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CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) convenes the September, 1999 EARLY HEARING DETECTION AND INTERVENTION AD HOC GROUP TELECONFERENCE The verbatim transcript of the EHDI Ad Hoc Group Teleconference convened at 2:00 p.m. on Tuesday, September 7, 1999 Table of Contents I. Welcome and Announcements II. Intervention Outcomes: Early Intervention and Language, Development at age Five and Factors Related to Success. III. Comparison of Language Achievement in Children with Cochlear Implants and Children using Hearing Aids IV. Deaf Mentor Program V. Indicators of Success in Various Therapies for children who are deaf/Hard of Hearing
JUNE HOLSTRUM: Welcome, everyone. I hope you all had a nice holiday weekend. I'm June Holstrum from the Centers for Disease Control and Prevention. Welcome to our teleconference on Early Hearing Detection and Intervention and thank you for joining us. Please remember to mute your microphones when you're not talking. Today's conference is being recorded and the transcript will be available on the Internet. Before we begin our scheduled program, are there any questions, or comments, announcements from any of our listeners? (NO RESPONSE WAS HEARD) If not, our first announcement is that we've just switched over to a different fax and e-mail system, and in the process, a number of names got bounced out. So if you have not received your agenda, let us know. Just give us either a fax or an e-mail with your name, fax, phone number, and e-mail on it and we'll get you back on the list. Secondly, we would like to thank all of you who have been participating in our EHDI teleconferences. We hope the teleconferences are helpful and informative. Since we're not always aware of the meetings, projects, or ongoing research, we are going to start sending out a "Call for Presentation" form shortly after each teleconference. On the form, it will describe the three categories of presentations, which are: announcements, updates, and reports. We'll give you a few examples of each of these. If you would like to make a presentation in any of these categories, you can fill out the form and send it back either through e-mail or fax. The form will have you fill out some basic information and then ask for a title and a brief description of the presentation. If you have a short handout that you want sent out to everyone, you can e-mail that to us and we can send it out to all the participants. The handouts must be in electronic form. Any questions? (NO RESPONSE WAS HEARD) If not, our first presenter is Mary Pat Moeller from Boys Town National Research Hospital, and her topic is "Intervention Outcomes: Intervention and Language Development at Age Five and Factors Related to Success." Mary Pat, go ahead. MARY PAT MOELLER’S presentation has been deleted from the transcript due to pre-publication restrictions. We will provide the complete reference as soon as the published article is ready for distribution. JUNE HOLSTRUM: Next, we have Bruce Tomblin and Linda Spencer from the University of Iowa to talk about "Comparison of Language Achievement in Children with Cochlear Implants and Children Using Hearing Aids." Bruce and Linda? BRUCE TOMBLIN: Thank you very much. Linda is on the line as well, and what I'll probably do is I will read the talk and then I'll -- I'm going to have to run in a few minutes, but Linda will be on the line for the rest of the time and she's the person who actually has the greatest contact with all of these children and really knows -- has the clinical insight that oftentimes I lack. So, with that preface . . . We've been following a large group of children here in Iowa who have received cochlear implants for, oh, about nine years now. The focus of this work has been to examine the speech and language development of these children and to determine if they are benefitting from these implants, particularly with regard to their communication skills. As you probably know, there's been considerable controversy about the use of implants with congenitally-deaf infants and children. Early work with congenitally-deaf adults showed that these people did not receive much benefit from cochlear implants. In contrast, adults who had developed their hearing loss after they had acquired speech and language, adventitiously deaf individuals, did receive considerable benefit from these devices. Using that logic, therefore, some believed that a cochlear implant would not provide enough information, linguistic and acoustic information, for speech and language development in children who are congenitally deaf. Some in the deaf community, in particular, also expressed concerns that these devices would result in children who were deaf being denied sign language experience and, thus, the opportunity to develop a solid language base in ASL and, yet, these devices also would not be good enough to allow them to become functional speakers and listeners in the hearing community. So, therefore, these children may be caught somewhere in between. These are reasonable concerns I believe and they're the kinds of concerns that have motivated our research in looking at the speech and language development of these children. Let me summarize some of the work that we've done regarding language that we have just recently published and then also some work that we have been conducting on reading that has not yet been published, but some of it is coming out in review. First of all, let me focus on the children that we're studying here. The children we're following range in age from about eighteen months to eighteen years, although the younger children are