Differential diagnosis as a process refers to the technique usually used in clinical distinguishing and differentiating disorders. The disorders are those that present with several similar or same symptoms and also, characteristics. Many studies have evaluated and analyzed similarities among symptoms related to autism spectrum disorder (ASD) in addition to sensory deficits ("Fundamentals of Audiology for the Speech-Language Pathologist", 2020). An excellent example from multiple studies is that of a child with severe to profound hearing loss is said not to respond when called. The same child will be exposed to difficulties in speech development plus language skills in the absence of intervention. It is the same case that happens to children who have autism spectrum since they also show delays in language acquisition. Based on the research done in 2010, the comorbidity of autism spectrum disorder (ASD) and hearing loss has increased from 1.7% to 3% of reported cases in the study conducted in the 2013 annual survey (Paul, 2020).
Furthermore, other researches have also discovered a rate that is as concerning as any other research has found. A few percentages, usually 6% to 7% of children with hearing loss are said to have co-occurring ASD and also, based on the health institute of the United States, average identification age in hearing loss was about three years ("Fundamentals of Audiology for the Speech-Language Pathologist", 2020). It was followed that; the degree of hearing loss goes undetected longer than it could be imagined. However, with the implementation of the UNHS (Universal Newborn Hearing Screening) in the US where almost all infants started being screened before being discharged from hospitals, the average age of diagnosis of hearing did go down considerably to even just a few months. For this reason, any child involved in delayed language development is said to be having hearing loss. Also, if the child's hearing screening is passed and completed, ruling out the risk of hearing impairment follows with it and that there might be other possibilities of etiologies.
Often, other possible etiologies might be due to genetic impairments that occur within the child and might be the cause of the late hearing loss onsets in the child's life. It, therefore, follows that pathologists concerned with speech-language should always refer children having developed any of the mentioned risk factors (regardless of the results of screening prior to discharge in hospitals) for complete audiological evaluations. Despite the reduction of the average age of ASD identification, the result of the screening and identification should not be entirely relied upon until the child is at least two years of age. It is because of the risk factors that do develop late on during the child's growth and development, for example, the risk factor due to genetic impairments. Unavailability of physical tests that conclusively would reveal and identify ASD absence or presence is another reason as to why a child should not be declared without ASD before the two years. Moreover, autism symptoms usually do not show up in the child's early development until he or she is about two years of age that autism symptoms can take place. Furthermore, a child with both hearing loss and ASD, it is the hearing loss that is identified first or earlier with vice versa not being true.
Speech-language pathologists play a vital role in the process of identifying, treating, coming up with plans and also, intervening of persons affected with communication disorders. It is based on the fact that a speech-language pathologist can spend more time with a child from the identification of a hearing loss, through intervention even more than an audiologist or social worker. For this reason, the pathologist can monitor closely the child's progress that follows with appropriate referrals. Therefore, collaborative efforts between audiologists and speech-language pathologists, plus even others like social workers are crucial at dealing with the disorders. The efforts involve differential diagnoses which are accurate enough, appropriate treatment plans, and also, comprehensive therapeutic interventions. These efforts altogether bring about success in dealing with communication-related disorders.
Hearing loss and Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD and hearing loss are often incorrectly identified due to similar symptoms. ADHD is often associated with educational disability in terms of sustaining attention, efforts, and motivation ("Fundamentals of Audiology for the Speech-Language Pathologist", 2020). Students who have ADHD have deficits in specific skill areas, such as in academics and social life. When a child is not able to hear their teacher, they will have difficulties to focus, pay attention, and complete assignments. These traits can incorrectly indicate that the child is experiencing ADHD, but in the real sense, they are suffering from hearing loss disorder. Symptoms of ADHD also include a lack of ability to listen and not following through with the directions. Unfortunately for the healthcare professionals trying to plan treatment interventions, educational, and communication challenges caused by hearing loss can make children behave in ways that look the same as a child with ADHD. These symptoms are the same in hearing loss and ADHD. Most of the problematic behaviors and performance difficulties in the children can be a result of ADHD, hearing loss, or a combination of the two. Other symptoms that are confused with ADHD encompasses strain in social interactions, low self-esteem, non-responsive when token to, and inattentiveness. Differential diagnosis is made to determine the possible disorder among the two conditions in the child. The realistic solution done through differential diagnosis is contacting and referring to a local audiologist to perform a comprehensive audiological intervention and assessment. This diagnosis involves remediating effectively and appropriately as possible through hearing aids. Through these steps, it is possible to know the behaviors are related to either ADHD or hearing loss. In some situations, students are affected by both disorders, and it is crucial to meticulously assess the reason behind the poor school performance of a child to avoid any unnecessary medication or misdiagnosis of ADHD. The most distinctive difference between ADHD and hearing loss is speech-language development. A child who has hearing loss usually have delays in speech-language development while those experiencing ADHD have healthy speech-language development.
