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Outcomes of Children with Hearing Loss A study of children ages birth to six

Outcomes of Children with Hearing Loss A study of children ages birth to six. A study funded by the National Institutes of Health – National Institute on Deafness and Other Communication Disorders (NIH-NIDCD) Grant # DC009560. Overview of Today’s Presentation.

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Outcomes of Children with Hearing Loss A study of children ages birth to six

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  1. Outcomes of Children with Hearing Loss A study of children ages birth to six A study funded by the National Institutes of Health – National Institute on Deafness and Other Communication Disorders (NIH-NIDCD) Grant # DC009560 Boys Town National Research Hospital

  2. Overview of Today’s Presentation • What is known about this group of children? • What recent changes affect these children? • What research gaps remain & how will OCHL address them? • Who are we recruiting? • Why is new research important? Boys Town National Research Hospital

  3. Prevalence and Incidence • Every day, 33 babies (12,000 each year) are born in the United States with permanent hearing loss. • 3/1000 newborns have hearing loss. 1 Boys Town National Research Hospital

  4. Prevalence and Incidence • Incidence increases by school age to 6/1000. • late identification • late onset • progressive hearing losses • 930,000 children with mild to severe HL 6-19 years of age. 2 Boys Town National Research Hospital

  5. What Do We Know about Outcomes of Children Who are HH? • Most studies have focused on children with severe to profound hearing loss • Children with mild to severe hearing loss are at risk for poorer: • Language • Academics • Social skills • Psychological outcomes Boys Town National Research Hospital

  6. Children with a unilateral hearing loss are ten times as likely to be held back at least one grade.3 Children with minimal losses: 37% fail one grade 8% don’t have skills at grade level 12-41% receive educational assistance All degrees of HL place children at risk “Minimal Is not inconsequential” ~Fred Bess Boys Town National Research Hospital

  7. Speech Production & Language Outcomes • Phonemic and syllabic speech patterns are delayed even for children with mild to moderate HL 4-7 • Children are at risk for delayed: 8 • vocabulary • word learning • advanced syntax • morphology • social use of language Boys Town National Research Hospital

  8. Social Communication Outcomes • More likely than their peers to demonstrate concerns about making friends, being teased and being socially accepted 8 • Delays in the use of advanced language to explain complex cognitive processes and social reasoning skills (ex: recounting past events, making excuses) 9 • Social reasoning, Theory of Mind and narrative discourse skills • These skills are essential for social interactions and literacy development 10-12 Boys Town National Research Hospital

  9. Educational success is strongly tied to performance in language and communication skills 13-15 The extent to which HL limits development of language may reflect academic outcomes in school. Verbal IQ Speech Perception in Noise Localization Academic Outcomes Boys Town National Research Hospital

  10. What recent changes may promote better outcomes? • Earlier access to interventions • Universal Newborn Hearing Screening (UNHS) • Birth to three programs • Improved access to sound • Technological advances in amplification Boys Town National Research Hospital

  11. Universal New Born Hearing Screening (UNHS) • 96% of newborns are being screened at or shortly after birth • State programs are reporting lower incidence of hearing loss than has been reported in literature Boys Town National Research Hospital

  12. Universal New Born Hearing Screening (UNHS) • As many as 80% of mild bilateral and unilateral losses can be missed at birth 16 • Historically were identified later than children with severe to profound losses.17, 18 Boys Town National Research Hospital

  13. Need for ongoing monitoring of preschoolers… “After the newborn hearing screening and before starting school, there is no common event that currently exists to trigger a second hearing screening for young children.”19 Boys Town National Research Hospital

  14. Early Intervention prevents or minimizes communication delays • By first grade, children identified before 6 months are 1-2 years ahead of their later identified peers in language, cognitive and social skills. 17, 20, 21 • Parents of Early Identified Children are better prepared to implement EI goals 22 Boys Town National Research Hospital

  15. Early vs. Late Identification Boys Town National Research Hospital

  16. Early Identification must be linked to timely & effective EI services • In 2005, only 59% of newly identified infants registered to Part C services were actually enrolled 23 • Programs designed specifically to address hearing loss bring about better outcomes than general education programs 24 Boys Town National Research Hospital

  17. Advances in Amplification: Improved Access to Spoken Language • Frequency Compression Hearing Aids • Personal FM use at home and school • Increased bandwidth, directional microphones • Noise reduction Boys Town National Research Hospital

