The World of Deaf Infants: A Longitudinal Study
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《新英格兰医药杂志》
Tremendous changes in the identification of, intervention for, and outcome of children with permanent hearing loss have occurred in the United States in the past 10 years. Data published as recently as 1986 by Gallaudet University indicated that youngsters whose deafness had been identified late were graduating from schools for the deaf in the United States with a third-grade reading ability. Recommendations made in 1994 by the Joint Committee on Infant Hearing that all infants be screened for hearing by one month of age, be given a diagnosis by three months, and receive interventional services by six months have resulted in major changes for children with permanent hearing loss and their families. This year, more than 90 percent of newborns in the United States are being screened at birth for permanent hearing loss, as compared with 5 percent in 1993.
The mean age at identification has dropped from 30 months in 1988 to 3 months, in most states, in 2004. Several studies have reported substantially improved outcomes in language, communication skills, and speech for children with hearing loss who receive interventional services by six months of age.
The publication of The World of Deaf Infants could not be more timely for the professionals who are providing services for increasing numbers of infants whose permanent hearing loss is identified early. There have been few prior published reports of outcomes in infants younger than two years of age. The research reported by Meadow-Orlans and colleagues is unique in that it is multidimensional, covering mother–infant interaction, mastery motivation, attachment, temperament, language, visual attention, play, and intervention. The investigators studied four groups of mother–child dyads: deaf mothers with deaf infants, deaf mothers with hearing infants, hearing mothers with deaf infants, and hearing mothers with hearing infants.
Longitudinal, detailed demographic and environmental data on mothers and infants — including maternal support systems, education, and stress and videotaped assessments of the mother–infant dyads when the children were 6, 9, 12 and 18 months of age — were collected and analyzed. The data demonstrate the unique nature of the communication styles and linguistic messages between the mothers and their infants. For example, deaf mothers with deaf infants almost always have more visual and tactile communication, with fewer linguistic messages, than do hearing mothers and children. This is attributed, in part, to the fact that visual conversation is slower than heard conversation and that deaf mothers appear to respond more synchronously than hearing mothers to the cues of their deaf infants. At 18 months of age, 22 percent of hearing children with hearing mothers, 37.5 percent of deaf children with deaf mothers, and 20 percent of hearing children with deaf mothers use multiword or multisign utterances, as compared with none of the deaf children with hearing mothers.
Language development for the total cohort of children with hearing loss in this study was not as nearly optimal as that indicated in other recent reports. This may be related, in part, to differences in the characteristics of the cohort or to a more comprehensive laboratory assessment of language.
The final chapter discusses the implications of the study results for the provision of appropriate interventional services for infants and their families. The results confirm that outcomes at 18 months of age are the product of a complex interaction of multiple factors among mothers and children, including maternal support systems, intuitive parenting skills on the part of the mother, and the efforts of knowledgeable professionals who are skilled in terms of the needs of children with hearing loss.
The conclusion of this longitudinal study is that, with appropriate support and early intervention, outcomes for infants with hearing loss and their families will continue to improve. A statement attributed to I. King Jordan, the first deaf president of Gallaudet University, seems to say it all: "Deaf children can do anything except hear."
Betty R. Vohr, M.D.
Women and Infants Hospital
Providence, RI 02905
bvohr@wihri.org((Perspectives on Deafness)
The mean age at identification has dropped from 30 months in 1988 to 3 months, in most states, in 2004. Several studies have reported substantially improved outcomes in language, communication skills, and speech for children with hearing loss who receive interventional services by six months of age.
The publication of The World of Deaf Infants could not be more timely for the professionals who are providing services for increasing numbers of infants whose permanent hearing loss is identified early. There have been few prior published reports of outcomes in infants younger than two years of age. The research reported by Meadow-Orlans and colleagues is unique in that it is multidimensional, covering mother–infant interaction, mastery motivation, attachment, temperament, language, visual attention, play, and intervention. The investigators studied four groups of mother–child dyads: deaf mothers with deaf infants, deaf mothers with hearing infants, hearing mothers with deaf infants, and hearing mothers with hearing infants.
Longitudinal, detailed demographic and environmental data on mothers and infants — including maternal support systems, education, and stress and videotaped assessments of the mother–infant dyads when the children were 6, 9, 12 and 18 months of age — were collected and analyzed. The data demonstrate the unique nature of the communication styles and linguistic messages between the mothers and their infants. For example, deaf mothers with deaf infants almost always have more visual and tactile communication, with fewer linguistic messages, than do hearing mothers and children. This is attributed, in part, to the fact that visual conversation is slower than heard conversation and that deaf mothers appear to respond more synchronously than hearing mothers to the cues of their deaf infants. At 18 months of age, 22 percent of hearing children with hearing mothers, 37.5 percent of deaf children with deaf mothers, and 20 percent of hearing children with deaf mothers use multiword or multisign utterances, as compared with none of the deaf children with hearing mothers.
Language development for the total cohort of children with hearing loss in this study was not as nearly optimal as that indicated in other recent reports. This may be related, in part, to differences in the characteristics of the cohort or to a more comprehensive laboratory assessment of language.
The final chapter discusses the implications of the study results for the provision of appropriate interventional services for infants and their families. The results confirm that outcomes at 18 months of age are the product of a complex interaction of multiple factors among mothers and children, including maternal support systems, intuitive parenting skills on the part of the mother, and the efforts of knowledgeable professionals who are skilled in terms of the needs of children with hearing loss.
The conclusion of this longitudinal study is that, with appropriate support and early intervention, outcomes for infants with hearing loss and their families will continue to improve. A statement attributed to I. King Jordan, the first deaf president of Gallaudet University, seems to say it all: "Deaf children can do anything except hear."
Betty R. Vohr, M.D.
Women and Infants Hospital
Providence, RI 02905
bvohr@wihri.org((Perspectives on Deafness)