Effects of parental style of interaction on language development in very young severe and profound deaf children

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.

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.

The Limits of "Communication Mode" as a Construct

Questions about communication mode (a.k.a. "communication options" or "communication opportunities") remain among the most controversial issues in the many fields that are concerned with the development and well-being of children (and adults) who are d/Deaf or hard of hearing. In this manuscript, we argue that a large part of the reason that this debate persists is due to limitations of the construct itself. We focus on what we term "the crucial question": namely, what kind of experience with linguistic input during infancy and toddlerhood is most likely to result in mastery of at least one language (spoken or signed) by school entry. We argue that the construct of communication mode-as currently construed-actively prevents the discovery of compelling answers to that question. To substantiate our argument, we present a review of a relevant subset of the recent empirical literature and document the prevalence of our concerns. We conclude by articulating the desiderata of an alternative construct that, if appropriately measured, would have the potential to yield answers to what we identify as "the crucial question."

Mental health in children with severe hearing impairment

Deafness does not in itself cause emotional/behavioural or cognitive problems or psychiatric disorders. However, children with hearing impairment are at greater risk of developing emotional/behavioural problems and neurodevelopmental disorders. The incidence of both seems to be higher in deaf children from hearing families. Most prelingual deafness is caused by recessive genes; hence, most deaf individuals come from hearing families, the majority of whom do not use sign language. Numerous studies, in both hearing and deaf populations, show how the lack of access to language has an impact on the emotional development of children. This article focuses on the mechanisms by which early language deprivation mediates emotional/behavioural difficulties and consequent emotional dysregulation, and may produce behaviours and symptoms that can be misdiagnosed as neurodevelopmental disorders in deaf children and adolescents (from infancy to 18 years of age).

Phenomenological needs assessment of parents of children with cochlear implants

Background

The use of cochlear implants has been a remarkable success in reducing disabilities in those with impaired hearing, which have made a significant change in the patients’ quality of life. Only by relying on cochlear implants, disabilities cannot be eliminated in the hearing impaired, and, alongside this intervention, rehabilitation practices such as through family and community support are necessary.

Aim

To explain the needs of parents of children with cochlear implants to increase the quality of rehabilitation services and family-based interventions.

Methods

A descriptive phenomenology study was performed with the participation of 16 people, including eight mothers, three fathers, and five experts involved with the rehabilitation of children aged 2–7 years with cochlear implants. The research setting was centers with speech therapy service providers for hearing-impaired children in the city of Shiraz (Iran) in 2015. Information was gathered through in-depth interviews with participants and analyzed by using Colaizzi’s nine-step analysis method and MAXQDA (Ver10) applications.

Results

The mean age of participants was 34 years, and the average age of diagnosis of hearing problems in children was 12 months. The obtained data from the analysis of interviews about the needs of parents of children with cochlear implants were categorized into 19 sub-contents and five contents, as follows: the need for access to health care services; psychological needs; mood-related needs of a child; educational needs and financial requirements.

Conclusion

Parents of children with cochlear implants have numerous needs, and they encounter problems based on their situation and experiences. The results indicate the necessity of close cooperation among different professionals such as an audiologist, pediatrician, psychologist, and speech therapist for the program’s success.

Sign Language and Spoken Language for Children With Hearing Loss: A Systematic Review

CONTEXT

Permanent hearing loss affects 1 to 3 per 1000 children and interferes with typical communication development. Early detection through newborn hearing screening and hearing technology provide most children with the option of spoken language acquisition. However, no consensus exists on optimal interventions for spoken language development.

OBJECTIVE

To conduct a systematic review of the effectiveness of early sign and oral language intervention compared with oral language intervention only for children with permanent hearing loss.

DATA SOURCES

An a priori protocol was developed. Electronic databases (eg, Medline, Embase, CINAHL) from 1995 to June 2013 and gray literature sources were searched. Studies in English and French were included.

STUDY SELECTION

Two reviewers screened potentially relevant articles.

DATA EXTRACTION

Outcomes of interest were measures of auditory, vocabulary, language, and speech production skills. All data collection and risk of bias assessments were completed and then verified by a second person. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the strength of evidence.

RESULTS

Eleven cohort studies met inclusion criteria, of which 8 included only children with severe to profound hearing loss with cochlear implants. Language development was the most frequently reported outcome. Other reported outcomes included speech and speech perception.

