Frequency of Early Intervention Sessions and Vocabulary Skills in Children with Hearing Loss.

BACKGROUND: A primary goal of early intervention is to assist children in achieving age-appropriate language skills. The amount of intervention a child receives is ideally based on his or her individual needs, yet it is unclear if language ability impacts amount of intervention and/or if an increased frequency of intervention sessions results in better outcomes. The purpose of this study was to determine the relationship between the frequency of early intervention sessions and vocabulary outcomes in young children with hearing loss. METHODS: This was a longitudinal study of 210 children 9 to 36 months of age with bilateral hearing loss living in 12 different states. Expressive vocabulary skills were evaluated using the MacArthur-Bates Communicative Development Inventories. RESULTS: A higher number of intervention sessions reported at the first assessment predicted better vocabulary scores at the second assessment, and more sessions reported at the second assessment predicted better scores at the third assessment. For each increase in the number of sessions reported, there was a corresponding, positive increase in vocabulary quotient. In contrast, children's vocabulary ability at an earlier time point did not predict intervention session frequency at a later point in time. CONCLUSIONS: A significant prospective effect was apparent with more therapy sessions resulting in improved vocabulary scores 9 months later. These findings underscore the importance of early intervention. Pediatricians and other health care professionals can help apply these findings by counseling parents regarding the value of frequent and consistent participation in early intervention.

Reading Proficiency Trends Following Newborn Hearing Screening Implementation.

OBJECTIVES: To investigate trends in population-level school-aged reading scores among students with hearing loss in an urban Colorado school district after implementation of universal newborn hearing screening (UNHS) and Early Hearing Detection and Intervention. METHODS: The final sample included 1422 assessments conducted during the 2000-2001 through 2013-2014 school years for 321 children with hearing loss in grades 3 through 10. Longitudinal hierarchical linear modeling analyses were used to examine reading proficiency (controlling for birth year, grade in school, free and reduced lunch status, additional disability services, and English not spoken in the home). The Colorado Student Assessment Program was administered to students in third through 10th grades throughout the state. The test years chosen included children born before and after implementation of UNHS. RESULTS: After implementation of UNHS, significant longitudinal reading proficiency improvements were observed by birth year and grade overall and for all subgroups. However, gains in reading proficiency were substantially less for children eligible for free and reduced lunch and those with moderate-severe to profound hearing loss. With each succeeding birth cohort and grade, increased numbers of children participated in testing because of improved language skills, with higher proportions identified as proficient or advanced readers. CONCLUSIONS: Notable improvements in reading proficiency after Early Hearing Detection and Intervention implementation were demonstrated, as all groups of children with hearing loss became more likely to achieve proficient and advanced reading levels. On the other hand, some disparities increased, with greater improvements in reading proficiency for children in economically advantaged families.

Early Intervention, Parent Talk, and Pragmatic Language in Children With Hearing Loss.

BACKGROUND AND OBJECTIVES: Pragmatic language skills form the foundation for conversational competence, whereas deficits in this area are associated with behavioral problems and low literacy skills. Children who are deaf or hard of hearing demonstrate significant delays in this critical area of language. Our purpose with this research was to identify variables associated with pragmatic language ability in children who are deaf or hard of hearing. METHODS: This was a longitudinal study of 124 children with bilateral hearing loss between 4 and 7 years of age living in Colorado. As part of a comprehensive speech and language assessment, pragmatic language skills were evaluated annually by using the Pragmatics Checklist. RESULTS: The children's pragmatic skills increased significantly with age. Higher levels of pragmatic language ability at 7 years of age were predicted by (1) meeting Early Hearing Detection and Intervention 1-3-6 guidelines (hearing screening by 1 month, identification of hearing loss by 3 months, and receiving intervention by 6 months of age), (2) greater quantity of parent talk, (3) higher nonverbal intelligence, (4) lesser degrees of hearing loss, and (5) higher maternal education. CONCLUSIONS: With the findings of this study, we underscore the importance of pediatricians and other health care professionals counseling parents about the value of adherence to the Early Hearing Detection and Intervention 1-3-6 guidelines with regard to intervention outcomes. The strong association between amount of child-directed parent talk in the first 4 years of life and pragmatic language outcomes at 7 years of age emphasizes the need for professionals to encourage parents to talk to their children as much as possible.

