1. Language Outcomes, Growth, and Predictors of Success: A Multi-State (NECAP) Perspective
WREIC
June 16, 2017

2. Presenter Allison Sedey, Ph.D., CCC-SLP, CCC-A
University of Colorado-Boulder
Colorado School for the Deaf and the Blind

3. Additional Author Christine Yoshinaga-Itano, Ph.D.
University of Colorado-Boulder

4. Acknowledgements Early interventionists in NECAP states
Participating families
Assessment Coordinators: Clare Neville, Anna Clark, and Mallene Wiggin
A long list of SLHS undergraduate and graduate student employees who assisted in scoring test protocols and data entry

5. Today’s Topics Brief description of NECAP Sample characteristics
Factors associated with more successful language outcomes
Language outcome data over time
Strengths and limitations in specific language skills

6. What is NECAP? All families are participating in NECAP
National Early Childhood Assessment Project
CDC-supported project examining language outcomes at a national level
Birth to 3
Children who are deaf or hard of hearing

7. Motivation for NECAP
2007 JCIH Position Statement (Goal 6 of 2013 Supplement) “All children who are D/HH should have their progress monitored every 6 months from birth to 36 months of age, through a protocol that includes the use of standardized, norm- referenced developmental evaluations”

8. Motivation for NECAP
Using a common set of instruments across states allows us to:
Examine outcomes nationally (rather than from a single program or state)
Improve the validity of outcome results by increasing sample size
Include children who are participating in different amounts and types of intervention

9. Demographic Characteristics of Participants with Bilateral Loss
English, Spanish and/or ASL used in the home
With and without additional disabilities
All degrees of hearing loss
Demographics that follow based on 448 children in predictive study
Individual studies vary slightly (by a few percentage points)

10. Participant Characteristics: EHDI Guidelines
Age at…
Mean (mos)
Identification
4.1
Intervention 7
*58% of children met the EHDI guidelines

11. Participant Characteristics: Degree of Hearing Loss%
Mild
35%
Moderate
22%
Moderately severe
15%
Severe 8%
Profound
20%

12. Participant Characteristics: Type of Amplification%
None
11%
Hearing aid
68%
Cochlear implant
16%
Bone conduction aid 5%

13. Participant Characteristics: Mother’s Level of Education
Highest degree completed
% of primary caregivers
Less than HS
13%
High school diploma
38%
Vocational or Associates
20%
Bachelor’s degree
22%
Graduate degree 7%

14. Participant Characteristics: Communication Mode
Communication mode used with child by family
% of primary caregivers
Primarily spoken language
74%
Spoken only
30%
Very occasional sign used
44%
Spoken + sign language
22%
Sign only 4%

15. Assessment Instruments

16. Assessments Minnesota Child Development Inventory
12 months to 6 years
Expressive Language and Language Comprehension subscales
MacArthur-Bates Communicative Developmental Inventory
8 to 30 months
Expressive vocabulary subscale (in spoken and/or sign language)

17. Assessment Characteristics
All 3 of the assessments are:
Standardized
Norm-referenced (normed on children who are hearing)
Parent report

18. Minnesota Child Development Inventory
Parents respond “yes” or “no” to a variety of statements about their child
Examples:
“Has a vocabulary of 20 or more words”
“Uses the word ‘not’ in sentences
“Expresses likes and dislikes in words”

19. MacArthur Bates Communicative Development Inventory
List of 680 words divided into semantic categories (toys, food, action words, descriptive words, etc.)
Parents indicate words their child produces
In spoken language
In sign language

20. Determining Language Quotient
Language Age/Chronological Age x 100
If LQ = 100, Language Age = CA
If LQ < 100, Language Age < CA
If LQ > 100, Language Age > CA
Average Range
Minnesota: LQs of 80+
MacArthur: LQs of 75+

21. Three Separate Studies
Titles of the 3 studies
“Predictive Analysis”
“Growth Analysis”
“Item Analysis”
What is different
Number of participants
Demographic characteristics (but very similar across studies)

22. Predictive Analysis: MacArthur Expressive Vocabulary

23. MacArthur Predictive Analysis: Participant Criteria
Bilateral, pre-lingual hearing loss
(all degrees -- mild to profound)
No diagnosis of auditory neuropathy
English or Spanish is written language of the home
Children with and without additional disabilities included

24. MacArthur Predictive Analysis: Number of Participants
448 children
Child’s most recent assessment used
Chronological age
Range = 8 to 39 months
Mean = 25 months

25. States Represented in Predictive Analysis
Arizona
California
Florida
Idaho
Indiana
Maine
North Dakota
Oregon
Texas
Utah
Wisconsin
Wyoming

26. Predictors of Better Vocabulary Outcomes: Multiple Regression
Significant predictors of MacArthur expressive vocabulary quotient
Presence of additional disabilities
Meeting EHDI guidelines
Higher mother’s level of education
Lesser degrees of hearing loss
Parent who is deaf or hard of hearing
Quotient decreases with age so gap between CA and Language Age is widening over time

27. Group Comparisons: Children with no additional disabilities
meets
Mild-Mod

28. Relationship of vocabulary quotient and chronological age

29. Group Comparisons: Vocabulary Quotient and Chronological Age
< 24 months
24+ months

30. Exploring the widening language gap
Exploring the widening gap between chronological age and language age
When does the gap begin?
How much does it widen over time?
Which general areas of language demonstrate the biggest gap?
Which specific language skills contribute least and most to the gap?

