Let's talk: the effect of maternal hearing status on interactions with toddlers who are deaf

Assessing a Video-Based Intervention to Promote Parent Communication Strategies with a Deaf Infant: A Feasibility and Acceptability Study

Infant–parent interaction forms the foundation for language learning. For the majority of deaf infants, hearing loss can impact access to, and the quality of communicative interactions, placing language development at risk. Support for families to meet the challenges faced during interaction is highly variable in the United Kingdom. In a step towards more standardized but tailorable family support, we co-produced an instructional, video-based intervention, testing for feasibility in terms of behavior change in seven communicative strategies and acceptability with 9 parents, forming study 1. Parents increased their use of the majority of behaviors and found content and delivery acceptable. However, further development was required to: (a) support use of semantically contingent talk and attention getting strategies to elicit infant attention, and (b) ensure the information was provided in a bite-size format that could be tailored to individual families. In study 2, the intervention was refined based on findings from study 1 and assessed for acceptability with 9 parents and 17 professionals, who reported similar high acceptability scores. Final refinements and modifications could be addressed in future interventions. The current studies provide a positive early step towards a standardized intervention to support communication that could be used in routine practice.

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.

Joint Attention in the Context of Hearing Loss: A Meta-Analysis and Narrative Synthesis

Joint attention is important for children's language development. We report two meta-analyses that demonstrate that the congruency in hearing status between parent and child affects the establishment and maintenance of joint attention. Dyads consisting of hearing parents and children with hearing loss, achieve fewer and briefer moments of joint attention in comparison to dyads of hearing parents and hearing children and dyads of deaf parents and deaf children. The theoretical and practical implications of these differences are discussed and placed in the context of two narrative syntheses. The first one focusing on parental strategies used to achieve and maintain moments of joint attention and the second one on the relation between joint attention and spoken language proficiency. We also expect that this review may serve as the start of quest towards a more detailed description (taxonomy) and operationalization of joint attention in the context of hearing loss.

Assessing Parent Behaviours in Parent-Child Interactions with Deaf and Hard of Hearing Infants Aged 0-3 Years: A Systematic Review

Background: Despite early identification and advancements in cochlear implant and hearing aid technology, delays in language skills in deaf children continue to exist. Good-quality parent–child interaction (PCI) is a key predictor for the successful development of deaf children’s signed and/or spoken language. Though professionals have standard assessments to monitor child language, a clinical tool to observe the quality of parental interaction is yet to be developed. Aims and methods: This systematic review with narrative synthesis aims to uncover which parent behaviours are assessed in PCI studies with deaf infants aged 0–3 years, how these behaviours are assessed, and which are correlated with higher scores in child language. Results: Sixty-one papers were included, spanning 40 years of research. Research included in the review assessed parents’ skills in gaining attention, joint engagement, emotional sensitivity, and language input. PCI was mostly assessed using coding systems and frame-by-frame video analysis. Some of the parent behaviours mentioned previously are associated with more words produced by deaf children. Conclusion: The results of the review provide the evidence base required to develop the content of a future clinical assessment tool for parent–child interaction in deafness.

Differences in Established Joint Attention in Hearing-Hearing and Hearing-Deaf Mother-Child Dyads: Associations With Social Competence, Settings, and Tasks

The authors examined relations among observed joint attention, maternal report of child's social competence, setting (home vs. laboratory), task (unstructured vs. semi-structured), and dyad type [hearing mother-hearing child (n = 55, M_age  = 25.8 months) vs. hearing mother-deaf child (n = 27, M_age  = 26.9 months)]. Hearing child dyads scored higher on joint attention during unstructured tasks, especially in their home environment. Hearing child dyads displayed similar joint attention to deaf toddler dyads when they engaged in a semi-structured task, but higher on these measures during unstructured free play. Unlike hearing children, joint attention was differentially related to social competence in deaf children, with relatively higher versus lower social competence depending on relatively high versus low observed joint attention, respectively.

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.

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.