Language Outcomes Improved Through Early Hearing Detection and Earlier Cochlear Implantation.

HYPOTHESIS: Early identification and intervention, earlier cochlear implantation, and mother's level of education will directly and/or indirectly impact the language outcomes of children with cochlear implants (CIs). BACKGROUND: Identifying factors that contribute to the wide range of language outcomes in children who use CIs will assist healthcare and rehabilitation professionals in optimizing service delivery for this population. Universal newborn hearing screening provides an opportunity to examine the relationship between meeting the early hearing detection and intervention (EHDI) 1-3-6 guidelines and child language outcomes. These guidelines recommend screening by 1 month, confirmation of hearing loss by 3 months, and intervention by 6 months of age. METHODS: Participants were 125 children with CIs ranging from 13 to 39 months of age. Language ability was measured using the Child Development Inventory and MacArthur-Bates Communicative Development Inventories. RESULTS: Meeting EHDI 1-3-6, higher levels of maternal education and earlier cochlear implant activation had a direct, positive impact on language outcomes. Meeting the EHDI 1-3-6 guidelines also had an indirect positive effect on language outcomes via increasing the probability that the children's CIs would be activated earlier. Maternal education did not significantly predict age of cochlear implant activation nor whether a child met EHDI 1-3-6. CONCLUSION: Ensuring families meet the EHDI 1-3-6 guidelines is an early step that can lead to higher language outcomes and also earlier cochlear implantation.

Early Hearing Detection and Vocabulary of Children With Hearing Loss.

BACKGROUND AND OBJECTIVES: To date, no studies have examined vocabulary outcomes of children meeting all 3 components of the Early Hearing Detection and Intervention (EHDI) guidelines (hearing screening by 1 month, diagnosis of hearing loss by 3 months, and intervention by 6 months of age). The primary purpose of the current study was to examine the impact of the current EHDI 1-3-6 policy on vocabulary outcomes across a wide geographic area. A secondary goal was to confirm the impact of other demographic variables previously reported to be related to language outcomes. METHODS: This was a cross-sectional study of 448 children with bilateral hearing loss between 8 and 39 months of age (mean = 25.3 months, SD = 7.5 months). The children lived in 12 different states and were participating in the National Early Childhood Assessment Project. RESULTS: The combination of 6 factors in a regression analysis accounted for 41% of the variance in vocabulary outcomes. Vocabulary quotients were significantly higher for children who met the EHDI guidelines, were younger, had no additional disabilities, had mild to moderate hearing loss, had parents who were deaf or hard of hearing, and had mothers with higher levels of education. CONCLUSIONS: Vocabulary learning may be enhanced with system improvements that increase the number of children meeting the current early identification and intervention guidelines. In addition, intervention efforts need to focus on preventing widening delays with chronological age, assisting mothers with lower levels of education, and incorporating adults who are deaf/hard-of-hearing in the intervention process.

A Look into the Crystal Ball for Children Who Are Deaf or Hard of Hearing: Needs, Opportunities, and Challenges.

Hearing is essential for the development of speech, spoken language, and listening skills. Children previously went undiagnosed with hearing loss until they were 2.5 or 3 years of age. The auditory deprivation during this critical period of development significantly impacted long-term listening and spoken language outcomes. Due to the advent of universal newborn hearing screening, the average age of diagnosis has dropped to the first few months of life, which sets the stage for outcomes that include children with speech, spoken language, and auditory skill testing in the normal range. However, our work is not finished. The future holds even greater possibilities for children with hearing loss.

The school to home link: summer preschool and parents.

This study investigates the amount of language available to children in the home environment and a summer preschool program. The purpose of this study was twofold. First, the study sought to gain information about patterns of language use among families of preschoolers with hearing loss. Additionally, the project was designed to provide an initial investigation into the impact of reduced educational programming over summer months for children with hearing loss. Children with varying degrees of hearing loss were enrolled in an auditory-oral 6-week part-time program. The language environment during preschool and at home was analyzed through use of Language ENvironment Analysis (LENA). LENA is a digital language processor that can record and analyze through specific measurements the natural language environment of a child. Overall, the children studied received significantly more complex language in preschool than in the home environment. The data suggest that children with hearing loss benefit from the opportunity to attend summer preschool programming. Additionally, it is critical that parents of preschoolers continue to receive parental education surrounding use of language strategies in the home environment. Implications for practice are discussed.