Are we slipping them through the cracks? The insufficiency of norm-referenced assessments for identifying language weaknesses in children with hearing loss

Tracking Listening Skill Development in Infants and Children with Hearing Loss: A Normative Dataset for the Functional Listening Index-Paediatric (FLI-P®)

BACKGROUND

Longitudinal studies highlight the importance of early intervention and timely device fitting for language development in children with congenital or early acquired hearing loss. Due to the variability in hearing loss, comorbidities, family circumstances, and service access, individualised monitoring of listening development is essential to inform decision-making. The Functional Listening Index-Paediatric (FLI-P), a 64-item hierarchical checklist of listening skills, has been validated for children with hearing loss aged 0-6 years. This study aimed to develop benchmarks for the FLI-P in typically hearing children, allowing for comparison with individual children with hearing loss.

METHODS

FLI-P scores were obtained from parents/caregivers of 561 typically hearing children aged 0-72 months. Each child's FLI-P score was categorised into a 6-month age block, with a minimum of 36 data points per block. Quantile regression was employed to establish percentiles of FLI-P scores by age.

RESULTS

FLI-P scores were successfully recorded for all 561 children. Regression analysis determined that the 16th and 84th percentiles of FLI-P scores corresponded to approximately ±1 standard deviation from the median score for each age group. A graphical representation of these percentile trajectories was created to facilitate comparison between children with hearing loss and the normative data.

CONCLUSION

A normative dataset of FLI-P scores from typically hearing children has been established, allowing for comparisons with the scores and developmental trajectories of individual children with hearing loss. The study demonstrates how FLI-P can guide early intervention decisions and effectively monitor progress.

Narrative Intervention for Preschoolers Who Are Deaf and Hard of Hearing Using Listening and Spoken Language: A Pilot Study

PURPOSE

This pilot study aimed to examine the effects of a caregiver-supported, narrative-based intervention program on the story retelling skills of a group of preschoolers who are deaf and hard of hearing (D/HH) using listening and spoken language (LSL).

METHOD

A concurrent multiple baseline design across participants was used to determine the effect of a narrative intervention on the story retelling skills of three preschool-age participants who demonstrated complex language delays. Their primary caregivers also functioned as participants. The 6-week narrative intervention program was implemented using a caregiver coaching model during individual therapy sessions. The dependent variable probes were administered twice per week across phases to assess the preschool participants' story retelling skills, including story grammar, complexity, and completeness. Social validity was also evaluated using a caregiver questionnaire.

RESULTS

A functional relation was demonstrated between the intervention and story retelling across all three preschool participants with notable increases in the inclusion of story grammar elements and episodic completeness. All three participants maintained scores above baseline levels on dependent variable probes across the 6-week maintenance period. Social validity was strong according to the results of a caregiver questionnaire completed at the conclusion of the intervention.

CONCLUSION

These findings offer preliminary support for the use of a caregiver-supported, narrative-based intervention program to improve storytelling and retelling skills in preschoolers who are D/HH using LSL.

Werfel K. An Analysis of Mental State Verb and Complex Syntax Use in Children Who Are Deaf and Hard of Hearing

PURPOSE

Children who are deaf and hard of hearing (DHH) have documented deficits with complex syntax and vocabulary knowledge. Mental state verbs (MSVs) are necessary for some kinds of complex syntax use and communicate abstract concepts needed for academic language. The purpose of this study was to examine the frequency, diversity, and syntactic context of MSV use in children who are DHH compared to children with typical hearing (CTH).

METHOD

Seventy-three preschool children (23 with cochlear implants, 22 with hearing aids, and 28 with typical hearing) completed a structured language sample as part of a larger assessment battery. Samples were analyzed and compared across groups for use of MSVs, diversity in MSV use, and syntactical context for MSVs.

RESULTS

Children who are DHH used significantly fewer MSV in complex syntax, a smaller diversity of MSV, and significantly fewer MSV in obligatory contexts compared to CTH. Results for the cochlear implants and hearing aid groups were not significantly different from one another despite differing levels of hearing loss.

