Muenster Parental Programme empowers parents in communicating with their infant with hearing loss

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

This article is the fifth 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 10 FCEI-DHH Principles are organized conceptually into three sections (a) Foundation Principles, (b) Support Principles, and (c) Structure Principles. Collectively, they describe the essential Principles that guide FCEI for children who are DHH and their families. This article describes the Foundation Principles (Principles 1 and Principle 2). The Foundation Principles emphasize the essential elements of ensuring that families with children who are DHH can access early intervention (EI) and other appropriate supports, as well as highlight the need for provision of EI that is family-centered. Implementation of these FCEI-DHH Principles is intended to improve the lives and the outcomes of children who are DHH and their families around the globe.

Assessing parent interaction with deaf infants: A quantitative survey of UK professional practice

BACKGROUND

Between 90% and 95% of deaf children are born to hearing parents who often need support with how to adapt their communication. Parent-child interaction (PCI) is an important predictor of deaf children's future language development. It is therefore necessary for professionals to assess parents' strengths and needs to identify areas for intervention. Qualified teachers of the deaf (QToDs), speech and language therapists (SLTs), psychologists, and national deaf child and adolescent mental health (NDCAMHS) professionals regularly support families with deaf children. With no current evidence-based tool available to assist with the assessment of PCI in deafness, it is important to gather information on current professional practice as this may differ from known practices within research.

AIMS

To survey the practices of UK-based professionals in the assessment of PCI where the deaf infant is aged 0-3 years. Professionals were QToDs, SLTs, psychologists or psychiatrists and professionals working at NDCAMHS services.

METHODS & PROCEDURES

After a pilot phase, an 85-item survey was distributed electronically through a range of professional and social media networks. Survey items were based on a systematic review of PCI with deaf infants. Survey questions were focused on parent behaviours that were assessed, methods of assessment, goal planning and service provision. Analysis was conducted using descriptive and inferential statistics.

OUTCOMES & RESULTS

A total of 190 professionals from across the UK completed part 1 of the survey; this decreased to 148 in part 4. Respondents were primarily female, hearing, used spoken English and had 16 years or more experience. Results indicate that PCI is routinely assessed by a large proportion of professionals and there is a substantial overlap in which parent behaviours are assessed. Some parent behaviours are assessed that do not feature in the research. Methods of assessment are informal and predominantly consist of observation and note making, with professionals using their own skills and experience to analyse interaction. Goal setting practices were largely similar between professionals, with many jointly deciding goals with parents.

CONCLUSIONS & IMPLICATIONS

This survey highlights the range of parent behaviours assessed by UK professionals in PCI with deaf children aged 0-3. This survey provides valuable information about and for professionals who assess PCI and set intervention goals with parents. Information from research and professional practice is important to consider in the design of a future PCI assessment. Implications are included for future research in this area.

WHAT THIS PAPER ADDS

What is already known on this subject Parental involvement is one of the greatest predictors of deaf children's language outcomes. With many deaf children born to hearing parents, parents often need guidance with how to facilitate effective communication. A recent systematic review identified the range of parent behaviours and methods used to analyse PCI in international research studies, but little evidence or guidance exists on how professionals assess this phenomenon in practice. What this study adds This is the first survey to generate large, valuable practice-based evidence for the assessment of parents' communication behaviours as they interact with their deaf infants aged 0-3. The survey recruited a range of multidisciplinary professionals working on interaction within this field: SLTs, qualified teachers of the deaf, psychologists or psychiatrists, and professionals working within deaf child and adolescent mental health services. The study reports on which behaviours these professionals assess and how, and includes information on the goal setting behaviours of practitioners. Most respondents were highly experienced; the survey, therefore, reveals expert practice within the field. What are the potential or actual clinical implications of this work? We recommend the following practice: (1) incorporate a range of parent-based behaviours in PCI assessments, including establishing joint engagement and parental sensitivity, as well as communication-focused behaviours; (2) video record PCI assessments where possible to enable professionals and parents to watch and reflect together; (3) following assessment, set parent-focused goals in collaboration with families, ensuring parents' skills, particularly their strengths, are considered. All primary caregivers should be included in the process where possible; and (4) reassess PCI regularly (at least termly) to monitor and encourage families' progress. The timing of reviews should be discussed between parent and professional.

