th
e Ch
ild
Beh
avio
ur C
heck
list
, Am
eric
an
Ann
als
of th
e D
eaf,
148:
390
-395
Net
herl
ands
Emot
iona
l B
ehav
iour
al P
robl
ems
Stud
y id
enti
fied
unde
r sea
rch
term
“m
enta
l”. R
esul
ts h
ighl
ight
ed th
e fin
ding
s w
ere
rela
ted
to s
ocio
-em
otio
nal d
ifficu
ltie
s an
d no
t wit
hin
the
sear
ch te
rm p
aram
eter
s.
38Va
n G
ent T
, Goe
dhar
t A, H
indl
ey P
and
Tre
ffer
s P
(200
7)
Prev
alen
ce a
nd c
orre
late
s of
psy
chop
atho
logy
in a
sam
ple
of
deaf
ado
lesc
ents
, Jou
rnal
of C
hild
Psy
chol
ogy
and
Psy
chia
try,
48
: 950
-958
Net
herl
ands
Emot
iona
l B
ehav
iour
al P
robl
ems
Stud
y id
enti
fied
unde
r sea
rch
term
“m
enta
l”. R
esul
ts h
ighl
ight
ed th
e fin
ding
s w
ere
rela
ted
to s
ocio
-em
otio
nal d
ifficu
ltie
s an
d no
t wit
hin
the
sear
ch te
rm p
aram
eter
s.
39Va
n N
aard
en B
raun
K, A
utry
A a
nd B
oyle
C (2
005)
A p
opul
atio
n ba
sed
stud
y of
the
recu
rren
ce o
f dev
elop
men
tal d
isab
ilit
ies,
Pa
edia
tric
and
Per
inat
al E
pide
mio
logy
, 19:
69-
79
Atl
anta
, G
eorg
ia, U
SASe
riou
s de
velo
pmen
tal
disa
bilit
ies
Dat
a on
pre
vale
nce
of h
eari
ng lo
ss
wit
h ot
her a
ddit
iona
l dis
abili
ties
not
pr
esen
ted.
40B
oule
t S, B
oyle
C a
nd S
chie
ve L
. (20
09) H
eath
car
e an
d he
alth
an
d fu
ncti
onal
impa
ct o
f dev
elop
men
tal d
isab
ilit
ies
amon
g U
S c
hild
ren,
199
7-20
05, A
rchi
ves
of P
edia
tric
s an
d A
dole
scen
t M
edic
ine,
163
: 19-
26
Atl
anta
, G
eorg
ia, U
SAD
evel
opm
enta
l D
isab
iliti
esD
ata
on p
reva
lenc
e of
hea
ring
loss
w
ith
othe
r add
itio
nal d
isab
iliti
es n
ot
pres
ente
d.
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Published by the National Deaf Children’s Society © NDCS November 201215 Dufferin Street, London EC1Y 8UR Tel: 020 7490 8656 (voice and text) Fax: 020 7251 5020NDCS is a registered charity in England and Wales no. 1016532 and in Scotland no. SC040779. This publication can be requested in large print, in Braille and on audio CD.
