Prev Next
Toddler Hearing vs. Toddler Listening

Toddler Hearing vs. Toddler Listening

By Amalah

Hi Amalah,

First, thank you for your awesome blog and excellent advice. I discovered your blog while nursing my son as an infant, and definitely survived the frequent nighttime feeding stage by reading the archives! I’ve also made good use of your sound, down-to-earth advice.

Some background: I have a darling eighteen month-old-son who is the light and joy of my life. He is our first and only child right now. I am a school-based occupational therapist, and have loved watching my little guy grow both personally and from a professional perspective. I’ve tried hard not to be one of those people obsessed with each milestone or overly worried about development as I know every child has their own pace and that the range of typical development is very wide.

Here’s my situation. My son attends a daycare center while I am at work for 3 days last school year, 4 days this year and is in the toddler 2 room, for kids 15 months to 2 years old. He moved up to this room in May, but has only been going to school one or two days a week over the summer while I’m off for the summer. His teacher mentioned that he doesn’t respond when she calls his name, and asked if we notice that at home. I was honest and said that I was concerned about that earlier, but once he had tubes placed in his ears for chronic infections at 14 months I was no longer concerned. She also mentioned that he tends to wander on his own frequently rather than playing with the other kids, but that sometimes the younger kids do that (he is the youngest boy in the class of eight kids). She had recently completed an assessment they do every three months as part of the program. I’m waiting to get the full report from the center. His previous assessment done before he transitioned from the infant room had no concerns.

I’m trying to balance my personal concern for my son with what I know and see professionally with the kids I work with, all of whom have some form of developmental delay. I know that not answering to his name can be a warning sign of autism. At home he will mostly respond if I call him, but he will also sometimes ignore me, especially if he’s really into something he’s doing. I find him very social and outgoing with other kids and people- following older kids at the playground or beach, trying to get the attention of others at the supermarket, etc. He is affectionate, points, makes eye contact, and I have no concerns about his joint attention. He has about 20 or so words, gets his needs across, and likes imitating sounds and hand play. I have questioned his overall hearing at times, but not as much after the tubes were placed. I’m planning to bring the teacher’s concerns up at his eighteen month appointment, but should I be making requests for a further evaluation? I feel like if someone came in to evaluate him they would think I just wasted their time, given he is doing all of those other things. Do I have too much info/anxiety because of my profession and need a smackdown? I just want to do what’s right for my baby.

Thank you so much for any insight,
OT Mom

So I don’t work professionally with kids with developmental delays, nor am I any sort of anecdotal expert on kids with developmental delays, not even my own. So I am certainly not qualified to make any sort of YES/NO judgement on whether you should seek additional evaluations.

That said, there’s not really anything jumping out at me here as a big-ass warning sign, especially given all the age-appropriate social/communication milestones your son seems to be hitting just fine. An 18-month-old ignoring an adult? Who is probably about to make a request/demand that he would also probably prefer to ignore? In a noisy daycare room with lots of other things competing for his attention and focus? Nah, that doesn’t really elicit much concern from me, nor does the fact that he prefers independent (or at this age, “parallel”) play.

(He’s an only child at home, so that’s just likely how he plays, but just the fact that he’s playing somewhat near or in the sphere of other kids means he’s still getting lots of good social stuff from his daycare experience. Same with in-home playdates at this age where the toddlers essentially show up to ignore each other. At least they aren’t fighting? Or biting or hitting? THIS PLAYDATE IS A HUGE SUCCESS!!)

If he was missing other key developmental milestones (no words yet, no hand gestures or imitating, sensory concerns like toe walking or unusual reactions to physical stimuli), then yes. I would suggest that you get him evaluated. I would still (and I imagine this is part of the post-tubes procedure anyways) suggest that you stay on top of hearing screenings to confirm that the tubes are doing their job and that he doesn’t have any permanent hearing loss from the earlier infections. It’s possible he’s still re-learning how to parse the sounds he hears, so a teacher calling his name in a noisy classroom simply isn’t getting prioritized by his brain because he’s focuses on a noisy toy right next to him.