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.

Benefits of Parent Training in the Rehabilitation of Deaf or Hard of Hearing Children of Hearing Parents: A Systematic Review

The present study is a systematic review on the effectiveness of Parent Training (PT) and coaching in deaf and hard of hearing (DHH) rehabilitation programs which reviews and synthesizes the existing body of evidence to assess the benefits of these programs in enhancing parents' sensitivity, responsivity and promoting language development in DHH children during the first years after HA fitting or CI activation. Five published studies met the Population, Intervention, Comparison and Outcomes (PICO) inclusion criteria and were eligible to be included, but heterogeneity in terms of the study design, interventions and outcomes did not allow for performing a meta-analysis. All included studies shared the view that a parent's learning is a circular (rather than frontal) process, and the results appear promising in terms of enhancing parents' responsiveness and promoting DHH child language development. Nevertheless, the available evidence was judged to not be robust enough due to limitations in the studies' designs. Further high-quality evidence is needed to evaluate the true degree of clinical value and the cost effectiveness of PT programs aimed at increasing parents' responsiveness to their DHH children.

A systematic scoping review of early interventions for parents of deaf infants

Background

Over 90% of the 50,000 deaf children in the UK have hearing parents, many of whom were not expecting a deaf child and may require specialist support. Deaf children can experience poorer long-term outcomes than hearing children across a range of domains. After early detection by the Universal Newborn Hearing Screening Programme, parents in the UK receive support from Qualified Teachers of the Deaf and audiologists but resources are tight and intervention support can vary by locality. There are challenges faced due to a lack of clarity around what specific parenting support interventions are most helpful.

Methods

The aim of this research was to complete a systematic scoping review of the evidence to identify early support interventions for parents of deaf infants. From 5577 identified records, 54 met inclusion criteria. Two reviewers screened papers through three rounds before completing data extraction and quality assessment.

Results

Identified parent support interventions included both group and individual sessions in various settings (including online). They were led by a range of professionals and targeted various outcomes. Internationally there were only five randomised controlled trials. Other designs included non-randomised comparison groups, pre / post and other designs e.g. longitudinal, qualitative and case studies. Quality assessment showed few high quality studies with most having some concerns over risk of bias.

Conclusion

Interventions commonly focused on infant language and communication followed by parental knowledge and skills; parent wellbeing and empowerment; and parent/child relationship. There were no interventions that focused specifically on parent support to understand or nurture child socio-emotional development despite this being a well-established area of poor outcome for deaf children. There were few UK studies and research generally was not of high quality. Many studies were not recent and so not in the context of recent healthcare advances. Further research in this area is urgently needed to help develop evidence based early interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02893-9.

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.

Assessing parent-child interaction in infant deafness

PURPOSE OF REVIEW

To highlight the importance of parent-child interaction (PCI) in infant deafness and address the lack of robust assessment tools in clinical practice.

RECENT FINDINGS

Most deaf babies are born to hearing parents with little experience in deafness. Deafness can reduce access to spoken language. Despite advancements in amplification technology, deaf children still present with delays in attention and communication skills at the start of nursery. Research reports that hearing parents of deaf infants can be more directive during interaction, spend less time following the child's focus of attention, and have more difficulty achieving successful turn-taking in conversation. Much research tells us that these factors impact on the quality and quantity of PCI. Good PCI, in all infants, but especially so in deafness, is a strong predictor of child language outcomes. Teachers of the Deaf and Speech and Language Therapists are the first professionals to support families in the home. For these professionals, having an objective way of assessing PCI would greatly assist and standardise their practice. However, to date, there are no deaf-specific assessments to observe and appraise a parent's communication behaviours when interacting with their deaf child.

SUMMARY

Intervention studies with families of deaf children have shown success in improving parental sensitivity and facilitative language techniques. An observational assessment in parent-deaf child interaction would ensure that communication interventions are appropriately targeted on the individual family's needs.

