The past two decades have been characterized by exciting changes in how we serve children who are deaf and hard of hearing. Universal newborn hearing screening (NHS) and Early Hearing Detection and Intervention (EHDI) programs have lowered the age of identification and intervention for children with hearing loss while also creating new areas of research and novel challenges for clinicians. Mary Pat Moeller, PhD, director of the Center for Childhood Deafness at Boys Town National Research Hospital (BTNRH), has been on the cutting edge of these developments—first as a clinician, and now as a researcher. I had the opportunity to talk with Dr. Moeller about her career during this period of rapid progress in the field.
Dr. McCreery: What experiences early in your career influenced the direction of your research?
Dr. Moeller: When I began working with deaf and hard-of-hearing children, we did not have access to the technologies we have today. I was particularly struck by the individual differences in outcomes of these children, even those from seemingly similar circumstances. It seemed that strong opinion and anecdotal experience often guided our interventions, and I recognized the need for empirical evidence to support clinical practices. I was always interested in child language development and research in that field.
I began attending the Symposium on Research in Child Language Disorders in Madison as a clinician and came to appreciate how these theories could be applied to the problems we faced with deaf children. I learned the value of collaboration when there were thorny issues to address. Dr. Ray Kent did a longitudinal project examining the spoken language behaviors of a set of twins—one was deaf and one was hearing. I served as a research assistant collecting data and felt honored to be on the sidelines of this fascinating work. I also worked with Dr. Mary Joe Osberger and Dr. Rich Lippmann on an automated speech training aid that was clearly ahead of its time. I became a believer in the need for interdisciplinary research efforts to guide our practices.
Dr. McCreery: What factors played a part in your decision to pursue a PhD after many years as a clinician?
Dr. Moeller: I was fortunate to have mentors along the way when I was a clinician. One of my first mentors was Noel Matkin. He recruited me to work on a multidisciplinary team at BTNRH. Noel was once called the “Alan Alda of Audiology,” and it was true! He has a nuanced understanding of the impact of hearing loss on child development. He taught me to “look beyond the ears” and to appreciate the critical importance of transdisciplinary teamwork. He encouraged all of us to share research results across disciplines, particularly with the pediatric community.
Later I had opportunities to work on projects in the labs of several key researchers who specialized in aspects of communicative development of children with hearing loss. I am grateful for each opportunity I had to work with Pat Stelmachowicz, Mary Joe Osberger, Arlene Carney, and Brenda Schick. After many years of clinical work, I felt that I had some insights and interesting questions, but I lacked the tools to address those questions. All of these mentors encouraged me to pursue a late-career PhD. It was watching their models that prompted me to pursue the degree.
It was not without challenges to enter school again after many years, but I felt like the luckiest person on earth to be in a rich academic environment. I love to learn, and I always had strong interests in the links between language and cognition. I was able to pursue those connections during my dissertation work. Fundamentally I could see that we lacked evidence to support approaches we used daily in the clinic. That also fueled me to gain research skills.
Dr. McCreery: What have you learned from your research about children who are deaf or hard of hearing that may have changed over the last 10 years with the advent of universal newborn hearing screening and early intervention?
Dr. Moeller: I have conducted a number of longitudinal studies in my lab comparing groups of infants with hearing loss to age-matched infants with normal hearing. Something that really stands out from that work is the strong foundation for language learning that typical 12-month-olds have from a year of language exposure. It made me more convinced than ever of the importance of giving children with hearing loss the earliest possible start in listening and language. I am not sure I was prepared for the challenges families would face in implementing consistent device use with toddlers, but it still beats trying to fit hearing aids for the first time on two-year-olds! What a remarkable shift to be able to identify hard-of-hearing infants early in infancy and provide audibility for language exposure during those critical early months.
Prior to NHS, most hard-of-hearing children were identified at 2 years of age or later, so we really had to be reactive rather than proactive. NHS has an added benefit in that it provides a research opportunity to systematically examine early stages of development in children with varying degrees of hearing loss. My earlier lab studies indicated that speech development was a vulnerable area for some children with hearing loss and that limited high frequency audibility may have played a role. Our early longitudinal studies provided some key insights that we are now able to examine on a much larger scale. We are able to avoid some of the challenging issues of the past—late identification confounders, limited information about amplification use—and prospectively examine factors that moderate or mediate developmental outcomes.
Our current study [Outcomes of Children with Hearing Loss, OCHL] is a multidisciplinary collaboration of BTNRH, the University of Iowa, and the University of North Carolina at Chapel Hill (see FastLinks). Today's technologies make interdisciplinary collaboration more effective and feasible, but I also have learned the value of strong leadership for projects of this nature. I am particularly fortunate to be codirecting this effort with Dr. J. Bruce Tomblin of the University of Iowa.
Dr. McCreery: What challenges must still be resolved to further improve outcomes for children who are deaf or hard of hearing (D/HH)?
Dr. Moeller: If I step back and look at the full picture, I see that we as a field have made a lot of progress toward the goal of characterizing developmental outcomes of children who are D/HH. In some ways, the advent of cochlear implants fueled a resurgence of interest in this population, and the science improved as a result. More recently, NHS has allowed a resurgence of interest in the development of HH children, as I mentioned. This body of work addresses important research gaps involving a new generation of children with early access to improved hearing technologies. However, as I step back, I see a major lack of intervention research. We do not have evidence to support which approaches work best with which families and children. This represents a major challenge for the future so that we can tailor interventions to address specific early-identified needs.
As a result of the OCHL project, I have an even deeper appreciation for the importance of transdisciplinary collaborations. Our study has identified gaps in the fitting and management of amplification that influence children's outcomes. Our discussions involving researchers in pediatric audiology, child language development, and statistics are leading us to innovate the ways we measure and examine the problem. When I went back to graduate school late in my career, I had a favorite statistics professor who always talked about interactions as “a more complicated story.” In my humble opinion, this entire area of research represents a more complicated story.
Understanding the story will require larger-scale studies with sophisticated analytic techniques, which in turn will require collaborative research. We need to examine children's performance in a controlled manner but in more realistic settings if we are to understand issues of communication access and their impact on development. We also need to look across disciplines and apply research strategies that will better inform us about the youngest children we serve.
© 2013 Lippincott Williams & Wilkins, Inc.
- Get additional information about the Outcomes of Children with Hearing Loss study at http://bit.ly/OCHLStudy.
- Learn more about Dr. Moeller's research at http://bit.ly/DrMoeller.
- Click and Connect! Access the links in The Hearing Journal by reading this issue on our website or in our new iPad app, both available at thehearingjournal.com.
- Comments about this article? Write to HJ at HJ@wolterskluwer.com.
- Follow us on Twitter at twitter.com/hearingjournal and like us on Facebook at www.facebook.com/HearingJournal.