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

A Longitudinal Investigation of the Home Literacy Environment and Shared Book Reading in Young Children With Hearing Loss

OBJECTIVES

The principle goal of this longitudinal study was to examine parent perceptions of home literacy environment (e.g., frequency of book reading, ease of book reading with child) and observed behaviors during shared book reading (SBR) interactions between parents and their children with hearing loss (HL) as compared with parents and their children with normal hearing (NH) across 3 time points (12, 24, and 36 months old). Relationships were also explored among home literacy environment factors and SBR behaviors and later language outcomes, across all three time points for parents of children with and without HL.

DESIGN

Participants were a group of parents and their children with HL (N = 17) and typically developing children with NH (N = 34). Parent perceptions about the home literacy environment were captured through a questionnaire. Observed parent behaviors and their use of facilitative language techniques were coded during videotaped SBR interactions. Children's oral language skills were assessed using a standardized language measure at each time point.

RESULTS

No significant differences emerged between groups of parents (HL and NH) in terms of perceived home literacy environment at 12 and 36 months. However, significant group differences were evident for parent perceived ease of reading to their child at 24 months. Group differences also emerged for parental SBR behaviors for literacy strategies and interactive reading at 12 months and for engagement and interactive reading at 36 months, with parents of children with HL scoring lower in all factors. No significant relationships emerged between early home literacy factors and SBR behaviors at 12 months and oral language skills at 36 months for parents of children with NH. However, significant positive relationships were evident between early home literacy environment factors at 12 months and oral language skills at 36 months for parents and their children with HL.

CONCLUSIONS

Although both groups of parents increased their frequency of SBR behaviors over time, parents of children with HL may need additional support to optimize SBR experiences to better guide their toddlers' and preschoolers' language skills. Early intervention efforts that focus on SBR interactions that are mutually enjoyed and incorporate specific ways to encourage parent-child conversations will be essential as children with HL acquire language.

Communication dynamics between mothers and their children with cochlear implants: Effects of maternal support for language production

This study examined (a) the functions and modalities of maternal and child communication during interaction between mothers and children with cochlear implants (CIs), comparing them with mothers and normally hearing (NH) children, and (b) the effectiveness of maternal support strategies in eliciting adequate answers in children with CI. Twenty preschoolers with CIs (M = 40 months) and 40 NH children - 20 matched by chronological age (CANH, M = 40 months) and 20 matched by hearing age (HANH, M = 25 months) - were videotaped during shared book reading and toy play with their mothers. Child and maternal utterances were coded for communicative functions and modalities (vocal, gestural, bimodal), including gesture types; maternal repairs were examined for type of support provided, and child answers for adequacy. Mothers in the CI group and in the CANH group displayed higher proportions of Informative Repairs than mothers of HANH children. However, unlike the mothers of NH children, mothers of children with CIs used bimodal utterances significantly more than vocal utterances. Sequential analysis revealed that maternal Informative Repairs elicited the production of Adequate Answers in both children with CIs and CANH. Interestingly, in the CI group this association was found only when Informative Repairs were accompanied by gestures. These findings offer suggestions for intervention programs focused on parent-child conversation.

Spontaneous language production of Italian children with cochlear implants and their mothers in two interactive contexts

BACKGROUND

In recent years many studies have shown that the use of cochlear implants (CIs) improves children's skills in processing the auditory signal and, consequently, the development of both language comprehension and production. Nevertheless, many authors have also reported that the development of language skills in children with CIs is variable and influenced by individual factors (e.g., age at CI activation) and contextual aspects (e.g., maternal linguistic input).

AIMS

To assess the characteristics of the spontaneous language production of Italian children with CIs, their mothers' input and the relationship between the two during shared book reading and semi-structured play.

METHODS & PROCEDURES

Twenty preschool children with CIs and 40 typically developing children, 20 matched for chronological age (CATD group) and 20 matched for hearing age (HATD group), were observed during shared book reading and semi-structured play with their mothers. Samples of spontaneous language were transcribed and analysed for each participant. The numbers of types, tokens, mean length of utterance (MLU) and grammatical categories were considered, and the familiarity of each mother's word was calculated.

