Maternal sensitivity predicts language gain in preschool children who are deaf and hard of hearing

Identification of effective strategies to promote language in deaf children with cochlear implants

Parental involvement and communication are essential for language development in young children. However, hearing parents of deaf children face challenges in providing language input to their children. This study utilized the largest national sample of deaf children receiving cochlear implants, with the aim of identifying effective facilitative language techniques. Ninety-three deaf children (≤ 2 years) were assessed at 6 implant centers prior to and for 3 years following implantation. All parent-child interactions were videotaped, transcribed, and coded at each assessment. Analyses using bivariate latent difference score modeling indicated that higher versus lower level strategies predicted growth in expressive language and word types predicted growth in receptive language over time. These effective, higher level strategies could be used in early intervention programs.

Quantity of parental language in the home environments of hard-of-hearing 2-year-olds

Automated analyses of full-day recordings were used to determine whether young children who are hard-of-hearing (HH) received similar levels of exposure to adult words and conversational interactions as age-matched peers with normal-hearing (NH). Differences in adult input between children in this study and in a normative database were considered. Finally, factors were examined that may have contributed to individual differences in the input characteristics of families. Results indicated that the NH and HH groups were exposed to similar numbers of adult words and conversational turns. However, both the NH and HH groups were exposed to more adult words and engaged in more conversational turns than the NH children in the normative sample. Considering only the HH group, both quantity of adult words and conversational exchanges were correlated with children's auditory characteristics. Children's receptive language ability was correlated with conversational exchanges but not with adult word counts.

Effects of Early Identification and Intervention on Language Development in Japanese Children with Prelingual Severe to Profound Hearing Impairment

Objectives:

Early identification and intervention for prelingual bilateral severe to profound hearing loss is supposed to reduce the delay in language development. Many countries have implemented early detection and hearing intervention and conducted regional universal newborn hearing screening (UNHS). However, the benefits of UNHS in later childhood have not yet been confirmed, although language development at school age has a lifelong impact on children's future. Our Research on Sensory and Communicative Disorders project attempted to reveal the effects of UNHS and those of early intervention on the development of verbal communication in Japanese children.

Methods:

In this study, 319 children with prelingual bilateral severe to profound hearing loss, 4 to 10 years of age, were evaluated with the Test of Question-Answer Interaction Development used as an objective variable. Participation in UNHS and early intervention were used as explanatory variables. The adjusted odds ratio (AOR) was calculated after adjusting several confounding factors with use of logistic regression analysis. In addition, caregivers' answers were obtained by a questionnaire, and the process of diagnosis with and without UNHS was analyzed retrospectively.

Results:

Early intervention was significantly associated with better language development (AOR, 3.23; p < 0.01). Participation in UNHS may contribute to better language development to some extent (AOR, 1.32), but not one that was statistically significant (p = 0.37). However, UNHS was significantly associated with early intervention (AOR, 20.21; p < 0.001). The questionnaire results indicated a lag in treatment after UNHS in more than 40% of screened cases.

Conclusions:

Early intervention strongly influenced language development. It is necessary to ensure that early identification leads directly to early intervention.

Emotional relationships between mothers and infants: knowns, unknowns, and unknown unknowns

An overview of the literature pertaining to the construct of emotional availability is presented, illustrated by a sampling of relevant studies. Methodological, statistical, and conceptual problems in the existing corpus of research are discussed, and suggestions for improving future investigations of this important construct are offered.

Mommy, speak clearly: induced hearing loss shapes vowel hyperarticulation

Talkers hyperarticulate vowels when communicating with listeners that require increased speech intelligibility. Vowel hyperarticulation is said to be motivated by knowledge of the listener's linguistic needs because it typically occurs in speech to infants, foreigners and hearing-impaired listeners, but not to non-verbal pets. However, the degree to which vowel hyperarticulation is determined by feedback from the listener is surprisingly less well understood. This study examines whether mothers' speech input is driven by knowledge of the infant's linguistic competence, or by the infant's feedback cues. Specifically, we manipulated (i) mothers' knowledge of whether they believed their infants could hear them or not, and (ii) the audibility of the speech signal available to the infant (full or partial audibility, or inaudible). Remarkably, vowel hyperarticulation was completely unaffected by mothers' knowledge; instead, there was a reduction in the degree of hyperarticulation such that vowels were hyperarticulated to the greatest extent in the full audibility condition, there was reduced hyperarticulation in the partially audible condition, and no hyperarticulation in the inaudible condition. Thus, while it might be considered adaptive to hyperarticulate speech to the hearing-impaired adult or infant, when these two factors (infant and hearing difficulty) are coupled, vowel hyperarticulation is sacrificed. Our results imply that infant feedback drives talker behavior and raise implications for intervention strategies used with carers of hearing-impaired infants.