I had tubes put in my ears when I was 5 years old, and while I immediately noticed things like the crazy high volume on the TV (which I could barely hear before the tubes), it took me longer to learn how to process all the competing sounds that I only now hear for the first time. My mom calling me for dinner while I hit the piano keys, while our next-door neighbor mowed his yard and our dog barked at the lawnmower and suddenly my mom was YELLING at me from the doorway to come to dinner, with a worried look on her face like maybe I still couldn’t hear her. I could hear! I just still needed to learn how to LISTEN.

Again! Not an anecdotal expert on tubes in the ears either! Just throwing out a possibility to keep you calm until you bring up your (and his teacher’s) concerns to your doctor. Which you should totally do. If your doctor says “wait and see, let’s do another hearing screen just to be safe,” I’d personally feel pretty satisfied with that.

(More useless anecdotes: We got the “wait and see, let’s give him three more months or so” answer at 18 months when our oldest son wasn’t talking or pointing yet. Three months later, he still wasn’t and we were referred to Early Invention. I still think the “wait and see” period was the appropriate response at that age, and we didn’t “lose” a damn bit of progress because of it.)

BUT. LOOK. IF YOU ARE WORRIED IT’S OKAY TO BE WORRIED AND PUSH FOR MORE. No Early Intervention caseworker  is ever going to be mad or annoyed because they tested your son had GOOD NEWS to give you as a result. (I mean, if they ARE mad or annoyed because they get to tell a parent that their child is developing typically, they should probably look for a different job). I feel like your situation is common among your profession: I’ve gotten a lot of letters from other OTs or SPs or special educators who are afraid their lens at work is clouded when it comes to their own child. I’ve also gotten letters from relatives, partners and friends who are upset because there’s a child with obvious needs but said child’s parent is a “child development expert” and thus feels qualified to deny that there’s a problem.

It never hurts to bring up and voice your concerns, even if the universal response is a soothing affirmation that you can let go of those concerns. It also never hurts to get as much information as you can about your child, be it from a daycare evaluation to something more formal from EI. Personally, I think your kiddo sounds just fine. Personally, I would still bring my concerns up to anyone whose job it is to listen to my concerns. You brought your concerns to me, so bravo! Step one. 18-month appointment is step two. You got this!

Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

icon icon
chat bubble icon

Comments

  • Amy Renee

    One other question – in addition to the ear infections/tube, does he often still get colds or seasonal allergies? My youngest has a tendency toward seasonal allergies, and when he is stuffy he doesn’t usually get an ear infection, but he doesn’t respond as quickly to his name being called, and he gets a lot louder and says “huh?” more – leading me to believe his ears are stuffed up, even if his nose isn’t (or isn’t much).

    Even with the tubes, your son’s ears could still be a little stuffy, so I’d keep an eye on that.

    Our oldest son also had hearing loss that wasn’t detected until he was 5, and even though it has caused a few challenges for him, he has overall been fine (and his doctors tell us earlier intervention wouldn’t have made a difference).

    So because of my experience, I am more likely not to jump to “he’s not responding to his name! Oh no, autism?” and more likely to “he’s not responding! Hearing loss?”

    I think it’s worth bringing to your ENT and pediatricians attention, but since he just got tubes a few months ago, watching and waiting is appropriate.

    FWIW, it’s not easy to detect non-severe hearing loss in young kids. When they get old enough to follow instructions like “pat the table when you hear a beep” you can do more detailed hearing checks, but for young kids its much more subtle. We’ve had my younger son evaluated 3 different times – once there was concern but 2x he checked out as “probably fine” – since it depends on the kids attention span it was hard to tell whether he wasn’t hearing the sounds they were doing to get his attention or whether he just didn’t care about them.

