Download Universal Newborn Hearing Screening (UNHS)

Background in Children
with Hearing Loss
birth to six
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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
35
Number per 10,000
30
25
20
15
10
5
0
Hearing loss
Cleft lip or
palate
Down
syndrome
Limb defects Spina bifida
Congenital Condition Type
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Sickle cell
anemia
PKU
Prevalence and Incidence
• Incidence increases by school age to 6/1000.
– late identification
– late onset
– progressive hearing losses
• 930,000 children with
mild to severe HL 6-19
years of age. 2
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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
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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
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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:
– vocabulary
– word learning
– advanced syntax
– morphology
– social use of language
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8
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
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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
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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
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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
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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.
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17, 18
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
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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
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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
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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
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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?
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Performance Measures
• Performance measured in:
– Speech and Language Development
– Social Development
– Academic Development
– Hearing, listening and hearing aid status
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Evidenced Based Practices
Professionals are looking for additional
guidance concerning the management of
these children.
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Hospital
Current Studies:
Areas of Evaluation
•
Audiological Information
–
–
–
–
•
Speech Production
•
– Understanding and use of
syntax
vocabulary
narrative discourse
morphological use
•
– Social reasoning (Theory of Mind)
Spelling
Reading comprehension
Word recognition
Math
Verbal reasoning
Psychosocial
behavioral/cognitive
– Cognitive reasoning
– Social behavior
– Teacher reports
Language
•
•
•
•
Academic
–
–
–
–
–
Tympanometry
Audiogram
Speech Perception
Hearing aid verification
– Articulation
– Speech Intelligibility
•
•
Family outcomes
– Parenting
– Quality of life/ Family Life
– Satisfaction of service delivery
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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.
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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.
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Hospital
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Hospital
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Hospital