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Vocabulary Outcomes for 5-Year-Old Children Who Are Deaf or Hard of Hearing: Impact of Age at Enrollment in Specialized Early Intervention

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Title: Vocabulary Outcomes for 5-Year-Old Children Who Are Deaf or Hard of Hearing: Impact of Age at Enrollment in Specialized Early Intervention
Language: English
Authors: Rudge, Amanda M. (ORCID 0000-0002-4998-5459), Coto, Jennifer, Oster, Monika-Maria, Brooks, Betsy Moog, Soman, Uma, Rufsvold, Ronda, Cejas, Ivette
Source: Journal of Deaf Studies and Deaf Education. Jul 2022 27(3):262-268.
Availability: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://jdsde.oxfordjournals.org/
Peer Reviewed: Y
Page Count: 7
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Vocabulary Development, Children, Deafness, Hearing Impairments, School Entrance Age, Early Intervention, Special Education
DOI: 10.1093/deafed/enac009
ISSN: 1081-4159
1465-7325
Abstract: The aims of this study were to examine vocabulary scores of 5-year-old children who are deaf or hard of hearing (DHH), as well as the impact of early enrollment in specialized intervention on vocabulary outcomes. Receptive and expressive vocabulary scores were analyzed for 342 five-year-old children who are DHH enrolled in specialized listening and spoken language intervention programs. Regression analyses were utilized to examine the effects of age at enrollment on vocabulary outcomes. Overall, participants achieved scores within normal test limits on receptive and expressive measures of vocabulary. Children who enrolled in intervention prior to 28 months of age had better vocabulary skills at 5 years old. The findings support that children who are DHH can understand and produce vocabulary at skill levels commensurate with their typically hearing peers, regardless of severity of hearing loss. Results highlight the crucial impact of specialized programs on children's lexical readiness to participate in general education settings by kindergarten.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1345544
Database: ERIC
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  Value: <anid>AN0158667166;big01jul.22;2022Aug25.01:22;v2.2.500</anid> <title id="AN0158667166-1">Vocabulary Outcomes for 5-Year-Old Children Who Are Deaf or Hard of Hearing: Impact of Age at Enrollment in Specialized Early Intervention </title> <p>The aims of this study were to examine vocabulary scores of 5-year-old children who are deaf or hard of hearing (DHH), as well as the impact of early enrollment in specialized intervention on vocabulary outcomes. Receptive and expressive vocabulary scores were analyzed for 342 five-year-old children who are DHH enrolled in specialized listening and spoken language intervention programs. Regression analyses were utilized to examine the effects of age at enrollment on vocabulary outcomes. Overall, participants achieved scores within normal test limits on receptive and expressive measures of vocabulary. Children who enrolled in intervention prior to 28 months of age had better vocabulary skills at 5 years old. The findings support that children who are DHH can understand and produce vocabulary at skill levels commensurate with their typically hearing peers, regardless of severity of hearing loss. Results highlight the crucial impact of specialized programs on children's lexical readiness to participate in general education settings by kindergarten.</p> <p>Abstract</p> <p>Vocabulary skills are essential for the development of higher-level complex language, including the ability to turn single words into two- or three-word combinations and to turn words into simple and complex phrases, sentences, and conversation ([<reflink idref="bib36" id="ref1">36</reflink>]; [<reflink idref="bib38" id="ref2">38</reflink>]). Early vocabulary knowledge contributes to linguistic and communicative competence, supplying the foundation for the development of spoken and written language, cognitive processing, and listening and reading comprehension. Importantly, several studies have reported that lexicon size predicts later linguistic, reading, and academic outcomes ([<reflink idref="bib11" id="ref3">11</reflink>]; [<reflink idref="bib30" id="ref4">30</reflink>]; [<reflink idref="bib34" id="ref5">34</reflink>]; [<reflink idref="bib41" id="ref6">41</reflink>]; [<reflink idref="bib46" id="ref7">46</reflink>]). Thus, children who are deaf or hard of hearing (DHH) are at a disadvantage due to the effects of auditory deprivation on vocabulary and spoken language development. However, limited research has examined the effects of enrollment in listening and spoken language (LSL) education programs on remediating vocabulary outcomes in children who are DHH ([<reflink idref="bib20" id="ref8">20</reflink>]; [<reflink idref="bib42" id="ref9">42</reflink>]; [<reflink idref="bib50" id="ref10">50</reflink>]). The current study assessed vocabulary outcomes of 5-year-old children who are DHH, as well as the impact of early enrollment in specialized intervention on their vocabulary skills.