CONCLUSION

Children who are DHH demonstrate significant differences in the rate, diversity, and complexity of MSV use compared to peers with typical hearing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24091860.

Oral Language Acquisition in Preschool Children Who are Deaf and Hard-of-Hearing

The purpose of this study was to compare developmental trajectories of oral language acquisition of children who are deaf and hard of hearing (DHH) and children with typical hearing across the preschool years. Thirty children who are DHH who use amplification and spoken language and 31 children with typical hearing completed an early language and literacy assessment battery every six months from age 4 to age 6. The developmental trajectories of each group's language skills were examined via growth curve analysis. Oral language skills were lower for children who are DHH than for children with typical hearing at study entry. For vocabulary, children who are DHH demonstrated growth over the two years but did not close the gap in performance over time. For morphosyntax, specifically verb tense marking, children who are DHH demonstrated growth over preschool, becoming more adult-like in their productions.

The Production of Complex Syntax in Spontaneous Language by 4-Year-Old Children With Hearing Loss

Purpose Proficiency with complex syntax is important for language and reading comprehension, and production of complex syntax begins to emerge shortly after a young child begins using two-word combinations. Complex syntax production in preschool children with hearing loss who use spoken language has been explored minimally. The purpose of this study was to compare complex syntax production of 4-year-old children with hearing loss to age-matched and language-matched peers with normal hearing. Method Seventy-two children completed a language assessment battery, including a structured language sample. Complex syntax density and number and accuracy of productions of particular types of complex syntax were compared across three groups: 4-year-old children with hearing loss, an age-matched group of children with normal hearing, and an mean length of utterance (MLU)-matched group of children with normal hearing. Results Children with hearing loss had lower complex syntax density and fewer correct productions of coordinated clauses, subordinate clauses, and simple infinitives than their age-matched, but not language-matched, peers. Furthermore, children with hearing loss had lower accuracy than the age-matched group on simple infinitives and lower accuracy than both the age- and MLU-matched groups on full propositional complements and subject relative clauses. Conclusion Children with hearing loss exhibit delays in complex syntax acquisition as compared to their same-age peers and disruptions in development on some complex structures as compared to MLU-matched, younger children. Supplemental Material https://doi.org/10.23641/asha.14080193.

The Relation Between Vocabulary Knowledge and Phonological Awareness in Children With Cochlear Implants

Purpose The purpose of this study was to evaluate the relation between lexical knowledge and phonological awareness performance of children with cochlear implants. Method Thirty children with cochlear implants (aged 5-7 years), 30 children with normal hearing matched for age, and 30 children with normal hearing matched for vocabulary size participated in the study. Children completed a vocabulary knowledge measure and three phonological awareness tasks with words that had high and low neighborhood density. Results Children with cochlear implants performed more poorly than their age-matched peers and similarly to their vocabulary-matched peers on phonological awareness tasks. When performance was analyzed according to the neighborhood density of the target word, children with cochlear implants and age-matched children performed better with high-density words. Across all groups, vocabulary size correlated significantly with phonological awareness performance. Conclusion Children with cochlear implants demonstrate delays in both vocabulary knowledge and phonological awareness performance, but children with cochlear implants appear to take advantage of lexical information similarly to their age-matched peers.

Language and Reading Outcomes in Fourth-Grade Children With Mild Hearing Loss Compared to Age-Matched Hearing Peers

Purpose There is ambiguity in the clinical and research communities regarding whether children with mild bilateral hearing loss (MBHL) are at risk for delays. The goal of the current article is to expand the evidence base surrounding outcomes for the current generation of children with MBHL. Method Using independent-samples t tests, we compared children with MBHL to same-age peers with normal hearing (NH) on measures of vocabulary, morphological awareness, listening comprehension, and reading. We completed regression analyses to explore the foundational linguistic skills that influenced reading abilities in both groups. For the children with MBHL, we examined whether hearing aid (HA) dosage was associated with individual differences in language scores. Results Group comparisons indicated that children with NH significantly outperformed children with MBHL on tests of morphological awareness and listening comprehension. There were no differences in vocabulary size or reading achievement; however, children with MBHL displayed significant differences in the factors that accounted for variability in reading scores compared to children with NH. HA dosage was significantly associated with variation in listening comprehension scores, but not vocabulary, reading, or morphological awareness. Conclusions The current results provide evidence that children with MBHL are at risk for persistent language deficits by 4th grade, particularly in aspects of language that involve form. Reading skills in children with MBHL appear to be commensurate with same-age hearing peers. Consistent use of well-fit HAs supports listening comprehension, although the amount of benefit from HAs may be reduced for children with higher unaided hearing levels.

