Development and Evaluation of an Audiological Outcome Measure Guideline for Use with Infants, Toddlers, and Preschool Children

The goals of the current work were to: 1) identify caregiver report questionnaires for inclusion in an outcome evaluation guideline for infants, toddlers, and preschool children who wear hearing aids and 2) evaluate the chosen tools to determine their usefulness for the population of interest. A critical review of auditory-related subjective outcome evaluation tools for infants, toddlers, and preschool children is presented (Chapter 2). Good psychometric properties and clinical feasibility were considered important elements for the guideline (Andresen, 2000). Existing norms for the chosen questionnaires were validated with normal hearing children from Canadian English-speaking families (Chapters 3 and 5). Finally, The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP), how it was used to collect clinical data with children who wear hearing aids, and their performance on the questionnaires is provided (Chapter 4). Children with comorbidities and complex factors related to hearing aid use were also investigated. The results of this work revealed two caregiver report questionnaires that were suitable for use within the UWO PedAMP (Chapter 2): the LittlEARS® Auditory Questionnaire (Tsiakpini, et al., 2004) and the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale (Ching & Hill, 2005). Both questionnaires were considered feasible for clinical use (Moodie, et al., 2011) and are supported by good psychometric properties. Norms for the questionnaires were found to be appropriate for use with normal hearing children (Chapters 3 and 5). Outcomes of children with hearing loss who wear hearing aids were investigated using the UWO PedAMP (Chapter 4). Results indicated typically developing children fitted with hearing aids displayed auditory development and performance similar to their normal hearing peers. Children with comorbidities displayed borderline normal auditory development which progressed as they got older. Children with complex factors related to hearing aid use displayed borderline normal development up to 12 months of age where it began to decline. This work also demonstrated that the UWO PedAMP can be used in a clinical setting to evaluate the outcome of hearing aid fitting to infants, toddlers, and preschool children. This is an important finding since outcome evaluation guidelines for this population are lacking

What do Speech-Language Pathologists want to know when assessing vocal development in children who are deaf/Hard-of-Hearing?

Abstract Purpose: Delays in vocal development are an early predictor of ongoing language difficulty for children who are deaf/hard-of-hearing (CDHH). Despite the importance of monitoring early vocal development in clinical practice, there are few suitable tools. This study aimed to identify the clinical decisions that speech-language pathologists (SLPs) most want to make when assessing vocal development and their current barriers to doing so. Method: 58 SLPs who provide services to CDHH younger than 22 months completed a survey. The first section measured potential barriers to vocal development assessment. The second section asked SLPs to rate the importance of 15 clinical decisions they could make about vocal development. Results: SLPs believed assessing vocal development was important for other stakeholders, and reported they had the necessary skills and knowledge to assess vocal development. Barriers primarily related to a lack of commercially available tests. SLPs rated all 15 clinical decisions as somewhat or very important. Their top 5 decisions included a variety of assessment purposes that tests are not typically designed to support, including measuring change, differential diagnosis, and goal setting. Conclusions: SLPs wish to make a number of clinical decisions when assessing vocal development in CDHH but lack access to appropriate tools to do so. Future work is needed to develop tools that are statistically equipped to fulfill these purposes. Understanding SLPs’ assessment purposes will allow future tests to better map onto the clinical decisions that SLPs need to make to support CDHH and their families and facilitate implementation into clinical practice

Usability and Feasibility of a Spoken Language Outcome Monitoring Procedure in a Canadian Early Hearing Detection & Intervention Program: Results of a 1-Year Pilot

Abstract Purpose: Best practice recommendations for Early Hearing Detection and Intervention (EHDI) programs include routine spoken language outcome monitoring. The present article reports on pilot data that evaluated the usability and feasibility of a spoken language outcome monitoring procedure developed for Ontario’s Infant Hearing Program (IHP). This procedure included both Program-level monitoring using omnibus language tests from birth to 6;0 and individual vulnerability monitoring of key domains of spoken language known to be at risk in children who are deaf/hard-of-hearing. Methodology: Speech-language pathologists (SLPs) in the IHP piloted the new procedures for one year and provided feedback on the procedure through surveys at the end of the pilot. Results: Data was suggestive that the Program-level procedure might be sensitive to change over time and known predictors of spoken language outcomes. Some, but not all, Program-level test scores were predicted by the presence of additional developmental factors. None of the test scores were significantly predicted by severity of hearing loss. Depending on the tests and scores used, some aspects of the Program-level procedure to change over time. There was insufficient evidence to support individual vulnerability monitoring. SLPs reported significant concerns about the time involved in implementing both procedures. Conclusions: This article describes preliminary evidence suggesting that the Program-level procedure might be feasible to implement and useful for evaluating EHDI programs. Future evaluations are needed to determine whether the procedure can be accurately implemented to scale in the IHP, and whether the data that results from the procedure can meaningfully inform stakeholders’ decision-making

