Association of Access Challenges and Family Support With Language Development for Children With Hearing Loss

To assess the association between access challenges, measured by the Access Challenge Index (ACI), and baseline language performance in young children with hearing loss. Children with hearing loss are at increased risk of language delays, which can be influenced by access to specialized care. However, the impact of access challenges on these disparities requires further study to develop targeted interventions.

An analysis of two prospective cohort studies' (NCT04928209) baseline assessments conducted at enrollment. This is a multicenter study, including four tertiary children's hospitals in California and Washington, with the cohort including 182 children, aged 0 to 27 months, with bilateral hearing loss, from diverse sociodemographic backgrounds. Language performance was measured using the Preschool Language Scales and Receptive-Expressive Emergent Language Scale, with scores analyzed against ACI. Expressive, receptive, and total language outcomes were included for analysis.

Of the 182 children who met inclusion criteria, 117 (64.3%) were lower income (defined as below the 266% of the federal poverty level), 85 (46.7%) were assigned female at birth, 99 (54.4%) had public health insurance, 45 (24.7%) identified as non-Hispanic White, and 71 (39.0%) used a language other than English primarily at home. Higher ACI scores were associated with worse total language scores in both PLS (-1.25, 95% confidence interval [CI]: -2.00, -0.50, p = 0.0012) and REEL (-2.31, 95% CI: -3.36, -1.26, p < 0.0001) after inverse probability weighting of the propensity score. Subsequent analysis with ACI subscales indicated Family Support to be a strong predictor of PLS total language outcome (-4.63, 95% CI: -7.48, -1.79, p = 0.0016) and for REEL total language (-9.01, 95% CI: -12.89, -5.12, p ≤ 0.0001).

Family support appears to be a key modifiable factor influencing language disparities for children with hearing loss. Targeted interventions to support families may improve language outcomes.