Children who are hard of hearing (HH) have mild through moderately severe hearing loss. These children are at-risk for long-term developmental difficulties due to limitations in their access to the auditory information in their world and in particular limitations in their access to spoken communication. Many of these children now receive clinical hearing and speech/language services to address this risk;however there has been very little research that focused on these children. This research gap was addressed during the current funding period with a large cohort of preschool-aged HH children via the Outcomes of Children with Hearing Loss (OCHL) project. Our research to date indicates that some children and some domains of development are more susceptible than others to the presence of mild to severe hearing during the preschool years. Vulnerabilities were most evident in areas dependent on processing fine details in the linguistic input, including syntax, grammatical morphology, phonology, and meta-phonological skills. Vocabulary and pragmatic language skills (related to social cognition) also showed effects of hearing loss. Additionally, we have identified systematic effects of degree of hearing loss on speech and language outcomes, as well as the protective effects of aided audibility on these outcomes. From this work, we have begun to construct an account of the basis for the observed variability in outcomes of HH children as well as its impact on development. The proposed research will extend this inquiry into the early school years.
Our aims i n this research concern whether the communication vulnerabilities we have seen in the preschool years persist into the school years and contribute to academic difficulties as well as continued communication problems. We are also interested in whether the early intervention received in the preschool years protects these children from some of the negative outcomes associated with early hearing loss. Finally, we plan to describe the special services and mainstream classroom environments these children find themselves in and whether these services and environments influence their outcomes. To accomplish this we will follow 276 HH children and 140 normal hearing (NH) classmates through 4th grade and obtain extensive information on their spoken language development and academic achievement. Additionally, for the HH children, we will obtain measures of services provided and their classroom environments during their 3rd and 4th grades. Also, of the HH children, 196 of them will have participated in our preschool longitudinal study and thus extensive information concerning hearing, speech/language services and early interventions can be associated with these school age outcomes. This study will inform theories about the consequences of inconsistent access to auditory input for developmental outcomes. Furthermore, our findings will provide empirical evidence to guide best practices by identifying early and concurrent risk and protective factors, identifying contributions of school-based interventions, and determining which children are at risk for late-emerging reading comprehension difficulties.

Public Health Relevance

This project will obtain critical information regarding the language and academic outcomes of a large group of children with mild to severe hearing loss in the school years. We will extend our comprehensive evaluation of preschoolers into the school age years, which will provide important insights into the effectiveness of interventions designed to minimize the consequences of hearing loss on language and academic development. Our findings regarding the relative contributions of auditory skills to outcomes will inform theories about developmental consequences of inconsistent linguistic access. These data will guide evidence-based practice and policy for the clinical management of children who are hard of hearing.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZDC1-SRB-Z (26))
Program Officer
Donahue, Amy
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Iowa
Other Health Professions
Schools of Arts and Sciences
Iowa City
United States
Zip Code
Arenas, Richard M; Walker, Elizabeth A; Oleson, Jacob J (2017) Developmental Stuttering in Children Who Are Hard of Hearing. Lang Speech Hear Serv Sch 48:234-248
Walker, Elizabeth A; Ambrose, Sophie E; Oleson, Jacob et al. (2017) False Belief Development in Children Who Are Hard of Hearing Compared With Peers With Normal Hearing. J Speech Lang Hear Res 60:3487-3506
McCreery, Ryan W; Brennan, Marc; Walker, Elizabeth A et al. (2017) Perceptual Implications of Level- and Frequency-Specific Deviations from Hearing Aid Prescription in Children. J Am Acad Audiol 28:861-875
Walker, Elizabeth A; Spratford, Meredith; Ambrose, Sophie E et al. (2017) Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions. Am J Audiol 26:38-52
Lewis, Dawna; Kopun, Judy; McCreery, Ryan et al. (2017) Effect of Context and Hearing Loss on Time-Gated Word Recognition in Children. Ear Hear 38:e180-e192
Walker, Elizabeth; McCreery, Ryan; Spratford, Meredith et al. (2016) Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes. J Am Acad Audiol 27:204-18
Ambrose, Sophie E; Thomas, Anne; Moeller, Mary Pat (2016) Assessing Vocal Development in Infants and Toddlers Who Are Hard of Hearing: A Parent-Report Tool. J Deaf Stud Deaf Educ 21:237-48
Harrison, Melody; Page, Thomas A; Oleson, Jacob et al. (2016) Factors Affecting Early Services for Children Who Are Hard of Hearing. Lang Speech Hear Serv Sch 47:16-30
McCreery, Ryan; Walker, Elizabeth; Spratford, Meredith et al. (2016) Stability of Audiometric Thresholds for Children with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Implications for Safety. J Am Acad Audiol 27:252-63
VanDam, Mark; Silbert, Noah H (2016) Fidelity of Automatic Speech Processing for Adult and Child Talker Classifications. PLoS One 11:e0160588

Showing the most recent 10 out of 37 publications