Usability and Feasibility of a Spoken Language Outcome Monitoring Procedure in a Canadian Early Hearing Detection & Intervention Program: Results of a 1-Year Pilot

Purpose: Best practice recommendations for Early Hearing Detection and Intervention (EHDI) programs include routine spoken language outcome monitoring. The present article reports on pilot data that evaluated the usability and feasibility of a spoken language outcome monitoring procedure developed for Ontario’s Infant Hearing Program (IHP). This procedure included both Program-level monitoring using omnibus language tests from birth to 6 years of age and individual vulnerability monitoring of key domains of spoken language known to be at risk in children who are deaf or hard of hearing. Methodology: Speech-language pathologists (SLPs) in the IHP piloted the new procedures for one year and provided feedback on the procedure through surveys at the end of the pilot. Results: Data was suggestive that the Program-level procedure might be sensitive to change over time and known predictors of spoken language outcomes. Some, but not all, Program-level test scores were predicted by the presence of additional developmental factors. None of the test scores were significantly predicted by severity of hearing loss. Depending on the tests and scores used, some aspects of the Program-level procedure were sensitive to change over time. There was insufficient evidence to support individual vulnerability monitoring. SLPs reported significant concerns about the time involved in implementing both procedures. Conclusions: This article describes preliminary evidence suggesting that the Program-level procedure might be feasible to implement and useful for evaluating EHDI programs. Future evaluations are needed to determine whether the procedure can be accurately implemented to scale in the IHP, and whether the data that results from the procedure can meaningfully inform stakeholders’ decision-making

A comment on test validation: The importance of the clinical perspective

© 2019 American Speech-Language-Hearing Association. Purpose: The misuse of standardized assessments has been a long-standing concern in speech-language pathology and traditionally viewed as an issue of clinician competency and training. The purpose of this article is to consider the contribution of communication breakdowns between test developers and the end users to this issue. Method: We considered the misuse of standardized assessments through the lens of the 2-communities theory, in which standardized tests are viewed as a product developed in 1 community (researchers/test developers) to be used by another community (frontline clinicians). Under this view, optimal test development involves a conversation to which both parties bring unique expertise and perspectives. Results: Consideration of the interpretations that standardized tests are typically validated to support revealed a mismatch between these and the interpretations and decisions that speech-language pathologists typically need to make. Test development using classical test theory, which underpins many of the tests in our field, contributes to this mismatch. Application of item response theory could better equip clinicians with the psychometric evidence to support the interpretations they desire but is not commonly found in the standardized tests used by speech-language pathologists. Conclusions: Advocacy and insistence on the consideration of clinical perspectives and decision making in the test validation process is a necessary part of our role. In improving the nature of the statistical evidence reported in standardized assessments, we can ensure these tools are appropriate to fulfill our professional obligations in a clinically feasible way

Protocol for Audiological Surveillance of Children at Risk for Permanent Hearing Loss

This document addresses procedures for the audiological surveillance of hearing of infants and young children at risk for late onset or progressive permanent hearing loss (PHL). It is closely linked with the Ontario Infant Hearing Program (IHP) Protocol for Universal Newborn Hearing Screening Auditory Brainstem Response Assessment (ABRA) Protocol, and the IHP protocol for Audiometric Assessment for Children Aged 6 to 60 Months with respect to risk indicators, hearing screening technology applied, screening bypass, and audiological assessment procedures

