Parental Linguistic Input and Its Relation to Toddlers' Visual Attention in Joint Object Play: A Comparison Between Children with Normal Hearing and Children With Hearing Loss

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.

Interactive Effects of Temperament and Family-Related Environmental Confusion on Spoken Language in Children Who Are Deaf and Hard of Hearing

PURPOSE

The aim of this study was to examine the influence of caregivers' reports of family-related environmental confusion-which refers to the level of overstimulation in the family home environment due to auditory and nonauditory (i.e., visual and cognitive) noise-on the relation between child temperament and spoken language outcomes in children who are deaf and hard of hearing (DHH) in comparison to age-matched children with typical hearing (TH).

METHOD

Two groups of families with children between 3 and 7 years of age (TH = 59, DHH = 58) were sequentially recruited from a larger longitudinal study on developmental outcomes in children who are DHH. Caregivers (all TH) completed questionnaires measuring three dimensions of child temperament (i.e., effortful control, negative affectivity, and surgency-extraversion) and family-related environmental confusion. A norm-referenced language measure was administered to children. Testing took place within the families' homes.

RESULTS

For children who are DHH, effortful control was positively related to spoken language outcomes, but only when levels of family-related environmental confusion were low to moderate. Family-related environmental confusion did not interact with temperament to influence spoken language in children with TH.

CONCLUSIONS

Homes with low-to-moderate levels of environmental confusion provide an environment that supports DHH children with better effortful control to harness their self-regulatory skills to achieve better spoken language comprehension than those with lower levels of effortful control. These findings suggest that efforts to minimize chaos and auditory noise in the home create an environment in which DHH children can utilize their self-regulatory skills to achieve optimal spoken language outcomes.

A Framework for Understanding the Relation Between Spoken Language Input and Outcomes for Children with Cochlear Implants

Spoken language outcomes after cochlear implantation are highly variable. Some variance can be attributed to individual characteristics. Research with typically hearing children suggests that the amount of language directed to children may also play a role. However, several moderating factors may complicate the association between language input and language outcomes in children with cochlear implants. In this article, I present a conceptual framework that posits that the association between total language input directed to children and language outcomes is moderated by factors that influence what is accessible, attended to, and coordinated with the child. The framework also posits that children with cochlear implants exhibit more variability on those moderating factors, which explains why the relation between language input and language outcomes may be more complex even if language input is more important for successful language outcomes in this population.

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.

Parent-Child Joint Behaviors in Novel Object Play Create High-Quality Data for Word Learning

This research takes a dyadic approach to study early word learning and focuses on toddlers' (N = 20, age: 17-23 months) information seeking and parents' information providing behaviors and the ways the two are coupled in real-time parent-child interactions. Using head-mounted eye tracking, this study provides the first detailed comparison of children's and their parents' behavioral and attentional patterns in two free-play contexts: one with novel objects with to-be-learned names (Learning condition) and the other with familiar objects with known names (Play condition). Children and parents in the Learning condition modified their individual and joint behaviors when encountering novel objects with to-be-learned names, which created clearer signals that reduced referential ambiguity and potentially facilitated word learning.

Social interaction in the emergence of toddler's mealtime spoon use

The use of a spoon for eating is among the important daily skills in early development. The article provides an analysis of how caregiver-toddler interactions guides the attention of toddlers who were first learning how to use a spoon to spoon-related action opportunities that were relevant to the mealtime context. Our analysis revealed several related results. First, caregivers often manipulated objects on the table (i.e., food and dishes), and toddlers were more likely than chance to use their spoon to contact food immediately after watching these caregiver manipulations. Second, toddlers looked more often at the caregiver's hand than at their face. Third, toddlers tended to look at the caregiver's hand when the caregiver was manipulating objects on the table, and after these looks, toddlers were more likely than chance to contact food with their spoon. Finally, the toddlers' choices about when to look at the caregiver were influenced by their own behavior, as if they wanted to know how the caregiver would react to what they had done. We discuss these results in terms of the learning of socially promoted action opportunities for meal-related spoon use.

What leads to coordinated attention in parent-toddler interactions? Children's hearing status matters

Coordinated attention between children and their parents plays an important role in their social, language, and cognitive development. The current study used head-mounted eye-trackers to investigate the effects of children's prelingual hearing loss on how they achieve coordinated attention with their hearing parents during free-flowing object play. We found that toddlers with hearing loss (age: 24-37 months) had similar overall gaze patterns (e.g., gaze length and proportion of face looking) as their normal-hearing peers. In addition, children's hearing status did not affect how likely parents and children attended to the same object at the same time during play. However, when following parents' attention, children with hearing loss used both parents' gaze directions and hand actions as cues, whereas children with normal hearing mainly relied on parents' hand actions. The diversity of pathways leading to coordinated attention suggests the flexibility and robustness of developing systems in using multiple pathways to achieve the same functional end.

Effects of children's hearing loss on the synchrony between parents' object naming and children's attention

Children's attentional state during parent-child interactions is important for word learning. The current study examines the real-time attentional patterns of toddlers with and without hearing loss (N = 15, age range: 12-37 months) in parent-child interactions. High-density gaze data recorded from head-mounted eye-trackers were used to investigate the synchrony between parents' naming of novel objects and children's sustained attention on the named objects in joint play. Results show that the sheer quantities of parents' naming and children's sustained attention episodes were comparable in children with hearing loss and their peers with normal hearing. However, parents' naming and children's sustained attention episodes were less synchronized in the hearing loss group compared to children with normal hearing. Possible implications are discussed.