LIMITATIONS

Several measures and metrics were reported across studies, and descriptions of interventions were sometimes unclear.

CONCLUSIONS

Very limited, and hence insufficient, high-quality evidence exists to determine whether sign language in combination with oral language is more effective than oral language therapy alone. More research is needed to supplement the evidence base.

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.

Effect of identification and intervention age on language development for Mandarin-speaking deaf children with high family involvement

OBJECTIVE

The purpose of this study is to assess the language ability between early-intervention and later-intervention Mandarin-speaking deaf children, who have normal cognition and high family involvement.

MATERIALS AND METHODS

There are 29 subjects enrolled. 11 born deaf children received early intervention (7 HA and 4 CI) before 6 months old as study group. Another 18 born deaf children received later intervention (11 HA and 7 CI) between 7 and 35 months old as reference group. They were all regarded as with normal cognition and high family involvement. Their mean assessment age was 50 months old in early group and 51 months old in later group. We used several tools to test their perceptive vocabulary size, to evaluate perceptive language syntax and to compare perceptive and expressive language scores.

RESULTS

Our study revealed there are significant difference between these two groups in the ability of vocabulary size, perceptive language syntax and perceptive language scores. The results showed there is no significant difference between these two groups in their expressive language scores, although their achievement score is higher in the early group.

CONCLUSIONS

It clearly showed the ability of perceptive language in early-intervention deaf children was better than that of later-intervention. The ability of their expressive language showed no difference between them.

O brincar e as habilidades sociais na interação da criança com deficiência auditiva e mãe ouvinte

Este artigo é resultado de um estudo que analisou a interação e o brincar entre 20 mães e seus filhos com deficiência auditiva, de graus severo e/ou profundo, com idades entre três e seis anos, em rotina de atendimento no Centro de Distúrbio da Audição, Linguagem e Visão do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo. As mães foram entrevistadas e as respostas, analisadas quantitativa e qualitativamente. Os resultados mostraram que a interação com a mãe durante o brincar favorece o desenvolvimento de habilidades sociais para a adequação da criança ao seu meio social, e que as mães carecem de orientações, a fim de que esse espaço seja utilizado mais eficientemente para o aprendizado.

[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.

Comparison of Cognitive Function in Deaf Children Between Before and After Cochlear Implant

OBJECTIVES

This study was conducted to examine improvements of cognitive abilities after cochlear implantation in deaf children. We also examined the psychosocial factors that predict good outcomes of cochlear implantation.

DESIGN

A neuropsychological test battery was administered to 17 deaf children (mean age, 7 yr 2 mo) before receiving the cochlear implant, and they were reassessed with the same test at 6-mo follow-up. Their parents completed questionnaires concerning their medical and educational history, parenting style, and parental emotional problems.

RESULTS

Deaf children showed marked improvement in speedy and delicate motor coordination and visual organization abilities. Their cognitive functions of comprehension, concentration, and sequential processing, as measured by nonverbal tests, were found to have improved from the levels of borderline to mild mental retardation to that of near-normal range. However, their performances on Information, Comprehension and Similarity, and Mathematics subtests requiring verbal abilities did not show significant changes. Deaf children's working memory improved significantly after cochlear implantation. However, they showed more omission errors in the visual attention test at follow-up than before cochlear implantation. Such inattentiveness for visual stimuli in children post-implantation could be attributed to distractibility of these children toward external noise. Mothers' depression was negatively correlated with scores of acquired knowledge of deaf children.

CONCLUSION

At the 6-mo follow-up after cochlear implant, deaf children showed marked improvement in nonverbal cognitive functions and working memory. Conversely, their verbal abilities did not significantly change. Maternal factors were found to be important for predicting the prognosis of cochlear implantation. The absence of a control group precludes the possibility of drawing any firm conclusions because the effect of the implant cannot be teased apart from the effects of maturation and training. Future studies should address this question with the use of appropriate control groups.

