Have you read this document published by ASHA on Facts About:
Hearing Loss in Children
Early Hearing Detection and Intervention
Technologies
Listening and Spoken Language
Educational Environments
Types of Educational Placements
Personnel Preparation
http://www.asha.org/aud/Facts-about-Pediatric-Hearing-Loss/
The information was compiled by Tamala S. Bradham, PhD, Chair; Teresa Caraway, PhD; Jean Moog; K. Todd Houston, PhD; and Julie Rosenthal with the support of the OPTION Schools, Inc., .
"During the past 20 years there has been a revolution in how we
identify and educate children with permanent hearing loss in the United States.
Below is a list of facts about pediatric hearing loss that are often widely
cited with their references.
Facts on Hearing Loss in Children
Approximately 3 in 1,000 babies are born with permanent hearing loss,
making hearing loss one of the most common birth defects in America. (Ross
et al., 2008)
Hearing loss affects 12,000 children born in the United States each
year, making it the most common birth defect. (White,
1997)
Children with hearing loss who begin early intervention earlier have
significantly better developmental outcomes than similar children who begin
intervention later. (Holt & Svirsky, 2008; Moeller, 2000;
Nicholas & Geers, 2006)
Most children with hearing loss who receive appropriate services from
trained staff are able to progress at age-appropriate rates. (Geers
et al., 2009)
92% of children with permanent hearing loss are born to two hearing
parents. 96% of children with permanent hearing loss are born to one hearing
parent and one parent with hearing loss.(Mitchell & Karchmer,
2004)
Parents usually suspect a hearing loss before the doctor does. (Harrison
& Roush, 1996)
Facts on Early Hearing Detection and Intervention
(including UNHS)
Of the 12,000 babies in the United States born annually with some form
of hearing loss, only half exhibit a risk factor—meaning that if only high-risk
infants are screened, half of the infants with some form of hearing loss will
not be tested and identified. (Harrison & Roush, 1996)
Newborn hearing screening has become the standard of care in the
United States. While 92% of all newborns are screened for hearing loss shortly
after birth, only 54% of these babies actually receive the recommended hearing
evaluation; the remaining 46% are "lost to the system".(Joint
Committee on Infant Hearing, 2007)
CDC reports that only 61% of children identified with hearing loss
begin ANY KIND of Part C early intervention services before 6 months of
age. (Centers for Disease Control and Prevention, 2006)
95% of newborns are screened for hearing loss. (White,
2003; Mitchell & Karchmer, 2004)
Despite extraordinary advances in early identification, early access
to sound through technology and early intervention, there is widespread
agreement among researchers, clinicians, program administrators and policy
makers that many children ages 0–5 with permanent hearing loss are not
receiving the benefits. (White, 2007; White, 2004)
Until the 1990s, children born with permanent hearing loss typically
would not have been identified and diagnosed until 2 ½ to 3 years of age. Since
the initiation of newborn hearing screening and EHDI programs, the average age
of hearing loss identification has decreased to 2–3 months of age. (White,
2008; Hoffman & Beauchine, 2007; Harrison et al., 2003)
Left undetected, mild or unilateral hearing loss can result in delayed
speech and language acquisition, social-emotional or behavioral problems, and
lags in academic achievement.(Yoshinaga-Itano et al., 1998; Bess,
1985; Bess et al., 1988)
Nearly 40% of children identified with hearing loss and their families
are not referred to the Part C early intervention system and may not be aware
of the broad array of services and funding available to them. Part C is the
primary source for families to link to other medical, audiologic and
intervention services. (Center for Disease Control and
Prevention, 2008)
When clear programmatic alternatives are available, the choices made
by parents of children who are DHH have changed dramatically over time. (Brown,
2006)
In 1995: 40% chose
spoken language options, compared to 60% who chose sign-language options
In 2005: 85% chose
spoken language options, compared to 15% who chose sign-language options
With appropriate early intervention, children with hearing loss can be
mainstreamed in regular elementary and secondary education classrooms. Recent
research has concluded that children born with a hearing loss who are
identified and given appropriate intervention before 6 months of age
demonstrated significantly better speech and reading comprehension than
children identified after 6 months of age. (Yoshinaga-Itano &
Apuzzo, 1998; Yoshinaga-Itano et al., 1998)
Facts on Technologies
Using 2000 US Census data with a total population of slightly over 231
million, 15,219 children presented with severe to profound hearing loss. Taking
into account some exclusions, 12,816 children would be considered cochlear
implant candidates. Based on the number of children who were implanted in 2000,
approximately 55% of the projected number of candidates received a cochlear
implant. (Bradham & Jones, 2008)
A cochlear implant can make oral proficiency in more than one language
possible for prelingually deaf children. (McConkey Robbinset
al., 2004)
Children who receive cochlear implants in the second year of life
attain better speech perception and language development outcomes than later
implantation. Children implanted between 12-24 months show similar language
skills as typical peers on some language measures administered at age
six. (Svirsky et al., 2004)
A recent study on cochlear implants demonstrated that special
education in elementary school is less necessary when children have had
"greater than two years of implant experience" before starting
