Speech, Sign, or Both? Factors Influencing Caregivers' Communication Method Decision Making for Deaf/Hard of Hearing Children

PURPOSE

Caregivers of deaf/hard of hearing infants are faced with challenging decisions regarding their child's communication method. The purpose of the current research note is to characterize the advice that caregivers receive and value as well as the factors that influence caregivers' decision making.

METHOD

The current study enrolled 105 caregiver-child dyads, including children between 12 and 18 months of age with bilateral, congenital hearing loss. All children were exposed to spoken language, and 63.81% of children were also exposed to sign language. Caregivers completed the "Making Decisions About Sign, Speech, and Multilingualism Survey" (Crowe et al., 2014).

RESULTS

Caregivers most frequently received advice to use both speech and sign and highly valued advice from speech-language pathologists. When considering the use of speech, the factors that caregivers most frequently rated as very important were "My child's future academic success" (96.19%), "My child's future literary success" (95.24%), and "My child's future access to higher education" (95.19%). When considering the use of sign, the factors that caregivers most frequently rated as very important were "My child's ability to form friendships and future relationships" (82.52%), "My child's future literary success" (81.37%), and "My child's future academic success" (81.37%).

CONCLUSIONS

Results of the current study suggest that throughout the decision-making process, caregivers' highest priority is understanding how their decisions will influence their child's future access to opportunities and relationships. Providers may consider discussing these factors early in the decision-making process to support caregivers' ability to make an informed choice regarding their child's communication method.

Hearing parents learning American Sign Language with their deaf children: a mixed-methods survey

Hearing parents with deaf children face difficult decisions about what language(s) to use with their child. Sign languages such as American Sign Language (ASL) are fully accessible to deaf children, yet most hearing parents are not proficient in ASL prior to having a deaf child. Parents are often discouraged from learning ASL based in part on an assumption that it will be too difficult, yet there is little evidence supporting this claim. In this mixed-methods study, we surveyed hearing parents of deaf children (n = 100) who had learned ASL to learn more about their experiences. In their survey responses, parents identified a range of resources that supported their ASL learning as well as frequent barriers. Parents identified strongly with belief statements indicating the importance of ASL and affirmed that learning ASL is attainable for hearing parents. We discuss the implications of this study for parents who are considering ASL as a language choice and for the professionals who guide them.

Systems that support hearing families with deaf children: A scoping review

BACKGROUND

Over 90% of deaf children are born to hearing parents who have limited knowledge about deafness and require comprehensive support and information to support and communicate with their deaf child. However, little is known about the systems that support hearing families with deaf children. We performed a scoping review to provide an overview of current literature on the topic.

METHODS

The protocol of the scoping review was prepared using the PRISMA statement guidelines for scoping reviews. Relevant search terms were used to identify eligible studies following discussion with the study's steering group. Databases searched were CINAHL, Medline, ProQuest Central and ASSIA, as well as grey literature from relevant journals and online sources. Included were studies published from 2000 to 2021 and available in English.

RESULTS

A search of databases identified 1274 articles. After excluding duplicates, screening titles and abstracts and full texts, 65 papers matched the identified inclusion criteria. Results included 1 RCT, 7 comparative studies, 6 literature reviews, 4 PhD theses, and 47 further empirical studies.

CONCLUSION

There is limited quality evidence on what supports hearing parents with deaf children. It is evident that further studies are needed to ensure comprehensive support is accessible and effective for hearing parents of deaf children.

Professionals' Perspectives on Supporting Deaf Multilingual Learners and Their Families

Parents frequently report that advice from professionals is important in making decisions about how their child with hearing loss will communicate. Little is currently known about how professionals support parents raising children with hearing loss in spoken language multilingual environments, children who are described as d/Deaf multilingual learners (DMLs). The purpose of this phenomenological study was to gain insight into professionals' perspectives and experiences working with such families, particularly in relation to supporting parents in decision-making about multilingualism and language choice. Nineteen professionals discussed their experiences working with DMLs and their families, the role of professionals in decision-making about multilingualism and language choice, and the factors that they considered were important when supporting DMLs and their families. Inductive thematic analysis yielded three themes: child characteristics (language, development), negotiating and supporting language (information, parents' language, role of language, timing, leadership, language management), and professional issues (knowledge, resources). This paper provides an important insight into professional considerations in supporting DMLs and their families, such as the role and functioning of evidence-based practice.

