Early Intervention for Children With Hearing Loss
Do children with hearing loss benefit from early intervention?
A first-of-its-kind study published in October by Dr. Mary Pat Moeller, Dr. Bruce Tomblin, and their colleagues examines this very question.
In recent years, infants and toddlers are being identified with hearing loss early in their development. This is due in part to the implementation of newborn hearing screening, early intervention, and advances in hearing technology. Clinicians have assumed that early identification and hearing aid fitting in infancy will result in long-term positive effects on learning, speech, language, and socialization in children with hearing loss (Gray, 2015); however, there was limited scientific evidence to support those claims (Moeller & Tomblin, 2015). In a press release of the study’s findings, Tomblin stated, “our research now provides strong evidence in support of these expectations.” (Gray, 2015).
The Outcomes of Children with Hearing Loss (OCHL) study was conducted across multiple sites by researchers at the University of Iowa, Boys Town National Research Hospital, and the University of North Carolina at Chapel Hill. It was the first of its kind to look at infants and preschoolers with varying levels of hearing loss to determine which supports and services will help them thrive alongside their hearing peers (Gray, 2015).
The research team followed children ages six months to seven years who had permanent, mild-to-severe hearing loss in both ears; the children entered the study as infants or toddlers and were followed for three or more years to look at their long-term development (Tomblin et al., 2015b). The study produced many important findings that were published across several articles. Nine of the major conclusions are highlighted below.
- Children with hearing loss are at risk for language delays.
Children with hearing loss on average had poorer language skills than hearing children even when the loss was identified early. Children with severe hearing loss were at the highest risk for delays; however, children with mild losses were also found to be at-risk (Tomblin et al., 2015a, as cited in Moeller, Tomblin, & the OCHL Collaboration, 2015). Although not every child with hearing loss will have delays, the researchers highlight the importance of parents supporting their children’s language skills by consistently talking to them (Outcomes of Children With Hearing Loss Study, 2015).
- Well-fit hearing aids reduce risk and provide some protection against language delay.
The positive news is that language delays can be limited. Well-fit hearing aids are ones where speech has been set to be as audible as possible (i.e., heard well). Giving infants and toddlers well-fit hearing aids was linked with better language development (Tomblin et al., 2015a, as cited in Moeller et al., 2015). Children with good aided audibility (i.e., heard speech well) showed steady improvement in their language skills across several years (McCreery et al., 2015b, as cited in Moeller et al., 2015).
- A significant percentage of children do not have well-fit hearing aids.
Unfortunately, over 30% of children’s hearing aids tested in the study were not well-fit; thus many children are not receiving optimal speech input from their hearing aids (McCreery et al., 2015a, as cited in Moeller et al., 2015). The OCHL team recommends families ask their audiologists to check aided audibility regularly (e.g., after hearing evaluations and earmold fittings) (Outcomes, 2015).
- Earlier fitting of hearing aids results in the best early language skills, but later-fit children still benefit from aids.
Children who received hearing aids before they were six months old had the best early language development (Tomblin et al., 2015a). These children either showed no delay or caught up to their hearing peers before the age of two. They also had better early development than children who were fit when they were older; however, children who were fit after 18 months old did show language gains after wearing the aids. The researchers remind parents to recognize that early fitting is best, but that later-fit children can still improve their language with hearing aids (Moeller & Tomblin, 2015).
- Consistent wearing of hearing aids gives children some protection against language delays and supports their listening skills.
Children with more consistent daily use of their hearing aids (i.e., 10 or more hours daily) had better language and auditory skills than those with less consistent use. These findings were especially true for children with moderate or moderately severe hearing loss. Children with low daily use had the lowest language scores over time (Tomblin et al, 2015a, as cited in Moeller et al., 2015). It can be difficult to get infants and toddlers to wear their hearing aids but use tends to improve over time (Walker et al., 2015 as cited in Moeller et al., 2015). Moeller, Tomblin, and colleagues suggest parents ask their audiologist to share the data on hearing aid use and seek help with problems preventing consistent use (Outcomes, 2015).
- Quality of parent’s language toward their children with hearing loss impacts the children’s language skills.
