Does Adherence to Early Infant Hearing Detection and Intervention Guidelines Positively Impact Pediatric Speech Outcomes?
Year: 2020
Type: article
Abstract: Infant hearing loss occurs at an incidence of 1.4 per 1,000 births, and children born with hearing loss are at a significant risk of language development delays.1 The identification, management, and reporting of infant hearing loss are public health issues overseen by the Centers for Disease Control and Prevention (CDC) and coordinated by state Early Infant Hearing Detection and Intervention (EHDI) programs. To prevent delays in diagnosis/intervention, universal infant hearing screening standards and programs were developed and piloted during the 1990s. These standards were subsequently implemented throughout the United States as a result of the position statements and policy recommendations by the United States Preventive Services Task Force, Joint Committee on Infant Hearing (JCIH), and the National Institutes of Health in 1999 to 2000.2 Through their joint efforts, these agencies created the EHDI guidelines, also known as the 1-3-6 guidelines, which recommends the following: all infants should have hearing screening after birth no later than 1 month of age, infants with abnormal screening results should have definitive diagnostic hearing testing no later than 3 months of age, and infants who are found to have hearing loss should receive early intervention services no later than 6 months of age.2 According to the CDC, EDHI programs exist in all 50 states, and 97% of infants in the United States undergo hearing screening; however, nearly 30% of infants with hearing loss are delayed in diagnosis, and approximately 30% of infants with hearing loss do not receive early intervention care.1 Lack of adherence to the 1-3-6 guidelines and poor utilization of EHDI services are high priority areas for the JCIH.2 EHDI programs require significant coordination and cost; thus, it is important to determine whether adherence to the 1-3-6 guidelines has any effect on speech development. The purpose of this article was to assess the literature regarding the impact of adherence to 1-3-6 EHDI guidelines on pediatric spoken language outcomes. The JCIH position statements are based on research that link earlier diagnosis/intervention with overall language development; however, those studies did not assess the impact of being adherent to all three components of the EHDI 1-3-6 guidelines.2 The National Early Childhood Assessment Project (NECAP) is a multistate program supported by the CDC to evaluate the outcomes of children with hearing loss and the impact of 1-3-6 EHDI recommendations.3, 4 A cross-sectional NECAP study from 2017 investigated 448 children, ranging in age from 8 to 39 months, who failed newborn hearing screening and were subsequently diagnosed with hearing loss across 12 states.4 This study assessed whether meeting all three components of the 1-3-6 EHDI time points influences expressive vocabulary, as expressed by a vocabulary quotient (VQ). Using multivariate linear regression, the authors found that children who were adherent to the EHDI guideline time points had significantly higher VQ values than children who did not. Those children who met only one of the time points (either 3-month age for diagnosis or 6-month age for intervention), but not both, had significantly lower VQ values than those who were adherent to all EHDI time points. Other significant independent variables influencing vocabulary development included age, presence of a disability, deaf or hard of hearing parent(s), maternal level of education, and degree of hearing loss. Nearly 90% of all children in this study were utilizing hearing aids, osseointegrated implants, or cochlear implants (CIs). This particular study did not specifically assess the age at implantation, duration of CI use, or the effect of implantation timing on language outcomes. In spite of timely diagnosis and intervention, those children with hearing loss who met the EHDI time points had significantly lower expressive vocabulary than expected vocabulary for children with normal hearing (VQ of 82 vs. 100). This indicates that other factors are at play, beyond the scope of this particular study, in pediatric language develop. This study was limited in that language development that was assessed was only expressive language, and data collection was performed by a variety of different individuals (interventionists and parents) across 12 different states. A follow-up NECAP study was conducted using a sample of 125 children with congenital hearing loss with cochlear implants.5 The purpose of the study was to investigate whether meeting the EHDI time points influenced overall language development and timing of cochlear implantation. The mean age of cochlear implant activation was 16.1 months (range = 5–34 months). Approximately 71% of the children in this study met the 1-3-6 time points. This study found that meeting the 1-3-6 EHDI guidelines had a direct effect on expressive language, expressive vocabulary, and comprehension/conceptual language, which may be due to earlier access to rehabilitation services and emotional support for families. Meeting the EHDI guidelines also has an indirectly positive effect on the same language outcomes by leading to earlier age of cochlear implant activation. Regarding expressive language outcomes, meeting EHDI guidelines equates to being implanted 15.1 months earlier, with similar effects seen in other language outcomes. Other variables that were found to have an independent effect on these language measures included maternal education and age of activation of the cochlear implant. Interestingly, maternal education level did not independently affect adherence to 1-3-6 guidelines nor the age of implant activation. One limitation of a study such as this is the lack of longitudinal data that could address the impact of meeting EHDI guideline on language development over the course of time. Other recent findings reinforce the early intervention and language development relationship. Dettman et al.5 conducted a study involving 403 congenitally deaf children who received cochlear implants under the age of 6 years. This study demonstrated an indirect relationship between age of implantation and receptive/expressive language development measures, with the children implanted younger than 12 months of age performing best. The large sample size of children implanted under 12 months (n = 151) was a unique strength of this article. Even though this study did not examine EHDI guidelines, it complements the NECAP studies in supporting early intervention and the positive effect that it has on language development. Adherence to meeting EHDI 1-3-6 diagnostic and intervention guidelines has a compelling effect on pediatric language development based on recent literature. Healthcare professionals need to play an active role within their states to support EHDI initiatives and adherence to these 1-3-6 guidelines. Otolaryngologists and audiologists who are involved in diagnosis and intervention for pediatric hearing loss should be proactive to ensure that children in their care, as well as those in their community, meet these guidelines, and to lead in early intervention, including cochlear implantation for appropriate candidates. Furthermore, based on the literature in this field, clinicians should strive to provide support and education for families regarding adherence to EHDI guidelines that may lead to timely diagnosis and intervention for congenital hearing loss, which in turn, may positively influence pediatric language development. This study included cross-sectional studies (level 2b), involving children from multiple states/centers along with case–control studies (level 3b).
Source: The Laryngoscope
DOI: 10.1002/lary.28994
Institution: University of Kentucky
Language: English
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W3047509318