Early Intervention Early Intervention OutcomesOutcomes

Recent Recent Findings and Findings and

Future Future ChallengesChallenges

Mary Pat MoellerMary Pat Moeller

Boys Town National Boys Town National Research HospitalResearch Hospital

Focus of Recent WorkFocus of Recent Work

““Earlier is better” (sensitive Earlier is better” (sensitive periods?)periods?)

What works & how? (EI What works & how? (EI approaches)approaches)

Understanding effects of Understanding effects of audibility & individual differencesaudibility & individual differences

Probability of language Probability of language development at “typical” development at “typical” levelslevels Yoshinaga-Itano, Coulter & Thomson, 2001Yoshinaga-Itano, Coulter & Thomson, 2001 N=294; CA = 12 to 60 months N=294; CA = 12 to 60 months No additional disabilitiesNo additional disabilities

82.4% probability of language development 82.4% probability of language development within normal range if child with a hearing within normal range if child with a hearing loss was born in a Colorado hospital that loss was born in a Colorado hospital that screened for hearingscreened for hearing

31.6% probability if born in a hospital that 31.6% probability if born in a hospital that did not screen for hearing prior to hospital did not screen for hearing prior to hospital discharge.discharge.

Receptive Language Over Receptive Language Over Time by Age of InterventionTime by Age of Intervention

102030405060708090

100110

Standard

Score

<11 m 12-23 m 24-35 m 36+ m

Age at Intervention

3 years4 years5 years

How lasting are the effects How lasting are the effects of early intervention?of early intervention?

Age of identification of hearing loss as Age of identification of hearing loss as a significant predictor of language a significant predictor of language developmentdevelopment

– 12 - 60 months of age (Yoshinaga-12 - 60 months of age (Yoshinaga-Itano, Coulter & Thomson, 2000, Itano, Coulter & Thomson, 2000, 2001) N=2942001) N=294

– 12 - 72 months of age (Pipp-Siegel, 12 - 72 months of age (Pipp-Siegel, Sedey, Mayne & Yoshinaga-Itano, Sedey, Mayne & Yoshinaga-Itano, 2003) N=2002003) N=200

What works….and What works….and how?how?

Family Family Communication:Communication: Maternal communication skills Maternal communication skills

strongest predictor of language, early strongest predictor of language, early reading and social-emotional skills (N = reading and social-emotional skills (N = 28, ages 4 – 7 years; Calderon, 2000)28, ages 4 – 7 years; Calderon, 2000)

In TC programs, strong maternal In TC programs, strong maternal signing associated with better child signing associated with better child language and earlier understanding of language and earlier understanding of thoughts of others (N = 26, ages 4 – 9 thoughts of others (N = 26, ages 4 – 9 years; Moeller, 2002)years; Moeller, 2002)

Verbal Reasoning at Age Verbal Reasoning at Age 55

Age EnrollAge Enroll Family Family InvolvementInvolvement

High Verbal High Verbal ReasoningReasoning

<13 months<13 months 4.44.4

Average Average ReasoningReasoning

21 months21 months 3.63.6

Low Low ReasoningReasoning

27 months27 months 2.62.6

N = 80

Is EI Relationship-Focused Is EI Relationship-Focused or Child-Focused?or Child-Focused?

McBride & Peterson (1997) observed a McBride & Peterson (1997) observed a child-focused dominance in 160 sessionschild-focused dominance in 160 sessions

Too little focus on parent-child Too little focus on parent-child relationshiprelationship

Mahoney, et al., (1998) – Interventions Mahoney, et al., (1998) – Interventions impact child development to the extent impact child development to the extent that parents are supported and that parents are supported and encouraged to engage in responsive encouraged to engage in responsive interactions with the childinteractions with the child

Intervention EffectsIntervention Effects

Early educational experience (oral Early educational experience (oral school vs. general special ed school vs. general special ed preschool) promoted development preschool) promoted development of effective perceptual processing of effective perceptual processing strategies (native like)strategies (native like)

Facilitated word storage and Facilitated word storage and understanding of complex grammarunderstanding of complex grammar

Nittrouer & Burton, 2003 N = 17, ages 8-10 years

Effects of AudibilityEffects of Audibility

Early Vocal Early Vocal DevelopmentDevelopment Audibility related to onset, quality Audibility related to onset, quality

and complexity of early babble and complexity of early babble (Bass-Ringdahl, 2002)(Bass-Ringdahl, 2002)

Cochlear implants influence rate Cochlear implants influence rate of learning (phonological, lexical) of learning (phonological, lexical) (Tomblin, 2002; Yoshinaga-Itano, (Tomblin, 2002; Yoshinaga-Itano, 2003)2003)

Prospective Prospective Longitudinal Study of Longitudinal Study of InfantsInfants Explore the role of auditory Explore the role of auditory

experience in speech and experience in speech and language learninglanguage learning

4 months to 5 years of age4 months to 5 years of age

20 NH and 16 Infants D/HH20 NH and 16 Infants D/HH

BTNRH, funded by NIDCD

Future ChallengesFuture Challenges

To support implementation of effective To support implementation of effective interventions….need for more research interventions….need for more research on what works and how….on what works and how….

Changing technologies dictate need for Changing technologies dictate need for further understanding of effects of further understanding of effects of audibility; need for controlled, audibility; need for controlled, prospective study prospective study

Greater understanding of individual Greater understanding of individual differences will support families in differences will support families in decision making decision making