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

The role of lexical and prosodic characteristics of mothers' child-directed speech for the early vocabulary development of Italian children with cochlear implants

BACKGROUND

Variability in the vocabulary outcomes of children with cochlear implants (CIs) is partially explained by child-directed speech (CDS) characteristics. Yet, relatively little is known about whether and how mothers adapt their lexical and prosodic characteristics to the child's hearing status (before and after implantation, and compared with groups with normal hearing (NH)) and how important they are in affecting vocabulary development in the first 12 months of hearing experience.

AIMS

To investigate whether mothers of children with CIs produce CDS with similar lexical and prosodic characteristics compared with mothers of age-matched children with NH, and whether they modify these characteristics after implantation. In addition, to investigate whether mothers' CDS characteristics predict children's early vocabulary skills before and after implantation.

METHODS & PROCEDURES

A total of 34 dyads (17 with NH, 17 with children with CIs; ages = 9-32 months), all acquiring Italian, were involved in the study. Mothers' and children's lexical quantity (tokens) and variety (types), mothers' prosodic characteristics (pitch range and variability), and children's vocabulary skills were assessed at two time points, corresponding to before and 1 year post-CI activation for children with CIs. Children's vocabulary skills were assessed using parent reports; lexical and prosodic characteristics were observed in semi-structured mother-child interactions.

OUTCOMES & RESULTS

Results showed that mothers of children with CIs produced speech with similar lexical quantity but lower lexical variety, and with increased pitch range and variability, than mothers of children with NH. Mothers generally increased their lexical quantity and variety and their pitch range between sessions. Children with CIs showed reduced expressive vocabulary and lower lexical quantity and variety than their peers 12 months post-CI activation. Mothers' prosodic characteristics did not explain variance in children's vocabulary skills; their lexical characteristics predicted children's early vocabulary and lexical outcomes, especially in the NH group, but were not related to later language development.

CONCLUSIONS & IMPLICATIONS

Our findings confirm previous studies on other languages and support the idea that the lexical characteristics of mothers' CDS have a positive effect on children's early measures of vocabulary development across hearing groups, whereas prosodic cues play a minor role. Greater input quantity and quality may assist children in the building of basic language model representations, whereas pitch cues may mainly serve attentional and emotional processes. Results emphasize the need for additional longitudinal studies investigating the input received from other figures surrounding the child and its role for children's language development.

WHAT THIS PAPER ADDS

What is already known on the subject Mothers' CDS is thought to facilitate and support language acquisition in children with various language developmental trajectories, including children with CIs. Because children with CIs are at risk for language delays and have acoustic processing limitations, their mothers may have to produce a lexically simpler but prosodically richer input, compared to mothers of children with NH. Yet, the literature reports mixed findings and no study to our knowledge has concurrently addressed the role of mothers' lexical and prosodic characteristics for children's vocabulary development before implantation and in the first 12 months of hearing experience. What this study adds to the existing knowledge The study shows that mothers of children with CIs produce input of similar quantity but reduced variety, and with heightened pitch characteristics, compared to mothers of children with NH. There was also a general increase in mothers' lexical quantity and variety, and in their pitch range, between sessions. Only their lexical characteristics predicted children's early vocabulary skills. Their lexical variety predicted children's expressive vocabulary and lexical variety only in the NH group. What are the practical and clinical implications of this work? These findings expand our knowledge about the effects of maternal input and may contribute to the improvement of early family-centred intervention programmes for supporting language development in children with CIs.

Deaf children, home language environments, and reciprocal-contingent family interactions

Engaged communication between mother and a child in their early developmental stages is one of the predictors of children's development of higher-order thinking skills. For deaf children, this engaged communication between mother and child hinges on the home language environment (HLE) being fully accessible to the child. This research uses agogical phenomenology in exploring the lived experiences of participants' HLE where sign language is used, with particular focus on the opportunities for extended discourse. Data were collected via semistructured interviews with the deaf children and their parents and observations in the HLEs of five signing families with at least one deaf child in the southwestern United States. The aim of this study was to document and provide insights into how language use in deaf children's HLE can impact their knowledge development; these insights uncovered the essence of reciprocal and contingent family interactions as a central aspect of the deaf child's HLE. It is hoped that the qualitative phenomenological findings will frame subsequent quantitative investigations of the variability in language access to home language components.

The Predictability of Naturalistic Evaluation of All-Day Recordings for Speech and Language Development

OBJECTIVES

The study aimed to investigate the predictive potential of language environment and vocal development status measures obtained through integrated analysis of Language ENvironment Analysis (LENA) recordings during the prelinguistic stage for subsequent speech and language development in Korean-acquiring children. Specifically, this study explored whether measures from both LENA-automated analysis and human coding at 6-8 months and 12-14 months of age predict vocabulary and phonological development at 18-20 months.

METHOD

One-day home recordings from 20 children were collected using a LENA recorder at 6-8 months, 12-14 months, and 18-20 months. Both LENA-automated measures and measures from human coding were obtained from recordings at 6-8 months and 12-14 months. The number of different words, consonant inventory, and utterance structure inventory were identified from recordings of 18-20 months. Correlation and multiple regression analyses were performed to investigate whether measures related to early language environment and child vocalization at 6-8 months and 12-14 months were predictive of vocabulary and phonological measures at 18-20 months.

RESULTS

The results showed that the two main LENA-automated measures, conversational turn count (CTC) and child vocalization count, were positively correlated with all vocabulary and phonological measures at 18-20 months. Multiple regression analysis revealed that CTC during the prelinguistic stages was the most significant predictor of a number of different words, consonant inventory, and utterance structure inventory at 18-20 months. Also, adult word count in LENA-automated measures, child-directed speech ratio, and canonical babbling ratio measured by human coding significantly predicted some vocabulary and phonological measures at 18-20 months.

CONCLUSION

This study highlights the multifaceted nature of language acquisition and collectively emphasizes the value of considering both quantitative and qualitative aspects of language input to understand early language development in children.

The Effect of LENA (Language ENvironment Analysis) for Children with Hearing Loss in Denmark including a Pilot Validation for the Danish Language

Background/Objectives: This study aimed to investigate whether day-long recordings with Language Environment Analysis (LENA) can be utilized in a hospital-based Auditory Verbal Therapy (AVT) program in Denmark for children with hearing loss and to conduct a pilot validation in the Danish language. Methods and materials: A license for the LENA system (LENA SP) was purchased, and trials were offered to three families enrolled in the AVT program. Each family made two day-long recordings with 3-4 months in between and received feedback during the therapy sessions. From 18 × 10-min clips randomly pulled out of the recordings, a comparison of adult word counts (AWC) between the LENA algorithm counts and the counts made by two human transcribers was made and used for the pilot validation. Results: LENA proved to be valuable as a guiding tool for Danish parents. Pilot validation showed good correlations and an acceptable limit of agreement (LoA). Conclusions: LENA holds the potential for Danish validation and use in AVT/clinical practice. When used in clinical practice, parents must be informed of the biases and limitations, and possible ethical issues must be considered. Because of the GDPR rules, there is a need to discuss the possibility of implementing this tool clinically in Denmark and the EU.