OUTCOMES & RESULTS

The children with CIs produced shorter utterances than the children in the CATD group. Their mothers produced language with lower levels of lexical variability and grammatical complexity, and higher proportions of verbs with higher familiarity than did the mothers in the other groups during shared book reading. The children's language was more strongly related to that of their mothers in the CI group than in the other groups, and it was associated with the age at CI activation.

CONCLUSIONS & IMPLICATIONS

The findings suggest that the language of children with CIs is related both to their mothers' input and to age at CI activation. They might prompt suggestions for intervention programs focused on shared-book reading.

Exploring Cascading Effects of Multimodal Communication Skills in Infants With Hearing Loss

Infants and toddlers with hearing loss (HL) are at risk for developing communicative delays that can have a substantial lasting effect. Understanding child characteristics that may be targeted in early intervention is essential to maximizing communicative outcomes in children with HL. Among the most malleable predictors of communication skills include maternal responsivity, gestures, and vocalizations. The purpose of this study was to examine the relationship among maternal responsivity, prelinguistic communication skills and expressive vocabulary in children with HL. Based upon the results we propose a theoretical cascading model of communicative outcomes for children with HL such that gesture use may be associated with future vocalizations which may in turn be related to long-term spoken language outcomes. This exploratory model may be supported by the underlying transactional model of bidirectional language development that occurs through maternal sensitivity in the first two years of life. Additionally, parents of children with HL may be less likely to respond to a single mode of communication than to a combination of modes. This exploratory study provides a theoretical framework by which multimodal communication development in infants and toddlers with HL may be better understood, and suggests hypotheses for future research and implications for intervention practice.

Quantity and Quality of Caregivers' Linguistic Input to 18-Month and 3-Year-Old Children Who Are Hard of Hearing

OBJECTIVES

The primary objective of this study was to examine the quantity and quality of caregiver talk directed to children who are hard of hearing (CHH) compared with children with normal hearing (CNH). For the CHH only, the study explored how caregiver input changed as a function of child age (18 months versus 3 years), which child and family factors contributed to variance in caregiver linguistic input at 18 months and 3 years, and how caregiver talk at 18 months related to child language outcomes at 3 years.

DESIGN

Participants were 59 CNH and 156 children with bilateral, mild-to-severe hearing loss. When children were approximately 18 months and/or 3 years of age, caregivers and children participated in a 5-min semistructured, conversational interaction. Interactions were transcribed and coded for two features of caregiver input representing quantity (number of total utterances and number of total words) and four features representing quality (number of different words, mean length of utterance in morphemes, proportion of utterances that were high level, and proportion of utterances that were directing). In addition, at the 18-month visit, parents completed a standardized questionnaire regarding their child's communication development. At the 3-year visit, a clinician administered a standardized language measure.

RESULTS

At the 18-month visit, the CHH were exposed to a greater proportion of directing utterances than the CNH. At the 3-year visit, there were significant differences between the CNH and CHH for number of total words and all four of the quality variables, with the CHH being exposed to fewer words and lower quality input. Caregivers generally provided higher quality input to CHH at the 3-year visit compared with the 18-month visit. At the 18-month visit, quantity variables, but not quality variables, were related to several child and family factors. At the 3-year visit, the variable most strongly related to caregiver input was child language. Longitudinal analyses indicated that quality, but not quantity, of caregiver linguistic input at 18 months was related to child language abilities at 3 years, with directing utterances accounting for significant unique variance in child language outcomes.

CONCLUSIONS

Although caregivers of CHH increased their use of quality features of linguistic input over time, the differences when compared with CNH suggest that some caregivers may need additional support to provide their children with optimal language learning environments. This is particularly important given the relationships that were identified between quality features of caregivers' linguistic input and children's language abilities. Family supports should include a focus on developing a style that is conversational eliciting as opposed to directive.

