Speech, language, functional communication, psychosocial outcomes and QOL in school-age children with congenital unilateral hearing loss.

Introduction: Children with early-identified unilateral hearing loss (UHL) might be at risk for delays in early speech and language, functional communication, psychosocial skills, and quality of life (QOL). However, a paucity of relevant research prohibits strong conclusions. This study aimed to provide new evidence relevant to this issue. Methods: Participants were 34 children, ages 9;0 to 12;7 (years;months), who were identified with UHL via newborn hearing screening. Nineteen children had been fitted with hearing devices, whereas 15 had not. Assessments included measures of speech perception and intelligibility; language and cognition; functional communication; psychosocial abilities; and QOL. Results and discussion: As a group, the children scored significantly below the normative mean and more than one standard deviation below the typical range on speech perception in spatially separated noise, and significantly below the normative mean on written passage comprehension. Outcomes in other aspects appear typical. There was however considerable within participant variation in the children's degree of hearing loss over time, raising the possibility that this pattern of results might change as children get older. The current study also revealed that participants with higher levels of nonverbal ability demonstrated better general language skills and better ability to comprehend written passages. By contrast, neither perception of speech in collocated noise nor fitting with a hearing device accounted for unique variance in outcome measures. Future research should, however, evaluate the fitting of hearing devices using random assignment of participants to groups in order to avoid any confounding influence of degree of hearing loss or children's past/current level of progress.

A validation and normative study of the Parents' Evaluation of Aural/Oral Performance of Children plus (PEACH+) rating scale in Malaysia.

OBJECTIVE: The purpose of the present study was to (1) translate and validate the PEACH + Rating Scale in Malay and (2) establish normative curves as a function of age and examine test-retest reliability for the Malay and English versions of PEACH+. DESIGN: This is a cross-sectional study that used a convenient sampling technique. STUDY SAMPLE: One hundred and fifty-seven parents of typically developing children aged between 4 months and 7 years participated in the study. Forty-nine completed the Malay PEACH + in a pen-to-paper format (Aim 1). One hundred and eight parents completed PEACH + online (69 completed the Malay version and 39 the English version), and 20 of them completed the questionnaire twice (Aim 2). RESULTS: The PEACH + in Malay showed high internal consistency and item-total correlation. The normative data revealed that scores for frequency of auditory behaviour increased rapidly with age until about 20 months and reached an asymptote of around 90% by about 40 months of age. A similar trend was observed for ease of listening scores, which asymptoted around 85%. CONCLUSIONS: The validated Malay PEACH + Rating Scale can be used as a guide to monitor auditory functional performance and listening efforts of Malaysian children in real-world environments.

Audiological characteristics of children with congenital unilateral hearing loss: insights into Age of reliable behavioural audiogram acquisition and change of hearing loss.