Fathers' unmodulated prosody in child-directed speech

Mothers and fathers modify prosodic characteristics of child-directed speech relative to adult-directed speech. Evidence suggests that mothers and fathers may differ in how they use child-directed speech as communicative partners. Thus, fathers create communicative challenges during father-child interaction that facilitate the child's adaptation to a wider potential range of interlocutors. In this paper, speech production differences are examined between mothers and fathers in child-directed speech to toddlers as compared to adult-directed speech. Using a longitudinal, large-scale design of audio recordings in naturalistic environments and automatic speech processing techniques, it was found that mothers, but not fathers, increased their fundamental frequency when addressing their toddlers. The results suggest that fathers do not modulate the prosody of their speech in the same way as mothers when communicating with their toddlers. Findings have implications for emotional and communicative practices of fathers compared to mothers and the differential role each plays in child development.

The validity of LENA technology for assessing the linguistic environment and interactions of infants learning Hebrew and Arabic

The present study assessed LENA's suitability as a tool for monitoring future language interventions by evaluating its reliability, construct validity, and criterion validity in infants learning Hebrew and Arabic, across low and high levels of maternal education. Participants were 32 infants aged 3 to 11 months (16 in each language) and their mothers, whose socioeconomic status (SES) was determined based on their years of education (H-high or L-low ME-maternal education). The results showed (1) good reliability for the LENA's automatic count on adult word count (AWC), conversational turns (CTC), and infant vocalizations (CVC), based on the positive associations and fair to excellent agreement between the manual and automatic counts; (2) good construct validity based on significantly higher counts for HME vs. LME and positive associations between LENA's automatic vocal assessment (AVA) and developmental questionnaire (DA) and age; and (3) good concurrent criterion validity based on the positive associations between the LENA counts for CTC, CVC, AVA, and DA and the scores on the preverbal parent questionnaire (PRISE). The present study supports the use of LENA in early intervention programs for infants whose families speak Hebrew or Arabic. The LENA could be used to monitor the efficacy of these programs as well as to provide feedback to parents on the amount of language experience their infants are getting and their progress in vocal production. The results also indicate a potential utility of LENA in assessing linguistic environments and interactions in Hebrew- and Arabic-speaking infants with developmental disorders, such as hearing impairment and cerebral palsy.

Symbolic and deictic gestures as a tool to promote parent-child communication in the context of hearing loss: A systematic review

BACKGROUND

Language and communication outcomes in children with congenital sensorineural hearing loss (cSNHL) are highly variable, and some of this variance can be attributed to the quantity and quality of language input. In this paper, we build from the evidence that human language is inherently multimodal and positive scaffolding of children's linguistic, cognitive, and social-relational development can be supported by Parent Centered Early Interventions (PCEI), to suggest that the use of gestures in these interventions could be a beneficial approach, yet scarcely explored.

AIMS AND METHODS

This systematic review aimed to examine the literature on PCEI focused on gestures (symbolic and deictic) used to enhance the caregiver-child relationship and infant's language development, in both typically and atypically developing populations. The systematic review was conducted following the PRISMA guidelines for systematic reviews and meta-analyses. From 246 identified studies, 8 met PICO inclusion criteria and were eligible for inclusion. Two reviewers screened papers before completing data extraction and risk of bias assessment using the RoB2 Cochrane scale.

RESULTS

Included studies measured the effect of implementing symbolic or deictic gestures in daily communication on the relational aspects of mother/parent-child interaction or on language skills in infants. The studies indicate that gesture-oriented PCEI may benefit deprived populations such as atypically developing children, children from low-income families, and children who, for individual reasons, lag behind their peers in communication.

CONCLUSIONS

Although gesture-oriented PCEI appear to be beneficial in the early intervention for atypically developing populations, this approach has been so far scarcely explored directly in the context of hearing loss. Yet, symbolic gestures being a natural part of early vocabulary acquisition that emerges spontaneously regardless of hearing status, this approach could represent a promising line of intervention in infants with cSNHL, especially those with a worse head start.

ASL Developmental Trends Among Deaf Children, Ages Birth to Five

Language development is an important facet of early life. Deaf children may have exposure to various languages and communication modalities, including spoken and visual. Previous research has documented the rate of growth of English skills among young deaf children, but no studies have investigated the rate of ASL acquisition. The current paper examines young deaf children's acquisition of ASL skills, the rate of growth over time, and factors impacting levels and growth rates. Seventy-three children ages birth to 5 were rated three times using the Visual Communication and Sign Language Checklist and given a scaled score at each rating. An average monthly gain score was calculated for each participant. The presence of a deaf parent, use of ASL at home, use of cochlear implant(s), whether the child was born deaf, and age of initial diagnosis were analyzed for their impact on the level of ASL skill and rate of growth. Results indicated that the use of ASL in the home has a significant positive effect on deaf children's ASL skill level. Additionally, children with lower initial ratings showed higher rates of growth than those with higher initial ratings, especially among school-aged children. The paper discusses implications and directions for future studies.

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.

Assessment of Communication Abilities in Four Children with Early Bilateral CIs in Clinical and Home Environments with LENA System: A Case Report

Children’s language acquisition is underpinned by the quantity and quality of linguistic stimulation. Early diagnosis and cochlear implantation (CI), along with a family-centered intervention, are regarded as critical factors in providing appropriate language stimulation and thus supporting successful language outcomes in children with sensory neural hearing loss (SNHL). Considering the lack of tools to assess early language skills and open issues regarding the early predictors of CI outcomes, our goal was to evaluate the potential usability of the Language ENvironment Analysis (LENA) system as an early assessment and/or predictive tool. Clinical video recordings, LENA home recordings, and vocabulary scores were used to assess the progression of communication abilities of four children with CIs (6–35 m.o.). The data revealed a positive correlation between the estimated mean length of utterance (EMLU), vocal conversational turns (CT) in clinical video recordings, and receptive vocabulary, as well as the CT count in LENA being a significant predictor of productive vocabulary. These findings lead us to conclude that the LENA system has the potential to be used as an additional (tele-)measure in the early assessment of communication abilities of children with CI, as well as as a tool in the research of early predictors of CI outcomes.

Gender differences in caregiver's use of spoken language with young children who are hard-of-hearing

PURPOSE

Shared parenting among caregivers of different gender is common in the Swedish society. It is unclear if this includes shared contribution for children's language development. The objective of this cross-sectional study was to explore the natural language environment of children who were hard-of-hearing compared to typically hearing controls.

METHODS

Seventy-two families with children aged 7-35 months participated; 22 children who were hard-of-hearing (Cochlear implants, n=11; Hearing aids, n=11) and 50 controls with typical hearing. The majority of caregivers had higher education background level, especially in the control group. Families conducted a daylong recording with the Language Environment Analysis technology, when both parents were present at home. An Interpreted Time Segmental analysis was performed to extract information about female versus male caregivers quantitative word use.

RESULTS

The results showed significant gender differences related to number of adult words, with less male words than female words (p <0.001). Male caregivers of children who were hard-of-hearing contributed with around 27 % of adult words during the recordings while males in the control group contributed with 37 %. There was a larger variation in number of female words in the study group than for controls, especially in mothers of children with cochlear implants.