Comparing Word Characteristic Effects on Vocabulary of Children with Cochlear Implants

Many studies have evaluated overall vocabulary knowledge of children who use cochlear implants, but there has been minimal focus on how word form characteristics affect this knowledge. This study evaluates the effects of neighborhood density and phonotactic probability on the expressive vocabulary of 81 children between five and seven years old (n = 27 cochlear implant users, n = 27 children matched for chronological age, and n = 27 children matched for vocabulary size). Children were asked to name pictures associated with words that have common and rare phonotactic probability and high and sparse neighborhood density. Results indicate that children with cochlear implants, similar to both groups of children with typical hearing, tend to know words with common probability/high density or with rare probability/ sparse density. Patterns of word knowledge for children with cochlear implants mirrored younger children matched for vocabulary size rather than age-matched children with typical hearing.

Language Sample Practices With Children Who Are Deaf and Hard of Hearing

Purpose

In this study, we aimed to identify common language sample practices of professionals who work with children who are Deaf/hard of hearing (DHH) who use listening and spoken language as a means to better understand why and how language sampling can be utilized by speech-language pathologists serving this population.

Method

An electronic questionnaire was disseminated to professionals who serve children who are DHH and use listening and spoken language in the United States. Participant responses were coded in an Excel file and checked for completeness. Descriptive statistics were used to analyze trends.

Results

A total of 168 participants participated in the survey. A majority of participants reported that they use language sampling as a part of their intervention when working with children who are DHH. However, approximately half of participants reported using norm-referenced testing most often when evaluating language of children who are DHH, regardless of the fact that they felt that language samples were more sensitive in identifying the errors of children who are DHH. Participants reported using language samples to monitor progress and set goals for clients. Participants rarely used language samples for eligibility and interprofessional collaboration.

Conclusions

Language samples offer a unique way to examine a child's language development that norm-referenced assessments are not sensitive enough to detect, particularly for children who are DHH. This offers insights into current practice and implications for the development of a more clearly defined language sample protocol to guide practices in the use of language samples with children who are DHH and use listening and spoken language.

Morphosyntax Production of Preschool Children With Hearing Loss: An Evaluation of the Extended Optional Infinitive and Surface Accounts

Purpose

The first aim of this study was to explore differences in profiles of morphosyntax production of preschool children with hearing loss (CHL) relative to age- and language-matched comparison groups. The second aim was to explore the potential of extending 2 long-standing theoretical accounts of morphosyntax weakness in children with specific language impairment to preschool CHL.

Method

This study examined conversational language samples to describe the accuracy and type of inaccurate productions of Brown's grammatical morphemes in 18 preschool CHL as compared with an age-matched group (±3 months, n = 18) and a language-matched group (±1 raw score point on an expressive language subtest, n = 18). Age ranged from 45 to 62 months. Performance across groups was compared. In addition, production accuracy of CHL on morphemes that varied by tense and duration was compared to assess the validity of extending theoretical accounts of children with specific language impairment to CHL.

Results

CHL exhibited particular difficulty with morphosyntax relative to other aspects of language. In addition, differences across groups on accuracy and type of inaccurate productions were observed. Finally, a unified approach to explaining morphosyntax weakness in CHL was more appropriate than a linguistic- or perceptual-only approach.

Conclusions

Taken together, the findings of this study support a unified theoretical account of morphosyntax weakness in CHL in which both tense and duration of morphemes play a role in morphosyntax production accuracy, with a more robust role for tense than duration.