How early management influences what children with hearing loss can achieve: LOCHI and CUHL Teresa Ching, PhD National Acoustic Laboratories, HEARing CRC Phonak Asia visit to NAL December 2015 Background Congenital hearing loss greatly reduces childrens language, psychosocial skills, academic attainment and life chances (Thompson et al, 2001; Moeller et al, 2007; Nelson et al, 2008). UNHS was implemented to improve outcomes of congenital hearing loss, but Efficacy not established US Preventive Services Task Force (2008) Moderate certainty that net benefit of screening all newborn infants for hearing loss is moderate Based on a single quasi-randomised trial T Ching, NAL, Hearing CRC StudynAge at fittingAge at Evaluation Outcomes measuredEffect of age at Intervention Yoshinaga-Itano et al mo (72 < 6 mo) 13 36 moParent report (CDI) Moeller mo (24 < 11 mo) 5 yrsReceptive vocab (PPVT) Wake et al, to 54 mo (11 < 6 mo) 7 8 yrsLanguage Sp. production X Kennedy et al, mo (57 < 9 mo) 5.4 11.7yrs, Mean: 8yrs Receptive language Expressive language Speech (Parent report) XXXX Fitzpatrick et al, mo (15 < 6 mo) 3 5 yrsReceptive vocab (PPVT) Language (PLS-4) Speech prod (GF2) X Sininger et al, to 72 mo (23 < 6 mo) 3 to 8 yrs Speech perception, Speech production, Language Korver et al, NHS:15.7m Dis: 29.2 m 48 mo vs 61 mo Child Dev Inventory, MB Communicative Inventory X What evidence is required to establish efficacy of early intervention? Population-based, Prospective, Direct comparison between early and later identified children, Directly administered assessments, Control for confounding variables. In 2005, L ongitudinal O utcomes of C hildren with H earing I mpairment NSW QLD VIC 2004: >95% 2002: > 98% 2005 ~57% T Ching, NAL, Hearing CRC Aims Does early intervention improve language outcomes, at a population level? What factors influence outcomes? Does early performance predict later outcomes? T Ching, NAL, Hearing CRC Lang/ Dev Outcomes Speech discrimination SES, Maternal education Early education Hypothesized impact of hearing loss on outcomes Device SEIFA Formal edn Language input Add. Disabilities Communi cation mode Hours Int Parental involvement Age enrol SNR SRM Gender PLS CDI DEAP Letter, PA WDRB PEACH PPVT Maths SDQ QoL Age HA pres Age at HA fitting/CI Hearing loss ANSD Cognit ion T Ching, NAL, Hearing CRC Participants (N=461) 55% Boys ~ 37% have additional disabilities ~ 10% have auditory neuropathy ~ 89% enrolled in early education ~ 78% have parents with no hearing impairment ~ 33% have parents who completed university education T Ching, NAL, Hearing CRC Across 3 states, Median: 7m Mean: 11.3m Quartile range: m Median: 4.4m Mean: 8.9m Quartile: 2.3 12.4m Median: 4.4m Mean: 8.9m Quartile: 2.3 12.4m T Ching, NAL, HEARing CRC At multiple intervals T Ching, NAL, HEARing CRC Factors Child Additional disabilities Aetiology Age of fitting Age of implantation Birth-weight Cognitive ability Gender Hearing levels Hearing aid prescription Family Maternal education Communication mode Language at home Socio-economic status Intervention Age of enrolment Type and amount Family involvement Language Expressive language Receptive language Vocabulary Language memory Speech Speech perception Speech production Speech intelligibility Literacy and numeracy Phonological awareness Reading Spelling Numeracy Psycho-emotional dev Functional performance Quality of life Education & employment Attainment Outcomes Age 5 yrs Test scores: 25 th, 50 th, 75 th percentiles T Ching, NAL, Hearing CRC Psychosocial skills Speech perception T Ching, NAL, Hearing CRC To analyse results, we combined 20 test scores into a global development score using factor analysis, Normal-hearing children 84 Distribution of Global language Scores at 5 years of age T Ching, NAL, Hearing CRC Global language scores T Ching, NAL, Hearing CRC Then performed standard multiple regression analysis, To identify characteristics/ variables that influence outcomes of children, Separately for Children using hearing aids Children using cochlear implants T Ching, NAL, Hearing CRC Children with hearing aids Predictor Significance (p)Impact Age first fit (log) FA hearing loss< (-0.33,0.35) Log Age first fit x 4FA (-0.25,0.01) Cognitive ability/WNV< (0.57,0.78) Gender (-1.08, 6.36) Birthweight (-2.86,2.0) Other disability (-9.52,-0.19) Maternal education (uni re s chool)< (3.53,13.16) Socio-economic status (dec) (-1.82,4.69) Communication mode (other re oral) (-1.68,-0.46) ANSD (-5.51, 9.72) HA prescription (04.96, 3.05) Early PLS