Objectives: The aims of this study were to report the audiological characteristics of children with congenital unilateral hearing loss (UHL), examine the age at which the first reliable behavioural audiograms can be obtained, and investigate hearing changes from diagnosis at birth to the first reliable behavioural audiogram. Method: This study included a sample of 91 children who were diagnosed with UHL via newborn hearing screening and had reliable behavioural audiograms before 7 years of age. Information about diagnosis, audiological characteristics and etiology were extracted from clinical reports. Regression analysis was used to explore the potential reasons influencing the age at which first reliable behavioural audiograms were obtained. Correlation and ANOVA analyses were conducted to examine changes in hearing at octave frequencies between 0.5 and 4 kHz. The proportions of hearing loss change, as well as the clinical characteristics of children with and without progressive hearing loss, were described according to two adopted definitions: Definition 1: criterion (1): a decrease in 10 dB or greater at two or more adjacent frequencies between 0.5 and 4 kHz, or criterion (2): a decrease in 15 dB or greater at one octave frequency in the same frequency range. Definition 2: a change of ≥20 dB in the average of pure-tone thresholds at 0.5, 1, and 2 kHz. Results: The study revealed that 48 children (52.7% of the sample of 91 children) had their first reliable behavioural audiogram by 3 years of age. The mean age at the first reliable behavioural audiogram was 3.0 years (SD 1.4; IQR: 1.8, 4.1). We found a significant association between children's behaviour and the presence or absence of ongoing middle ear issues in relation to the delay in obtaining a reliable behavioural audiogram. When comparing the hearing thresholds at diagnosis with the first reliable behavioural audiogram across different frequencies, it was observed that the majority of children experienced deterioration rather than improvement in the initial impaired ear at each frequency. Notably, there were more instances of hearing changes (either deterioration or improvement), in the 500 Hz and 1,000 Hz frequency ranges compared to the 2,000 Hz and 4,000 Hz ranges. Seventy-eight percent (n = 71) of children had hearing deterioration between the diagnosis and the first behavioural audiogram at one or more frequencies between 0.5 and 4 kHz, with a high proportion of them (52 out of the 71, 73.2%) developing severe to profound hearing loss. When using the averaged three frequency thresholds (i.e., definition 2), only 26.4% of children (n = 24) in the sample were identified as having hearing deterioration. Applying definition 2 therefore underestimates the proportion of children that experienced hearing changes. The study also reported diverse characteristics of children with or without hearing deterioration. Conclusion: The finding that 78% of children diagnosed with UHL at birth had a decrease in hearing loss between the hearing levels at first diagnosis and their first behavioural audiogram highlights the importance of monitoring hearing threshold levels after diagnosis, so that appropriate intervention can be implemented in a timely manner. For clinical management, deterioration of 15 dB at one or more frequencies that does not recover warrants action.

List Equivalency and Critical Differences of a Mandarin Bamford-Kowal-Bench Sentence in Babble Noise Test for Adults and Preschool Children With Normal Hearing.

PURPOSE: The purpose of this study was to determine the speech recognition equivalence of Mandarin Bamford-Kowal-Bench (BKB) sentence lists with adults and children with normal hearing. METHOD: A total of 32 lists, each of nine sentences, were compiled from a corpus of BKB-like sentences with paired babble in Mandarin. Interlist equivalence, critical differences, and sensitivity of performance to signal-to-noise ratio (SNR) were examined. Experiment 1 included 64 native Mandarin-speaking adults with normal hearing. Experiment 2 included 54 native Mandarin-speaking children with normal hearing aged 4-6 years. RESULTS: Among the 32 sentence lists, 28 lists were confirmed to be equivalent in adults, with a mean SNR required for 50% correct (SNR50) of -5.9 ± 0.1 dB, a mean slope of 22.3%/dB ± 1.5%/dB, and a grand 95% critical difference subsequently calculated as 27.2% for score. From the 28 equivalent lists, 27 lists were selected and observed to be equivalent in children, with a mean SNR50 threshold of -2.0 ± 0.2 dB, a mean slope of 15.8%/dB ± 1.1%/dB, and a grand 95% critical difference of 24.6% for score. CONCLUSIONS: The Mandarin BKB sentences in babble noise test offers an opportunity for clinicians and researchers to assess speech understanding in adults and preschool children in an efficient manner. For comparisons of performance in different test conditions, 28 equivalent lists are available for adults and 27 equivalent lists for preschool children. The 95% critical difference values can be used for total percentage correct or SNR for 50% performance. Future work will examine the clinical utility for school-age children and children who are deaf and hard of hearing. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24400066.

Mild matters: trial learnings and importance of community engagement in research for early identified bilateral mild hearing loss.