just entering into the program and, therefore, won't contribute to the data today. Some have been just implanted and some have had over ten years of implant experience. This is a study that essentially just takes all the children that come through our implant programs and enrolls them then in a longitudinal follow-up study. Most of our recent work is concentrated on the children who have been followed for about three years or more. These children were, on average, about ten or eleven years of age when we last saw them and were implanted, on average, at about five years of age. The age of implantation is a variable that is changing with time. Those children that are being implanted now tend to be younger than this, so this five-year age average represents a little bit more of a historic picture of the population of children, here at least, that are being implanted. Most of these children have been from Iowa or nearby states, and the children that we'll be talking about today have been largely in their own home communities and receiving services from the local schools. In nearly all cases, they're in total communication programs. Now, we focused on the study that was recently published in the Journal of Speech, Language and Hearing Research, and this study concerned the grammatical development, actually the acquisition of English and grammar, in children with implants. In this study, we compared children who were implanted with children who were also profoundly deaf and, in fact, had very similar pre-implant hearing to the implanted children, but these children -- this comparison group consisted of children who were not implanted. All of these children were audiometrically eligible for implants and they stand the same age range as our implanted children. In fact, actually several of the children that we used in our deaf non-implanted comparison group became implanted at a later date. So some of the same children -- Actually, 19 of the 29 -- served in both groups, in one case, serving as non-implanted deaf children and then later on were in the implanted group. For purposes of the language study that we did, we used the story re-tell task to elicit spontaneous language samples from these children. I should note that in this case, because these were all total communicators, we used both their signed and spoken utterances in this analysis. So our data are not just spoken language but signed and spoken. The implanted children, we have these data on them, pre-implant and then every year subsequent to their implantation. So for the children receiving implants, we have longitudinal data. The measure that we used to evaluate grammatical development in these children was the Index of Productive Syntax that was developed by Hall Scarborough. This measures the emergence of grammatical forms and, in particular, it emphasizes English grammatical forms. And that was one of the primary reasons that we selected the IPSON, was that, unlike mean length of utterance, which is often used as a general index of grammatical development, we wanted something in this case that was committed to English. One can get a higher MLU score even though the utterances that are produced are not at all well-formed in terms of English. So we wanted the index, the measure of grammatical development, to be reflective of English usage in case children were doing some pigeon signing or such. We didn't want to count that as evidence of grammatical development in this case. The first thing we did was to look at the IPSON scores for the non-implanted children. In this case, we found that the average score of 40.69, which doesn't mean a lot to you at this point, but from our experience with this measure, this is a score that's found in children who are around four years of age, normal-hearing children. Whereas, these deaf children, non-implanted deaf children, were, on average, nine years of age. We also found that there was a strong correlation between the IPSON scores of these non-implanted children and their chronological age. That correlation was .80. The fact that there was this strong relationship in these deaf children between IPSON score and age allowed us to develop a prediction, a linear prediction, of what an IPSON score should be in a deaf child given that child's age. Using that predictive system, we were able to then look at our implanted children and use their age and look at the IPSON scores that they obtained at a given age relative to the predicted scores. First of all, we looked at just the IPSON scores for the most recent examination, at the last visit that we had seen them, and the scores of the children at that point, their IPSON scores were 60.34. Therefore, they were about 20 points higher than the non-implanted group. Our implanted children were, on average, about ten years of age at this point; and the non-implanted children were nine years of age. So they were slightly older, but by using a covariance approach, we were able to compare the implant to the non-implant children and found that there was a statistically-significant difference to the -- in the direction of favoring the implant children on their IPSON scores. This tells us something about the statistical significance of the data, but to get a better feeling for possibly the clinical significance of these data, we asked how much better were these children who had received the cochlear implants than the predictions from the non-implant children. In doing this, we found that 16 of the 29 children with the cochlear implants were above the 95 percent confidence interval for prediction of new scores, which you can think of as essentially saying that 16 of the 29 