</p> <p>Despite advances in hearing technology, children who are DHH have historically demonstrated poorer vocabulary skills compared to age-matched hearing peers ([<reflink idref="bib7" id="ref11">7</reflink>]; [<reflink idref="bib28" id="ref12">28</reflink>]; [<reflink idref="bib29" id="ref13">29</reflink>]; [<reflink idref="bib45" id="ref14">45</reflink>]). Specifically, children who are DHH have smaller vocabularies and widening achievement gaps in comparison with typically hearing peers ([<reflink idref="bib9" id="ref15">9</reflink>]; [<reflink idref="bib16" id="ref16">16</reflink>]; [<reflink idref="bib19" id="ref17">19</reflink>]; [<reflink idref="bib35" id="ref18">35</reflink>]; [<reflink idref="bib50" id="ref19">50</reflink>]). This disparity is likely consequential to lost listening time and degraded auditory input during formative months of auditory system development ([<reflink idref="bib14" id="ref20">14</reflink>]; [<reflink idref="bib18" id="ref21">18</reflink>]; [<reflink idref="bib33" id="ref22">33</reflink>]). Delayed access to quality auditory input and intervention negatively affects speech perception skills and vocabulary development (e.g. [<reflink idref="bib42" id="ref23">42</reflink>]). Other factors such as degree of hearing loss, age at identification and amplification (e.g. [<reflink idref="bib2" id="ref24">2</reflink>]; [<reflink idref="bib3" id="ref25">3</reflink>]; [<reflink idref="bib4" id="ref26">4</reflink>]; [<reflink idref="bib31" id="ref27">31</reflink>]; [<reflink idref="bib49" id="ref28">49</reflink>]), and age or duration of enrollment in educational intervention services (e.g. [<reflink idref="bib9" id="ref29">9</reflink>]; [<reflink idref="bib17" id="ref30">17</reflink>]; [<reflink idref="bib32" id="ref31">32</reflink>]; [<reflink idref="bib43" id="ref32">43</reflink>], [<reflink idref="bib44" id="ref33">44</reflink>]; [<reflink idref="bib50" id="ref34">50</reflink>]) have also been shown to affect vocabulary skills.</p> <p>More recent work has suggested that children who are DHH achieve greater gains in vocabulary outcomes that may help to close the gap between their performance and that of their age-mates when they (a) meet the Early Hearing Detection and Intervention (EHDI) 1-3-6 guidelines: hearing screening by 1 month, identification by 3 months, and intervention by 6 months, ([<reflink idref="bib27" id="ref35">27</reflink>]; [<reflink idref="bib50" id="ref36">50</reflink>]); (b) receive longer durations of intervention ([<reflink idref="bib17" id="ref37">17</reflink>]); and (c) enroll earlier in intervention programs ([<reflink idref="bib9" id="ref38">9</reflink>]). A 2017 study by [<reflink idref="bib50" id="ref39">50</reflink>]) revealed that children who met the EHDI 1-3-6 guidelines demonstrated higher vocabulary sizes at each testing time point on the MacArthur-Bates Communicative Development Inventory lists compared to those who did not meet the guidelines. The difference in vocabulary sizes between the group that did meet the guidelines and the group that did not was statistically significant, even when controlling for a number of other factors previously reported to affect language development, such as age, degree of hearing loss, maternal education level, additional diagnosis, and the presence of a DHH adult in the home. Subsequent research identified the influence of early intervention frequency (based on duration of services and number of hours received) on later language outcomes ([<reflink idref="bib17" id="ref40">17</reflink>]). [<reflink idref="bib17" id="ref41">17</reflink>]) found that children with higher quantities of early intervention hours were shown to benefit linguistically, as demonstrated by achieving more gain in vocabulary outcomes on the Peabody Picture Vocabulary Test (PPVT) and Expressive Vocabulary Test (EVT) during preschool and elementary years. Recently, [<reflink idref="bib9" id="ref42">9</reflink>] investigated the effects of age at intervention enrollment on language outcomes, including vocabulary scores, finding a significant inverse effect of ages at intervention on vocabulary outcomes. Children who enrolled in intervention at earlier ages were more likely to achieve higher expressive vocabulary scores than those who enrolled later.</p> <p>EHDI 1-3-6 guidelines, along with the Individuals with Disabilities Education Act ([<reflink idref="bib25" id="ref43">25</reflink>]), have had tremendous implications for children who are DHH. A seminal article by [<reflink idref="bib1" id="ref44">1</reflink>]) described educational settings for children who are DHH across the United States, revealing that 44% of students who are DHH spent more than 16 hr a week in classrooms with typically hearing peers. In the last 10 years, the field of deaf education has continued to trend toward increased inclusion of children who are DHH in general education settings. U.S. Department of Education data from the [<reflink idref="bib24" id="ref45">24</reflink>] IDEA Section 618 state-level files reveal an increase of students in general education settings, with 88% of students who are DHH attending public schools and 64% participating in general education classrooms all or the majority of the school day. This trend is also observed beyond the United States, as the Consortium for Research into Deaf Education reports that in 2021, 66% of deaf children in England, 80% of deaf children in Northern Ireland, and 74% in Wales were educated in a mainstream school ([<reflink idref="bib6" id="ref46">6</reflink>]).