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

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?

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

• 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” (>90%)
• Some states determine eligibility if/when
“appropriate treatment still leaves significant impairment”

• 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

Mild Hearing Loss

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

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

Mild Loss
Moderate Loss
Moderate / Severe
Severe Loss
Profound Loss
Mom < HS Education
Mom > HS Education
No Medicaid
Medicaid
Hearing Loss Only
Multiple Disabilities
The early identification effect on language
(N=85)
MCDI Total Language Quotient (Mean)
After 6 Months By 6 Months
Yoshinaga-Itano, et al (1998)

Unilateral Hearing Loss

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

• 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
– “Don’t worry, your child has one good ear”.
– “Be sure to arrange for preferential seating when your child starts school”.

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

• 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

• 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

• 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

Colorado n
24
New Mexico 1
Virginia 1
%
92
4
4

Male
Female
n
14
12
%
54
46

Caucasian
Asian American
African American
Hispanic
Hispanic/Caucasian
Other mixed minority n
18
2
1
2
1
2
%
69
8
4
8
4
8

No disabilities n %
22 85
Additional disabilities 4 15

Range Median
Years of educ
Mother
Father 1
Income 2
12 to 21
12 to 20
<$10,000 to
>$100,000
16
16
$60,000
1 n = 24 2 n = 22

Oral
Occasional sign
Frequent sign n
17
7
2
%
65
27
8

Screened
Not screened
Don’t know
(child adopted) n
23
2
1
%
89
4
4

< 6 months
14 months
18 months n %
22 92
1
1
4
4
N = 24

Congenital
Acquired
- 1 at 4 days (meningitis)
- 1 at 3 months (seizures)
Don’t know n %
22 88
2 8
1 4
N = 25

Unknown
Heredity n
20
3
Waardenburg 1
%
77
12
4
Meningitis
Seizures
1
1
4
4

Atresia
Mondini
None n
6
%
23
2 8
18 69

Right
Left n
14
12
%
54
46

Mild
Moderate
Moderate-severe
Severe 4
Severe or profound 7
6
6 n
2
N = 25
%
8
24
24
16
28

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

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

• 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

n
Expressive
Borderline (70 – 79)
Average (80+)
Receptive
Below average (< 70)
Borderline (70 – 79)
Average (80+)
3
15
1
3
14
5% of hearing children borderline or below average
%
17
83
6
17
78

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

• 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

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

MacArthur Inventories n %
Expressive
< 10 th percentile
> 10 th percentile
2
10
17
83
Receptive
< 10 th percentile
> 10 th percentile
2
9
18
82
10% of hearing children would be expected to fall below the 10th percentile

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

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

• 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%)

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

• 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

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 (n=5)
• Receptive language (n=1)
• MLU (n=1)
• Speech development (n=1)

Minimal is not inconsequential
Bess, 2004