children in our sample were above the 95th percentile for their age. That is, just blindly guessing, we would guess that they would be at the 50th percentile for deaf children and, instead, 16 of the children, more than half, 55 percent, were above the 95th percent confidence interval. We would expect, on average, to find about 5 percent of children above this 95 percent confidence interval. So that suggests that there is a subsequent improvement in grammatical development, English grammatical development, relative to these non-implanted children. Unlike the deaf children, we found that there was a rather low correlation -- In non-implanted deaf children, we found that there is a rather low correlation between chronological age and IPSON scores for the implanted children. We found a correlation in this case of .42. Whereas, it was .80 in the non-implanted children. This is somewhat surprising given that language growth is always well correlated with chronological age. The missing variance there can be found in looking at the correlation between years of implantation -- That could be their hearing age -- and their IPSON score. In this case, we found a correlation of .64, higher than their chronological age. This indicates, to me at least, that the child's implant experience, the length of the child's implant experience, begins to become a more important variable in accounting for their language development than the child's chronological age, and it adds a little more weight to the evidence that the implant is actually providing language benefit. We also looked at the growth of IPSON scores over the post-implant time. This is now across -- the individuals following the children along, and we found that there is a very clear growth trend in the development of IPSON scores away from the prediction so that for each year that we went out past implantation, the scores of the children increased in -- the difference between the scores that they got and their predicted scores increased. By two years of age post-implant or two years post-implant, there is a very clear difference between the two groups suggesting that by two years of age, we should see that there is a rather clear benefit provided by the implant for language development. Let me just now move onto the reading results and give you a brief summary of what we've learned so far on that. In recent years, it's been shown that children's development of reading is strongly influenced by their language ability. These are hearing children. Furthermore, children who are deaf have been found to be particularly poor in reading development, probably because of their English language skills. Given that, we would predict that children who are implanted and if, in fact, they're obtaining gains in terms of language, we should see concomitant gains in reading. We've begun to look at the reading skills of our implant children using the Woodcock Reading Mastery Test and, in particular, the passage comprehension subtest of this which evaluates the child's reading comprehension. The children that we gave this to were all children who were in first grade or higher and, therefore, had at least been exposed to reading instruction. The results of this reading comprehension test given at the most recent evaluation showed that they had an average percentile score of 30 compared to hearing age mates. Furthermore, those children who had gone past the fourth grade were averaging the 36th percentile. Whereas, the children below the fourth grade were at the 20th percentile. These data may suggest that there is actually gain in reading performance over grades and that implant children start off at a lower level of reading and actually make gains relative to their hearing peers in terms of reading development. We also looked to see -- It is well-known that most deaf children by the time they're in high school are still reading at or below the fourth grade level. We looked at all of the children in our sample who were in fifth grade or higher and found that 84 percent of the children in our sample, 3 of 19, were reading above the fourth grade level. And this compares with about 8 to 14 percent of non-implanted deaf adolescents. In fact, a group older than the children that were in this study. So, to summarize, our data are showing a consistently better level of language development in children with implant experience than in children who are deaf and not implanted and these data seem to be consistent with other data that are found. We are also now finding, in general, that earlier implantation leads to not only earlier -- an earlier start in language development, but also, it seems, steeper growth rates in language development. This then may support the trend that's already happening to implants at an earlier age and now there's greater consideration being given to implantation even in infancy, though this results in substantial challenges for evaluating children for candidacy at that point. So I'll end at that point and I'll take questions. TRACY BELL: My name is Tracy Bell and I'm from the National Association of the Deaf. I would like to ask: Is there any way that information is going to be printed or published? Is it published? BRUCE TOMBLIN: Yes. The grammatical data are published in the Journal of Speech, Language and Hearing Research. I believe it was in the -- this last year. LINDA SPENCER: I think it was April of 99. TRACY BELL: Thank you. BARBARA RAIMONDO: Hello. This is Barbara Raimondo from Washington, D.C. I wondered if you looked at any of the variables related to the parents. Did you do any kind of comparison of parents who chose implants versus ones who did