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A Descriptive Analysis of Language and Speech Skills in 4- to 5-Yr-Old Children With Hearing Loss

Fitzpatrick, Elizabeth M.1; Crawford, Leah2; Ni, Andy3; Durieux-Smith, Andrée1

doi: 10.1097/AUD.0b013e31821348ae
Research Articles

Objective: Early intervention through hearing aids (HAs) and cochlear implants (CIs) aims to reduce the negative effects of childhood hearing loss and to promote optimal communication development over time. The primary goal of this study was to examine the communication outcomes of children with CIs and children with HAs at age 4 to 5 yrs and to consider their spoken language skills relative to a group of typically developing hearing peers.

Design: In this multicenter observational study, communication results were obtained for a total of 88 children at age 4 to 5 yrs. Participants were recruited from three clinical programs in two cities in the province of Ontario, Canada. This study was undertaken shortly after the introduction of a new provincial population screening initiative and included both children who were screened and not screened for hearing loss. The study sample comprised 51 children with sensorineural hearing loss and 37 children with normal hearing. Of the 51 children with hearing loss, 26 used CIs and 25 used HAs. The degree of hearing loss ranged from mild to profound. All children were enrolled in rehabilitation programs focused on oral language development. Children's language skills were assessed with an extensive battery of child- and parent-administered speech and language measures.

Results: Assessment of language skills showed no significant differences between the children with severe to profound hearing loss using CIs and children with varying degrees of hearing loss using HAs. However, children with HAs showed better articulation skills. Overall, both groups of children obtained scores on communication measures that were lower than their hearing peers. The number of children with hearing loss who obtained spoken speech-language scores within 1 SD of normative populations ranged from 65 to 86% depending on the test measure. Children with average hearing loss of 70 dB HL or better generally obtained scores on all measures in line with those of age-matched norms while scores were quite variable for children with severe and profound hearing loss. Factors influencing performance in children with hearing loss included degree of hearing loss (pure-tone average) and parent education. Age at diagnosis of hearing loss was not a significant predictor of speech-language outcomes in this study.

Conclusions: Results indicated that overall, children with all degrees of hearing loss who were fit with hearing technology and who received auditory-based rehabilitation services during the preschool years demonstrated the potential to develop spoken language communication skills. As a group, children with CIs and children with HAs did not differ significantly on language abilities although there were differences in articulation skills. Their performance at age 4 to 5 yrs was delayed compared with a group of hearing peers. The findings reinforce the need for research to identify factors that are likely to lead to age-appropriate communication skills for preschool-age children with hearing loss.

This study examined communication outcomes in 51 children aged 4 to 5 yrs with hearing loss and 37 normal-hearing peers. Communication abilities were compared for the 26 children with severe and profound losses who were fit with cochlear implants and the 25 children with hearing losses ranging from mild to severe who used hearing aids. The two hearing loss groups were also compared with their normal-hearing age-mates. The children in the two hearing loss groups did not differ overall in their communication outcomes. However, both groups of children obtained communication scores that were lower than their hearing peers.

1Audiology/Speech-Language Pathology, Faculty of Health Sciences, University of Ottawa; 2Master's in Health Sciences Program - Audiology/Speech-Language Pathology, University of Ottawa; 3Department of Biostatistics, University of North Carolina-Chapel Hill.

This work was supported by the Canadian Language and Literacy Research Network and the Masonic Foundation of Ontario.

E. M. Fitzpatrick received funding through a Canadian Institutes of Health Research New Investigator Award.

Address for correspondence: Elizabeth M. Fitzpatrick, PhD, Faculty of Health Sciences, Audiologie-Speech-Language Pathology, 451 Smyth Road (3071), Ottawa, Ontario K1H 8M5, Canada. E-mail:

Received May 22, 2010; accepted January 30, 2011.

© 2011 Lippincott Williams & Wilkins, Inc.