Introduction: Early identification of mild hearing loss has resulted in early hearing amplification without adequate evidence of effectiveness. This paper describes learnings from a pilot trial, combined with a qualitative study, to highlight the importance of community engagement in designing research studies to determine whether early amplification benefits young children with bilateral mild hearing loss. Methods: PART 1 of the study is a proof-of-concept non-blinded multi-centre randomised controlled trial (RCT) of hearing device fitting vs. no fitting aimed to gather preliminary data and determine its acceptability/feasibility in children <2 years old with bilateral mild hearing loss. Results: PART 2 is a qualitative study to understand the barriers/enablers to RCT participation. Of 40 potentially eligible families, nine (23%) declined, three were uncontactable (7%), 26 (65%) ineligible: of these, nine (35%) did not meet hearing threshold inclusion criteria, 11 (42%) were already fitted or had made decisions on fitting hearing device, two (7%) had conductive loss and four (16%) were ineligible for other reasons. Two of 11 (18%) eligible families were randomised. With the limited sample size, outcome measures were not compared between groups. Both participants completed the trial, reported the RCT to be acceptable, and neither changed group post-enrolment. Discussion: Whilst recruitment uptake could potentially be increased by altering the eligibility criteria, better communication with and reimbursement of clinicians as recruiters, and improving awareness of the study amongst external stakeholders, the RCT methodology does not conform to family-centred practice, and potentially raises ethical concerns regarding potential adverse consequences of not offering early amplification. Parental perception of losing control over choice of management due to randomisation is not an easily modifiable factor. Alternative methodological approaches without randomisation are required to determine whether hearing amplification benefits infants with mild hearing loss.Clinical Trial Registration: identifier [ACTRN12618001608257].

Acoustic change complex for assessing speech discrimination in normal-hearing and hearing-impaired infants.

OBJECTIVE: This study examined (1) the utility of a clinical system to record acoustic change complex (ACC, an event-related potential recorded by electroencephalography) for assessing speech discrimination in infants, and (2) the relationship between ACC and functional performance in real life. METHODS: Participants included 115 infants (43 normal-hearing, 72 hearing-impaired), aged 3-12 months. ACCs were recorded using [szs], [uiu], and a spectral rippled noise high-pass filtered at 2 kHz as stimuli. Assessments were conducted at age 3-6 months and at 7-12 months. Functional performance was evaluated using a parent-report questionnaire, and correlations with ACC were examined. RESULTS: The rates of onset and ACC responses of normal-hearing infants were not significantly different from those of aided infants with mild or moderate hearing loss but were significantly higher than those with severe loss. On average, response rates measured at 3-6 months were not significantly different from those at 7-12 months. Higher rates of ACC responses were significantly associated with better functional performance. CONCLUSIONS: ACCs demonstrated auditory capacity for discrimination in infants by 3-6 months. This capacity was positively related to real-life functional performance. SIGNIFICANCE: ACCs can be used to evaluate the effectiveness of amplification and monitor development in aided hearing-impaired infants.

Predicting 9-Year Language Ability from Preschool Speech Recognition in Noise in Children Using Cochlear Implants.

The presence of congenital permanent childhood hearing loss has a negative impact on children's development and lives. The current literature documents weaknesses in speech perception in noise and language development in many children with hearing loss. However, there is a lack of clear evidence for a longitudinal relationship between early speech perception abilities and later language skills. This study addressed the evidence gap by drawing on data collected as part of the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. Cross-lagged regression analyses were used to examine the influence of speech perception in noise at age 5 years on language ability at age 9 years and vice versa (i.e. the influence of language ability at age 5 years on speech perception in noise at age 9 years). Data from 56 children using cochlear implants were analysed. We found that preschool speech perception in noise was a significant predictor of language ability at school age, after controlling for the effect of early language. The findings lend support to early intervention that targets the improvement of language skills, but also highlight the need for intervention and technology to enhance young children's auditory capabilities for perceiving speech in noise in early childhood so that outcomes of children with hearing loss in school can be maximized.

Audiologists' perspectives on management of mild bilateral hearing loss in infants and young children.

OBJECTIVE: Universal newborn hearing screening programs have led to early identification of infants with congenital mild bilateral hearing loss (MBHL). The current lack of evidence-based protocols to guide audiological management of infants with MBHL has led to clinical equipoise about fitting of hearing aids. The purpose of this study was to increase understanding about the perspectives of paediatric audiologists on factors influencing their management of MBHLin infants and young children. DESIGN: A qualitative descriptive research methodology involving semi-structured interviews with audiologists. STUDY SAMPLE: Twenty-three paediatric audiologists in diagnostic and rehabilitation settings in Victoria, Australia. RESULTS: Three main themes that influenced management were identified. These include: (1) evidence, or the lack of it, influences audiologists' practice; (2) audiologists recognise the need to be fluid; and (3) family characteristics and parents' perspectives. "Audiologists delivering family-centred practice" was identified as an overarching theme across these factors. CONCLUSIONS: Audiologists recognised the importance of adopting a family-centred approach in their management of MBHL in infants and young children. Embodied in their practice was the acknowledgement of limited evidence, the consideration of multiple child and family factors, and the incorporation of perspectives of parents and families in adopting a fluid approach to provide individualised services.

