Elsevier

Journal of Communication Disorders

Volume 37, Issue 5, September–October 2004, Pages 451-465
Journal of Communication Disorders

Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI)

https://doi.org/10.1016/j.jcomdis.2004.04.008Get rights and content

Abstract

Levels of evidence differ according to the audience addressed. Implementation of universal newborn hearing screening requires responses to a complex myriad of diverse groups: the general public, families with children who are deaf or hard of hearing, the deaf and hard of hearing communities, hospital administrators, physicians (pediatricians, general practitioners, ear nose and throat physicians, geneticists), managed care, Medicaid, insurance agencies, and politicians. The level of evidence required by medical/health agencies and task forces may differ from the levels of evidence available in education and intervention. Issues related to the low incidence of the disability, the lack of a normal distribution within the disability study, the obstacles to random assignment to treatment, and designs that include a control group with “no treatment” have implications legally and ethically for the professional providing services to families and children who are deaf or hard of hearing. This session will discuss issues related to “convenience samples,” number of subjects included in research studies, and the population required to obtain a large enough sample of children with low-incidence disabilities. The level of evidence required to demonstrate sensitive periods of development, which are a critical element for justification of implementing a universal newborn hearing screening includes both behavioral and neurological information. Sensitive periods may have different duration for different aspects of development, such as social-emotional development, auditory and speech development, or language development. Further complicating the question of sensitive periods of development are the distinct possibility that different sensitive periods exist for development of age-level vocabulary, for establishing English phonology, or for mastering English syntax. Research outcomes provide evidence that age of identification of hearing loss is reduced, that age of intervention initiation is lowered, and that the outcomes of intervention are better because of the establishment of a screening program. Most professionals in communication disorders believe that screening is not the actual cause of better developmental outcomes but that the age when children begin to have access to language and communication and the characteristics of the intervention are the primary cause of better outcomes. Screening is the avenue through which access to quality intervention is made available. The research still remains at an infant level of development such that there is very little evidence for the efficacy of specific characteristics of the intervention provided.

Learning outcomes

(1) The learner will be able to identify the obstacles in conducting research on the effectiveness of intervention of children identified through universal newborn hearing screening programs. (2) The learner will be able to identify the type of research on developmental outcomes of children with early-identified hearing loss.

Section snippets

Does universal newborn hearing screening (UNHS) result in earlier identification of the hearing loss?

The USPSTF (2001) stated that, “Studies of statewide universal newborn hearing screening programs in the United States have found that the mean age of identification of hearing impairment has decreased from 12 to 13 months before screening programs were introduced to 3–6 months since their introduction.”

Prior to UNHS, the average age of diagnosis of hearing loss in Rhode Island was 20 months, not 12–13 months (Vohr, Carty, Moore, & Letourneau, 1998). No public or private program has ever

Summary

The Colorado studies investigated the relationship of universal newborn hearing screening through logistical regression statistical techniques on a population of 294 children with significant hearing loss. All children meeting the selection criteria were included in the study. The study included children with hearing loss only and excluded those with multiple disabilities. In addition, the Colorado studies investigated the question of early-identification and early intervention for children

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