not, and whether that influenced any of this? BRUCE TOMBLIN: Well, I'll let Linda probably comment on this more because she -- Our problem is that many of these, particularly with family backgrounds, were parents who, obviously in the implant group, had selected implants, and in the comparison group, even some of those children in the deaf comparison group went on to be implanted. So they were probably of the same background. Now, we did have a subgroup that were not. They were children who were not headed toward an implant program. I don't know, Linda, if you noticed a difference in the parents. LINDA SPENCER: There was a big variety as far as educational levels and SES levels in the group of children who ended up with hearing aids. The children in the group that did get cochlear implants, they are very similar, not a lot of variation in those two groups. BARBARA RAIMONDO: Right. I guess what I was thinking more along the lines of was level of parental involvement, because I'm wondering if maybe the cochlear implant itself had some kind of influence on level of parental involvement. LINDA SPENCER: In the group of children with hearing aids, they were a group of children who were in the public schools -- Some of them were in Wisconsin and some of them were in Iowa -- and I know that there is a very strong parental involvement in the hearing aid group. They have a very strong program there. I don't -- This wasn't looked at specifically, but I don't feel like there was a huge difference in those two levels of involvements. BARBARA RAIMONDO: Okay, thank you. LINDA SPENCER: Are there any other questions? ELISE DIMON: I have a question about what is the earliest stage that children are currently being implanted according to FDA regulations and where do we see that going in the near future? Are there any more plans to allow younger children to be implanted? This is Elise Dimon from Michigan. LINDA SPENCER: Okay. Hi. Currently, children must be eighteen months of age to receive a cochlear implants, but there are exceptions to that rule. For example, if a child has had hearing and suddenly loses their hearing to meningitis and is below that eighteen-month cutoff, there are -- those children may be allowed to get an implant earlier because of boney growth that could happen in the cochlear. So they want to get an implant in as soon as possible. I do know that there have been children around the world who have been implanted earlier than eighteen months. At this point, a lot is not known about that subset of children. That data is just now coming in. That is something our center is going to be looking at. We are currently writing a grant for the next five years. We get five-year grants and our next grant cycle is up. It is something we are going to start to look at because we feel this is a very important area, and one would intuitively think that the younger a child is that they get an implant, the better they may do, but there are surgical risks with younger implantation. So that's an area that's going to be approached with caution. ELISE DIMON: Okay, thank you. JUNE HOLSTRUM: Any other questions for Bruce or Linda? (NO RESPONSE WAS HEARD) If not, thank you very much, both of you, and we appreciate that presentation. Our next presenter is Paula Pittman from Utah State University to tell us about the deaf mentor program there. PAULA PITTMAN: Thank you for inviting me to be involved with this teleconference call and hello to everyone. I appreciate the opportunity to tell you about the Deaf Mentor program. It is a project that the SKI-HI institute began in 1993 as a federally funded three-year experimental project to investigate the effectiveness of Deaf Mentor services to young children who are deaf, ages birth to six years of age, and their families. These services focused on Deaf adults, known as mentors, who made regular home visits to the children and their families; taught the family ASL, and shared their culture, and personal knowledge of deafness with the families as well as serving as role models for the children. The children also received regular home visits from a hearing Parent Advisor who helped the family promote the child's early listening, English, and literacy skills. The result was a bilingual-bicultural home environment for these children. The children who received Deaf Mentor services were compared to matched children who did not receive these services but who received Parent Advisor services. The basic concept behind the Deaf Mentor project was to examine some ways that we could perhaps help families to create a bilingual-bicultural environment in their home and present children with exposure to both English and ASL, as well as Hearing and Deaf cultures. Currently, Parent Infant Programs across the country that are using SKI-HI materials train Parent Advisors, or Early Interventionists, to present information to families in a variety of areas, including auditory development, hearing aid use, communication development, early language development, and communication methodology options. We wanted to create a program that would fit with these current services being provided to families across the country and wanted to be able to provide families with a new option in communication methodology, the bilingual-bicultural, or bi-bi method. To do this we had to train and introduce Deaf adults into the current SKI-HI early programming model. So we hired and trained several Deaf Mentors, 12 initially, in the State of Utah to work with families in conjunction with Parent Advisors. While we were developing the program, we were also gathering data on the children and the services that they were