school. These children are mainstreamed at twice the rate or more of
age-matched children with profound hearing loss who do not have implants. (Francis
et al., 1999)
The skills and knowledge that speech, language, and hearing
professionals possess in the area of cochlear implant services will enhance a
cochlear implant child's acquisition and use of auditory skills, which, in
turn, will impact other aspects of the student's life. (Teagle
& Moore, 2002)
Fitting of personal amplification in an infant or young child is an
on-going process. Minimally, an audiologist should see the child every three
months during the first two years of using amplification and every 4-6 months
after that time. (The Pediatric Working Group, 1996)
Facts on Costs
When children are not identified and do not receive early
intervention, special education for a child with hearing loss costs schools an
additional $420,000, and has a lifetime cost of approximately $1 million per
individual. (Johnson et al., 1993)
The Center for Disease Control and Prevention has estimated that the
lifetime economic cost to the public for a child with hearing loss is over
$400,000, mostly for special education services.(Honeycutt et al.,
2004; Mohr et al., 2000)
Most of the severe to profound hearing loss population are poorer than
other Americans.(Blanchfield et al., 2001)
53% of family income
made less than $25,000 compared to 35% of the general US population
Earnings are less (Mohr et al., 2000)
50–70% who have severe
to profound hearing loss before retirement age are expected to earn only 50 to
70% of their non-hearing loss peers.
AND
Lose between $220,000
and $440,000 in earnings depending on when the hearing loss occurred.
Based on incidence data, it is estimated that there will be slightly
over 15,000 new cases each year (Mohr et al., 2000)
Societal losses will
amount to $4.6 billion over the lifetime
If early identification
and intervention shifted 10% of the children into mainstreamed settings,
the return on investments would be more than double!
Facts on Listening and Spoken Language
There is evidence that children prefer and encode auditory stimuli
over visual stimuli. (Sloutsky & Napolitano, 2003)
There is substantial evidence that hearing is the most effective
modality for the teaching of spoken language, reading, and cognitive
skills. (Cole & Flexer, 2007)
Hearing is a first-order event for spoken language, reading, and
learning. (Cole & Flexer, 2007)
Listening experience in infancy is critical for the development of
both speech and language in young children and a strong spoken language base is
essential for reading. (Cole & Flexer, 2007)
The critical language learning window is from birth to approximately 3
years of age when brain neuroplasticity is the greatest. (Sharma
et al., 2002)
There is a critical window for auditory neural development. Studies in
brain development show that sensory stimulation of the auditory centers of the
brain is critically important, and indeed, influences the actual organization
of auditory brain pathways. (Cole & Flexer, 2007)
Research suggests that children receiving implants earlier may benefit
from the relatively greater plasticity of the auditory pathways than children
implanted later within the developmentally sensitive period. (Manrique
et al., 1999; Harrison et al., 2005; Sharma et al., 2002)
Data show that 90% of children born with a profound hearing loss who
obtain a CI before they are 18 months old attain intelligible speech. If a
cochlear implant is obtained between 2 and 4 years of age, about 80% of the
children born with profound hearing loss will attain intelligible speech. In
contrast, only about 20% of children born with a profound hearing loss who wear
hearing aids and not a cochlear implant attain intelligible speech. (Cole
& Flexer, 2007)
Neural imaging has shown that the same brain area—the primary and
secondary auditory areas—are most active when a child listens and when a child
reads. (Cole & Flexer, 2007)
Communication mode has been shown to have a highly statistically
significant association with speech and language outcomes of children with
cochlear implants. Children exposed to spoken language have a greater
probability of scoring higher on speech and language assessments than children
exposed to some degree of either sign support or sign language. (Percy-Smith
et al., 2008)
Children receiving auditory-based intervention score the highest on
speech production and speech recognition measures. These results improve as the
emphasis on audition increases.(Wie et al., 2007)
Recent data indicates that introducing sign language prior to cochlear
implantation does not enhance outcomes compared to emphasis on spoken language
alone. (Nittrouer, 2008)
Recent data indicates that use of sign language was detrimental for
the development of spoken langauge for children identified with hearing loss
after their first birthday. (Nittrouer, 2008)
Listening and spoken language professionals encourage caregivers to
interact with a child through spoken language and create a listening
environment that helps a child to learn.(Estabrooks, 2006)
Better speech, spoken language and auditory outcomes are associated
with greater emphasis on spoken language. Since 1992, over 90% of children with
profound hearing loss developed intelligible spoken language. (Yoshinaga-Itano,
2008)
Speech production, speech recognitionn, expressive language,
complexity of utterances and syntax and narrative ability are better for
children using a listening and spoken language approach than children using total
communicaiton. (Moog & Geers, 2003)
The literature in developmental psychology tells us that about 90% of
what very young children know about the world is from incidental
learning. (Moog & Geers, 2003)
a. The auditory-oral communication mode is important to the speech and
language development of children after cochlear implantation.