A critical review of audiological outcome measures for infants and children

Outcome evaluation is an important stage in the pediatric hearing aid fitting process, however a systematic way of evaluating outcome in the pediatric audiology population is lacking. This is in part due to the need for an evidence-based outcome evaluation guideline for infants and children with hearing loss who wear hearing aids. As part of the development of a guideline, a critical review of the existing pediatric audiology outcome evaluation tools was conducted. Subjective outcome evaluation tools that measure auditory-related behaviors in children from birth to 6 years of age were critically appraised using a published grading system (Andresen, 2000). Of the tools that exist, 12 were appraised because they met initial criteria outlined by the Network of Pediatric Audiologists of Canada as being appropriate for children birth to 6 years of age who wear hearing aids. Tools that were considered for the guideline scored high in both statistical and feasibility criteria. The subjective outcome evaluation tools that were ultimately chosen to be included in the guideline were the LittlEARS Auditory Questionnaire (Tsiakpini et al., 2004) and the Parents\u27 Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale (Ching & Hill, 2005b) due to the high grades they received in the critical review and their target age ranges. Following this critical review of pediatric outcome evaluation tools, the next step was for the Network Clinicians to evaluate the guideline (Moodie et al., 2011b)

Consensus practice parameter: audiological assessment and management of unilateral hearing loss in children

Objective: Provide recommendations to audiologists for the management of children with unilateral hearing loss (UHL) and for needed research that can lend further insight into important unanswered questions. Design: An international panel of experts on children with UHL was convened following a day and a half of presentations on the same. The evidence reviewed for this parameter was gathered through web-based literature searches specifically designed for academic and health care resources, recent systematic reviews of literature, and new research presented at the conference that underwent peer review for publication by the time of this writing. Study sample: Expert opinions and electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Education Resources Information Centre (ERIC), Google Scholar, PsycINFO, PubMed, ScienceDirect, and Turning Research into Practice (TRIP) Database. Results: The resulting practice parameter requires a personalised, family-centred process: (1) routine surveillance of speech-language, psychosocial, auditory, and academic or pre-academic development; (2) medical assessments for determination of aetiology of hearing loss; (3) assessment of hearing technologies; and (4) considerations for family-centred counselling. Conclusions: This practice parameter provides guidance to clinical audiologists on individualising the management of children with UHL. In addition, the paper concludes with recommendations for research priorities

Protocol for the Provision of Amplification v 2023.01

This Protocol addresses the provision of amplification (hereafter: \u27Amplification\u27) to infants and children who are receiving services from the Ontario Infant Hearing Program (IHP). For the purposes of this protocol, providing amplification includes the processes of prescribing a hearing aid (air or bone conduction) and/or other hearing assistance technologies based on appropriate assessment information, verification that the specified acoustical performance targets have been achieved, fitting the device on the child, and ongoing evaluation of device effectiveness in daily life. Amplification within the IHP does not include the provision of cochlear implants

Validation of the Parents\u27 Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale

BACKGROUND: The Parents\u27 Evaluation of Aural/Oral Performance of Children (PEACH) is a caregiver report questionnaire that is suitable for use with children who wear hearing aids. It is available in both a Diary format and a Rating Scale format. Following a critical review of subjective outcome evaluation tools for infants, toddlers, and preschool children (Bagatto, Moodie, Seewald et al, 2011), the Rating Scale version of the PEACH was included in a recently developed guideline for monitoring real-world auditory performance of children who have hearing loss (Bagatto, Moodie, Malandrino et al, 2011). Normative data exist only for the PEACH Diary, not the Rating Scale. PURPOSE: This article evaluates whether published normative data for the PEACH Diary (Ching and Hill, 2007) are replicated on a different sample of children using the PEACH Rating Scale. RESEARCH DESIGN: Fifty-nine children with normal hearing aged 2 mo to 83 mo and their primary caregivers participated in the study. Caregivers completed the PEACH Rating Scale for each child with normal hearing. RESULTS: Results indicated close agreement to existing normative data collected with the PEACH Diary, with no differences in scores between males and females and good internal consistency. Age-related trends published for the Diary version were replicated using the Rating Scale version, as significantly lower scores were observed for children 20 mo of age and younger compared to those older than 20 mo of age. CONCLUSIONS: The currently published norms for the PEACH Diary are valid for use with the PEACH Rating Scale with caregivers of normal hearing children. This validation work adds to the evidence base of the PEACH Rating Scale and supports its use in clinical practice