ROADMAP TO SPOKEN LANGUAGE C H R I S T I N E Y O S H I N A G A - I T A N O, P H. D. U N I V E R S I T Y O F C O L O R A D O, B O U L D E R

Transcription

1 ROADMAP TO SPOKEN LANGUAGE C H R I S T I N E Y O S H I N A G A - I T A N O, P H. D. U N I V E R S I T Y O F C O L O R A D O, B O U L D E R

2 THE JOURNEY BEGINS WITH AN OPPORTUNITY

3 2011 NATIONAL CDC EHDI DATA S O U R C E : C D C E H D I H E A R I N G S C R E E N I N G A N D F O L L O W - U P S U R V E Y ( H S F S ) INGLOSS/EHDI -DATA.HTML

4 Documented Diagnostic Status of Infants Not Passing Hearing Screening (U.S., 2011) Total Not Pass = 59,161 No Hearing Loss, 48.3% Hearing Loss, 8.6% In Process, 2.7% Died / Declined, 3.4% Non-resident / Moved, 1.7% LFU/LTD, 35.3%

5 Documented Intervention Status of Infants with Hearing Loss (U.S., 2011) Total w. Hearing Loss = 5,170 LFU/LTD, 26.0% Died/Declined, 5.2% Not Eligible Part C, 2.8% Receiving EI, 62.9% Monitoring Only (No EI), 1.8% Non-resident / Moved, 1.5%

6 LFU/LTD, NEVER REFERRED, INELIGIBLE TO ENROLL IN EI Of children identified 37.1% are not enrolled = LFU/LTDabout 2000 children Part C requirements for enrollment of children identified through UNHS vary widely across the United States, especially with respect to the following populations: Children with unilateral hearing loss Children with auditory neuropathy/auditory dyssyncrhony Children with conductive non-permanent HL Children with minimal hearing loss NATIONAL SCORECARD: US National: Children who are ineligible for Part C services rarely receive any EI services

7 DELAYED ACCESS TO AMPLIFICATION In US, access to amplification is often dependent upon whether or not the state has legislation regarding insurance coverage of pediatric hearing aids 18 states have HA legislation mandating insurance companies to cover HAs for children Non-issue in the UK

8 QUALITY OF DIAGNOSIS

9 BEST PRACTICE PROTOCOLS: DIAGNOSIS, AMPLIFICATION FIT American Academy of Audiology infant/children diagnostic evaluation ary/documents/201208_audguideassesshear_yout h.pdf American Academy of Audiology amplification guidelines: infant/toddler ary/documents/pediatricamplificationguidelines.p df

10 AUDIOLOGISTS DIAGNOSIS HEARING LOSS WITH BEST PRACTICE PROTOCOLS OR ERRORS IN DIAGNOSIS ABR thresholds at low and high frequencies AC and BC ABR thresholds Diagnostic OAES High frequency tympanometry COLORADO SCORECARD: Over 10 years of screening: 97% of the diagnostic audiologic evaluations of infants followed best practice protocol. 95% diagnosed hearing loss with click ABR, 2% used tone ABR (Johnson, Thomson & Yoshinaga-Itano, 2011). 3% did not use ABR to diagnose hearing loss in a child birth through 6 months. Tone ABR or ASSR used for fitting HAs National: No data on whether audiologists are following best practice protocols, state/territory system data not collected

11 QUALITY OF AMPLIFICATION FIT

12 AMPLIFICATION IS FIT TO PRESCRIPTION AND INFANTS HAVE AUDIBILITY ACROSS SPEECH SPECTRUM OR LACK OF AUDIBILITY No data available about the HA fitting protocol across almost all of the US states/territories COLORADO SCORECARD: No data hope to implement recording of SII data, follow-through audiograms collected CHIP providers standardly teach parents to conduct Ling 6 sound behavioral evaluation and work with Colorado pediatric audiologists for optimal fitting. No standard data collected. NIH study findings thus far are SII is an important predictive piece of information (McCreery, 2013) National: no US data yet from UNHS

13 OCHL

14 OCHL

15 WHAT S NEW RE: HEARING AID VERIFICATION Cortical auditory evoked potentials P1sassurance that sound is reaching the cortex May be extremely useful NR ABRs AN/AD (ANSD) Index of that sound has reached the cortex audibility HEARLAB designed in Australia National Acoustics Laboratory Ma-ta-ga low-mid-high frequencies To verify that sound reaches the cortex with hearing aids across the speech frequencies Now FDA approved in US FRYE Electronics

