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

Early assessment of communicative competence in children with hearing loss using the Child-Caregiver Communication Assessment through Rebesco's Evaluation (CC-CARE) method

PURPOSE

This work presents a new frame-by-frame video analysis method called Child-Caregiver Communication Assessment through Rebesco's Evaluation (CC-CARE), developed in the context of pediatric hearing loss as a rehabilitation tool for assessing children's early communication skills. CC-CARE stems from the commonly used Tait video analysis and extends it by including a new set of parameters aimed at disentangling between hearing-dependent and hearing-independent aspects of communication.

METHOD

In this paper, we collected video samples of child-caregiver interactions in a group of 65 normal-hearing children and a group of 165 hearing-impaired children. For each group, we present the CC-CARE method and describe the parameters, their score distributions, correlations and we estimate the adherence of the CC-CARE scores with children's developmental trajectory. Moreover, we compare the results of CC-CARE scores between the two groups having had different development of the auditory system. Finally, a fully-data driven approach was employed to assess the consistency of the communicative efficacy index (CEI), a score aiming to capture a global result of the CC-CARE procedure.

RESULTS

Correlations among parameter scores were found in each within-group analysis, revealing CC-CARE's internal consistency in measuring associated but nonoverlapping communication dimensions. For both groups, CC-CARE scores were associated with participants' age. Differences between scores emerged for a between-group analysis, indicating CC-CARE sensitivity to extract communication differences as a function of the hearing status. For both groups, the data analysis revealed that the CEI captures large variance portions across all parameter scores of the CC-CARE method.

CONCLUSIONS

Results provide the first evidence that the CC-CARE video analysis method could be a reliable tool capable of highlighting the cascading effects of hearing impairment on children's preverbal communicative efficacy. The CC-CARE method aims to support early rehabilitation of hearing loss by describing a child's communicative efficacy.

The timeline of non-vocal and vocal communicative skills in infants with hearing loss

Objective

The study investigates what is the link between early verbal and non-vocal abilities, when does predominantly verbal communicative style occur after the intervention with cochlear implants (CI) or hearing aids (HA), and how predictive it is of later linguistic development in deaf and hard of hearing (DHH) infants and children.

Methods

Cohort: children with moderate-to-profound hearing impairment (N = 49, 20 girls, mean age at HA or CI intervention = 15 months, range: 4-35 months).

Measures

Receptive and productive vocabulary at 24 and 36 months and video analysis at 12 months post-intervention. Analysis: Predictive values of total and verbal responses to communicative turns for later vocabulary development were assessed, as well as the relative time course of the development of vocal/verbal communication in DHH children.

Results

Vocabulary at 24 months is predicted by auditory responses at 12 months, as well as by overall responsiveness before intervention. Non-vocal responses decline and overall verbal responses increase significantly between 6 and 12 months after intervention. The trend is delayed in children with delayed (>12 months of age) treatment with CI or HA.

Conclusions

Age of intervention affects the development of vocal/verbal communicative style. Language development, in particular, vocabulary growth, can be further stimulated by the enhancement of preverbal (both vocal and non-vocal) communicative skills.

Executive Function in Deaf Native Signing Children

The aim of this study is twofold: To examine if deafness is invariably associated with deficits in executive function (EF) and to investigate the relationship between sign language proficiency and EF in deaf children of deaf parents with early exposure to a sign language. It is also the first study of EF in children acquiring Polish Sign Language. Even though the mothers of the deaf children (N = 20) had lower levels of education compared with the mothers of a hearing control group, the children performed similarly to their hearing peers (N = 20) on a variety of EF task-based assessments. Only in the Go/No-go task were weaker inhibition skills observed in younger deaf children (6-9 years) compared with hearing peers, and this difference was not seen in older children (10-12 years). Hence, deafness does not necessarily impair EF; however, attentional and inhibition abilities may be acquired via a different route in deaf children. Sign language receptive skills predicted EF in deaf children. In conclusion, we highlight the importance of deaf parenting building the scaffolding for EF in deaf children.

Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language

PURPOSE

The purpose of this study is to determine whether and how learning American Sign Language (ASL) is associated with spoken English skills in a sample of ASL-English bilingual deaf and hard of hearing (DHH) children.