b. The dominant educational factor associated with high performance
levels was the extent to which a child's classroom communication mode
emphasized speech and auditory skill development.
c. Parents and
Professionals can help a child achieve maximum benefit from a cochlear implant
by selecting an educational environment that provides a consistent emphasis on
developing speech, auditory, and spoken language skills.
Children enrolled in a program focused on listening and spoken
language showed an average of one year of language growth for each year in the
program. At the end of a four-year period, the gap between chronological age
and language age was nonexistent. (Rhoades & Chisolm, 2000)
Children who were deaf or hard of hearing and developed spoken
language through listening developed reading ability comparable to their peers
who hear normally. (Robertson & Flexer, 1993)
In the recent past, it has been reported that the vast majority of
persons educated in deaf schools (95%) reach a reading age of only 9 years. (Traxler,
2000)
Studies examining the effects of cochlear implantation on reading
indicate that the improved auditory skills may be associated with better
reading outcomes...Above and beyond the positive effects of the cochlear
implant, it is anticipated that auditory / speech training may increase the
deaf child's access to phonological information and word comprehension. (Geers,
2003)
A study looking at outcomes as related to communication modes for
children with hearing loss recommended that all educational programs
incorporate a well-designed and implemented speech and language development and
auditory training program. (Connor et al., 2000)
Constant use of auditory input to monitor speech production and to
comprehend spoken language provides the concentrated practice needed for
optimum benefit from a cochlear implant. (Geers & Brenner,
2003)
Listening and spoken language programs seek to improve speech
perception, speech production, and spoken language skills by teaching a child
to listen. Improved hearing sensitivity (as provided by a CI) does not, by
itself, guarantee the ability to discriminate between sounds or to interpret
speech for oral communication purposes. Children who receive CI continue to
require intensive auditory, speech, and language training. (Wilkins
& Ertmer, 2002)
Even mild hearing loss can significantly interfere with the reception
of spoken language and education performance. Research indicates that children
with unilateral hearing loss (in one ear) are ten times as likely to be held
back at least one grade compared to children with normal hearing. (Cho
Lieu, 2004; Bess, 1985; Oyler et al., 1988)
Facts on Educational Environments
Acoustic environments
All children need a quieter environment and a louder signal than
adults to hear well enough to understand. Children with hearing loss need an
even greater signal to noise ratio than children with typical hearing (Crandell
et al., 2005)
ASHA standards require background noise levels not to exceed 30 dBA,
reverberation times not to exceed 0.4 seconds or less, and an overall teacher
signal-to-noise ratio (SNR) of + 15 dB. ANSI guidelines for schools call for
background noise level to not exceed 35 dBA, reverberation time (RT) not to
exceed 0.6–0.4 seconds, and a SNR of + 15 dB. (American
Speech-Language-Hearing Association, 2005)
Listeners who are cochlear implant users need a minimum of + 10 SNR to
function communicatively but require at least a + 15 SNR if they are to be
expected to access verbal instruction, even in a classroom that meets ANSI
standards. (American Speech-Language-Hearing Association,
2005)
FM units provide dramatic improvement in signal to noise ratio,
especially in noisy mainstream classroom. In addition to helping achieve a +15
SNR in a classroom, it also addresses the degradation of speech across distance
and interference of minimal or fluctuating noise for children with hearing
loss. (American Speech-Language-Hearing Association, 2005)
Types of Educational Placement
Early intervention services for infants with confirmed hearing loss
should be provided by professionals with expertise in hearing loss, including
educators the deaf, speech-language pathologists, and audiologists. (American
Speech-Language-Hearing Association, 2007; Joint Committee on Infant Hearing,
2007)
Oral communication performance of children with cochlear implants is
not only influenced by the mode of communication used educationally but also
the educational setting. (Toby et al., 2003)
Children with cochlear implants who are in programs emphasizing listening
and talking have higher speech production scores than children in programs that
put less emphasis on these actions. (Toby et al., 2003)
Children with cochlear implants who are in mainstream classrooms where
they must rely on listening and talking outperform children who are in special
education classrooms where they may rely less on listening and talking. (Toby
et al., 2003)
Data indicated that higher expectations are appropriate for children
with cochlear implants than were previously realistic for profoundly deaf
children who wore hearing aids. The data also indicate that parents and
professionals can help a child achieve maximum benefit from a cochlear implant
by:
1. Selecting an educational environment that provides a consistent
emphasis on developing speech, auditory, and spoken language skills.
