Ask an Audiologist: Help! My 4 Year-Old Child Can’t Talk

Development milestones

For the most part, a child’s development, or the development of most children, is pretty predictable for the bigger milestones in their life.

On average children start taking their first ‘baby steps’ between 9 and 12 months. By the time they’re about 14 to 15 months old, they’ve pretty much mastered walking.

Is hearing loss a factor?

So, by what age should your child begin to speak and by what stage will they be able to hold a proper conversation? You might start hearing ‘mama’ or ‘dada’ as early as six months and by the time your child is approximately between 18 months and 2 years-old, they should be able to string together simple two to four-word sentences.

What happens when your child is 4 years-old and this doesn’t happen? Is hearing loss a factor in speech delay? One mom decided it was time to Ask an Audiologist.

Ask an Audiologist

My son is nearly 4 and has a severe speech and language delay. He has almost no intelligible words. In December he had a hearing test that showed a flat hearing loss around the 30-40 dB (decibel) mark. A similar loss was found by a second audiologist in January.

However, his OAE was normal. Is it possible that two audiologists were wrong and he actually has normal hearing? Can you have hearing loss and normal OAE? Is it more likely that he has auditory neuropathy?

Audiologist Response

Thank you for your submission to Ask an Audiologist.

I am sorry to hear about your situation. I know that it can be a stressful and confusing time. Anything is possible, but to be honest I highly doubt that two Audiologists would have obtained the same inaccurate test results from your son. Speech and language delays are also a significant red flag that your son may have a hearing loss.

OAE (Otoacoustic Emissions) testing is typically used as a screening measure to determine if a hearing loss is likely, and where in the hearing system the hearing loss may be present? So, to answer your question – yes – it’s possible to have hearing loss and normal OAEs. Based on what you’ve explained, my best guess is that your son has ANSD (Auditory Neuropathy Spectrum Disorder). However, it’s hard to be certain without further testing. The most conclusive test to confirm that he has a hearing loss would be an ABR (Auditory Brainstem Response) test, which is an objective neurological test that checks the transmission of sound from the inner ear to the brain. I would encourage you to discuss recommendations and further testing with your son’s Audiologist(s).

I hope that this information is helpful to you. Please do not hesitate to contact me if you have any further questions.

Wishing you and your son all the best,

Stephanie is an Audiologist registered with CASLPO (College of Audiologists and Speech-Language Pathologists of Ontario). Stephanie currently sees patients at Hearing Solutions’ Carlingwood Shopping Centre location in Ottawa.