Auditory development in early amplified children: factors influencing auditory-based communication outcomes in children with hearing loss

OBJECTIVE

The purpose of this study was to determine the influence of selected predictive factors, primarily age at fitting of amplification and degree of hearing loss, on auditory-based outcomes in young children with bilateral sensorineural hearing loss.

DESIGN

Forty-four infants and toddlers, first identified with mild to profound bilateral hearing loss, who were being fitted with amplification were enrolled in the study and followed longitudinally. Subjects were otherwise typically developing with no evidence of cognitive, motor, or visual impairment. A variety of subject factors were measured or documented and used as predictor variables, including age at fitting of amplification, degree of hearing loss in the better hearing ear, cochlear implant status, intensity of oral education, parent-child interaction, and the number of languages spoken in the home. These factors were used in a linear multiple regression analysis to assess their contribution to auditory-based communication outcomes. Five outcome measures, evaluated at regular intervals in children starting at age 3, included measures of speech perception (Pediatric Speech Intelligibility and Online Imitative Test of Speech Pattern Contrast Perception), speech production (Arizona-3), and spoken language (Reynell Expressive and Receptive Language).

RESULTS

The age at fitting of amplification ranged from 1 to 72 mo, and the degree of hearing loss ranged from mild to profound. Age at fitting of amplification showed the largest influence and was a significant factor in all outcome models. The degree of hearing loss was an important factor in the modeling of speech production and spoken language outcomes. Cochlear implant use was the other factor that contributed significantly to speech perception, speech production, and language outcomes. Other factors contributed sparsely to the models.

CONCLUSIONS

Prospective longitudinal studies of children are important to establish relationships between subject factors and outcomes. This study clearly demonstrated the importance of early amplification on communication outcomes. This demonstration required a participant pool that included children who have been fit at very early ages and who represent all degrees of hearing loss. Limitations of longitudinal studies include selection biases. Families who enroll tend to have high levels of education and rate highly on cooperation and compliance measures. Although valuable information can be extracted from prospective studies, not all factors can be evaluated because of enrollment constraints.

Maternal interactions with a hearing and hearing-impaired twin: similarities and differences in speech input, interaction quality, and word production

PURPOSE

This study examined a mother's speech style and interactive behaviors with her twin sons: 1 with bilateral hearing impairment (HI) and the other with normal hearing (NH).

METHOD

The mother was video-recorded interacting with her twin sons when the boys were 12.5 and 22 months of age. Mean F0, F0 range, duration, and F1/F2 vowel space of the corner vowels /i/, /u/, and /a/ were compared in her infant-directed (ID) and adult-directed (AD) speech. The interactions were also coded for emotional availability, and vocabulary size was collected at 17 and 22 months.

RESULTS

Acoustic analyses revealed no difference among mean F0, F0 range, and duration between the twins. In contrast, when the corner vowels were plotted in F1/F2 vowel space, the results showed a diminished vowel space in speech to the HI twin compared to the NH twin. Ratings of emotional availability were lower for the HI than the NH twin, but the HI twin had a larger expressive vocabulary on both occasions, albeit in the lower percentile.

CONCLUSIONS

The mother appears more focused on maintaining the attention of the HI infant using the typical ID exaggerations to prosody and overlooking linguistic features such as the hyperarticulation of her vowels. The results have implications for early intervention strategies.

Association of maternal communicative behavior with child vocabulary at 18-24 months for children with congenital hearing loss

OBJECTIVES

To identify important maternal and child factors associated with development of vocabulary in a cohort of children with and without permanent hearing loss (HL).

METHODS

Children with HL and typical hearing were enrolled after the newborn hearing screen. Mother-child dyads were evaluated at 18-24 months of age. Mothers completed the MacArthur-Bates Communicative Development Inventory (MCDI). Maternal communicative effectiveness was scored using the Parent/Caregiver Involvement Scale (PCIS) from a 10 min play session. Correlations and regression models were run to identify the important predictors of number of child words produced.