16 MONITORING AUDITORY SKILL DEVELOPMENT IN THE FIRST YEAR OF LIFE

17 VALIDATION OF HEARING AID FIT OR COCHLEAR IMPLANT MAP THROUGH SPEECH PERCEPTION VISUAL REINFORCEMENT INFANT SPEECH DISCRIMINATION (VRISD) Clinical VRISD unit Intelligent Hearing Systems

18 VISUAL REINFORCEMENT INFANT SPEECH DISCRIMINATION VRISD Beginning 6 to 7 months Children with hearing aids and cochlear implants (pre-ci and day after activation, 1 mo, 2 mo., 3 mo.) Vowel discrimination begin with /a/, /u/, /i/ Place discrimination ba/da, pa/ka Voicing discrimination- ta/da, ba/pa, ka/ga High frequency discrimination sa/sha

19 HEARING AID FITTING SUFFICIENT FOR DISCRIMINATION OF VOWELS AND CONSONANTS Visual Reinforcement Infant Speech Discrimination possible as soon as infants provide a VRA audiogram. Colorado infants with mild through severe bilateral hearing loss can discriminate: 1) vowels, 2) place, 3) voicing, 4) sa/sha within first year of life COLORADO SCORECARD: Children with hearing aids and children with cochlear implants can provide reliable results at 7 months of age. (Uhler et al 2009), Fredrickson, National: LittleEars parent questionnaire appropriate for profound HL Cincinnati Auditory Skills Checklist -

20 COM/OUR- RESEARCH/PEDIATRIC

21 Parent questionnaire: Auditory Skills Checklist: Average Scores: Children with Hearing Loss (Tyberg et al., 2013) 2-3 years Comprehension Identification Discrimination Detection

22 HEARING AID FIT IS NOT ENOUGH IF CHILD DOES NOT WEAR AMPLIFICATION HEARING AID USAGE

23 FREQUENCY OF HEARING AID USAGE Some hearing aids have data usage function COLORADO SCORECARD: No data on frequency of hearing aid usage for Colorado children has been reported. However, in the NECAP study of 9 states (CO not included) and 474 cases, parents/ei providers reported that (all children CA > 12 months: 15% wore HA <3 hours/day (N=82) 11% wore HA 3-5 hours/day (N=60) 25% wore HA 6-10 hours/day (N=137) 25% wore HA hours/day (N=126)

24 HA USAGE English spoken at home 19.5% <3 hrs 14.2% 3-5 hrs, 28.1% 6-10 hrs, hrs. Spanish spoken at home fewer families self-report that they are in lowest quartile 12% <3 hrs 14.1% 3-5 hrs 28.3% 6-10 hrs 28.3%

25 Sign language used at home NOTE: No difference parent report of amplification use parents using spoken language only, parents using sign language in the home. 21.1% < 3 hrs 14.3% 3-5 hrs 29.2% 6-10 hrs 23.6% hrs

26 SENSORY STRUCTURE ABNORMALITIES OR 8 TH NERVE ABNORMALITIES

27 ABNORMALITY OF SENSORY AND/OR NEURAL STRUCTURES SNHL (NOT ANSD) McClay et al., (2008) 40% of 170 pediatric SNHL participants had structural abnormalities Diagnosed with MRI Most frequent Cochlear abnormalities Auditory nerve abnormalities Severe to profound higher prevalence of abnormality than mild to moderate Unilateral HL higher prevalence of abnormalities than bilateral HL COLORADO SCORECARD: No data on our population of deaf or hard of hearing children

28 AUDITORY NEUROPATHY/DYSSYNCHRONY Gardner-Barry, 2012 N=142 CIs over 10 year period Sydney Cochlear Implant Center, 16% had abnormalities on their CT scans, which included Mondini deformities, wide internal auditory meatus, dysplastic apical turn, and abnormal vestibule and lateral semi-circular canals. 20% of the children with bilateral AN and 6% of the children with unilateral AN had compromised auditory nerves. A total of 43% of the children had disabilities in addition to HL. COLORADO SCORECARD: No imaging data on the Colorado AN/AD population only those with CI candidacy.