  18. Gaps in the Research • Reduced body of literature regarding children with hearing losses less than severe or profound. • What are the unique needs of these children • What else can we do to better serve them? • Limited research on the access to, benefits from, and outcomes of services for children with mild to severe hearing losses. • Is early identification and intervention helping to reduce speech, language and academic delays? Boys Town National Research Hospital

  19. Our Purpose • To understand the factors that lead to successor struggles for these children and their families. • Performance will be measured in these areas: • Speech and Language Development • Social Development • Academic Development • Hearing, listening and hearing aid status Boys Town National Research Hospital

  20. Why is the OCHL Study Important? • To date, the largest group of subjects consisted of a group of 40 children 8 • OCHL hopes to recruit 400 children across 4 states Boys Town National Research Hospital

  21. Evidenced Based Practices Professionals are looking for additional guidance concerning the management of these children. Boys Town National Research Hospital

  22. OCHL Goals • Measure the developmental, behavioral, and familial outcomes of children with mild to severe hearing loss. • Examine the background characteristics of the child and family. • Characterize intervention services and factors associated with service variations. Boys Town National Research Hospital

  23. Identify variance in age of fitting and type of hearing aid, and identify barriers in hearing aid use. Identify to what extent child, family, and community factors contribute to the access of intervention services and functional outcomes. OCHL Goals Boys Town National Research Hospital

  24. Mild to Severe Hearing Loss PTA of 25-75 dB HL (500, 1k, 2k, 4 kHz) Children who have one of the following types of HL: High Frequency Unilateral Sensorineural Permanent Conductive Mixed No major secondary disabilities (ex: CP, Down’s Syndrome, severe PDD) Speaks English and has at least one primary caregiver that speaks English in the home Age at entry: 6 months to 6 years, followed annually Target Population Boys Town National Research Hospital

  25. Audiological Information Tympanometry Audiogram Speech Perception Hearing aid verification Speech Production Articulation Speech Intelligibility Language Understanding and use of syntax vocabulary narrative discourse morphological use Social reasoning (Theory of Mind) Academic Spelling Reading comprehension Word recognition Math Verbal reasoning Psychosocial behavioral/cognitive Cognitive reasoning Social behavior Teacher reports Family outcomes Parenting Quality of life/ Family Life Satisfaction of service delivery Areas of Evaluation Boys Town National Research Hospital

  26. Value for Subjects • Testing results and information can be sent to schools/service providers to help with qualification and planning. • Monetary compensation for participation. • Nominate a friend to participate with you. • Control group of normal hearing children Boys Town National Research Hospital

  27. A comprehensive look at the demographics of this population. Understanding overall outcomes of children with mild to severe hearing loss. An overview of the access, efficiency and quality of service delivery. Future modifications of service provision. Value for Community Boys Town National Research Hospital

  28. Value for Community • By the time a child with hearing loss graduates from high school more than $400,000 per child can be saved in special education costs if the child is: • Identified early and • Given appropriate educational, medical and audiological services. • These savings in special education costs will pay for universal newborn hearing screenings and appropriate intervention services many times over. Boys Town National Research Hospital

  29. Participating Sites • University of Iowa Marlea O’Brien (800) 551-5601 • Boys Town National Research Hospital Merry Spratford (402) 452-5054 • University of North Carolina-Chapel Hill Melody Harrison (919) 966-9459 Boys Town National Research Hospital

