Significantly better language development was associated with early identification of hearing loss and early intervention. There was no significant difference between the earlier- and later-identified groups on several variables frequently associated with language ability in deaf and hard-of-hearing children. Thus, the variable on which the two groups differed (age of identification and intervention) must be considered a potential explanation for the language advantage documented in the earlier-identified group.

Use of a cochlear implant has had a dramatic impact on the linguistic competence of profoundly hearing-impaired children. More than half of the children in this sample with average learning ability produced and understood English language at a level comparable with that of their hearing age mates. Such mature language outcomes were not typical of children with profound hearing loss who used hearing aids. Use of a visual (i.e., sign) language system did not provide the linguistic advantage that had been anticipated. Children educated without use of sign exhibited a significant advantage in their use of narratives, the breadth of their vocabulary, in their use of bound morphemes, in the length of their utterances and in the complexity of the syntax used in their spontaneous language. An oral educational focus provided a significant advantage for both spoken and total language skills.

Results of this study support the provision of CIs to children at the youngest age possible. In addition, it highlights the substantial role that cognition plays in later language outcomes. Although the students' use of sign to enhance language skills during the elementary years does not appear to have a negative impact on later language skills, students who continue to rely on sign to improve their vocabulary comprehension into high school typically exhibit poorer English language outcomes than students whose spoken language comprehension parallels or exceeds their comprehension of speech + sign. Overall, the language results obtained from these teenagers with more than 10 yrs of CI experience reflect substantial improvement over the verbal skills exhibited by adolescents with similar levels of hearing loss before the advent of CIs. These optimistic results were observed in teenagers who were among the first in the United States and Canada to receive a CI. We anticipate that the use of improved technology that is being initiated at even younger ages should lead to age-appropriate language levels in an even larger proportion of children with CIs.

BACKGROUND AND OBJECTIVES To date, no studies have examined vocabulary outcomes of children meeting all 3 components of the Early Hearing Detection and Intervention (EHDI) guidelines (hearing screening by 1 month, diagnosis of hearing loss by 3 months, and intervention by 6 months of age). The primary purpose of the current study was to examine the impact of the current EHDI 1-3-6 policy on vocabulary outcomes across a wide geographic area. A secondary goal was to confirm the impact of other demographic variables previously reported to be related to language outcomes. METHODS This was a cross-sectional study of 448 children with bilateral hearing loss between 8 and 39 months of age (mean = 25.3 months, SD = 7.5 months). The children lived in 12 different states and were participating in the National Early Childhood Assessment Project. RESULTS The combination of 6 factors in a regression analysis accounted for 41% of the variance in vocabulary outcomes. Vocabulary quotients were significantly higher for children who met the EHDI guidelines, were younger, had no additional disabilities, had mild to moderate hearing loss, had parents who were deaf or hard of hearing, and had mothers with higher levels of education. CONCLUSIONS Vocabulary learning may be enhanced with system improvements that increase the number of children meeting the current early identification and intervention guidelines. In addition, intervention efforts need to focus on preventing widening delays with chronological age, assisting mothers with lower levels of education, and incorporating adults who are deaf/hard-of-hearing in the intervention process.

This study examined parental stress in 184 hearing mothers of young children who are deaf or hard of hearing. Stress levels were measured in three domains using the short-form of the Parental Stress Index (PSI; Abidin, 1995). Mothers in this study demonstrated significantly less parental distress on the PSI than a normative, hearing group, although this difference was quite small. Differences between the hearing and hearing loss samples did not reach conventional levels of significance for the Dysfunctional Parent-Child Interactions or the Difficult Child subscales. An examination of potential predictors of maternal stress revealed that mothers who perceived their daily hassles as more intense also obtained higher stress ratings on all three subscales. Additional predictors of parental distress were frequency of hassles, social support, and annual family income. Increased stress on the Dysfunctional Parent-Child Interaction subscale was predicted by children who had disabilities in addition to hearing loss, more delayed language relative to their chronological age, and less severe degrees of hearing loss. No additional, significant predictors were obtained for the Difficult Child subscale. When all measured variables were controlled for, characteristics that did not predict maternal stress on any of the three subscales included the child's gender, ethnicity, age of identification, mode of communication used, maternal education, and months between age of identification and child age at the time of observation.