CONCLUSIONS

Female caregivers talk significantly more close to young children than male caregivers, and especially in the subgroup of children with cochlear implants. Children who are hard-of-hearing are dependent on a rich language environment, and might be especially vulnerable if male caregivers are less involved as language facilitators. More studies are needed to explore caregiver gender differences, both related to quantitative and qualitative language stimulation.

Longitudinal assessment of listening skills in UK infants with hearing aids using the LittlEARS® auditory questionnaire

OBJECTIVE

To investigate listening skills in infant hearing aid users using the LittlEARS^® Auditory Questionnaire (LEAQ).

DESIGN

Caregivers completed the LEAQ, and hearing aid data logging was recorded, at infant age 3-7 months and 7-21 months.

STUDY SAMPLE

Seventy infant hearing aid users with permanent bilateral hearing loss, no developmental comorbidities, aged 3-7 months at first visit.

RESULTS

Infants with mild and moderate losses tended to have scores within the normative range at the early time point (88%), but 29% were below the normative range when older. Thirty percent of infants with severe hearing loss were outside the normative range at the early time point and 60% outside the normative range when older. Infants with profound loss were almost always (95%) outside the normative range. At the later time point, and for infants with severe-to-profound loss, low LEAQ scores were associated with fewer daily hours hearing aid use. Scores were poorer than previous reports in the literature for infant hearing aid users.

CONCLUSIONS

This study provides further knowledge on infant listening performance and hearing aid use over time that can be used to guide management of individual cases and to develop and audit service quality improvements.

Multidimensional Family-Centred Early Intervention in Children with Hearing Loss: A Conceptual Model

At least two per thousand newborns are affected by hearing loss, with up to 40% with an additional disability. Early identification by universal newborn hearing screening and early intervention services are available in many countries around the world, with limited data on their effectiveness and a lack of knowledge about specific intervention-related determinants of child and family outcomes. This concept paper aimed to better understand the mechanisms by which multi-dimensional family-centred early intervention influences child outcomes, through parent behaviour, targeted by intervention by a review of the literature, primarily in the field of childhood hearing loss, supplemented by research findings on physiological and atypical child development. We present a conceptual model of influences of multi-disciplinary family-centred early intervention on family coping/functioning and parent–child interaction, with effects on child psycho-social and cognitive outcomes. Social communication and language skills are postulated as mediators between parent–child interaction and non-verbal child outcomes. Multi-disciplinary networks of professionals trained in family-centred practice and the evaluation of existing services, with respect to best practice guidelines for family-centred early intervention, are recommended. There is a need for longitudinal epidemiological studies, including specific intervention measures, family behaviours and multidimensional child outcomes.

Reciprocal Patterns of Peer Speech in Preschoolers with and without Hearing Loss

Children with hearing loss often attend inclusive preschool classrooms aimed at improving their spoken language skills. Although preschool classrooms are fertile environments for vocal interaction with peers, little is known about the dyadic processes that influence children's speech to one another and foster their language abilities and how these processes may vary in children with hearing loss. We used new objective measurement approaches to identify and quantify children's vocalizations during social contact, as determined by children's proximity and mutual orientation. The contributions of peer vocalizations to children's future vocalizations and language abilities were examined in oral language inclusion classrooms containing children with hearing loss who use hearing aids or cochlear implants and their typically hearing peers. Across over 600 hours of recorded vocal interactions of twenty-nine 2.5-3.5 year olds (16 girls) in three cohorts of children in a classroom, we found that vocalizations from each peer on a given observation predicted a child's vocalizations to that same peer on the subsequent observation. Children who produced more vocalizations to their peers had higher receptive and expressive language abilities, as measured by a standardized end-of-year language assessment. In fact, vocalizations from peers had an indirect association with end-of-year language abilities as mediated by children's vocalizations to peers. These findings did not vary as a function of hearing status. Overall, then, the results demonstrate the importance of dyadic peer vocal interactions for children's language use and abilities.

A Framework for Understanding the Relation Between Spoken Language Input and Outcomes for Children with Cochlear Implants

Spoken language outcomes after cochlear implantation are highly variable. Some variance can be attributed to individual characteristics. Research with typically hearing children suggests that the amount of language directed to children may also play a role. However, several moderating factors may complicate the association between language input and language outcomes in children with cochlear implants. In this article, I present a conceptual framework that posits that the association between total language input directed to children and language outcomes is moderated by factors that influence what is accessible, attended to, and coordinated with the child. The framework also posits that children with cochlear implants exhibit more variability on those moderating factors, which explains why the relation between language input and language outcomes may be more complex even if language input is more important for successful language outcomes in this population.

Language development in infants with hearing loss: Benefits of infant-directed speech

The majority of infants with permanent congenital hearing loss fall significantly behind their normal hearing peers in the development of receptive and expressive oral communication skills. Independent of any prosthetic intervention ("hardware") for infants with hearing loss, the social and linguistic environment ("software") can still be optimal or sub-optimal and so can exert significant positive or negative effects on speech and language acquisition, with far-reaching beneficial or adverse effects, respectively. This review focusses on the nature of the social and linguistic environment of infants with hearing loss, in particular others' speech to infants. The nature of this "infant-directed speech" and its effects on language development has been studied extensively in hearing infants but far less comprehensively in infants with hearing loss. Here, literature on the nature of infant-directed speech and its impact on the speech perception and language acquisition in infants with hearing loss is reviewed. The review brings together evidence on the little-studied effects of infant-directed speech on speech and language development in infants with hearing loss, and provides suggestions, over and above early screening and external treatment, for a natural intervention at the level of the carer-infant microcosm that may well optimize the early linguistic experiences and mitigate later adverse effects for infants born with hearing loss.

Home Auditory Environments of Children With Cochlear Implants and Children With Normal Hearing

OBJECTIVES

Early home auditory environment plays an important role in children's spoken language development and overall well-being. This study explored differences in the home auditory environment experienced by children with cochlear implants (CIs) relative to children with normal hearing (NH).

DESIGN

Measures of the child's home auditory environment, including adult word count (AWC), conversational turns (CTs), child vocalizations (CVs), television and media (TVN), overlapping sound (OLN), and noise (NON), were gathered using the Language Environment Analysis System. The study included 16 children with CIs (M = 22.06 mo) and 25 children with NH (M = 18.71 mo). Families contributed 1 to 3 daylong recordings quarterly over the course of approximately 1 year. Additional parent and infant characteristics including maternal education, amount of residual hearing, and age at activation were also collected.

RESULTS

The results showed that whereas CTs and CVs increased with child age for children with NH, they did not change as a function of age for children with CIs; NON was significantly higher for the NH group. No significant group differences were found for the measures of AWC, TVN, or OLN. Moreover, measures of CTs, CVs, TVN, and NON from children with CIs were associated with demographic and child factors, including maternal education, age at CI activation, and amount of residual hearing.

CONCLUSIONS

These findings suggest that there are similarities and differences in the home auditory environment experienced by children with CIs and children with NH. These findings have implications for early intervention programs to promote spoken language development for children with CIs.