</p> <p>Specialized education programs are crucial to preparing children who are DHH for mainstream education. A common goal for these early intervention programs is to achieve progress and outcomes that allow integration with their hearing peers, both academically and socially. To achieve this goal, having vocabulary skills that are commensurate with typically hearing peers is essential. The current study aimed to examine vocabulary outcomes of 5-year-old children who are DHH, as well as the impact of early enrollment in specialized LSL education programs on vocabulary skills. Specifically, this study assessed receptive and expressive vocabulary scores of 5-year-old children. Potential predicting factors of receptive and expressive lexical achievement were considered, including degree of hearing loss, age at amplification, hearing technology utilized, and age at enrollment in a specialized LSL education program.</p> <hd id="AN0158667166-2">Method</hd> <p>Participants</p> <p>The sample consisted of 342 children who are DHH enrolled in a specialized LSL education program. Children had a mean age of 65.17 months (SD = 3.48) and 46.8% were female. Most parents identified their children as White (57.4%) and English was the primary language spoken in the home (89.2%). Type of hearing loss was primarily sensorineural (83.5%) and degree of hearing loss was mostly profound (45%). The majority of children wore hearing aids (53.7%), followed by cochlear implants (39.8%) and bone conduction devices (5%). See Table 1 for further descriptive information.</p> <p>Table 1 Sample demographic characteristics</p> <p> <ephtml> <table><thead><tr><th>Characteristic. </th><th>Mean (SD). </th><th><italic>N</italic> (%). </th></tr></thead><tbody><tr><td>Child age (months) </td><td>65.17 (3.48) </td><td>– </td></tr><tr><td>Child gender (% female) </td><td>– </td><td>160 (46.8%) </td></tr><tr><td colspan="3">Child race/ethnicity </td></tr><tr><td> Caucasian </td><td>– </td><td>194 (57.4%) </td></tr><tr><td> Black/African American </td><td>– </td><td>33 (9.8%) </td></tr><tr><td> Hispanic </td><td>– </td><td>41 (12.1%) </td></tr><tr><td> Middle Eastern </td><td>– </td><td>8 (2.4%) </td></tr><tr><td> Native Hawaiian </td><td>– </td><td>2 (.6%) </td></tr><tr><td> Asian </td><td>– </td><td>28 (8.3%) </td></tr><tr><td> American Indian </td><td>– </td><td>4 (1.2%) </td></tr><tr><td> Multiracial </td><td>– </td><td>28 (8.3%) </td></tr><tr><td>Maternal education </td><td>– </td><td /></tr><tr><td> Eighth grade or less </td><td>– </td><td>3 (1.0%) </td></tr><tr><td> Some high school </td><td>– </td><td>4 (1.4%) </td></tr><tr><td> High school diploma </td><td /><td>60 (20.8%) </td></tr><tr><td> Some college </td><td /><td>63 (21.9%) </td></tr><tr><td> Bachelor's degree </td><td>– </td><td>97 (33.7%) </td></tr><tr><td> Post-graduate degree </td><td>– </td><td>61 (21.2%) </td></tr><tr><td colspan="3">Primary language spoken in the home </td></tr><tr><td> English </td><td>– </td><td>305 (89.2%) </td></tr><tr><td> Spanish </td><td>– </td><td>14 (4.1%) </td></tr><tr><td> ASL </td><td>– </td><td>3 (.9%) </td></tr><tr><td> Other </td><td>– </td><td>20 (5.8%) </td></tr><tr><td>Age when hearing loss diagnosed (months) </td><td>13.45 (17.27) </td><td /></tr><tr><td colspan="3">Hearing device type </td></tr><tr><td> Cochlear implant </td><td>– </td><td>135 (39.8%) </td></tr><tr><td> Hearing aid </td><td>– </td><td>182 (53.7%) </td></tr><tr><td> Bone anchored device </td><td>– </td><td>17 (5.0%) </td></tr><tr><td> None </td><td>– </td><td>5 (1.5%) </td></tr><tr><td colspan="3">Hearing loss </td></tr><tr><td> Unilateral </td><td>– </td><td>21 (6.1%) </td></tr><tr><td> Bilateral </td><td>– </td><td>321 (93.9%) </td></tr><tr><td colspan="3">Degree of hearing loss (worse ear) </td></tr><tr><td> Slight 15–25 </td><td>– </td><td>7 (2.0%) </td></tr><tr><td> Mild 26–40 </td><td>– </td><td>19 (5.6%) </td></tr><tr><td> Moderate 41–55 </td><td>– </td><td>59 (17.3%) </td></tr><tr><td> Moderately severe 56–70 </td><td>– </td><td>61 (17.8%) </td></tr><tr><td> Severe 71–90 </td><td>– </td><td>42 (12.3%) </td></tr><tr><td> Profound 90+ </td><td>– </td><td>154 (45.0%) </td></tr><tr><td colspan="3">Type of hearing loss </td></tr><tr><td> Sensorineural </td><td>– </td><td>284 (83.5%) </td></tr><tr><td> Neural </td><td>– </td><td>13 (3.8%) </td></tr><tr><td> Conductive </td><td>– </td><td>16 (4.7%) </td></tr><tr><td> Mixed </td><td>– </td><td>16 (4.7%) </td></tr><tr><td> Normal </td><td>– </td><td>11 (3.2%) </td></tr></tbody></table> </ephtml> </p> <p>Procedures</p> <p>Data were extracted from the OPTION programs' Listening and Spoken Language Data Repository (LSL-DR). OPTION programs are a consortium of highly specialized private schools, centers, and clinics dedicated to educating children who are DHH using a LSL approach. The majority of OPTION programs serve children from birth through age 5, while several programs serve children through age 8 or older. The LSL-DR is maintained by OPTION programs and is a robust source of speech, language, and educational outcome data on children who are DHH and have attended an OPTION program. For this study, inclusion criteria consisted of children from all OPTION programs between the ages of 5;0 to 5;11 years who had receptive vocabulary scores from the PPVT or expressive vocabulary scores from the EVT. Children with a diagnosis of developmental delay or autism were excluded from the analyses (<emph>n</emph> = 6). Approval for this study was granted by the University of XXX Institutional Review Board (IRB# 20200959).</p> <p>Upon yearly registration in an OPTION program, families receive notification and are given the opportunity to opt-out of their child's participation in the LSL-DR. OPTION member programs enter demographic, audiological, and assessment data related to speech, vocabulary, and language skills for all enrolled students. Data for the current study were extracted from children's assessments conducted between the 2015 and 2020 academic years.