Abstract
The COVID-19 pandemic has led to many unintended, long-lasting consequences for society. Preventative practices such as mask wearing, social distancing, and virtual meetings and classrooms to address contagion concerns may negatively affect communication, particularly in the pediatric population, as schools have begun to open this fall. Increasing awareness and creating innovative methods to promote communication and language learning in settings both in person and virtual is paramount. Although more studies are needed to characterize the pandemic’s impact on pediatric speech and language development, clinicians and parents should be cognizant of this phenomenon and proactive in facilitating an optimal communication environment for children.
Keywords
Preventative strategies such as mask wearing and social distancing have become a part of everyday life in an attempt to reduce the risk of infection during the COVID-19 pandemic. As schools have begun to open this fall, there are increasing concerns over how the COVID-19 pandemic will affect the younger generation. For example, in-person classes have been canceled in favor of virtual meetings and classrooms due to contagion concerns. Increased use of masks, social distancing, and the quarantine of individuals exposed to or infected with COVID-19 have been encouraged to prevent the spread of the virus. Although necessary, these practices may have unintended consequences on children’s language and communication skills during their critical development years.
Disproportionate Impact on Communication in Children With Hearing Loss
Incidental features of the COVID-19 pandemic may have long-lasting effects on the development of communication skills. Masks are known to degrade the speech signal, serving as a low-pass filter by attenuating high frequencies spoken by the wearer; the decibel level of attenuation ranges from 3 to 4 dB for simple medical masks and close to 12 dB for N95 masks. 1 In children with hearing loss, this seemingly small change may significantly affect speech understanding as compared with their normal-hearing peers. Speech perception also involves audiovisual integration of information, which is diminished by wearing masks because articulatory gestures may be obscured. Children with hearing loss may be more dependent on lip-reading; loss of this visual cue may exacerbate the distortion and attenuation effects of masks. Loss of such visual cues could also influence language acquisition in young children without developmental challenges. Salient visual cues contribute to speech processing during crucial periods of language and speech development. 2
Children with hearing loss may be disproportionately affected by virtual education as compared with their normal-hearing peers. Individuals with a hearing impairment are particularly affected by what has been coined “Zoom fatigue,” which is due to the increased listening effort from difficulties interpreting nonverbal cues (eg, inability to lip-read because of pixelated video), poor audio quality, and audiovisual dyssynchrony. 3 Studies have shown that listening becomes effortful in challenging auditory environments, such as a noisy background or when the listeners themselves have deficits in auditory processing. Studies supporting this “information degradation hypothesis” demonstrate short-term and possibly long-term effects of auditory processing on diminished cognitive performance in adults. 4 This phenomenon has yet to be extensively studied in school-age children.
Impact on Social Interaction and Language Development
Social interaction is also essential for language development. Social distancing measures and restrictions on large group gatherings have affected school-age children from having meaningful, in-person interactions with peers. “Peer talk” is a crucial component of pragmatic development; this includes conversational skills such as turn taking and understanding the implied meaning behind a speaker’s words. 5 Masks can also obscure social cues provided through facial expressions. The emergence of virtual and hybrid schools will ultimately result in fewer opportunities to exercise conversational and social skills in person rather than asynchronously or via virtual screens.
Mitigation Strategies
Several strategies can be employed to mitigate the effects of the COVID-19 pandemic on developing communication skills in children. These include the use of transparent masks to allow for visual input in an in-person setting. In virtual classrooms, educators should ensure optimization of the visual and auditory environment using adequate equipment, video chat capabilities (eg, chat, mute, and “raise hand” functions), as well as supplemental captioning, recording, and transcribing services. Zoom fatigue can be avoided by allowing the opportunity for students to “unplug” and obtain appropriate rest in between meetings.
Clinicians should be aware of the potential language and communication ramifications of the COVID-19 pandemic, particularly in the pediatric population. Health care personnel such as otolaryngologists, audiologists, and speech-language pathologists are the gatekeepers of communication. As such, these providers are in a prime position to facilitate primary and secondary prevention of communication impairment (ie, language delay). This can be achieved by educating parents (particularly those of children with hearing loss), teachers, and the general public and by providing strategies to mitigate the possible risk for developmental language delay. Scheduling teletherapy sessions via videoconferencing can help facilitate continuity of care during the pandemic. Speech-language pathologists can also provide useful strategies for parents to optimize the home environment for speech and language development. 6
The COVID-19 pandemic continues to present many unintended consequences for society. Preventative practices such as mask wearing, social distancing, and virtual meetings and classrooms to address contagion concerns may negatively affect communication. Increasing awareness and creating innovative methods to promote communication and language learning in such settings of decreased environmental language input or unfavorable auditory environments is paramount. Although more studies are needed to characterize the pandemic’s impact on pediatric speech and language development, clinicians and parents should be cognizant of this phenomenon and proactive in facilitating an optimal communication environment for children. Although new research on telehealth, virtual parent training, and optimizing online teaching is needed, there are ample evidence-based strategies available to facilitate teaching, speech perception, and speech and language development to at least partially offset the adverse conditions that all are experiencing during this pandemic.