Children Who Are Hard of Hearing: Still Forgotten? A longitudinal study points to factors affecting language outcomes for children with mild to severe hearing loss who use hearing aids. All Ears on Audiology
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All Ears on Audiology  |   June 01, 2017
Children Who Are Hard of Hearing: Still Forgotten?
Author Notes
  • Mary Pat Moeller, PhD, CCC-A, is director of the Center for Childhood Deafness and the Language Development Laboratory at Boys Town National Research Hospital. marypat.moeller@boystown.org
    Mary Pat Moeller, PhD, CCC-A, is director of the Center for Childhood Deafness and the Language Development Laboratory at Boys Town National Research Hospital. marypat.moeller@boystown.org×
  • Ryan McCreery, PhD, is the director of research at Boys Town National Research Hospital. He is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. ryan.mccreery@boystown.org
    Ryan McCreery, PhD, is the director of research at Boys Town National Research Hospital. He is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. ryan.mccreery@boystown.org×
Article Information
Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / All Ears on Audiology
All Ears on Audiology   |   June 01, 2017
Children Who Are Hard of Hearing: Still Forgotten?
The ASHA Leader, June 2017, Vol. 22, 16-17. doi:10.1044/leader.AEA.22062017.16
The ASHA Leader, June 2017, Vol. 22, 16-17. doi:10.1044/leader.AEA.22062017.16
In 1977, researcher Julia Davis’ classic edited volume “Our Forgotten Children: Hard of Hearing Pupils in the Schools” highlighted a societal tendency to underestimate the needs of children with less-than-severe hearing loss who wear hearing aids.
Classroom teachers and other professionals rarely received training to work with these students. Amplification devices, if worn by the child, were poorly monitored. Research on children who are hard of hearing was too limited to challenge “business as usual” practices.
Today, many of these historical issues remain. A 2006 panel convened by the National Institute on Deafness and Other Communication Disorders (NIDCD) identified persistent gaps in the literature related to children who are hard of hearing. The NIDCD panel called for large-scale studies to investigate fundamental questions about the impact of early service provision, including hearing aids, on outcomes for these children. The need was especially urgent in this era of newborn hearing screening—where children have early access to amplification and intervention—so our team set out to get it started.

It is critical that we expect children who are hard of hearing to achieve at the same academic level as their peers.

The study and its findings
With funding from NIDCD, researchers from our teams at the University of Iowa, Boys Town National Research Hospital and University of North Carolina at Chapel Hill joined in 2008 to implement a prospective, longitudinal study to address the research gaps. The ongoing project, led by J. Bruce Tomblin and Mary Pat Moeller, is called Outcomes of Children with Hearing Loss (OCHL). The team follows 317 children who are hard of hearing and 117 hearing children matched by age and socioeconomic status.
In the first five years of this study, we found that children who are hard of hearing are at risk for language delays—and this risk increases with the severity of hearing loss. The results, published in a supplement volume of Ear and Hearing in 2015, also revealed that these children performed nearly one standard deviation below the matched control group on language measures, albeit within the average to low-average range compared to test norms. If we want to avoid underestimating the needs of these children, it is critical that we expect them to achieve at the same academic level as their peers.
Another key finding from our research is that well-fitted hearing aids provide protection against developmental risks for children who are hard of hearing. However, more than half of the children’s hearing aids were not fitted optimally, which affected audibility, speech perception and language outcomes. These results support the vital importance of hearing aid verification and validation practices, which stand to directly affect children’s outcomes.
Speech and language delays—but why?
We reasoned that children who are hard of hearing are at risk for speech and language delays due to variations in their access to linguistic input. Access to input is essential for all language-learners, and if that access is inconsistent, the quality and quantity of auditory experience is affected. And this could potentially lead to language delays. The research team identified three primary factors that influenced children’s linguistic access and contributed to differences in their language outcomes:
  1. Boost in audibility (ability to hear speech) provided by hearing aids. Children with better-aided audibility with hearing aids showed stronger language growth in preschool than those with more limited audibility, even after controlling for the effects of degree of hearing loss.

  2. Consistency and duration of hearing aid use. Children who wore hearing aids regularly (more than 10 hours daily) and those fitted early (younger than 6 months old) showed the most optimal language outcomes. However, later-fitted children demonstrated a pattern of catching up with peers after regular and extended hearing aid use. Infants, children with mild hearing loss, and children in homes with lower levels of maternal education were at greatest risk for inconsistent hearing aid use. Given that consistent hearing aid use matters for language outcomes, we need to consider unique supports for families of children in these groups.

  3. Quality of language input in the home. Caregivers used fewer abstract concepts and more directive talk (“sit down,” “say ‘baby’”) when addressing 3-year-old children who are hard of hearing than when addressing children with normal hearing. Both of these differences matter because they were shown to influence language outcomes.

We hope to promote practice shifts so that these children will no longer be characterized as “forgotten.”

Overall, the results support early identification of and intervention with childhood hearing loss. Notably, the children in our study were more advantaged—socioeconomically and in maternal education—than a typical U.S. population, which tempers generalization of results. However, we expect that families with fewer resources struggle the most with the challenges we pinpointed, suggesting a need to understand how best to serve them.
This project is ongoing. The second phase follows the children into school years to understand factors influencing later language, literacy and social outcomes. The team is exploring the effect of complex listening situations on the outcomes of children who are hard of hearing. We hope to promote practice shifts so that these children will no longer be characterized as “forgotten.”
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June 2017
Volume 22, Issue 6