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Early intervention investigation:

Children who are deaf and hard of hearing.

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Impact on Development

Regardless of cause, the type of hearing loss and whether the loss is complete or partial impacts a child’s speech and language acquisition. All domains of personal development are connected and interrelated; therefore hearing loss creates challenges with cognitive, social, and emotional development. Another factor in considering the impact of deafness is the difference between pre-lingual and post-lingual hearing loss.

It has been confirmed that children born with congenital hearing loss are at greater risks for language delays compared with children who have had auditory language experience previous to hearing loss (Diefendorf, 1999). These children are at risk of delay because they do not have the naturalistic experiences and exposure to oral language that contribute to language acquisition more than direct instruction (McKinley, 2000).

One distinction that needs to be addressed is the difference between language and speech. Language is defined as the means to communicate whether orally, manually, or through written word. Speech is the vocalization of language. Similar to language development, children require experience listening and imitating adult speech in order to develop their own speech ability. Research suggests children have 2 to 3 months in utero to use their auditory skills, specifically in recognizing and understanding speech (Yoshinaga-Itano, 1998; Calderon, 1998). Children born with hearing loss are at a disadvantage immediately from the birthing canal. While this may seem to be an overstatement, DeCasper and Spence (1986) studied this phenomenon and found children prefer to listen to books that had been read to them pre-natally compared to other storybooks! Hearing-impaired infants are lacking the 2 to 3 months hearing newborns have already had to become used to listening speech.

Additionally, the normal developmental timeline for verbal language development in an infant consists of 12 to 15 months of listening to speech and engaging in other communication before verbalizing the first word (Calderon, 1998). During this time frame, infants become aware oral communication consists of verbal turn taking (Yoshinaga-Itano, 1998); a period of “I say, you say.” Deaf children, or those with severe hearing loss not only lack this important aspect of speech and verbal communication, but they also lack the naturalistic learning opportunities these dialogues create.

Along with what children learn from what they hear and imitate, their cognitive ability is enhanced with the development and increase in listening ability and spoken language skills (Simser, 1993; Calderon, 1998). As children become more attentive in listening to others speech, their own vocabulary and understanding of language grows. Incorporating that understanding and vocabulary growth into spoken speech increases cognition and creates building blocks for meta cognition.

Hearing loss also affects the domains of social and emotional development. Consider the current literature on parental attachment agreeing children already have an attachment to their primary caregiver by the second year of life and communication between the child and caregiver are critical to the development of that attachment (Hadadian, 1995). This begs the question if the communication barrier between deaf children and their hearing parents has an effect on attachment. Despite initial assumptions, results of Hadadian’s (1995) study showed no statistical differences in the development of attachment between deaf children and their hearing parents. Simply translated, deafness is not a factor in the security of a child’s attachment to their primary caregiver.

Even if the security of the relationship is not a factor, those who do not develop proper language and communication skills will suffer more emotional stress in family communication, friendships, and may suffer from peer isolation (Diefendorf, 1995) and other psychological aspects such as mental health (Calderon, 1998; Magnuson, 2000). Evidence found supports this stating good language skills are associated with a more positive socio-emotional adjustment and decreases in behavior problems (Calderon, 1998).

Along with increases in stress, consequences of hearing impairment that extend beyond development need to be taken into consideration when making decisions about interventions and services. Hearing loss creates a significant economic burden with increased medical expenses. On top of the extra financial burden, few deaf people are employed in professional, technical, and managerial positions, severely affecting earning potential (Diefendorf, 1995). Therefore decisions about intervention services should be based on maximizing the potential of the child.

Screening for Infant Hearing Loss

The first step toward intervention is screening for hearing loss in newborns. So far, 19 states have a mandated universal screening program for infants, and an additional 9 states have limited screening programs (Diefendorfer, 1999). For these programs Diefendorfer (1999) refers to six major criteria required for the universal screening of infants:

1. Significant consequences must result when the disorder is not detected

2. The disorder must be otherwise undetectable by clinical signs or risk factors

3. Early detection programs for hearing impairment must be available and accessible

4. An easy-to-use, inexpensive test must be available that is highly sensitive and minimizes referral for additional assessment

5. Birth-admission screening, detection, and intervention must result in an improved outcome

6. The screening program must be documented to be acceptably cost-effective and long-term outcomes must be cost beneficial.

Clinical reports of existing screening programs indicate a fulfillment of these six criteria. By 2000, it was reported nearly one-third of U.S. born children had their hearing screened before discharge from the hospital (Yoshinaga-Itano, 1998).

Follow-up appointments are essential to newborn hearing screening; yet they constitute the weakest element in the programs. Reports indicate that anywhere from 25% to 80% of children from neonate intensive care units attrite (Diefendorfer, 1999). This tends to be a reflection of parents’ impressions toward the screening program not being essential, especially where mild hearing loss is concerned. This is especially troubling when considering the potential value of early detection.

The major reason for a mandatory screening program is that early detection of hearing impairment is essential for children to achieve their full potential with respect to language skills through intervention services (Magniuson, 2000). Research indicates early-identified children with hearing loss have better language skills and concurrently, children with better language skills also have better speech ability (Yoshinaga-Itano, 1998). Fortunately because of these screening programs the common occurrence of most hearing loss in children not being identified or diagnosed until between ages 2.5 and 3 years (Givens, 2000) is being corrected. Earlier detection is now allowing access to early intervention services. An additional benefit to early detection is found in parents whose children were identified before the age of 9 months, and who report lower stress levels when compared to parents of children identified later in life (Meadow-Orlans, 1995).