29 BEST PRACTICE PROTOCOL: EARLY INTERVENTION SERVICES /2013/03/18/peds citation EI supplement to JCIH 2007 First International Family Centered Early intervention Conference best practice protocol stract

30 HEARING AID NOT FUNCTIONING

31 Marion s Way summer preschool for 8 children (6 week program) daily hearing aid/cochlear implant check with audiology Motivation of families and dedication extremely high 50% each day had functioning issues (Cyr, 2012) Batteries Ear molds Hook-up with personal FM Consistent with all historical literature only 50% of amplification on children is functioning optimally

32 AMOUNT OF PARENT TALK (SPEECH, SIGN, BOTH)

33 VARIABILITY IN OUTCOME AT 84 MONTHS: EOWPVT, TACL (BACA ET AL., 2011) 68% of variability in EOWPVT age score at 84 months explained 71% of variability in TACL age score at 84 months explained *Frequency of parent words Maternal level of education *Early expressive language quotient *Degree of hearing loss Age of identification *Non-verbal IQ

34 HALF HOUR VIDEOTAPE SAMPLE Parent-word- Frequency total words c Lower quartile 984 Middle quartile 1245 Upper quartile 1515

35 PARENT WORD FREQUENCY: EOWPVT III Expressive Vocabulary at 84 months A Low SES High SES Lower Quartile Inter Quartile Upper Quartile

36 PARENT WORD FREQUENCY: TACL Language Comprehension at 84 months B Low SES High SES Lower Quartile Inter Quartile Upper Quartile

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38 COMPARISON OF D/HH IN ENGLISH-SPEAKING HOMES AND D/HH IN SPANISH- SPEAKING HOMES LENA: LANGUAGE ENVIRONMENT ANALYSIS

39 TV: Spanish D/HH vs English D/HH (in percent) Normal Hearing Typical Development: 10% Min: Max: Mean: Standard Deviation Spanish D/HH English D/HH 2% 33% 14% 10% 2% 28% 8% 6%

40 Noise: Spanish D/HH vs English D/HH (in percent) Normal Hearing Typical: 3% Min: Max: Mean: Standard Deviation Spanish D/HH English D/HH 1% 20% 4% 6 1% 11% 3% 3

41 Silence: Spanish D/HH vs English D/HH (in percent) Normal Hearing Typical: 28% Min: Max: Mean: Standard Deviation Spanish D/HH English D/HH 13% 59% 34% 14 20% 66% 47% 10

42 Range: Adult Word Count Number of Adult Words Spoken/day Spanish D/HH Typically Developing Spanish Typically Developing English English D/HH 3rd Quartile 1st Quartile

43 1400 Range: Conversational Turns Number of Conversational Turns/day rd Quartile 1st Quartile 0 Spanish D/HH Typically Developing Spanish Typically Developing English English D/HH

44 Range: Child Vocalizations 5000 Number of Child Vocalizations/day Spanish D/HH Typically Developing Spanish Typically Developing English English D/HH 3rd Quartile 1st Quartile

45 NECAP: N A T I O N A L E A R L Y C H I L D H O O D A S S E S S M E N T P R O J E C T : D E A F A N D H A R D O F H E A R I N G S T A T E S C O L L E C T I N G O U T C O M E S O F C H I L D R E N I D E N T I F I E D T H R O U G H U N H S / E H D I P R O G R A M S

46 PARTICIPATING STATES Arizona Arizona School for the Deaf and Blind California Fremont School for the Deaf and Blind, LA Unified Public Schools Colorado: Colorado State School for the Deaf and Blind Idaho: Idaho State School for the Deaf and Blind Indiana: Indiana State School for the Deaf and Blind Texas: 5 pilot sites Wisconsin: state EHDI program Wyoming: state EHDI program Oregon Maine Minnesota Utah

47 ASSESSMENTS COMPLETED 1000 assessments completed not including Colorado Colorado has over 3000 assessments

48 PARTICIPANT CHARACTERISTICS (EXCLUDING COLORADO) Bilateral loss = 249; Unilateral loss = 10 Auditory Neuropathy = 7 English-speaking home = 239; Spanish-speaking home = 20 No additional disabilities = 229; Have additional disabilities = 30 Boys = 140; girls = 119

49 PARTICIPANT CRITERIA FOR LANGUAGE OUTCOMES ANALYSIS Bilateral hearing loss English-speaking home No other disabilities that would affect speech or language development

50 STATES REPRESENTED IN CURRENT LANGUAGE OUTCOMES ANALYSIS Arizona Colorado Idaho New Mexico (previous participant) Texas Utah (previous participant) Wisconsin Wyoming Note: CA and IN just initiated NECAP; data now being collected

51 MINNESOTA CDI: MEDIAN LANGUAGE QUOTIENTS

52 MACARTHUR-BATES: MEDIAN VOCABULARY PRODUCTION QUOTIENTS

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