Variability in Quantity and Quality of Early Linguistic Experience in Children With Cochlear Implants: Evidence from Analysis of Natural Auditory Environments

OBJECTIVES

Understanding how quantity and quality of language input vary across children with cochlear implants (CIs) is important for explaining sources of large individual differences in language outcomes of this at-risk pediatric population. Studies have mostly focused either on intervention-related, device-related, and/or patient-related factors, or relied on data from parental reports and laboratory-based speech corpus to unravel factors explaining individual differences in language outcomes among children with CIs. However, little is known about the extent to which children with CIs differ in quantity and quality of language input they experience in their natural linguistic environments. To address this knowledge gap, the present study analyzed the quantity and quality of language input to early-implanted children (age of implantation <23 mo) during the first year after implantation.

DESIGN

Day-long Language ENvironment Analysis (LENA) recordings, derived from home environments of 14 early-implanted children, were analyzed to estimate numbers of words per day, type-token ratio (TTR), and mean length of utterance in morphemes (MLUm) in adults' speech. Properties of language input were analyzed across these three dimensions to examine how input in home environments varied across children with CIs in quantity, defined as number of words, and quality, defined as whether speech was child-directed or overheard.

RESULTS

Our per-day estimates demonstrated that children with CIs were highly variable in the number of total words (mean ± SD = 25,134 ± 9,267 words) and high-quality child-directed words (mean ± SD = 10,817 ± 7,187 words) they experienced in a day in their home environments during the first year after implantation. The results also showed that the patterns of variability across children in quantity and quality of language input changes depending on whether the speech was child-directed or overheard. Children also experienced highly different environments in terms of lexical diversity (as measured by TTR) and morphosyntactic complexity (as measured by MLUm) of language input. The results demonstrated that children with CIs varied substantially in the quantity and quality of language input experienced in their home environments. More importantly, individual children experienced highly variable amounts of high-quality, child-directed speech, which may drive variability in language outcomes across children with CIs.

CONCLUSIONS

Analyzing early language input in natural, linguistic environments of children with CIs showed that the quantity and quality of early linguistic input vary substantially across individual children with CIs. This substantial individual variability suggests that the quantity and quality of early linguistic input are potential sources of individual differences in outcomes of children with CIs and warrant further investigation to determine the effects of this variability on outcomes.

Benefits of Parent Training in the Rehabilitation of Deaf or Hard of Hearing Children of Hearing Parents: A Systematic Review

The present study is a systematic review on the effectiveness of Parent Training (PT) and coaching in deaf and hard of hearing (DHH) rehabilitation programs which reviews and synthesizes the existing body of evidence to assess the benefits of these programs in enhancing parents' sensitivity, responsivity and promoting language development in DHH children during the first years after HA fitting or CI activation. Five published studies met the Population, Intervention, Comparison and Outcomes (PICO) inclusion criteria and were eligible to be included, but heterogeneity in terms of the study design, interventions and outcomes did not allow for performing a meta-analysis. All included studies shared the view that a parent's learning is a circular (rather than frontal) process, and the results appear promising in terms of enhancing parents' responsiveness and promoting DHH child language development. Nevertheless, the available evidence was judged to not be robust enough due to limitations in the studies' designs. Further high-quality evidence is needed to evaluate the true degree of clinical value and the cost effectiveness of PT programs aimed at increasing parents' responsiveness to their DHH children.

Vocal Turn-Taking in Families With Children With and Without Hearing Loss

OBJECTIVE

Vocal turn-taking is an important predictor of language development in children with and without hearing loss. Most studies have examined vocal turn-taking in mother-child dyads without considering the multitalker context in a child's life. The present study investigates the quantity of vocal turns between deaf and hard-of-hearing children and multiple members of their social environment.

DESIGN

Participants were 52 families with children who used hearing aids (HA, mean age 26.3 mo) or cochlear implants (CI, mean age 63.2 mo) and 27 families with normal-hearing (NH, mean age 26.6 mo) children. The Language ENvironment Analysis system estimated the number of conversational turns per hour (CTC/hr) between all family members (i.e., adult female, adult male, target child, and other child) during full-day recordings over a period of about 1 year.

RESULTS

The CTC/hr was lower between the target child and the adult female or adult male in the CI compared with the HA and NH groups. Initially, CTC/hr was higher between the target child and the adult female than between the adult male or the other child. As the child's age increased, turn-taking between the target child and the adult female increased in comparison to that between the target child and the adult male. Over time, turn-taking between the target child and the other child increased and exceeded turn-taking between the target child and the adult caregivers. The increase was observed earlier in families with siblings compared with those without.

CONCLUSIONS

The quantity of vocal turn-taking depends on the degree of child hearing loss and the relationship between the children and the members of their social environment. Longitudinally, the positive effect of an assistive device on the quantity of turns between the children and their family members was found. The effect was stronger in families with siblings.

Relationships Between Daily Device Use and Early Communication Outcomes in Young Children With Cochlear Implants

OBJECTIVES

Children with significant hearing loss can gain access to sound via a cochlear implant (CI), but they must wear the device to reap the communication benefits of the device. That is, poor daily device use may result in underdeveloped perceptual and language skills in children and adolescents using CIs. This retrospective study focuses on the relationship between daily CI use and communication performance (auditory skills, speech recognition, expressive and receptive language) in young children, with the hypothesis that greater daily device use coincides with better communication outcomes.

DESIGN

The authors conducted a clinical chart review of patients with CIs younger than 5 years old who used at least 1 CI speech processor with datalogging technology. Participants (n = 65) had a mean chronologic age of 3.5 years, mean implantation age of 1.9 years, and mean device experience of 1.6 years. Approximately one quarter of participants had additional disabilities. Daily device use (i.e., datalogging information), child characteristics (e.g., age at CI), and assessments of communication skills (i.e., parent questionnaires, speech recognition tests, standardized language assessments) were obtained from each child's records. The investigators performed correlational analyses to examine relationships between communication outcomes and daily device use, and they employed group comparisons and correlations to identify child characteristics that were significantly associated with daily device use (p < 0.05, corrections for family-wise error).

RESULTS

Young children with CIs used their device, on average, 6.7 hr/d, with 63% below full-time use (<8 hr/d). Children without additional disabilities who wore their CI more hours per day had significantly better auditory, speech recognition, and language skills. A significant correlation also emerged between daily device use and early auditory skills in young CI users with additional disabilities, though relationships were more complicated for this subsample. Longer daily device use significantly correlated with younger age at CI and longer device experience. Differences in device use occurred in regards to absence versus presence of additional disabilities, bilateral versus unilateral device configuration, sign versus spoken language, and private versus government-assisted insurance.

CONCLUSIONS

The strong relationship between daily device use and early communication suggests clinicians and parents should focus on increasing the number of hours per day young children wear their CIs to enhance auditory and language outcomes. However, intervention strategies must consider barriers to consistent device use and goals of the family to efficiently and effectively support families of young children with CIs who struggle with inconsistent device use.

