Parental mode of communication is essential for speech and language outcomes in cochlear implanted children

Measuring "Language Access Profiles" in Deaf and Hard-of-Hearing Children With the DHH Language Exposure Assessment Tool

Purpose The purposes of this study were (a) to introduce "language access profiles" as a viable alternative construct to "communication mode" for describing experience with language input during early childhood for deaf and hard-of-hearing (DHH) children; (b) to describe the development of a new tool for measuring DHH children's language access profiles during infancy and toddlerhood; and (c) to evaluate the novelty, reliability, and validity of this tool. Method We adapted an existing retrospective parent report measure of early language experience (the Language Exposure Assessment Tool) to make it suitable for use with DHH populations. We administered the adapted instrument (DHH Language Exposure Assessment Tool [D-LEAT]) to the caregivers of 105 DHH children aged 12 years and younger. To measure convergent validity, we also administered another novel instrument: the Language Access Profile Tool. To measure test-retest reliability, half of the participants were interviewed again after 1 month. We identified groups of children with similar language access profiles by using hierarchical cluster analysis. Results The D-LEAT revealed DHH children's diverse experiences with access to language during infancy and toddlerhood. Cluster analysis groupings were markedly different from those derived from more traditional grouping rules (e.g., communication modes). Test-retest reliability was good, especially for the same-interviewer condition. Content, convergent, and face validity were strong. Conclusions To optimize DHH children's developmental potential, stakeholders who work at the individual and population levels would benefit from replacing communication mode with language access profiles. The D-LEAT is the first tool that aims to measure this novel construct. Despite limitations that future work aims to address, the present results demonstrate that the D-LEAT represents progress over the status quo.

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.

Effectiveness of Rehabilitation Approaches Proposed to Children With Severe-to-Profound Prelinguistic Deafness on the Development of Auditory, Speech, and Language Skills: A Systematic Review

Purpose The purpose of this systematic review is to identify and evaluate the available scientific evidence on the effectiveness of rehabilitation approaches proposed to children with severe-to-profound prelinguistic deafness on the hearing, speech, and language skills development. Method Databases (PubMed, CINHAL, PsycInfo, Cochrane, ERIC, and EMBASE) were searched with relevant key words (children, deafness, rehabilitation approach, auditory, speech, and language). Studies published between 2000 and 2017 were included. The methodological quality of the studies was evaluated with the Quality Assessment Tool for Quantitative Studies, and the level of evidence was evaluated with the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Every step of the selection and analysis was made by 2 independent judges. Results Of 1,739 articles listed in different databases, 38 met the inclusion criteria and were selected for analysis. The majority of included articles present a relatively low level of evidence. Rehabilitation approaches that do not include signs appear more frequently associated with a better auditory, speech, and language development, except for receptive language, than approaches that included any form of signs. Conclusion More robust studies are needed to decide on the approach to prioritize with severe-to-profound deaf children.

Psychosocial development of 5-year-old children with hearing loss: Risks and protective factors

OBJECTIVE

The aims of this paper were to report on the global psychosocial functioning of 5-year-old DHH children and examine the risk and protective factors that predict outcomes.

DESIGN

A cross-sectional analysis of data collected from a prospective, population-based longitudinal study.

STUDY SAMPLE

Parents/caregivers of 356 children completed questionnaires on psychosocial development (CDI, SDQ), functional communication (PEACH) and demographic information. Children completed standardized assessments of non-verbal cognitive ability (WNV) and language (PLS-4).

RESULTS

On average, global psychosocial functioning was within the range of typically developing children; however, variability was high and 12% of children had scores that were more than 2 SDs below the norm. Non-verbal cognitive ability, presence of additional disabilities, language and functional communication significantly predicted outcomes. In contrast, type of hearing device, severity of hearing loss and age at intervention did not.

CONCLUSION

The global psychosocial functioning of this cohort of 5-year-old DHH children fell within the range of typically developing children. The findings suggest that spoken language ability and functional communication skills are vital for healthy psychosocial development.

Auditory Deprivation Does Not Impair Executive Function, But Language Deprivation Might: Evidence From a Parent-Report Measure in Deaf Native Signing Children

Deaf children are often described as having difficulty with executive function (EF), often manifesting in behavioral problems. Some researchers view these problems as a consequence of auditory deprivation; however, the behavioral problems observed in previous studies may not be due to deafness but to some other factor, such as lack of early language exposure. Here, we distinguish these accounts by using the BRIEF EF parent report questionnaire to test for behavioral problems in a group of Deaf children from Deaf families, who have a history of auditory but not language deprivation. For these children, the auditory deprivation hypothesis predicts behavioral impairments; the language deprivation hypothesis predicts no group differences in behavioral control. Results indicated that scores among the Deaf native signers (n = 42) were age-appropriate and similar to scores among the typically developing hearing sample (n = 45). These findings are most consistent with the language deprivation hypothesis, and provide a foundation for continued research on outcomes of children with early exposure to sign language.

Predictors of pediatric cochlear implantation outcomes in South Africa

OBJECTIVE

To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population.

METHODS

A retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement.

RESULTS

Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education.

CONCLUSION

An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling.

Communication Assessment and Intervention: Implications for Pediatric Hearing Loss

Historically, children with hearing loss have fallen well behind their hearing peers in the areas of speech and language development, which has often limited their participation in a range of social, educational, and vocational activities. However, with early identification and appropriate intervention coupled with current hearing technology, children with hearing loss can achieve speech and language milestones at rates commensurate with hearing peers. To attain the best outcomes for these children, an early intervention system that provides thorough and unbiased information to families and allows for the efficient and coordinated efforts of qualified professionals must be present.