Current trends in outcome studies for children with hearing loss and the need to establish a comprehensive framework of measuring outcomes in children with hearing loss in China

Since the 1970s, outcome studies for children with hearing loss expanded from focusing on assessing auditory awareness and speech perception skills to evaluating language and speech development. Since the early 2000s, the multi-center large scale research systematically studied outcomes in the areas of auditory awareness, speech-perception, language development, speech development, educational achievements, cognitive development, and psychosocial development. These studies advocated the establishment of baseline and regular follow-up evaluations with a comprehensive framework centered on language development. Recent research interests also include understanding the vast differences in outcomes for children with hearing loss, understanding the relationships between neurocognitive development and language acquisition in children with hearing loss, and using outcome studies to guide evidence-based clinical practice. After the establishment of standardized Mandarin language assessments, outcomes research in Mainland China has the potential to expand beyond auditory awareness and speech perception studies.

Symbolic Play and Novel Noun Learning in Deaf and Hearing Children: Longitudinal Effects of Access to Sound on Early Precursors of Language

In the largest, longitudinal study of young, deaf children before and three years after cochlear implantation, we compared symbolic play and novel noun learning to age-matched hearing peers. Participants were 180 children from six cochlear implant centers and 96 hearing children. Symbolic play was measured during five minutes of videotaped, structured solitary play. Play was coded as "symbolic" if the child used substitution (e.g., a wooden block as a bed). Novel noun learning was measured in 10 trials using a novel object and a distractor. Cochlear implant vs. normal hearing children were delayed in their use of symbolic play, however, those implanted before vs. after age two performed significantly better. Children with cochlear implants were also delayed in novel noun learning (median delay 1.54 years), with minimal evidence of catch-up growth. Quality of parent-child interactions was positively related to performance on the novel noun learning, but not symbolic play task. Early implantation was beneficial for both achievement of symbolic play and novel noun learning. Further, maternal sensitivity and linguistic stimulation by parents positively affected noun learning skills, although children with cochlear implants still lagged in comparison to hearing peers.

Sources of variability in language development of children with cochlear implants: age at implantation, parental language, and early features of children's language construction

The aim of the present study was to analyze the relative influence of age at implantation, parental expansions, and child language internal factors on grammatical progress in children with cochlear implants (CI). Data analyses used two longitudinal corpora of spontaneous speech samples, one with twenty-two and one with twenty-six children, implanted between 0;6 and 3;10. Analyses were performed on the combined and separate samples. Regression analyses indicate that early child MLU is the strongest predictor of child MLU two and two-and-a-half years later, followed by parental expansions and age at implantation. Associations between earliest MLU gains and MLU two years later point to stability of individual differences. Early type and token frequencies of determiners predict MLU two years later more strongly than early frequency of lexical words. We conclude that features of CI children's very early language have considerable predictive value for later language outcomes.

More Than “Try This at Home”—Including Parents in Early Intervention

Current state and federal recommendations encourage the delivery of early intervention services in a child's natural environment with typical communication partners (Individuals With Disabilities Education Act [IDEA], 2004). As such, speech-language pathologists (SLPs) often provide intervention services in homes and work closely with parents. However, only 30% of SLPs have early intervention expertise (ASHA, 2014) and 68% of SLPs report low-levels of competence in working with infants and toddlers (Campbell, Chiarello, Wilcox, & Milbourne, 2009). This may be due to the fact that the majority of graduate programs (60%) provide little or no training in early intervention (Bruder & Dunst, 2005). Working in early intervention is a challenging albeit rewarding task for even the most seasoned therapist. Given that the largest percentage of children served under part C of IDEA are children with language delays (Hebbeler et al., 2007), it is essential that SLPs working in early intervention implement effective strategies for both parents and children. The purpose of this paper is to: (a) explain why including parents in intervention is important; (b) discuss ways of including parents in early intervention; (c) examine strategies used to teach parents; (d) describe a method for teaching parents; (e) compare methods of measuring parent progress; and (f) propose future directions for research.

