Family-Level Executive Functioning and At-Risk Pediatric Hearing Loss Outcomes

Reading Comprehension of Chinese-Speaking Children With Hearing Loss: The Roles of Metalinguistic Awareness and Vocabulary Knowledge

PURPOSE

This study aims to explore the contributions of phonological awareness (PA) and morphological awareness (MA) to the reading comprehension skills of Chinese-speaking children with hearing loss (HL) and examine the possible mediation effect of vocabulary knowledge on the relationships of PA and MA with their reading comprehension.

METHOD

The participants were 28 Chinese-speaking children with HL, who were followed from Grade 1 through Grade 2. They were administered a series of tests that measured their PA and MA at the beginning of Grade 1, vocabulary knowledge at the end of Grade 1, and reading comprehension at the end of Grade 2.

RESULTS

MA significantly accounted for additional variance in reading comprehension beyond the effect of PA but not vice versa. Both PA and MA contributed uniquely to vocabulary knowledge, which completely mediated the relationships of PA and MA with reading comprehension.

CONCLUSIONS

PA and MA are both essential to the development of vocabulary knowledge and reading comprehension in Chinese-speaking children with HL; however, MA seems to be more important than PA in their reading comprehension. PA and MA significantly affect children's reading comprehension through their influence on vocabulary knowledge. This study has replicated previous evidence on the importance of PA, MA, and vocabulary knowledge in the reading comprehension of children with typical hearing, and has extended its significance to children with HL. In addition, the findings have the potential to inform educational practitioners regarding the importance of teaching essential reading skills to Chinese-speaking children with HL.

Associations Between Paternal Play and Executive Function in Deaf and Hard of Hearing Children

PURPOSE

Responsive and dynamic aspects of father-child play are associated with behavioral and neurocognitive development in children and could represent an important contributor to executive function (EF) skills for children who are deaf and hard of hearing (DHH). This study examined associations between paternal behaviors during play and EF skills of DHH children and children with typical hearing (TH).

METHOD

Father-child dyads in families with DHH children (n = 30) and TH children (n = 29) participated in a 15-min video-recorded free-play session that was coded for parental behaviors using Parent-Child Interaction Rating Scales and Rough and Tumble Play Quality. Families also completed an age-appropriate version of the Behavior Rating Index of Executive Function as a measure of child EF.

RESULTS

DHH children were rated as having significantly more everyday difficulties with working memory than TH children. Fathers of DHH children were rated as more intrusive during play than fathers of TH children; however, there were no other differences between paternal groups on coded dimensions of father child play. Paternal respect for child autonomy was associated with fewer child difficulties with planning and organization skills and paternal play engagement was associated with fewer child EF difficulties. Moderation analyses revealed that paternal sensitivity was associated with more working memory difficulties and paternal respect for child autonomy was associated with fewer working memory difficulties for DHH children only.

CONCLUSIONS

Paternal play could be an important environmental context for DHH outcomes. Fathers supporting independent play might generally support EF. Paternal engagement in play might also benefit EF. Results highlight paternal behavioral attributes that could lead to potential father-embedded intervention models.

Associations Between Parent Mental State Language and Child Inhibitory Control in Children Who Are Deaf or Hard of Hearing

PURPOSE

Children who are deaf or hard of hearing (D/HH) are at increased risk for neurocognitive delays, which can have cascading effects on development. Associations between neurocognition and the content of parental language-specifically the use of mental state vocabulary-have been observed in typically hearing (TH) children. This study investigated the role of parental use of mental state language (e.g., vocabulary related to thought processes, desires, and emotions) in explaining variability in neurocognition in children who are D/HH.

METHOD

Dyads of 62 TH and 69 D/HH children who wear hearing aids or cochlear implants (ages 3-8 years) and their primary parent were videorecorded during a 20-min play session. Specific mental state words used by parents were extracted. Child neurocognition (specifically, inhibitory control) was assessed using norm-referenced measures.

RESULTS

Parent use of mental state language predicted child inhibitory control differentially based on hearing status, with a significant relation in the D/HH but not the TH group. Mental state vocabulary related to cognition (e.g., "think," "know"), but not to desire (e.g., "want," "like") or emotion (e.g., "feel," "frustrated"), predicted child inhibitory control in the D/HH group. Finally, there was a significant relation between the use of first person, but not second or third person, mental state verbs (e.g., "I think") and child inhibitory control.

CONCLUSIONS

Parental use of cognitive mental state vocabulary models language around thought processes, and parents' use of first-person referents models "self-talk." Modeling of these linguistic forms is likely foundational for developing self-regulation. Children who are D/HH often experience reduced auditory access and/or language delays and thus rely on high-quality parental language input for longer periods of development than their TH peers. Continued support from interventionists is indicated to coach parents to be high-quality models of more abstract, decontextualized language, supporting complex language development and inhibitory control in children who are D/HH.

Variation in Auditory Experience Affects Language and Executive Function Skills in Children Who Are Hard of Hearing

OBJECTIVE

Children who are hard of hearing (CHH) experience delays in spoken language and executive function, but the mechanisms for these deficits remain unresolved. Differences in auditory experience and language skills have been examined as contributing factors to deficits in executive function, primarily with children who are deaf and children with cochlear implants. The theoretical model of cumulative auditory experience quantifies auditory dosage as how much speech is audible and how often children wear their hearing aids. CHH with higher auditory dosage have better language outcomes than peers with less auditory dosage. However, the effects of auditory experience on executive function have not been studied in CHH. The goal of this study was to examine the influences of auditory experience and language skills on the development of executive function in CHH.

DESIGN

We collected measures of aided speech audibility, hearing aid use, executive function, and receptive vocabulary in 177 CHH and 86 children with typical hearing who were 5- to 10 years old and matched for socioeconomic status and nonverbal intelligence. Auditory dosage was calculated by combining each child's average hours of hearing aid use with their audibility for speech to create a variable that quantifies individual differences in auditory access.

RESULTS

CHH had lower receptive vocabulary and deficits in executive function related to working memory and selective attention compared to peers with typical hearing. CHH with greater auditory dosage had higher receptive vocabulary than CHH with lower auditory dosage. Better receptive vocabulary was associated with better scores on executive function measures related to working memory and attention. Auditory dosage was also directly associated with measures of verbal working memory.

CONCLUSIONS

CHH have deficits in language and some, but not all, areas of executive function related to working memory and attention. Auditory dosage was associated with language abilities and verbal working memory. Language was associated with individual differences in executive function skills related to attention and working memory. These results provide support for systems theories regarding the development of executive function in CHH. Interventions that improve auditory access and language may be effective for improving executive function related to working memory and attention in CHH.

Congenital and Neonatally Acquired Sensorineural Hearing Loss

Hearing loss is one of the most common congenital diagnoses, recognized in large part by a robust newborn hearing screening program. Ensuring appropriate follow-up of failed newborn hearing screening is crucial to avoid delay in initiation of treatment for hearing loss. The most common etiology for congenital hearing loss is genetic, but some cases can be acquired. Understanding of the etiology aids in counseling for the family and in direction of treatment. Early diagnosis and treatment results in dramatically improved speech and developmental outcomes for affected children. Treatment including amplification, speech therapy, adaptations in the classroom, and family support leads to gains in academic performance, parental satisfaction, and quality of life. Early cochlear implantation has been shown to be beneficial in obtaining speech and language skills in patients with severe to profound sensorineural hearing loss and should be considered in the appropriate patient population. [Pediatr Ann. 2021;50(7):e292-e296.].