Characteristics of hearing families and their young deaf and hard of hearing children. Early intervention follow-up

Hearing Impairment Among Children Referred to a Public Audiology Clinic in Gaborone, Botswana

Objective. To describe and quantify hearing impairment among children referred to the audiology clinic in Princess Marina Hospital, a public referral hospital in Botswana. Methods. In a retrospective case series, we reviewed medical records of children aged 10 years and younger whose hearing was assessed between January 2006 and December 2015 at the audiology clinic of Princess Marina Hospital in Gaborone, Botswana. Results. Of 622 children, 50% were male, and median age was 6.7 years (interquartile range = 5.0-8.3). Hearing impairment was diagnosed in 32% of clinic attendees, comprising sensorineural (23%), conductive (25%), and mixed (11%) hearing loss, while 41% of children with diagnosed hearing impairment did not have a classification type. Hearing impairment was mild in 22.9%, moderate in 22.4%, severe in 19.4%, profound in 16.9%, and of undocumented severity in 18.4%. Children younger than 5 years were 2.7 times (95% confidence interval = 1.29-5.49; P = .008) more likely to be diagnosed with sensorineural hearing impairment compared with those older than 5 years. By contrast, children older than 5 years were 9.6 times (95% confidence interval = 2.22-41.0; P = .002) more likely to be diagnosed with conductive hearing loss compared with those under 5 years. Conclusion. Hearing impairment was common among children referred to this audiology clinic in Botswana. Of those with hearing impairment, more than a third had moderate or severe deficits, suggesting that referrals for hearing assessments are not occurring early enough. Hearing awareness programs individually tailored to parents, educators, and health care workers are needed. Neonatal and school hearing screening programs would also be beneficial.

The reality of every day communication for a deaf child using sign language in a developing country

BACKGROUND

Research that focuses on the communication between deaf children and their hearing families is scarce despite the majority of deaf children being born into hearing families where a common communication mode needs to be forged.

OBJECTIVE

The aim of the study was to explore, describe and compare the nature of communication across typical daily contexts of a deaf child who uses South African Sign Language (SASL) and who is born into a hearing family with no prior experience of SASL.

METHODS

A case study design which included quantitative and qualitative components was used to observe a nine year old grade one child with profound hearing loss. Spontaneous communication was observed with 13 communication partners in the home context and these included the mother, a sibling and peers. Two educators and 11 peers were observed in the educational context. Surveillance cameras were used to obtain 27 hours of video-recording in the home and 19 hours at the school. Interviews were conducted with the mother, siblings, educators, and the deaf child.

RESULTS

It was observed that communication using SASL, albeit minimal, home signs, natural gestures and oral communication were used extensively. Due to a mismatch in the communication mode in the home context communication interactions were fewer and predominantly oral, impoverished and with frequent breakdowns whereas the communication interactions in the school were characterized by SASL, was meaningful and had fewer communication breakdowns.

CONCLUSION

Communication for deaf children within the home is problematic as communication partners are not fluent in SASL.

Profound childhood hearing loss in a South Africa cohort: risk profile, diagnosis and age of intervention

OBJECTIVE

To describe profound childhood hearing loss in a South African population of pediatric cochlear implant recipients in terms of risk profile, and age of diagnosis and intervention.

METHODS

A retrospective review of patient files for 264 pediatric cochlear implant recipients from five cochlear implant programs was conducted. Data was captured from 264 eligible subjects, of which all were implanted between 1996 and 2013 and PCEHL was confirmed under the age of 5 years old. Data collected included demographical information, risk factors from case histories, diagnostic test procedures conducted, diagnosis (type, onset and degree of hearing loss) and documented ages of caregiver suspicion, initial diagnosis and intervention.

RESULTS

Risk factors for permanent childhood hearing loss were present in 51.1% of cases, with the most prevalent risks being NICU admittance (28.1%), family history of childhood hearing loss (19.6%) and prematurity (15.1%). An associated syndrome was diagnosed in 10% of children and 23.5% presented with at least one additional developmental condition. Hearing loss for most (77.6%) children was confirmed as congenital/early onset, while 20.3% presented with postnatal onset of hearing loss. ANSD was diagnosed in 5% of children, with admittance to NICU (80%) and hyperbilirubinemia (50%) being the most prevalent risk factors for these cases. Hearing loss was typically diagnosed late (15.3 months), resulting in delayed initial hearing aid fitting (18.8 months), enrollment in early intervention services (19.5 months) and eventual cochlear implantation (43.6 months).

