Pediatricians and other primary care providers recognize the benefits of early detection and intervention for permanent hearing loss in infants. The current system of newborn hearing screening can be enhanced by strengthening the medical community's involvement in the process from screening to follow-up. Physician roles will be supported through the provision of action-oriented resources that educate parents about the importance of follow-up and that prepare professionals to incorporate appropriate surveillance procedures in daily practice.

A community assessment of preschool providers' attitudes was conducted to examine readiness for inclusive preschool participation. Participants included providers from private, community-based preschools, Head Start classes, and Chapter 1 programs. Multiple dimensions of preschool directors' and teachers' attitudes were assessed by examining their general attitudes toward inclusion, their attitudes toward serving children across diverse handicapping conditions and special needs, their perceived abilities and support needs in appropriately serving such children, and their actual behavioral choices when given an opportunity to sign up for inclusion-related activities. The findings indicated that respondents held moderately positive attitudes toward the general concept of inclusion. Providers differentiated between different types of special needs and they based decisions on where children should be served, accordingly. Implications for incremental development of inclusive options are discussed. One of the primary intents of Part B of the Individuals with Disabilities Education Act(IDEA) is to ensure, to the greatest possible extent, that children with disabilities receive the services to which they are entitled in the educational settings they would be attending if they did not have a disability (Salisbury, 1990). Part B of IDEA and the subsequent clarifying comment on the least restrictive environment (LRE) regulation require schools to provide a variety of placement options along a continuum of inclusiveness to preschool children who are eligible for special education services. Inclusive options for these children may consist of placement in preschool programs operated by public agencies (i.e., Head Start or Chapter 1) and in private community-or school-based preschool programs that normally serve children without disabilities (34 CFR § 300.552). The legal rationale for the development of community-based preschool options has recently been strengthened by the Americans with Disabilities Act (ADA), which supports the rights of children with disabilities to participate in public and private preschools with their typically developing peers. Hence, both education legislation (IDEA) and civil rights legislation (ADA) underscore the responsibility of communities Fiserman,

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This study assessed the feasibility of doing hearing screening in Migrant, American Indian and Early Head Start programs using otoacoustic emissions (OAE) technology. Staff members were trained to screen 0-3-year-old children for hearing loss using handheld OAE equipment and a multi-step screening and referral protocol. Of the 3486 children screened as a part of the study, 77% passed an OAE screening at the first step, 18% more passed an OAE screening at the second step, and 5% were ultimately referred for medical or audiological follow-up. Eighty children were identified as having a hearing loss or disorder of the outer, middle or inner ear requiring treatment. Of these 80, six had permanent bilateral or unilateral hearing loss. Although the protocol suggested that the multi-step screening procedure should be completed within a 4-week time period or less, analysis of the data showed that for children requiring more than an initial OAE screening, the length of time over which the screening was completed ranged from 7 to 12 weeks. The median time required to complete a single OAE screening session was 4 minutes per child. The results demonstrate that OAE screening of young children using this protocol is practical and effective. The implications for conducting periodic hearing screening throughout early childhood are discussed.

WHAT'S KNOWN ON THIS SUBJECT: The incidence of permanent hearing loss doubles between birth and school age. Otoacoustic emissions screening has been used successfully in early childhood educational settings to identify children with losses not found through newborn screening. WHAT THIS STUDY ADDS:Using otoacoustic emissions to screen the hearing of young children during routine health care visits is feasible and can lead to the identification of permanent hearing loss overlooked by providers relying solely on subjective methods. abstract OBJECTIVES: Otoacoustic emissions (OAE) technology, used widely in newborn hearing screening programs and validated by professional organizations as a reliable and objective tool, is beginning to be recognized as superior to subjective methods when screening young children in a variety of settings. This study examines the efficacy of integrating OAE hearing screening into services routinely provided in health care settings. METHODS:Three federally funded clinics serving low-income and uninsured people in a metropolitan area participated in the 10-month study. Subjects included 846 children (842 in the target population ,5 years of age and 4 older siblings) who were screened during routine visits to their primary care providers using a distortion product OAE instrument. A multistep screening and diagnostic protocol, incorporating middle ear evaluation and treatment, was followed when children did not pass the initial screening. Audiological evaluation was sought for children not passing a subsequent OAE screening. RESULTS:Of the 846 children screened, 814 (96%) ultimately passed the screening or audiological assessment and 29 (3%) exited the study. Three children (1 was ,5 years of age and 2 were .5) were identified with permanent hearing loss. CONCLUSIONS:The rate of identification of permanent hearing loss in this study is similar to findings from a study of OAE screening in early childhood educational settings. OAE screening holds the potential for being an effective method for helping to identify young children with permanent hearing loss in primary care settings.

Sich day In tin-life of ;i young child with an undetected hearing Ids-, is ;i day without lull access to language. When hearing loss goes undetected, the remitting language deficits can become overwhelming obstacles to literacy, educational achievement, socialization, and school readiness Several programs, such a.-Head Stan, Early and Periodic Screening, Diagnosis and Treatment, and Pan C of the Individuals with Disabilities Education Act, are responsible for providing hearing screening to many young children nationwide. These programs have typically bad to rely on subjec tive hearing screening methods. Otoacousilc emissions technology, used widely in hospital-based newborn screening programs, is beginning to be recognized as a more practical and effective al ternative when screening children from birth to^years of agi-. Successful otoacoustic emissions screening in early childhood settings Is dependent on consultation from an experienced pedlatrk audlologlst, selcctfon ofappropriate equipment, adherence to an appropriate screening and followup protocol, ami access to training and follow-up technical assistance. When these elements are prcsi-nt. children with a wide ranj:c of hearing health conditions tan be identified in a timely manner.

The objective of the study was to determine whether participating in reverse-role tutoring would improve nonhandicapped students' attitudes toward behaviorally disordered peers. A total of 88 students participated in the study; 6 fifth grade and 8 sixth grade aged behaviorally disordered tutors, 12 fifth grade and 16 sixth grade aged regular class tutees, and 46 fifth and sixth grade aged regular class students comprising two control groups. A pretest-posttest control group design was utilized to compare the responses made by tutees on a student attitudes questionnaire with the responses made by those in the control groups. Analysis of variance of the regular class students' pretest responses indicated that the behaviorally disordered students were less accepted than were regular class peers. Analysis of covariance showed that the tutees rated their behaviorally disordered tutors significantly higher than different-class controls. The tutees did not, however, generalize more positive attitudes toward a class of behaviorally disordered students with whom they did not have tutoring contact.

Physicians and other health-care providers should play a central role in helping families of children with permanent hearing loss receive timely and appropriate screening, diagnostic, and early intervention services. Because the technology and procedures for ensuring timely and appropriate services for infants and young children with hearing loss have changed so dramatically over the past 15 years, many health-care providers are not well informed about the best ways to provide effective services. Audiologists can help to ensure that physi cians and other health-care providers are better informed about the services needed by infants and young children with hearing loss. This article notes some of the areas where information and support is most needed and suggests resources and strategies for addressing these needs.KEYWORDS: Hearing loss, childhood, physician, continuing education Learning Objectives: As a result of this activity, the participant will be able to (1) describe the physician role in supporting follow-up from newborn hearing screening, (2) identify strategies for communicating key information to physicians, and (3) identify resources to support timely follow-up from newborn hearing screening.