1. Early Intervention Outcomes Recent Findings and Future Challenges Mary Pat Moeller Boys Town National Research Hospital

2. Focus of Recent Work Earlier is better (sensitive periods?) Earlier is better (sensitive periods?) What works & how? (EI approaches) What works & how? (EI approaches) Understanding effects of audibility & individual differences Understanding effects of audibility & individual differences

3. Probability of language development at typical levels Yoshinaga-Itano, Coulter & Thomson, 2001 Yoshinaga-Itano, Coulter & Thomson, 2001 N=294; CA = 12 to 60 months N=294; CA = 12 to 60 months No additional disabilities No additional disabilities 82.4% probability of language development within normal range if child with a hearing loss was born in a Colorado hospital that screened for hearing 82.4% probability of language development within normal range if child with a hearing loss was born in a Colorado hospital that screened for hearing 31.6% probability if born in a hospital that did not screen for hearing prior to hospital discharge. 31.6% probability if born in a hospital that did not screen for hearing prior to hospital discharge.

4. Receptive Language Over Time by Age of Intervention

5. How lasting are the effects of early intervention? Age of identification of hearing loss as a significant predictor of language development Age of identification of hearing loss as a significant predictor of language development –12 - 60 months of age (Yoshinaga-Itano, Coulter & Thomson, 2000, 2001) N=294 –12 - 72 months of age (Pipp-Siegel, Sedey, Mayne & Yoshinaga-Itano, 2003) N=200

6. What works….and how?

7. Family Communication: Maternal communication skills strongest predictor of language, early reading and social-emotional skills (N = 28, ages 4 – 7 years; Calderon, 2000) Maternal communication skills strongest predictor of language, early reading and social-emotional skills (N = 28, ages 4 – 7 years; Calderon, 2000) In TC programs, strong maternal signing associated with better child language and earlier understanding of thoughts of others (N = 26, ages 4 – 9 years; Moeller, 2002) In TC programs, strong maternal signing associated with better child language and earlier understanding of thoughts of others (N = 26, ages 4 – 9 years; Moeller, 2002)

8. Verbal Reasoning at Age 5 Age Enroll Family Involvement High Verbal Reasoning <13 months 4.4 Average Reasoning 21 months 3.6 Low Reasoning 27 months 2.6 N = 80

9. Is EI Relationship-Focused or Child-Focused? McBride & Peterson (1997) observed a child- focused dominance in 160 sessions McBride & Peterson (1997) observed a child- focused dominance in 160 sessions Too little focus on parent-child relationship Too little focus on parent-child relationship Mahoney, et al., (1998) – Interventions impact child development to the extent that parents are supported and encouraged to engage in responsive interactions with the child Mahoney, et al., (1998) – Interventions impact child development to the extent that parents are supported and encouraged to engage in responsive interactions with the child

10. Intervention Effects Early educational experience (oral school vs. general special ed preschool) promoted development of effective perceptual processing strategies (native like) Early educational experience (oral school vs. general special ed preschool) promoted development of effective perceptual processing strategies (native like) Facilitated word storage and understanding of complex grammar Facilitated word storage and understanding of complex grammar Nittrouer & Burton, 2003 N = 17, ages 8-10 years

11. Effects of Audibility

12. Early Vocal Development Audibility related to onset, quality and complexity of early babble (Bass- Ringdahl, 2002) Audibility related to onset, quality and complexity of early babble (Bass- Ringdahl, 2002) Cochlear implants influence rate of learning (phonological, lexical) (Tomblin, 2002; Yoshinaga-Itano, 2003) Cochlear implants influence rate of learning (phonological, lexical) (Tomblin, 2002; Yoshinaga-Itano, 2003)

13. Prospective Longitudinal Study of Infants Explore the role of auditory experience in speech and language learning Explore the role of auditory experience in speech and language learning 4 months to 5 years of age 4 months to 5 years of age 20 NH and 16 Infants D/HH 20 NH and 16 Infants D/HH BTNRH, funded by NIDCD

18. Future Challenges To support implementation of effective interventions….need for more research on what works and how…. To support implementation of effective interventions….need for more research on what works and how…. Changing technologies dictate need for further understanding of effects of audibility; need for controlled, prospective study Changing technologies dictate need for further understanding of effects of audibility; need for controlled, prospective study Greater understanding of individual differences will support families in decision making Greater understanding of individual differences will support families in decision making