FEATURE

Communication Outcomes of Pre-school Children with Hearing Loss Enrolled in Auditory-Verbal Therapy Programs in Ontario

Alice Eriks-Brophy, Andree Durieux-Smith, Janet Olds, Elizabeth Fitzpatrick, Robin Gaines, Linda Moran, David Schramm and JoAnne Whittingham

This prospective, longitudinal research study examined the question of how children with permanent bilateral hearing loss (PBHL) enrolled in Auditory-Verbal Therapy (AVT) programs in Ontario compared to their hearing peers on standardized measures of speech, language, and global development.

Two groups of children participated in the study; a group of 65 children with hearing loss enrolled in recognized AVT centres
in Toronto and Ottawa, and a control group of 48 children with normal hearing. The participating children in both groups ranged in age

from 12 to 60 months and had no additional severe handicapping conditions that might have impacted on their speech and language development. In addition to being enrolled in AVT, inclusion criteria for children with hearing loss were the presence of a bilateral sensorineural or conductive
hearing loss with congenital or early onset (< 6 months), consistent use of hearing technology, and English as language of intervention. Of the participating children with permanent bilateral hearing loss (PBHL), 68% had severe to profound hearing losses. Thirty two of the children with PBHL wore cochlear implants (CIs) and 33 wore bilateral hearing aids. Mean age of diagnosis was 13.9 months (range 0.8–42.9 months) and mean length of enrollment in AVT was 29.5 months (range 9.3–53.7 months).

Both groups of children were administered the Preschool Language Scale- Fourth Edition (PLS-4) (Zimmerman, Steiner, and Pond 2002), the Peabody Picture Vocabulary Test Third Edition (PPVT-III) (Dunn and Dunn 1997), the Goldman Fristoe Test of Articulation, Second Edition (GFTA-2) (Goldman and Fristoe 2000), and the Child Development Inventory (CDI) (Ireton 1995). The number of children who were tested with each measure varied depending on their age at the time of their last assessment. These standardized measures are commonly used assessment tools that have sound psychometric properties and have been normed on hearing children.

Analyses indicated that over 65% of participants with permanent bilateral hearing loss (PBHL) scored in or above the normal range on the speech and language measures used in the study. More specifically, for the PLS-4, 86.8% with scores for this test fell into the normal range for receptive language and 74.6% for expressive language. For the PPVT-III, 67.9% of children with scores for this test performed at or above the normal
range. For the GFTA-2, 66.0% of children with scores for this test performed at or above the normal range. Results from the CDI, a parent report instrument, showed no significant differences in performance between the children with hearing loss with scores for this measure and their hearing peers on the scales of gross motor, fine motor, self-help, and social development. Significant differences in expressive and receptive language were found between the two groups of children; however, the findings are highly variable for the group of children with hearing loss. Findings from the CDI indicate that parents appear to be reliable reporters of their children’s development across all domains.

Degree of hearing loss was found to be correlated with several of the standardized outcome measures, however no single variable consistently discriminated between the higher and lower performing groups of children with permanent bilateral hearing loss (PBHL). No consistent correlations with any of the outcome measures and hearing age or age of diagnosis were found, nor were the differences between the higher and lower performing children consistently attributable to age at assessment or type of hearing technology.

The results of the study suggest that a large percentage of the children enrolled in AVT fell within normal limits in their performance on the individual measures used in the study. Results also suggested differences in development between the two groups of children are apparent in the areas of speech and language, but not consistently in other areas.

The study addressed some of the criticisms of previous research examining outcomes of AVT through the inclusion of a control group and the adoption of a prospective, longitudinal research design. Additional analyses examining the potential influences of age of diagnosis, hearing age, degree of hearing loss, global development, SES, parental involvement and other variables of interest are ongoing.