Early care in children with permanent hearing impairment

The implementation of regional protocols for newborn hearing screening and early audiologic diagnosis represent the first step of the entire diagnostic, rehabilitative and prosthetic programme for children with permanent hearing impairment. The maximum benefit of early diagnosis can indeed be obtained only by prompt rehabilitation aimed at fostering the child's communicative, linguistic and cognitive development. Within the framework of the CMM 2013 project of the Ministry of Health entitled "Preventing Communication Disorders: a Regional Program for Early Identification, Intervention and Care of Hearing Impaired Children", the problems concerning the promotion of the global development of children with PHI through an early rehabilitation project based on shared knowledge and scientific evidence. In this project, our specific aim was to define the features and modes of access to a precise and specialised rehabilitation project for the small hearing-impaired child within three months from audiologic diagnosis. Three main recommendations relative to assessment and rehabilitation aspects of early care emerged from the study.

A Prospective Longitudinal Study of U.S. Children Unable to Achieve Open-Set Speech Recognition 5 Years After Cochlear Implantation

OBJECTIVE

To identify characteristics associated with the inability to progress to open-set speech recognition in children 5 years after cochlear implantation.

STUDY DESIGN

Prospective, longitudinal, and multidimensional assessment of auditory development for 5 years.

SETTING

Six tertiary cochlear implant (CI) referral centers in the United States.

PATIENTS

Children with severe-to-profound hearing loss who underwent implantation before age 5 years enrolled in the Childhood Development after Cochlear Implantation study, categorized by level of speech recognition ability.

INTERVENTION(S)

Cochlear implantation before 5 years of age and annual assessment of emergent speech recognition skills.

MAIN OUTCOME MEASURE(S)

Progression to open-set speech recognition by 5 years after implantation.

RESULTS

Less functional hearing before implantation, older age at onset of amplification, lower maternal sensitivity to communication needs, minority status, and complicated perinatal history were associated with the inability to obtain open-set speech recognition by 5 years.

CONCLUSION

Characteristics of a subpopulation of children with CIs associated with an inability to achieve open-set speech recognition after 5 years of CI experience were investigated. These data distinguish pediatric CI recipients at risk for poor auditory development and highlight areas for future interventions to enhance support of early implantation.

An Introduction to the Outcomes of Children with Hearing Loss Study

The landscape of service provision for young children with hearing loss has shifted in recent years as a result of newborn hearing screening and the early provision of interventions, including hearing technologies. It is expected that early service provision will minimize or prevent linguistic delays that typically accompany untreated permanent childhood hearing loss. The post-newborn hearing screening era has seen a resurgence of interest in empirically examining the outcomes of children with hearing loss to determine if service innovations have resulted in expected improvements in children's functioning. The Outcomes of Children with Hearing Loss (OCHL) project was among these recent research efforts, and this introductory article provides background in the form of literature review and theoretical discussion to support the goals of the study. The Outcomes of Children with Hearing Loss project was designed to examine the language and auditory outcomes of infants and preschool-age children with permanent, bilateral, mild-to-severe hearing loss, and to identify factors that moderate the relationship between hearing loss and longitudinal outcomes. The authors propose that children who are hard of hearing experience limitations in access to linguistic input, which lead to a decrease in uptake of language exposure and an overall reduction in linguistic experience. The authors explore this hypothesis in relation to three primary factors that are proposed to influence children's access to linguistic input: aided audibility, duration and consistency of hearing aid use, and characteristics of caregiver input.

Epilogue: Conclusions and Implications for Research and Practice

The primary purpose of the epilogue article is to synthesize the key findings from the Outcomes of Children with Hearing Loss (OCHL) study by presenting a set of 10 major conclusions. The conclusion statements provide a concise summary of the main results related to children's auditory and language outcomes and factors identified as moderators of these outcomes. The second section of this article summarizes the primary clinical implications that follow from the OCHL study in relation to three questions: (1) Can we afford to be complacent about the current outcomes of children who are hard of hearing? (2) Which malleable factors can be addressed to promote success through implementation of best practices? and (3) Which nonmalleable factors are consequential and what are their implications for practice? The authors end with some future research directions for the OCHL project.

