Timeliness of EHDI benchmarks in infants with a NICU admission greater than five days: Analysis from a retrospective cohort

The purpose of this study was to examine the timeline of early hearing healthcare in infants with a history of lengthy (\u3e 5 days) admission to a neonatal intensive care unit (NICU) compared to non-NICU peers. We compiled four years of state Early Hearing Detection and Intervention (EHDI) records from 156,335 infants using a statewide administrative database. We compared age at the time of newborn hearing screening, diagnostic audiological evaluation, and entry into early intervention in NICU infants and non-NICU infants. We also compared the proportion of NICU and non-NICU infants meeting prescriptive EHDI timing benchmarks based on the Joint Committee on Infant Hearing position statement. Results indicated that NICU infants experienced delayed newborn hearing screening and diagnostic evaluation compared to non-NICU peers and reached both benchmarks in lower proportions. NICU and non-NICU infants entered early intervention at equivalent ages and met the early intervention benchmark in similar proportions. Considering the important medical factors that drive lengthy NICU admissions, our results suggest that specific clinical guidelines for the timing of early hearing healthcare in NICU infants may be warranted

Language Growth in Children with Mild to Severe Hearing Loss who Received Early Intervention by 3 Months or 6 Months of Age

Purpose: To evaluate the impact of hearing screening, diagnosis, and early intervention (EI) by 3 months or 6 months of age on language growth trajectories for children with hearing loss (HL) relative to children with normal hearing (NH). Method: We recruited 133 children with mild to severe HL through universal newborn hearing screening records and referrals from audiologists in the United States; 116 children with NH who served as a comparison group. Examiners administered a battery of developmentally appropriate language measures between 12 months and 8 years of age. We constructed latent growth curve models of global language, grammar, and vocabulary using Bayesian statistics. Results: Children with HL demonstrated no significant differences in initial language skills compared to children with NH. Children in the 1-3-6 group also showed no difference in language growth compared to children with NH. The slope for the 1-2-3 group was significantly steeper than children with NH for global language and grammar. Conclusions: This study documents the positive impact of EI on language outcomes in children with congenital HL. It is among the first to provide evidence to support the potential effects of very early intervention by 3 months of age

Factors associated with reading comprehension in adolescents who are hard of hearing

Many children with mild to severe hearing loss are identified and receive early intervention at very young ages. Even with this early intervention, however, children who are hard of hearing (CHH) are at risk for delays in language acquisition due to reduced auditory access. These challenges may have cascading effects on reading development because language plays a foundational role in reading. Much of the research that has been conducted on reading comprehension has focused on elementary-age children who are deaf or combined CHH with children who are deaf. It is unclear if the delays that we see in word reading accuracy and reading comprehension apply to contemporary groups of CHH in secondary grades. There is a lack of evidence regarding reading comprehension trajectories in CHH. This knowledge gap hinders our understanding of the underlying mechanisms that drive reading achievement in CHH, which in turn, limits the ability to develop scientifically based interventions and instructional programs. The current proposal will rectify some of the limitations of past research by leveraging our access to a large, prospective, well-described cohort of children with mild to severe HL and age-matched hearing peers who have been followed on an annual basis from preschool to fourth grade. We propose to prospectively test this cohort out to 11th grade. Our access to this cohort will allow us to conduct a rigorous longitudinal investigation of developmental trajectories in word-level decoding and text-level reading comprehension and the causal factors that affect these trajectories. We can also more fully explore the heterogeneity in reading and language skills for CHH in secondary grades by identifying clusters of adolescents based on their reading component skill profiles. This proposal is based on the simple view of reading, which posits that reading comprehension is the product of decoding and language comprehension. This proposal is also based on the cumulative auditory experience hypothesis, which posits that inconsistent auditory access in early childhood leads to reduced opportunities for language learning. Specifically, the current proposal tests the hypothesis that auditory access, quantified by aided audibility and hearing aid use, predicts growth rates in reading comprehension in CHH, and this relationship is mediated by oral language. Three aims are proposed: Aim 1. To establish a developmental trajectory of reading ability in CHH over an 8-year period and characterize the reading profiles of adolescents who are HH. We will establish this trajectory through a combination of retrospective (K-4th grade) and prospective (7th-11th grade) data. Aim 2. To specify the underlying mechanisms that influence reading trajectories. Aim 3. To determine the effects of hearing status and auditory access on fundamental factors of language processing that subserve reading comprehension. The data generated from this proposal will inform theoretical models regarding the component skills involved in reading for adolescents who are HH, using a mechanistic approach to examine reading comprehension. The proposed study will also provide empirical evidence for the development of effective interventions for children with hearing loss