Improving communication outcomes for children with hearing loss in their early years: tracking progress and guiding intervention

A growing number of studies have examined predictive factors to language outcomes for children with hearing loss (Ching, Dillon, Leigh, & Cupples, 2018; Geers & Sedey, 2011; Tomblin, Oleson, Ambrose, Walker, & Moeller, 2014). Findings from these studies have led to best practice position statements and universal shifts in clinical practice, including the introduction of newborn hearing screening, early access to appropriate audiological and educational intervention, and family-centered partnerships with integrated teams of professionals (Joint Committee on Infant Hearing, 2000, 2007, 2013). The level of evidence for effective intervention, therapy and training programs though, still needs to be understood (beyond the comparison of outcomes for children taught using different communication approaches). Data on the use of communication approaches in published studies suggests the majority of child participants (52% to 98%) use a spoken component or oral communication system (Ching, Dillon, et al., 2013b; Gallaudet Research Institute, 2011; Niparko et al., 2010; Percy-Smith et al., 2013; Watson, Archbold, & Nikolopoulos, 2006; Yoshinaga-Itano, Sedey, Wiggin, & Chung, 2017). Despite considerable investment in research, design and development of hearing devices and coding strategies (Scollie et al., 2010; Vandali & van Hoesel, 2011; Wilson & Dorman, 2008), it is difficult to accurately evaluate the effect of device fitting and audibility levels over time in young children. Although there is a wide range of auditory measures available, in practice there are limitations to their use. These include a lack of versatility across age ranges, limited incorporation of real-world skills, minimal detail of how sound is used at a cognitive level, and the lack of ability to visually track progress and provide next steps. How a child with hearing loss detects, uses, and processes linguistic input in their everyday settings, that is, their 'functional listening skills', is critical to understanding how well they are able to develop oral language. As such, the development of an outcome measure, the Functional Listening Index (FLI®) was considered. It was suggested that such a measure could track the acquisition of a child's listening skills over time and provide a trajectory of developing listening competency. This information could be used by parents and caregivers to inform and guide early decisions, enabling and empowering choices regarding their child's intervention. Similarly, such information could be used by professionals to monitor progress and optimise intervention through targeted listening, learning and language experiences in a child's early and critical developmental years. Tracking functional listening acquisition through a tool such as the FLI may have the potential to improve a child's language and communication outcomes through informed, timely decisions, and individually, appropriately targeted intervention -- abstract.