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Lisa Honigfeld, Ph.D. Child Health and Development Institute of Connecticut Brenda Balch, M.D.

Pediatrician's Connection of Children to Hearing Evaluation Services Following ASD Screening: An Important Opportunity for Hearing Evaluation. Lisa Honigfeld, Ph.D. Child Health and Development Institute of Connecticut Brenda Balch, M.D. CT AAP Chapter Champion. Conflicts of Interest.

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Lisa Honigfeld, Ph.D. Child Health and Development Institute of Connecticut Brenda Balch, M.D.

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  1. Pediatrician's Connection of Children to Hearing Evaluation Services Following ASD Screening:An Important Opportunity for Hearing Evaluation Lisa Honigfeld, Ph.D. Child Health and Development Institute of Connecticut Brenda Balch, M.D. CT AAP Chapter Champion

  2. Conflicts of Interest Presenters do not have any conflicts and have filed statements with the EHDI Meeting Administration.

  3. Today’s Talk • Developmental/Autism screening as an aid in detecting young children with late onset/progressive hearing loss • Risk for late onset/progressive hearing loss • Improving detection of young children who have late onset/progressive losses

  4. AAP Recommendation Primary care providers regularly screen young children to identify development concerns Including: general developmental screening @ 9,18, & 24-30 months specific screening for autism@ 18 and 24-30 months

  5. Autism Screening… M-CHAT @ 18 & 24 months • parent completed • 23 item questionnaire • free of charge • available in several languages

  6. Select M-CHAT Items • **Does your child respond to his/her name when you call? • **Have you ever wondered if your child is deaf? • Does your child understand what people say? ** “critical items”

  7. Scoring the M-CHAT “failing” 2 of 6 “critical” items, or any 3 items: refer for evaluation “failing”> 8 is virtually diagnostic: refer for evaluation/services

  8. What we learned about pediatricians’ follow-up when children show concerns from M-CHAT screening

  9. Further evidence for the need for resources to help connect children to hearing services after the newborn period From a cohort of 5 practices currently completing the ASD MOC activity: • Only 5 of 10 (50%) children who showed concern on M-CHAT screening were connected to hearing evaluation services

  10. What Pediatricians Told Us About Hearing Evaluations Following Failed M-CHATS • One of our patients refused audiology. Our practice has discussed how we can better handle refusals. • We have gotten a lot better at ordering audiology evaluations now that we know their relationship to failed M-CHAT screenings. • We actually had twins who were found to have hearing loss and not autism….and they both passed hospital newborn hearing screening.

  11. What Can We Do To Capture Those Infants Who Passed Newborn Hearing Screen But Have Late-onset Or Progressive Hearing Loss? • Always solicit parental concerns about hearing and communication • Do developmental screening per the AAP’s recommendation (9, 18, 30 month visits) • Use the M-CHAT screening to highlight connection of children ages 18-24 months to audiology services

  12. First Evaluate Hearing! • Any child • Any age • Any concerns about • Communication • Social responsiveness

  13. Prevalence of Hearing Loss Over Time The prevalence of hearing loss in neonates is .3% and increases in older age groups.

  14. RECOMMENDATIONS • Joint Committee on Infant Hearing (2007) recommends at least one diagnostic audiology evaluation between 24 and 30 months for those infants with at least one risk factor for hearing loss • CT EHDI Task Force recommends PCP consider audiology evaluations every 6 months until age 3 for those infants with risk factors for hearing loss

  15. Risk Indicators for Hearing Loss Caregiver concern regarding hearing, speech, language or developmental delay *Family history of PCHL * NICU care >5 days • *May include extracorporeal membrane oxygenation (ECMO) assisted ventilation • Exposure to ototoxic medications (gentamycin and tobramycin) or loop diuretics (furosemide/lasix) • Hyperbilirubinemia requiring exchange transfusion * Are of greater concern for delayed onset hearing loss. Source: Joint Committee on Infant Hearing

  16. Risk Indicators Associated with Permanent Early Onset and/or Late Progressive Hearing Loss In-utero infections such as *cytomegalovirus, herpes, rubella, syphilis, and toxoplasmosis Craniofacial anomalies, including those involving the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies Physical findings such as white forelock, associated with a syndrome known to include a sensorineural or permanent conductive hearing loss Chemotherapy * Are of greater concern for delayed onset hearing loss. Source: Joint Committee on Infant Hearing

  17. Risk Indicators for Hearing Loss Syndromes associated with hearing loss or progressive or late onset hearing loss* such as neurofibromatosis and osteopetrosis as well as Usher’s, Waardenburg ,Alport ,Pendred and Jervell and Lange-Nielson syndromes *Neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich’s ataxia and Charcot-Marie-Tooth syndrome *Culture positive postnatal infections associated with sensorineural hearing loss • Confirmed bacterial and viral (especially herpes viruses and varicella) meningitis *Are of greater concern for delayed onset hearing loss Source: Joint Committee on Infant Hearing

  18. Encourage PCPs to Do Regular Developmental Surveillance and Screening and Monitor Auditory Skills National survey of children’s health 2011/2012: percent of children age 10 months to 5 years who received standardized screening for developmental or behavior concerns only 30.8%

  19. Progress in CT on Developmental Screening

  20. In Connecticut: Continue To Engage PCPs In Education About Hearing Loss • Epic modules-uses academic detailing to the whole practice to change behavior • MD to MD Program-MD provides direct education, consultation and guidance to the PCP of children with hearing loss • MOC-American Board of Pediatrics Maintenance of Certification; Part IV, evidence of satisfactory performance in practice

  21. Additional Resources In CT • Birth to Three (Early Intervention) • Pediatric audiologists • Speech and language pathologists • Otolaryngology services • CT DPH EHDI program • CT Hands & Voices • CT Parent Advocacy Center • NICHQ Learning Collaborative

  22. In Progress • Committee on public health is presently reviewing bill 5147: • An act concerning newborn screening for globoid cell leukodystrophy and cytomegalovirus and establishing a public education program for cytomegalovirus • CMV is the most common IU infection in the US • Approximately 30-50% of symptomatic and 8-12% of asymtomatic babies with congenital CMV will develop sensorineural hearing loss

  23. Recommendations for Moving Forward • Implement the tracking of late-onset and progressive hearing loss to document trends and identify system gaps. This would require developing a mechanism for audiologists to report on late-onset and progressive hearing loss. • Collect and track data on dual diagnoses - hearing loss and autism. Recent studies suggest that children with hearing loss are twice as likely to have autism, especially those with severe or profound hearing loss.

  24. Questions? Lisa Honigfeld, Ph.D. honigfeld@uchc.edu Brenda Balch, M.D. bkbalch@sbcglobal.net

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