Hearing Loss and Dementia
Both dementia and hearing loss is associated with ageing and mostly occur together when people are getting old. There is significant evidence that shows that hearing loss doubles the chances of developing dementia. Due to similar symptoms, physicians typically misdiagnosis hearing loss as dementia. Dementia has negative impacts on different functions such as language, problem-solving, attention, cognition, and memory ("Fundamentals of Audiology for the Speech-Language Pathologist", 2020). Various literature has shown that hearing loss and dementia occur simultaneously. For instance, found that approximately 83% of the standardized patients that were diagnosed with dementia also had symptoms of hearing loss. Dementia is mostly characterized by memory loss.
On the other hand, a patient with hearing loss experiences difficulty hearing other people clearly and hence misunderstanding what they are saying. As a result, the difficulty in hearing and asking people to repeat themselves in individuals who have hearing loss can be mistaken as memory loss, which is a significant symptom of dementia. Another similar symptom is the failure of opening the door. In dementia, people experience difficulty with decision making and thinking, such as should they open the door. In hearing loss disorder, an individual fails to hear the doorbell or phone. As a result of this hearing loss can be mistaken as dementia or vice versa. Differential diagnosis is essential since the patient avoids misdiagnosis and wrong medication in either disorder. Differential diagnosis assesses the medical history carefully and behavioral changes in day to day functions and thinking. In terms of hearing loss, diagnosis is made through aural rehabilitative counselling and the use of assistive listening devices and hearing aids. After the individual can communicate and hear efficiently as possible, the physician is in a good position of determining if the observed behaviors are signs of dementia.
Hearing loss and depression
The symptoms of depression include low self-esteem, isolation, and reduced conversation in vocational, social, or academic settings. Hearing loss and depression are closely linked since one can lead to the other. For instance, hearing loss causes difficulty in communication, and this can lead to isolation, fatigue and stress, which are the significant aspects of depression ("Fundamentals of Audiology for the Speech-Language Pathologist", 2020). Individuals with hearing loss and those suffering from depression all experience trouble in paying attention and concentration. As a result, these individuals experience nausea, dizziness, and headaches. The probable cause of these symptoms cannot be determined if its depression or hearing loss. The truth of the matter is that any diagnosis on the affected patients cannot determine if the complaints and behavior are caused by which specific disorder. In all age categories, research shows that both conditions can happen simultaneously. Due to the significant number of common symptoms that are indicators of both disorders such as isolation, it is crucial to conduct a differential diagnosis, which will help to ascertain which of the two genuinely exist and confirm the presence of comorbidity occurring conditions. In diagnosis, the astute clinician collaborates with and refers to other medical professionals to clearly define the characteristics, severity, and nature of each disorder. When hearing loss is identified, the antisocial behaviors such as isolation that are caused by hearing loss are remediated efficiently. If the hearing loss is not detected, the probable cause is depression, and hence effective measures are taken. Due to the differential diagnosis, the physician and the patient are now in a good position of identifying any other area of concern and have an accurate diagnosis.
Fundamentals of Audiology for the Speech-Language Pathologist. Google Books. (2020). Retrieved 13 March 2020, from https://books.google.co.ke/books?id=UKEuDwAAQBAJ&pg=PA43&lpg=PA43&dq=(Hoevenaars-van+den+Boom,+Antonissen,+Knoors,+%26+Vervloed,+2009;+Myck-Wayne,+Robinson,+%26+Henson,+2011)&source=bl&ots=aocWJywYHO&sig=ACfU3U3TM1tgLvOb39vOahGbDfnkKYjlWQ&hl=sw&sa=X&ved=2ahUKEwjW6M6g-JfoAhWjUhUIHVWdDeUQ6AEwAHoECAUQAQ#v=onepage&q=(Hoevenaars-van%20den%20Boom%2C%20Antonissen%2C%20Knoors%2C%20%26%20Vervloed%2C%202009%3B%20Myck-Wayne%2C%20Robinson%2C%20%26%20Henson%2C%202011)&f=false.
Paul, P. (2020). The Education of d/Deaf and Hard of Hearing Children. Google Books. Retrieved 13 March 2020, from https://books.google.co.ke/books?id=l7jPDwAAQBAJ&pg=PA115&lpg=PA115&dq=Office+of+Research+Support+and+International+Affairs,+2014&source=bl&ots=uZDKYbADqX&sig=ACfU3U0c_lADoUEK1tPmLZvYTayJ50gzzQ&hl=sw&sa=X&ved=2ahUKEwjfyu339pfoAhX9VBUIHXF1DikQ6AEwA3oECAkQAQ#v=onepage&q=Office%20of%20Research%20Support%20and%20International%20Affairs%2C%202014&f=false.
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