Auditory Verbal Therapy in Children with Hearing Loss: We do not have
Enough Specialists Habib Rizk MD, Don Goldberg PhD**, Ted Meyer, MD PhD
14th Annual Pediatric CI Symposium
ACIA Symposium Nashville, TN
DECEMBER 13th, 2014
Medical University of South Carolina Department of Otolaryngology
** College of Wooster, Cleveland Clinic
Disclosures
• Don Goldberg: Immediate Past President of the Alexander Graham Bell AssociaSon for the Deaf and Hard of Hearing
• Ted Meyer: President-‐Elect AG Bell
WHAT IS A LISTENING AND SPOKEN LANGUAGE SPECIALIST (LSLS)?
• Licensed audiologists, speech-‐language pathologists, or educators of the deaf who have attained high-‐level of specialty education, experience, and certification.
• LSLS work with infants and children who are deaf or hard of hearing and their families seeking a listening and spoken language outcome.
• Certification is delivered by AG Bell Academy
Hearing and Hearing
Technology 12%
Auditory Functioning 16%
Spoken Language
Communication 16%
Child Development 9%
Parent Guidance, Education and Support 13%
Strategies for Listening and
Spoken Language
Development 18%
History, Philosophy, and
Professional Issues 4%
Education 6%
Emergent Literacy 6%
The LSLS Domains of Knowledge
Differences between Auditory-‐Oral and Auditory-‐Verbal Therapy
• Listening and Spoken Language approaches were known as Auditory-‐Verbal (A-‐V) and Auditory-‐Oral (AO)
• AO focuses on speech and provides the patient with visual cues
• AV focuses on listening • Evidence-‐based research found these approaches
have more similarities than differences • Resulting in a single certification: the Listening
and Spoken Language Specialist Certification (LSLS)
One cerSficaSon, Two DesignaSons
• The LSLS Cert. AVT works one-‐on-‐one with the child and family in all intervention sessions.
• The LSLS Cert. AVEd involves the family and also works directly with the child in individual or group/classroom settings.
Both have similar knowledge and skills and
work on behalf of the child and family.
Who are LSLS?
37.7%
12.2%
43.2%
6.9%
Speech-‐Language Pathologist
Audiologist
Educator of the Deaf
School Adminstrator
* Out of 547 Certified LSLS; some of our professionals fill more than one role
89%
6% 4%1%
Communication Outcomes Selected by Families
Listening and Spoken LanguageTotal Communication
American Sign Language
Cued Speech
Source: BEGINNINGS of North Carolina is a non-profit agency providing an impartial approach to meeting the diverse needs of families with children who are deaf or hard of hearing and the professionals who serve them
Importance of LSLS
• Total costs for special educaSon programs for children with hearing impairments was $11,006 per child (2000 value)
• LifeSme educaSon cost (2007 value) of hearing loss (moderate and more severe): $115,600 per child
Grosse SD. EducaSon cost savings from early detecSon of hearing loss: New findings. Volta Voices 2007;14(6):38-‐40.
Importance of LSLS
LifeSme Costs of Severe to Profound Hearing Loss
Age of Onset
Component Prelingual (0-‐2) PrevocaSonal (3-‐17)
Lost ProducSvity $433,400 (42%) $444,300 (48%)
Special EducaSon $504,900 (50%) $401,000 (44%)
VocaSonal RehabilitaSon $11,500 (1%) $12,600 (1%)
AssisSve Devices, medical costs and others
$70,200 (7%) $61,100 (7%)
Total $1,020,000 $919,000 95% confidence interval $464,000 -‐ $1,733,000 $401,000 -‐ $1,623,000
Mohr PE, F. J., Dunbar JL, McConkey-‐Robbins A, Niparko JK, Ri?enhouse RK and Skinner M (2000). "The Societal Costs of Severe to Profound Hearing Loss in the United States." InternaPonal Journal of Technology Assessment in Health Care 16(4): 1120-‐1135.