</p> <p>Measures</p> <p>Audiological/program information</p> <p>Various audiological and program information were extracted from the LSL-DR. Specifically, age at enrollment in an OPTION program, age at amplification, hearing device type, as well as type and degree of hearing loss.</p> <p>Peabody Picture Vocabulary Test (PPVT)</p> <p>The PPVT ([<reflink idref="bib13" id="ref47">13</reflink>]<emph>;</emph>[<reflink idref="bib12" id="ref48">12</reflink>]) is a norm-referenced assessment that is used to measure a child's receptive vocabulary—words that a child understands. Children are shown four pictures, the examiner presents a word, and the child is asked to point to the picture that best represents this word. This test has been normed on individuals between the ages of 2 years, 6 months, and 90 years. Standard scores, percentiles, and age-equivalence scores can be obtained. The mean standard score is 100 with a standard deviation of 15 points. Standard scores between 85 and 115 are considered to be in the average range. The PPVT has been used in a variety of typically and atypically developing pediatric populations. It has been used in numerous studies examining the vocabulary outcomes of children who are DHH. Eighty percent of children in this sample completed the PPVT-4, while 20% completed the PPVT-5.</p> <p>Expressive Vocabulary Test (EVT)</p> <p>The EVT ([<reflink idref="bib47" id="ref49">47</reflink>]<emph>,</emph>[<reflink idref="bib48" id="ref50">48</reflink>]) is a norm-referenced assessment that is used to measure a child's expressive vocabulary—words that a child can say. Children are shown pictures and asked to name them or provide a synonym. This test has been normed on individuals between the ages of 2 years, 6 months, and 90 years. Standard scores, percentiles, and age-equivalence scores can be obtained. The mean standard score is 100 with a standard deviation of 15 points. Standard scores between 85 and 115 are considered to be in the average range. The EVT has been used in a variety of typically and atypically developing pediatric populations. It has been used in numerous studies examining the vocabulary outcomes of children who are DHH. Eighty percent of children in this sample were administered the EVT-2, while 20% were administered the EVT-3.</p> <p>Data Analyses</p> <p>Analyses were conducted using the Statistical Package for Social Sciences, version 26 ([<reflink idref="bib23" id="ref51">23</reflink>]). Hearing loss was defined as degree of hearing loss in the worse ear. Hearing device type was collapsed into one variable with those with a cochlear implant (CI) in either ear categorized in the CI group. There were limited missing data and Little's MCAR test revealed that data were missing completely at random (⁠|${\chi}$|2 = 36.81, <emph>p</emph> =.12). Preliminary analyses were conducted between demographic variables and all outcome variables to identify any associations. No significant correlations were found between age, gender, EVT, and PPVT standard scores. However, significant correlations were found between age at amplification and age at enrollment in an OPTION program and EVT and PPVT scores, respectively. See Table 2. Next, descriptive analyses were conducted for demographic and outcome variables. Independent <emph>t</emph>-tests were conducted to examine differences between the CI and hearing aid (HA) groups across outcomes. Children in the bone-conduction hearing device (<emph>n</emph> = 17) and no device (<emph>n</emph> = 5) groups were excluded due to a small sample size. Lastly, regression analyses were conducted to examine the effects of age at amplification, age at enrollment in an OPTION program, and receptive and expressive vocabulary scores (EVT and PPVT).</p> <p>Table 2 Correlations between demographic and outcome variables</p> <p> <ephtml> <table><thead><tr><th>. </th><th>Gender. </th><th>Age. </th><th>Age at amplification. </th><th>Age at enrollment. </th><th>EVT standard score. </th><th>PPVT standard score. </th></tr></thead><tbody><tr><td>Gender </td><td>– </td><td>.08 </td><td>−.06 </td><td>−.00 </td><td>.02 </td><td>−.02 </td></tr><tr><td>Age </td><td>.08 </td><td>– </td><td>.15<sup>*</sup><sup>*</sup></td><td>.13<sup>*</sup></td><td>−.01 </td><td>−.05 </td></tr><tr><td>Age at amplification </td><td>−.06 </td><td>.15<sup>*</sup><sup>*</sup></td><td>– </td><td>.64<sup>*</sup><sup>*</sup></td><td>−.09 </td><td>−.01 </td></tr><tr><td>Age at enrollment in OPTION program </td><td>−.01 </td><td>.13<sup>*</sup></td><td>.64<sup>*</sup><sup>*</sup></td><td>– </td><td>−.19<sup>*</sup><sup>*</sup></td><td>−.14<sup>*</sup></td></tr><tr><td>EVT standard score </td><td>.02 </td><td>−.01 </td><td>−.09 </td><td>−.19<sup>*</sup><sup>*</sup></td><td>.- </td><td>.87<sup>*</sup><sup>*</sup></td></tr><tr><td>PPVT standard score </td><td>−.02 </td><td>−.05 </td><td>−.01 </td><td>−.14<sup>*</sup></td><td>.87<sup>*</sup><sup>*</sup></td><td>– </td></tr></tbody></table> </ephtml> </p> <p>Note.</p> <p>1 **Significant at.01; *significant at.05.