31. Growth Analysis: Minnesota Language and MacArthur Expressive Vocabulary

32. Growth Analysis: Participant Criteria
Bilateral, pre-lingual hearing loss
(all degrees -- mild to profound)
No diagnosis of auditory neuropathy
English is written language of the home
No other disabilities that would affect speech or language development

33. Minnesota CDI Growth Analysis: Number of Participants/Assessments
Outcomes are a combination of cross- sectional and longitudinal data
457 children
Assessed on 1 to 5 occasions
Total assessments = 739

34. MacArthur CDI Growth Analysis: Number of Participants/Assessments
Outcomes are a combination of cross- sectional and longitudinal data
634 children
Assessed on 1 to 5 occasions
Total assessments = 1,066

35. States Represented in Language Growth Analysis
Arizona
California
Florida
Idaho
Indiana
Maine
Minnesota
New Mexico
North Dakota
Oregon
Texas
Utah
Wisconsin
Wyoming

36. Growth Analysis: Participant Characteristics
Chronological age
Range = 12 to 35 months
Minnesota mean CA = 24 months
MacArthur mean CA = 23 months

37. Minnesota CDI: Expressive Language Subscale

38. Minnesota CDI: Language Comprehension/Conceptual Lang

39. MacArthur-Bates CDI: Expressive Vocabulary

40. MacArthur-Bates CDI: Expressive Vocabulary Size – 50th Percentile

41. Item Analysis: Minnesota Expressive Language and Language Comprehension

42. Item Analysis: Participant Criteria
Bilateral, pre-lingual hearing loss
(all degrees -- mild to profound)
English is written language of the home
No other disabilities that would affect speech or language development

43. Minnesota CDI Item Analysis: Number of Participants/Assessments
Outcomes are a combination of cross- sectional and longitudinal data
535 children
Assessed on 1 to 6 occasions
Total assessments = 935

44. Minnesota CDI Item Analysis: Participant Characteristics
Chronological age
Range = 12 to 35 months
Mean = 24 months

45. Primary Contributing States (each > 5% of the database)
Colorado – 39%
Idaho – 20%
Arizona
Indiana
Texas
Wisconsin

46. Secondary Contributing States (< 5% of the database)
California
Florida
Maine
Minnesota
New Mexico
North Dakota
Oregon
Utah
Wyoming

47. Minnesota CDI Item Analysis: Results: Language Quotients
Expressive Language
Median = 95
LQ of 80 and above = 79%
Comprehension and Conceptual Language
Median = 87
LQ of 80 and above = 65%

48. Determining Item Age Level
Group children into 3-month age brackets (e.g., “12 month group” = 12 to 14 months)
Find the first age group at which 75% of the children achieve a given item
These same procedures followed in the test’s normative sample

49. Linguistic skills at age level
Non-verbal communication
“Points”
Asks for drink or food using words or sounds
Early verbal communication (first 20 to 40 words)
Uses at least 10 words
Greets people with “hi” or similar expression

50. Linguistic skills at age level
Basic comprehension
Follows simple instructions
Understands the meaning of “up” and “down”
Rote language
Says/signs “please” and “thank you”
Greets people with “hi” or similar expression

51. Linguistic skills: Mildly delayed
Comprehension of early conceptual vocabulary
Understands what “off” & “on” mean
Understands what “open” & “close” mean
Concrete, single word utterances
Names a few familiar objects in picture books
Uses 50 or more different words

52. Linguistic skills: Moderately delayed
Early number concepts
Understands “one” and gives you just one when you ask for “one”
Use of first pronoun
Says/signs “mine” or “my”

53. Linguistic comprehension skills: Severely delayed
Prepositions
Understands the meaning of at least 3 location words (“in,” “on,” “under,” etc.)
Complex comprehension
Follows 2-part instructions

54. Linguistic production skills: Severely delayed
Pronoun use
Use of negative forms (not, don’t, won’t, can’t, etc.)
Conceptual vocabulary
“Points to/names the bigger of 2 objects”
“Expresses feelings in words”
Says/signs when something is heavy

55. Linguistic production skills: Severely delayed
Grammar
Uses plural words (e.g., “girls,” “cats”)
Asks questions with ‘what’ or ‘where’
Uses the words “a,” “an,” and “the”

56. Summary Better language scores are associated with:
Absence of additional disabilities
Meeting the EHDI guidelines
Higher maternal level of education
Less significant degrees of hearing loss
Parent who is deaf/hoh

57. Summary
One of the strongest predictors of language quotients is chronological age
As CA increases, Language Quotient decreases

58. Summary
As language demands increase over time, gap between CA and Language Age widens
Divergence from age expectations starts at:
25 mos for general, surface structure expressive language
20 mos for cognitive-linguistic skills
16 mos for expressive vocabulary

59. Summary
By 35 months of age the gap between language age and chronological age is:
7 mos for general, surface structure expressive language
8 mos for cognitive-linguistic skills
12 mos for expressive vocabulary

60. Summary
The majority of 12- to 18-month level language items are demonstrated at or close to on schedule
Children who are d/hoh demonstrated delays on almost all language items at or above the 21-month level

61. Summary
Beginning at 19 mos, hearing children produce 35 to 40 new words per month
Beginning at 19 months, children who are deaf or hard of hearing average 15 new expressive words per month
It is important for parents and interventionists to keep typical development in mind when assessing progress and setting goals

62. Summary
Average language scores for a group of children from birth to 3 typically underestimate the skill level of children below 2 years of age and overestimate the skills of children above 2 years of age
Research and accountability data for this age range should divide the children into two age groups