Document Type


Publication Date



The Journal of Early Hearing Detection and Intervention





First Page


Last Page


URL with Digital Object Identifier



Purpose: Routine spoken language outcome monitoring is one component of Early Hearing Detection and Intervention (EHDI) programs for children who are hard of hearing and learning a spoken language. However, there is no peerreviewed research that documents how spoken language outcome monitoring may be achieved, or what processes EHDI programs can use to develop these procedures. The present article describes the process used by a Canadian EHDI program and the final recommendations that were developed from this process.

Methodology: Through consultation with the program’s stakeholders, consideration of the Joint Committee on Infant Hearing’s recommendations, and drawing on our own expertise in spoken language assessment, we developed an overall framework for monitoring spoken language. Based on the needs of the EHDI program, we conducted a scoping review and critical appraisal of norm-referenced tests to identify candidate tests to use within this framework.

Results: We recommended a two-pronged assessment approach to measuring spoken language outcomes, including program-level assessment and individual vulnerability testing. We identified several tests that have been previously used to measure spoken language outcomes. There was little consistency in how tests were used across studies with no clear indicators as to which tests are the most appropriate to accomplish for which outcome monitoring purposes.

Conclusions: This article reports on the framework and tests used by a Canadian EHDI program to accomplish spoken language outcome monitoring. We highlight different factors that need to be considered when designing spoken language outcome monitoring procedures and the complexity in doing so. Future work evaluating the effectiveness and feasibility of our recommendations is warranted.

Keywords: Spoken language outcome monitoring; Program Evaluation

Acronyms: CASL = Comprehensive Assessment of Spoken Language; CDI = Child Development Inventory; CELF = Comprehensive Evaluation of Language Fundamentals; COSMIN = Consensus Based Standards for the Selection of Health Status Measurement Instruments; DEAP = Diagnostic Evaluation of Articulation and Phonology; EHDI = Early Hearing Detection and Intervention; EOWPVT = Expressive One Word Vocabulary Test; EVT = Expressive Vocabulary Test; GFTA = Goldman-Fristoe Test of Articulation; IHP = Infant Hearing Program; KLPA = Khan-Lewis Phonological Analysis; MBCDI = MacArthur Bates Communicative Development Inventories; (M)CDI = (Minnesota) Child Development Inventory; MSEL = Mullen Scales of Early Learning; PLAI = Preschool Language Assessment Inventory; PLS = Preschool Language Scale; PPVT= Peabody Picture Vocabulary Test; SLP = speech language pathologist; TACL = Test of Auditory Comprehension of Language, VABS = Vineland Adaptive Behavior Scales

Acknowledgements: The authors have no conflicts of interest to declare. This work was funded by the Ontario Ministry of Children, Community and Social Services. The authors would like to thank the speech-language pathologists, audiologists, and program managers who contributed to the development of these procedures and recommendations. We would also like to thank Kelsi Breton for her work in evaluating articles for inclusion and exclusion.

Correspondence concerning this article should be addressed to: Olivia Daub, Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, Elborn College, London, Ontario, Canada, N6G 1H1. Email:


Daub, O. & Cardy, J. (2021). Developing a Spoken Language Outcome Monitoring Procedure for a Canadian Early Hearing Detection and Intervention Program: Process and Recommendations. Journal of Early Hearing Detection and Intervention, 6(1), 12-31. DOI:

Retrieved from

First published in the Journal of Hearing Detection and Intervention, vol. 6, issue 1 (2021)

Find in your library