Tailoring the Input to Children's Needs: The Use of Fine Lexical Tuning in Speech Directed to Normally Hearing Children and Children With Cochlear Implants

Purpose: The aim of the present study was to explore fine lexical tuning in Dutch infant-directed speech (IDS) addressed to congenitally deaf infants who received a cochlear implant (CI) early in life (<2 years of age) in comparison with children with normal hearing (NH). The longitudinal pattern of parents' utterance length in the initial stages of the child's lexical development was examined. Parents' utterances containing the words the children eventually acquired in the earliest developmental stages were selected and their MLU (Mean Length of Utterance) was measured.

Method: Transcriptions of monthly recordings of spontaneous interactions of 10 CI children and 30 NH children with their parents were analyzed. The children with CI were followed from the moment their device was switched on, and the NH children from the age of 6 months onwards. A total of 57,846 utterances of parents of CI children and 149,468 utterances of parents of NH children were analyzed.

Results: IDS addressed to children with NH and children with CI exhibits fine lexical tuning: parents adjust the MLU of the utterances that contain the words that children are on the verge of producing themselves. More specifically, the parents' mean length of those utterances decreased in relation to the point when the children began using the item. Consequently, the number of occurrences in isolation of the lexical item increased. The speech addressed to all the children exhibited this phenomenon, but it was significantly more strongly present in speech addressed to the children with CI.

Conclusions: The speech addressed to children with NH and CI is characterized by fine lexical tuning and a high incidence of single-word utterances in the period leading up to the children's first use of words in speech production. Notwithstanding striking commonalities, IDS addressed to children with a hearing impairment is markedly different, which suggests that parents take this specific character of the children into account.

The interplay between early social interaction, language and executive function development in deaf and hearing infants

In this article, we review the influence of early social interaction on the development of executive function and language in infants. We first define social interaction, executive function and language and show how they are related in infant development. Studies of children born deaf are used to illustrate this connection because they represent cases where there has been a disruption to early social interaction and the development of intersubjectivity. Unlike other groups, the disturbance to development is known to be largely environmental rather than neuro-biological. This enables us to more accurately tease apart those impacts on EF that are associated with social interaction and language, since the potential confounds of disordered cognitive development are largely controlled for. The review offers a unifying model for how social, cognitive and linguistic development work together in early human development.

Tracking Home Language Production and Environment in Children Who Are Deaf or Hard of Hearing

OBJECTIVE

To use an automated speech-processing technology to identify patterns in sound environments and language output for deaf or hard-of-hearing infants and toddlers.

STUDY DESIGN

Observational study based on a convenience sample.

SETTING

Home observation conducted by tertiary children's hospital.

METHODS

The system analyzed 115 naturalistic recordings of 28 children <3.5 years old. Hearing ability was stratified into groups by access to sound. Outcomes were compared across hearing groups, and multivariable linear regression was used to test associations.

RESULTS

There was a significant difference in age-adjusted child vocalizations (P = .042), conversational turns (P = .022), and language development scores (P = .05) between hearing groups but no significant difference in adult words (P = .11). Conversational turns were positively associated with each language development measure, while adult words were not. For each hour of electronic media, there were significant reductions in child vocalizations (β = -0.47; 95% CI, -0.71 to -0.19), conversational turns (β = -0.45; 95% CI, -0.65 to -0.22), and language development (β = -0.37; 95% CI, -0.61 to -0.15).

CONCLUSIONS

Conversational turn scores differ among hearing groups and are positively associated with language development outcomes. Electronic media is associated with reduced discernible adult speech, child vocalizations, conversational turns, and language development scores. This effect was larger in children who are deaf or hard of hearing as compared with other reports in typically hearing populations. These findings underscore the need to optimize early language environments and limit electronic noise exposure in children who are deaf or hard of hearing.

Effects of Parents' Mealtime Conversation Techniques for Preschool Children With Hearing Loss Who Use Listening and Spoken Language

Purpose This mixed-methods study aimed to examine the conversation techniques used by parents of young children with hearing loss (HL) during dinnertime at home. Parents' usage rates of open- and closed-ended language elicitation, reformulation, imitation, directives, and explicit vocabulary instruction were examined in relation to children's receptive vocabulary and basic-concepts skills. Method Twenty-minute dinnertime segments were extracted from naturalistic, daylong recordings of 37 preschoolers with HL who used listening and spoken language. The segments were hand-coded for parents' use of conversation techniques. Children's receptive vocabulary and basic concepts were assessed using standardized measures. Results Parents' use of conversation techniques varied widely, with closed-ended elicitation and directives used most frequently during dinner. Explicit vocabulary instruction was correlated with general receptive vocabulary and basic-concepts skills. Thematic analysis of the conversations revealed common themes, including concrete topics and sibling speakers. In addition, parents who used many techniques often introduced abstract conversation topics; electronic media was present in all conversations with few techniques. Conclusions Parents of preschoolers with HL may benefit from specific coaching to elicit language and introduce new vocabulary during home routines. These techniques may help develop their children's receptive language.

Language Environments and Spoken Language Development of Children With Hearing Loss

This study examined the relationships between adult language input and child language production in regard to the quantity and diversity of spoken language, as well as children's knowledge of basic concepts and vocabulary. The quantity and diversity of language provided by teachers and parents were related to children's language output and knowledge. Language ENvironment Analysis technology audio-recorded the language environments of 26 preschool children with hearing loss over 2 days. The language samples were analyzed for quantity (adult word count, child vocalization count, and conversational turn count) and diversity (lexical diversity, syntactical complexity, and clausal complexity) of language. Results indicated a relationship between adult language input and child language production, but only in regard to the quantity of language. Significant differences between the teachers and parents were reported in regard to the diversity of adult language input. These results suggest that the language input provided by adults across environments (school versus home) is considerably different and warrants further investigation.

Natural Language Input: Maternal Education, Socioeconomic Deprivation, and Language Outcomes in Typically Developing Children

Purpose The current study was designed to investigate the differences in language input related to family factors (maternal level of education [MLE] and socioeconomic level of deprivation [SLD]) and their association with language outcomes in preschoolers. Method This study used New Zealand SLD and MLE classification systems to examine differences in language input related to these factors among 20 typically developing preschool children aged 2-5 years. The quantity of children's language input (adult words [AWs], conversational turns [CTs]) was calculated using the Language ENvironment Analysis audiotaping technology for two typical weekend days. Four 5-min Language ENvironment Analysis recording segments were transcribed and coded, and parental language strategies were classified as optimal language strategy, moderate language strategy, or sub-optimal language strategy (S-OLS) for child language outcomes. The receptive and expressive language of each child was assessed using the Preschool Language Scales-Fifth Edition. Results Mann-Whitney U tests showed significant differences between the quantity of language input (AWs/hr, CTs/hr) for high and low MLE and high and low SLD groups. Consistent with the literature, the use of S-OLSs was significantly lower for families with high MLE (Mdn = .25, IQR = .14) and low SLD (Mdn = .22, IQR = .13) than for families with low MLE (Mdn = .41, IQR = .24) and high SLD (Mdn = .41, IQR = .26). Spearman correlation coefficients indicated significant associations between language input (AWs/hr, CTs/hr, S-OLSs) and language outcomes. Conclusions Reduced language input and the frequent use of S-OLSs associated with low maternal education and high deprivation and low language outcomes for these children highlight the importance for all parents/families to learn optimal language strategies to support the development of strong language skills in their children in young age.