Importance of LSLS
• Education is expensive – better technology, better rehabilitation, …
• Earlier identification means Earlier Intervention
• Will hopefully lead to less lost revenue and more opportunities for children with hearing loss as adults
• And a cost savings in the long run
Methods • Databases reviewed for demographic informaSon for new born screening, prevalence of hearing impairment…: – CDC-‐Early Hearing DetecSon and IntervenSon databases
– NaSonal Health and NutriSon ExaminaSon Surveys
– NaSonal Health Interview Surveys – Gallaudet University Database
DEMOGRAPHICS OF CHILDREN WITH IMPAIRED HEARING UP TO 2012 (2013
WAS STILL BEING PROCESSED)
Methods
• AG Bell academy database was reviewed for the number of LSLS
• The incidence staSsScs were used as surrogates to esSmate: – PopulaSon of preschool children and schoola ge children needing LSLS
– Need for LSLS per state for this populaSon
Results
• 2012 NaSonal Early Hearing and DetecSon Survey PUBLISHED September 2014: – 3.8 million children screened (96.6%) – 6000 screened had HEARING LOSS (1.6/1000) – 87.6% OF HEARING IMPAIRED Children are referred to Part C EI
• Only 83.1% were eligible (STATE DEFINITIONS OF DEVELOPMENTAL DELAY)
557
379
598
437
621
448
640
467
678
501
717
516
0 100 200 300 400 500 600 700 800
WORLDWIDE
USA
2014 2013 2012 2011 2010 2009
LSLS
2014
StaSsScs
• NaSonal – 1 LSLs per 228 children with hearing loss
StaSsScs
US State 2013 PopulaPon
GDP per capita rank
Number of children
Conclusions • Growth of LSLS numbers over the past 5 years: Slow? Steady?Adequate?
• Unequal distribuSon between states – unequal distribuSon within counSes of a state
• Need for more LSLS in all of the 50 states plus DC and territories
• Some states have tremendous needs ADEQUATE REHABILITATION=BETTER OPPORTUNITIES FOR THE CHILDREN=LOWER
ECONOMICAL BURDEN ON SOCIETY
References • Eriks-‐Brophy A (2004). "Outcomes of auditory-‐verbal therapy: A
review of the evidence and a call for acSon." The Volta Review 104(1): 21-‐36.
• Baldassari, C. M., et al. (2009). "RecepSve language outcomes in children aoer cochlear implantaSon." Otolaryngol Head Neck Surg 140(1): 114-‐119.
• Connor, C. M., et al. (2000). "Speech, vocabulary, and the educaSon of children using cochlear implants: oral or total communicaSon?" J Speech Lang Hear Res 43(5): 1185-‐1204.
• Dornan D, H. L., Murdoch B and Houston T (2007). "Outcomes of an Auditory-‐Verbal Program for Children with Hearing Loss: A ComparaSve Study with a Matched Group of Children with Normal Hearing." Volta Review 107: 37-‐54
• Dornan D, H. L., Murdoch B and Houston T (2008). "Speech and language outcomes for children with hearing loss educated in auditory-‐verbal programs: A review of the evidence." CommunicaSve Disorders Review 2: 157-‐172.
References • Dornan D, H. L., Murdoch B and Houston T (2009). "Longitudinal
study of Speech PercepSon and language for children with hearing loss in auditory-‐verbal programs." Volta Review 109: 61-‐86.
• Rhoades EA,(2001). "Language progress with an auditory-‐verbal approach for young children with hearing loss." InternaSonal Pediatrics 16(1): 41-‐47.
• Rhoades EA, (2006). "Research outcomes of auditory-‐verbal intervenSon: is the approach jusSfied? ." Deafness & EducaSon InternaSonal 8(3): 125-‐143.
• Easterbrooks SR, O. R. C., Todd NW (2000). "Child and family factors associated with deaf children’s success in auditory-‐verbal therapy." Am J Otol 21: 341-‐344.
• Estabrooks, W. I. (2000). Auditory-‐Verbal PracSce. Cochlear Implants. N. C. Susan Waltzman. New York, NY, Thieme Medical Publishers: 225-‐256.
References • Feldman, H. M. (2007). "Using the language
characterisScs of clinical populaSons to understand normal language development." Pediatr Clin North Am 54(3): 585-‐607
• Fitzpatrick E, R. E., Dornan D, Thomas E and Goldberg DM (2012). What are some of the evidence-‐based outcomes of auditory-‐verbal pracSce 101 Frequently Asked QuesSons about Auditory-‐Verbal PracSce. W. Estabrooks, Alexander Graham Bell AssociaSon for the Deaf and Hard of Hearing: 419-‐436.
