BACKGROUND AND OBJECTIVES To date, no studies have examined vocabulary outcomes of children meeting all 3 components of the Early Hearing Detection and Intervention (EHDI) guidelines (hearing screening by 1 month, diagnosis of hearing loss by 3 months, and intervention by 6 months of age). The primary purpose of the current study was to examine the impact of the current EHDI 1-3-6 policy on vocabulary outcomes across a wide geographic area. A secondary goal was to confirm the impact of other demographic variables previously reported to be related to language outcomes. METHODS This was a cross-sectional study of 448 children with bilateral hearing loss between 8 and 39 months of age (mean = 25.3 months, SD = 7.5 months). The children lived in 12 different states and were participating in the National Early Childhood Assessment Project. RESULTS The combination of 6 factors in a regression analysis accounted for 41% of the variance in vocabulary outcomes. Vocabulary quotients were significantly higher for children who met the EHDI guidelines, were younger, had no additional disabilities, had mild to moderate hearing loss, had parents who were deaf or hard of hearing, and had mothers with higher levels of education. CONCLUSIONS Vocabulary learning may be enhanced with system improvements that increase the number of children meeting the current early identification and intervention guidelines. In addition, intervention efforts need to focus on preventing widening delays with chronological age, assisting mothers with lower levels of education, and incorporating adults who are deaf/hard-of-hearing in the intervention process.

Hypothesis: Early identification and intervention, earlier cochlear implantation, and mother's level of education will directly and/or indirectly impact the language outcomes of children with cochlear implants (CIs). Background: Identifying factors that contribute to the wide range of language outcomes in children who use CIs will assist healthcare and rehabilitation professionals in optimizing service delivery for this population. Universal newborn hearing screening provides an opportunity to examine the relationship between meeting the early hearing detection and intervention (EHDI) 1-3-6 guidelines and child language outcomes. These guidelines recommend screening by 1 month, confirmation of hearing loss by 3 months, and intervention by 6 months of age. Methods: Participants were 125 children with CIs ranging from 13 to 39 months of age. Language ability was measured using the Child Development Inventory and MacArthur-Bates Communicative Development Inventories. Results: Meeting EHDI 1-3-6, higher levels of maternal education and earlier cochlear implant activation had a direct, positive impact on language outcomes. Meeting the EHDI 1-3-6 guidelines also had an indirect positive effect on language outcomes via increasing the probability that the children's CIs would be activated earlier. Maternal education did not significantly predict age of cochlear implant activation nor whether a child met EHDI 1-3-6. Conclusion: Ensuring families meet the EHDI 1-3-6 guidelines is an early step that can lead to higher language outcomes and also earlier cochlear implantation.

BACKGROUND AND OBJECTIVES: Pragmatic language skills form the foundation for conversational competence, whereas deficits in this area are associated with behavioral problems and low literacy skills. Children who are deaf or hard of hearing demonstrate significant delays in this critical area of language. Our purpose with this research was to identify variables associated with pragmatic language ability in children who are deaf or hard of hearing. METHODS: This was a longitudinal study of 124 children with bilateral hearing loss between 4 and 7 years of age living in Colorado. As part of a comprehensive speech and language assessment, pragmatic language skills were evaluated annually by using the Pragmatics Checklist. RESULTS: The children's pragmatic skills increased significantly with age. Higher levels of pragmatic language ability at 7 years of age were predicted by (1) meeting Early Hearing Detection and Intervention 1-3-6 guidelines (hearing screening by 1 month, identification of hearing loss by 3 months, and receiving intervention by 6 months of age), (2) greater quantity of parent talk, (3) higher nonverbal intelligence, (4) lesser degrees of hearing loss, and (5) higher maternal education. CONCLUSIONS: With the findings of this study, we underscore the importance of pediatricians and other health care professionals counseling parents about the value of adherence to the Early Hearing Detection and Intervention 1-3-6 guidelines with regard to intervention outcomes. The strong association between amount of child-directed parent talk in the first 4 years of life and pragmatic language outcomes at 7 years of age emphasizes the need for professionals to encourage parents to talk to their children as much as possible.

Background: A primary goal of early intervention is to assist children in achieving age-appropriate language skills. The amount of intervention a child receives is ideally based on his or her individual needs, yet it is unclear if language ability impacts amount of intervention and/or if an increased frequency of intervention sessions results in better outcomes. The purpose of this study was to determine the relationship between the frequency of early intervention sessions and vocabulary outcomes in young children with hearing loss. Methods: This was a longitudinal study of 210 children 9 to 36 months of age with bilateral hearing loss living in 12 different states. Expressive vocabulary skills were evaluated using the MacArthur–Bates Communicative Development Inventories. Results: A higher number of intervention sessions reported at the first assessment predicted better vocabulary scores at the second assessment, and more sessions reported at the second assessment predicted better scores at the third assessment. For each increase in the number of sessions reported, there was a corresponding, positive increase in vocabulary quotient. In contrast, children’s vocabulary ability at an earlier time point did not predict intervention session frequency at a later point in time. Conclusions: A significant prospective effect was apparent with more therapy sessions resulting in improved vocabulary scores 9 months later. These findings underscore the importance of early intervention. Pediatricians and other health care professionals can help apply these findings by counseling parents regarding the value of frequent and consistent participation in early intervention.