Outcomes and benefits of pediatric cochlear implantation in children with additional disabilities: a review and report of family influences on outcomes

The number of children with hearing loss with additional disabilities receiving cochlear implantation has increased dramatically over the past decade. However, little is known about their auditory and speech and language development following implantation. The purpose of this review is to evaluate the effects of cochlear implantation on the most common genetic and developmental disorders in children with hearing loss. Benefits of cochlear implantation for children with autism spectrum disorder, developmental delay, CHARGE syndrome, cerebral palsy, learning disorders, Usher syndrome, Waardenburg syndrome, and attention deficit/hyperactivity disorder are reviewed. Our review indicates that children with hearing loss and additional disabilities benefit from cochlear implantation, especially when implanted early. Thus, early interventions seem as important for these children as for deaf children without additional disabilities. Comparisons of outcomes across these disabilities indicate that children with little to no cognitive impairment (eg, Waardenburg sydrome, attention deficit hyperactivity disorder) have better outcomes than those with greater deficits in intellectual functioning (eg, autism, CHARGE syndrome). In addition, parents of children with hearing loss and additional disabilities report higher levels of parenting stress and greater child behavior problems than those without comorbid diagnoses. However, these parents are as sensitive when interacting with their children as parents with typically developing children using cochlear implantation. Given these results, it is critical to evaluate these children's developmental milestones to provide early implantation and intervention, appropriately counsel families regarding realistic expectations for the implant, and facilitate family adaptation.

Improving behavior using child-directed interaction skills: A case study determining cochlear implant candidacy

OBJECTIVE AND IMPORTANCE

Children with hearing loss (HL) are at increased risk of developing externalizing behavior problems (e.g., hyperactivity, attention problems). These problems can lead to cascading effects on children's overall development. However, few studies have identified evidence-based interventions for this population.

CLINICAL PRESENTATION

A 6-year-old boy with bilateral HL presented to the clinic with significant behavioral challenges. These challenges (e.g., fatigued quickly, poor attention, and hyperactivity) were affecting the reliability of audiological testing to determine cochlear implant candidacy. Thus, the child was referred for Parent-Child Interaction Therapy (PCIT) to address these behavioral challenges.

INTERVENTION AND TECHNIQUE

PCIT is an evidence-based intervention that has been shown to significantly improve externalizing behavior problems. This study describes how the Child-Directed Interaction phase of PCIT was tailored for a child with bilateral HL. The goal of the intervention was to reduce externalizing behaviors in order to reliably complete a cochlear implant evaluation. Post-intervention, significant improvements were noted in behavior, including a decrease in disruptive behavior to normal levels. This led to completion of previously unsuccessful audiological testing and determination of cochlear implant candidacy.

CONCLUSION

This study illustrates how PCIT was successfully tailored to one child with an HL. This is critical as children with HL are at risk for behavior problems, and effective interventions for disruptive behaviors in children with HL may lead to significant improvements in medical and psychosocial outcomes for children with HL and their families.

Adequate formal language performance in unilateral cochlear implanted children: is it indicative of complete recovery in all linguistic domains? Insights from referential communication

OBJECTIVES

Referential communication (RC) is a key element in achieving a successful communication. This case series aimed to evaluate RC in children with unilateral cochlear implants (CIs) with formal language skills within the normal range.

METHODS AND MATERIALS

A total of 31 children with CIs, with language development within the normal range, were assessed using the Pragmatic Language Skills test (MEDEA).

RESULTS

Of the children with CIs, 83.9% reached performance levels appropriate for their chronological ages. The results confirmed a positive effect of cochlear implantation on RC development, although difficulties remained in some CI users.

CONCLUSIONS

The outcomes emphasize the need to pay greater attention to the pragmatic aspects of language, assessing them with adequate testing in the early phase after cochlear implantation. Clear knowledge of children's communicative competence is the key in optimizing their communicative environments in order to create the basis for future successful interpersonal exchanges and social integration.

Development of joint engagement in young deaf and hearing children: effects of chronological age and language skills

PURPOSE

To evaluate joint engagement (JE) in age-matched children with and without hearing and its relationship to oral language skills.

METHOD

Participants were 180 children with severe-to-profound hearing loss prior to cochlear implant surgery, and 96 age-matched children with normal hearing; all parents were hearing. JE was evaluated in a 10-minute videotaped free play task with parents. Engagement states ranged from the lowest (unengaged) to the highest level (symbol-infused coordinated). Standardized language measures were administered.