Mild matters: parental insights into the conundrums of managing mild congenital hearing loss.

OBJECTIVE: To explore and describe parental experiences related to the management of mild bilateral congenital hearing loss in children. DESIGN: Using qualitative methods, we conducted semi-structured interviews with parents/caregivers until saturation of themes was achieved. We analysed transcripts using inductive content analysis. STUDY SAMPLE: Caregivers of children under 3-years-old with mild bilateral sensorineural hearing loss. RESULTS: We interviewed 12 parents. Parental perception of advice regarding hearing aid fitting was varied; almost all children were offered hearing aids. Perceived positives related to hearing aids: feeling empowered that action has been taken; improvements in the child's hearing perception and; facilitation of behavioural management. Perceived negatives of hearing aid use: difficulties with compliance resulting in parental frustration and guilt, damage/loss of equipment, discomfort, parental discord, altered quality of natural sound and potential bullying/stigma. Some parents were ambivalent about the effect of the hearing aids. Where hearing aids were offered and not fitted, there was significant ongoing uncertainty, and the family carried the burden of their decision. CONCLUSIONS: There was a wide variation in perceived advice regarding early hearing aid fitting in children with mild bilateral hearing loss. We identified parental perceptions of positive/negative impacts of hearing aid fitting and potential perceived harms from not fitting.

The Chinese version of the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) rating scale for infants and children with normal hearing.

OBJECTIVE: This study aimed to establish Chinese norms for the Chinese version of the Parent's Evaluation of Aural/Oral of Children (PEACH) rating scale. DESIGN AND STUDY SAMPLE: The PEACH scores were collected from 198 parents whose children have normal hearing. The test-retest reliability of the PEACH scale was evaluated in a subgroup of 34 parents. Another 27 parents also filled out a Putonghua Communicative Development Inventory which was used to explore the relationship between the PEACH ratings and language scores. RESULTS: The normative curve was established using a logit regression function. The total scores increase rapidly with increasing age. A plateau starts from 22 months with the PEACH score reaching 90% and achieves the maximum score of 95% by 47 months of age. The test-retest analyses showed high reliability for all subscales, with all the correlation coefficients values exceeding 0.9 (p < 0.01). The 90% and 95% confidence intervals were provided to facilitate evaluation of differences between scores obtained under different conditions. A significant correlation was found between the PEACH total score and language performance (p < 0.05). CONCLUSIONS: Normative data from the Chinese population was provided to enable performance of an individual child to be related to their normally hearing peers.

An Economic Evaluation of Australia's Newborn Hearing Screening Program: A Within-Study Cost-Effectiveness Analysis.

