Hearing and vision problems in people with developmental disability

People with developmental disability are more likely to have sensory impairments than the general population across all life stages; however, they or their carers may not be aware of a deficit, alteration or deterioration, and may not be able to report it. Losses in vision or hearing can affect the person’s engagement and ability to function; lack of response may be attributed to behaviour (eg stubbornness) and the person may not be investigated for possible sensory impairment.

Ophthalmological abnormalities (eg strabismus, refractive errors, squint) are common in people with developmental disability. Recurrent respiratory infections and otitis media are also common, and can contribute to hearing loss.

Early identification and intervention are important as sensory impairments can compromise development in children, and have a significant impact on mental health, function and behaviour at any age. For advice on assessment of hearing and vision in people with developmental disability, see Recommendations for hearing and vision review in people with developmental disability. Be aware:

  • of the limitations of standard tests (eg Snellen or picture charts, whispered voice test) in people with more severe disability
  • that loss of skills (eg mobility, personal care, independent activity) or confidence may reflect deteriorating vision and hearing.

For hearing and vision screening recommendations in people with Down syndrome, see here.

No matter how severe their disability, all people with vision and hearing impairments benefit from improving their sight and hearing.

Note: No matter how severe their disability, all people with vision and hearing impairments benefit from improving their sight and hearing.
Figure 1. Recommendations for hearing and vision review in people with developmental disability

Children

Refer to an ophthalmologist for formal vision assessment by the time the child starts school, then review annually for a known eye disorder.

Test hearing in all children presenting with developmental delay or disability to demonstrate sufficient hearing for normal speech and language development (even if hearing was screened at birth); subsequent concerns should be followed up with formal testing as hearing problems can emerge throughout childhood.

Adolescents and adults

Perform an otoscopy annually (look for wax build-up in people with hearing aids) or more frequently if indicated.

Perform annual audiology assessment and vision testing. Check hearing aids or glasses are being used correctly.

Recommend annual ophthalmological review for known eye disorders.

Refer to audiologist and ophthalmologist for formal assessment:

  • every 3 to 5 years, or more frequently in people who are ageing and in those with cardiovascular comorbidities (eg diabetes, hypertension)
  • if concerned or uncertain about vision or hearing loss between routine assessments.

Family members and other support people can help with use of glasses and hearing aids.

Hearing can also be enhanced by general measures, such as:

  • turning off radios and televisions when speaking to the person
  • speaking clearly from in front of the person.

Vision can also be improved by general measures, including:

  • removing glare
  • increasing light
  • providing contrast.

Occupational therapy assessment of the person’s environment may be helpful for those with sensory impairment. This is especially important if it is not practical for the person with disability to use glasses or hearing aids. Consider referral to a speech pathologist if communication is impaired by sensory loss. Funding may be available through the National Disability Insurance Scheme (NDIS); see Support funded by the NDIS.

Further advice is available from Hearing Australia, Vision Australia or a low vision clinic.