Measurement of child-directed speech: A survey of clinical practice

Purpose: Clear correlations exist between the quality and quantity of child-directed speech (CDS) and children's language development. Interventions for children with poor language skills involve manipulation of the quality and/or quantity of CDS in a child's daily experience. Assessment of CDS is therefore important. There are a range of CDS measures reported in the literature, however no data exist on the use of these in clinical practice. The aim of this study was to identify current clinical practices in measurement of CDS.Method: An online survey was developed using the Qualtrics platform. Brief study information and a link to the survey were distributed to speech-language pathologists working in New Zealand and Australia.Result: Responses from 116 clinicians were analysed. Participants mainly reported using informal analysis of adult-child observations, checklists and informal discussion with adults to measure CDS. The barriers to measuring CDS reported were time, teaming with adults and psychometric properties of informal methods.Conclusion: There are few psychometrically validated clinical tools which are "fit for purpose" to measure qualitative aspects of CDS. Automated speech analysis technology appears to have potential as a quantitative measure of CDS to support clinical practice.

Parental Linguistic Input and Its Relation to Toddlers' Visual Attention in Joint Object Play: A Comparison Between Children with Normal Hearing and Children With Hearing Loss

Parent-child interactions are multimodal, often involving coordinated exchanges of visual and auditory information between the two partners. The current work focuses on the effect of children's hearing loss on parent-child interactions when parents and their toddlers jointly played with a set of toy objects. We compared the linguistic input received by toddlers with hearing loss (HL) and their chronological age-matched (CA) and hearing age-matched (HA) normal-hearing peers. Moreover, we used head-mounted eye trackers to examine how different parental linguistic input affected children's visual attention on objects when parents either led or followed children's attention during joint object play. Overall, parents of children with HL provided comparable amount of linguistic input as parents of the two normal-hearing groups. However, the types of linguistic input produced by parents of children with HL were similar to the CA group in some ways and similar to the HA group in other ways. Interestingly, the effects of different types of linguistic input on extending the attention of children with HL qualitatively resembled the patterns seen in the CA group, even though the effects were less pronounced in the HL group. We discuss the implications of these results for our understanding of the reciprocal, dynamic, and multi-factored nature of parent-child interactions.

The Input Matters: Assessing Cumulative Language Access in Deaf and Hard of Hearing Individuals and Populations

Deaf and hard-of-hearing (DHH) children present several challenges to traditional methods of language assessment, and yet language assessment for this population is absolutely essential for optimizing their developmental potential. Whereas assessment often focuses on language outcomes, this Conceptual Analysis argues that assessing cumulative language input is critically important both in clinical work with DHH individuals and in research/public health contexts concerned with DHH populations. At the individual level, paying attention to the input (and the person's access to it) is vital for discriminating disorder from delay, and for setting goals and strategies for reaching them. At the population level, understanding relationships between cumulative language input and resulting language outcomes is essential to the broader public health efforts aimed at identifying strategies to improve outcomes in DHH populations and to theoretical efforts to understand the role that language plays in child development. Unfortunately, several factors jointly result in DHH children's input being under-described at both individual and population levels: for example, overly simplistic ways of classifying input, and the lack of tools for assessing input more thoroughly. To address these limitations, this Conceptual Analysis proposes a new way of characterizing a DHH child's cumulative experience with input, and outlines the features that a tool would need to have in order to measure this alternative construct.

A meta-analysis of the predictability of LENA™ automated measures for child language development

Early language environment plays a critical role in child language development. The Language ENvironment Analysis (LENA™) system allows researchers and clinicians to collect daylong recordings and obtain automated measures to characterize a child's language environment. This meta-analysis evaluates the predictability of LENA's automated measures for language skills in young children. We systematically searched reports for associations between LENA's automated measures, specifically, adult word count (AWC), conversational turn count (CTC), and child vocalization count (CVC), and language skills in children younger than 48 months. Using robust variance estimation, we calculated weighted mean effect sizes and conducted moderator analyses exploring the factors that might affect this relationship. The results revealed an overall medium effect size for the correlation between LENA's automated measures and language skills. This relationship was largely consistent regardless of child developmental status, publication status, language assessment modality and method, or the age at which the LENA recording was taken; however, the effect was weakly moderated by the gap between LENA recordings and language measures taken. Among the three measures, there were medium associations between CTC and CVC and language, whereas there was a small-to-medium association between AWC and language. These findings extend beyond validation work conducted by the LENA Research Foundation and suggest certain predictive strength of LENA's automated measures for child language. We discussed possible mechanisms underlying the observed associations, as well as the theoretical, methodological, and clinical implications of these findings.

Female caregivers talk more to 18-56-months-old children with and without hearing impairment than male caregivers measured with LENA™ - A cross-sectional pilot study

The objective of the current study was to investigate possible differences in word count use per day (number of adult words) by caregivers of different gender, in a sample of Norwegian children (N = 17) with hearing impairment (HI) (n = 8) and normal hearing (NH) (n = 9), aged 18-56 months. The current study had a cross-sectional, descriptive study design. One all-day recording with the LENA technology was conducted to measure adult word use in the home environment (Md length: 12.46 h, 9.13-16 h). Female caregivers used a significantly higher amount of words than male caregivers close to the children, regardless of their hearing status, HI: p = .01, NH: p = .01. All children were exposed to a higher number of adult words from female caregivers. There is a need to conduct more and further research about possible caregiver differences, and investigate not only the quantity of word use, but also the qualitative interaction patterns between caregivers of different gender and young children with HI, and in relation to early intervention actions.

Associations Between Parenting Stress, Language Comprehension, and Inhibitory Control in Children With Hearing Loss

Purpose Parenting stress has been studied as a potential predictor of developmental outcomes in children with normal hearing and children who are deaf and hard of hearing. However, it is unclear how parenting stress might underlie at-risk spoken language and neurocognitive outcomes in this clinical pediatric population. We investigated parenting stress levels and the shared relations between parenting stress, language comprehension, and inhibitory control skills in children with and without hearing loss (HL) using a cross-sectional design. Method Families of children with HL (n = 39) and with normal hearing (n = 41) were tested. Children completed an age-appropriate version of the Concepts & Following Directions subtest of the Clinical Evaluation of Language Fundamentals and the NIH Toolbox Flanker Test of Attention and Inhibitory control. Caregivers completed the Parenting Stress Index-Short Form 4. Results Parenting stress levels were not significantly different between parents of children with and without HL. A significant negative association was observed between parenting stress and our measure of language comprehension in children with HL. A negative association between parenting stress and inhibitory control skills was also found in families of children with HL, but not hearing children. The parenting stress-inhibitory control relationship was indirectly accounted for by delayed language comprehension skills in children with HL. Conclusion Even at moderate levels of parenting stress similar to parents of children with normal hearing, increases in parenting stress were associated with lower scores on our measures of language comprehension and inhibitory control in children with HL. Thus, parenting stress may underlie some of the variability in at-risk pediatric HL outcomes.

