NECAP:  National Early Childhood Assessment Project – D/HH

National Early Childhood Assessment Project (NECAP – “kneecap”)

Principal Investigator: Christine Yoshinaga-Itano, Ph.D.

Project Coordinator: Allison Sedey, Ph.D.

NECAP is a project funded by Disability Research and Dissemination Center (DRDC) through its Cooperative Agreement Number 5U01DD001007 from the Centers for Disease Control (CDC) and Prevention

This research was supported by the Disability Research and Dissemination Center (DRDC) through its Cooperative Agreement Number 5U01DD001007, from the Association of University Centers on Disabilities, and from the Centers for Disease Control (CDC) and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the DRDC, AUCD or the CDC.

The aims of this project are to:

1. Support interested states in implementing a standard assessment battery for children from birth to 4 years of age who are deaf or hard of hearing
2. Examine the feasibility of creating a national database of early childhood outcomes
3. Assist states in interpreting assessment results and using these results to drive intervention goals and decisions
4. Characterize the service delivery models of early intervention programs throughout the United States
5. Determine early intervention program characteristics that are related to more successful language outcomes for children who are deaf or hard of hearing
6. Identify system and/or intervention program characteristics that facilitate or prevent the collection and use of population developmental outcome data
7. identify EHDI programs (other than Colorado) that incorporate language and development outcomes into their state database
8. Investigate how the skills, competencies and knowledge of interventionists differ within and across jurisdictional boundaries?
9. Investigate how parent and consumer systems involvement differ within/across states
10. Determine how developmental quotients differ by degree of hearing loss and number of ears affected (i.e., unilateral vs. bilateral)
11. Determine how developmental quotients differ by the various demographic variables
12. Determine which developmental and demographic variables are significantly related to each other? (e.g., degree of hearing loss, Medicaid status, maternal level of education, hours of use of amplification, cognitive status, presence of additional disabilities, age of the child)
13. Determine what child/family or interventionist characteristics are predictive of developmental outcomes
14. Determine whether developmental outcomes differ by state

Eligible Participants

All children from 6 months to 4 years of age with permanent hearing loss are eligible to participate.  Children whose loss is not permanent (e.g., cases where the hearing loss is solely a result of otitis media) are not eligible.  Eligible children may have:

• Unilateral or bilateral loss
• Conductive, senori-neural, or mixed hearing loss
• Any degree of permanent hearing loss from mild to profound
• Multiple disabilities or hearing loss only
• English or Spanish as the language of the home

Benefits of Participation

Individual Child and Family Benefits

• Includes parent input in the assessment process
• Measures children’s skills and abilities across a variety of developmental areas
• Allows parents and interventionists to monitor a child’s progress over time and identify potential delays at their onset
• Compares a child’s language abilities to both children who are hearing and other children with hearing loss
• Provides a data-driven approach to making educational programming decisions
• Assists in the generation of IFSP/IEP goals

Program Benefits

• Provides statewide and program-specific accountability data on an annual basis
• Allows programs to examine outcomes across different subgroups of children
• Informs professional personnel preparation needs
• Includes access to normative test data on children who are deaf or hard or hearing
• Results in networking with program directors and EHDI personnel in other states
• Gives states an opportunity to contribute to a national database which will allow us to characterize the language strengths and weaknesses of children with hearing loss and identify factors that are predictive of more successful language outcomes

If you have questions or are interested in becoming involved in this project, please contact:

Allison Sedey
University of Colorado-Boulder
409 UCB
Boulder, CO  80309
303: 492-0078
Allison.Sedey@Colorado.edu

PUBLICATIONS:

Yoshinaga-Itano, C., Sedey, S., Wiggin, M., & Chung, W. (2017). Early Hearing Detection and Vocabulary of Children With Hearing Loss.  Pediatrics, published on line July 08, 2017.  doi: 10.1542/peds.2016-2964.

http://pediatrics.aappublications.org/content/early/2017/07/06/peds.2016-2964..info

To access all 31 slides, use access arrows on top bar. 

ASSESSMENTS:

Kent Infant Development Scales

• Birth to 15 months of age

252 caregiver item report

The KID Scale elicits caregiver responses on child competencies in five areas: cognitive, motor, language, self-help, and social.

Child Development Inventory:  Minnesota

• 12 months to 6 years
• Expressive language most sensitive from 15 months to 3½ years
• Language Comprehension most sensitive from 12 months to 3½ years
• Parent report
  • Parents respond “yes” or “no” to a variety of statements about their child
  • Example: “Has a vocabulary of 20 or more words”
• 8 areas of development assessed

CU ADAPTATIONS:

• Based on original adaptations made at Gallaudet
• Clarification that sign or spoken language is acceptable
• Some auditory items adapted to include a visual counterpart

Areas assessed

• Social
• Self Help
• Gross Motor
• Fine Motor
• Expressive Language
• Language Comprehension
• Letters
• Numbers
• Situation Comprehension (from 1974 version)
• General Development
• Composite score
• Selected items from all subscales
• Age scores assigned on each subscale
• Plotted on a profile sheet relative to:
  • Chronological Age
  • Borderline delay (20% below CA)
  • Significant delay (30% below CA)