Developing new scales for assessing parents' aural and oral rehabilitation skills to interact with children with hearing loss

OBJECTIVE

Scales for evaluating the teaching and behavioural skills of parents enrolled in aural and oral rehabilitation programs for children with hearing loss are lacking. This study developed and validated scales for assessing parental teaching and behavioural skills of those parents for use in guiding their child to develop language and communication skills.

DESIGN

Scales were constructed and evaluated using exploratory and confirmatory factor analysis. The performance of parents in teaching and behavioural skills was also explored.

STUDY SAMPLE

The teaching and behavioural skills of 344 parents (179 for scale development and 165 for validation) were rated by their intervention therapists using parental teaching skill (PTS) and parental behavioural skill (PBS) scales.

RESULTS

Good reliability and model fit (validity) were observed for both scales, which ultimately included 13 and 10 items, respectively. Maternal educational level was a significant indicator of their performance ratings.

CONCLUSIONS

The PTS and PBS scales were validated and can be used by early intervention professionals to evaluate the relative interaction and behavioural skills of parents of children with hearing loss, and enrolled in listening and spoken language intervention programs.

Evidence and Open Questions for the Use of Video-Feedback Interventions With Parents of Children With Neurodevelopmental Disabilities

The Video-Feedback Intervention (VFI) is a technique aimed at promoting positive parenting that has been found to be supportive of child development and parent-child interaction in different at-risk and clinical populations. The application of VFI with parents of children with neurodevelopmental disabilities (ND; e.g., cerebral palsy, sensory and/or psychomotor delay, and genetic syndromes) is growing. Nonetheless, no systematic review is currently available documenting whether this type of intervention improves children's developmental outcomes (e.g., behavioral stability and cognitive abilities), parental caregiving skills (e.g., responsive parenting), and parental emotional well-being (e.g., depressive symptomatology). In the present mini-review, 212 VFI records were retrieved from three databases (i.e., PubMed, Scopus, and Web of Science), and 10 papers were finally included. Abstracted information included age, diagnosis, methodological aspects (timing, setting, and themes), and child/parent outcomes. Significant improvements from pre- to post-VFI were observed in all studies. Specifically, the VFIs were significantly associated with better children developmental outcomes and parental caregiving skills. Inconsistent findings emerged for the VFI effects on parental emotional well-being. Overall, the current mini-review supports the potential effectiveness of parent-focused VFI interventions for parents of children with ND, despite the presence of open questions that need to be addressed in future clinical trials.

Video feedback for parental sensitivity and attachment security in children under five years

BACKGROUND

Children who are securely attached to at least one parent are able to be comforted by that parent when they are distressed and explore the world confidently by using that parent as a 'secure base'. Research suggests that a secure attachment enables children to function better across all aspects of their development. Promoting secure attachment, therefore, is a goal of many early interventions. Attachment is mediated through parental sensitivity to signals of distress from the child. One means of improving parental sensitivity is through video feedback, which involves showing a parent brief moments of their interaction with their child, to strengthen their sensitivity and responsiveness to their child's signals.

OBJECTIVES

To assess the effects of video feedback on parental sensitivity and attachment security in children aged under five years who are at risk for poor attachment outcomes.