CONCLUSION

Most prevalent risk factors in profound childhood hearing loss were admittance to NICU, family history and prematurity. Diagnosis and intervention was typically delayed predisposing this population to poorer outcomes.

Evaluating a prediction model for infant hearing loss

OBJECTIVES/HYPOTHESIS

The objective of this study was to determine whether a prognostic model using risk factors for hearing loss could predict the chance that infants who failed a newborn hearing screen would subsequently be found to have hearing loss diagnosed by auditory brainstem response testing.

STUDY DESIGN

Individual retrospective case-control study.

METHODS

We studied 229 infants with hearing loss compared with 458 infants with normal hearing. All infants had undergone natural sleep or sedated auditory brainstem response, predominantly for not passing a newborn hearing screen. Risk factors, birth history, and other information were extracted via medical record review. Multiple logistic regression analyses identified independent predictors of hearing loss.

RESULTS

Four risk factors were independently predictive of hearing loss diagnosed by sleep or sedated auditory brainstem response: prematurity, 5-minute APGAR score ≤ 6, intracranial complication, and craniofacial abnormality. A prognostic model developed from these risk factors was associated with a 15% rate of hearing loss in stage I, 52% rate of hearing loss in stage II, and 96% rate of hearing loss in stage III.

CONCLUSIONS

The presence of any one of four independently predictive risk factors in infants who did not pass newborn hearing screen was associated with a 50% rate of hearing loss; having three or more was associated with a 90% rate of hearing loss. Knowing that an infant is at high risk of hearing loss can motivate parents to follow up with diagnostic auditory brainstem response testing so that early identification can lead to early intervention.

Parenting styles of mothers with deaf or hard-of-hearing children and hearing siblings

The present study aims to determine whether rearing a deaf or hard-of-hearing (d/hh) child would differentiate the parenting and disciplinary preference of parents between the d/hh and the hearing child. The parenting styles of 30 hearing mothers from Cyprus were assessed using the Greek version of the Parenting Styles & Dimensions Questionnaire. Additionally, mothers rated sibling interactions using the sibling inventory of behavior. The results indicated that the dominant parenting style for both the hearing and the d/hh children among the participating mothers was the authoritative type and the least prevalent parental types were the permissive and the strict. Moreover, mothers' perceptions of sibling relationship were found to be a significant factor in predicting mothers' reported parenting styles in this sample. The contribution of the present findings to our knowledge of the parenting characteristics and practices of families who have a d/hh child along with their possible implications for child and family services are discussed.

Association of maternal communicative behavior with child vocabulary at 18-24 months for children with congenital hearing loss

OBJECTIVES

To identify important maternal and child factors associated with development of vocabulary in a cohort of children with and without permanent hearing loss (HL).

METHODS

Children with HL and typical hearing were enrolled after the newborn hearing screen. Mother-child dyads were evaluated at 18-24 months of age. Mothers completed the MacArthur-Bates Communicative Development Inventory (MCDI). Maternal communicative effectiveness was scored using the Parent/Caregiver Involvement Scale (PCIS) from a 10 min play session. Correlations and regression models were run to identify the important predictors of number of child words produced.

RESULTS

Results from 40 children with typical hearing and 31 children with HL are reported. Words produced (134+/-135 vs. 71+/-112) and words produced percentile (33+/-42 vs. 17+/-23) scores on the MCDI were significantly higher for children with hearing compared to children with HL. Greater maternal stress was associated with decreased verbal involvement, positive regard, availability, and enjoyment. Regression analysis revealed HL, stay in a Neonatal Intensive Care Unit (NICU), and maternal stress were associated with fewer words produced whereas more optimal maternal atmosphere and quality of control and directiveness were associated with more words produced.

CONCLUSIONS

Maternal communicative behaviors, maternal stress, child HL, and child stay in the NICU were all associated with number of words produced at 18-24 months.

Family Quality of Life Following Early Identification of Deafness

Purpose

Family members' perceptions of their quality of life were examined following early identification of deafness in children.

Method

A questionnaire was used to solicit ratings of satisfaction from the family members of 207 children who were deaf and younger than 6 years of age.

Results

Results indicated that families were generally satisfied with the areas of family life surveyed. Descriptive analysis suggested lower satisfaction ratings in the area of emotional well-being. Families also reported that their child’s deafness had the largest impact on their emotional well-being. Family members of children using oral communication with a cochlear implant reported higher satisfaction with their child’s speech production and perception outcomes than family members of children using hearing aids alone.