  30. Works Cited • White, K. R. (1997). The scientific basis for newborn hearing screening: Issues and evidence. Invited keynote address to the Early Hearing Detection and Intervention (EHDI) Workshop sponsored by the Centers for Disease Control and Prevention, Atlanta, Georgia. • National Institute of Deafness and Communication Disorders. (2006). NICHD Statistical Report: prevalence of hearing loss in U.S. children, 2005 epidemiology and biostatistics program. • Bess, F. H., & Tharpe, A. M. (1986). Case history data on unilaterally hearing-impaired children. Ear and Hearing, 7(1), 14-19. • Eisenberg, L. S. (2007). Current State of Knowledge: Speech Recognition and Production in Children with Hearing Impairment. Ear and Hearing, 28, 766-772. • McGowan, R. S., Nittrouer, S., Chenausky, K. (2008). Speech Production in 12-Month-Old Children with and without Hearing Loss. Journal of Speech, Language, and Hearing Research, 51, 879-888. • Moeller, M.P., Hoover, B., Putman, C., Arbataitis, K., Bohnenkamp, G., Peterson, B., Wood, S., Lewis, D., Pittman, A., & Stelmachowicz, P. G. (2007). Vocalizations of infants with hearing loss compared with infants with normal hearing: Part I- Phonetic Development. Ear and Hearing, 28 (5), 605-627. • Moeller, M. P., Hoover, B., Putman, C., Peterson, B., Arbataitis, K., Bohnenkamp, G., Lewis, D., Estee, S., Pittman, A., & Stelmachowicz, P. G. (2007). Vocalizations of infants with hearing loss compared with infants with normal hearing: Part II- Transition to words. Ear and Hearing, 28 (5), 628-642. • Davis, J. M., Elfenbein, J., Schum, R., & Benler, R. A. (1986). Effects of mild and moderate hearing impairments on language, educational, and psychosocial behavior of children. Journal of Speech and Hearing Disorders, 51, 53-62. Boys Town National Research Hospital

  31. Works Cited • Sedey, A. L. (2004). Language of young deaf and hard-of-hearing children: What’s missing? Colorado Symposium on Deafness, Language, and Learning. Colorado Springs, Colorado. • Moeller, M. P., & Schick, B. S. (2005). Development of social understanding in children with hearing loss: Implications for audiologist. In R. C. Seewald & J. M. Bamford (Eds.), A Sound Foundation Through Early Amplification: Proceedings of the Third International Conference Stafa, Switzerland: Phonak AG. • Moeller, M.P., & Schick, B. S. (2006). Relations between mother-child talk and theory-of-mind understanding in deaf children. Child Development, 77(3), 751-766. • Peterson, C. C., & Siegal, M. (2000). Insights into theory of mind from deafness and autism. Mind and Language, 15, 123-45. • Catts, H., Fey, M., Zhang, X., & Tomblin, J. B. (2001). Estimating the risk of future reading difficulties in kindergarten children: A research-based model and its clinical implementation. Language, Speech, and Hearing Services in School, 32, 38-50. Moeller, M. P. (2000). Early intervention and language development in children who are deaf and hard of hearing. Pediatrics, 106(3), 1-9. • Scarborough, H. S. (1990). Very early language deficits in dyslexic children. Child Development, 61, 1728-43. • Tomblin, J. B. (2006). A normativist account of language-based learning disability. Learning Disabilities: Research and Practice, 21, 8-18. • Johnson, et al (2005). Pediatrics Boys Town National Research Hospital

  32. Works Cited • Harrison, M., & Roush, J. (1996). Age of suspicion, identification, and intervention for infants and young children with hearing loss: A national study. Ear and Hear., 17, 55-62. • Mace, A. L., Wallace, K. L., Whan, M. Q., & Stelmachowicz, P.G. (1991). Relevant factors in the identification of hearing loss. Ear and Hearing, 12, 287-93. • Ross, D., Holstrum, W.J., Gaffney, M., Green, D., Oyler, R.F., Gravel, J.S.  2008.  Hearing Screening and Diagnostic Evaluation of Children With Unilateral and Mild Bilateral Hearing Loss.  Trends in Amplification, 12(1), 27-34. • Yoshinaga-Itano, C., Sedey, A. L., Coulter, D. K., & Mehl, A. L. (1998). Language of early- and later- identified children with hearing loss. Pediatrics, 102, 1161-71. • Moeller, M. P. (2000). Early intervention and language development in cheildren who are deaf and hard of hearing. Pediatrics, 106(3), 1-9. • Calderon, R., Bargones, J., & Sidman, S. (1998). Characteristics of hearing families and their young deaf and hard of hearing children: Early intervention follow-up. Am. Ann. Of the Deaf, 143, 347-62. • Centers for Disease Control (2007). Preliminary Summary of 2005 National EHDI Data (Version 4). http://www.cdc.gov/ncbddd/ehdi/data.htm • Nittrouer, S., & Burton, L. T. (2003). The role of early language experience in the development of speech perception and language processing abilities in children with hearing loss. Volta Review, 103, 5-38. Boys Town National Research Hospital

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