SEARCH METHODS

In November 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, nine other databases and two trials registers. We also handsearched the reference lists of included studies, relevant systematic reviews, and several relevant websites SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that assessed the effects of video feedback versus no treatment, inactive alternative intervention, or treatment as usual for parental sensitivity, parental reflective functioning, attachment security and adverse effects in children aged from birth to four years 11 months.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review includes 22 studies from seven countries in Europe and two countries in North America, with a total of 1889 randomised parent-child dyads or family units. Interventions targeted parents of children aged under five years, experiencing a wide range of difficulties (such as deafness or prematurity), or facing challenges that put them at risk of attachment issues (for example, parental depression). Nearly all studies reported some form of external funding, from a charitable organisation (n = 7) or public body, or both (n = 18). We considered most studies as being at low or unclear risk of bias across the majority of domains, with the exception of blinding of participants and personnel, where we assessed all studies as being at high risk of performance bias. For outcomes where self-report measures were used, such as parental stress and anxiety, we rated all studies at high risk of bias for blinding of outcome assessors. Parental sensitivity. A meta-analysis of 20 studies (1757 parent-child dyads) reported evidence of that video feedback improved parental sensitivity compared with a control or no intervention from postintervention to six months' follow-up (standardised mean difference (SMD) 0.34, 95% confidence interval (CI) 0.20 to 0.49, moderate-certainty evidence). The size of the observed impact compares favourably to other, similar interventions. Parental reflective functioning. No studies reported this outcome. Attachment security. A meta-analysis of two studies (166 parent-child dyads) indicated that video feedback increased the odds of being securely attached, measured using the Strange Situation Procedure, at postintervention (odds ratio 3.04, 95% CI 1.39 to 6.67, very low-certainty evidence). A second meta-analysis of two studies (131 parent-child dyads) that assessed attachment security using a different measure (Attachment Q-sort) found no effect of video feedback compared with the comparator groups (SMD 0.02, 95% CI -0.33 to 0.38, very low-certainty evidence). Adverse events. Eight studies (537 parent-child dyads) contributed data at postintervention or short-term follow-up to a meta-analysis of parental stress, and two studies (311 parent-child dyads) contributed short-term follow-up data to a meta-analysis of parental anxiety. There was no difference between intervention and comparator groups for either outcome. For parental stress the SMD between video feedback and control was -0.09 (95% CI -0.26 to 0.09, low-certainty evidence), while for parental anxiety the SMD was -0.28 (95% CI -0.87 to 0.31, very low-certainty evidence). Child behaviour. A meta-analysis of two studies (119 parent-child dyads) at long-term follow-up found no evidence of the effectiveness of video feedback on child behaviour (SMD 0.04, 95% CI -0.33 to 0.42, very low-certainty evidence). A moderator analysis found no evidence of an effect for the three prespecified variables (intervention type, number of feedback sessions and participating carer) when jointly tested. However, parent gender (both parents versus only mothers or only fathers) potentially has a statistically significant negative moderation effect, though only at α (alpha) = 0.1 AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that video feedback may improve sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties. There is currently only little, very low-certainty evidence regarding the impact of video feedback on attachment security, compared with control: results differed based on the type of measure used, and follow-up was limited in duration. There is no evidence that video feedback has an impact on parental stress or anxiety (low- and very low-certainty evidence, respectively). Further evidence is needed regarding the longer-term impact of video feedback on attachment and more distal outcomes such as children's behaviour (very low-certainty evidence). Further research is needed on the impact of video-feedback on paternal sensitivity and parental reflective functioning, as no study measured these outcomes. This review is limited by the fact that the majority of included parents were mothers.

Association of Parent Training With Child Language Development: A Systematic Review and Meta-analysis

IMPORTANCE

Training parents to implement strategies to support child language development is crucial to support long-term outcomes, given that as many as 2 of 5 children younger than 5 years have difficulty learning language.

OBJECTIVE

To examine the association between parent training and language and communication outcomes in young children.

DATA SOURCES

Searches of ERIC, Academic Search Complete, PsycINFO, and PsycARTICLES were conducted on August 11, 2014; August 18, 2016; January 23, 2018; and October 30, 2018.

STUDY SELECTION

Studies included in this review and meta-analysis were randomized or nonrandomized clinical trials that evaluated a language intervention that included parent training with children with a mean age of less than 6 years. Studies were excluded if the parent was not the primary implementer of the intervention, the study included fewer than 10 participants, or the study did not report outcomes related to language or communication.

DATA EXTRACTION AND SYNTHESIS

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included.

MAIN OUTCOMES AND MEASURES

Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment.

RESULTS

This meta-analysis included 59 randomized clinical trials and 17 nonrandomized clinical trials including 5848 total participants (36.4 female [20.8%]; mean [SD] age, 3.5 [3.9] years). The intervention approach in 63 studies was a naturalistic teaching approach, and 16 studies used a primarily dialogic reading approach. There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean [SE] Hedges g, -0.33 [0.06]; P < .001). The association between parent training and parent use of language support strategies was large (mean [SE] Hedges g, 0.55 [0.11], P < .001). Children with developmental language disorder had the largest social communication outcomes (mean [SE] Hedges g, 0.37 [0.17]); large and significant associations were observed for receptive (mean [SE] Hedges g, 0.92 [0.30]) and expressive language (mean [SE] Hedges g, 0.83 [0.20]). Children at risk for language impairments had moderate effect sizes across receptive language (mean [SE] Hedges g, 0.28 [0.15]) and engagement outcomes (mean [SE] Hedges g, 0.36 [0.17]).

