TVR_106-3

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The Volta Review, Volume <strong>106</strong>(3) (monograph), 237-258 Early Intervention for Children with Permanent Hearing Loss: Finishing the EHDI Revolution Karl R. White, Ph.D. The value of identifying permanent hearing loss during the first few months of life and providing effective treatment to ameliorate or even eliminate the negative consequences has been recognized for many decades. Unfortunately, improvements in achieving this goal were very gradual until the early 1990s. At that time, the combination of technological advances in screening and diagnostic equipment and hearing technologies created a revolution in our ability to identify and provide intervention to children with permanent hearing loss during the first few months of life. Evidence continues to accumulate that for those children who are identified early and provided with appropriate hearing technologies and early intervention, dramatic progress is often possible. However, there are many infants and young children who are not yet benefiting from this revolution because timely and appropriate early intervention services are not available in many parts of the country. Part of the reason why so many children are missing out on these benefits is there has not been sufficient coordination between the state Early Hearing Detection and Intervention (EHDI) programs and the federally sponsored Infant and Toddler programs for which states receive partial funding under Part C of the Individuals with Disabilities Improvement Act of 2004. This article discusses how the early intervention aspects of EHDI programs could be improved by closer attention to the components required under Part C of eligibility criteria, child-find and referral systems, preservice and inservice personnel development, coverage of hearing aids and public awareness programs. Introduction At the beginning of this decade, the U.S. Department of Health and Human Services issued national health objectives (Healthy People 2010, 2000) that Karl White, Ph.D., is a professor of psychology at Utah State University and the founding director of the National Center for Hearing Assessment and Management (NCHAM). Finishing the EHDI Revolution 237
identified the most significant preventable threats to the health of people in the United States and established national goals to improve people’s health and well-being. Developed by a broad array of stakeholders and using the best scientific evidence available, the objectives in Healthy People 2010 were predicated on the simple but powerful idea that broad awareness of understandable health objectives will enable various stakeholders to work together to achieve important outcomes. The fact that early identification of permanent hearing loss in children 1 was included as one of the goals in this high-visibility national plan is an important indication of how thinking about early identification and intervention with children who are deaf or hard of hearing (referred to hereafter as DHH children) has changed over the last 20 years. Goal 28-11 from Healthy People 2010 states, “Increase the proportion of newborns who are screened for hearing loss by age 1 month, have audiologic evaluation by age 3 months, and are enrolled in appropriate intervention services by age 6 months.” The idea behind this goal is not new, but the belief that it could be achieved is a significant change in what people have believed for the past hundred years. Some of the first to advocate for systematic and sustained efforts to identify DHH children during the first few months of life were Ewing and Ewing (1944), when they called for the: need to study further and more critically methods of testing hearing in young children . . . during this first year the existence of deafness needs to be ascertained . . . training needs to be begun at the earliest age that the diagnosis of deafness can be established. (page 309) For more than 50 years following the Ewings’ call to action, many people agreed that it was important to identify DHH children early and provide early intervention services, but most were skeptical that it could be done effectively. For example, as recently as 1996, the prestigious United States Preventive Services Task Force, while noting that “congenital hearing loss is a serious health problem associated with developmental delay in speech and language function,” concluded that “there is little evidence to support the use of routine, universal screening for all neonates.” Skepticism about the practicality of early identification and intervention with DHH children began to change in the late 1980s when Dr. C. Everett Koop, then the Surgeon General of the United States, recognized the potential of technological advances in procedures and equipment for revolutionizing 1 Many different terms are used to refer to children with permanent hearing loss (e.g., deafness, hearing impairment, auditory disorders). Recognizing that there are limitations to any single term, this article will use the term “deaf and hard of hearing (DHH) children” to refer to children who are deaf or hard of hearing, except in those cases where another source is being quoted. 238 White
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Page 11 and 12: Figure 1. Percentage of newborns sc
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Table 6. Relationships Between Mate
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Table 8. Summary of Regression Mode
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Roper & Dunst, 2003). Everyday occu
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References Akey, T., Marquis, J., &
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Lerner, G. (1952). Mr. Potato Head
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Appendix Scale of Parent Involvemen
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Parents want to know why their chil
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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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