receiving. We had an experimental group here in Utah of 18 children and a control group of 18 children in Tennessee. We wanted to observe the development of children in current SKI-HI programs where English was the primary language being presented to the child, either in spoken or manual form, with children who were receiving a bilingual-bicultural approach through the Deaf Mentor Program. We wanted a control group of children where half of the children were involved in an aural-oral methodology approach and the other half involved in a total communication approach. The experimental group was composed of children who were receiving a bi-bi approach with visits to the family by both a Parent Advisor and a Deaf Mentor. We ultimately went to Tennessee for the subjects in the control group because after the Utah families were told about the Deaf Mentor Project, all of the families who were using a total communication approach decided that they wanted to be involved in the Deaf Mentor Program, which placed them into the experimental group. That left us with no families who were receiving instruction in a total communication approach. Children and families for the control group were chosen from the Tennessee Infant Parent Program because it has a strong SKI-HI program that is implementing both aural-oral and total communication options for children and families and they were willing to be involved with the project. We did a series of evaluations with the children in both control and experimental groups. We conducted both pre- and post tests on all of the children, plus some data on the children periodically throughout the study. As you know, finding assessment tools for children who are under the age of five and are deaf or hard of hearing can be quite difficult. After much discussion and review, we decided upon a variety of evaluation tools. We selected the Patterned Elicited Syntax Test, the Grammatical Analysis of Elicited Language, and the Language Development Scale, which is a SKI-HI evaluation tool that relies on parent report. We also created two additional tools: a parent perception survey, which actually questioned parents on their ideas and concepts about the Deaf community and Deaf people, in general; and then also the communication data sheet, which is also a tool that relies on parent report. It was designed to evaluate the degree to which family members felt they could understand and communicate freely with their deaf child. It evaluates the child's communicative ability and the communication ability of the parents and other family members. The results of our study can be found in the American Annals of the Deaf, 1998, volume 123, no. 1, pp. 29-34. If you're interested in the article, I'll be glad to send a copy of it to you. In short, what we found was that Deaf Mentors making regular home visits to the family, in addition to program services provided by a Parent Advisor, made quite an impact, both on the child's language development and perhaps more importantly on the attitude and perception of families. What we found was that parents who were in this program were able to really move ahead with intervention with their children, were able to accept their children for who they were, were able to freely communicate with their children using both English in the manual form with simultaneous speech and ASL. In the end, parents were communicating freely with their children and children were freely communicating back with parents in a manner that was most appropriate and comfortable for them. Parents perceived no obstacles or barriers to communicating with their child. Parents involved in the Deaf Mentor Program seem to move more quickly through the grieving process. We believe this is due in part to the influence of the Deaf Mentor. Parents have become very comfortable and involved in the deaf community as a result of the program. This involvement has led to a greater understanding of their child's potential and possible future, and gives parents hope for their child , which, in turn, eliminates the fears that many parents face when they realize they have a child who is deaf or hard of hearing. One very interesting result that we found from this research project was that the kids who received bi-bi programming were, at the end of the 17month treatment time, performing better on assessments that evaluated English structures than the children in Tennessee who received aural-oral or total communication that emphasize the use of English alone. This seems to indicate that the learning of ASL actually strengthens the learning of English. Overall, children receiving this early bilingual-bicultural programming made greater language gains during treatment time, had considerably larger vocabularies, and scored higher on measures of communication, language, and English syntax than the matched children. There are limits to the study that should be pointed to. Number one, children in the Deaf Mentor program were provided with the additional service of the mentor to the services already being provided by the Parent Advisor. Children in Tennessee were not receiving additional services other than their weekly visit by their Parent Advisor. Also, our sample numbers were small. Our control and experimental groups had only eighteen subjects that could be matched on degree of hearing loss, amount of intervention service receive prior to treatment, and pretest scores. So there are things to consider about this study, as there are in all research studies. However, we have found that it has been very successful with the families here both in terms of perception and attitude toward their child and about deafness, and