Health Care Initiatives & Primary Health Outcomes
Dictate the Importance of Hearing Loss as a
Public Health Priority
Healthy People 2010
In the early 2000s the US Department of Health and Human Services issued a set of national health objectives known as Healthy People 2010. These objectives identified the most significant preventable threats to people’s health and established national goals to reduce these threats. The fact that early detection of hearing loss was included in this important national plan is a significant indication of how the identification of hearing loss has become a public health priority. The goals states:
Increase the proportion of newborns that are screened for hearing loss by age 1 month, have audiologic evaluation by age 3 months, and are enrolled in appropriate intervention services by age 6 months.
Advances in Perinatal and Neonatal Care
During the last 3 decades, advances in perinatal and neonatal care have been made that dramatically improve the survival rate and quality of long-term survival for very low birth weight (VLBW) infants (<1500 grams). Along with improved survival of infants weighing less than 1500 grams, the quality of long-term survival also has improved, particularly in larger infants. With 95% survival of infants weighing 1001 to 1500 grams, long-term studies generally suggest that the majority of these infants are perfectly normal (Robertson, Saue, and Christianson, 1994). However, while advances in medical care have enhanced survival rates for these infants (1001 to 1500 grams), increasing numbers of smaller infants are at risk for a host of adverse sequelae, particularly those less than 750 grams.
Studies note the high rate of significant morbidity evident in the smallest infants, particularly those less than 750 grams. As reported by Hack, Taylor, Klein, et al. (1994), infants weighing less than 750 grams born in the mid-1980s had decreased cognitive ability, psycho-motor skills, academic achievement, and poor social and adaptive skills. In addition, Hack et al. concluded that of the children studied with birth weights less than 750 grams, 1% had deafness and 22% had mild to moderate hearing loss. These data provide some explanation for the thirty to 40% of children with hearing loss demonstrating additional disabilities that may have concomitant effects on communication and related development (Gallaudet University Center for Assessment and Demographic Study, 1998; Schildroth & Hotto, 1993). Other handicapping conditions that can coexist with hearing loss and serve to exaggerate the effects of the hearing impairment on developmental processes are listed below. As such, interdisciplinary assessment and intervention are essential to address the developmental needs of all children who are hard of hearing or deaf, particularly those with additional developmental disabilities.
Additional Handicapping Conditions* among Children
Who are Hard-of-Hearing or Deaf
Physical Conditions
Asthma
Brain damage or injury
Cardiovascular defects
Cerebral palsy
Endocrine abnormalities (e.g., hypothyroidism, diabetes, kernicterus)
Epilepsy
Immunologic abnormalities
Kidney defects
Legal blindness
Neurologic abnormalities
Orthopedic abnormalities
Uncorrected or uncorrectable visual problem
Cognitive Intellectual Conditions
Mental retardation
Specific learning disability which may include: visual/auditory perceptual problems; fine motor coordination problems; attention deficit
disorder; developmental delay.
Emotional/behavioral problems which may include: autism spectrum
disorder; hyperactivity; passive/withdrawn behavior (social
isolation);reduced self-esteem; aggressive/abusive behavior;
unfounded physical complaints and symptoms.
* Sixty to seventy percent of children present with no additional handicapping conditions, while 30 % to 40 % present with one
(or more) additional handicapping conditions.