CONCLUSIONS AND RELEVANCE

The findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention.

Utilisation of coaching practices in early interventions in children at risk of developmental disability/delay: a systematic review

Background: To conduct a systematic review of early intervention programs (0-5 years) utilising coaching practice characteristics, to identify (i) implementation fidelity; (ii) parent training processes, and (iii) outcome measures of capacity building in parents. The coaching practice characteristics of (1) joint planning, (2) observation, (3) action/practice, (4) reflection and (5) feedback identified by Rush and Shelden were utilised.Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. A comprehensive search of 6 electronic databases was undertaken in March 2016 and updated in February 2018.Results: Of 2397 articles, 18 papers met full inclusion criteria. Of these, 5 were randomised controlled trials. Only one specifically evaluated the impact of parent coaching versus therapist only delivered interventions. Risk of bias and study quality using Downs and Black checklist for clinical trial quality yielded the following descriptive ratings: Seven studies: "Poor" (scores 1-13); Six studies: "Fair" (scores 15-17); and five "Good" (scores 20-24).Conclusion: Coaching in early intervention is well accepted. Nevertheless, this review identified a continued lack of operationalised definitions; inconsistency in the reporting of therapist training and adherence to active ingredients/coaching principles; and an absence of outcome measures focused on parent capacity.Implications for RehabilitationContemporary early intervention services recognise the importance of engaging parents as active participators in their child's development. This is evident by the increase in interventions that utilise parent coaching practices. The findings of this systematic review indicate the need for professionals to:•Describe and document fidelity of coaching practices in the delivery of intervention.•Objectively measure changes in parent capacity and self-efficacy as a result of the coaching based intervention.The reporting of parent capacity measures will allow us to truly examine the effectiveness of coaching practices in empowering families to support their child to realise their full potential.

Análise da efetividade de um programa de intervenção para famílias de crianças com deficiência auditiva

RESUMO Objetivo Avaliar a efetividade de um programa de intervenção para famílias de crianças com deficiência auditiva. Método Pesquisa de intervenção, com delineamento longitudinal e análise estatística inferencial. Foram realizadas 20 sessões de intervenção, durante oito meses; destas, 19 ocorreram em situação de grupo e uma sessão foi individual. Para a análise dos dados pré e pós-intervenção, foram aplicados instrumentos específicos e realizado o registro em vídeo da interação da família com a criança após quatro e oito meses. Resultados Houve mudança clínica positiva confiável nas interações comunicativas das famílias com seus filhos, após 8 meses de intervenção. A necessidade de informações das famílias se modificou ao longo da intervenção e diminuiu para todas as famílias. Conclusão verificou-se a efetividade da proposta de programa de intervenção para famílias de crianças com deficiência auditiva.

The Power of Language Nutrition for Children's Brain Development, Health, and Future Academic Achievement

Language Nutrition, a term created to describe language exposure that is rich in quality and quantity and delivered in the context of social interactions, is crucial for a child's development and is strongly associated with his/her future literacy, academic achievement, and health. However, significant differences in children's early language environments contribute to disparities in their educational and health trajectories. Interventions, including book distribution programs, coaching parents to enrich their child's language environment, and public awareness campaigns, have all been shown to positively influence a child's access to language-rich interactions. Incorporating Language Nutrition coaching and literacy promotion into pediatrics is a promising platform for building the capacity of parents to provide language exposure to their children. By teaching parents both how and why to treat their child as a conversational partner and by modeling such interactions, pediatric health care providers can help parents set their children on a pathway toward literacy, educational success, and health.

[Muenster Parental Programme--Feedback from Parents: How do parents evaluate an early intervention programme for improving the communication with their baby or toddler with hearing impairment?]

BACKGROUND

With the implementation of the UNHS, early educational services' existing concepts of early intervention have to be adapted to the situation and needs of families with a preverbal child who is deaf or hard of hearing. The Muenster Parental Programme (MPP), a module in early family-centered intervention, fulfils this requirement.

