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Efficacy of an Early Intervention Addressing the Needs of Children with Hearing Loss

Sophie Ambrose, PhD

Approximately 2 babies of every 1,000 born have a hearing loss, and as a result are at risk for significant delays in language development, which can lead to negative academic, social, and employment outcomes. Access to spoken language can be improved when children consistently use appropriately fit hearing devices, including hearing aids and cochlear implants, and when they are provided with linguistic input that meets their unique needs. Unfortunately, many families struggle to establish consistent hearing device use and to modify their interactions in ways that support their children's language development. This project sought to better understand the barriers families face in establishing consistent hearing device use and providing their children with optimal language environments, and to develop interventions addressing these barriers.

Over 50% of families indicated they had experienced the one or more of the following barriers at least sometime in the past month: the devices falling off their child's head/ear; being busy with other things happening in the home; the child taking the devices off; the child being sick; fear of losing the devices; and the child not wanting the devices to be put on. We also found that approximately 15% of parents did not feel confident that their child's hearing devices were critical in helping their child learn to communicate. These children were at especially high risk for being poor device users.

The resulting intervention we developed was named Ears On. The intervention initially focuses on ensuring caregivers: 1) understand their child's hearing loss, 2) understand the potential impact of their child's hearing loss on development if hearing devices are not used consistently, 3) recognize that device use is the primary means of preventing delays associated with hearing loss, and 4) feel empowered to improve device use. The rest of the intervention content focuses on providing families with strategies to address the device use barriers they are personally experiencing. The effectiveness of the intervention was tested in a study that included three families. All three families initially demonstrated poor device use, despite enrollment in traditional early intervention services. Participating in the intervention resulted in increased device use for all three families, indicating that Ears On may have promise for eventually being used in early intervention settings. 

Regarding children's language environments, our work indicated most early intervention providers did not have training or experience with Enhanced Milieu Teaching (EMT), an evidence-based intervention used to help young children learn language. We worked with Dr. Ann Kaiser, a renowned scientist whose career has focused on developing and testing EMT, to adapt it to meet the unique needs of young children with hearing loss. The resulting intervention is called COACH (Caregiver's Optimizing Achievement of Children with Hearing Loss). In COACH, parents are taught to respond to their children's gestures, signs, and words in ways that will help their children learn language. They are also taught strategies for increasing how much their children communicate. We are currently testing the effectiveness of COACH and early results indicate parents can learn the skills taught in the intervention.