Early Identification of Hearing Loss and Language Development at 32 Months of Age.

This study examines the relationship between the early identification of hearing loss and language outcomes for deaf/hard of hearing (D/HH) children, with bilateral or unilateral hearing loss and with or without additional disabilities. It was hypothesized that hearing loss identified by 3 months of age would be associated with better language outcomes. Using a prospective, longitudinal design, 86 families completed developmental instruments at two time points: at an average age of 14.8 months and an average age of 32.1 months. Multiple regression examined how hearing loss identified by 3 months of age contributed to later language outcomes while controlling for developmental level at the first time point. Hearing loss identified by 3 months of age was positively associated with better language outcomes for D/HH children at 32 months of age; however, D/HH children still exhibited language delays, compared to normative scores for same-aged hearing peers for reported measures. Language outcomes of children with unilateral hearing loss were not better than those of children with mild-to-moderate bilateral hearing loss. Children with additional disabilities and more severe bilateral hearing loss had lower language scores than those without.

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.

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.

Language and verbal reasoning skills in adolescents with 10 or more years of cochlear implant experience.

OBJECTIVES: The purpose of this study is to identify factors predictive of successful English language outcomes in adolescents who received a cochlear implant (CI) between 2 and 5 yrs of age. DESIGN: All 112 participants had been part of a previous study examining English language outcomes at the age of 8 and 9 yrs with CIs. The participants were given a battery of language and verbal reasoning tests in their preferred communication mode along with measures of working memory (digit span) and verbal rehearsal speed (sentence repetition duration). The degree to which students' language performance was enhanced when sign was added to spoken language was estimated at both test sessions. Multiple linear regression analyses were used to document factors contributing to overall language outcomes. RESULTS: A substantial proportion of the adolescents obtained test scores within or above 1SD compared with hearing age-mates in the tests' normative samples: 71% on a verbal intelligence test, 68% on a measure of language content, 71% on receptive vocabulary, and 74% on expressive vocabulary. Improvement in verbal intelligence scores over an 8-yr interval exceeded expectation based on age-mates in the test's normative sample. Better English language outcomes were associated with shorter duration of deafness before cochlear implantation, higher nonverbal intelligence, higher family socioeconomic status, longer digit spans, and faster verbal rehearsal speed as measured by sentence repetition rate. Students whose current receptive vocabulary scores were not enhanced by the addition of signs also exhibited higher English language scores than those without sign enhancement; however, sign enhancement demonstrated in the elementary school years was not predictive of later high-school language skills. CONCLUSIONS: Results of this study support the provision of CIs to children at the youngest age possible. In addition, it highlights the substantial role that cognition plays in later language outcomes. Although the students' use of sign to enhance language skills during the elementary years does not appear to have a negative impact on later language skills, students who continue to rely on sign to improve their vocabulary comprehension into high school typically exhibit poorer English language outcomes than students whose spoken language comprehension parallels or exceeds their comprehension of speech + sign. Overall, the language results obtained from these teenagers with more than 10 yrs of CI experience reflect substantial improvement over the verbal skills exhibited by adolescents with similar levels of hearing loss before the advent of CIs. These optimistic results were observed in teenagers who were among the first in the United States and Canada to receive a CI. We anticipate that the use of improved technology that is being initiated at even younger ages should lead to age-appropriate language levels in an even larger proportion of children with CIs.

Describing the trajectory of language development in the presence of severe-to-profound hearing loss: a closer look at children with cochlear implants versus hearing aids.

OBJECTIVE: The objective of this investigation was to describe the language growth of children with severe or profound hearing loss with cochlear implants versus those children with the same degree of hearing loss using hearing aids. STUDY DESIGN: A prospective longitudinal observation and analysis. SETTING: University of Colorado Department of Speech Language and Hearing Sciences. PATIENTS: There were 87 children with severe-to-profound hearing loss from 48 to 87 months of age. INTERVENTION: All children received early intervention services through the Colorado Home Intervention Program. Most children received intervention services from a certified auditory-verbal therapist or an auditory-oral therapist and weekly sign language instruction from an instructor who was deaf or hard of hearing and native or fluent in American Sign Language. MAIN OUTCOME MEASURES: The Test of Auditory Comprehension of Language, 3rd Edition, and the Expressive One Word Picture Vocabulary Test, 3rd Edition, were the assessment tools for children 4 to 7 years of age. The expressive language subscale of the Minnesota Child Development was used in the infant/toddler period (birth to 36 mo). RESULTS: Average language estimates at 84 months of age were nearly identical to the normative sample for receptive language and 7 months delayed for expressive vocabulary. Children demonstrated a mean rate of growth from 4 years through 7 years on these 2 assessments that was equivalent to their normal-hearing peers. As a group, children with hearing aids deviated more from the age equivalent trajectory on the Test of Auditory Comprehension of Language, 3rd Edition, and the Expressive One Word Picture Vocabulary Test, 3rd Edition, than children with cochlear implants. When a subset of children were divided into performance categories, we found that children with cochlear implants were more likely to be "gap closers" and less likely to be "gap openers," whereas the reverse was true for the children with hearing aids for both measures. CONCLUSION: Children who are educated through oral-aural combined with sign language instruction can achieve age-appropriate language levels on expressive vocabulary and receptive syntax ages 4 through 7 years. However, it is easier to maintain a constant rate of development rather than to accelerate from birth through 84 months of age, which represented approximately 80% of our sample. However, acceleration of language development is possible in some children and could result from cochlear implantation.