RESULTS

Results from 40 children with typical hearing and 31 children with HL are reported. Words produced (134+/-135 vs. 71+/-112) and words produced percentile (33+/-42 vs. 17+/-23) scores on the MCDI were significantly higher for children with hearing compared to children with HL. Greater maternal stress was associated with decreased verbal involvement, positive regard, availability, and enjoyment. Regression analysis revealed HL, stay in a Neonatal Intensive Care Unit (NICU), and maternal stress were associated with fewer words produced whereas more optimal maternal atmosphere and quality of control and directiveness were associated with more words produced.

CONCLUSIONS

Maternal communicative behaviors, maternal stress, child HL, and child stay in the NICU were all associated with number of words produced at 18-24 months.

Maternal control strategies, maternal language usage and children's language usage at two years

The present study determined whether parenting style, defined by control strategies varying in power-assertion mediated the established relation between maternal language usage (grammar and semantics) and child language (grammar, semantics and pragmatics) during toddlerhood (n=60). Based upon their use of control strategies mothers were categorized into continuum-of-control groups (i.e., high guidance (HG), high control (HC) or high negative control (HNC)). Mothers in the high negative control group, who characteristically used high levels of prohibitions and commands, had children who performed relatively poorly overall on the language measures (i.e., MLU, number of bound morphemes, number of different words and use of language functions). In contrast, children of mothers in the HG and HC groups exhibited more advanced language usage overall. The relation between maternal and child language usage was mediated by parenting style for child pragmatics and partially for child grammar.

Early intervention for children with unilateral and mild bilateral degrees of hearing loss

Some children with unilateral hearing loss or mild bilateral hearing loss are at risk for developmental delays, educational difficulties, and other adverse effects. However, these children face several challenges in receiving services that can prevent such problems. Many do not meet existing eligibility requirements for early intervention services in their state. Information disseminated to professionals and parents often does not convey the significance of unilateral and mild bilateral hearing loss. Some professionals indicate that there are insufficient guidelines defining appropriate intervention services for these children. Factors that influence developmental outcomes in this population are not well understood, making it difficult to determine which children can benefit from intervention services. Additional data are needed about how to minimize or prevent adverse outcomes in these children. This article presents suggestions for intervention and future research that were developed by participants of the 2005 National Workshop on Mild and Unilateral Hearing Loss.

Play and emotional availability in young children with Down syndrome

This study investigates mother-child interaction and its associations with play in children with Down syndrome (DS). There is consensus that mother-child interaction during play represents an important determinant of typical children's play development. Concerning children with DS, few studies have investigated mother-child interaction in terms of the overall emotional quality of dyadic interaction and its effect on child play. A sample of 28 children with DS (M age = 3 years) took part in this study. In particular, we studied whether the presence of the mother in an interactional context affects the exploratory and symbolic play of children with DS and the interrelation between children's level of play and dyadic emotional availability. Children showed significantly more exploratory play during collaborative play with mothers than during solitary play. However, the maternal effect on child symbolic play was higher in children of highly sensitive mothers relative to children whose mothers showed lower sensitivity, the former displaying more symbolic play than the latter in collaborative play. Results offer some evidence that dyadic emotional availability and child play level are associated in children with DS, consistent with the hypothesis that dyadic interactions based on a healthy level of emotional involvement may lead to enhanced cognitive functioning.

Translational research on early language development: Current challenges and future directions

There is a pressing need for the early and accurate identification of young children at risk for language and other developmental disabilities and the provision of timely, age-appropriate intervention, as mandated by Part C of the Individuals with Disabilities Education Act. Research has shown that early intervention is effective for many language impaired children in different etiological groups, and can reduce the functional impact of persistent disorders on children and their families. Yet, the accurate identification of infants and toddlers at risk for language impairment remains elusive, especially for late-talking children without obvious genetic or neurological conditions. In this paper, the need for translational research on basic processes in early language development in typical and atypical populations and the contextual factors that affect them are discussed, along with current challenges and future directions for its successful implementation. Implications of this research for clinical evidence-based practice are also considered.

Contributions of mother-child storybook telling and joint writing to literacy development in kindergartners with hearing loss

PURPOSE

This study investigated mother-child storybook telling and joint writing as predictors of early literacy among kindergartners with hearing loss.