</p> <hd id="AN0158667166-3">Results</hd> <p>Statistical Analyses</p> <p>One-way Analyses of Variance (ANOVAs) were conducted to examine differences in EVT and PPVT scores by degree of hearing loss, respectively. Analyses revealed significant differences on EVT scores by degree of hearing loss [<emph>F</emph>(<reflink idref="bib5" id="ref52">5</reflink>,<reflink idref="bib337" id="ref53">337</reflink>) = 4.82, <emph>p</emph> <.001]. Specifically, there were significant differences between children with profound hearing loss (<emph>M</emph> = 89.41) and mild (<emph>M</emph> = 102.16, <emph>p</emph> <.05) and moderate hearing loss (<emph>M</emph> = 99.56, <emph>p</emph> <.01), respectively. Similarly, children with profound hearing loss scored significantly lower (<emph>M</emph> = 85.08) on the PPVT [<emph>F</emph>(<reflink idref="bib5" id="ref54">5</reflink>,<reflink idref="bib330" id="ref55">330</reflink>) = 8.67, <emph>p</emph> <.001], compared to children with slight (<emph>M</emph> = 104.43, <emph>p</emph> <.05), mild (<emph>M</emph> = 101.68, <emph>p</emph> <.001), moderate (<emph>M</emph> = 97.41, <emph>p</emph> <.001), and moderately severe (<emph>M</emph> = 93.36, <emph>p</emph> <.01) hearing loss, respectively.</p> <p>Additionally, independent <emph>t</emph>-tests were conducted to examine differences between the CI and HA groups on age when hearing loss was diagnosed, age at amplification, and age child entered an OPTION program. There were significant differences between groups on age at hearing loss diagnosis [<emph>t</emph> (<reflink idref="bib306" id="ref56">306</reflink>) = −4.70, <emph>p</emph> <.001] and age at amplification [<emph>t</emph> (<reflink idref="bib304" id="ref57">304</reflink>) = −4.08, <emph>p</emph> <.001] with children in the CI group being diagnosed (CI: <emph>M</emph> = 7.83, HA: <emph>M</emph> = 16.47) and fit with a hearing device (CI: <emph>M</emph> = 12.88, HA: <emph>M</emph> = 20.44) earlier than children in the HA group. Additional <emph>t</emph>-tests were conducted to examine differences between the CI and HA groups on EVT standard scores and PPVT standard scores. There were significant differences between groups for both the EVT [<emph>t</emph> (<reflink idref="bib311" id="ref58">311</reflink>) = −3.34, <emph>p</emph> <.001] and PPVT [<emph>t</emph> (<reflink idref="bib309" id="ref59">309</reflink>) = −3.73, <emph>p</emph> <.001], with children in the HA group (EVT <emph>M</emph> = 96.44; PPVT <emph>M</emph> = 92.81) scoring significantly higher than the CI group (EVT <emph>M</emph> = 89.52; PPVT <emph>M</emph> = 85.68).</p> <p>Linear regressions were conducted to examine the association between age at enrollment in an OPTION program, age at device fitting, and vocabulary standard scores, controlling for hearing device type. Age when child enrolled in an OPTION program was significantly related to EVT standard scores [<emph>F</emph>(<reflink idref="bib3" id="ref60">3</reflink>,<reflink idref="bib317" id="ref61">317</reflink>) = 5.49, <emph>p</emph> <.001], with children who began an OPTION program at an older age having lower EVT scores (<emph>B</emph> = −.15, <emph>p</emph> <.05). For the PPVT, there were no significant associations after controlling for device type. See Table 3 for descriptive statistics of outcome variables and Table 4 for regression analyses.</p> <p>Table 3 Descriptives of outcome variables</p> <p> <ephtml> <table><thead><tr><th>Outcome. </th><th>Mean (SD). </th><th>Range. </th></tr></thead><tbody><tr><td>EVT standard score </td><td>93.86 (18.25) </td><td>20–150 </td></tr><tr><td>PPVT standard score </td><td>90.56 (17.22) </td><td>44–130 </td></tr><tr><td>Age at amplification (months) </td><td>18.34 (17.05) </td><td>0–72 </td></tr><tr><td>Age at enrollment in OPTION program (months) </td><td>28.57 (19.07) </td><td>0–70 </td></tr></tbody></table> </ephtml> </p> <p>Table 4 Regression analyses</p> <p> <ephtml> <table><thead><tr><th>. </th><th>β. </th><th>B (SE b). </th><th>95% CI. </th><th>Model <italic>R</italic><sup>2</sup>. </th><th><italic>F</italic>. </th></tr></thead><tbody><tr><td colspan="6">Model 1: EVT </td></tr><tr><td> Age at enrollment </td><td>−.16<sup>*</sup></td><td>.15 (.07) </td><td>−.28, −.01 </td><td>.05 </td><td>5.49<sup>*</sup><sup>*</sup></td></tr><tr><td> Age at device fitting </td><td>−.03 </td><td>−.03 (.08) </td><td>−.19,.12 </td><td /><td /></tr><tr><td colspan="6">Model 2: PPVT </td></tr><tr><td> Age at enrollment </td><td>−.13 </td><td>−.12 (.07) </td><td>−.25,.01 </td><td>.04 </td><td>4.82<sup>*</sup></td></tr><tr><td> Age at device fitting </td><td>.03 </td><td>.03 (.08) </td><td>−.12,.18 </td><td /><td /></tr></tbody></table> </ephtml> </p> <p> <emph>Note.</emph> All analyses controlled for device type.</p> <p>2 **Significant at p <.001; *Significant at p <.05.</p> <p>To further explore the impact of age when entering an OPTION program, we conducted an independent samples <emph>t</emph>-test using a median split (early entry as 0–28 months and late entry as 29–70 months). There was a significant difference between groups on EVT standard scores [<emph>t</emph> (<reflink idref="bib334" id="ref62">334</reflink>) = 3.20, <emph>p</emph> <.001] with those who entered earlier (0–28 months; <emph>M</emph> = 97.04) scoring six points higher than those who entered later (29–70 months; <emph>M</emph> = 90.73). Similarly, there was a significant difference between groups on PPVT standard scores [<emph>t</emph> (<reflink idref="bib332" id="ref63">332</reflink>) = 1.96, <emph>p</emph> <.05] with those who entered earlier (0–28 months; <emph>M</emph> = 92.42) scoring three points higher than those who entered later (29–70 months; <emph>M</emph> = 88.75).