"Part of our world": Influences on caregiver decisions about communication choices for children with hearing loss

Differentiating Language for Students Who Are Deaf or Hard of Hearing: A Practice-Informed Framework for Auditory and Visual Supports

PURPOSE

Speech-language pathologists (SLPs) serving students who are d/Deaf or hard of hearing (Deaf/hh) and their deaf education counterparts must navigate complexities in language that include modalities that are spoken or signed and proficiency, which is often compromised. This tutorial describes a practice-informed framework that conceptualizes and organizes a continuum of auditory and visual language supports with the aim of informing the practice of the SLP whose training is more inherently focused on spoken language alone, as well as the practice of the teacher of the Deaf/hh (TDHH) who may focus more on visual language supports.

METHOD

This product resulted from a need within interdisciplinary, graduate programs for SLPs and TDHHs. Both cohorts required preparation to address the needs of diverse language learners who are Deaf/hh. This tutorial includes a brief review of the challenges in developing language proficiency and describes the complexities of effective service delivery. The process of developing a practice-informed framework for language supports is summarized, referencing established practices in auditory-based and visually based methodologies, identifying parallel practices, and summarizing the practices within a multitiered framework called the Framework of Differentiated Practices for Language Support. Recommendations for use of the framework include guidance on the identification of a student's language modality/ies and proficiency to effectively match students' needs and target supports.

CONCLUSIONS

An examination of established practices in language supports across auditory and visual modalities reveals clear parallels that can be organized into a tiered framework. The result is a reference for differentiating language for the interdisciplinary school team. The parallel supports also provide evidence of similarities in practice across philosophical boundaries as professionals work collaboratively.

Australian families of deaf and hard of hearing children: Are they using sign?

BACKGROUND

Deaf and hard of hearing (DHH) children may experience communication delays, irrespective of early intervention and technology. Australian Sign Language (Auslan) is one approach in early intervention to address language delays. Current prevalence of Auslan use among Australian families with DHH children is unknown.

AIMS

The first aim was to determine the proportion of families enrolled in an Australian statewide hearing loss databank who use Auslan with their DHH child. The second aim was to explore the relationships between indicators of child hearing loss (bilateral or unilateral hearing loss, degree of hearing loss, and device use: hearing aids and cochlear implants), family factors (maternal education, attendance at early intervention, family history of deafness, and socio-economic disadvantage) and the family's reported use of Auslan.

METHODS

We analysed the enrolment data from 997 families who participated in an Australian statewide hearing loss databank between 2012 and 2021. We described the proportion of families who used Auslan with their DHH child at home. The association between indicators of child hearing loss and family factors, and the parental reports of communication approach were examined using correlation analyses.

RESULTS

Eighty-seven of 997 parents (8.7%) reported using Auslan with their DHH child. Of these, 26 (2.6%) used Auslan as their primary language. The use of Auslan at home was associated with the following indicators of child hearing loss: bilateral hearing loss, profound compared to mild hearing loss, and cochlear implant and hearing aid use compared to no device use. The family factors associated with the use of Auslan were: referral or attendance at early intervention compared to those who did not attend, and a family history of deafness compared to those with none. No association was found between maternal education and socio-economic disadvantage and the use of Auslan.

CONCLUSION

This Australian study found a low proportion (8.7%) of families with a DHH child who reported using Auslan. Seven child hearing loss and family factors were considered, and five were significantly associated with using Auslan at home. Children with a greater degree of hearing loss, attendance at early intervention and family history of deafness tended to use Auslan.

Linguistic identity in multigenerational ethnic minority/ethnically heterogeneous deaf families

This paper discusses language use and identity patterns in ethnic minority/ethnically heterogeneous multigenerational deaf families in Romania, where at least one of the family members belongs to the ethnic Hungarian minority. Early childhood and school linguistic socialization, language use within the family, and cross-generational transmission of identity to children are explored. The research is based on five ethnic minority/ethnically heterogeneous multigenerational deaf family case studies. The research results show that within ethnic-national minority/ethnically heterogeneous multigenerational deaf families, complex identity patterns may develop and multifaceted linguistic communication models may prevail, including the use of national oral languages and national sign languages of the parties involved. At the same time, a kind of special linguistic and cultural enrichment, a striving for cultural-linguistic balance, may occur.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Support Principles

This article is the sixth in a series of eight articles that comprise a special issue on Family-Centered Early Intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, or FCEI-DHH. The Support Principles article is the second of three articles that describe the 10 Principles of FCEI-DHH, preceded by the Foundation Principles, and followed by the Structure Principles, all in this special issue. The Support Principles are composed of four Principles (Principles 3, 4, 5, and 6) that highlight (a) the importance of a variety of supports for families raising children who are DHH; (b) the need to attend to and ensure the well-being of all children who are DHH; (c) the necessity of building the language and communication abilities of children who are DHH and their family members; and (d) the importance of considering the family's strengths, needs, and values in decision-making.

