THE POSITION STATEMENT The Joint Committee on Infant Hearing (JCIH) endorses early detection of and intervention for infants with hearing loss. The goal of early hearing detection and intervention (EHDI) is to maximize linguistic competence and literacy development for children who are deaf or hard of hearing. Without appropriate opportunities to learn language, these children will fall behind their hearing peers in communication, cognition, reading, and social-emotional development. Such delays may result in lower educational and employment levels in adulthood.1 To maximize the outcome for infants who are deaf or hard of hearing, the hearing of all infants should be screened at no later than 1 month of age. Those who do not pass screening should have a comprehensive audiological evaluation at no later than 3 months of age. Infants with confirmed hearing loss should receive appropriate intervention at no later than 6 months of age from health care and education professionals with expertise in hearing loss and deafness in infants and young children. Regardless of previous hearing-screening outcomes, all infants with or without risk factors should receive ongoing surveillance of communicative development beginning at 2 months of age during well-child visits in the medical home.2 EHDI systems should guarantee seamless transitions for infants and their families through this process.

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Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs

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.

Early Intervention and Language Development in Children Who Are Deaf and Hard of Hearing

The implementation of universal screening programs to detect hearing defects in newborns has dramatically increased the identification of hearing loss in infants. Recent advances in understanding the nature and causes of prelingual hearing loss, combined with advances in technology, suggest that further improvement in these programs can readily be achieved.

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Newborn Hearing Screening — A Silent Revolution

ObjectiveInsertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ea...

https://journals.sagepub.com/doi/pdf/10.1177/0194599813487302

Clinical Practice Guideline Tympanostomy Tubes in Children

The Joint Committee on Infant Hearing (JCIH) endorses early detection of, and intervention for infants with hearing loss (early hearing detection and intervention, [EHDI]) through integrated, interdisciplinary state and national systems of universal newborn hearing screening (UNHS), evaluation, and family-centered intervention. The goal of EHDI is to maximize linguistic and communicative competence and literacy development for children who are hard of hearing or deaf. Without appropriate opportunities to learn language, children who are hard of hearing or deaf will fall behind their hearing peers in language, cognition, and social-emotional development. Such delays may result in lower educational and employment levels in adulthood (Gallaudet University Center for Assessment and Demographic Study, 1998). Thus, all infants' hearing should be screened using objective, physiologic measures to identify those with congenital or neonatal onset hearing loss. Audiologic evaluation and medical evaluations should be in progress before 3 months of age. Infants with confirmed hearing loss should receive intervention before 6 months of age from health care and education professionals with expertise in hearing loss and deafness in infants and young children. Regardless of prior hearing screening outcomes, all infants who demonstrate risk indicators for delayed onset or progressive hearing loss should receive ongoing audiologic and medical monitoring for 3 years and at appropriate intervals thereafter to ensure prompt identification and intervention (American Speech-Language-Hearing Association [ASHA], 1997). EHDI systems should guarantee seamless transitions for infants and their families through this process.

Appropriate early intervention programs are family-centered, interdisciplinary, culturally competent, and build on informed choice for families (Baker-Hawkins and Easterbrooks, 1994). To achieve informed decision-making, families should have access to professional, educational, and consumer organizations; and they should have opportunities to interact with adults and children who are hard of hearing and deaf (Ogden, 1996; Thompson, 1994). Families should have access to general information on …

/pdf/year-2000-position-statement-principles-and-guidelines-for-3g4wba15sj.pdf

Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs

Objective. To compare the language abilities of earlier- and later-identified deaf and hard-of-hearing children. Method. We compared the receptive and expressive language abilities of 72 deaf or hard-of-hearing children whose hearing losses were identified by 6 months of age with 78 children whose hearing losses were identified after the age of 6 months. All of the children received early intervention services within an average of 2 months after identification. The participants9 receptive and expressive language abilities were measured using the Minnesota Child Development Inventory. Results. Children whose hearing losses were identified by 6 months of age demonstrated significantly better language scores than children identified after 6 months of age. For children with normal cognitive abilities, this language advantage was found across all test ages, communication modes, degrees of hearing loss, and socioeconomic strata. It also was independent of gender, minority status, and the presence or absence of additional disabilities. Conclusions. Significantly better language development was associated with early identification of hearing loss and early intervention. There was no significant difference between the earlier- and later-identified groups on several variables frequently associated with language ability in deaf and hard-of-hearing children. Thus, the variable on which the two groups differed (age of identification and intervention) must be considered a potential explanation for the language advantage documented in the earlier-identified group.

http://www.depistageneonatal.be/pro_surdite/articles/Itano2.pdf

Language of Early- and Later-identified Children With Hearing Loss

OBJECTIVE: To compare the speech and language development of children with bilateral hearing loss and normal cognition who were born in hospitals with universal newborn hearing screening to that of their peers who were born in hospitals without this screening program. STUDY DESIGN: Subjects for the major analyses are 50 Colorado children (25 matched pairs) from 9 to 61 months old who are participants in a study of the development of children birth to six with bilateral hearing loss. Analyses included parametric dependent t-tests and analysis of covariance, nonparametric χ-squared and Wilcoxon signed rank tests, descriptive statistics and odds ratios. RESULTS: Newborn screening programs for hearing loss are positively related to scores in expressive and receptive language (p<0.001) and vocabulary production (p<0.001) on standardized inventories; speech intelligibility (p=0.015) from independent ratings; number of different simple consonants (p<0.01) and consonant blends (p=0.026) from phonological transcripts; and total number of intelligible words (p<0.01) and number of different words produced (p<0.01) from computer analysis of videotaped language samples. CONCLUSION: Hospital-based newborn hearing screening programs are positively related to language and speech performance for children in early intervention programs who are deaf and hard of hearing.

The Colorado Newborn Hearing Screening Project: effects on speech and language development for children with hearing loss.

Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs.

This paper includes 3 tables for quick power estimates that require no computation for the most common designs involving comparisons of 2 and 3 means in ANOVA and ANCOVA situations. Power can be estimated for (from .1σ to 1σ) for 4 effect sizes at alpha levels from .01 to .20, for samples sizes from 5 to 400 per group, and for directional and nondirectional tests.

Diane K. Coulter

Papers

Language of Early- and Later-identified Children With Hearing Loss

The Colorado Newborn Hearing Screening Project: effects on speech and language development for children with hearing loss.

Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs.

Tables for Quick Power Estimates When Comparing Means