Promovendo a interação mãe-criança com implante coclear: um estudo de caso

O objetivo deste estudo foi verificar os efeitos de uma intervenção conduzida com a mãe de uma criança com implante coclear através da avaliação de mudanças comportamentais identificadas após o programa. Participou deste estudo uma díade mãe ouvinte-criança com deficiência auditiva e implante coclear, filmada em quatro sessões de observação: uma situação de brinquedo e outra do cotidiano, antes e após a intervenção. Esta constou de dois encontros nos quais a mãe assistiu às filmagens e foi orientada quanto à sua conduta com relação à criança. Os resultados mostraram aumento no número de verbalizações maternas nas categorias informar e solicitar, bem como de falas da criança nas categorias falar espontaneamente e fazer solicitação, quando comparadas as medidas pré e pós-testes nas duas situações observadas. O estudo mostra a importância de intervenções que favoreçam a relação mãe-filho para o desenvolvimento de habilidades comunicativas da criança com deficiência auditiva e implante coclear.

Contributions of mother-child storybook telling and joint writing to literacy development in kindergartners with hearing loss

PURPOSE

This study investigated mother-child storybook telling and joint writing as predictors of early literacy among kindergartners with hearing loss.

METHOD

Participants were 30 Israeli kindergartners with hearing loss and their mothers. Early literacy assessments tapped children's alphabetic skills (e.g., word writing, word recognition, and letter knowledge) and linguistic skills (e.g., phonological awareness, general knowledge, and receptive vocabulary). Each mother told her child the story of a wordless book and helped her child write words. Both interactions were videotaped and analyzed.

RESULTS

Our major findings showed that maternal storybook telling correlated with linguistic skills, and maternal writing mediation correlated with basic alphabetic skills. A series of 3-step hierarchical regression analyses revealed that beyond children's age, children's degree of hearing loss, and joint writing, storybook telling predicted children's phonological awareness (22%), general knowledge (28%), and receptive vocabulary (18%). Beyond children's age, children's degree of hearing loss, and storybook telling, joint writing predicted word writing (15%), word recognition (31%), and letter knowledge (36%).

IMPLICATIONS

Recommendations focused on encouraging parent and teacher awareness about the differential contributions of storybook telling and writing mediation to early literacy. We also advocated enhancing parents' skills for promoting children's literacy.

The development of proto-performative utterances in deaf toddlers

PURPOSE

The purpose of this study was to examine and compare the development of proto-imperative and proto-declarative utterances in normally developing, non-neonatally screened, profoundly deaf toddlers.

METHOD

Both types of proto-declarative are considered to be the most basic prelinguistic and early linguistic communicative functions. Eighteen normally developing, non-neonatally screened, profoundly deaf toddlers participated in a longitudinal study. All children were enrolled in the same oral-aural home guidance program. At the time of the study, none of the children had received a cochlear implant. At the ages of 18, 24, and 30 months, proto-imperative utterances were elicited using an adapted version of M. Casby and J. A. Cumpata's (1986) Protocol for the Assessment of Prelinguistic Intentional Communication. For eliciting proto-declarative intentions, a video clip was used.

RESULTS

Results revealed a significant increase in both frequency and level of utterances for both types of proto-performatives. Although there was a clear development from nonlinguistic toward linguistic communication, utterances remained predominantly deictic-gestural for the imperative intentions and referential-gestural for declaratives.

CONCLUSIONS

The data support the notion from the literature that both types of performatives are susceptible to elicitation. Results also suggest that after neonatal screening, both total communication and oral-aural approaches might accelerate conventionalization of the earliest communicative utterances of profoundly deaf toddlers.

Detección precoz de sorderas. ejemplo de intervención en salud pública

INTRODUCTION

We present a statistic study comparing all the options we can take to face congenital deafness as a problem of public health.

PATIENTS AND METHODS

We collected and analyzed data obtained between 1991 and 1995, just before our universal screening program started. They were separated into two groups with the 144 children explored using ABR, and the results were compared depending on the option taken in each group (no screening or high risk screening) and finally with those obtained in a universal program.

RESULTS

The establishment of a high risk screening program was followed by a drastic reduction of the severe deafness diagnosis (29.5% to 8%), and also of the mean age of diagnosis (24 to 14 months), which were found statistically significant. The mean age with universal screening is 3 months.

DISCUSSION AND CONCLUSIONS

Early detection of congenital hearing impairment has brought an important advance in the management of this problem of public health minimizing its sequels as the diagnosis is reached earlier. The universal screening of deafness is feasible as based on cheap and easy diagnostic techniques available in any centre, and it must be performed with the rest of Health Children Programs.