Exploring how parents of children with unilateral hearing loss make habilitation decisions: a qualitative study

OBJECTIVE

This study sought to explore the decision making needs of parents managing the hearing and communication needs of children with unilateral hearing loss.

DESIGN

An inductive, qualitative method was used. The data were analysed using a constant comparative approach, consistent with Grounded Theory method.

STUDY SAMPLE

Twenty one families participated in interviews yielding data on twenty two children. Each of these families had at least one child with unilateral hearing loss. The age range of the children varied from four months to sixteen years old. All parents were English speaking and received care from National Health Service Audiology departments across the United Kingdom.

RESULTS

Parents valued professionals' opinions, but information provision was inconsistent. As their children mature, parents increasingly valued their child's input. Parent-child discussions focussed on how different management strategies fit their child's preferences. Parents were proactive in obtaining professional advice, and integrating this with their own iterative assessment of their child's performance.

CONCLUSIONS

Decision making is an iterative process. Parents make nuanced decisions which aim to preserve a sense of what is normal for them. Clinicians need to recognise the parental view, including where it may contrast with a medicalised or clinical view.

Parental Decision-Making and Deaf Children: A Systematic Literature Review

Parents or caregivers of children who are deaf or hard of hearing are required to make complex and rational decisions soon after the confirmation of hearing loss. Ways of facilitating decision-making have been a focus within the healthcare sector for two decades and shared decision-making is now widely viewed as the standard for good clinical care. A systematic literature review was undertaken to identify the extent to which the principles of shared decision-making and informed choice have been implemented for parents when they make decisions related to their children with permanent hearing loss. Five databases were searched for peer-reviewed papers describing the results of original research published from 2000 to 2017, yielding 37 relevant papers. Studies were reviewed using the three phases of decision-making-information exchange, deliberation, and implementation. Two decisions dominated these studies-implantable devices and communication modality. Most papers dealt with decision-making in the context of bilateral hearing loss, with only one study focusing on unilateral hearing loss. The review identified gaps where further research is needed to ensure the lessons learnt in the broader decision-making literature are implemented when parents make decisions regarding their child who is deaf or hard of hearing.

Factors Influencing Caregiver Decision Making to Change the Communication Method of their Child with Hearing Loss

The communication journey of a child with hearing loss is often a complex, interwoven process in which the child's use of language or method of communication may change numerous times. As there has been limited research exploring the caregiver decision making process behind making such changes, this qualitative descriptive study aimed to explore the factors which influence the caregiver decision making process to change the communication method of their child with hearing loss. Individual semi-structured in-depth interviews were conducted with seven caregivers of children with hearing loss in Australia. Thematic analysis revealed five key themes which influenced caregiver decisions regarding changes to their child's method of communication, including: (1) family characteristics; (2) family access to information; (3) family strengths; (4) family beliefs; and (5) family-centered practice. The overall finding that the family unit is at the core of decision-making has important clinical implications regarding early intervention professionals' provision of family-centered services when working with the families of children with hearing loss.

Factors influencing parents' decisions about communication choices during early education of their child with hearing loss: a qualitative study

OBJECTIVE

To explore the factors influencing parents' choice of communication mode during early education of their child with hearing loss.

DESIGN

Qualitative descriptive analysis of semi-structured interviews of parents of children with hearing loss.

STUDY SAMPLE

Fourteen parents of children who participated in the Longitudinal Outcomes of Children with Hearing Impairment study.

