title: Outcomes of early- and late-identified children at 3 years of age: findings from a prospective population-based study.
abstract: OBJECTIVE
  To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment.
  
  
  METHODS
  All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children's speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes.
  
  
  RESULTS
  Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children's performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age.
  
  
  CONCLUSIONS
  Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.
authors: National Acoustic Laboratories, Sydney, Australia. teresa.ching@nal.gov.au
authors: Teresa Y C
authors: TY
authors: Ching
authors: Harvey
authors: H
authors: Dillon
authors: Vivienne
authors: V
authors: Marnane
authors: Sanna
authors: S
authors: Hou
authors: Julia
authors: J
authors: Day
authors: Mark
authors: M
authors: Seeto
authors: Kathryn
authors: K
authors: Crowe
authors: Laura
authors: L
authors: Street
authors: Jessica
authors: J
authors: Thomson
authors: Patricia
authors: P
authors: Van Buynder
authors: Vicky
authors: V
authors: Zhang
authors: Angela
authors: A
authors: Wong
authors: Lauren
authors: L
authors: Burns
authors: Christopher
authors: C
authors: Flynn
authors: Linda
authors: L
authors: Cupples
authors: Robert S C
authors: RS
authors: Cowan
authors: Greg
authors: G
authors: Leigh
authors: Jessica
authors: J
authors: Sjahalam-King
authors: Angel
authors: A
authors: Yeh
mesh_terms: D001315:Australia; D002663:Child Language; D002675:Child, Preschool; D019929:Cochlear Implantation; D016208:Databases, Factual; D060345:Education of Persons with Hearing Disabilities; D005260:Female; D005500:Follow-Up Studies; D006310:Hearing Aids; D034381:Hearing Loss / Q000175:diagnosis* / Q000534:rehabilitation*; D006313:Hearing Loss, Central / Q000175:diagnosis* / Q000534:rehabilitation*; D006801:Humans; D007804:Language Development; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D013067:Speech Perception; D011795:Surveys and Questionnaires