Early Intervention for Hearing Impairment: Identifying and Measuring Individual Differences in the Timing of Communication and Language Development

This paper reports in-depth case study material which illuminates the issue of impact of early aiding on the rate of acquisition of communicative and linguistic behaviours of a small group of severely and profoundly deaf infants (average better ear loss of 101 dB) aided between 3 and 6 months of age. A comparison is made of each infant's development of gestural and vocal productions between the ages of 6 and 21 months. Data derive from video and audio recorded social interaction between deaf and hearing infants and their principal caregivers taken across three contexts. The effects of earlier identification, amplification and fluctuations in early auditory stimulation, on the deaf infants' acquisition of communicative, symbolic and linguistic skills are discussed.     

Neonatal hearing screening

Approximately 1 to 2 per thousand live-born infants suffer from a serious perceptive hearing loss. Normal hearing from birth is essential for optimal human development (language and speech, social and emotional development, communicative skills and learning). The earlier the hearing loss is diagnosed the better the prognosis for the infant with a hearing impairment. Suitable methods are now available for neonatal hearing screening: automated measurement of auditory brain stem response and measurement of oto-acoustic emissions. Screening must be viewed as only the first step in a program of diagnosis, treatment and habilitation of these children. The ultimate goal of the implementation of neonatal hearing screening is: identification of bilateral hearing losses before the age of 3 months and start of therapy and counselling before the age of 6 months.     

Early markers of vulnerable language skill development in galactosaemia

There are no known biomedical or genetic markers to identify which infants with galactosaemia (GAL) are most at risk of poor language skill development, yet pre-linguistic communicative ‘red flag’ behaviours are recognised as early identifiers of heightened vulnerability to impaired language development. We report on pre-linguistic development in two 18-month-old infants with GAL (one of each gender). Results identified the male as displaying significantly poorer pre-linguistic skills than both his matched peers and relative to the female infant with GAL, whose pre-linguistic skills were commensurate with or better than her matched peers. The results suggest that by 18 months of age, differential developmental language skills can be identified in infants with GAL when the focus is on pre-linguistic communication behaviours.     

Maternal responsiveness and infant intentional communication: implications for the early communicative and linguistic development

BACKGROUND: Maternal responsiveness has been found to have an important role in early language acquisition. From early on, children can also be regarded as active participants in interaction who demonstrate increasing competence in conveying messages to their interactive partners. Hence, in order to demonstrate consistent effects of maternal responses, it is important to take into account individual differences among children. In the present study, the relation between the frequencies of maternal responses and infant intentional communicative acts as well as their predictive validity to subsequent early communicative and linguistic skills was examined. METHODS: The participants were 27 Finnish-speaking mothers and their healthy firstborn infants. Maternal and infant interactive behaviour was analysed from 20-min samples of free play collected during home visits at the infants' age of 10 months. At 12 months the children were assessed for their communicative and linguistic skills by using the Finnish version of the MacArthur Communicative Development Inventories and the Communication and Symbolic Behaviour Scales. RESULTS: The frequencies of maternal responses and infant intentional communicative acts were not intercorrelated. As for subsequent communicative and linguistic skills, the results of regression analyses indicated that both maternal responsiveness and infant intentional communication predict early comprehensive skills, whereas expressive skills--the use of both verbal and gestural communicative means--are predicted only by infant intentional communication. CONCLUSION: The results of the present study suggest that maternal responsiveness during the prelinguistic stage is not necessarily dependent on children's communicative competence. As predictors of early communicative and linguistic skills, both maternal responsiveness and infant intentional communication make a distinctive contribution.     

Caregivers' sensitivity to the communicative and linguistic needs of their deaf infants

This paper questions the effect of variations in caregiver sensitivity on the timing of their severely and profoundly deaf infants' acquisition of communication skills. The behaviour of five caregivers of deaf infants, matched with five normally hearing caregiver and infant dyads, was examined from when the infants were 6 to 21 months of age. Six-weekly video recorded sessions of social interaction were scored according to the caregivers' ability to turn-about their infants' gestural and vocal contributions. The caregivers of hearing infants were similar to each other in both the pattern and timing of their turn-abouts; caregivers of deaf infantsshowed considerably more variation in the pattern and timing of contingent behaviours with their infants. Issues related to caregiver sensitivity of responsiveness to infants are examined in relation to the known contextual features of family functioning.     

