TVR_106-3

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Table 1. Estimates From Primary Health Care Providers Regarding When Children Can Be Fit with Hearing Aids Type of Physician Age at Which Hearing Aids Can Be Fit Less than 1 month 2-3 mos 4-6 mos 7-11 mos 15+ mos Pediatrician (n = 1145) 36.3% 16.9% 29.0% 2.1% 15.6% Family Physician (n = 531) 38.2% 15.6% 23.2% 0.9% 22.0% Neonatologist (n = 52) 28.8% 21.2% 32.7% 0.0% 17.3% Ear, Nose & Throat Specialist (n = 58) 27.6% 15.5% 20.7% 1.7% 34.5% been made in the last 15 years. Many of these changes affect the way early intervention services should be provided. Unless people are aware of these changes, they will continue to make decisions based on old data, thus preventing DHH children and families from accessing the most effective services. One particularly important group who need to be educated about the progress that has been made are primary healthcare providers. The American Academy of Pediatrics has worked hard to include pediatricians in the early intervention process for all children with disabilities (AAP, 1999a, 2001). One area in particular in which the AAP has worked to educate healthcare providers is the recent advances in early identification of hearing loss and how that should impact the advice they give to parents about early intervention services for their DHH child (AAP 1999b, 2006). There is still much work to be done in this area. In a recent study reported by Moeller, White, & Shisler (2006) in which responses to a survey were collected from almost 2,000 primary care physicians from across the United States, it was found that even though pediatricians and other primary care providers recognized the benefits of early detection and intervention for DHH children, many of them were not current in their understanding of how early intervention services can best be provided to this population. For example, in response to an open-ended question in which they were asked, “What is your best estimate of the earliest age at which a child can begin wearing hearing aids,” 41.6% said this could not occur until children were six months of age or older. As shown in Table 1, the results were not much different for pediatricians, family physicians, neonatologists and ENTs. Respondents were also asked to list any specialists to whom they would “routinely refer the family of a child with a confirmed permanent hearing loss.” According to the JCIH (2000), all such children should be referred for an ophthalmological and genetic evaluation. Yet, less than 1% of the respondents indicated they would refer the child to an ophthalmologist, and only 9% indicated they would refer the child to a geneticist. Almost half of the respondents gave incorrect responses to the question asking which children would be candidates for cochlear implant surgery (indicating that children Finishing the EHDI Revolution 253
with unilateral profound losses, bilateral mild to moderate losses, and unilateral mild to moderate losses would be candidates for a cochlear implant). These gaps in knowledge are all the more concerning given that 89% of the respondents said that they were very confident or somewhat confident in explaining the newborn hearing screening process to parents who had questions about their infant’s results. The fact that primary healthcare providers are unaware of many of the recent improvements in early intervention services for this population is not surprising given how rapidly changes have happened and the relatively small percentage of DHH children in the population. Nonetheless, effective early intervention services depend, in large part, on families obtaining upto-date, accurate information, and primary healthcare providers are a primary and trusted source of information for many families (Arnold et al., 2006). Therefore, an important part of strengthening the early intervention system will be to ensure that healthcare providers (including nurses, nurse practitioners and physician assistants) are educated about the changes that have occurred during the last 15 years. Conclusions The importance of identifying DHH children as soon as possible and providing them with appropriate early intervention services (including medical, audiological and educational services) has been recognized for many years. In the last 15 years, technological advances and the widespread implementation of universal newborn hearing screening programs have stimulated progress at an accelerated rate. Unfortunately, for many DHH infants and young children, improvements in the early intervention process have lagged behind other components of EHDI. Completing the EHDI revolution will require systematic and sustained attention to providing comprehensive, up-to-date early intervention services to children identified through newborn hearing screening programs. Part Cof IDEA provides a framework for these changes to occur. However, in the past EHDI programs and Part C programs have not worked together as comprehensively as they should. The framework for such cooperative work is present, but more attention needs to be given to ensuring that all DHH children are eligible for Part C services and that EHDI screening and diagnostic programs are better coordinated with Part C child-find procedures. Additionally, both preservice and inservice personnel preparation activities must become responsive to changes in parent preferences for the type of intervention they want for their child. Hearing aids and other assistive listening devices must be more accessible to all DHH children and, finally, various stakeholders must become educated about the progress and changes that have occurred in the last 15 years. 254 White
Page 1 and 2: Volume 106, Number 3 ISSN 0042-8639
Page 3 and 4: The Volta Review Early Hearing Dete
Page 5 and 6: The Volta Review, Volume 106(3) (mo
Page 7 and 8: Center at Bar Ilan University, Rama
Page 9 and 10: identified the most significant pre
Page 11 and 12: Figure 1. Percentage of newborns sc
Page 13 and 14: Figure 2. Percentage of infants and
Page 15 and 16: components will contribute to impro
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Page 19 and 20: 1991, there is only about $1,000 av
Page 21 and 22: parents, when they are given an opt
Page 23: Historically, the federal Departmen
Page 27 and 28: Culbertson, J., & Gilbert, A.M. (19
Page 29 and 30: Office of Special Education and Reh
Page 31 and 32: University of North Carolina at Cha
Page 33 and 34: When children begin to walk and the
Page 35 and 36: years is attributable to partnershi