MACARTHUR-BATES COMMUNICATIVE DEVELOPMENT INVENTORIES:

Words and Gestures

8 to 18 months language level

Words and Sentences

16 to 30 months language level

Areas assessed:  (8 to 18 months language level)

Words & Gestures:

• Comprehension of phrases
• Vocabulary comprehension
• Expressive vocabulary (396 words)
• Communicative gestures
• Symbolic gestures/pretend play

Areas assessed (16 to 30 months language level)

Words & Sentences

• Expressive vocabulary (680 words)
• Semantic functions (how child uses words)
• Word endings
• Irregular nouns and verbs
• Sentence length/complexity

DEVELOPMENTAL OUTCOMES:

CHILDREN WITH BILATERAL HEARING LOSS:

SUMMARY OF CHILDREN WITH BILATERAL HEARING LOSS WITH NORMAL COGNITIVE DEVELOPMENT:

2014 Results:

• Acquiring an age-appropriate lexicon is a challenge for many children with 47% demonstrating significant delays
• Typically children scored more poorly on cognitive-linguistic items compared to more concrete/routine language items
• Typically language quotients were higher (by 7 to 15 points) for children who had:
  • No additional disabilities
  • Intervention by 6 months of age
  • Mild or moderate hearing loss
  • Deaf parent(s)
  • Unilateral hearing loss
  • Parents whose written language was English
  • Mothers with degrees beyond a HS diploma

2015 Results:

Acquiring an age-appropriate lexicon is a challenge for many children with bilateral hearing loss with 57% of the group demonstrating significant delays

• Typically language quotients were higher (by 6 to 19 points) for children who:
  • Were less than 2 years of age
  • Had mild or moderate hearing loss
  • Had mothers with B.A. degrees or higher
  • Were identified by 3 months and in intervention by 6 months of age
  • Had deaf parent(s)

Link 1:  NECAP 2014 powerpoint

Link 2:  NECAP 2015 powerpoint

CHILDREN WITH UNILATERAL HEARING LOSS

• Depending on the assessment, 25% to 35% of the participants demonstrated delayed language
  • Previous research reports similar percentages of children with UHL who demonstrate academic difficulties
• Language delays typically not apparent until the child is 2 years of age
  • Language demands increase exponentially just prior to this age
  • Average expressive vocabulary size at:
    • 12 months = 5 words
    • 18 months = 85 words
    • 24 months = 300 words
  • It is very difficult to predict which subgroups of children with UHL are at more risk for language delays
    • Some indication that children of mothers with lower levels of education are at increased risk
  • Children with UHL should be re-evaluated just after turning 2 years old and again at transition to preschool so that data-driven decisions can be made regarding delivery of intervention services

Links to graphs in the folder

Link 1: Unilateral HL:  total group

Link 2:  Unilateral by degree of HL

Link 3:  Unilateral by age

Link 4:  Presentation

CHILDREN FROM SPANISH-SPEAKING HOMES:

• More than half of the children demonstrated significant language delays
• Median language quotients were lower for children from Spanish-speaking compared to English-speaking homes
• Typically children scored more poorly on cognitive-linguistic items compared to both vocabulary and more concrete/routine language items
• Expressive vocabulary quotients were higher (on average by 20-25 points) for children who had:
  • Unilateral hearing loss
  • Intervention by 6 months of age
  • No additional disabilities
  • Mild or moderate hearing loss

LINK 1:  MEAN LQS SPANISHSPEAKING HOMES CDIEL CDIE CC MCDI

LINK 2:  PERCENT LQS NORMAL RANGE SPANISH SPEAKING

LINK 3:  PERCENT LQS NORMAL RANGE SPANISH VERSUS ENGLISH

LINK 4:  SPANISH OUTCOMES POWERPOINT

CHILDREN WITH COCHLEAR IMPLANTS

• Children with cochlear implants identified by 3 months of age have significantly higher language quotients on the Child Development Inventory Expressive Language(CDIEL), Child Development Inventory Comprehension Conceptual(CDICC) and the MacArthur-Bates Communicative Development Inventories:  Words Produced (MBCDI).
• Children with cochlear implants enrolled in intervention by 6 months of age have significantly higher language quotients than those identified after 6 months of age on the CDIEL, CDICC and M-BCDI.
• Children with cochlear implants activated by 18 months had significantly higher language quotients than those activated after 18 months on the CDIEL, CDICC and MBCDI.
• Children with cochlear implants had significantly lower language quotients than children with mild-moderate hearing loss and hearing aids and children with moderate-severe to profound hearing loss with hearing aids.

Identified by 3 months

Enrolled in intervention by 6 months

Cochlear implant activation by 18 months

Cochlear implant language quotients compared to children with hearing aids

STATE COMPARISONS:

Participating States:

Arizona

California

Colorado

Florida

Idaho

Indiana

Maine

Minnesota

North Dakota

South Dakota

Texas

Utah

Wisconsin

Wyoming

States differ from one another in the developmental outcomes of their children on the MacArthur Bates Communicative Development Inventories and the Child Develoment Inventory:  Expressive Language and Comprehension-Conceptual.

Link 1:  MacArthur Bates

Link 2:  Child Development Inventory