Implications

We recommend that service providers and early hearing detection and intervention program coordinators consider additional supports for family well-being following the early identification of deafness in children.

Service Delivery for Children Who Are Deaf: Thoughts of Families in Turkey

Laws mandate early intervention programs across many different countries, such as the United States, the countries of the European Union, and Turkey. Studies have shown that such programs can be critical to the healthy development of children with disabilities, especially those who are deaf. Furthermore, research addressing the delivery of early intervention programs offers guidelines that, when followed, presumably maximize the programs’ intended benefits. In this study, the authors used a quasi-mixed, monostrand method to investigate how families of children with disabilities in Turkey perceived the service delivery they were receiving. Organizing their perceptions under a framework related to the Turkish-law-mandated guidelines, the authors found that the provision of services varied greatly from one professional team task to the next. Implications for the improvement of service delivery are discussed.

Early language outcomes of early-identified infants with permanent hearing loss at 12 to 16 months of age

OBJECTIVES

The objectives of this study were to determine the early language outcomes of children with mild to profound hearing loss, compared with hearing control children, at 12 to 16 months of age and to examine the effects of "very early" enrollment (</=3 months) in early intervention.

METHODS

This was a prospective longitudinal study of the outcomes of a cohort of 30 infants identified in the Rhode Island universal newborn hearing screening program and 96 hearing control subjects. Eligible families with children with all degrees of congenital hearing loss were invited to enroll. Child language skills were assessed by using the MacArthur-Bates Communicative Development Inventory, Words and Gestures, at 12 to 16 months.

RESULTS

Children with moderate/profound hearing loss had significantly lower numbers of phrases understood, words understood, and early, later, and total gestures, compared with children with mild/minimal hearing loss and hearing control subjects. Furthermore, children with hearing loss who were enrolled in early intervention at </=3 months had significantly higher percentile scores for number of words understood, words produced, and early, later, and total gestures, compared with those enrolled at >3 months. Regression analyses to test the independent effects on language skills of children with hearing loss identified enrollment in early intervention at </=3 months as an independent predictor of percentile scores for word and early gesture production.

CONCLUSIONS

Very early enrollment (</=3 months) in early intervention has beneficial effects on early language for children with hearing loss. Nevertheless, 12- to 16-month-old children with moderate/profound hearing loss exhibit delayed receptive and expressive language skills in oral and signed English modes, compared with peers with either mild/minimal hearing loss or typical hearing sensitivity.

Maternal Contributions: Supporting Language Development in Young Children with Cochlear Implants

OBJECTIVE

The principal goal of this study was to investigate the relationships between maternal contributions (e.g., involvement, self-efficacy, linguistic input) and receptive and expressive (oral and sign) language skills in young children with cochlear implants.

DESIGN

Relationships between maternal contributions and children's language skills were investigated by using correlation and regression analyses. Thirty-two mothers (mean age = 36.0 yr) and their children (mean age = 4.8 yr) were videotaped during free play and storybook interactions. Mothers' and children's quantitative (MLU, number of word-types) and mothers' qualitative (facilitative language techniques) linguistic input were analyzed. Mothers completed a measurement tool specifically designed to quantify their sense of involvement and self-efficacy (Scale of Parental Involvement and Self-Efficacy). The Reynell Developmental Language Scales and data from videotaped transcription analyses were used to evaluate children's oral and sign language skills.

RESULTS

Maternal involvement and self-efficacy relating to children's speech-language development were positively related to mothers' quantitative and qualitative linguistic input. After controlling for child's age, mothers' MLU and two facilitative language techniques (recast and open-ended question) were positively related to children's language skills.

CONCLUSIONS

The performance of young implant users may vary in part because of their mothers' sense of involvement and self-efficacy, as well as the ways in which mothers interact with their children. Given this information, it would be fruitful for professionals working with these families to incorporate goals that enhance caregivers' involvement, self-efficacy, and linguistic input to better support language development in young children after cochlear implantation.

Prediction of Auditory Brainstem Reflex Screening Referrals in High-Risk Infants

OBJECTIVES/HYPOTHESIS

The objectives of this study were to 1) quantify the relative importance of established risk factors for congenital hearing loss (HL), 2) identify other risk factors for congenital HL, and 3) create a prognostic system that can predict the chance of an infant having HL.