RESULTS

Four themes emerged from thematic analysis of the interview data: (1) parents draw on a variety of experiences and information to make decisions; (2) parents' preferred outcomes for their children drive their choices; (3) child's preference and proficiency drive parental choice; and (4) parents' fears and worries influence decisions. Parents required unbiased, descriptive information as well as evaluative information from professionals, so that they could consider all options in making a decision that met their needs. They required continual support for implementation of their choices as they adjusted to their children's changing needs.

CONCLUSIONS

Decisions around communication mode are rarely made in isolation, but occur within a larger decision-making matrix that include device choices, early intervention agency choices and "future-proofing" the child's future communication options.

Language Outcomes in Children Who Are Deaf and Hard of Hearing: The Role of Language Ability Before Hearing Aid Intervention

PURPOSE

Early auditory experiences are fundamental in infant language acquisition. Research consistently demonstrates the benefits of early intervention (i.e., hearing aids) to language outcomes in children who are deaf and hard of hearing. The nature of these benefits and their relation with prefitting development are, however, not well understood.

METHOD

This study examined Ontario Infant Hearing Program birth cohorts to explore predictors of performance on the Preschool Language Scale-Fourth Edition at the time of (N = 47) and after (N = 19) initial hearing aid intervention.

RESULTS

Regression analyses revealed that, before the hearing aid fitting, severity of hearing loss negatively predicted 19% and 10% of the variance in auditory comprehension and expressive communication, respectively. After hearing aid fitting, children's standard scores on language measures remained stable, but they made significant improvement in their progress values, which represent individual skills acquired on the test, rather than standing relative to same-age peers. Magnitude of change in progress values was predicted by a negative interaction of prefitting language ability and severity of hearing loss for the Auditory Comprehension scale.

CONCLUSIONS

These findings highlight the importance of considering a child's prefitting language ability in interpreting eventual language outcomes. Possible mechanisms of hearing aid benefit are discussed.

SUPPLEMENTAL MATERIALS

https://doi.org/10.23641/asha.5538868.

The parents' perspective of the early diagnostic period of their child with hearing loss: information and support

OBJECTIVE

This study aimed to explore the perspectives of caregivers regarding the information and support they received following diagnosis of their child's hearing loss.

DESIGN

A mixed methods explanatory sequential design was conducted.

STUDY SAMPLE

A total of 445 caregivers of children completed a written survey, and five parents participated in qualitative in-depth interviews.

RESULTS

The most common sources of information for caregivers were discussion with an audiologist, written information, and discussion with a medical professional. Approximately 85% of caregivers reported they were satisfied with the personal/emotional support and information received from service providers. Additional comments from 91 caregivers indicated that 11% experienced a breakdown in information transfer with health professionals. Interviews conducted with five parents from three families revealed two themes which described the diagnostic period as a difficult and emotional experience for parents: (1) support and information provided during diagnosis: what happens first? and (2) accessing early intervention services following a diagnosis of hearing loss: navigating the maze.

CONCLUSIONS

The findings of this study give insight into the perspectives of caregivers who have a child diagnosed with hearing loss. The importance of providing timely information and personal/emotional support to caregivers cannot be underestimated.

Professionals’ Guidance About Spoken Language Multilingualism and Spoken Language Choice for Children With Hearing Loss

The purpose of this research was to investigate factors that influence professionals’ guidance of parents of children with hearing loss regarding spoken language multilingualism and spoken language choice. Sixteen professionals who provide services to children and young people with hearing loss completed an online survey, rating the importance of a range of potential influences on the guidance they provide to parents. These participants were invited to comment on the importance of these influences. Participants included teachers of the deaf, speech-language pathologists, special education teachers, psychologists, auditory-verbal therapists, Auslan interpreters, and curriculum coordinators. All participants had experience working with multilingual families and reported that they would sometimes or always recommend multilingualism for children with hearing loss, with fewer reporting that they would sometimes recommend monolingualism. Professionals placed greater importance on factors relating to family and community considerations (e.g., family language models, communication within the family, community engagement), and less importance on organisational policy and children's characteristics. This research provides an initial insight into the factors that professionals consider when guiding parents around spoken language and spoken language multilingualism decision-making for their children with hearing loss.