Joint attention in toddlerhood predicts internalizing problems at early school age

The authors examined the longitudinal relation between joint attention and socioemotional functioning in a low-risk, typically developing sample of children when the children were toddlers and again during the early school-age years. Fifty-eight mothers and their children were observed in the home or laboratory engaging in 1 unstructured and 4 semistructured tasks designed to assess joint attention episodes when the children were toddlers. Approximately 4 years later, the mother-child dyads were contacted again and mothers completed the Child Behavior Checklist as a measure of their children's socioemotional outcome at the early school years. The authors found that lower frequencies of joint attention episodes at toddlerhood predicted higher internalizing behaviors at early school age. Preliminary findings are discussed in terms of their theoretical implications for work on early mother-child interactions and children's typical and atypical sociemotional development.

Joint attention in parent-child dyads involving children with selective mutism: a comparison between anxious and typically developing children

Although joint attention processes are known to play an important role in adaptive social behavior in typical development, we know little about these processes in clinical child populations. We compared early school age children with selective mutism (SM; n = 19) versus mixed anxiety (MA; n = 18) and community controls (CC; n = 26) on joint attention measures coded from direct observations with their parent during an unstructured free play task and two structured tasks. As predicted, the SM dyads established significantly fewer episodes of joint attention through parental initiation acts than the MA and CC dyads during the structured tasks. Findings suggest that children with SM may withdraw from their parents during stressful situations, thus missing out on opportunities for learning other coping skills. We discuss the implications of the present findings for understanding the maintenance and treatment of SM.

Analogous and distinctive patterns of prelinguistic communication in toddlers with and without hearing loss

PURPOSE

This study was conducted to compare the prelinguistic communicative abilities of toddlers with hearing loss and without hearing loss during the 2nd year of life and shortly before the emergence of productive single-word lexicons.

METHOD

The participants were 28 toddlers with hearing loss who participated in an early intervention program and 92 toddlers with normal hearing at similar language levels and close chronological ages. The assessment consisted of the Hebrew Parent Questionnaire-Communication and Early Language (HPQ-CEL; E. Dromi, H. Ben-Shahar-Treitel, E. Guralnik, & D. Ringwald-Frimerman, 1992) that guided parents' observations of their toddlers in 6 contexts at home. Parents reported on a range of prelinguistic communicative abilities.

RESULTS

Profile analysis indicated that the 2 groups used a remarkably similar overall profile of prelinguistic behaviors. Interrelationships among behaviors were noticeably similar, too. Two communication properties unique to toddlers with hearing loss were relatively lower spontaneous use of words and reduced involvement in triadic book reading interactions. In addition, the associations between use of words and gestures in toddlers with hearing loss were slightly different from the toddlers with normal hearing, and the range of innovative gestures that they produced was greater.

CONCLUSION

The remarkable similarity between the 2 groups support the feasibility of adopting goals and principles known to hold true in typical development for fostering communication in toddlers with hearing loss.

[Effect of sound amplification on parent's communicative modalities]

BACKGROUND

auditory rehabilitation in deaf children users of sign language.

AIM

to verify the effects of sound amplification on parent's communicative modalities when interacting with their deaf children.

METHOD

participants were twelve deaf children, aged 50 to 80 months and their hearing parents. Children had severe or profound hearing loss in their better ear and were fitted with hearing aids in both ears. Children communicated preferably through sign language. The cause-effect relation between the children's auditory skills profile (insertion gain, functional gain and The Meaningful Auditory Integration Scale--MAIS) and the communicative modalities (auditive-oral, visuo-spacial, bimodal) used by parents was analyzed. Communicative modalities were compared in two different experimental situations during a structured interaction between parents and children, i.e. when children were not fitted with their hearing aids (Situation 1) and when children were fitted with them (Situation 2). Data was analyzed using descriptive statistics.

RESULTS

the profile of the deaf children's auditory skills demonstrated to be lower than 53% (unsatisfactory). Parents used predominately the bimodal modality to gain children's attention, to transmit and to end tasks. A slight positive effect of sound amplification on the communicative modalities was observed, once parents presented more turn-takings during communication when using the auditory-oral modality in Situation 2.

CONCLUSION

hearing parents tend to use more turn-takings during communication in the auditory-oral modality to gain children's attention, to transmit and to end tasks, since they observe an improvement in the auditory skills of their children.