METHODS

The authors conducted a retrospective cohort study with validation of a prognostic system. The authors used a medical record review on 1,863 infants admitted to level II and level III nurseries who underwent auditory brainstem reflex (ABR) hearing screening from 1998 to 1999 (derivation cohort). The primary outcome was hearing screening referral (i.e., hearing screening failure) classified as mild to moderate, moderate to severe, and severe to profound loss. To validate the prognostic system, a medical record review of a separate cohort of 437 infants admitted to a level III nursery who underwent ABR hearing screening in 2002 (validation cohort) was performed.

RESULTS

In the derivation cohort, 1,513 infants (81%) passed the ABR screen at 30 dB, 77 (4%) had a unilateral referral, 243 (13%) had a bilateral referral, and 30 (1.6%) did not have a complete screening. In multivariable analysis, the following risk factors were clinically and statistically significant: craniofacial abnormalities, cytomegalovirus infection, bronchopulmonary dysplasia (BPD), maternal ethanol use, syndromes, hydrocephalus, and hyperbilirubinemia.

CONCLUSIONS

Our results reaffirm the importance of several established risk factors for congenital HL, but suggest that BPD is an important predictor in high-risk populations. Whether these risk factors are causal or merely associated in congenital HL remains to be determined.

Parent-Reported Health-Related Quality of Life in Children With Congenital Hearing Loss: A Population Study

OBJECTIVE

To report 1) health-related quality of life (HRQoL) in 7- to 8-year-old children with congenital hearing loss and 2) effects of severity and age of diagnosis on parent-reported child HRQoL.

METHODS

SETTING

State of Victoria, Australia.

DESIGN

Two population-based cohorts of 7- to 8-year-old children.

PARTICIPANTS

Cohort 1 consisted of 83 children (51 boys) fitted with hearing aids or cochlear implants for congenital hearing loss by 4.5 years, born before universal newborn hearing screening, and without intellectual disability (the Children with Hearing Impairment in Victoria OUTCOME Study). Cohort 2 consisted of 895 children representative of the Victorian 7- to 8-year-old school population (the 1997 Health of Young Victorians Study).

OUTCOME

The 28-item parent-proxy Child Health Questionnaire measure of HRQoL.

RESULTS

Response rate for cohort 1 was 67%; 22% had mild, 33% had moderate, 17% had severe, and 29% had profound hearing loss; and the mean nonverbal IQ was 105.4 (SD = 16.5). Children with hearing loss scored significantly more poorly than the normative sample on 6 Child Health Questionnaire scales (Role/Social-Physical, Behavior, Mental Health, Parent Impact-Emotional, Parent Impact-Time, and Family Activities) and on the Psychosocial Summary Score. HRQoL was poorer with milder losses, accounting for 10% and 11% of variance in the Physical and Psychosocial Summary scores, respectively. Age at diagnosis did not contribute significantly to the Summary scores, but only 11 children were diagnosed <6 months of age.

CONCLUSIONS

Parent-reported psychosocial well-being of 7- to 8-year-old children with hearing loss is poorer than that of their hearing peers. Future studies should determine whether HRQoL has improved after introduction of universal newborn hearing screening.

Examining multiple sources of influence on the reading comprehension skills of children who use cochlear implants

Children with profound deafness are at risk for serious reading difficulties. Multiple factors affect their development of reading skills, including use of cochlear implants. Further, multiple factors influence the overall success that children experience with their cochlear implants. These factors include the age at which they receive an implant, method of communication, vocabulary skills, preoperative residual hearing, and socioeconomic status. Ninety-one children with prelingual and profound hearing impairments who received cochlear implants at varying ages participated in the study. Structural equation modeling confirmed that multiple factors affected young cochlear implant users' reading comprehension skills and that there were significant associations between the predictors of reading comprehension. Pre-implant vocabulary had an indirect positive effect on reading through postimplant vocabulary, which had a direct positive effect on reading. Overall, children with stronger language skills demonstrated stronger reading outcomes. Age at implantation both directly and indirectly, through postimplant vocabulary, affected reading outcomes, and the total effect was large. Children who were younger when they received their implants tended to have higher reading comprehension scores. Socioeconomic status negatively affected reading. Children who used total communication prior to implantation tended to have stronger pre-implant vocabulary scores, but the total effect of pre-implant communication method on children's reading skills was negligible. Research and educational implications are discussed.

Early intervention and language development in children who are deaf and hard of hearing

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.