Christine Yoshinaga-Itano, PhD

Christine Yoshinaga-Itano, PhD, University of Colorado, Boulder

In a presentation that was sprinkled with a good measure of amusing anecdotes about Marion Downs, Christine Yoshinaga-Itano, PhD, University of Colorado, Boulder, provided a comprehensive update of how far we have come in early hearing screenings and interventions, thanks to the combined efforts of Downs and the many dedicated colleagues she inspired. Yoshinaga-Itano’s talk, titled “Past, Present & Future: Developmental Outcomes for Children Who Are Deaf or Hard of Hearing,” was the 11th presentation in a series of Marion Downs Lectures in Pediatric Audiology, sponsored by the American Academy of Audiology Foundation with a grant from the Oticon Foundation, that are being given by select hearing care industry experts.

Before launching into her topic, Yoshinaga-Itano honored Marion Downs by saying what a privilege it had been to collaborate with the audiology pioneer—considered by many to be the “Mother of Pediatric Audiology”—who died last year at age 100. She shared stories of Marion’s favorite pastimes (having fun) and colors (purple and teal), and mentioned how much Marion’s family had been touched by the December 2014 tribute that aired on National Public Radio (NPR).

Yoshinaga-Itano, who has been a leader of research in the area of language, speech, and social-emotional development of deaf and hard-of-hearing (HOH) infants and children for 30 years, provided the AAA 2015 audience with a historical context of how things were before Marion Downs and colleagues began to advocate for Universal Newborn Hearing Screening (UNHS), compared to how far we’ve come.

Yoshinaga-Itano said the vision for identifying newborns with hearing loss began in the 1960s when Marion Downs established the Joint Committee on Infant Hearing. At that time, children in the United States were typically identified with hearing loss at 4-5 years of age or later, as compared to how things are today, when most children are identified within 3 months of birth.

In the 1970s -90s, only about 20-25% of the population of children who were deaf or hard-of-hearing achieved language development within the average range as compared to a goal of 80% or greater for deaf and HOH children today.

Yoshinaga-Itano was careful to point out, however, that optimal outcomes are not guaranteed simply because of early identification. She expanded upon this by describing what else is needed for early interventions and appropriate treatments to be implemented, and to succeed. She credited Marion Downs with providing the formula needed for gaining support from Public Health and the State legislature to establish a UNHS program that has the best chance for success. She said Downs’s formula included these 7 components:

  1. Frequency of the disorder merits screening
  2. Ability to detect accurately in mass screening
  3. Acceptable ratio of false-positive screenings
  4. Screening programs do not cause parental harm
  5. Effective treatment is available and assured
  6. Early intervention improves outcome
  7. Costs are reasonable and justified

Yoshinaga-Itano also listed the different people or organizations who must be convinced that a universal newborn screening program is not just important, but necessary. These include the public, various committees, the US Prevention Task Force, insurance providers, and pediatricians.

“You have to convince pediatricians that a program for screening deafness is as serious as the PICU, and that intervention is just as critical,” she said.

Yoshinaga-Itano told the AAA 2015 audience that in order to establish and maintain the first UNHS programs, they had to prove the expertise of the UNHS staff, that early interventions were effective, that the quality of the interventions were monitored, and that early intervention made a difference.

“We were able to show that early identified kids had language development scores of 80%, which were just shy of “normal” kids whose scores were 90%,” said Yoshinaga-Itano. “And this is what convinced pediatricians to get behind the early identification movement. The pediatricians actually determined that, by not intervening early, we are causing a deficit.”

Yoshinaga-Itano explained that, although the quality of early intervention is not yet assured nationwide, thanks to many of the early intervention programs now in place, today’s children with hearing loss have the same cognitive levels as normal children. She provided many more details on the methods and outcomes of today’s programs that help children with hearing loss succeed, including ways to identify characteristics of children who are able to achieve age-appropriate developmental outcomes (language, speech/spoken language, social-emotional) as a result of earlier identification and appropriate early intervention services. She also discussed characteristics of children who are at risk for significant delays in their developmental outcomes despite earlier identification; and differences among children from Spanish and English-speaking families, those with cochlear implants and hearing aids, and those with hearing, deaf or hard-of-hearing parents.

Yoshinaga-Itano also described differences in state systems.

“States that don’t have a specialized system with expertly trained staff don’t get the same results, so quality of intervention is important,” she said, stressing the significant achievements of all who have worked so hard to establish UNHS in the US, and to make the programs better.

Yoshinaga-Itano said that pediatric audiologists are now seeing new cortical potentials in children with hearing loss who received high-quality early intervention—potentials that weren’t there before, Yoshinaga-Itano emphasized.

“What if we could evaluate the effect of our auditory therapies and interventions by the changes in cortical auditory pathway organizations?” Yoshinaga-Itano asked the audience. “What if we could use the technology to identify secondary disorders like autism and provide effective early intervention so they could be ready for a mainstream kindergarten by age 5? That is my dream!”

“Marion always believed in the impossible, and got us to do things we didn’t think could be done,” Yoshinaga-Itano concluded.

This lecture is available for free viewing and access on the American Academy of Audiology’s CEU source page:

Christine Yoshinaga-Itano, PhD, Professor, University of Colorado, Boulder, has conducted research and published papers on her findings that have had a broad impact on health and education policies have changed globally; professional standards in audiology, medicine, early childhood, and deaf education have been revised; and families worldwide with children who are deaf and hard-of-hearing have new hope for their children’s futures.