</p> <hd id="AN0158667166-4">Discussion</hd> <p>The overall goal of this study was to document the lexical achievement of 5-year-old children who are DHH enrolled in OPTION programs. Results indicate that by age five, on average, children were within normal test limits for vocabulary achievement in both receptive and expressive areas. It should be noted that although the mean vocabulary achievement scores from this sample were within the average range, the distribution of scores was positively skewed in a way that normative distributions of scores from typically hearing populations are not ([<reflink idref="bib21" id="ref64">21</reflink>]). This indicates that more children who are DHH score below the mean when compared to peers who are typically hearing. At the same time, the results suggest that it is possible for children who are DHH and who have received specialized intervention to demonstrate age-appropriate receptive and expressive vocabulary skills by the time they reach kindergarten age.</p> <p>Despite the overall average scores, there was a notable difference between children's receptive and expressive vocabulary scores. Typical language development is characterized by larger receptive vocabulary sizes than expressive vocabulary sizes, with children understanding more words than they are able to use ([<reflink idref="bib15" id="ref65">15</reflink>]). In contrast, while the EVT and PPVT do not measure vocabulary size but rather vocabulary knowledge, more children in the current study (73%) had expressive vocabulary scores at or above the average range compared to the number of children with receptive vocabulary scores (64%) at or above the average range. This is a trend which has been previously discussed by [<reflink idref="bib28" id="ref66">28</reflink>]), who suggested that by the time a child who is DHH learns a new vocabulary word, the new word is embedded in both receptive and expressive knowledge. This phenomenon might be attributable to how children who are DHH engage in word learning, often requiring direct intervention to build lexical knowledge. More work is needed to explore the trends in lexical acquisition of children who are DHH.</p> <p>Moreover, consistent with prior literature, degree of hearing loss, type of hearing technology utilized, age at which amplification was received, and age at enrollment in early intervention also predicted vocabulary outcomes. In the current study, children with profound hearing loss were shown to score significantly lower on the PPVT and EVT than children with more mild degrees of hearing loss. Hearing technology utilized was also associated with receptive vocabulary scores. Although both groups were in the average range, children who wore HAs demonstrated higher receptive vocabulary scores than their peers who used CIs. These findings are similar to those of other studies (e.g. [<reflink idref="bib28" id="ref67">28</reflink>]; [<reflink idref="bib39" id="ref68">39</reflink>]). Children with CIs also had more variability in their performance when compared to children using other hearing technology. Together, these findings suggest that children with more severe hearing loss, who are likely CI candidates or recipients, have greater difficulties with vocabulary acquisition and thus may need more targeted intervention. Possible explanations for these results include that children with HAs may have better access to sound earlier in life, have better residual hearing, and may have more opportunities to engage in incidental learning. Although data from the current study cannot be used to draw any conclusions related to this discrepancy, future studies may compare different program characteristics to better address this question.</p> <p>In contrast to receptive vocabulary, the primary factor found to influence expressive vocabulary outcomes at age 5 was age at enrollment in OPTION programs. Children were more likely to achieve higher EVT standard scores when they enrolled in an OPTION program at earlier ages, even after controlling for other factors, such as type of hearing technology and age of amplification. Further analyses revealed that age at enrollment was the primary driver for vocabulary development, indicating that children who enrolled before 28 months of age achieved both higher receptive and expressive vocabulary scores. These results suggest that enrolling in intervention early in life can support vocabulary outcomes at age 5 that are, on average, comparable to those of children with typical hearing. This finding may not seem surprising, as it is well documented that providing early intervention leads to better outcomes in children who are DHH (e.g. [<reflink idref="bib17" id="ref69">17</reflink>]; [<reflink idref="bib26" id="ref70">26</reflink>]; [<reflink idref="bib32" id="ref71">32</reflink>]; [<reflink idref="bib50" id="ref72">50</reflink>]). However, past studies generally have shown significant disparities in quantities of known vocabulary words for children who are DHH compared to their hearing age-matched peers ([<reflink idref="bib7" id="ref73">7</reflink>]; [<reflink idref="bib8" id="ref74">8</reflink>]; [<reflink idref="bib16" id="ref75">16</reflink>]; [<reflink idref="bib19" id="ref76">19</reflink>]; [<reflink idref="bib35" id="ref77">35</reflink>]; [<reflink idref="bib37" id="ref78">37</reflink>]; [<reflink idref="bib40" id="ref79">40</reflink>]). The majority of participants in the current study demonstrate vocabulary outcomes within normal test limits, indicating lexical abilities similar to those of their hearing peers. Thus, illustrating the positive effects of intervention on closing the gap in vocabulary development for children who are DHH.