RESULTS

Multivariate analyses were conducted between the groups, stratified by chronological and language age. Children who were deaf (Deaf) spent less time in total symbol-infused JE than children with normal hearing (NH) across all ages. The majority of the Deaf group (83%) fell in the lowest language age group, in comparison to 35% of the NH group, and spent significantly less time in symbol-infused JE than hearing children. These delays were also observed in the Deaf group, who fell into the 18-36 month language age. No children in the Deaf group had achieved a language age of > 36 months.

CONCLUSIONS

Young children with and without hearing had different developmental trajectories of JE, which were related to oral language skills.

What can we expect of normally-developing children implanted at a young age with respect to their auditory, linguistic and cognitive skills?

As a result of neonatal hearing screening and subsequent early cochlear implantation (CI) profoundly deaf children have access to important information to process auditory signals and master spoken language skills at a young age. Nevertheless, auditory, linguistic and cognitive outcome measures still reveal great variability in individual achievements: some children with CI(s) perform within normal limits, while others lag behind. Understanding the causes of this variation would allow clinicians to offer better prognoses to CI candidates and efficient follow-up and rehabilitation. This paper summarizes what we can expect of normally developing children with CI(s) with regard to spoken language, bilateral and binaural auditory perception, speech perception and cognitive skills. Predictive factors of performance and factors influencing variability are presented, as well as some novel data on cognitive functioning and speech perception in quiet and in noise. Subsequently, we discuss technical and non-technical issues which should be considered in the future in order to optimally guide the child with profound hearing difficulties. This article is part of a Special Issue entitled <Lasker Award>.

Parental Support for Language Development During Joint Book Reading for Young Children With Hearing Loss

Parent and child joint book reading (JBR) characteristics and parent facilitative language techniques (FLTs) were investigated in two groups of parents and their young children; children with normal hearing (NH; n = 60) and children with hearing loss (HL; n = 45). Parent-child dyads were videotaped during JBR interactions, and parent and child behaviors were coded for specific JBR behaviors using a scale developed for this study. Children's oral language skills were assessed using the Preschool Language Scale-4 (PLS-4). Parents of children with HL scored higher on two of the four subscales of JBR: Literacy Strategies and Teacher Techniques. Parents of children with NH utilized higher level FLTs with their children who had higher language skills. Higher level FLTs were positively related to children's oral language abilities. Implications are discussed for professionals who work with families of very young children with HL.

Developmental and cross-modal plasticity in deafness: evidence from the P1 and N1 event related potentials in cochlear implanted children

Cortical development is dependent on extrinsic stimulation. As such, sensory deprivation, as in congenital deafness, can dramatically alter functional connectivity and growth in the auditory system. Cochlear implants ameliorate deprivation-induced delays in maturation by directly stimulating the central nervous system, and thereby restoring auditory input. The scenario in which hearing is lost due to deafness and then reestablished via a cochlear implant provides a window into the development of the central auditory system. Converging evidence from electrophysiologic and brain imaging studies of deaf animals and children fitted with cochlear implants has allowed us to elucidate the details of the time course for auditory cortical maturation under conditions of deprivation. Here, we review how the P1 cortical auditory evoked potential (CAEP) provides useful insight into sensitive period cut-offs for development of the primary auditory cortex in deaf children fitted with cochlear implants. Additionally, we present new data on similar sensitive period dynamics in higher-order auditory cortices, as measured by the N1 CAEP in cochlear implant recipients. Furthermore, cortical re-organization, secondary to sensory deprivation, may take the form of compensatory cross-modal plasticity. We provide new case-study evidence that cross-modal re-organization, in which intact sensory modalities (i.e., vision and somatosensation) recruit cortical regions associated with deficient sensory modalities (i.e., auditory) in cochlear implanted children may influence their behavioral outcomes with the implant. Improvements in our understanding of developmental neuroplasticity in the auditory system should lead to harnessing central auditory plasticity for superior clinical technique.