Community-Based Provision for Young Deaf Children Aged from Birth to Five Years

It is widely expected that earlier habilitation will enable the deaf infant to achieve milestones of communicative competence (in sign and/or speech) in as normal a way as possible. Evidence exists to suggest that deaf infants identified as a result of neonatal screening are on average, two years ahead in their vocal communicative skills than deaf infants identified through more traditional means. With appropriate aiding and effective habilitative strategies, evidence now indicates that profoundly deaf infants can acquire communicative competence at an age more typical of their normally hearing peers. It remains the case however that 'appropriate early intervention' means different things to different people: it is equally the case that across England and Wales the resources available for early identification of deaf infants and the quality of professional support subsequently available to promote habilitation, is quite variable. Since no systematic survey of service-based provision for preschool age deaf children has previously been undertaken within the UK, the extent and nature of variability is essentially unknown. This paper reports on the preliminary findings of the first national survey of services which exist to identify and provide specialist support to profoundly deaf infants and young.     

Early Detection of Hearing Impairment in Japan

Screening for hearing impairment in babies and young children in Japan is the responsibility of each administrative district and as such there is considerable variation in the methods and applications across districts. Every child who is resident in a particular district is given a registration card which must go with them to their medical examinations at six months, eighteen months and three years of age. Hearing screening depends chiefly on a questionnaire concerning the development of first words and the state of hearing. This paper first describes the Japanese system of medical examinations. Then the paper reports the results of Tokushima Prefecture where all children are screened for hearing impairment at 18 months of age. In Tokushima Prefecture teachers from the local school for the deaf administer the 18 month old screen in co-operation with public health nurses. As a result of this screen the average age of diagnosis of hearing impairment reduced from 2.1 years of age to 1.2 years of age. Screening for hearing impairment at 18 months resulted in two clear developments: First, all the hard of hearing children were identified and second, public health nurses became more aware of and alert to hearing impairment in young children.     

儿童早期发展训练对婴儿神经心理发育影响的分析

目的 探讨儿童早期发展训练对婴儿神经心理发育的影响,推广应用示范性与个性化教育模式,从而更好地促进儿童早期发展。方法 定期随访早教组婴儿71例和对照组70例至12月,两组婴儿在6、9、12月龄时,采用Gesell发育量表评估并比较分析两组发育商(developmental quotient,DQ)。结果 9月龄时,早教组在精细动作、语言两个能区的DQ显著高于对照组(P＜0.05);12月龄时,早期训练组在精细动作、语言及社会适应三个能区的DQ显著高于对照组(P＜0.05)。结论 儿童早期发展训练可促进婴儿神经心理发育,精细动作和语言更依赖于环境的刺激,示范性和个体化的训练模式对儿童早期发展具有长远和积极的意义。     

Health-Related Quality of Life in Children With Low Language or Congenital Hearing Loss,as Measured by the PedsQL and Health Utility Index Mark 3

ObjectivesTo examine health-related quality of life (HRQoL) in young children with low language or congenital hearing loss and to explore the value of assessing HRQoL by concurrently administering 2 HRQoL instruments in populations of children.MethodsData were from 2 Australian community-based studies: Language for Learning (children with typical and low language at age 4 years, n = 1012) and the Statewide Comparison of Outcomes study (children with hearing loss, n = 108). HRQoL was measured using the parent-reported Health Utilities Index Mark 3 (HUI3) and the Pediatrics Quality of Life Inventory 4.0 (PedsQL) generic core scale. Agreement between the HRQoL instruments was assessed using intraclass correlation and Bland-Altman plots.ResultsChildren with low language and with hearing loss had lower HRQoL than children with normal language; the worst HRQoL was experienced by children with both. The lower HRQoL was mainly due to impaired school functioning (PedsQL) and speech and cognition (HUI3). Children with hearing loss also had impaired physical and social functioning (PedsQL), vision, hearing, dexterity, and ambulation (HUI3). Correlations between instruments were poor to moderate, with low agreement.ConclusionsChildren with low language and congenital hearing loss might benefit from interventions targeting overall health and well-being, not just their impairments. The HUI3 and PedsQL each seemed to provide unique information and thus may supplement each other in assessing HRQoL of young children, including those with low language or congenital hearing loss.     