</p> <p>This study utilized one of the largest and nationally representative datasets of children who are DHH and enrolled in LSL intervention programs. OPTION is composed of 35 programs from a variety of regions across the nation, which allowed authors of this study to investigate a uniquely large and geographically representative population of children. While diverse in geographical representation, the sample was somewhat homogenous in representation of maternal education, an often-reported proxy for socioeconomic status ([<reflink idref="bib5" id="ref80">5</reflink>]; [<reflink idref="bib10" id="ref81">10</reflink>]; [<reflink idref="bib22" id="ref82">22</reflink>]). Additionally, it should be noted that the current study included children with no additional diagnoses whose home language was primarily spoken English. This study provided a first overview of lexical achievement of 5-year-olds in this database; however, a more comprehensive view of lexical development is likely to tell a broader story of what is possible for children who are DHH. Future directions could include a longitudinal investigation of vocabulary development. The relationships between vocabulary skills and other areas of kindergarten readiness, such as syntactic skills, literacy skills, and social skills were not addressed in the current study. Additionally, an investigation of varying intervention components, including the effectiveness of intervention strategies utilized across programs would be warranted in future studies. Further, variables which have been previously shown to affect vocabulary outcomes, such as aided hearing thresholds and frequency of intervention, were unable to be included in the present study. Further investigation taking these variables into account is recommended.</p> <p>In summary, results of this study indicate that children who are DHH can achieve vocabulary outcomes within the average range by age 5. Findings support ensuring that children are enrolled as early as possible in intervention programs offers the best opportunity for success in receptive and expressive vocabulary development. This study is consistent with others which have reported age at enrollment as an influential factor in vocabulary outcomes ([<reflink idref="bib9" id="ref83">9</reflink>]; [<reflink idref="bib17" id="ref84">17</reflink>]; [<reflink idref="bib50" id="ref85">50</reflink>]). Ongoing investigations of vocabulary development and associated factors could provide teachers, caregivers, and policymakers with a deeper understanding of the importance of early specialized intervention and how to best serve children who are DHH.</p> <p>Conflicts of Interest</p> <p>No conflicts of interest were reported.</p> <ref id="AN0158667166-5"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref44" type="bt">1</bibl> <bibtext> Antia, S. D., Jones, P. B., Reed, S., & Kreimeyer, K. H. (2009). Academic status and progress of deaf and hard-of-hearing students in general education classrooms. 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Forty Drive, Saint Louis, MO 63141, USA</p> </aug> <nolink nlid="nl1" bibid="bib36" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib38" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib11" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib30" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib34" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib41" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib46" firstref="ref7"></nolink> <nolink nlid="nl8" bibid="bib20" firstref="ref8"></nolink> <nolink nlid="nl9" bibid="bib42" firstref="ref9"></nolink> <nolink nlid="nl10" bibid="bib50" firstref="ref10"></nolink> <nolink nlid="nl11" bibid="bib28" firstref="ref12"></nolink> <nolink nlid="nl12" bibid="bib29" firstref="ref13"></nolink> <nolink nlid="nl13" bibid="bib45" firstref="ref14"></nolink> <nolink nlid="nl14" bibid="bib16" firstref="ref16"></nolink> <nolink nlid="nl15" bibid="bib19" firstref="ref17"></nolink> <nolink nlid="nl16" bibid="bib35" firstref="ref18"></nolink> <nolink nlid="nl17" bibid="bib14" firstref="ref20"></nolink> <nolink nlid="nl18" bibid="bib18" firstref="ref21"></nolink> <nolink nlid="nl19" bibid="bib33" firstref="ref22"></nolink> <nolink nlid="nl20" bibid="bib31" firstref="ref27"></nolink> <nolink nlid="nl21" bibid="bib49" firstref="ref28"></nolink> <nolink nlid="nl22" bibid="bib17" firstref="ref30"></nolink> <nolink nlid="nl23" bibid="bib32" firstref="ref31"></nolink> <nolink nlid="nl24" bibid="bib43" firstref="ref32"></nolink> <nolink nlid="nl25" bibid="bib44" firstref="ref33"></nolink> <nolink nlid="nl26" bibid="bib27" firstref="ref35"></nolink> <nolink nlid="nl27" bibid="bib25" firstref="ref43"></nolink> <nolink nlid="nl28" bibid="bib24" firstref="ref45"></nolink> <nolink nlid="nl29" bibid="bib13" firstref="ref47"></nolink> <nolink nlid="nl30" bibid="bib12" firstref="ref48"></nolink> <nolink nlid="nl31" bibid="bib47" firstref="ref49"></nolink> <nolink nlid="nl32" bibid="bib48" firstref="ref50"></nolink> <nolink nlid="nl33" bibid="bib23" firstref="ref51"></nolink> <nolink nlid="nl34" bibid="bib337" firstref="ref53"></nolink> <nolink nlid="nl35" bibid="bib330" firstref="ref55"></nolink> <nolink nlid="nl36" bibid="bib306" firstref="ref56"></nolink> <nolink nlid="nl37" bibid="bib304" firstref="ref57"></nolink> <nolink nlid="nl38" bibid="bib311" firstref="ref58"></nolink> <nolink nlid="nl39" bibid="bib309" firstref="ref59"></nolink> <nolink nlid="nl40" bibid="bib317" firstref="ref61"></nolink> <nolink nlid="nl41" bibid="bib334" firstref="ref62"></nolink> <nolink nlid="nl42" bibid="bib332" firstref="ref63"></nolink> <nolink nlid="nl43" bibid="bib21" firstref="ref64"></nolink> <nolink nlid="nl44" bibid="bib15" firstref="ref65"></nolink> <nolink nlid="nl45" bibid="bib39" firstref="ref68"></nolink> <nolink nlid="nl46" bibid="bib26" firstref="ref70"></nolink> <nolink nlid="nl47" bibid="bib37" firstref="ref78"></nolink> <nolink nlid="nl48" bibid="bib40" firstref="ref79"></nolink> <nolink nlid="nl49" bibid="bib10" firstref="ref81"></nolink> <nolink nlid="nl50" bibid="bib22" firstref="ref82"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Vocabulary Outcomes for 5-Year-Old Children Who Are Deaf or Hard of Hearing: Impact of Age at Enrollment in Specialized Early Intervention
