Kindergarten Readiness in Children Who Are Deaf or Hard of Hearing Who Received Early Intervention

Abstract

BACKGROUND: Children who are deaf or hard of hearing (D/HH) have improved language outcomes when enrolled in early intervention (EI) before the age of 6 months. Little is understood about the long-term impact of EI on outcomes of kindergarten readiness (K-readiness). The study objective was to evaluate the impact of EI before the age of 6 months (early) versus after 6 months (later) on K-readiness in children who are D/HH. METHODS: In this study, we leveraged data from the Ohio Early Hearing Detection and Intervention Data Linkage Project, which linked records of 1746 infants identified with permanent hearing loss born from 2008 to 2014 across 3 Ohio state agencies; 417 had kindergarten records. The Kindergarten Readiness Assessment was used to identify children as ready for kindergarten; 385 had Kindergarten Readiness Assessment scores available. Multiple logistic regression was used to investigate the relationship between K-readiness and early EI entry while controlling for confounders (eg, hearing loss severity and disability status). RESULTS: Children who were D/HH and entered EI early (n = 222; 57.7% of the cohort) were more likely to demonstrate K-readiness compared with children who entered EI later (33.8% vs 20.9%; P = .005). Children who entered early had similar levels of K-readiness as all Ohio students (39.9%). After controlling for confounders, children who entered EI early were more likely to be ready for kindergarten compared with children who entered later (odds ratio: 2.02; 95% confidence interval 1.18-3.45). CONCLUSIONS: These findings support the sustained effects of early EI services on early educational outcomes among children who are D/HH. EI entry before the age of 6 months may establish healthy trajectories of early childhood development, reducing the risk for later academic struggles. WHAT'S KNOWN ON THIS SUBJECT: Enrollment into early intervention (EI) before the age of 6 months is associated with enhanced language, compared with later enrollment ages. Little is understood about the impact of EI on outcomes occurring beyond the EI period (such as early academic outcomes). WHAT THIS STUDY ADDS: In this study, we include public health and education data across 3 state agencies to provide evidence supporting enrollment into EI before the age of 6 months (versus later ages) for children who are deaf or hard of hearing on the increased likelihood of being kindergarten ready.

Factors Associated with Early Intervention Intensity for Children Who Are Deaf or Hard of Hearing

“…For infants and toddlers who are DHH, EI plays a prominent role by providing services that support language and other skills important for growth and development. Research has historically focused on outcomes associated with age of EI enrollment; earlier exposure to EI is associated with better outcomes in both the short-term (language and vocabulary) [ 8 , 9 , 10 , 11 ] and longer-term (early academic outcomes) [ 16 , 33 ]. However, few reported studies have evaluated intensity measures in this population.…”

“…Detailed information on the Ohio Data Linkage Project, describing the linkage methodology and data for the present study, has been published previously [ 15 , 16 ] and is summarized briefly here. The Ohio Data Linkage Project was a multi-agency collaboration that successfully linked data from two state-level public health databases to better understand outcomes in children who are DHH born between 2008 and 2014.…”

Cochlear Implantation in Infants: Why and How

“…The U.S. National Institutes of Health Consensus Development Conference (1993) released a consensus statement recommending implementation of UNHS for all children by 3 months of age.The availability of UNHS allowed for the Joint Committee on Infant Hearing of the American Academy of Pediatrics (2007) to establish the “1-3-6” guideline: that children undergo hearing screening by 1 month of age, complete diagnostic assessment by 3 months of age if needed, and receive early intervention by 6 months of age if they have hearing loss ( Meinzen-Derr et al.,2020 ). For a child with congenital deafness, hearing amplification will not provide benefit; therefore, intervention requires adoption of sign language, cochlear implantation, or often a combination of both.…”

Multidimensional Family-Centred Early Intervention in Children with Hearing Loss: A Conceptual Model

“…Only about half of the teenagers with cochlear implants attain an age-appropriate level of reading comprehension [ 21 ]. In contrast to risk for academic underachievement later in life, a recent study on 385 pre-schoolers with HL showed that those who started receiving early intervention by the age of 6 months had similar rates of kindergarten readiness to the total population of kindergarteners [ 22 ]. A substantial number of studies report cognitive delays in children with HL, particularly elevated risks for delays in social cognition [ 23 , 24 ] and executive functioning [ 25 , 26 , 27 ].…”