Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Health and Rehabilitation Sciences


Oram Cardy, Janis

2nd Supervisor

Daub, Olivia



International recommendations suggest that all children with permanent hearing loss enrolled in Early Hearing Detection and Intervention programs should have their language development routinely monitored. This study was a retrospective database review designed to understand the reasons behind a significant absence of spoken language outcome monitoring data in the Ontario Infant Hearing Program’s database. The study aims included evaluating variations in language outcome monitoring implementation, exploring regional differences in procedure adoption, and identifying the reasons why speech-language pathologists were unable to assess eligible children (and any regional variation in these reasons). Results suggested that implementation improved significantly from one year to the next and that there were important regional differences in procedure adoption. Additionally, SLPs primarily cited child factors as the main reason for not assessing certain children. There were no notable regional variations in the reasons reported by SLPs for not completing the procedures.

Summary for Lay Audience

This thesis focuses on understanding why there was a lack of language development data for children with permanent hearing loss in the Ontario Infant Hearing Program’s database. It aimed to figure out why speech and language evaluations were not being conducted as recommended by international guidelines, that is, every six months until the age of three and yearly after that, and why some eligible children were not assessed. We looked at language assessment rates across the province, whether there were differences in how various regions implemented them, and why speech-language pathologists (SLPs) could not assess certain kids.

The findings showed that more children were assessed in the second period of program evaluation than in the first in all regions but one, and in the province overall. We also discovered that there were variations in the numbers and percentages of children assessed in different regions. While some regions had very low implementation rates and a lot of missing data, others were a lot closer to evaluating all the children who were eligible for assessment.

The main reason that SLPs reported they could not assess some children was factors related to the kids themselves. The reasons reported were similar across different regions.

In summary, the study found that there were improvements in monitoring language development in children with hearing loss in Ontario over time, but there were differences between regions in how this was being implemented. Despite this, the reasons why some children were not evaluated seemed consistent across different regions.

Available for download on Tuesday, April 01, 2025