Language skills of children with early cochlear implantation.

OBJECTIVE: This study investigated factors contributing to the comprehension and production of English language by children with prelingual deafness after 4 to 7 yr of multichannel cochlear implant use. The analysis controlled for the effects of child and family characteristics so that educational factors most conducive to maximum implant benefit could be identified. DESIGN: A battery of language tests were administered to 181 8- and 9 yr-old children from across the United States and Canada who received a cochlear implant by age 5. Tests of comprehension, verbal reasoning, narrative ability and spontaneous language production were administered either in speech and sign or in the child's preferred communication mode. These constituted the Total Language measures. Spoken Language measures were derived from a speech-only language sample. Type and amount of educational intervention since implantation constituted the independent variables. Characteristics of the child and the family were considered intervening variables. A series of multiple regression analyses determined the amount of variance in Total Language and Spoken Language ability accounted for by the intervening variables and the amount of additional variance attributable to the independent variables. RESULTS: More than half of the children (with performance intelligence quotients in the average range) exhibited language skills that were similar to those of hearing 8 to 9 yr olds on measures of verbal reasoning, narrative ability, utterance length, and lexical diversity. Significant predictors of language ability were similar for Total and for Spoken Language outcomes and included greater nonverbal intelligence, smaller family size, higher socio-economic status and female gender. Age at receiving an implant did not affect language outcome. After the variance due to these variables was controlled, the primary rehabilitative factors associated with linguistic outcome were amount of mainstream class placement and an educational emphasis on speech and auditory skills. CONCLUSIONS: Use of a cochlear implant has had a dramatic impact on the linguistic competence of profoundly hearing-impaired children. More than half of the children in this sample with average learning ability produced and understood English language at a level comparable with that of their hearing age mates. Such mature language outcomes were not typical of children with profound hearing loss who used hearing aids. Use of a visual (i.e., sign) language system did not provide the linguistic advantage that had been anticipated. Children educated without use of sign exhibited a significant advantage in their use of narratives, the breadth of their vocabulary, in their use of bound morphemes, in the length of their utterances and in the complexity of the syntax used in their spontaneous language. An oral educational focus provided a significant advantage for both spoken and total language skills.

Mastery motivation and expressive language in young children with hearing loss.

We studied the relation between mastery motivation and expressive language in 200 young children with hearing loss. Hearing mothers assessed their children's expressive language (Minnesota Child Development Inventory; Ireton & Thwing, 1974) and several aspects of mastery motivation including mastery pleasure and three components of mastery persistence (gross motor, object oriented, and social/symbolic) using the Dimensions of Mastery Motivation Questionnaire (Morgan et al., 1992). Simple correlations revealed significant relations between expressive language and all mastery motivation scales. When demographic and hearing loss variables were entered into a regression equation, only increased social/symbolic persistence was significantly related to, and increased object-oriented persistence was marginally related to, increases in expressive language quotients. Expressive language quotients also increased significantly as child age and degree of hearing loss decreased and as mothers' ratings of their child's general competence increased. In addition, decreases in the age at which the child was enrolled in intervention were marginally related to increases in expressive language quotients (f =.06).

Predictors of parental stress in mothers of young children with hearing loss.

This study examined parental stress in 184 hearing mothers of young children who are deaf or hard of hearing. Stress levels were measured in three domains using the short-form of the Parental Stress Index (PSI; Abidin, 1995). Mothers in this study demonstrated significantly less parental distress on the PSI than a normative, hearing group, although this difference was quite small. Differences between the hearing and hearing loss samples did not reach conventional levels of significance for the Dysfunctional Parent-Child Interactions or the Difficult Child subscales. An examination of potential predictors of maternal stress revealed that mothers who perceived their daily hassles as more intense also obtained higher stress ratings on all three subscales. Additional predictors of parental distress were frequency of hassles, social support, and annual family income. Increased stress on the Dysfunctional Parent-Child Interaction subscale was predicted by children who had disabilities in addition to hearing loss, more delayed language relative to their chronological age, and less severe degrees of hearing loss. No additional, significant predictors were obtained for the Difficult Child subscale. When all measured variables were controlled for, characteristics that did not predict maternal stress on any of the three subscales included the child's gender, ethnicity, age of identification, mode of communication used, maternal education, and months between age of identification and child age at the time of observation.