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New screening tools help improve the hearing health of Aborignal and Torres Strait Islander children earlier

Published: 8/3/2023 6:05:03 AM

World leading hearing screening resources have been developed by the National Acoustic Laboratories (NAL), to identify hearing problems earlier in young Aboriginal and Torres Strait Islander children.
NAL, the research division of Hearing Australia, has co-developed the Parent-evaluated Listening and Understanding Measure (PLUM) and the Hearing and Talking Scale (HATS) in collaboration with Aboriginal health and early education services. With a focus on First Nations infants and young children, these tools are the only resources of their kind in Australia and they are available for free on
“With the support of government, Hearing Australia is increasing its focus on improving the hearing health of all Australians through the prevention of avoidable hearing loss," says Kim Terrell, Managing Director, Hearing Australia. “We remain steadfast in our commitment to reduce the rate of hearing loss in Aboriginal and Torres Strait Islander children by at least half by 2029.”
Hearing loss in Aboriginal and Torres Strait Islander children is most commonly due to middle ear infection, also known as otitis media2. These infections are often without pain and frequently start before the child’s first birthday.  Because the signs are subtle, hearing loss is often not picked up until children start school. Long term, undetected hearing loss in these early years raises the risk of children not being developmentally ‘on track’ when they start school3,4,5. Now there are tools to help identify these children so they can get the hearing help they need.
“Listening and communication skills are skills for life,” says Dr Teresa Ching, Head of Communication Sciences, NAL.
“The first three years of life are crucial for developing these skills. They are building blocks for learning language and culture, building relationships, learning in school and becoming independent in life. Being able to hear well early in childhood directly affects children’s development of language, communication and social skills. These are skills that impact hugely on children’s life experience and futures.”
Research indicates that almost half of childhood hearing loss is preventable1, with Aboriginal and Torres Strait Islander children experiencing significantly higher rates of hearing loss than non-Indigenous Australian children2.
For three-year-old Tjandamurra and his Mum, Kaylah, using the PLUM and HATS resources was a crucial step forward for Tjandamurra on his hearing journey. Due to his chronic ear issues, Tjandamurra struggled to hear and had difficulty learning to communicate well. 
The PLUM assessment indicated he was well below the acceptable level of listening skill for a three-year-old. Kaylah decided to get Tjandamurra fitted with a hearing device to provide immediate help. With this hearing technology, the world opened up for the vibrant boy. Tjandamurra is now wearing his hearing device and working with his regular speech therapist to improve his speech and listening skills.
Within a month, Tjandamurra had gone from a toddler with little-to-no speech to now being able to say 30 sentences. It's a huge jump in his development. Now that he can hear there is no looking back.
“I get tears when I speak about it, it’s been such a long road,” says Kaylah. “Now he can hear me clear as day and he even responds – it's so good to hear his voice. He has a little man voice.”
PLUM and HATS make use of parents’ and carers’ observations of their children in everyday situations that can be reported so that hearing and talking problems in infants and young children can be detected early on.

  • The PLUM assessment includes 10 questions that screen listening skills.
  • The HATS assessment includes 5 questions that screen communication skills.

These assessments can be conducted in 10-15 minutes as either part of an annual health check or when there are concerns about ongoing ear trouble.  

Kaylah’s advice to other parents concerned about their child’s hearing is to ask for the PLUM and HATS assessment now – don’t wait. “You don’t want to leave it. The earlier you can get your little one help, the better.”

The PLUM and HATS resources are being used by Hearing Australia’s Hearing Assessment Program – Early Ears, dubbed, HAPEE. This program is a result of a $30 million investment by the Australian Government to reduce the long-term effects of ear disease in Aboriginal and Torres Strait Islander children. HAPEE has conducted diagnostic hearing assessments of over 2,100 children and 76 communities since it began 12 months ago. To date, Hearing Australia has identified 455 children with undiagnosed hearing loss and helped them to get the clinical services they need.
According to Sam Harkus, Principal Audiologist, Aboriginal and Torres Strait Islander Services at Hearing Australia, by using the PLUM and HATS checklists, health workers and early childhood educators can quickly understand how a young child’s listening and communication skills are developing.
“This enables health workers and parents to decide whether a child needs help from a hearing or speech specialist so that the child can thrive in the early years before school,” says Sam. “Catching and treating hearing and talking issues in the first three years helps children to be ready for learning in school and learning for life.”
NAL has created a website at for families and health workers to learn about PLUM and HATS and download the resources. Health workers can also complete the PLUM and HATS assessments with parents online. The online version is scored automatically and a report with recommendations can be downloaded. The website also has a portal that provides training for using the tools. In addition, communication material is available to increase community awareness and understanding of the resources.
“The PLUM and HATS tools will help build awareness and empower parents and carers to talk about their bub’s listening and communication skills. As part of standard care for young Aboriginal and Torres Strait Islander children, these tools could help make a difference to the lives and futures of many children,” concludes Sam.


 1 World Health Organisation (2016) Deafness and hearing loss (estimates for developed countries)

2 Natural history, definitions, risk factors and burden of otitis media by Kelvin Kong and Harvey LC Coates

3 Developmental vulnerability of Australian school-entry children with hearing loss by Andrea Simpson, Bojana Sarkic, Joanne C. Enticott, Zoe Richardson and Kimberly Buck

4 Chronic Illness and Developmental Vulnerability at School Entry by Megan F Bell, Donna M Bayliss, Rebecca Glauert, Amanda Harrison and Jeneva L Ohan

5 Impact of hearing impairment on early childhood development in Australian Aboriginal children: A data linkage study by Jiunn‐Yih Su, Steven Guthridge, Vincent Y He, Damien Howard and Amanda J Leach.

About the National Acoustic Laboratories (NAL)
NAL is the research division of Hearing Australia. Since 1947, research conducted by NAL into hearing has opened new ways to help people with hearing loss. NAL’s mission is to lead the world in hearing research and evidence-based innovation to improve hearing health and transform the lives of people with hearing difficulties.
About Hearing Australia
For over 75 years, Hearing Australia has been helping Australians rediscover the joy of sound. Its purpose is to provide world leading research and hearing services for the wellbeing of all Australians. Hearing Australia operates in 168 permanent hearing centres as well as visiting sites across Australia and is the nation’s largest provider of government-funded hearing services for children, young adults up to 26, adults with complex communication needs, Aboriginal and Torres Strait Islander people, pensioners and veterans. 

Media enquiries:    
Vicky Saunders-Flaherty
Hearing Australia
02 9412 7024 / 0436 522 196        

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