不同出生体重儿婴儿期生长方式

不同出生体重及胎龄的新生儿在婴儿期呈现不同的生长方式,足月儿体重和身长在第2个月有一生长高峰:高出生体重儿生后头两个月显示“低速”生长趋势,但实际生长值始终高于正常儿组;足月小样儿在第1年展示不同程度的追赶生长,尤其在前半年。然而1岁时并未达到正常儿生长水平,并且也落后于早产儿;早产儿生长与胎龄有关,“足月”前显示缓慢增长,“足月”后加速生长。     

Evaluation of the localization auditory screening test in children 6-18 months of age.

The present paper is a report of a project to develop an automated auditory screening test for infants six to 18 months of age. The first year of the project was devoted to developing equipment and test procedures; the second year was concerned with testing the effectiveness of the equipment and procedures on an actual population of six to 18 month old infants. Two-hundred and fifty infants were screened auditorily as part of a county health department child development clinic. The pass/fail results of the screening test were evaluated in terms of physical and developmental examination following the screening and by means of a case review of the child's previous history. The results indicate that the procedure under investigation can be used to differentiate the normal hearing infant from the infant with possible hearing problems. It is shown by the test environment in which this study was conducted that the procedure reported can be successfully incorporated into a public health program, i.e., child development clinics or EPSDT programs.     

早产儿语言发育迟缓的临床研究

目的研究早产的各种影响因素与语言发育迟缓的关系,以及语言发育迟缓与智能发育特征之间的关系。方法对在开封市妇产医院儿保科2015-2017年建立0~3岁健康档案并定期体检的300例早产儿为研究对象,采用0~6岁儿童神经心理发育量表进行发育评估。结果早产儿语言发育迟缓与出生体重、胎龄、月龄、语言环境和养育人存在差异并具统计学意义(P<0.05),出生体重越低、胎龄越小,语言发育迟缓人数越多;随着年龄的增长,语言发育迟缓人数逐渐增多,在24~30个月达高峰,36个月明显下降;父母养育与语言环境良好的儿童语言发育迟缓人数相对较少。语言发育落后的同时存在社交行为的落后,智能发育各能区中除大运动、精细动作两组差异无统计学意义(P>0.05),适应能力、语言、社会交往3组存在差异并具统计学意义(P<0.05)。结论关注早产儿的语言发育,在语言发育的关键期做好语言发育的筛查,早期发现影响早产儿语言发育的相关因素及可能伴随的其他发育问题,采取相应的干预措施,改善预后。     

河南省0～2岁婴幼儿碘营养状况和喂养方式与生长发育的关系

目的 探讨0～2岁婴幼儿的喂养方式和碘营养状况对其生长发育的影响。方法 采用整群抽样的方法,在河南省的18个省辖市各随机抽取2个县,每个县调查100名0～2岁婴幼儿的尿碘水平、喂养方式、生长指标。利用WHO Anthro软件计算年龄别体重评分（weight for age Z score,WAZ）和年龄别身高评分（height for age Z score,HAZ）。分别采用单因素方差分析和多元线性回归探讨碘营养水平和喂养方式对婴幼儿身高和体重的影响。结果 不同碘营养水平之间,13～18月龄组婴幼儿WAZ差异有统计学意义（F = 2.494,P = 0.043）;不同喂养方式之间,13～18月龄组WAZ差异有显著性（F = 3.040,P = 0.049）,19～24月龄组HAZ差异有统计学意义（F = 3.428,P = 0.034）。在校正了父母亲身高和体重、母亲年龄和文化程度、家庭收入等变量后,多元线性回归分析结果显示:13～18月龄的婴幼儿尿碘水平在50 μg/L以下的婴幼儿体重显著低于尿碘水平在50 μg/L以上的婴幼儿,未发现碘营养水平和身长的相关关系有统计学意义;在13～18月龄组,人工喂养的婴儿比母乳喂养的婴儿体重偏低（t = - 2.381,P = 0.018）;但在19～24月龄组,人工喂养的婴儿比母乳喂养的婴儿身长偏高（t = 2.639,P = 0.009）。结论 碘营养水平对婴儿的生长发育有一定影响,应保持婴儿适宜的碘营养水平。母乳喂养和人工喂养的婴儿生长方式存在一定的差异,但都在正常范围之内。     