OBJECTIVES: Hearing loss is one of the most prevalent congenital disorders among children. Many countries have implemented universal newborn hearing screening (UNHS) for the early diagnosis and treatment of hearing loss. Despite widespread implementation, the value for money of UNHS is unclear due to lack of cost and outcomes data from rigorous study designs. The objective of this research is to conduct a within-study cost-effectiveness analysis of UNHS compared with targeted screening (targeting children with risk factors of hearing loss) from the Australian healthcare system perspective. This evaluation is the first economic evaluation to assess the cost-effectiveness of UNHS compared to targeted screening using real-world data from a natural experiment. DESIGN: The evaluation assumed the Australian healthcare system perspective and considered a time horizon of 5 years. Utilities were estimated using responses to the Health Utilities Index Mark III. Screening costs were estimated based on the Victorian Infant Hearing Screening Program. Ongoing costs were estimated based on administrative data, while external data sources were used to estimate costs related to hearing services. Missing data were handled using the multiple imputation method. Outcome measures included quality-adjusted life years (QALYs) and four language and communication-related outcomes: Peabody Picture Vocabulary Test, Wechsler Nonverbal Scale of Ability, Progressive Achievement Test, and comprehensive, expressive, and total language scores based on the Preschool Language Scale. RESULTS: On average, the UNHS cost an extra Australian dollar (A$)22,000 per diagnosed child and was associated with 0.45 more QALYs per diagnosed child compared with targeted screening to 5 years, resulting in an incremental cost-effectiveness ratio (ICER) of A$48,000 per QALY gained. The ICERs for language outcomes lay between A$3,900 (for expressive language score) and A$83,500 per one-point improvement in language score (for Wechsler Nonverbal Scale of Ability). UNHS had a 69% probability of being more cost-effective compared to targeted screening at a willingness to pay threshold of A$60,000 per QALY gained. ICERs were most sensitive to the screening costs. CONCLUSIONS: The evaluation demonstrated the usefulness of a within-study economic evaluation to understand the value for money of the UNHS program in the Australian context. Findings from this evaluation suggested that screening costs were the key driver of cost-effectiveness results. Most outcomes were not significantly different between UNHS and targeted screening groups. The ICER may be overestimated due to the short follow-up period. Further research is warranted to include long-term resource use and outcome data, late diagnosis, transition and remission between severity levels, and timing of diagnosis and treatment.

Development and Evaluation of a Language-Independent Test of Auditory Discrimination for Referrals for Cochlear Implant Candidacy Assessment.

OBJECTIVES: The purpose of this study was to (1) develop a Language-independent Test of Auditory Discrimination (LIT-AD) between speech sounds so that people with hearing loss who derive limited speech perception benefits from hearing aids (HAs) may be identified for consideration of cochlear implantation and (2) examine the relationship between the scores for the new discrimination test and those of a standard sentence test for adults wearing either HAs or cochlear implants (CIs). DESIGN: The test measures the ability of the listener to correctly discriminate pairs of nonsense syllables, presented as sequential triplets in an odd-one-out format, implemented as a game-based software tool for self-administration using a tablet computer. Stage 1 included first a review of phonemic inventories in the 40 most common languages in the world to select the consonants and vowels. Second, discrimination testing of 50 users of CIs at several signal to noise ratios (SNRs) was carried out to generate psychometric functions. These were used to calculate the corrections in SNR for each consonant-pair and vowel combination required to equalize difficulty across items. Third, all items were individually equalized in difficulty and the overall difficulty set. Stage 2 involved the validation of the LIT-AD in English-speaking listeners by comparing discrimination scores with performance in a standard sentence test. Forty-one users of HAs and 40 users of CIs were assessed. Correlation analyses were conducted to examine test-retest reliability and the relationship between performance in the two tests. Multiple regression analyses were used to examine the relationship between demographic characteristics and performance in the LIT-AD. The scores of the CI users were used to estimate the probability of superior performance with CIs for a non-CI user having a given LIT-AD score and duration of hearing loss. RESULTS: The LIT-AD comprises 81 pairs of vowel-consonant-vowel syllables that were equalized in difficulty to discriminate. The test can be self-administered on a tablet computer, and it takes about 10 min to complete. The software automatically scores the responses and gives an overall score and a list of confusable items as output. There was good test-retest reliability. On average, higher LIT-AD discrimination scores were associated with better sentence perception for users of HAs (r = -0.54, p <0.001) and users of CIs (r = -0.73, p <0.001). The probability of superior performance with CIs for a certain LIT-AD score was estimated, after allowing for the effect of duration of hearing loss. CONCLUSIONS: The LIT-AD could increase access to CIs by screening for those who obtain limited benefits from HAs to facilitate timely referrals for CI candidacy evaluation. The test results can be used to provide patients and professionals with practical information about the probability of potential benefits for speech perception from cochlear implantation. The test will need to be evaluated for speakers of languages other than English to facilitate adoption in different countries.