2. Making sure that the child receives audiological management that
includes access to the most up-to-date speech processing strategies and careful
monitoring of the implant to ensure a well-fitted Map.
In this study all performance outcome measures were significantly
higher for cochlear implanted children in educational environments emphasizing
listening and speaking...the current findings represent the most compelling
support for an oral emphasis educational environment to be found in the
pediatric cochlear implant literature. (Moog & Geers, 2003)
Cochlear implantation aided by aural habilitation a) enhances the
growth in language skills that presumably underlies the increased rate of
mainstream placement, b) equips most children with an increasing ability to
participate in and benefit from the mainstream classroom. c) increases access
to acoustic information of spoken language, leading to higher rates of
mainstream placement in schools and lower dependence on special education
support services. (Francis et al., 1999)
The Commission on Deaf Education states the IEP should also address
the child's emotional and psycho-social needs. Deaf children are too often
inappropriately placed in a classroom with a wide range of ages, or in
cross-categorical groupings of children with different types of
disabilities. (Joint Committee on Infant Hearing, 2007)
In response to a previous emphasis on natural environments, the Joint
Committee on Infant Hearing (JCIH) recommends that both home-based and
center-based intervention options should be offered. (American
Speech-Language-Hearing Association, 2007; Joint Committee on Infant Hearing,
2007)
Speech Language Pathologists (SLPs) with backgroud in articulation and
language development may have the skills to work with a hearing impaired child
in those areas (langauge and speech); however, frequently they have little
training or experience in auditory learning strategies for children with
hearing loss. The task of developing an auditory learning program for a child
with a cochlear implant can be challenging. (Teagle & Moore,
2002)
Children with mild hearing loss miss 25–50% of speech in the classroom
and may be inappropriately labeled as having a behavior problem or learning disability.
Accommodations need to be made for these children. (Bess,
1985; Bess et al., 1998)
Literacy
Studies examining the effects of cochlear implantation on reading
indicate that the improved auditory skills may be associated with better
reading outcomes. Above and beyond the positive effects of the cochlear
implant, it is anticipated that auditory/speech training may increase the deaf
child's access to phonological information and word comprehension. (Geers,
2003)
Children who are deaf and hard of hearing are at risk for serious
reading deficiencies. (Carney & Moeller, 1998)
Recent reports suggest a better long-term prognosis related to
improved speech perception skills resulting from universal newborn screening
and advances in technology, such as cochlear implants. (Spencer
& Oleson, 2008)
For typical developing children, phonological awareness, alphabetic,
and vocabulary form the foundation to read words and passages
meaningfully. (Shanahan, 2006)
Vocabulary is another influential component in literacy development.
In children with typical hearing higher-level vocabulary affects reading
outcomes for struggling readers. (Bowyer-Crane et al., 2008)
Vocabulary plays an important role in reading for children who are
Deaf or Hard of Hearing.(Geers & Moog, 1989; Paul, 1996)
Many children with hearing loss start preschool with significant gaps
and fewer words in their lexicons when compared to children with typical
hearing, which may be another cause of reading challenges. (Prezbindowski
& Lederberg, 2003)
Results of study suggest that many of today's self-contained early
childhood classes successfully help children who are DHH to develop
auditory-based phonological and phonics skills. Scores on literacy tasks that
involved recognition of letters, recognition of common written words suggested
performance of children who are DHH was similar to that of children with
typical hearing. (Easterbrooks et al., 2008)
First, similarities between children who are DHH suggest that research
on effective reading instruction for children with typical hearing may form the
basis for effective intervention for children who are DHH. Second,
instructional strategies need to be adapted to meet the specific needs of
children who are DHH, including instructional language that is more explicit,
especially for rhyming and vocabulary. This instruction has to be
individualized to the language and phonological sensitivity skills of children
who are DHH. All of these can occur more easily in self-contained classes, such
as those provided by Option schools. (Easterbrooks et al., 2008)
Personnel Preparation
Most existing personnel preparation programs (whether or not they are
funded by OSERS) emphasize sign-language options even though most parents
choose spoken language options when they are available.
Of all graduates from DHH Teacher Education programs in 2004
74% were from TC
programs
18% were from Bi-Bi
programs
8% were from A/O
programs
Of the 19 OSERS-funded teacher preparation programs
10 are primarily TC
emphasis
6 are primarily Bi-Bi
emphasis
3 are primarily A/O
emphasis"
