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Objective: To investigate the feasibility and effectiveness of early autism intervention with the Early Start Denver Model (ESDM) implemented with low intensity in a community service in Europe., Methods: Subjects were boys (n = 13, ages 34-54 months, mean age 43.3 months) consecutively diagnosed with autism spectrum disorder in a regional autism center in Austria. The subjects either received the ESDM intervention for 4.6 hours weekly over 12 months (n = 7) or intervention as usual (n = 6). Feasibility of the ESDM intervention was evaluated by parent and teacher questionnaires, ESDM fidelity measures, and therapists' feedback. Developmental status was assessed through standardized instruments (Mullen Scales of Early Learning [MSEL], Vineland Adaptive Behavior Scales Second Edition, Communicative Development Inventory, Pervasive Developmental Disorder Behavior Inventory [PDDBI], Parenting Sense of Competence Scale) at baseline and after intervention., Results: The ESDM intervention was delivered with high fidelity (>80%) by a newly trained multiprofessional team. Acceptability by parents was rated as high. The ESDM was considered to be compatible with both family and preschool routines without any major adaptations. The ESDM group showed a trend toward improved receptive language (MSEL receptive language; p = 0.09, effect size [ES] = 0.72) and reduction in parent-reported core autism symptoms (PDDBI Autism Composite Score; p = 0.04; ES = 0.95). No such improvement was noted in the control group., Conclusion: Low-intensity implementation of the ESDM in a non-English-speaking community service context is feasible. Although outcomes from this small feasibility study should be interpreted with caution, our findings suggest a more favorable response to the ESDM intervention group compared with the control group.

: Disorders that affect communication are multifaceted and have significant impact throughout the life cycle, leading to different needs at different stages of life. This article describes the development of a comprehensive program that provides services for the whole range of patients with communication and problems over the life span.

Objective: To investigate the impact of age at diagnosis and age at onset of intervention on language outcomes in children with hearing impairments., Methods: Receptive and expressive language outcomes of a sample of 63 children (mean age 5;1 years) with hearing loss (mean 78dB, SD 25.3) enrolled in the only specific early intervention program in Upper Austria were assessed. The sample can be regarded as representative for children with significant hearing loss. For 89% the hearing loss was congenital. Language results were related to age at diagnosis, age at first fitting of hearing aids and age at enrolment in the intervention program. Confounding variables such as IQ, degree of hearing loss and family parameters were controlled for in regression analyses., Results: Early commencement of family centred intervention had a significant impact on language outcomes as opposed to age at diagnosis and age at fitting of hearing aids., Conclusion: In managing intervention in children with hearing loss, time between diagnosis and onset of early intervention should be kept as short as possible. However, age of entry to early intervention explained only about 4% of the variance in language outcomes., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Early identification of deaf-blindness is essential to ensure appropriate management. Previous studies indicate that deaf-blindness is often missed. We aim to discover the extent to which deaf-blindness in people with intellectual disability (ID) is undiagnosed., Method: A survey was made of the 253 residents of an institute offering residential and occupational facilities for people with IDs. Data are included for the 224 individuals who were able to complete both auditory and visual assessments. Otoacoustic emissions were used to screen for hearing impairment; those who did not pass were assessed by behavioural audiometry. Visual acuity was assessed with one of the following: EH-Optotypes, LH-Optotypes, Teller Acuity Cards, Cardiff Acuity Cards or the Stycar Ball Vision Test., Results: Prior to the study hearing impairment had been diagnosed in 12.5% of the 224 subjects, and visual impairment in 17%. Upon completion of the study these figures rose to 46% and 38.4% respectively. Deaf-blindness was diagnosed in 3.6% of the subjects before, and in 21.4% after, the study. Most (87.5%) of the deaf-blind individuals had profound ID., Conclusion: Deaf-blindness is most often not identified either by standard medical screening or by care staff. Individuals with this disability, however, require provision of special kinds of care. Four categories of deaf-blindness are proposed, according to the severity of sensory impairment in each modality. The tests used in this study are non-invasive and are appropriate for individuals with ID and children. Early and periodic screening for visual and hearing impairment in individuals with ID is recommended.

Aim: The aim of this study was to elucidate factors related to the high rate of mental health disorders seen in those with impaired hearing, including social factors and audiological measures., Method: A representative sample of 95 pupils (47 females, 48 males; mean age 11y 1mo, range 6y 5mo to 16y, SD 2y 7mo) with hearing impairments of at least 40dB and normal non-verbal intelligence (IQ 97.5, SD 19.5), was assessed audiologically and with a structured clinical interview giving both current and lifetime diagnoses, and the Strengths and Difficulties Questionnaire. Detailed social information was gathered from parents and teachers., Results: Point and lifetime prevalence rates for any psychiatric disorder (32.6%; 45.3%) and depression (7.4%; 26.3%) were higher than in general population samples and not related to the degree of hearing loss. There was a relation between having a lifetime diagnosis and the child's ability to be understood within the family (25.6% vs 7.7%, odds ratio 4.12 [1.2-14.1], p=0.02). Internalizing mental health disorders were between three and six times more likely in those who had been teased, maltreated by classmates, or isolated., Interpretation: We conclude that the increased risk of depression in those who have been teased, isolated, or maltreated is not peculiar to deafness, but the ability to make oneself understood is, and is modestly related (r=0.22-0.34) to the probability of these adverse experiences.

In the past decade, the living conditions of hearing impaired children have been changing due to new technologies and mainstreaming in schools. The majority of population-based studies in deaf pupils were conducted before these changes started to take place. The present study aimed to evaluate the current situation regarding aspects of mental health and, for the first time, quality of life in a representative sample of deaf pupils. The sample stems from a population of 145,000 pupils attending the first to ninth grades during the school years 2003-2005 in Upper Austria. From 186 children with bilateral hearing impairment of at least 40 dB registered at the centre for special education for children with sensory impairments, 99 with a performance IQ above 70 were included in the present study. Parents and teachers completed the strengths and difficulties questionnaire (SDQ), while parents and children were administered the inventory for the assessment of the quality of life in children and adolescents (ILC). Results indicated that deaf children scored significantly higher on the SDQ than their counterparts from normative samples according to both parent and teacher ratings. Differences were most marked with regard to conduct problems, emotional problems, and peer problems, and less marked for hyperactivity/inattention. While parents of deaf children had a generally positive view of their children's quality of life, deaf children provided a more complex picture, stressing areas of dissatisfaction. Mental health and quality of life were found to be unrelated to the child's degree of deafness.

The understanding of isolated written words by deaf adults was checked using a basic list of 500 German words developed for this study. Even at this basic level about 7% of the words could not be identified by the deaf subjects. There were particular problems with words from colloquial German, function words, terms without mouthing in sign language and cover terms. Concerning rehabilitation the use of sign language vocabulary already known by the deaf for written language vocabulary training and a stronger orientation towards functional everyday communication is recommended.