Language Underperformance in Young Children Who Are Deaf or Hard-of-Hearing: Are the Expectations Too Low?

The families may have enrolled because they were worried about their child's language, so the sample could contain more children with language concerns than the general deaf or hard-of-hearing population. The analysis used one time point, so it cannot show how language relative to nonverbal IQ changes over time or whether language underperformance causes later problems. The study was not powered to look separately at age groups or hearing-device status, so subgroup patterns are uncertain. Early intervention frequency and duration, device-wearing consistency, and otitis media with effusion history were not measured. School placement was parent-reported and could be inaccurate during summer months, and individualized education program information was not collected. The language measure may not have been challenging enough, so the true rate of language underperformance could be higher than 41.5%. Three of 152 enrolled children were excluded after later autism spectrum disorder diagnoses, and aided threshold data were missing for 13 observations (8.7%).

The authors reported no relevant conflicts of interest. The funding agencies had no involvement in the study design, data collection, analysis, interpretation, writing of the report, or decision to publish.

Do not conclude that a child is adequately supported because their language score is in the average range. In this study, 61 of 149 children had receptive language below 85% of their nonverbal IQ, and higher nonverbal IQ was associated with greater odds of language underperformance. This is an observational study, so it does not prove that any specific therapy will close the gap.