METHOD

Participants were 30 Israeli kindergartners with hearing loss and their mothers. Early literacy assessments tapped children's alphabetic skills (e.g., word writing, word recognition, and letter knowledge) and linguistic skills (e.g., phonological awareness, general knowledge, and receptive vocabulary). Each mother told her child the story of a wordless book and helped her child write words. Both interactions were videotaped and analyzed.

RESULTS

Our major findings showed that maternal storybook telling correlated with linguistic skills, and maternal writing mediation correlated with basic alphabetic skills. A series of 3-step hierarchical regression analyses revealed that beyond children's age, children's degree of hearing loss, and joint writing, storybook telling predicted children's phonological awareness (22%), general knowledge (28%), and receptive vocabulary (18%). Beyond children's age, children's degree of hearing loss, and storybook telling, joint writing predicted word writing (15%), word recognition (31%), and letter knowledge (36%).

IMPLICATIONS

Recommendations focused on encouraging parent and teacher awareness about the differential contributions of storybook telling and writing mediation to early literacy. We also advocated enhancing parents' skills for promoting children's literacy.

Development of audiovisual comprehension skills in prelingually deaf children with cochlear implants

OBJECTIVE

The present study investigated the development of audiovisual comprehension skills in prelingually deaf children who received cochlear implants.

DESIGN

We analyzed results obtained with the Common Phrases (Robbins et al., 1995) test of sentence comprehension from 80 prelingually deaf children with cochlear implants who were enrolled in a longitudinal study, from pre-implantation to 5 years after implantation.

RESULTS

The results revealed that prelingually deaf children with cochlear implants performed better under audiovisual (AV) presentation compared with auditory-alone (A-alone) or visual-alone (V-alone) conditions. AV sentence comprehension skills were found to be strongly correlated with several clinical outcome measures of speech perception, speech intelligibility, and language. Finally, pre-implantation V-alone performance on the Common Phrases test was strongly correlated with 3-year postimplantation performance on clinical outcome measures of speech perception, speech intelligibility, and language skills.

CONCLUSIONS

The results suggest that lipreading skills and AV speech perception reflect a common source of variance associated with the development of phonological processing skills that is shared among a wide range of speech and language outcome measures.

Prelinguistic predictors of language growth in children with developmental disabilities

This study followed 18 children with developmental disabilities, whose chronological ages were between 3 years and 6 years at the start of the study, over a 2-year period. At initial observation, children communicated primarily through prelinguistic gestures, vocalizations, and single-word utterances. Children's language skills were measured every 6 months with the Sequenced Inventory of Communication Development-Revised (D. E. Hedrick, E. M. Prather, and A. R. Tobin, 1984). Prelinguistic communication rate and parental responsiveness were also measured at each observation. Development of language over time differed between participants in accordance with their entry-level communication. Hierarchical linear modeling indicated that children's level of gestural attainment, rate of communication, and parent response contingency were significant predictors of language outcome.

Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study

OBJECTIVE

To estimate the prevalence of confirmed permanent childhood hearing impairment and its profile across age and degree of impairment in the United Kingdom.

DESIGN

Retrospective total ascertainment through sources in the health and education sectors by postal questionnaire.

SETTING

Hospital based otology and audiology departments, community health clinics, education services for hearing impaired children.

PARTICIPANTS

Children born from 1980 to 1995, resident in United Kingdom in 1998, with severe permanent childhood hearing impairment (hearing level in the better ear >40 dB averaged over 0.5, 1, 2, and 4 kHz).

MAIN OUTCOME MEASURES

Numbers of cases with date of birth and severity of impairment converted to prevalences for each annual birth cohort (cases/1000 live births) and adjusted for under ascertainment.

RESULTS

26 000 notifications ascertained 17 160 individual children. Prevalence rose from 0.91 (95% confidence interval 0.85 to 0.98) for 3 year olds to 1.65 (1.62 to 1.68) for children aged 9-16 years. Adjustment for under ascertainment increased estimates to 1.07 (1.03 to 1.12) and 2.05 (2.02 to 2.08). Comparison with previous studies showed that prevalence increases with age, rather than declining with year of birth.

CONCLUSIONS

Prevalence of confirmed permanent childhood hearing impairment increases until the age of 9 years to a level higher than previously estimated. Relative to current yields of universal neonatal hearing screening in the United Kingdom, which are close to 1/1000 live births, 50-90% more children are diagnosed with permanent childhood hearing impairment by the age of 9 years. Paediatric audiology services must have the capacity to achieve early identification and confirmation of these additional cases.