Minimal Hearing Loss: Impact

1
Minimal Hearing Loss Impact Treatment

• Arlene Stredler Brown
• Colorado School for the Deaf and the Blind (CSDB)
• University of Colorado - Boulder
• Marion Downs Hearing Center _at_ University of
  Colorado Hospital

2
Collecting the Evidence Asking the Questions

• A portion of school-age children with unilateral
  hearing loss experience academic delays.. Do
  children with UHL, in the birth 3 population,
  experience delays? If so, is the percentage the
  same?
• Do children, birth 3, with minimal hearing loss
  require intervention?

3
Part C Eligibility for Children with Minimal
Hearing Loss.. (NCHAM
Survey, 2002)

• 46 states (including DC) reporting
• All 46 states have established risk conditions
  that make a child eligible for Part C-funded
  services
• 40 states list specific conditions for
  eligibility
• 30 states note hearing loss as a specific
  condition
• 15 states operationally define hearing loss in
  their State Plan or other official documents

4
State of the States

• 11 states define mild hearing as eligible for
  Part C services
• 7 states define UHL as eligible for Part C
  services (some limit degree of hearing loss)
• Some states require an eligible condition to be
  associated with a high probability of
  significant developmental delay (gt90)
• Some states determine eligibility if/when
  appropriate treatment still leaves significant
  impairment

5
Eligibility for EHDI Programs

• Each state operationally defines their own
  screening procedures, diagnostic criteria, and
  early intervention
• Intervention is, to varying degrees, determined
  in collaboration with different initiatives
  funding sources
• Part C
• Schools for the Deaf
• Private treatment centers

6
Collecting the Evidence

• Mild Hearing Loss

7
Mild Hearing Loss Colorado Outcome Data

• As a group, children with mild, bilateral hearing
  loss have better language skills than children
  with more severe degrees of hearing loss
• As a group, children with mild, bilateral hearing
  loss do not have language quotients comparable to
  their hearing peers

8
Treatment Data

• Colorados model supports direct services to all
  children with bilateral, mild hearing loss
• Intensity of services is identified on the IFSP

9
The early identification effect on language
(N85)
MCDI Total Language Quotient (Mean)
Yoshinaga-Itano, et al (1998)
10
Collecting the Evidence

• Unilateral Hearing Loss

11
History of the Colorado Project

• Identification of need subsequent to the start of
  UNHS
• BCHD repeatedly asked for guidance for families
  of very young children with UHL
• Started in 1997 by the Colorado Home Intervention
  Program (CHIP) at the Colorado School for the
  Deaf and the Blind (CSDB) in collaboration with
  the University of Colorado-Boulder

12
History

• Purpose To identify if the negative impact of
  UHL on some school-age children is apparent
  during the birth 5 years
• Purpose To confirm a need to change current
  practices regarding young children with UHL
• Dont worry, your child has one good ear.
• Be sure to arrange for preferential seating when
  your child starts school.

13
Guiding Principles

• Establish an assessment protocol to monitor
  development of individual children and the total
  group
• A professional with expertise related to hearing
  loss is the familys primary contact person,
  answers questions, provides consultation
• The audiologist coordinates with the other
  professionals involved in the childs/familys
  care physician, clinical audiologist, Part C
  service coordinator, direct service providers

14
Participants in the Project

• Six counties in Denver-metro area
• 30 children in the original database
• Identified by diagnosing audiologist and/or EHDI
  database at CDPHE
• Designated service coordinator (a clinical
  audiologist) contacts families
• Initial contact by phone
• Offers home visit
• Provides written materials UHL brochure, CHIP
  brochure, Tips for UHL, current articles
• Explains pilot project including FAMILY Assessment

15
The FAMILY Assessment

• Multi-disciplinary assessment consisting of
  videotaped interaction and parent-completed
  protocols
• Receptive expressive language vocabulary,
  syntax, speech intelligibility, articulation
• Cognitive/play skills
• Gross/fine motor skills
• Social-emotional skills
• Functional auditory skill development
• Functional vision checklist
• Family Needs Survey

16
Unilateral to Bilateral Loss

• 30 children initially identified with unilateral
  loss
• 2 (7) progressed to bilateral within first year
  of life
• 2 (7) later diagnosed with bilateral losses that
  apparently were present from birth
• One mild (30dB) in poorer ear
• One moderate low frequency loss with normal high
  frequency hearing