METHOD

This cross-sectional study of vocabulary size included 56 DHH children between 8 and 60 months of age who were learning both ASL and spoken English and had hearing parents. English and ASL vocabulary were independently assessed via parent report checklists.

RESULTS

ASL vocabulary size positively correlated with spoken English vocabulary size. Spoken English vocabulary sizes in the ASL-English bilingual DHH children in the present sample were comparable to those in previous reports of monolingual DHH children who were learning only English. ASL-English bilingual DHH children had total vocabularies (combining ASL and English) that were equivalent to same-age hearing monolingual children. Children with large ASL vocabularies were more likely to have spoken English vocabularies in the average range based on norms for hearing monolingual children.

CONCLUSIONS

Contrary to predictions often cited in the literature, acquisition of sign language does not harm spoken vocabulary acquisition. This retrospective, correlational study cannot determine whether there is a causal relationship between sign language and spoken language vocabulary acquisition, but if a causal relationship exists, the evidence here suggests that the effect would be positive. Bilingual DHH children have age-expected vocabularies when considering the entirety of their language skills. We found no evidence to support recommendations that families with DHH children avoid learning sign language. Rather, our findings show that children with early ASL exposure can develop age-appropriate vocabulary skills in both ASL and spoken English.

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.

Differential At-Risk Pediatric Outcomes of Parental Sensitivity Based on Hearing Status

Purpose The aim of this study was to investigate the role of parental sensitivity in language and neurocognitive outcomes in children who are deaf and/or hard of hearing (DHH). Method Sixty-two parent-child dyads of children with normal hearing (NH) and 64 of children who are DHH (3-8 years) completed parent and child measures of inhibitory control/executive functioning and child measures of sentence comprehension and vocabulary. The dyads also participated in a video-recorded, free-play interaction that was coded for parental sensitivity. Results There was no evidence of associations between parental sensitivity and inhibitory control or receptive language in children with NH. In contrast, parental sensitivity was related to children's inhibitory control and all language measures in children who are DHH. Moreover, inhibitory control significantly mediated the association between parental sensitivity and child language on the Clinical Evaluation of Language Fundamentals-Fifth Edition Following Directions subscale (6-8 years)/Clinical Evaluation of Language Fundamentals Preschool-Second Edition Concepts and Following Directions subscale (3-5 years). Follow-up analyses comparing subgroups of children who used hearing aids (n = 29) or cochlear implants (CIs; n = 35) revealed similar correlational trends, with the exception that parental sensitivity showed little relation to inhibitory control in the group of CI users. Conclusions Parental sensitivity is associated with at-risk language outcomes and disturbances in inhibitory control in young children who are DHH. Compared to children with NH, children who are DHH may be more sensitive to parental behaviors and their effects on emerging inhibitory control and spoken language. Specifically, inhibitory control, when scaffolded by positive parental behaviors, may be critically important for robust language development in children who are DHH.

Deaf Children of Hearing Parents Have Age-Level Vocabulary Growth When Exposed to American Sign Language by 6 Months of Age

OBJECTIVE

To examine whether children who are deaf or hard of hearing who have hearing parents can develop age-level vocabulary skills when they have early exposure to a sign language.

STUDY DESIGN

This cross-sectional study of vocabulary size included 78 children who are deaf or hard of hearing between 8 and 68 months of age who were learning American Sign Language (ASL) and had hearing parents. Children who were exposed to ASL before 6 months of age or between 6 and 36 months of age were compared with a reference sample of 104 deaf and hard of hearing children who have parents who are deaf and sign.

RESULTS

Deaf and hard of hearing children with hearing parents who were exposed to ASL in the first 6 months of life had age-expected receptive and expressive vocabulary growth. Children who had a short delay in ASL exposure had relatively smaller expressive but not receptive vocabulary sizes, and made rapid gains.

CONCLUSIONS

Although hearing parents generally learn ASL alongside their children who are deaf, their children can develop age-expected vocabulary skills when exposed to ASL during infancy. Children who are deaf with hearing parents can predictably and consistently develop age-level vocabularies at rates similar to native signers; early vocabulary skills are robust predictors of development across domains.