A qualitative study of mothers' experiences adopting deaf or hard-of-hearing children

The current study presents the results of a qualitative investigation into the perspectives of mothers who have adopted children who are deaf or hard of hearing. Nine mothers, recruited via convenience and snowball sampling, participated in semi-structured interviews via videoconference technology. The interviews were transcribed and coded for thematic analysis. Parent perspectives on the following topics were analyzed: motivation, reaction to identification, communication and technology decisions, language, services pre- and post-adoption, others' reactions, expectations, race and ethnicity, and attachment and adjustment. Based on thematic analysis of the participants' responses, key themes and implications for professional practice are proposed.

Reliability and validity assessment of a survey: Measuring satisfaction with cochlear implant rehabilitation services for children in Jordan

BACKGROUND

Assessing parental satisfaction with healthcare services is crucial, particularly for parents and their children, who are the primary recipients of these services. In the context of Arabic-speaking parents, there is a notable absence of survey instruments tailored to measure their satisfaction. This study seeks to address this gap by validating a survey designed to evaluate parental satisfaction with rehabilitation services (RSs) provided to Jordanian children who have received cochlear implants (CIs).

METHODS

The study included 92 participants and followed a four-step methodology: 1) a literature review and expert input; 2) cognitive interviews, pilot testing, and test-retest reliability testing; 3) data collection; 4) validity and reliability assessments.

RESULTS

The survey's validity was confirmed. Expert input and cognitive interviews improved content validity, and factor analysis established construct validity by revealing six factors explaining 82.33% of the variance in the survey scale. Convergent and discriminant validity were confirmed (composite reliability >0.7 and average variance extracted value >0.5). Cronbach's α exceeded 0.8 for each factor and reached 0.855 for the total scale. Survey results showed reliance on speech therapy and audiology, varied rehabilitation durations, and progress. Parents expressed overall satisfaction, particularly influenced by technical quality and efficacy/outcome dimensions. Parents' recommendations to enhance satisfaction with RSs included financial support, improved service accessibility, enhanced service delivery, specialized education, and increased public awareness.

CONCLUSION

This study validates an Arabic satisfaction survey, emphasizing the significance of multidisciplinary, extended rehabilitation programs, skilled professionals, and positive outcomes. It emphasizes the necessity for improved access to specialized care and collaboration among healthcare, government, and media to shape parental perceptions of RSs. While the findings indicate overall satisfaction, they also reveal challenges faced by parents, highlighting the need for comprehensive support systems. These insights assist healthcare providers and policymakers in enhancing care quality and meeting the needs of CI children's families, thereby improving the RSs experience in Jordan.

What Are Parents' Experiences With Their Child's Hearing Aid Use in the First 5 Years?

OBJECTIVES

Parents are required to make informed choices for their children regarding the use of hearing amplification after hearing loss has been diagnosed. If parents choose a listening and spoken language approach for their child where the development of age appropriate spoken language is the parents' goal, then the early fitting and frequent use of hearing aids is crucial. Within the framework of family centered care, parents have the ultimate responsibility for supporting their child's hearing aid use. However, few studies have focused on parents' insights regarding the aspects that shape hearing aid use in the early years. Thus the aim of this study was to explore parents' firsthand experiences with their child's hearing aid use in the first 5 years. Understanding parents' insights will help improve service provision to optimize outcomes for children with hearing loss.

DESIGN

The study utilized a prospective qualitative design to explore parents' firsthand experiences with their child's hearing aid use. Purposive sampling was used to recruit 12 parents who participated in semi-structured interviews. Parents' responses were analyzed using thematic analysis.

RESULTS

Three overarching themes were conceptualized, namely: (a) towards hearing aids - journey into the wilderness; (b) adjusting to hearing aids - it's the journey, not the destination; and (c) support for my child's hearing aid use - it's not where you are going, it's who you have beside you. Each theme was further divided into categories and subcategories.

CONCLUSIONS

This study identified that parents have much to contribute to service providers' understanding regarding the aspects that shape consistent hearing aid use in young children. Parents shared many insights such as the emotionally daunting nature of the first few months post hearing loss confirmation, the influence of family support, and the importance of building connections and understanding about hearing loss and hearing aid use within their social networks. Based on these insights, the authors provide recommendations for clinical best practice that draw upon key principles of family centered care. They consist of practical suggestions including strategic support to overcome less optimal hearing aid use and ways to facilitate parent support within their familial and communal networks.