17
State of Residence
n
Colorado 24 92
New Mexico 1 4
Virginia 1 4
18
Gender
n
Male 14 54
Female 12 46
19
Ethnicity
n
Caucasian 18 69
Asian American 2 8
African American 1 4
Hispanic 2 8
Hispanic/Caucasian 1 4
Other mixed minority 2 8
20
Additional Disabilities
n
No disabilities 22 85
Additional disabilities 4 15
21
Socio-Economic Status
Range Median
Years of educ Mother Father1 12 to 21 12 to 20 16 16
Income2 lt10,000 to gt100,000 60,000
1n 24 2n 22
22
Mode of Communication
n
Oral 17 65
Occasional sign 7 27
Frequent sign 2 8
23
Newborn Hearing Screening
n
Screened 23 89
Not screened 2 4
Dont know (child adopted) 1 4
24
Age of Identification
n
lt 6 months 22 92
14 months 1 4
18 months 1 4
N 24
25
Age of Onset
n
Congenital 22 88
Acquired - 1 at 4 days (meningitis) - 1 at 3 months (seizures) 2 8
Dont know 1 4
N 25
26
Etiology
n
Unknown 20 77
Heredity 3 12
Waardenburg 1 4
Meningitis 1 4
Seizures 1 4
27
Malformation of Ear Structures
n
Atresia 6 23
Mondini 2 8
None 18 69
28
Ear with Hearing Loss
n
Right 14 54
Left 12 46
29
Degree of Loss
n
Mild 2 8
Moderate 6 24
Moderate-severe 6 24
Severe 4 16
Severe or profound 7 28
N 25
30
Language Ability

• Assessments
• Minnesota Child Development Inventory
• MacArthur Communicative Development Inventories
• Spontaneous language sample

31
Minnesota Inventory

• Participant Description
• 18 children
• No additional disabilities
• Selected oldest age available
• Chronological age
• Range 7 to 59 months
• Mean 25 months

32
Minnesota Inventory

• Test Description
• Parent report questionnaire
• Expressive and receptive language subscales
• Language Quotient (LQ) derived
• Language age/Chronological age x 100
• LQ of 100 means language age chronological age

33
Minnesota Inventory
n
Expressive Borderline (70 79) Average (80) 3 15 17 83
Receptive Below average (lt 70) Borderline (70 79) Average (80) 1 3 14 6 17 78
5 of hearing children borderline or below
average
34
MacArthur Inventory Expressive

• Participant Description
• 12 children
• No additional disabilities
• Chronological age
• Range 14 to 28 months
• Mean 21 months

35
MacArthur Inventory Receptive

• Participant Description
• 11 children
• No additional disabilities
• Selected all children who were the appropriate
  age for the test
• Chronological age
• Range 12 to 16 months
• Mean 14.5 months

36
MacArthur Inventories

• Test Description
• Assesses vocabulary abilities
• Parent report questionnaire
• Parent indicates words child can understand and
  produce
• Percentile scores determined relative to test
  norms

37
MacArthur Inventories
n
Expressive lt 10th percentile gt 10th percentile 2 10 17 83
Receptive lt 10th percentile gt 10th percentile 2 9 18 82
10 of hearing children would be expected to fall
below the 10th percentile
38
Spontaneous Language Sample

• Participant Description
• 15 children
• No additional disabilities
• Selected oldest age available for each child
• Chronological age
• Range 15 to 62 months
• Mean 29 months

39
Spontaneous Language Sample

• Mean Length of Utterance (MLU)
• 10 (67) children within age expectations
• 5 (33) children below age expectations

40
Summary of Language Results

• 15 children examined across measures and time
• Considered assessments after 12 months of age
• No additional disabilities
• Number of children with language delays
• Delayed 4 (27)
• Borderline 1 (7)

41
Profile of 4 Children with Delays

• Caucasian
• Identified by 2 months of age
• Congenital
• Etiology unknown
• Parents use oral communication only
• Parental education 16 years or more
• Annual income gt 80,000

42
Profile of Children with Delays

• No outer or middle ear malformation
• Affected ear 50 right, 50 left
• Degree of loss
• All severe or profound (i.e., no response on
  ABR) or profound

43
Current Case Studies from Colorado

• 5 children with delays on developmental
  assessments
• Chronological ages 1-5 to 1-11
• Developmental delays in the following areas
• Vocabulary development (n5)
• Receptive language (n1)
• MLU (n1)
• Speech development (n1)

44
Lets remember
Minimal is not inconsequential
Bess, 2004