Responsive parenting intervention after identification of hearing loss by Universal Newborn Hearing Screening: the concept of the Muenster Parental Programme

BACKGROUND

Parents of newborns with hearing loss (HL) identified by Universal Newborn Hearing Screening (UNHS) programmes wish for educational support soon after confirmation and for contact with other affected families. Besides pedaudiological care, a high level of family involvement and an early start of educational intervention are the best predictors for successful oral language development in children with HL. The implementation of UNHS has made it necessary to adapt existing intervention concepts for families of children with HL to the needs of preverbal infants. In particular, responsiveness has proven to be a crucial skill of intuitive parental behaviour in early communication between parents and their child. Since infants with HL are being fitted earlier with hearing devices, their chances of learning oral language naturally in daily communication with family members have noticeably improved.

OBJECTIVES

The Muenster Parental Programme (MPP) aims at empowering parents in communicating with their preverbal child with HL and in (re-)building confidence in their own parental resources. Additionally, it supplies specific information about auditory and language development and enables exchange with other affected parents shortly after the diagnosis.

CONCEPT

The MPP is a responsive parenting intervention specific to the needs of parents of infants with HL identified by UNHS or through other indices and testing within the first 18 months of life. It is based on the communication-oriented Natural Auditory Oral Approach and trains parental responsiveness to preverbal (3-18 months) infants with HL. The MPP has been developed for groups of 4-6 families and comprises six group sessions (without infants), two single training sessions with video feedback, and two individual counselling sessions. At the age of 24-30 months, an individual refresher training session is offered to the parents for adapting their responsiveness to the current verbal level of the child via dialogic book reading. The programme also benefits parents of paediatric cochlear implant (CI) candidates preimplantation and postimplantation.

CONCLUSIONS

The MPP is evidence-based (see Glanemann et al., this volume) and meets the current need for effective family-centred educational intervention after UNHS.

Narrative spoken language skills in severely hearing impaired school-aged children with cochlear implants

Cochlear implants have a significant positive effect on spoken language development in severely hearing impaired children. Previous work in this population has focused mostly on the emergence of early-developing language skills, such as vocabulary. The current study aims at comparing narratives, which are more complex and later-developing spoken language skills, of a contemporary group of profoundly deaf school-aged children using cochlear implants (n=66, median age=8 years 3 months) with matched normal hearing peers. Results show that children with cochlear implants demonstrate good results on quantity and coherence of the utterances, but problematic outcomes on quality, content and efficiency of retold stories. However, for a subgroup (n=20, median age=8 years 1 month) of deaf children without additional disabilities who receive cochlear implantation before the age of 2 years, use two implants, and are raised with one spoken language, age-adequate spoken narrative skills at school-age are feasible. This is the first study to set the goals regarding spoken narrative skills for deaf children using cochlear implants.

Effects of maternal sensitivity and cognitive and linguistic stimulation on cochlear implant users' language development over four years

OBJECTIVES

To examine the effects of observed maternal sensitivity (MS), cognitive stimulation (CS), and linguistic stimulation on the 4-year growth of oral language in young, deaf children receiving a cochlear implant. Previous studies of cochlear implants have not considered the effects of parental behaviors on language outcomes.

STUDY DESIGN

In this prospective, multisite study, we evaluated parent-child interactions during structured and unstructured play tasks and their effects on oral language development in 188 deaf children receiving a cochlear implant and 97 normal-hearing children as controls. Parent-child interactions were rated on a 7-point scale using the National Institute of Child Health and Human Development's Early Childcare Study codes, which have well-established psychometric properties. Language was assessed using the MacArthur Bates Communicative Development Inventories, the Reynell Developmental Language Scales, and the Comprehensive Assessment of Spoken Language.

RESULTS

We used mixed longitudinal modeling to test our hypotheses. After accounting for early hearing experience and child and family demographics, MS and CS predicted significant increases in the growth of oral language. Linguistic stimulation was related to language growth only in the context of high MS.

CONCLUSION

The magnitude of effects of MS and CS on the growth of language was similar to that found for age at cochlear implantation, suggesting that addressing parenting behaviors is a critical target for early language learning after implantation.