also in terms of communication and language development on the part of the parent and the child. After the completion of this experimental project, we wrote a grant to take the project to outreach. It was funded, and we are in the second year of a three-year outreach program where we are involved in training other states and helping them to establish Deaf Mentor programs. We have currently done training in Texas, Vermont, Arizona, and Wisconsin and will be beginning training in Ohio this fall. This year is booked up for training, but we have three training slots available for next year. So that's a little bit about this project. Are there any questions? MARY PAT MOELLER: Paula, this is Mary Pat. Are you open to requests for training in states? PAULA PITTMAN: Yes, we are. Hello, Mary Pat. Yes, we are open to that. Like I said, we have three slots available for next year. The training involves one day of awareness training, three days of on-site training with Deaf Mentors and Parent Advisors or Early Interventionists, and then one day of follow-up. MARY PAT MOELLER: And are you the contact person, Paula? PAULA PITTMAN: Yes, I am. MARY PAT MOELLER: Thank you. PAULA PITTMAN: You're welcome. JUNE HOLSTRUM: Any other questions for Paula? UNIDENTIFIED SPEAKER: Could we have Paula's telephone number or e-mail address? PAULA PITTMAN: Yes. I'll give you both. My phone number is (435) 797-5589. My e-mail address is ppittman@cc.usu.edu. JUNE HOLSTRUM: Thank you, Paula. Any other questions for Paula? LINDA SPENCER: Paula, this is Linda Spencer from Iowa. Do you think that if a child has a cochlear implant they will have a harder time being accepted into this program or being matched with an adult who uses ASL? PAULA PITTMAN: All I can speak of is our children here in Utah, but we have three kids in our program right now who have cochlear implants and we have had no problem matching them with a Deaf Mentor. However, their Deaf Mentors do not have cochlear implants themselves, but the cochlear implant will not exclude a child from this program. LINDA SPENCER: Great. PAULA PITTMAN: Part of the training that we provide to Deaf Mentors emphasizes the importance of remaining neutral on some of these really heavy issues like cochlear implants. The Deaf Mentors are encouraged to share their opinion and the opinion of the Deaf community as part of the information gathering that a parent goes through when they're trying to decide about cochlear implants, but they are really purely there to share that information, along with other information as well, positives and negatives, and to be supportive of the family regardless of how intense their interest in hearing aid use, auditory and speech development, or interest in cochlear implant. LINDA SPENCER: Thank you. JUNE HOLSTRUM: Thank you, Paula, and I hope you'll keep us informed as you continue with your next project. PAULA PITTMAN: We'd love to do that. Thank you. JUNE HOLSTRUM: Our last speaker is Susan Easterbrooks from Georgia State University. Susan is going to be talking about "Indicators of Success in Various Therapies for Children who are Deaf and Hard-of-Hearing." Susan?
SUSAN EASTERBROOKS: Thank you, June. I, like Paula, have managed to catch a little bug in the last few days. So if I start sneezing at you, I apologize. The study that I'm going to report on today is part of a larger study looking at various treatment options, and this particular study was auditory/verbal therapy. At the invitation of the Board of Trustees of an auditory/verbal international clinic here in the area, we studied a decade of A/V clients. The decade was from January, '86, through December, '95. As you know, auditory/verbal therapy is an early habilitation approach. It's not a classroom intervention approach. The present study looked retroactively at this decade and followed-up with phone calls to the parents. The purpose of this study was to identify the general demographics of the children who availed themselves of auditory/verbal therapy and, secondly, to identify child and family factors associated with differences between those clients for whom the therapy led to success and for whom it did not. As I said, the study was done with retroactive case reviews followed up by telephone interviews with the parents. The interviews lasted anywhere from forty-five minutes to two and a half hours, depending upon the parents' willingness to share. We identified approximately 161 individuals who could -- who were in that pool who had attended that therapy over the decade. 51 were culled from the study because they had been enrolled for less than one year. We culled them based on the assumption that at least one year of therapy was needed before any treatment effect would be seen. That left 110. Of the 110 cases, 72, or 65.1 percent, participated in the interview. During the interview, we asked general questions whether the students had graduated or whether the family had left dissatisfied. The second group that either graduated or left dissatisfied equaled 40 students, and that became the focus of the second part of the study. Regarding the traits of the overall population, we found that most of the subjects came from a very atypical group -- a very atypical group of families. 95.8 percent of the mothers in the group had completed high school, 63 percent completed college or greater. 