晚期早产儿与足月儿神经行为发育在不同时期的比较

目的：了解晚期早产儿和足月儿在生后第12个月和第18个月两个年龄段的神经行为发育差异,并比较两个年龄段的神经行为发育变化。方法以75例晚期早产儿和80例足月儿为两组样本,检测其在生后第12个月和第18个月2个年龄段的神经行为发育水平,并进行比较。结果在生后第12个月,晚期早产儿的大运动、精细运动、适应能力、语言、个人社交等5方面发育商得分均显著低于足月儿（t值分别为-3．837、-5．801、-3．532、-5．258和-4．582,均P＜0．05）;在第18个月作比较,晚期早产儿的上述5方面发育商得分均显著低于足月儿（ t值分别为-2．786、-3．967、-4．946、-4．155和-3．449,均P＜0．05）;晚期早产儿第18个月的大运动得分显著高于第12个月,而个人社交得分显著低于第12个月（ t值分别为1．982和-4．214,均P＜0．05）;足月儿第18个月的大运动、适应能力得分显著高于第12个月,而个人社交得分显著低于第12个月（ t值分别为2．188、2．683和-3．880,均P＜0．05）。结论晚期早产儿在第12个月和第18个月年龄段的神经行为发育与足月儿比较仍处于低值;晚期早产儿或足月儿其个人社交在第18个月的分值均低于第12个月,其原因有待进一步探讨。晚期早产儿神经行为发育不够成熟,关注和促进晚期早产儿早期发育非常重要。     

不同出生胎龄婴幼儿期神经行为发育水平研究

目的 探讨不同出生胎龄婴幼儿神经行为发育水平差异。方法 采用随机抽样的方法抽取2019年1月1日至2020年6月30日在西北妇女儿童医院出生的新生儿作为研究对象,按照出生胎龄分为早产儿组（胎龄28～36周）、早期儿组（胎龄37～38周）、足月儿组（胎龄≥39周）。早产儿与早期儿于纠正胎龄40周、足月儿于生后24 h进行新生儿神经行为评分（NBNA）;分别在早产儿、早期儿、足月儿生后6个月、12个月、24个月时随访,采用北京首都儿童研究所《0～6岁儿童神经心理发育量表》评估其进行神经心理发育水平。结果 本次研究共纳入986名新生儿,早产儿组122例,其中男54例,女68例,平均胎龄（32.42±1.54）周;早期儿组275例,其中男122例,女153例,平均胎龄（37.54±1.21）周;足月儿组589人,其中男245人,女344人,平均胎龄（39.89±0.52）周。6月龄时,早产儿组、早期儿组总发育商以及大运动、精细运动、认知、语言、社会交往5方面评分均显著低于足月儿组（均P<0.01）。12月龄时、24月龄时,早产儿组总发育商以及大运动、精细运动、认知、语言、社会交往5方面评...     

早期综合发展对早产儿体格和智能发育的影响

目的探讨社区早期综合发展对早产儿体格和智能发育的影响。方法将在广州市越秀区矿泉街社区卫生服务中心儿童保健科建卡的103例早产儿以家长知情同意为原则分为干预组（51例）和对照组（52例）,干预组开展早期综合发展服务,对照组按广州市高危儿管理要求进行基础保健,分别于纠正6月龄时进行体格测量和智能发育评估,用SPSS19.0软件进行χ2检验、t检验等统计学分析。结果纠正6月龄时,干预组和对照组早产儿的身长、体质量、头围和前囟分别做比较,差异均无统计学意义（P〉0.05）;大运动、精细动作、适应能力及语言能区、全量表分和发育商的比较,干预组优于对照组,差异均有统计学意义（P〈0.05）;社交行为能区比较,差异无统计学意义（P=0.454）。结论早期综合发展服务能明显促进纠正6月龄内早产儿的智能发育,但对其体格发育无明显促进作用,长远影响有待进一步研究。     