Parents of toddlers with hearing loss used more directive talk (e.g., say “cat,” “sit here”) while parents of hearing children used more responsive talk (e.g., commenting, sharing ideas). Directive talk was negatively linked with language skills in children with hearing loss. The quality (i.e., directive compared to responsive), but not quantity (i.e., amount of input), of the parent’s talk at 18 months predicted their child’s language skills at 36 months (Ambrose et al., 2015 as cited in Moeller et al., 2015). The research team cautions parents to “describe and chat more than you ‘direct’” (Outcomes, 2015).
- Receptive language and aided audibility influence children’s hearing and speech recognition skills.
Language skills and hearing skills are linked. Children’s high receptive language skills (i.e., understanding language) were connected with high auditory development (i.e., hearing skills). In addition, children with better aided audibility and receptive language skills had better speech recognition from age two through early school-age. Thus, well-fit hearing aids influence children’s auditory development as well as their language (McCreery et al., 2015b, as cited in Moeller et al., 2015).
- Children with hearing loss are at risk for delays in language structure.
Children with hearing loss have difficulty developing certain speech sounds and word endings because sounds such as “s” at the end of plural words are difficult for them to hear (Tomblin et al., 2015a as cited in Moeller et al., 2015). The OCHL researchers remind parents that children with hearing loss may need more practice to develop these specific skills (Outcomes, 2015).
- Aided audibility, hearing aid use, and characteristics of language input all influence the impact of hearing loss on children’s language development.
Overall, the study found that aided audibility, amount of hearing aid use, and the type of parent’s language had the most influence on children with hearing loss’ development of language (Ambrose et al., 2015 as cited in Moeller et al., 2015). The researchers recommend that parents focus on these three factors and seek help from professionals and other parents in supporting their children’s language development (Outcomes, 2015).
The findings presented by Moeller & Tomblin help shed light on factors that impact language delays in young children with hearing loss. Notably, the three most influential factors (i.e., aided audibility, hearing aid use, and language input) are all adjustable. As a whole, Dr. Tomblin and Dr. Moeller believe their study presents an optimistic picture of steps parents and professionals can make to help decrease language delays in children with hearing loss.
For further information on this project, including a parent handout summarizing the findings, visit the Outcomes of Children With Hearing Loss website at http://ochlstudy.org/.
Ambrose, S.E., Walker, E.A., Unflat-Berry, L.M., Oleson, J.J., & Moeller, M.P. (2015). Quantity and quality of caregivers’ linguistic input to 18-month and 3-year-old children who are hard of hearing. Ear and Hearing, 36, 48S-59S.
Gray, L. (2015, October 10). Helping children hear better: First-of-its-kind study shows kids with hearing loss benefit from early intervention. Iowa Now. Retrieved from
McCreeery, R.W., Walker, E.A., Spratford, M., Bentler, R., Holte, L., Roush, P., Oleson, J., Van Buren, J., Moeller, M.P., (2015a). Longitudinal predictors of aided speech audibility in infants and children. Ear and Hearing, 36, 38S-47S.
McCreery, R.W., Walker, E.A., Spratford, M., Oleson, J., Bentler, R., Holte, L., & Roush, P. (2015b). Speech recognition and parent ratings from auditory development questionnaires in children who are hard of hearing. Ear and Hearing, 36, 60S-75S.
Moeller, M.P., & Tomblin, J.B. (2015). An introduction to the outcomes of children with hearing loss study. Ear and Hearing, 36, 4S-13S.
Moeller, M.P., Tomblin, J.B., & the OCHL Collaboration (2015b). Epilogue: Conclusions and implications for research and practice. Ear and Hearing, 36, 92S-98S.
Outcomes of Children with Hearing Loss Study (2015, October 21). Preschoolers with mild to severe hearing loss: Findings and Implications [parent handout]. Retrieved from http://ochlstudy.org/parent-handout.html
Tomblin, J.B., Harrison, M., Ambrose, S.E., Walker, E.A., Oleson, J.J., & Moeller, M.P. (2015a). Language outcomes in young children with mild to severe hearing loss. Ear and Hearing, 36, 76S-91S.
Tomblin, J.B., Walker, E.A., McCreery, R.W., Arenas, R.M., Harrison, M. & Moeller, M.P. (2015b). Outcomes of children with hearing loss: Data collection and methods. Ear and Hearing, 36, 14S-23S.
Walker, E.A., McCreery, R.W., Spratford, M., Oleson, J., Van Buren, J., Bentler, R., Roush, P., & Moeller, M.P. (2015). Trends and predictors of longitudinal hearing aid use for children who are hard of hearing. Ear and Hearing, 36, 38S-47S.