56 percent of the mothers worked outside of the home and 89 percent of the parents reported annual income in 1997 in excess of fifty thousand dollars. So it was an atypical group. In general, regarding the overall clinic population, we found that there were fewer males than the U.S. deaf population. There were more females. There were 98 percent Caucasians as opposed to 58 percent in the general school-aged U.S. population based on the annual Gallaudet survey. Approximately 80 percent of the population did not have any additional disability. Whereas, about 60 percent of the overall population did have some kind of additional problems that they were dealing with. Mothers typically worked. As I said, the income was typically higher. Interestingly, of the overall population, outcomes for this group were that 57 percent of the students that received the program were in regular education classes full-time with only 30 percent being with any kind of assistance from a special education teacher. Regarding the groups that we labeled the graduates versus the leavers, that is those whose parents took their children out of the program because they were dissatisfied, again, there were more females who graduated than males, 80 percent versus 36.5 percent. Again, a lower rate of additional disabilities. Only 38 percent of the graduates had implants, but you have to recall that -- although it's an auditory/verbal therapy, you have to recall the decade that was studied beginning in '86. I would imagine that if you looked at more recent figures, then the number of implants in that particular population would increase. Of the population of students who graduated from auditory/verbal therapy, 75 percent were in regular education services with no contact or services at all from a teacher of the deaf, including no services from a speech and language pathologist, which really surprised me. We did some Chi-squares and t-tests to look at significant differences between the graduates and those whose families took them out dissatisfied and found a high degree of significance, .008 level, for sex of the child with there being a great benefit in the direction of females. That was the most notable specific. In addition, we asked the parents of these children to give us information regarding the children's language gap at this particular point in time and we asked them to give us information from the IEPs. If they did not have the IEP, we asked them to report any assessment information that they had. We also used information from the A/V clinic. If we didn't have that, then we asked the parents to tell us the current reading level or to identify a reader or a book the child was currently successfully reading, and we compared those to standards which identified grade placement. And we found that looking at gaps in language and reading, greater than one year versus less than one year, there was a statistically significant difference between the graduates and the children who left. Most of the graduates were within a year of language and reading age compared to the group who had left. We also need to note here that the unaided peer tone average scores of the graduate tended to be lower, the mean unaided score, with a mean of 79 dB compared to the leavers, whose mean was 94 dB. The children who graduated enrolled earlier by about a year and a half and stayed longer by about a year and a half. So length of stay in the program was a contributing factor. Sex was a contributing factor, and it's really difficult to tease out other aspects because the group was such an unusual group relative to the general education population to begin with. A-V therapy typically is available in the private sector. If in fact the children who graduated from this program were so successful in becoming integrated into regular education, then the question becomes: How can the essential elements of A-V therapy be made more generally available through public services? We're following this up with looking at the specifics and looking at the data on the families who left early, that is, left before they had been there for a year, to find out what options they chose and to find out current placement conditions for their children.
UNIDENTIFIED SPEAKER: Susan, where did you say this was published? SUSAN EASTERBROOKS: This has been -- This was presented at the American Otological Society and it has been submitted to the Journal of the American Otological Society. It is currently under their editorial review and we've been through the first round of suggested revisions. So I'm hoping they'll accept this next round. UNIDENTIFIED SPEAKER: Okay, thanks. JUNE HOLSTRUM: Maybe, Susan, when that is published or when you have a publish date, you can announce that in one of the future teleconferences. SUSAN EASTERBROOKS: All right. Thank you. JUNE HOLSTRUM: Any other comments, or questions, or announcements from any of our listeners before we close? PAT DEWEY: June, this is Pat Dewey from Virginia. I tuned in a little bit late. Could you tell us what the status of the national database is? JUNE HOLSTRUM: Yes. There's not a lot of change from last time. We have finished the pilot in which four states participated. We are in the process of putting the data together. We will be talking next week at the DIPS meeting to see if we want to make further revisions. Then, at that point, it would be available for any state that would like to participate and send in their '98 data. So not much we can say right now about how it came out, but we will have more information on that later. We would like to hear from whatever states that would like to participate. We'll be talking more, like I said, at the DIPS meeting and then deciding how we want to get that information out to everyone. PAT DEWEY: Great, thanks. JUNE HOLSTRUM: Any other questions? If not, that's our program for today. Our next meeting will be November 2nd. Again, thank you for joining us and we'll talk to you in November. |