Early Predictors of Development of Children With Permanent Hearing Impairment

Theoretical background: Overall, 6.1?% of the population are affected by hearing impairment (HI). There is high variability in developmental outcomes of children with permanent hearing loss. Even though outcomes have significantly improved over the past two decades, hearing impairment is still a risk factor for delayed or insufficient language development with effects on other developmental dimensions such as mental health, behavior, quality of life, and academic skills. Objective: A review of the literature presents current evidence for early predictors of language and communication development in children with hearing impairment. Method: A literature search of PubMed was performed including search terms describing child characteristics, language development, and family environment. Results and Discussion: The search yielded 349 articles related to early predictors of language development in children with hearing impairment. After exclusion of children with intellectual disability, it was found that about every second child with hearing loss still does not arrive at an age-appropriate language level. The results on predictive factors presented in the review are divided into three groups: child- , intervention- , and family-related factors. The child characteristics related to better language outcomes are less severe degrees of hearing loss, lack of additional disabilities (occurring in approximately 40 % of children with HI), and higher levels of intellectual functioning as well as language-specific factors such as the capacity of the phonological working memory. The review identified a number of factors that can be influenced by intervention. These include early identification of HI followed by early hearing-aid fitting and (if required) consecutive early cochlear implantation guaranteeing high audibility, as well as consistent use of hearing devices. As an alternative or additionally, early access to sign language can provide a child with HI with the language skills required for learning, social development, and mental health. A strong influence of family factors on child development has been demonstrated in many studies. Particularly, high-quality parental language input, that is a responsive interaction style, and the use of facilitative language techniques adapted to the individual child can improve speech and language development enormously. On the contrary, parental stress and negative or uninvolved parenting have a negative influence on language development. Strengthening parent-child interactions therefore is crucial. Conclusion: The developmental outcomes of children with HI are highly malleable. A lot can be done if the HI is detected early and timely hearing intervention is provided. Family-centered interventions can strengthen parents' self-efficacy and the quality of parent-child interactions. By implementing best practice, young children with hearing loss now have the opportunity to reach language and communicative skills similar to their peers with typical hearing, which has positive effects on learning, social inclusion, and mental health.