Modelling the early expressive communicative trajectories of infants/toddlers with early cochlear implants

For children with normal hearing (NH), early communication skills predict vocabulary, a precursor to grammar. Growth in early communication skills of infants with cochlear implants (CIs) was investigated using the Early Communication Indicator (ECI), a play-based observation measure. Multilevel linear growth modelling on data from six ECI sessions held at three-monthly intervals revealed significant growth overall, with a non-significant slower growth rate than that of children with NH (comparison age centred at 18 months). Analyses of gesture use and of nonword vocalisations revealed the CI group used significantly more of each, with more rapid growth. In contrast, the CI group used significantly fewer single words and multiword utterances, and with slower growth. Maternal education and time to achieve consistent CI use impacted significantly on growth for the CI sample. The results indicate that progression to vocabulary by young CI users can be supported by encouraging their use of prelinguistic communication.

Parent-Implemented Communication Treatment for Infants and Toddlers With Hearing Loss: A Randomized Pilot Trial

Purpose Despite advances in cochlear implant and hearing aid technology, many children with hearing loss continue to exhibit poorer language skills than their hearing peers. This randomized pilot trial tested the effects of a parent-implemented communication treatment targeting prelinguistic communication skills in infants and toddlers with hearing loss. Method Participants included 19 children between 6 and 24 months of age with moderate to profound, bilateral hearing loss. Children were randomly assigned to the parent-implemented communication treatment group or a "usual care" control group. Parents and children participated in 26, hour-long home sessions in which parents were taught to use communication support strategies. The primary outcome measures were the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 2003), a measure of child prelinguistic skills, and parental use of communication support strategies during a naturalistic play session. Results Parents in the treatment group increased their use of communication support strategies by 17%. Children in the treatment group made statistically significant more gains in speech prelinguistic skills ( d = 1.09, p = .03) as compared with the control group. There were no statistically significant differences in social and symbolic prelinguistic skills; however, the effect sizes were large ( d = 0.78, p = .08; d = 0.91, p = .10). Conclusions This study provides modest preliminary support for the short-term effects of a parent-implemented communication treatment for children with hearing loss. Parents learned communication support strategies that subsequently impacted child prelinguistic skills. Although these results appear promising, the sample size is very small. Future research should include a larger clinical trial and child-level predictors of response to treatment.

Children with cochlear implants in infancy: predictors of early vocabulary

BACKGROUND

Language outcomes for children with cochlear implants (CIs) vary widely, even for those implanted before 2 years of age. Identifying the main influencing factors that account for some of the variability is important in order to provide information to guide appropriate clinical and intervention services for young children with CIs. However, there is limited research focusing on the predictors of early vocabulary development for children implanted in infancy.

AIMS

To identify significant predictors of vocabulary (12-15 months post-implant) for a sample of 33 children with CIs, the majority implanted between 6 and 10 months of age, drawing on predictors of vocabulary reported for children with normal hearing. Of particular interest was the impact of pre-implant development and use of gestures.

METHODS & PROCEDURES

Children with severe to profound hearing loss, and no other known disabilities, were recruited from CI clinics in Australia before receiving their CIs. Subscales from the Bayley Scales-III (receptive and expressive communication, gross and fine motor, and cognition) were used to assess their development at that time. Using the Macarthur-Bates Communicative Development Inventory (Words and Gestures) we documented the children's (1) use of gestures at six data-collection times 3 months apart; and (2) vocabulary at the last three time points. Time since implant and time to consistent use of the CIs were also included as potential predictors. Data were analysed using generalized linear models, assuming a negative binomial response with a log-link function. Stepwise variables selection was followed to retain a smaller number of the covariates.

OUTCOMES & RESULTS

A year after implantation, the significant predictors identified for vocabulary were pre-implant receptive communication and early gesture use. Together with fine motor and cognitive skills, these two variables were also significant predictors of vocabulary 3 months later. With maternal education entered into the models, higher vocabulary scores were significantly associated with higher maternal education 12 months post-implantation, but not 15 months.

CONCLUSIONS & IMPLICATIONS

Pre-implant abilities are important in explaining some variability in the early vocabulary of infants with CIs, together with their use of early gestures post-implantation. That is, having a non-verbal means to express a concept can assist in their development of oral vocabulary. Identifying strategies to help develop fine motor skills for infants with CIs, and encouraging their use of gestures to communicate their needs/intentions, are likely to be of benefit.