Many other functional assessments based on report of behaviors are being developed for assessing outcomes in children with hearing loss. For example, the Functional Auditory Performance Indicators (FAPI), from Stredler-Brown and Johnson (2001), address many functional areas, including localization, discrimination, and short-term auditory memory. It can be used over time to map a given child’s progress. Each of these inventories has strengths in evaluating certain aspects of auditory development and may best be suited to a particular environment or degree of hearing loss.

Direct Measures for Toddlers and Young Children. To be appropriate for infants and toddlers, measures of speech perception ability that can be used to evaluate adequacy of amplification must be modified to be age appropriate for both the task and the perceptual skills of the children. If speech stimuli are used, the influence of the children’s linguistic capacity on speech perception must be considered carefully. For example, it is easier to perceive words in one’s vocabulary or to perceive a sentence when one has the grammatical capacity to construct such a sentence. Eisenberg and Dirks (1995) looked at children’s ability to judge speech clarity using paired comparison and category rating tasks. They found that by 5 years of age, children could make reliable clarity judgments of distorted speech, especially with the paired comparison method. Dawson, Nott, Clark, and Cowan (1998) evaluated a test procedure using a play paradigm for assessing the ability of young children to discriminate between pairs of speech sounds. They found that 82 percent of 3- and 4-year-old children and 50 percent of 2-year-old children could perform this task and would reliably indicate when two stimuli were discriminated. Boothroyd and colleagues have developed an imitative speech perception test that allows for evaluation of speech feature perception in toddlers and has the added attraction of allowing a comparison of visual, auditory, and auditory + visual perception ability (Kosky and Boothroyd, 2003). This simple task (IMSPAC) can be used with toddlers as young as 3 years of age. To date, we know of no studies that have used these measures to evaluate the outcome of amplification in children.

Age at Amplification. Both Yoshinaga-Itano et al. (1998) and Moeller (2000) have found that language outcomes in children with hearing loss are significantly related to age at intervention. Specifically, both studies found that if infants are enrolled in an early-intervention program for deaf and hard-of-hearing children before 1 year of age (Yoshinaga-Itano found 6 months to be critical and Moeller found 11 months), there is a significant positive effect on the child’s later language ability. Conversely, delayed intervention leads to poorer language outcomes in children. However, in



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