Reading Proficiency Trends Following Newborn Hearing Screening Implementation

On average, literacy outcomes of school-aged children with hearing loss in the United States have been below basic levels, with the gap with hearing peers increasing with age. Dr. Yoshinago-Itano and colleagues (2021) investigated school-aged reading scores among students with hearing loss in an urban Colorado school district after implementation of universal newborn hearing screening (UNHS) and Early Hearing Detection and Intervention (EHDI). 

Participants were students in third to tenth grades who were born between 1990 and 2006, were identified with hearing loss by audiologists, were enrolled in the district at some point during the 2000–2001 through 2013–2014 academic years, and had at least one state assessment. The final sample included 1,422 assessments conducted during the aforementioned school years for 321 children with hearing loss in grades 3–10. These years were chosen to capture children born before and after UNHS implementation (1998).

Longitudinal hierarchical linear modeling analyses were used to examine reading proficiency (controlling for birth year, grade in school, free and reduced lunch status, additional disability services, and English not spoken in the home) as measured by either the Colorado Student Assessment Program (CSAP) or the Transitional Colorado Assessment Program (TCAP). 

Because children born in different years experienced different exposure to UNHS and EHDI, the effect for time was divided into two variables: birth year and grade in school. Birth year captures the between-child differences based on birth cohort with later birth years reflecting increased exposure to UNHS and EHDI diagnostic and early intervention. Grade in school reflected the growth or decline (annually) in proficiency over time, capturing the within-child differences. 

After the implementation of UNHS and EHDI in Colorado, significant improvements in reading proficiency of successive birth cohorts of students with hearing loss were observed. Gains were observed both within students, year-to-year over time, and between students in different birth year cohorts. Despite sociodemographic disparities, significant shifts to higher levels of proficiency since 2000–2001 were observed in all groups with hearing loss. Reading proficiency gains were similar irrespective of the language spoken in the home. Children with unilateral hearing loss had similar proficiency gains to children with mild-moderate bilateral hearing loss.

Not all groups of children, however, experienced equivalent gains in reading proficiency. Children with moderate-severe to profound hearing loss had significant gains of lesser magnitude than those with unilateral or mild-moderate bilateral hearing loss. Most concerning was that, although children eligible for free or reduced lunch (FRL) made significant gains, these gains were less than half the gains experienced by children from higher-income families.

This study provides further evidence that children with hearing loss post UNHS and EHDI implementation can experience substantial literacy gains. The increased sociodemographic disparity in reading proficiency among children with hearing loss in this study indicates a health equity issue. This is of particular concern because it suggests that the provision of intervention services after early identification may favor children in relatively advantaged families compared with those in disadvantaged families.

UNHS is only the first step in the EHDI process; improved outcomes depend on early diagnosis and intervention along with minimizing disparities in receipt of services

Reference

Yoshinaga-Itano C, Mason CA, Wiggin M, et al. (2021) Reading proficiency trends following newborn hearing screening implementation. Pediatrics 148(4):e2020048702