1. Boys Town National Research Hospital Background in Children with Hearing Loss birth to six

2. Boys Town National Research Hospital 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

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

4. Boys Town National Research Hospital 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

5. Boys Town National Research Hospital All degrees of HL place children at risk 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

6. Boys Town National Research Hospital 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

7. Boys Town National Research Hospital 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

8. Boys Town National Research Hospital Academic Outcomes 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

9. Boys Town National Research Hospital 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

10. Boys Town National Research Hospital 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

11. Boys Town National Research Hospital 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

12. Boys Town National Research Hospital 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

13. Boys Town National Research Hospital 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

14. Boys Town National Research Hospital 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

15. Boys Town National Research Hospital 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

16. Boys Town National Research Hospital 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?

17. Boys Town National Research Hospital Performance Measures Performance measured in: –Speech and Language Development –Social Development –Academic Development –Hearing, listening and hearing aid status

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

19. Boys Town National Research Hospital Current Studies: Areas of Evaluation 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

20. Boys Town National Research Hospital Value for Community 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.

21. Boys Town National Research Hospital 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.

22. Boys Town National Research Hospital REFERENCES 1.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. 2.National Institute of Deafness and Communication Disorders. (2006). NICHD Statistical Report: prevalence of hearing loss in U.S. children, 2005 epidemiology and biostatistics program. 3.Bess, F. H., & Tharpe, A. M. (1986). Case history data on unilaterally hearing-impaired children. Ear and Hearing, 7(1), 14-19. 4.Eisenberg, L. S. (2007). Current State of Knowledge: Speech Recognition and Production in Children with Hearing Impairment. Ear and Hearing, 28, 766-772. 5.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. 6.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. 7.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. 8.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.

23. Boys Town National Research Hospital REFERENCES 9.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. 10.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. 11.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. 12.Peterson, C. C., & Siegal, M. (2000). Insights into theory of mind from deafness and autism. Mind and Language, 15, 123-45. 13.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. 14.Scarborough, H. S. (1990). Very early language deficits in dyslexic children. Child Development, 61, 1728-43. 15.Tomblin, J. B. (2006). A normativist account of language-based learning disability. Learning Disabilities: Research and Practice, 21, 8-18. 16.Johnson, et al (2005). Pediatrics

24. Boys Town National Research Hospital REFERENCES 17.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. 18.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. 19.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. 20.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. 21.Moeller, M. P. (2000). Early intervention and language development in cheildren who are deaf and hard of hearing. Pediatrics, 106(3), 1-9. 22. 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. 23.Centers for Disease Control (2007). Preliminary Summary of 2005 National EHDI Data (Version 4). http://www.cdc.gov/ncbddd/ehdi/data.htmhttp://www.cdc.gov/ncbddd/ehdi/data.htm 24.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.