these guidelines in the preparation of recommendations. In contrast to the suggested adult standards for PTA hearing level, we are suggesting that the degree of hearing loss that is considered disabling in infants and children is 35 dB HL or greater before the age of 6 years, 50 dB from 6 to 12 years, and 70 dB from 12 to 18 years of age. We have selected these criteria for the reasons stated below.

As emphasized in the text of this chapter, a loss of hearing sensitivity can have a more detrimental effect on infants and children who are in critical learning periods for speech, language, and general communication ability than on their adult counterparts. School-age children depend on communication skills for all means of learning. Development of communication skills may be the most important task for an infant because it provides the basis for almost all subsequent learning.

The committee chose 35 dB HL as the minimum hearing loss criterion on the basis of studies that have documented significant delays in speech production, language, verbal intelligence, and associated areas of learning (Briscoe et al., 2001; Davis et al., 1986) in children with hearing loss, including those with mild loss. The strongest evidence that even mild bilateral hearing loss is debilitating to young children comes from the endorsement of groups like the National Institutes of Health (1993), the American Academy of Pediatrics Task Force on Newborn and Infant Hearing (1999), and the American Academy of Pediatrics (2000), that endorse programs for early detection of mild hearing loss of 30 to 40 dB because of evidence that this degree of loss will cause significant communication and educational delays.

The needs for intervention for children with hearing loss are particularly acute in the infant and preschool period, when peak gains are attained in language and speech. Particularly if language skills are developing well, the elementary-school-age child should be able to tolerate slightly more hearing loss and the criterion level for disability is adjusted to moderate (50 dB) rather than mild. It should be noted that at this age and older, assessments of speech perception and language skills are also recommended as part of the disability determination evaluation. Although the hearing level criterion for disability is less stringent at this age for a child than for an adult, it should be noted that a child with a moderate hearing loss whose speech perception skills and language ability are normal for his or her age may not be considered disabled. As these communication skills emerge, more emphasis is placed on them and the criterion for hearing level is raised.

Finally, we recommend a 70 dB HL criterion for high school students, which is less strict than the 90 dB recommended for adults. The child of high school age with a hearing loss is significantly challenged by the



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