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Updated: Jun 18, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Newborn hearing screening speeds diagnosis and access to intervention by 20-25 months
Yvonne S Sininger1, Amy Martinez, Laurie Eisenberg
1Division of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095-1624, USA. ysininger@mednet.ucla.edu
Insights
Newborn Hearing Screening (NHS) programs significantly reduce diagnosis and intervention times for infants with hearing loss. Children not screened face substantial delays, highlighting the critical role of early detection through NHS.
Area of Science:
- Audiology
- Pediatrics
- Public Health
Background:
- Newborn Hearing Screening (NHS) programs aim to identify hearing loss in infants early.
- Few studies directly compare screened and unscreened children within the same timeframe.
- This study leverages California's emerging screening programs to assess intervention milestones based on screening status.
Purpose of the Study:
- To compare intervention outcomes for children with hearing loss based on whether they were screened at birth.
- To evaluate performance against benchmarks set by the Joint Committee for Infant Hearing.
Main Methods:
- Observational study of 64 children with bilateral permanent hearing loss.
- Categorization into three groups: screened with fail, screened with pass, and not screened.
- Analysis of age at diagnosis, amplification fitting, and early intervention enrollment using descriptive statistics and t-tests.
Main Results:
- Screened infants were diagnosed 24.6 months earlier, received hearing aids 23.5 months earlier, and entered early intervention 19.9 months earlier than unscreened infants.
- Screening status did not impact delays between diagnosis and subsequent interventions.
- Infants who passed newborn hearing screening showed slightly, but not significantly, earlier achievement of milestones compared to unscreened infants.
Conclusions:
- Newborn Hearing Screening (NHS) programs effectively meet established benchmarks for early identification and intervention.
- Lack of screening results in significant delays, up to 24 months, in achieving critical intervention milestones.
- The NHS process is unequivocally responsible for improving timely diagnosis, hearing aid fitting, and intervention enrollment.
Background:
Newborn Hearing Screening (NHS) programs aim to reduce the age of identification and intervention of infants with hearing loss. It is generally accepted that NHS programs achieve that outcome, but few studies have compared children who were screened to those not screened in the same study and during the same time period. This study takes advantage of the emerging screening programs in California to compare children based on screening status on age at intervention milestones.
Purpose:
The purpose of this studywas to compare the outcomes of cohorts of children with hearing loss, some screened for hearing loss at birth and others not screened. Specifically, the measures compared are the benchmarks suggested by the Joint Committee on Infant hearing for determining the quality of screening programs.
Study Sample:
Records from 64 children with bilateral permanent hearing loss who were enrolled in a study of communication outcomes served as data for this study. Of these children, 47 were screened with 39 failing and 8 passing, and 17 were not screened.
Intervention:
This study was observational and involved no planned intervention.
Data Collection And Analysis:
Outcome benchmarks included age at diagnosis of hearing loss, age at fitting of amplification, and age at enrollment in early intervention. Delays between diagnosis and fitting or enrollment were also calculated. Hearing screening status of the children included screened with fail outcome, screened with pass outcome, and not screened. Analysis included simple descriptive statistics, and t-tests were used to compare outcomes by groups: screened/not screened, screened pass/screened failed, and passed/not screened.
Results:
Children with hearing loss who had been screened as newborns were diagnosed with hearing loss 24.62 months earlier, fitted with hearing aids 23.51 months earlier, and enrolled in early intervention 19.98 months earlier than those infants who were not screened. Screening status did not influence delays in fitting of amplification or enrollment in intervention following diagnosis. Eight of the infants with hearing loss (12.5%) passed the NHS, and the ages at benchmarks of those children were slightly but not significantly earlier than infants who had not been screened.
Conclusions:
The age at achievement of benchmarks such as diagnosis, fitting of amplification, and enrollment in early intervention in children who were screened for hearing loss is on target with stated goals provided by the Academy of Pediatrics and the Joint Committee on Infant Hearing. In addition, children who are not screened for hearing loss continue to show dramatic delays in achievement of benchmarks by as much as 24 months. Evaluating achievement of benchmarks during the start-up period of NHS programs allowed a direct evaluation of ability of these screening programs to meet stated goals. This demonstrates, unequivocally, that the NHS process itself is responsible for improvements in age at diagnosis, hearing aid fitting, and enrollment in intervention.