• Ganek, H., et al. (2012). "Language outcomes aoer cochlear implantaSon." Otolaryngol Clin North Am 45(1): 173-‐185.
References • Geers, A. E., et al. (2000). "Effects of communicaSon mode on
skills of long-‐term cochlear implant users." Ann Otol Rhinol Laryngol Suppl 185: 89-‐92.
• Greers AE, M. J., Biedenstein J, et al. (2009). "Spoken language scores of children using cochlear implants compared to hearing age-‐mates at school entry." J Deaf Stud Dead Educ 14(3): 371-‐385.
• Hickson L Thy BS, A. M., Murdoch B, ConstanSnescu G and Path BS (2010). "Is auditory-‐verbal therapy effecSve for children with hearing loss?" The Volta Review 110(3): 361-‐387.
• Horn, R. M., et al. (1991). "Audiological and medical consideraSons for children with cochlear implants." Am Ann Deaf 136(2): 82-‐86.
• Lim S, S. J. (2005). "Auditory-‐Verbal Therapy for children with hearing impairment." Ann Acad Med Singapore 34: 307-‐312.
References • Ling, D., Novelli-‐Olmsted T, Rouleisch S and Simser J The
unique principles of Auditory-‐Verbal PracSce. • Meyer, T. A., et al. (1998). "Improvements in speech
percepSon by children with profound prelingual hearing loss: effects of device, communicaSon mode, and chronological age." J Speech Lang Hear Res 41(4): 846-‐858.
• Mitchell RE, Y. T., Bachleda B, Karchmer MA (2006). "How Many People Use ASL in the United States? Why EsSmates Need UpdaSng." Sign Language Studies 6(3): 306-‐335.
• Miyamoto, R. T., et al. (1994). "Variables affecSng implant performance in children." Laryngoscope 104(9): 1120-‐1124.
• Moog, J. S. and A. E. Geers (2010). "Early educaSonal placement and later language outcomes for children with cochlear implants." Otol Neurotol 31(8): 1315-‐1319.
References • Nicholas, J. G. and A. E. Geers (2006). "Effects of early
auditory experience on the spoken language of deaf children at 3 years of age." Ear Hear 27(3): 286-‐298.
• O'Donoghue, G. M., et al. (2000). "Determinants of speech percepSon in children aoer cochlear implantaSon." Lancet 356(9228): 466-‐468.
• O'Neill, C., et al. (2002). "VariaSons in gains in auditory performance from pediatric cochlear implantaSon." Otol Neurotol 23(1): 44-‐48.
• Osberger, M. J., et al. (2002). "Cochlear implant candidacy and performance trends in children." Ann Otol Rhinol Laryngol Suppl 189: 62-‐65.
References • Mitchell RE, (2006). "How Many Deaf People Are There in the United
States? EsSmates From the Survey of Income and Program ParScipaSon." J. Deaf Stud. Deaf Educ. 11(1): 112-‐119.
• Mohr PE, F. J., Dunbar JL, McConkey-‐Robbins A, Niparko JK, Riwenhouse RK and Skinner M (2000). "The Societal Costs of Severe to Profound Hearing Loss in the United States." InternaSonal Journal of Technology Assessment in Health Care 16(4): 1120-‐1135.
• Semenov, Y. R., et al. (2012). "Cochlear implants: clinical and societal outcomes." Otolaryngol Clin North Am 45(5): 959-‐981.
• Soman, U. G., et al. (2012). "RehabilitaSon and educaSonal consideraSons for children with cochlear implants." Otolaryngol Clin North Am 45(1): 141-‐153.
• Waltzman, S. B., et al. (1994). "Long-‐term results of early cochlear implantaSon in congenitally and prelingually deafened children." Am J Otol 15 Suppl 2: 9-‐13.
References
• Wu, C.-‐J. D., Brown, P.Margaret (2004). "Parents' and Teachers' ExpectaSons of Auditory-‐Verbal Therapy." The Volta Review 104(1): 5-‐20.
• Yanbay, E., et al. (2014). "Language outcomes for children with cochlear implants enrolled in different communicaSon programs." Cochlear Implants Int 15(3): 121-‐135.