Talk with me! Parental linguistic input to toddlers with moderate hearing loss

This study examined the quantity and quality of parental linguistic input to toddlers with moderate hearing loss (MHL) compared with toddlers with normal hearing (NH). The linguistic input to eighteen toddlers with MHL and twenty-four toddlers with NH was examined during a 10-minute free-play activity in their home environment. Results showed that toddlers with MHL were exposed to an equivalent amount of parental linguistic input compared to toddlers with NH. However, parents of toddlers with MHL used less high-level facilitative language techniques, used less mental state language, and used shorter utterances than parents of toddlers with NH. Quantity and quality measures of parental linguistic input were positively related to the expressive language abilities of toddlers with MHL.

Quantity and Quality of Parental Utterances and Responses to Children With Hearing Loss Prior to Cochlear Implant

This study investigated the extent to which parental language input to children with hearing loss (HL) prior to cochlear implant (CI) differs from input to children with typical hearing (TH). A 20-min parent-child interaction sample was collected for 13 parent-child dyads in the HL group and 17 dyads in the TH group during free play. Ten minutes were transcribed and were coded for four variables: (a) overall utterances, (b) high-quality utterances, (c) utterances in response to child communicative acts (i.e., overall responses), and (d) high-quality utterances in response to child communicative acts (i.e., high-quality responses). Differences were detected for both quantity and quality of parental language input across the two groups. Early language skills correlated with three out of the four parental variables in both groups. Post hoc analyses suggested that the lower rate of high-quality responses in parents of children with HL could be attributed to lower intelligibility of child communication.

A modular, extensible approach to massive ecologically valid behavioral data

We explore here the application of modern computer hardware and software to the collection and analysis of behavioral data. We discuss the issues of ecological validity, storage and processing, data permanence, automation, validity, and algorithmic determinism. Taking the modern landscape into account, we demonstrate several varying projects we have recently undertaken as proofs of concept of the viability and utility of this approach. In particular, we describe four research projects, which involve work on child-directed speech; the application of automatic methods to clinical populations, including children with hearing loss; quality control and the assessment of validity; and the sharing of data in a public database. We conclude by pointing out how the methodology described here can be extended to a wide variety of interdisciplinary and detailed projects that are likely to lead to better science and improved outcomes for populations served by the behavioral, social, and health sciences.

Effects of children's hearing loss on the synchrony between parents' object naming and children's attention

Children's attentional state during parent-child interactions is important for word learning. The current study examines the real-time attentional patterns of toddlers with and without hearing loss (N = 15, age range: 12-37 months) in parent-child interactions. High-density gaze data recorded from head-mounted eye-trackers were used to investigate the synchrony between parents' naming of novel objects and children's sustained attention on the named objects in joint play. Results show that the sheer quantities of parents' naming and children's sustained attention episodes were comparable in children with hearing loss and their peers with normal hearing. However, parents' naming and children's sustained attention episodes were less synchronized in the hearing loss group compared to children with normal hearing. Possible implications are discussed.

Using a Digital Language Processor to Quantify the Auditory Environment and the Effect of Hearing Aids for Adults with Hearing Loss

BACKGROUND

Auditory environments can influence the communication function of individuals with hearing loss and the effects of hearing aids. Therefore, a tool that can objectively characterize a patient's real-world auditory environments is needed.

PURPOSE

To use the Language Environment Analysis (LENA) system to quantify the auditory environments of adults with hearing loss, to examine if the use of hearing aids changes a user's auditory environment, and to determine the association between LENA variables and self-report hearing aid outcome measures.

RESEARCH DESIGN

This study used a crossover design.

STUDY SAMPLE

Participants included 22 adults with mild-to-moderate hearing loss, age 64-82 yr.

INTERVENTION

Participants were fitted with bilateral behind-the-ear hearing aids from a major manufacturer.

DATA COLLECTION AND ANALYSIS

The LENA system consists of a digital language processor (DLP) that is worn by an individual and records up to 16 hr of the individual's auditory environment. The recording is then automatically categorized according to time spent in different types of auditory environments (e.g., meaningful speech and TV/electronic sound) by the LENA algorithms. The LENA system also characterizes the user's auditory environment by providing the sound levels of different auditory categories. Participants in the present study wore a LENA DLP in an unaided condition and aided condition, which each lasted six to eight days. Participants wore bilateral hearing aids in the aided condition. Percentage of time spent in each auditory environment, as well as median levels of TV/electronic sounds and speech, were compared between subjects' unaided and aided conditions using paired sample t tests. LENA data were also compared to self-report measures of hearing disability and hearing aid benefit using Pearson correlations.

RESULTS

Overall, participants spent the greatest percentage of time in silence (∼40%), relative to other auditory environments. Participants spent ∼12% and 26% of their time in meaningful speech and TV/electronic sound environments, respectively. No significant differences were found between mean percentage of time spent in each auditory environment in the unaided and aided conditions. Median TV/electronic sound levels were on average 2.4 dB lower in the aided condition than in the unaided condition; speech levels were not significantly different between the two conditions. TV/electronic sound and speech levels did not significantly correlate with self-report data.

CONCLUSIONS

The LENA system can provide rich data to characterize the everyday auditory environments of older adults with hearing loss. Although TV/electronic sound level was significantly lower in the aided than unaided condition, the use of hearing aids seemed not to substantially change users' auditory environments. Because there is no significant association between objective LENA variables and self-report questionnaire outcomes, these two types of measures may assess different aspects of communication function. The feasibility of using LENA in clinical settings is discussed.

Analysis of Amount and Style of Oral Interaction Related to Language Outcomes in Children With Hearing Loss: A Systematic Review (2006-2016)

Purpose This systematic review summarizes the evidence for differences in the amount of language input between children with and without hearing loss (HL). Of interest to this review is evaluating the associations between language input and language outcomes (receptive and expressive) in children with HL in order to enhance insight regarding what oral language input is associated with good communication outcomes. Method A systematic review was conducted using keywords in 3 electronic databases: Scopus, PubMed, and Google Scholar. Keywords were related to language input, language outcomes, and HL. Titles and abstracts were screened independently, and full-text manuscripts meeting inclusion criteria were extracted. An appraisal checklist was used to evaluate the methodological quality of studies as poor, good, or excellent. Results After removing duplicates, 1,545 study results were extracted, with 27 eligible for full-text review. After the appraisal, 8 studies were included in this systematic review. Differences in the amount of language input between children with and without HL were noted. Conversational exchanges, open-ended questions, expansions, recast, and parallel talk were positively associated with stronger receptive and expressive language scores. The quality of evidence was not assessed as excellent for any of the included studies. Conclusions This systematic review reveals low-level evidence from 8 studies that specific language inputs (amount and style) are optimal for oral language outcomes in children with HL. Limitations were identified as sample selection bias, lack of information on control of confounders and assessment protocols, and limited duration of observation/recordings. Future research should address these limitations.

