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Building Blocks

Tracking Outcomes with Growth Charts for Baby Ears

McCreery, Ryan PhD

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doi: 10.1097/01.HJ.0000455838.21650.a0
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Hearing screened within one month of birth? Check.

Diagnostic hearing evaluation by 3 months of age? Check.

Amplification fit within one month of confirmation? Check.

Enrolled in early intervention by 6 months of age? Check.

© iStock/BrianAJackson

This hypothetical baby born with hearing loss is on the way to developing auditory and communication skills, right? By meeting these goals for early intervention services, we hope to give children the opportunity to reach their full potential. How can we monitor these children to assure ourselves and their caregivers that our efforts are effective, though?

Ryan McCreery, PhD

In past Building Blocks columns, I have highlighted audibility verification with the Speech Intelligibility Index (HJ April 2013 issue, p. 8 and hearing aid use time (HJ December 2013 issue, p. 18 as important metrics to monitor in children who wear hearing aids. While good aided audibility and consistent hearing aid use are important, neither factor can tell us about the child's development of auditory and communication skills.

Some professionals may assume that the responsibility for monitoring these skills falls to other professionals, like speech-language pathologists and teachers of the deaf. However, a number of validated, easy-to-use questionnaires can help hearing healthcare professionals document a child's developmental progress and listening abilities.

What is the child's developmental age?

The first question that helps narrow down the selection of potential questionnaires relates to the child's developmental age. Since children who are hard of hearing are likely to experience developmental delays, professionals must choose an instrument that is appropriate for the emerging skills.

The use of chronological age alone as a guide can mean that the questionnaires do not yield the intended information. Parents or caregivers also may become frustrated if their child has already mastered the skills being queried or, conversely, has not yet developed the skills.

Parents and other professionals who work with the child may provide a general assessment of abilities that can help guide the decision about which measures to use. The interpretation of the questionnaire results may also depend on the child's developmental age.

What specific abilities should be assessed?

Auditory development questionnaires can differ in terms of the domains they assess. For example, questionnaires such as the LittlEARS Auditory Questionnaire reflect the emergence of early language and listening skills in infants and young children ( Int J Pediatr Otorhinolaryngol 2009;73[12]:1761-1768

Other questionnaires, like the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH; J Am Acad Audiol 2007;18[3]:220-235 or the pediatric version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ; Ear Hear 2007;28[4]:470-482, may assess how the child listens in background noise or in situations with multiple talkers. Another category of questionnaires includes the Screening Instrument for Targeting Educational Risk (SIFTER), which is completed by classroom teachers to assess the child's listening skills at school (

The selection of skills to evaluate with an auditory development questionnaire should be based on the needs of the specific child.

Carefully interpret the results.

Most auditory development and listening questionnaires have procedures for determining a score for each child. The score can then be compared with normative data.

Professionals should pay close attention to whether the normative range for the scale is based on a group of children who are hard of hearing or same-age peers with normal hearing. These differences will affect the interpretation of results and how parents and caregivers are counseled about them.

Take action.

If questionnaires are to yield useful information, the results must be actionable. This means that a score outside of the normal range should lead to specific recommendations or actions to support the child.

Examples of specific actions include changes in amplification or referral to a cochlear implant team for evaluation of a child who is not performing at expected levels. The introduction of educational accommodations or hearing assistance technology is another possible step.

In some cases, notifying early intervention providers, physicians, or other professionals involved in the care of the child can help supplement the information they're already gathering and guide clinical decisions.

If questionnaires are not applied effectively, the entire process of collecting this information is a waste of time.

Share results with parents or caregivers.

Parents and caregivers should be informed about the results of any developmental questionnaires used with their child. The information provided to them should include the purpose of the questionnaire and the expectations for the particular measure, as well as whether the results will be tracked over time.

Most questionnaires are designed only to identify children who are at risk for delays in auditory development and those who are not. In other words, questionnaires may not yield detailed information about the specific areas or skills of concern. Comprehensive developmental assessments may be indicated to help provide information about the child's specific strengths and weaknesses.

A wide range of factors can influence performance on questionnaires. Professionals should interpret results that are outside the normal range with caution, particularly when it comes to trying to determine a specific cause for the findings.


Professionals serving children who are hard of hearing and their families have made enormous progress in identifying these children and providing them with amplification at earlier ages than ever before. The next step in the process of improving outcomes will be to document auditory development and listening skills throughout childhood and take specific actions based on those results.

The information provided by questionnaires can give families confidence that their efforts to support their child are effective. The development of new questionnaires and the refinement of existing tools will help us keep up with the progress being made by children who are hard of hearing.

Read past Building Blocks columns in a special collection on the HJ website:

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