Read Full Text: Developmental Outcomes of Early-Identified Children who are Hard of Hearing at 12 to 18 Months of Age (Free to access)
Journal: Early Human Development
Year Published: 2015
**Ranked 86th on our 2015-2020 list of the 100 most influential OT-related articles.
As OT professionals, we know that involving family members is crucial to providing excellent care.
This week, we have the opportunity to look at research that supports this belief. We’re exploring an article that dives deep into early intervention services for children who are hard of hearing (HOH).
The researchers first looked at language and emotional development among kids who are HOH. Then, then they took things a step further by considering parental impact—namely, how parents’ feelings of stress and efficacy (or lack thereof) play into these kids’ development.
This article will be a helpful read for those of you who have kids who are HOH on your caseload. And, it serves as an important reminder to all of us: we should always strive to increase caregiver self-efficacy and decrease caregiver stress as part of our holistic OT plan for any patient.
Let’s dive in.
A brief background on the improvement in newborn hearing screenings…
Over the past decade, hospitals have begun performing universal hearing screenings for all children born in their facilities. Since then, children with not only profound hearing loss, but also with milder degrees of hearing loss, are able to be identified at earlier ages.
In fact, before universal hearing screening was implemented, the average age of identifying congenital hearing loss was 2-3 years of age.
Now it is 3 months!
We know from previous research that this opportunity for early intervention is critical. It has been shown to reduce negative outcomes for these children, who are at risk of:
- Speech-language delays
- Poor academic achievement
- Literacy delays
- Psychological difficulties
Severe and profound hearing loss” versus “hard of hearing"
Hearing loss is categorized by the decibel level, or volume, at which you can hear sounds.
- Children who can only hear sounds above 70 decibels have severe and profound hearing loss.
- Children who can hear sounds between 29-79 decibels have mild-to-moderate hearing loss. These children are considered hard of hearing (HOH).
Much of the past decade’s research has focused on children with severe and profound hearing loss. There hasn’t been much research exploring how this new cohort of children, who now have the luxury of an early diagnosis of HOH, has been impacted by early intervention and treatment options.
Which leads us to this study…
What was the research question being studied in this trial?
The authors had two main areas of focus for this study.
First, the authors compared this cohort of kids to those with normal hearing. They asked: is there difference in development—primarily language and emotional development—between kids diagnosed early with HOH and those with normal hearing?
Secondly, the authors considered parental stress levels and feelings of self-efficacy. They asked: what impact do parents’ stress levels and feelings of efficacy have on their children’s development?
Who was included in this study?
This study included 28 children who were HOH and their mothers.
The children in this study were all 12-18 months old, which makes them significantly younger than the children who participated in other similar studies.
There was also a control group of children in a similar age range, making the total number of children involved 42.
None of the children in either group had other developmental delays or medical diagnoses.
What outcome measures did they track?
This article used a lot of assessments—7 in total—and only one of them, the Vineland Adaptive Behavior Scales, would be considered a typical OT assessment.
The researchers compiled a huge amount of information, including demographic and social information, as well as questions about the families’ participation in their local early intervention programs.
Multiple assessments were used to examine language development, emotional development, and adaptive skill development—as well as parental stress levels and self-reported feelings of efficacy. Here are the assessments listed in the article:
- Mullen Scales of Early Learning (MESL)
- Preschool Language Scale, 4th Edition (PLS-4)
- MacArthur-Bates Communicative Development Inventories (MB-CDIs)
- Vineland Adaptive Behavior Scales | Third Edition (Vineland-3)
- The Infant-Toddler Social and Emotional Assessment (ITSEA)
- The Parenting Stress Index - Short Form (PSI-SF)
- Maternal Self-Efficacy Scale (MSES)
What were the results?
With the amount of data collected, the authors were able to present several important findings.
- Overall, families were pleased with the early intervention services they received, and found them helpful in meeting the needs of their children.
- Despite looking at a huge variety of factors, there was no significant difference between the two groups of children in any of the areas of development or behavior—with one caveat. In the group of children with normal hearing, there was a higher incidence of difficult behaviors reported.
The most important findings appear to be in the area of parental stress and maternal self-efficacy.
- There was no significant difference in levels of parental stress between the two groups.
- There was a negative correlation between stress and efficacy in both groups of parents. In other words, when parents in both groups felt less self-efficacy, their stress levels were found to be higher.
- For the group of children who are hard of hearing, as parental stress decreased, developmental gains increased and challenging behaviors decreased. There was also a significant link between improved self-efficacy in parents and developmental gains in their kids—and a similar link between low levels of self-efficacy among parents and more challenging behaviors among their kids.
What did the authors conclude/discuss?
There was very optimistic indications from this research:
It seems that children who are hard of hearing (and identified early and provided services) can demonstrate age-appropriate development in multiple domains by 12-18 months.
Historically, children who are hard of hearing had been shown in studies to demonstrate increased shy behaviors—but that was back before early identification and intervention became a priority.
In the current study, children who were hard or hearing actually showed LESS shy behavior than their counterparts with normal hearing. One theory attributes this to the fact that these children become accustomed to interacting with early intervention professionals at a young age.
Finally, mothers of children who are HOH reported similar levels of self-efficacy to mothers of children with normal hearing.
The importance of maternal self efficacy was underscored by this research. Higher self-efficacy in parents was associated with better language skills, improved overall adaptive behavior, and increased social-emotional competence in children.
They also noted the importance of early intervention, such as family-centered care. The researchers stressed, through their own findings as well as findings by other authors, that engaging with parents early could help cultivate parental self-efficacy.
Takeaways for OT practitioners
(These were our personal takeaways, and were not mentioned in the article.)
1.) Family-centered care is paramount when working with this age range, and OTs are uniquely qualified to provide such care.
We already know occupational therapists are incredibly well suited to provide family-centered care. We can look at the various contexts and co-occupations that occur with our families, and provide evidence-based interventions in multiple areas. This article only reinforced the need to consider more than just the child in order to improve parental self-efficacy and long-term developmental gains.
2.) OTs have the skills needed to wear multiple hats, and we need to make sure we practice wearing them all in turn.
While OT practitioners are great at providing direct interventions, we are also great at providing guidance from a broader lens. For example, we can help families learn how to access community resources, interact with other medical professionals, and advocate for their children’s and family’s needs.
Some families might only need a cheerleader, but others might need assistance in other ways, such as with organizing, researching, and synthesizing information.
3.) It’s important to advocate for how we can help a wide variety of clients, even if we aren’t the most obvious practitioners for the job.
When I first read this article, I was a bit surprised it had made it onto our list of 100 most influential articles. This definitely felt like a speech-language pathology article, and there was only one mention of OT. But, as you read this article, our professional language jumps off the page. It was clear to me that occupational therapists are needed when working with children who are hard of hearing.
Despite this, in our current healthcare climate, practitioners can often be challenged to prove they can meet a given client’s needs. If we can stay true to our roots as occupation-based interventionists, research like this article illustrates how we can help a wide variety of clients, even if we aren’t always the most obvious choice.
(Possibly) Earn CEUs/PDUs for reading this article.
Many of you can receive continuing education credits for reading this article. Here’s a form to help you do it, along with information to help you understand who qualifies.
And, here’s the full APA citation you many need:
Stika, C. J., Eisenberg, L. S., Johnson, K. C., Henning, S. C., Colson, B. G., Ganguly, D. H., & Desjardin, J. L. (2015). Developmental outcomes of early-identified children who are hard of hearing at 12 to 18months of age. Early Human Development, 91 (1), 47-55. doi:10.1016/j.earlhumdev.2014.11.005