    • I also was thinking it would be appropriate to ask for a hearing test, and not so much worried about Autism with the not responding to his name. (Though like Amy pointed out, if he’s responding to his name in other situations then it’s likely something about that one environment and not so much an issue with his development!). But if you asked at his next appointment I would think the doctor could put in the order for the hearing test without much fuss, just to put you at ease 🙂 

  • Traci

    I would first question whether the childcare teacher is qualified to assess this issue.  When I was teaching in a childcare setting I constantly heard teachers with little child development training diagnosing kids with problems when the kids behavior was completely within the normal development range.  The fact that the teacher didn’t consider recent tubes in the ears and doesn’t grasp that children this age do not typically play together (as Amy mentioned they typically do parallel play at this age) as the issue makes me think this is the case. I have a bachelor’s in developmental psych and know that while I know quite a bit about child development, I am not qualified to diagnose. That being said, everything described sounds within typical behavior for that age. I have also seen many kids who need or recently got tubes exhibit the same behavior. His brain has not been able to process sounds bc it wasn’t receiving the info. Now that it is, the brain needs time to learn how to process and prioritize a lot of information. Little kids brains are highly adaptive, so he’ll catch up quick!  I’d give this time and revisit in a few months. I’d also follow up with the doctors to make sure the tubes were successful, but I imagine that’s already lined up.

    On a side note, I totally do the worry thing too bc I know all of the things that can be wrong.  It helps to stop and look at the big picture (as you have).  Often development is all over the place and happens at uneven rates. So if one area is advanced there is often another area a little behind, it all evens out in the end. To really put my mind at ease I will often look at my Milestones flipbook. It’s a quick reference guide to typical development from birth to old age. I wish they distributed these to parents. It can be ordered from http://www.maxishare.com It is made by Children’s Hospital of Wisconsin. One of my professors had us get them and I use it often. 

  • Mel

    My daughter did this ALL THE TIME around this age and doesn’t appear to be on the autism spectrum–she just didn’t feel like dealing with people when they called her name. 🙂

  • Myriam

    My daughter is almost 2 and already a pro of the “selective hearing” thing! She’ll slow down, then realizes she doesn’t want to do what you’re asking, so she keeps on going as if nothing happens!

  • OT Mom

    Thanks everyone! After I sent this email, I felt a lot better – I think I needed to write it all down and vent it out in order to get it out of my head! I think a lot of my concern was really stemming from going back to work and being away from my little guy after a great summer. He absolutely knows his name, and I think he still feels a little unsure in the room with the older kids. We received his written assessment today, and several things he was noted as not doing there yet he is doing here at home. He just needs a bit more time.

    I am going to stay on top of the hearing screenings – at his most recent ENT appointment (the same day the teacher mentioned her concerns) he just passed the hearing test. He was very distracted in the beginning, but when he goes for the next one he’ll be two years old, and I am going to make sure they go through the test a little more carefully. Thank you again everyone, I really appreciate the info and support!

  • Autumn

    I’m a physical therapist, and I used to (prior to kids) work in pediatrics.  

    A co-worker was so concerned about herself overanalyzing her kiddo’s development that she had some of us do varied developmental assessments on her daughter every couple of months or so.  Professionally, it was good for us to assess a “typical” child, and it helped her feel better rather than overanalyzing a bad day.  

    Perhaps a colleague would be willing to perform an assessment of your choosing?  (I’ve been out of peds for 8 years and I’ve purposefully have not unpacked the box with my peds developmental stuff so I don’t start over analyzing )

  • Michele

    When my daughters were younger (and even sometimes still today), they didn’t often listen to other adults.  If we were at a library program, the adult-in-charge would give directions, but they often didn’t participate until I repeated the directions.  It took until they were in school everyday that they started listening for and consistently other adults’ voices. It’s better now, but I often find that the first or second time they interact with an adult, they don’t always recognize to follow that person’s directions.  They have passed all their hearing tests, so I chalked it up to it sounding to them like Peanuts’ adult voices (“Wah-wahwah-wah-wahwahwah”)

  • Holly W.

    Like one of the other commenters, while I’d stay on top of his hearing checks to be sure, it sounds like the daycare teacher is comparing your son to the other various-aged children with an incredibly small sample size, instead of actual developmental milestones. Its very rare for kids that young to play together, so that rings a bell that what she thinks is concerning is absolutely normal. My youngest just turned two, and there was often (and sometimes sill is) times when he totally ignores his name being called because he’s busy (and he’s in full-time daycare. Now that he’s two, he often just yells “NO!” when I ask him to listen/do something 🙂 so I know he can hear me ha. I’d check with the leadership at your daycare to make sure their assessments are built from a strong, developmentally appropriate “play” curriculum, so the things he’s being evaluated for are the right things!