ACQ Vol 13 No1 2011

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ACQ Volume 13, Number 1 2011 55
that early intervention can mitigate the deleterious effects of
early hearing loss on later outcomes (e.g., Moeller, 2000;
Yoshinaga-Itano et al., 1998). Other studies have found a
relationship between the level of hearing loss and later
language outcomes, but no relationship between the age of
identification of hearing loss and the development of
language (e.g., Fitzpatrick et al., 2007; Wake et al., 2005).
Similarly as with language, speech production was also
found by these studies to have no relationship with age of
intervention. The purpose of this longitudinal study was to
determine the effect that the age of fitting (of amplification)
had on auditory-based outcomes, including speech
perception, speech production, and spoken language.
Participants were 44 children identified with bilateral,
congenital, sensorineural hearing loss sufficient to require
amplification. Exclusionary criteria included additional
disability, neonatal factors, reduced cognitive function,
auditory neuropathy and late onset loss. The key predictor
variables considered were the age the amplification was
fitted and the degree of hearing loss. Additional variables
included parent–child interaction, home language, and type
and intensity of intervention. Outcome measures included
speech perception tests (Paediatric Speech Intelligibility test
and the Online Imitative Test of Speech Patterns Contrast
Perception), a speech production test (Arizona Articulation
Proficiency Scale–3) and a spoken language measure
(Reynell Developmental Language Scales).
Results indicated that the age of fitting amplification had
a significant influence on all outcomes measured. Degree of
hearing loss predicted speech production and receptive and
expressive language but did not predict speech perception
outcomes. Use of a cochlear implant was the only other
major contributor to speech perception, speech production
and language outcomes.
Although this study presents some significant findings
suggesting that early fitting of amplification predicts auditory-
based outcomes for children with hearing impairment,
the age of the children at the final testing period and their
educational levels were unclear, making it difficult to interpret
the longitudinal evidence presented. The authors stated
some of the other limitations of the study, such as the issue
of selection bias in many longitudinal studies, with families
from higher SES more represented than those from lower
SES. They also noted that children with hearing impairment
often have additional disabilities and this study chose only to
look at otherwise typically functioning children with hearing
loss. They discussed the importance of studying early
factors on later outcomes with all children with hearing loss.
Despite these limitations, this study makes a valuable
contribution to the growing body of research looking at the
complex issue of the age of identification of hearing loss to
later outcomes.
This study has several limitations that need to be
taken into account when considering its findings. Limited
information is provided about the participant. For example,
his occupation is not reported. Also, readers in Australia may
be unfamiliar with some of the assessments used (although
a table of subtest scores over each assessment period is
provided which helps the reader to interpret the results, i.e.,
the participant’s improvement over time). The paper also
focused on an impairment level of function; it would have
been useful and more comprehensive to provide some
report of generalisation through assessment of participation
in life roles and quality of life or well-being/distress. The
details of treatment and assessment were also unclear; for
example, the location of the assessment, whether “language
rehabilitation” was undertaken by a speech pathologist, and
who completed the assessments were not reported. Thus,
some sources of bias cannot be excluded. As the paper did
not report on a controlled intervention study, the contributing
factors to this participant’s recovery could not be isolated.
As with all single case studies, this participant’s pattern of
recovery may not be representative of other individuals with
similar histories and impairments.
Despite these limitations, this paper has a lot to offer
the speech pathology clinician. It provides us with some
guidelines which we can use to discuss potential recovery
patterns with clients and their families. It also suggests that
some people with global aphasia may improve in different
communication domains at different times, which could
help us in more realistically evaluating progress and further
potential to improve. The results of this study support what
many of us already know through anecdotal evidence –
recovery from aphasia can continue for many years. Data
from this paper can be used to advocate for treatment
funding for people with chronic aphasia. I think the most
important information this paper provided me was that long-
term longitudinal research with the dysphasic population is
possible and valuable. Further single case studies as well
as larger group studies will help us to understand how our
intervention aids our clients with dysphasia not just during
intensive treatment, but over the long term.
Factors influencing auditory development in early
amplified children with hearing loss
Sininger, Y., Grimes, A. & Christensen, E. (2010) Auditory
development in early amplified children: Factors influencing
auditory-based outcomes in children with hearing loss. Ear
Hear, 31(2): 166–85.
Julia Day
Hearing loss early in life has shown to have a significant
impact on the development of speech, language, and
educational progress. Previous studies have demonstrated