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Rudge%2C+Amanda+M%2E%22">Rudge, Amanda M.</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4998-5459">0000-0002-4998-5459</externalLink>)<br /><searchLink fieldCode="AR" term="%22Coto%2C+Jennifer%22">Coto, Jennifer</searchLink><br /><searchLink fieldCode="AR" term="%22Oster%2C+Monika-Maria%22">Oster, Monika-Maria</searchLink><br /><searchLink fieldCode="AR" term="%22Brooks%2C+Betsy+Moog%22">Brooks, Betsy Moog</searchLink><br /><searchLink fieldCode="AR" term="%22Soman%2C+Uma%22">Soman, Uma</searchLink><br /><searchLink fieldCode="AR" term="%22Rufsvold%2C+Ronda%22">Rufsvold, Ronda</searchLink><br /><searchLink fieldCode="AR" term="%22Cejas%2C+Ivette%22">Cejas, Ivette</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Deaf+Studies+and+Deaf+Education%22"><i>Journal of Deaf Studies and Deaf Education</i></searchLink>. Jul 2022 27(3):262-268.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://jdsde.oxfordjournals.org/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 7
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Vocabulary+Development%22">Vocabulary Development</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Deafness%22">Deafness</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22School+Entrance+Age%22">School Entrance Age</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Intervention%22">Early Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Education%22">Special Education</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1093/deafed/enac009
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1081-4159<br />1465-7325
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The aims of this study were to examine vocabulary scores of 5-year-old children who are deaf or hard of hearing (DHH), as well as the impact of early enrollment in specialized intervention on vocabulary outcomes. Receptive and expressive vocabulary scores were analyzed for 342 five-year-old children who are DHH enrolled in specialized listening and spoken language intervention programs. Regression analyses were utilized to examine the effects of age at enrollment on vocabulary outcomes. Overall, participants achieved scores within normal test limits on receptive and expressive measures of vocabulary. Children who enrolled in intervention prior to 28 months of age had better vocabulary skills at 5 years old. The findings support that children who are DHH can understand and produce vocabulary at skill levels commensurate with their typically hearing peers, regardless of severity of hearing loss. Results highlight the crucial impact of specialized programs on children's lexical readiness to participate in general education settings by kindergarten.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2022
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1345544
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1345544
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1093/deafed/enac009
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 7
        StartPage: 262
    Subjects:
      – SubjectFull: Vocabulary Development
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Deafness
        Type: general
      – SubjectFull: Hearing Impairments
        Type: general
      – SubjectFull: School Entrance Age
        Type: general
      – SubjectFull: Early Intervention
        Type: general
      – SubjectFull: Special Education
        Type: general
    Titles:
      – TitleFull: Vocabulary Outcomes for 5-Year-Old Children Who Are Deaf or Hard of Hearing: Impact of Age at Enrollment in Specialized Early Intervention
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Rudge, Amanda M.
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            NameFull: Coto, Jennifer
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            NameFull: Oster, Monika-Maria
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            NameFull: Brooks, Betsy Moog
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            NameFull: Soman, Uma
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            NameFull: Rufsvold, Ronda
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            NameFull: Cejas, Ivette
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          Dates:
            – D: 01
              M: 07
              Type: published
              Y: 2022
          Identifiers:
            – Type: issn-print
              Value: 1081-4159
            – Type: issn-electronic
              Value: 1465-7325
          Numbering:
            – Type: volume
              Value: 27
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Journal of Deaf Studies and Deaf Education
              Type: main
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