Choosing the appropriate habilitative track for the newly identified hearing-impaired child.

Based on prospective longitudinal data collected on 38 hearing-impaired infants, this study addresses the question, "What constitutes adequate progress in habilitation of the young deaf child?" The components of the newly developed Diagnostic Early Intervention Program aimed at selecting the most appropriate habilitative-educational track for the hearing-impaired infant will be described, together with data from the first 15 children who have completed the 6-month program. The results of a multidisciplinary medical evaluation completed on these children, including audiology, otolaryngology, aural rehabilitation, pediatrics, neurology, radiology, and genetics, will illustrate the important assistance these findings provide to the decision-making process of the habilitative-educational team.

Treatment efficacy: hearing loss in children.

This article provides a review of the topic of treatment efficacy for children with hearing loss. Efficacy is related to a wide range of treatment goals in the areas of sensory and perceptual skill development, language development (regardless of communication modality), speech-production skill development, academic performance, and social-emotional growth. Topics addressed in this article include (a) the definition of hearing loss in children; (b) incidence and prevalence data; (c) the effects of childhood hearing loss on daily life, including language and literacy, speech perception and production, socialization and family dynamics; (d) the role of audiologists and speech-language pathologists in managing children with hearing loss; and (e) a summary of pertinent efficacy research for children with hearing loss. The analysis of the available research suggests that (a) early intervention for children who are deaf or hard of hearing has long-term positive effects on overall development; (b) a variety of communication modalities exist for this population, and research to date has been more descriptive than prognostic on the choice of modality; (c) sensory aids (hearing aids, tactile aids, and cochlear implants) provide different degrees of benefit for children in the areas of speech perception, production, and language development, depending upon the extent of their hearing loss; (d) few studies have addressed rates of learning and long-term outcomes, but existing data suggest that enriched programs provide some children with hearing loss with the ability to overcome developmental lags in language and academic skills.

Application of the Supreme Court's Daubert criteria in radiation litigation.

In 1993, the U.S. Supreme Court set forth the standard for determining the admissibility of expert scientific evidence in litigation. This standard is known as the Daubert criteria, named after the pertinent case, Daubert v. Merrell Dow Pharmaceuticals, Inc. The Daubert criteria require the courts to determine whether an expert's testimony reflects scientific knowledge, whether his/her findings are derived by the scientific method, and whether the work product is based on good science. The Daubert criteria are especially important in radiation litigation because issues involving radiation doses and effects are often complex and thus a jury will typically rely heavily on the analysis and opinions of experts. According to the Daubert criteria, scientific opinions must be based on a methodology that has a valid, testable hypothesis; has been subject to peer review; and is generally accepted in the scientific community. Additionally, the expert must be qualified to present opinions based on the methodology. Although the application of the Daubert criteria in radiation litigation is highly dependent on the specific court and judge presiding over the case, there have been recent high-profile cases in which application of the criteria has resulted in the dismissal of analysis and opinions offered by scientific experts. Reasons for the dismissals have included basic scientific errors such as failure of the expert to consider all possible explanations for an observed phenomenon, the selective use of data by the expert, and the failure to acknowledge and resolve inconsistencies between the expert's results and those of other investigators. This paper reviews the Daubert criteria as they apply to radiation litigation and provides examples of the application of the criteria from recent judgments involving the Three Mile Island and Hanford Downwinders cases.

New directions in early intervention: P.L. 99-457.

In conclusion, P.L. 99-457 has important implications for professionals who serve hearing-impaired infants and toddlers. The law challenges traditional, child-focused intervention models, and requires professionals to develop programs that are responsive to families' needs. Professionals will need to become familiar with family systems theories, useful family assessment tools, and strategies for collaborative service delivery. Professionals are challenged to determine how enabling relationships can be built with family members. Empowerment of the family system could have far-reaching, positive consequences for the hearing-impaired child.

Early intervention and language development in children who are deaf and hard of hearing.

OBJECTIVE: The primary purpose of this study was to examine the relationship between age of enrollment in intervention and language outcomes at 5 years of age in a group of deaf and hard-of-hearing children. METHOD: Vocabulary skills at 5 years of age were examined in a group of 112 children with hearing loss who were enrolled at various ages in a comprehensive intervention program. Verbal reasoning skills were explored in a subgroup of 80 of these children. Participants were evaluated using the Peabody Picture Vocabulary Test and a criterion-referenced measure, the Preschool Language Assessment Instrument, administered individually by professionals skilled in assessing children with hearing loss. A rating scale was developed to characterize the level of family involvement in the intervention program for children in the study. RESULTS: A statistically significant negative correlation was found between age of enrollment and language outcomes at 5 years of age. Children who were enrolled earliest (eg, by 11 months of age) demonstrated significantly better vocabulary and verbal reasoning skills at 5 years of age than did later-enrolled children. Regardless of degree of hearing loss, early-enrolled children achieved scores on these measures that approximated those of their hearing peers. In an attempt to understand the relationships among performance and factors, such as age of enrollment, family involvement, degree of hearing loss, and nonverbal intelligence, multiple regression models were applied to the data. The analyses revealed that only 2 of these factors explained a significant amount of the variance in language scores obtained at 5 years of age: family involvement and age of enrollment. Surprisingly, family involvement explained the most variance after controlling for the influence of the other factors (r =.615; F change = 58.70), underscoring the importance of this variable. Age of enrollment also contributed significantly to explained variance after accounting for the other variables in the regression (r = -.452; F change = 19.24). Importantly, there were interactions between the factors of family involvement and age of enrollment that influenced outcomes. Early enrollment was of benefit to children across all levels of family involvement. However, the most successful children in this study were those with high levels of family involvement who were enrolled early in intervention services. Late-identified children whose families were described as limited or average in involvement scored >2 standard deviations below their hearing peers at 5 years of age. Even in the best of circumstances (eg, early enrollment paired with high levels of family involvement), the children in this study scored within the low average range in abstract verbal reasoning compared with hearing peers, reflecting qualitative language differences in these groups of children. CONCLUSIONS: Consistent with the findings of Yoshinaga-Itano et al,(1) significantly better language scores were associated with early enrollment in intervention. High levels of family involvement correlated with positive language outcomes, and, conversely, limited family involvement was associated with significant child language delays at 5 years of age, especially when enrollment in intervention was late. The results suggest that success is achieved when early identification is paired with early interventions that actively involve families.