Vocal and Tactile Input to Children Who Are Deaf or Hard of Hearing

Purpose Caregivers may show greater use of nonauditory signals in interactions with children who are deaf or hard of hearing (DHH). This study explored the frequency of maternal touch and the temporal alignment of touch with speech in the input to children who are DHH and age-matched peers with normal hearing. Method We gathered audio and video recordings of mother-child free-play interactions. Maternal speech units were annotated from audio recordings, and touch events were annotated from video recordings. Analyses explored the frequency and duration of touch events and the temporal alignment of touch with speech. Results Greater variance was observed in the frequency of touch and its total duration in the input to children who are DHH. Furthermore, touches produced by mothers of children who are DHH were significantly more likely to be aligned with speech than touches produced by mothers of children with normal hearing. Conclusion Caregivers' modifications in the input to children who are DHH are observed in the combination of speech with touch. The implications for such patterns and how they may impact children's attention and access to the speech signal are discussed.

Deaf Children as ‘English Learners’: The Psycholinguistic Turn in Deaf Education

The purpose of this literature review is to present the arguments in support of conceptualizing deaf children as ‘English Learners’, to explore the educational implications of such conceptualizations, and to suggest directions for future inquiry. Three ways of interpreting the label ‘English Learner’ in relationship to deaf children are explored: (1) as applied to deaf children whose native language is American Sign Language; (2) as applied to deaf children whose parents speak a language other than English; and (3) as applied to deaf children who have limited access to the spoken English used by their parents. Recent research from the fields of linguistics and neuroscience on the effects of language deprivation is presented and conceptualized within a framework that we refer to as the psycholinguistic turn in deaf education. The implications for developing the literacy skills of signing deaf children are explored, particularly around the theoretical construct of a ‘bridge’ between sign language proficiency and print-based literacy. Finally, promising directions for future inquiry are presented.

A step-by-step guide to collecting and analyzing long-format speech environment (LFSE) recordings

Recent years have seen rapid technological development of devices that can record communicative behavior as participants go about daily life. This paper is intended as an end-to-end methodological guidebook for potential users of these technologies, including researchers who want to study children’s or adults’ communicative behavior in everyday contexts. We explain how long-format speech environment (LFSE) recordings provide a unique view on language use and how they can be used to complement other measures at the individual and group level. We aim to help potential users of these technologies make informed decisions regarding research design, hardware, software, and archiving. We also provide information regarding ethics and implementation, issues that are difficult to navigate for those new to this technology, and on which little or no resources are available. This guidebook offers a concise summary of information for new users and points to sources of more detailed information for more advanced users. Links to discussion groups and community-augmented databases are also provided to help readers stay up-to-date on the latest developments.

A Cross-cultural Mixed Methods Investigation of Language Socialization Practices

This embedded mixed methods study explores how cultural differences in language socialization practices influence parent-child verbal interactions. The Language ENvironment Analysis (LENA) System audio recorded families of children who are and are not deaf and hard of hearing in Canada and Vietnam. Software automatically calculated an average conversational turn count. Canadian families participated in more turns than Vietnamese families regardless of hearing status. Interviews with the children's caregivers provided context for these results. Within Vietnamese families, the language socialization practice "Intelligence" results in reduced opportunities for turn-taking, while the Canadian focus on creating personal "Identity" encouraged them. "Intelligence" encompasses Vietnamese participants' desire to ensure their children are learning and "Identity" expresses the Canadian participants' appeal to encourage individuality in their children. The findings suggest directions for the adaptation of intervention. It is the first known study to incorporate LENA results into a mixed methods design.

Characteristics of Real-World Signal to Noise Ratios and Speech Listening Situations of Older Adults With Mild to Moderate Hearing Loss

OBJECTIVES

The first objective was to determine the relationship between speech level, noise level, and signal to noise ratio (SNR), as well as the distribution of SNR, in real-world situations wherein older adults with hearing loss are listening to speech. The second objective was to develop a set of prototype listening situations (PLSs) that describe the speech level, noise level, SNR, availability of visual cues, and locations of speech and noise sources of typical speech listening situations experienced by these individuals.

DESIGN

Twenty older adults with mild to moderate hearing loss carried digital recorders for 5 to 6 weeks to record sounds for 10 hours per day. They also repeatedly completed in situ surveys on smartphones several times per day to report the characteristics of their current environments, including the locations of the primary talker (if they were listening to speech) and noise source (if it was noisy) and the availability of visual cues. For surveys where speech listening was indicated, the corresponding audio recording was examined. Speech-plus-noise and noise-only segments were extracted, and the SNR was estimated using a power subtraction technique. SNRs and the associated survey data were subjected to cluster analysis to develop PLSs.

RESULTS

The speech level, noise level, and SNR of 894 listening situations were analyzed to address the first objective. Results suggested that as noise levels increased from 40 to 74 dBA, speech levels systematically increased from 60 to 74 dBA, and SNR decreased from 20 to 0 dB. Most SNRs (62.9%) of the collected recordings were between 2 and 14 dB. Very noisy situations that had SNRs below 0 dB comprised 7.5% of the listening situations. To address the second objective, recordings and survey data from 718 observations were analyzed. Cluster analysis suggested that the participants' daily listening situations could be grouped into 12 clusters (i.e., 12 PLSs). The most frequently occurring PLSs were characterized as having the talker in front of the listener with visual cues available, either in quiet or in diffuse noise. The mean speech level of the PLSs that described quiet situations was 62.8 dBA, and the mean SNR of the PLSs that represented noisy environments was 7.4 dB (speech = 67.9 dBA). A subset of observations (n = 280), which was obtained by excluding the data collected from quiet environments, was further used to develop PLSs that represent noisier situations. From this subset, two PLSs were identified. These two PLSs had lower SNRs (mean = 4.2 dB), but the most frequent situations still involved speech from in front of the listener in diffuse noise with visual cues available.

CONCLUSIONS

The present study indicated that visual cues and diffuse noise were exceedingly common in real-world speech listening situations, while environments with negative SNRs were relatively rare. The characteristics of speech level, noise level, and SNR, together with the PLS information reported by the present study, can be useful for researchers aiming to design ecologically valid assessment procedures to estimate real-world speech communicative functions for older adults with hearing loss.

Using the Language ENvironment Analysis (LENA) System to Investigate Cultural Differences in Conversational Turn Count

PURPOSE

This study investigates how the variables of culture and hearing status might influence the amount of parent-child talk families engage in throughout an average day.

METHOD

Seventeen Vietnamese and 8 Canadian families of children with hearing loss and 17 Vietnamese and 13 Canadian families with typically hearing children between the ages of 18 and 48 months old participated in this cross-comparison design study. Each child wore a Language ENvironment Analysis system digital language processor for 3 days. An automated vocal analysis then calculated an average conversational turn count (CTC) for each participant as the variable of investigation. The CTCs for the 4 groups were compared using a Kruskal-Wallis test and a set of planned pairwise comparisons.

RESULTS

The Canadian families participated in significantly more conversational turns than the Vietnamese families. No significant difference was found between the Vietnamese or the Canadian cohorts as a function of hearing status.

CONCLUSIONS

Culture, but not hearing status, influences CTCs as derived by the Language ENvironment Analysis system. Clinicians should consider how cultural communication practices might influence their suggestions for language stimulation.