OBJECTIVE

We report feedback from participating parents regarding processes and outcomes of the MPP. The self-developed questionnaire was checked for its suitability as feedback instrument for measuring parental satisfaction with the MPP.

METHOD

29 parents who participated in the MPP assessed the programme by using the standardised FBB and the self-developed questionnaire FB-MEP, which is specific to the MPP.

RESULTS

Using the FBB, 96% of parents judged the MPP to be good or very good. With the FB-MEP, parents rated setting, contents and didactics as highly as they did using the FBB (r = 0.7, p < 0.01). In particular, parents judged both the contact and exchange with other affected parents, and the specific individual support for communicating with their child (including video feedback) as especially helpful.

CONCLUSIONS

The results reflect parents' high level of satisfaction with the setting, content, didactics and individual benefit gained by their child and themselves from the MPP. The parents are aware of the efficacy of the MPP, which was shown in the controlled intervention study. The self-developed questionnaire FB-MEP was shown to be a suitable instrument for quality assurance measurements of the MPP.

Language Outcomes in Children With Unilateral Hearing Loss: A Review

Unilateral hearing loss (UHL) in children is only recently beginning to be widely appreciated as having a negative impact. We now understand that simply having one normal-hearing ear may not be sufficient for typical child development, and leads to impairments in speech and language outcomes. Unfortunately, UHL is not a rare problem among children in the United States, and is present among more than 1 out of every 10 of adolescents in this country. How UHL specifically affects development of speech and language, however, is currently not well understood. While we know that children with UHL are more likely than their normal-hearing siblings to have speech therapy and individualized education plans at school, we do not yet understand the mechanism through which UHL causes speech and language problems. The objective of this review is to describe what is currently known about the impact of UHL on speech and language development in children. Furthermore, we discuss some of the potential pathways through which the impact of unilateral hearing loss on speech and language might be mediated.

Adequate formal language performance in unilateral cochlear implanted children: is it indicative of complete recovery in all linguistic domains? Insights from referential communication

OBJECTIVES

Referential communication (RC) is a key element in achieving a successful communication. This case series aimed to evaluate RC in children with unilateral cochlear implants (CIs) with formal language skills within the normal range.

METHODS AND MATERIALS

A total of 31 children with CIs, with language development within the normal range, were assessed using the Pragmatic Language Skills test (MEDEA).

RESULTS

Of the children with CIs, 83.9% reached performance levels appropriate for their chronological ages. The results confirmed a positive effect of cochlear implantation on RC development, although difficulties remained in some CI users.

CONCLUSIONS

The outcomes emphasize the need to pay greater attention to the pragmatic aspects of language, assessing them with adequate testing in the early phase after cochlear implantation. Clear knowledge of children's communicative competence is the key in optimizing their communicative environments in order to create the basis for future successful interpersonal exchanges and social integration.

Parent-to-parent support for parents with children who are deaf or hard of hearing: a conceptual framework

BACKGROUND

Parent-to-parent support for parents with children who are deaf or hard of hearing (D/HH) is identified as an important component of Early Hearing Detection and Intervention (EHDI) programs for children with hearing loss.

PURPOSE

The specific aim of this review was to identify the constructs and components of parent-to-parent support for parents of children who are D/HH.

RESEARCH DESIGN

An extensive scoping literature review identified 39 peer-reviewed articles published from 2000 to 2014. Studies were selected and reviewed based on standardized procedures.

RESULTS

Data were identified, extracted, and organized into libraries of thematic and descriptive content. A conceptual framework of parent-to-parent support for parents of children who are D/HH was developed and presented in a comprehensive, bidirectional informational graphic. The constructs and components of the conceptual framework are (a) well-being: parent, family, and child; (b) knowledge: advocacy, system navigation, and education; and (c) empowerment: confidence and competence.

CONCLUSION

The findings from this scoping review led to the development of a structured conceptual framework of parent-to-parent support for parents of children who are D/HH. The conceptual framework provides an important opportunity to explore and clearly define the vital contribution of parents in EHDI programs.