INTRODUCTIONCochlear implantation has become a common recommendation for parents of children with severe to profound hearing loss. This surgical intervention has numerous reported benefits including improved speech and language skills as well as higher academic achievement. (1)(2)(3) In fact, there is evidence that some children receiving cochlear implants before 24 months have attained some aspects of language comparable to their normal hearing peers, but we currently have no indication that implantation between 6 and 12 months results in significantly better language development than those implanted between 12 and 24 months of age. (4)(5)(6)(7) Regardless of early implantation, this population of children maintains a substantial amount of variability in language outcomes. (8) Some known predictors of language outcomes include parent level of education and non-verbal cognitive development. (9) The socio-economic levels of many families in cochlear implant research articles are often quite high with a typical average of college education or above (16 years or greater) which may contribute to an upward bias in outcomes or an indication of how family characteristics may relate to treatment choices.Advances in CI technology and surgical procedures have closely coincided with early intervention initiatives and advances in hearing aid technology as well. In this technological age, it should be noted that many families still choose hearing aids rather than implantation for their child with severe or profound hearing loss. As such, this paper aims to compare the language developmental trends as well as the background characteristics of children with hearing aids (HA) and children with cochlear implants (CI) with severe to profound hearing loss under the establishment of universal newborn screening in the state of Colorado. One aspect of our study population that is unusual compared to other states is that Colorado represents a state-wide population with children who have been implanted in various programs. At the time of data collection for the current study, there were seven cochlear implant programs in the state, three of the seven programs implanted the majority of the children in the Denver metropolitan area but some of the children were implanted in other areas of the state. The parents of these children chose to enroll their children in the Colorado Home Intervention Program, a public program that provides early intervention services to over 90% of the children identified with hearing loss from birth through three years of age.In addition, almost all children who received cochlear implants also received services through a clinic-based program after implantation and were seen by speech/language pathologists who were certified auditory verbal specialists or auditory-oral specialists with extensive experience.It is not uncommon for Colorado families to participate in sign language instruction. Over 80 percent of the families in our data source engage in sign language instruction from an individual who was deaf or ha...

This study investigated the validity of a parent report measure of vocabulary development, the MacArthur Communicative Development Inventory: Words and Sentences (CDI), in children with and without developmental disabilities. Concurrent validity was examined by comparing results from the CDI and laboratory measures of vocabulary in 44 children with Down syndrome and 46 typically developing children with mental ages from 12 to 27 months. Significant correlations between .70 and .82 were obtained. Predictive validity was examined by measuring the vocabulary of 20 children with Down syndrome and 23 typically developing children first at approximately 20 months mental age and later at a mental age of approximately 28 months. Significant correlations were obtained between the CDI at Time A and all but one of the vocabulary measures at Time B ( r = .46 to .66). These results establish the validity of parent measures of vocabulary development for children with Down syndrome and confirm their validity for typically developing children.

Hypothesis: Early identification and intervention, earlier cochlear implantation, and mother's level of education will directly and/or indirectly impact the language outcomes of children with cochlear implants (CIs). Background: Identifying factors that contribute to the wide range of language outcomes in children who use CIs will assist healthcare and rehabilitation professionals in optimizing service delivery for this population. Universal newborn hearing screening provides an opportunity to examine the relationship between meeting the early hearing detection and intervention (EHDI) 1-3-6 guidelines and child language outcomes. These guidelines recommend screening by 1 month, confirmation of hearing loss by 3 months, and intervention by 6 months of age. Methods: Participants were 125 children with CIs ranging from 13 to 39 months of age. Language ability was measured using the Child Development Inventory and MacArthur-Bates Communicative Development Inventories. Results: Meeting EHDI 1-3-6, higher levels of maternal education and earlier cochlear implant activation had a direct, positive impact on language outcomes. Meeting the EHDI 1-3-6 guidelines also had an indirect positive effect on language outcomes via increasing the probability that the children's CIs would be activated earlier. Maternal education did not significantly predict age of cochlear implant activation nor whether a child met EHDI 1-3-6. Conclusion: Ensuring families meet the EHDI 1-3-6 guidelines is an early step that can lead to higher language outcomes and also earlier cochlear implantation.