北京市海淀区婴儿期夜晚睡眠-觉醒模式的纵向研究

目的 应用Actiwatch评估婴儿出生后第一年夜晚睡眠-觉醒模式发展变化轨迹,为评估指导婴儿早期睡眠提供参考依据。方法 调查2009年10月-2011年10月期间,在北京市海淀区妇幼保健院分娩的32例婴儿在家庭自然环境状态下前瞻性追踪婴儿0~12个月的夜晚睡眠-觉醒模式的发展轨迹,监测年龄点包括出生后1~6、9、12月龄各1次,共8次。观察时间为每次60 h。通过Actiwatch腕表式活动记录仪采集各监测年龄点的睡眠-觉醒信息。结果 随着年龄的增长,婴儿夜晚总睡眠时间(366.07~497.04 min)和最长连续睡眠时间(213.21~381.10 min)逐渐延长,婴儿夜晚总睡眠时间5月龄与出生后1月龄相比增加了102.57 min、最长连续睡眠6月龄与1月龄相比增加了99.39 min,差异均有统计学意义(t=4.12、5.45,P均＜0.05)。婴儿的入睡潜伏期(56.85~15.13 min)和夜晚觉醒次数(2.83~1.60次)随月龄增长呈下降趋势,婴儿入睡潜伏期4月龄相比1月龄降低了29.65 min、夜晚觉醒次数5月龄相比1月龄减少了0.36次,差异均有统计学意义(t=9.47、3.51,P均＜0.05);相邻年龄点比较及不同性别比较差异均无统计学意义。结论 海淀区海淀街道婴儿夜晚睡眠-觉醒模式在生后4~6个月内变化发展最为迅速,随年龄增长婴儿夜晚入睡能力和连续睡眠能力增强。     

Effects of high-dose fish oil supplementation during early infancy on neurodevelopment and language: a randomised controlled trial

n-3 Long-chain PUFA (LC-PUFA) intake during infancy is important for neurodevelopment; however, previous studies of n-3 LC-PUFA supplementation have been inconclusive possibly due to an insufficient dose and limited methods of assessment. The present study aimed to evaluate the effects of direct supplementation with high-dose fish oil (FO) on infant neurodevelopmental outcomes and language. In the present randomised, double-blind, placebo-controlled trial, 420 healthy term infants were assigned to receive a DHA-enriched FO supplement (containing at least 250?mg DHA/d and 60?mg EPA/d) or a placebo (olive oil) from birth to 6 months. Assessment occurred at 18 months via the Bayley Scales of Infant and Toddler Development (3rd edition; BSID-III) and the Child Behavior Checklist. Language assessment occurred at 12 and 18 months via the Macarthur-Bates Communicative Development Inventory. The FO group had significantly higher erythrocyte DHA (P?=?0·03) and plasma phospholipid DHA (P?=?0·01) levels at 6 months of age relative to placebo. In a small subset analysis (about 40?% of the total population), children in the FO group had significantly higher percentile ranks of both later developing gestures at 12 and 18 months (P?=?0·007; P?=?0·002, respectively) and the total number of gestures (P?=?0·023; P?=?0·006, respectively). There was no significant difference between the groups in the standard or composite scores of the BSID-III. The results suggest that improved postnatal n-3 LC-PUFA intake in the first 6 months of life using high-dose infant FO supplementation was not beneficial to global infant neurodevelopment. However, some indication of benefits to early communicative development was observed.     

新生儿缺氧缺血性脑病对婴儿期神经心理发育的影响

【目的】 探讨早期规范治疗的轻、中度新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy, HIE)患儿婴儿期神经心理发育水平,为HIE患儿的婴儿期发育评价及研究提供依据。 【方法】 将应用GM1规范治疗的轻、中度HIE患儿分别做为观察1组和观察2组,将与该类HIE患儿同期在本院出生的正常新生儿做为对照组,三组新生儿分别建立专科档案进行1年的随访,并均在3、6、12个月时,用Gesell婴幼儿发育量表进行测试评估。 【结果】 1)3个月时观察1组和观察2组的5个能区发育商(developmental quotient, DQ)均低于对照组,差异有高度统计学意义(P＜0.01);2)6个月时观察1组与对照组5个能区的DQ差异无统计学意义(P＞0.05);观察2组5个能区的DQ比对照组婴儿低,差异有统计学意义(P＜0.05);3)12个月时观察2组的精细动作和适应行为的DQ仍比对照组的相应能区低,差异有统计学意义(P＜0.05)。 【结论】 轻、中度HIE患儿在婴儿期可遗留智力发育及心理行为发育落后,但随着月龄的增加,智力及行为发育有个追赶过程,尤其在大运动、语言和个人社交方面追赶明显,轻度HIE患儿可达到正常儿发育水平;部分中度HIE患儿的精细运动和适应行为追赶缓慢,在今后的实践中,干预的重点是精细动作和适应行为。