Predicting Quality of Life and Behavior and Emotion from Functional Auditory and Pragmatic Language Abilities in 9-Year-Old Deaf and Hard-of-Hearing Children.

Children who are deaf or hard of hearing (DHH) are likely to exhibit difficulties in development of psychosocial skills, pragmatic language skills, and use of hearing for social communication in real-world environments. Some evidence suggests that pragmatic language use affects peer-relationships and school engagement in these children. However, no studies have investigated the influence of functional auditory performance and use of language and speech in real-world environments on children's behavior and emotion, and on their health-related quality of life. This study explored the relationship in DHH children at 9 years of age. Data from 144 participants of the Longitudinal Outcomes of Children with Hearing Impairment study were analyzed. Parent reports were obtained on quality of life, behavior and emotion, pragmatic language skills, and auditory functional performance of children in real life. Children's spoken language abilities and speech intelligibility were assessed by research speech pathologists. On average, performance of children in all domains was within the range of typically developing peers. There were significant associations among functional auditory performance, use of speech and language skills, psychosocial skills, and quality of life. Multiple linear regression analyses revealed that better auditory functional performance and pragmatic language skills, rather than structural language abilities, were associated with better psychosocial abilities and quality of life. The novel findings highlight the importance of targeted intervention for improving functional hearing skills and social communication abilities in DHH children, and emphasize the importance of collaborative approaches among medical, audiology, allied health, and educational professionals to identify those at risk so that timely referral and intervention can be implemented for improving psychosocial health and well-being in DHH children.

Relationship between objective measures of hearing discrimination elicited by non-linguistic stimuli and speech perception in adults.

Some people using hearing aids have difficulty discriminating between sounds even though the sounds are audible. As such, cochlear implants may provide greater benefits for speech perception. One method to identify people with auditory discrimination deficits is to measure discrimination thresholds using spectral ripple noise (SRN). Previous studies have shown that behavioral discrimination of SRN was associated with speech perception, and behavioral discrimination was also related to cortical responses to acoustic change or ACCs. We hypothesized that cortical ACCs could be directly related to speech perception. In this study, we investigated the relationship between subjective speech perception and objective ACC responses measured using SRNs. We tested 13 normal-hearing and 10 hearing-impaired adults using hearing aids. Our results showed that behavioral SRN discrimination was correlated with speech perception in quiet and in noise. Furthermore, cortical ACC responses to phase changes in the SRN were significantly correlated with speech perception. Audibility was a major predictor of discrimination and speech perception, but direct measures of auditory discrimination could contribute information about a listener's sensitivity to acoustic cues that underpin speech perception. The findings lend support for potential application of measuring ACC responses to SRNs for identifying people who may benefit from cochlear implants.

Considering the impact of Universal Newborn Hearing Screening and early intervention on language outcomes for children with congenital hearing loss.

OBJECTIVE: In this paper we draw on evidence to address the impact of earlier identification of congenital hearing loss through universal newborn hearing screening (UNHS) and the associated earlier access to interventions including cochlear implant technology on outcomes of children with hearing loss. METHOD: Data from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study were analyzed to examine the impact of UNHS and earlier intervention on language outcomes. The LOCHI study includes more than 450 deaf and hard of hearing Australian children whose hearing losses were identified variously through newborn hearing screening or later paths to confirmation and intervention. RESULTS: Seventy-two percent of the screened group received hearing aid fitting before 6 months of age, which more than doubled the 32% in the non-screened group. On average, children who received earlier intervention achieved language at age 5 years commensurate with their typically developing peers. Children who do not have disabilities in addition to hearing loss and received their first cochlear implants before age 12 months achieved language scores within the range of typically developing peers. CONCLUSION: Newborn hearing screening led to earlier intervention. Children who received earlier intervention achieved better outcomes than those who received later intervention.

Early Cognitive Predictors of 9-Year-Old Spoken Language in Children With Mild to Severe Hearing Loss Using Hearing Aids.

