You’ve just received the devastating news that your child has hearing loss. You are overwhelmed by emotion. Caring professionals try to reassure you, but are they just saying these things to make you feel better? Can your child really live a normal life, go to a regular school and even hear with technology and learn spoken language?
Research about infants and children with hearing loss has identified some very important objective reassurance and will continue to improve how we assess and intervene in cases of children with hearing loss.
Our research at the University of Colorado has been on infants and children with hearing loss and their families who live in Colorado and it must be interpreted within the context of the characteristics of the population. Our recent studies from the late 1990s to 2006 include children with all degrees of hearing loss who were identified early through universal newborn hearing screening. Our children came from all socio-economic levels, 30 percent of them had multiple disabilities and 25 percent were ethnically diverse. At the time we studied them, their ages ranged from nine months to seven years old. Each of the studies had different groups of children but most studies included a minimum of 100 children and several had over 200 children participating.
In Colorado, over 80 percent of children with hearing loss are identified within the first six months of life. Currently, the average age of identification of hearing loss for Colorado newborns referred through universal newborn hearing screening is 29 days. Age of identification statistics are improving each year in our state and throughout the United States. The majority of these Colorado infants were referred to early intervention services within 24 hours of identification of the hearing loss. And most began early intervention services in the second month of life; this included being fit with amplification – a hearing aid.
Each child enrolled in the Colorado Home Intervention Program receives 1.5 hours a week of intervention services at home by providers who have specialized training in early intervention services for children with hearing loss.
All Colorado infants in early intervention programs are assessed with a developmental protocol every six months involving developmental questionnaires and speech/language sample analyses. The intervention team then sets personalized objectives for the child based on the child’s score on the protocol. Colorado families are offered sign language instruction from fluent or native sign language instructors, the vast majority of whom are deaf or hard of hearing. Other consultants that may provide services to them include auditory verbal specialists, psychologists, social workers, physical therapists, occupational therapists and medical specialists in otology.
Our research on children identified with hearing loss in the newborn period has provided evidence that the earlier access to language, speech and hearing a child has, the better the developmental outcomes. Identification of hearing loss in the first six months of life with immediate and appropriate early intervention services is a significant predictor of language development in the first five years of life. Though the children with hearing loss in our studies still, on average, have significantly lower mean scores on language development assessments as compared to their hearing peers, about 80 percent of the children with early-identified hearing loss and no additional disabilities have maintained language development in the low-average range for hearing children.
What predicts optimal outcomes for early-identified children with hearing loss?
• Nonverbal cognitive development and nonverbal symbolic play development are significant predictors of language development in the first five years of life.
• Personal social development of the child is significantly related to language development of infants/children with hearing loss.
• Language development is highly related to the age at which hearing loss is identified.
• Language development is highly related to parent-infant emotional availability, a measure of bonding between parent and child.
• Mastery motivation, a temperament trait, is highly related to language development of the child. Mastery motivation can be measured by the persistence of a child in social interactions, such as being understood or understanding a communication, despite the possibility of failure. Children with multiple disabilities with stronger mastery motivation have higher language development than those with lower mastery motivation.
There are also some characteristics of early-identified children with hearing loss that were not found to be related to language development:
• Degree of hearing loss
• Socio-economic status (educational level of the mother)
• Race/ethnicity
• Mode of communication.
Speech Development
Language development, degree of hearing loss, the age at which hearing loss is identified and presence of an additional disability are significant predictors of speech development.
Seventy-five percent of children with mild to severe hearing loss who use hearing aids or cochlear implants and received early diagnosis and early intervention develop intelligible speech by five years of age.
Again, we found these characteristics not to be related to speech development:
• Socio-economic status
• Race/ethnicity
• Mode of communication for children with severe to profound hearing loss.
Auditory Development
We found that infants with early-identified hearing loss using conventional amplification are able to demonstrate prelinguistic speech discrimination as early as six to seven months of age. Infants with early-identified hearing loss using cochlear implants are also able to demonstrate prelinguistic speech discrimination in the second year of life, as early as 12 to 14 months of age, beginning from the day of activation.
Specifically for children with cochlear implants, we found that most children with later identified hearing loss, implanted between two and four years of age, develop intelligible speech by five years of age. However, infants with early-identified hearing loss, age-appropriate language development prior to the implant, and who are implanted between 12 and 24 months of age transition to spoken English communication within 12 to 18 months after implantation.
Later-identified children with hearing loss have significant delays in language development with average rate gains from 50 to 60 percent of the normal range of development. The rate of development for early-identified children with hearing loss more closely parallels development of hearing children. If provided with appropriate intervention services, early-identified children with hearing loss can achieve language development that is comparable to their hearing peers. By five years of age, early-identified children with hearing aids and those with early cochlear implantation are speaking intelligibly. Other related Colorado data indicates that early-identified children are maintaining this language advantage throughout early childhood.
Children with hearing loss can have social-emotional development that is the same as hearing peers and seem to have even better maternal-child bonds. Clearly, parent participation is a key component and highly related to language outcomes. Your hope is not in vain.
