Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers

"It doesn't matter if we're the most amazing professionals in the world…" A qualitative study of professionals' perspectives on parent-child interaction assessment with deaf infants

Introduction

Parent child interaction (PCI) is positively associated with deaf children's language development. However, there are no known, deaf-specific tools to observe how a parent interacts with their deaf child aged 0-3 years. Without a framework for professionals to use with families, it is unknown how professionals assess PCI, what they assess, why they assess, and how the assessment results relate to case management.

Methods

Eighteen hearing and deaf professionals, who work with deaf and hard of hearing infants aged 0-3 years and their families, attended online focus groups. The aim of the study was to gain insight into the professional assessment of PCI. Data were analyzed using thematic analysis.

Findings

Six themes were generated from the dataset. Professionals discussed how central parents were in the support offered to families in the home, the importance of knowing and understanding the individual family, and accounting for and supporting parental wellbeing. Descriptions on how to administer a best practice PCI assessment included which parent behaviors to assess and how to make adaptations for different populations. Professionals shared how the assessment and review process could be used to inform and upskill parents through video reflection and goal setting.

Discussion

This study provides insight into the mechanisms and motivations for professionals assessing the interactive behaviors of parents who have deaf children aged 0-3. Professionals acknowledged that family life is multi-faceted, and that support is most meaningful to families when professionals worked with these differences and incorporated them into assessment, goal setting, and intervention plans.

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.

Development of Social-Pragmatic Understanding in Children With Congenital Hearing Loss and Typical Hearing Between the Ages of 4 and 6 Years

PURPOSE

This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH.

METHOD

The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years.

RESULTS

The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context.

CONCLUSIONS

Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.

Technology assisted language intervention (TALI) for children who are deaf/hard of hearing: promising impact on pragmatic skills

Children who are deaf and hard of hearing (DHH) often demonstrate pragmatic language difficulties which can impact academic and social outcomes. This randomized control trial for DHH children, ages 3-12 years, explored the Technology-Assisted Language Intervention (TALI), incorporating augmentative and alternative communication technology (AAC) into traditional speech/language therapy, compared to treatment-as-usual (TAU) to determine impact on pragmatics. Pragmatic outcome measures included parent reported Pragmatics Profile of the CELF-5 (for children age ≥5 years) and CELF-P Descriptive Pragmatics Profile (for children <5 years) in addition to parent reported Social and Communication domains of the Vineland Adaptive Behavior Scales,Third Edition (VABS). Over 24 weeks, children ≥5 years in the TALI made significantly more progress (increase in raw scores) on the Pragmatics Profile compared to children in TAU (12.7 points vs. -6.0 points; p = 0.04) and also showed significant gains on two of the three subscales. For children ≥5 years, no significant VABS changes were seen in either intervention group. For children <5 years, there were no statistically significant differences in growth on the CELF-P total pragmatics raw score or on any subdomain. However, children in TALI had significant increases in the mean VABS Communication (86.7-99.1) and Social domain standard scores (91.8-97.4;p = 0.01), while gains for children in TAU on the Communication and Social domain standard scores were not statistically significant. These promising results support the need for additional research exploring the effectiveness of AAC supported speech/language therapy to enhance DHH children's pragmatic language skills.

Trial registration

ClinicalTrials.gov identifier: NCT02998164.

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.

Family-Centered Early Intervention (FCEI) Involving Fathers and Mothers of Children Who Are Deaf or Hard of Hearing: Parental Involvement and Self-Efficacy

(1) Background: Studies related to family-centered early intervention (FCEI) for children who are deaf or hard of hearing (DHH) have largely focused on mothers, at the exclusion of fathers. Yet, understanding fathers’ experiences with FCEI is also important and may inform service delivery. The present study explores self-efficacy and involvement with FCEI in both fathers and mothers. (2) Methods: Dutch fathers and mothers completed questionnaires about their parental self-efficacy, involvement in FCEI, perceived support from their primary EI provider, and the impact of raising a child who is DHH on parenting. (3) Results: Both fathers and mothers reported relatively high levels of self-efficacy. Mothers reported higher levels than fathers on some domains of self-efficacy and tended to be more involved in their child’s FCEI than fathers. In fathers, but not mothers, higher levels of self-efficacy were related to higher levels of involvement and higher levels of perceived support. (4) Conclusions: Similarities and differences were found between fathers and mothers in their perspectives on self-efficacy and involvement. This points to potential differences related to their FCEI needs. EI providers need to address both the needs of fathers and mothers to promote optimal development among child who are DHH.

Pragmatics in Deaf and Hard of Hearing Children: An Introduction

We introduce this supplement and highlight the importance of the development of pragmatic skills in children who are DHH.