Deaf parents of cochlear-implanted children: beliefs on bimodal bilingualism

This study investigated 17 Deaf (1) families in North America with cochlear-implanted children about their attitudes, beliefs, and practices on bimodal bilingualism (defined as using both a visual/manual language and an aural/oral language) in American Sign Language (ASL) and English. A survey and follow-up interviews with 8 families were conducted. The majority of the Deaf families exhibited positive beliefs toward bimodal bilingualism, where they set high expectations for their children to become equally fluent in both languages. However, their perspectives about the purpose for each language differed; they viewed English as a "survival language" and ASL as a "cultural language" but supported the use of both languages at home as part of their children's lives.

Lexical and semantic ability in groups of children with cochlear implants, language impairment and autism spectrum disorder

OBJECTIVE

Lexical-semantic ability was investigated among children aged 6-9 years with cochlear implants (CI) and compared to clinical groups of children with language impairment (LI) and autism spectrum disorder (ASD) as well as to age-matched children with normal hearing (NH). In addition, the influence of age at implantation on lexical-semantic ability was investigated among children with CI.

METHODS

97 children divided into four groups participated, CI (n=34), LI (n=12), ASD (n=12), and NH (n=39). A battery of tests, including picture naming, receptive vocabulary and knowledge of semantic features, was used for assessment. A semantic response analysis of the erroneous responses on the picture-naming test was also performed.

RESULTS

The group of children with CI exhibited a naming ability comparable to that of the age-matched children with NH, and they also possessed a relevant semantic knowledge of certain words that they were unable to name correctly. Children with CI had a significantly better understanding of words compared to the children with LI and ASD, but a worse understanding than those with NH. The significant differences between groups remained after controlling for age and non-verbal cognitive ability.

CONCLUSIONS

The children with CI demonstrated lexical-semantic abilities comparable to age-matched children with NH, while children with LI and ASD had a more atypical lexical-semantic profile and poorer sizes of expressive and receptive vocabularies. Dissimilar causes of neurodevelopmental processes seemingly affected lexical-semantic abilities in different ways in the clinical groups.

Relationships between spoken word and sign processing in children with cochlear implants

The effect of using signed communication on the spoken language development of deaf children with a cochlear implant (CI) is much debated. We report on two studies that investigated relationships between spoken word and sign processing in children with a CI who are exposed to signs in addition to spoken language. Study 1 assessed rapid word and sign learning in 13 children with a CI and found that performance in both language modalities correlated positively. Study 2 tested the effects of using sign-supported speech on spoken word processing in eight children with a CI, showing that simultaneously perceiving signs and spoken words does not negatively impact their spoken word recognition or learning. Together, these two studies suggest that sign exposure does not necessarily have a negative effect on speech processing in some children with a CI.

Multilingual children with hearing loss: Factors contributing to language use at home and in early education

Understanding the relationship between children's cultural and linguistic diversity and child, caregiver, and environmental characteristics is important to ensure appropriate educational expectations and provisions. As part of the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study, children's caregivers and educators completed questionnaires on demographic characteristics, including the communication mode (oral, manual, or mixed) and languages used in home and early educational environments. This article reports an exploratory analysis to examine factors associated with language use and communication mode of children at 3 years of age. A Chi Square Automatic Interaction Detector (CHAID) analysis was performed on data from 406 children to examine factors influencing communication mode and oral language use. The factor that most influenced children's communication mode at home was the communication mode used by their female caregiver. Children's communication mode in their early education environment was most related to the communication mode they used at home, and then related to the presence of additional needs in the children, female caregivers' level of education and the male caregivers' use of languages other than English (LOTEs). A second exploratory CHAID analysis of data for children from multilingual families (n = 106) indicated that female caregivers' use of English at home significantly influenced whether children used a LOTE at home. Finally, the use of a LOTE at home was associated with the use of a LOTE in the early education environment. These findings serve as an initial description of the factors that were associated with the communication mode and language use of children with hearing loss.

Language understanding and vocabulary of early cochlear implanted children

OBJECTIVES

The aim of the study was to identify factors associated with the level of language understanding, the level of receptive and active vocabulary, and to estimate effect-related odds ratios for cochlear implanted children's language level.

METHODS

The patient material included all children born in Denmark between January 2005 and January 2011, having received a cochlear implant (CI) and with a minimum of 6 months of hearing with their CI (N=94). The participation rate was 88% (N=83). Sixty-eight (82%) of the participating children were implanted bilaterally. Mean age at implantation was 19.6 months. The mean age at test was 46.3 months and the mean age of hearing with CI was 25.9 months. The children were tested with three different tests, the PPVT-4, the Reynell receptive part and a Danish test "Viborgmaterialet" for active vocabulary. Logistic regression models were used for analysis of the potential influence of eighteen different factors upon the test outcomes.

RESULTS

The majority of children did not have age equivalent language understanding and vocabulary. There was significant effect of the following factors upon the test outcomes: age at hearing aid start before implantation, age at implantation, length of hearing, communication mode, mode of implantation, amount of support teaching, residence and educational placement. Children who started HA treatment before 6 months of age, were implanted before 12 months or did not use total communication had the highest odds of having age equivalent language understanding and vocabulary.

CONCLUSIONS

The majority of hearing impaired children in Denmark received hearing aids before six months of hearing and the majority was implanted before 18 months of age. Despite these medical and technical advances the vast majority did not have age equivalent language understanding and vocabulary. Data suggest that the language gap is not closed in two years after implantation.