Page 37 and 38: hearing loss, including audiologic
Page 39 and 40: infants and toddlers who are deaf o
Page 41 and 42: early intervention program personne
Page 43 and 44: audiology symposium that brings tog
Page 45 and 46: Cyndie Bennett, superintendent of t
Page 47 and 48: 2001), places an emphasis on parent
Page 49 and 50: family involvement strongly influen
Page 51 and 52: Table 1. Demographic Characteristic
Page 53 and 54: In the self-efficacy section, mothe
Page 55 and 56: the Reynell Developmental Language
Page 57 and 58: Table 4. Definitions and Examples o
Page 59 and 60: Table 6. Relationships Between Mate
Page 61 and 62: Table 8. Summary of Regression Mode
Page 63 and 64: Roper & Dunst, 2003). Everyday occu
Page 65 and 66: References Akey, T., Marquis, J., &
Page 67 and 68: Lerner, G. (1952). Mr. Potato Head
Page 69 and 70: Appendix Scale of Parent Involvemen
Page 71 and 72: Parents want to know why their chil
Page 73 and 74: Incidence of UHL Impact of UHL Defi
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Children with UHL are at risk for a
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with this population of children to
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who have UHL and the BAHA implant s
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Progression of hearing loss is a co
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ongoing services because of a speci
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Environmental and Acoustic Modifica
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negative effects of unilateral hear
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of children with unilateral sensori
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The Volta Review, Volume 106(3) (mo
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Theories on Speech Development Theo
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indicating an interaction of a norm
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as Spanish, automatically there are
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In summary, young children with sev
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documenting speech production patte
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were determined by the child’s pr
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Table 1. Observed-to-Expected Ratio
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His Spanish language use did impact
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implants: Profiles and implications
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http://eire.census.gov/popest/data/
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Introduction Since the early 1980s,
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delayed, thereby increasing parenta
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fitting the second processor easier
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quickly and naturally. Children who
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Figure 2. Graphic example of a loud
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Table 2. Patients Patient ID Time L
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Speech Discrimination Tasks In addi
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The last two children with equal mo
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Figure 7. Loudspeaker arrangement f
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children will retain monaural stimu
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van Hoesel, R., Tong, Y., Hallow, R
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with hearing loss who receive early
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5 years (i.e., met the age cut-off
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location. Informed consent was obta
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Figure 1. Loneliness score and age
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analysis was conducted to determine
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eceive cochlear implants, significa
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effective public school programs fo
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for promoting EHDI in developing co
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Table 1. Levels of Prevention for C
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or unilateral hearing loss because
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were usually higher when babies wer
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Table 2. World Bank Classification
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total public expenditure (Gottret &
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is more cost effective to institute
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Figure 2. Proportion of births in h
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scant, although they are likely to
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a widely reported controversy conce
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their babies at such an early age b
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active, ongoing, culturally appropr
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this goal achievable. Reservations
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Clemens, C.J., Davis, S.A., & Baile
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Kale, R. (1995). Traditional healer
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A dream realized or nightmare in th
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Penn, C. (1998). The study of child
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Watkin, P.M., Baldwin, M., & McEner
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education or general education, the
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for both developmental and remedial
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Table 1. Type and Number of RSP Con
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process of closing the language gap
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phonologic and phonemic awareness;
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Westchester Institute for Human Ser
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Bohnert, Andrea; Spitzlei, Vera; Li
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