This study examined the extent to which cognitive ability at 5 years of age predicted language development from 5 to 9 years of age in a population-based sample of children with hearing loss who participated in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. The developmental outcomes of 81 children with hearing loss were evaluated at 5 and 9 years of age. Hearing loss ranged from mild to severe degrees, and all participants used hearing aids. They all used spoken language as the primary mode of communication and education. Nine-year-old language was assessed using the Clinical Evaluation of Language Fundamentals - 4th edition (CELF-4), the Peabody Picture Vocabulary Test - 4th edition (PPVT-4), and the Expressive Vocabulary Test - 2nd edition (EVT-2). Multiple regression analyses were conducted to examine the extent to which children's scores on these standardized assessments were predicted by their cognitive ability (non-verbal IQ and verbal working memory) measured at 5 years of age. The influence of early language scores at 5 years and a range of demographic characteristics on language scores at 9 years of age was evaluated. We found that 5-year-old digit span score was a significant predictor of receptive and expressive language, but not receptive or expressive vocabulary, at 9 years of age. Also, 5-year-old non-word repetition test score was a significant predictor of only expressive language and vocabulary, but not receptive language or vocabulary at 9 years of age. After allowing for the effects of non-verbal IQ and 5-year-old receptive vocabulary, early digit span score (but not non-word repetition score) was a significant predictor of expressive and receptive language scores at 9 years of age. The findings shed light on the unique role of early verbal working memory in predicting the development of receptive and expressive language skills and vocabulary skills in children who use hearing aids.

Correction to: Economic Evaluations of Childhood Hearing Loss Screening Programmes: A Systematic Review and Critique.

The third author's first name should have been spelled "Teresa" rather than "Theresa".

Economic Evaluations of Childhood Hearing Loss Screening Programmes: A Systematic Review and Critique.

BACKGROUND: Permanent childhood hearing loss is one of the most common birth conditions associated with speech and language delay. A hearing screening can result in early detection and intervention for hearing loss. OBJECTIVES: To update and expand previous systematic reviews of economic evaluations of childhood hearing screening strategies, and explore the methodological differences. DATA SOURCES: MEDLINE, Embase, the Cochrane database, National Health Services Economic Evaluation Database (NHS EED), the Health Technology Assessment (HTA) database, and Canadian Agency for Drugs and Technologies in Health's (CADTH) Grey matters. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Economic evaluations reporting costs and outcomes for both the intervention and comparator arms related to childhood hearing screening strategies. RESULTS: Thirty evaluations (from 29 articles) were included for review. Several methodological issues were identified, including: few evaluations reported outcomes in terms of quality-adjusted life years (QALYs); none estimated utilities directly from surveying children; none included disutilities and costs associated with adverse events; few included costs and outcomes that differed by severity; few included long-term estimates; none considered acquired hearing loss; some did not present incremental results; and few conducted comprehensive univariate or probabilistic sensitivity analysis. Evaluations published post-2011 were more likely to report QALYs and disability-adjusted life years (DALYs) as outcome measures, include long-term treatment and productivity costs, and present incremental results. LIMITATIONS: We were unable to access the economic models and, although we employed an extensive search strategy, potentially not all relevant economic evaluations were identified. CONCLUSIONS AND IMPLICATIONS: Most economic evaluations concluded that childhood hearing screening is value for money. However, there were significant methodological limitations with the evaluations.

Maternal education influences Australian infants' language experience from six months.

Disparities in children's early language skills associated with socioeconomic factors have led to many studies examining children's early language environments, but few as yet in the first year of life. This longitudinal study assessed the home language environments of 50 Australian infants, who varied in maternal education (university education, or not). Full-day audio recordings were collected and analyzed using the LENA system when infants were aged 6-9 months and 12-15 months. Using the device-specific analysis software, we assessed 12-h projected counts of (1) adult speech input, (2) conversational interactions, and (3) child vocalizations. At both ages, higher maternal education was associated with higher counts of adult words and conversational turns, but not child vocalizations. The study adds to the literature by demonstrating disparities in the infants' language experience within the first year of life, related to mothers' education, with implications for early intervention and parenting supports.