Speech-Language Pathologists' Support for Parents of Young d/Deaf Multilingual Learners

Increasing cultural and linguistic diversity among children and families brings new challenges for early intervention professionals. The purpose of this study was to identify the specific roles and needs of speech-language pathologists (SLPs) who practice in early intervention settings with culturally and linguistically diverse families of d/Deaf multilingual learners (DMLs). Thirteen SLPs completed an online survey about their practices and needs. Interviews were conducted with five parents of DMLs. Results showed that SLPs have lower self-satisfaction with families of DMLs compared to mainstream families. Parents were highly satisfied with the support they received. Both groups of participants reported a need for specific tools or adaptations, especially if there was no shared language. Thematic analysis identified three themes: communication and partnership, professional resources for responding to diversity, and diversity of parental profiles. This article provides an insight into the perspectives of both professionals and culturally and linguistically diverse parents, and identifies specific aspects of early intervention services with parents of DMLs: developing partnership in the context of cultural and/or linguistic differences, discussing topics related to multilingualism, and providing highly adaptable family-centered services.

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.

Professionals' Perspectives on Supporting Deaf Multilingual Learners and Their Families

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

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

OBJECTIVE

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

DESIGN

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

STUDY SAMPLE

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

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

OBJECTIVE

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

DESIGN

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

STUDY SAMPLE

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

SUPPLEMENTAL MATERIALS

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

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

OBJECTIVE

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

DESIGN

A mixed methods explanatory sequential design was conducted.

STUDY SAMPLE

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

RESULTS

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

CONCLUSIONS

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

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

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

Pediatric Audiology Report: Assessment and Revision of an Audiology Report Written to Parents of Children With Hearing Impairment

OBJECTIVE

The purpose of this study was twofold: first, to evaluate a typical pediatric diagnostic audiology report to establish its readability and comprehensibility for parents and, second, to revise the report to improve its readability, as well as the comprehension, sense of self-efficacy, and positive opinions of parent readers.

METHOD

In Experiment 1, a mock audiology report was evaluated via a readability analysis and semistructured interviews with 5 parents. In Experiment 2, the report was revised using best practice guidelines and parental recommendations from Experiment 1. The revision was verified by randomly assigning 32 new parent participants to read either the revised or unrevised report before their comprehension, self-efficacy, and opinions were assessed.

RESULTS

In Experiment 1, results confirmed that the report was difficult to read and understand. In Experiment 2, parents who read the revised report had significantly greater comprehension, self-efficacy, and opinion ratings than those who read the unrevised report. In addition, the readability of the revised report was markedly improved compared with the unrevised report.

CONCLUSIONS

This study shows that pediatric diagnostic audiology reports can be revised to adhere to best practice guidelines and yield improved readability, in addition to improving the comprehension, sense of self-efficacy, and positive opinions of parents of children with hearing impairment.

Speech, Sign, or Multilingualism for Children With Hearing Loss: Quantitative Insights Into Caregivers' Decision Making

Purpose

The authors sought to investigate the influence of a comprehensive range of factors on the decision making of caregivers of children with hearing loss regarding the use of speech, the use of sign, spoken language multilingualism, and spoken language choice. This is a companion article to the qualitative investigation described in Crowe, Fordham, McLeod, and Ching (2014).

Method

Through a questionnaire, 177 caregivers of 157 Australian children with hearing loss (ages 3;5 to 9;4 [years;months], M age = 6;6) rated the importance of a range of potential influences on their decision making regarding their children's communication. The majority of children were reported to use speech (96.6%) as part or all of their communication system, with fewer children reported to use sign (20.9%). Few children used more than one spoken language (8.3%).

Results

Proportional analyses and exploratory factor analyses were conducted. Overall, caregivers' decisions were influenced by their children's audiological and intervention characteristics, communication with those around them, community participation, access to intervention and education services in English, and concerns about their children's future lives. The advice of speech-language pathologists, audiologists, and specialist teachers was more important to caregivers than advice from medical practitioners and nonprofessionals.

Conclusion

Caregivers' decision making regarding communication mode and language use is influenced by factors that are not equally weighted and that relate to child, family, community, and advice from others. Knowledge of these factors can assist professionals in supporting caregivers making choices regarding communication.

Supplemental Material

https://doi.org/10.23641/asha.6170282