Parents' use of Signing Exact English: a descriptive analysis.

Parental use of simultaneous communication is advocated by many programs serving hearing-impaired students. The purpose of the present study was to describe in detail the input characteristics of five hearing parents, who were attempting to use one such system, Signing Exact English or SEE 2 (Gustason, Pfetzing, & Zawolkow, 1980). The parents were intermediate-level signers, motivated to use SEE 2. Voiced and signed segments from videotaped language samples were transcribed and coded for equivalence and other features of interest. Results were that parents' signed mean lengths of utterance (MLUs) were lower than those of their children although the majority of their sign utterances were syntactically intact. Structures categorized as complex in the Developmental Sentence Scoring procedure (Lee, 1974) and considered abstract in a semantic coding scheme (Lahey, 1988) were seldom used by the parents. Parents provided a narrow range of lexical items in their sign code. Results are discussed in terms of the type of input the parents are providing and the procedures used to identify priorties for parent education.

Enhancing parents' use of SEE-2. Progress and retention.

This study documented the changes in spoken and signed input of five hearing parents to their hearing-impaired children over a 12-month time period. Two baseline sessions per parent were videotaped and analyzed (Moeller & Luetke-Stahlman, 1990), and then two intervention sessions and one retention session were filmed. Parents were seen individually by one author of this study after each session and given feedback on specific characteristics of their communication abilities. Transcription sheets, graphs, and their child's IEP (Individual Educational Plan) objective were used to help parents target goals for improvement. All parents improved in at least one linguistic area of need, and several parents changed impressively in form, content, and use of Manually Coded English. These improvements allowed the parents to completely and consistently provide comprehensible messages to their children.

Nonverbal intelligence and English language ability in deaf children.

The relationship between nonverbal intelligence and English language ability in a sample of 25 deaf children between the ages of 6-10 was examined. Intelligence measure included the Performance Scale of the Wechsler Intelligence Scale for Children-Revised (Wechsler, 1974) and the Hiskey-Nebraska Test of Learning Aptitude (Hiskey, 1966). Language measures were the Test of Language Development (Newcomer & Hammill, 1977) and the Reynell Developmental Language Scales (Reynell, 1977). Average correlations of .45 were obtained between nonverbal IQ and the language measures. The average multiple correlation between the individual subtests from the intelligence scales and language scores was .68. Subtests which require visual memory consistently entered the multiple regression equations as the best predictors of language performance. Language performance was attenuated in this sample and did not correlate with chronological age. The finding of significant correlations between nonverbal IQ and English language, in spite of the attenuated language performance, suggests that nonverbal intelligence and visual memory skills, in particular, may be important in understanding the success of some hearing-impaired children in acquiring English and the failure of others.

Longitudinal study of FM system use in nonacademic settings: effects on language development.

OBJECTIVE: The overall objective of the present study was to assess the efficacy of FM system use in the home setting for a group of preschool children with mild-to-severe sensorineural hearing loss. Changes in language acquisition were monitored and compared with similar measures from a group of children who used hearing aids. Secondarily, the perceived benefits and practical problems associated with FM system use across a variety of nonacademic situations were documented. DESIGN: Ten children with mild-to-severe sensorineural hearing loss participated in a 2-yr longitudinal study investigating the efficacy of FM system use in the home setting. The subjects were divided into two groups: one group was instructed to use FM systems at home as often as possible while the other used only their personal hearing aids. Changes in language acquisition were monitored in both groups. Subjective benefit and the practical problems associated with use of FM systems outside of traditional academic environments were monitored via daily use logs, a weekly observation inventory, and a situational listening profile. RESULTS: The majority of children in both groups improved in all measures of language development over the study interval. Although there were relatively large individual differences in performance for some measures, no statistically significant differences between the FM and hearing aid users were found. However, some children in the FM group made unusually large gains in some aspects of language development over the study interval. In addition, both parents and children reported benefits of FM system use in specific listening situations. Throughout the 2-yr study, a number of practical problems associated with FM system use outside the classroom were identified. CONCLUSIONS: Formal language measures did not yield significant differences between the FM and HA groups, but some subjects had rates of language acquisition which suggested that FM system use may be beneficial in selected cases. In addition, subjective reports of FM system benefit suggest that appropriate use of the device may facilitate effective communication in a variety of listening situations. Although recent advances in FM system design may minimize some of the factors that reportedly restricted consistent FM use in this study, the complexities associated with the modes of operation and problems with FM interference remain issues that require consistent audiologic monitoring of FM system use in nonacademic environments.