Geographic, Sociodemographic, and Clinical Factors Associated With Parental Self-Efficacy in Pediatric Patients With Hearing Loss

OBJECTIVE

To identify geographic, sociodemographic, and clinical factors associated with parental self-efficacy in a diverse cohort of deaf or hard-of-hearing (DHH) children.

STUDY DESIGN

Cross-sectional study.

SETTING

Tertiary children's hospital.

METHODS

Four hundred forty parents of DHH children aged 0 to 17 completed the 25-item Scale of Parental Involvement and Self-Efficacy (SPISE) survey from 2014 to 2022. Residential addresses were geocoded and assigned Area Deprivation Index and Social Vulnerability Index rankings, and univariable and multivariable analyses were conducted using sociodemographic and clinical variables, including sex, race/ethnicity, insurance type, survey language, age at the survey, comorbidities, newborn hearing screening results, and hearing loss laterality and severity.

RESULTS

Compared to English and Spanish-speaking parents, Chinese-speaking parents were associated with overall lower parental self-efficacy and involvement (regression coefficient = -0.518, [-0.929, -0.106]), Cohen's d = 0.606) and lower scores on items related to their ability to affect multiple aspects of their child's development and expression of thoughts as well as competency in checking and putting on their child's sensory device. Across univariable and multivariable analyses, besides Chinese language, all other sociodemographic, clinical, and geographic variables were not associated with SPISE score.

CONCLUSION

To achieve the best patient outcomes, care teams can use the SPISE to evaluate parental self-efficacy and provide targeted support to parents at risk for having lower knowledge and confidence scores about critical skills necessary to facilitate their child's auditory access and language development. Notably, this study found similar reports of parental efficacy across various sociodemographic, clinical, and geographic variables but significantly lower SPISE scores in Chinese-speaking families.

"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.

The Difference in the Creativity of People Who Are Deaf or Hard of Hearing and Those with Typical Hearing: A Scoping Review

The scoping review aimed to describe differences in creativity between deaf and hard of hearing and typically hearing people. The research question for the review was: what are the differences in the creativity of deaf and hard-of-hearing people in comparison with people with typical hearing? A total of eleven databases were used for the search, as well as sources of the unpublished studies/gray literature. The scoping review was prepared following the Joanna Briggs Institute methodology and PRISMA frame as a basis for reporting scoping reviews. A total of 30 studies were analyzed concerning the selected research areas. Intrinsic creativity was the first area identified. Specific activities for the development of creativity formed the second area for analysis. The third area focused on differences in creativity between deaf and hard of hearing and typically hearing. The fourth area includes studies that call for an equitable research environment.

İletişim bozukluğu tanılı çocuklarda duygusal davranışsal sorunlar, ebeveyn tutum özellikleri, ebeveyn stres düzeyi ve ilişkili faktörlerin sağlıklı kontrollerle karşılaştırılması

Purpose: We aimed to compare emotional and behavioral problems, parental attitude characteristics, and the risk of parental anxiety and depression between children diagnosed with a communication disorder and healthy controls. Materials and Methods: A total of 117 children diagnosed with a communication disorder in the psychiatric evaluation according to the DSM-5 diagnostic criteria and their parents were included in the communication disorder group, whereas 105 children who presented to the outpatient clinics other than child psychiatry and were not diagnosed with a communication disorder, and their parents formed the control group. Sociodemographic Data Form, Child Adjustment and Parent Efficacy Scale (CAPES-TR), The Parenting Styles and Dimensions Questionnaire-Short Form (PSDQSF), and Hospital Anxiety Depression Scale (HADS) were filled in by the parents. Results: Psychiatric comorbidity was found in 27.3% of the children in the communication disorder group, with the most common diagnoses being Attention deficit and hyperactivity disorder (n=17, 15.5%) and Conduct disorder (n=4, 3.6%). CAPES-TR child adjustment total difficulty score and the mean scores of emotional problems and behavioral problems were higher in the communication disorder group. The mean CAPES-TR parental self-efficacy score was lower in the communication disorder group. In the communication disorder group, democratic parenting attitudes were lower , whereas authoritarian and permissive parenting attitudes were higher. HAD-D mean score was higher in the communication disorder group. Conclusion: Our study provides essential information such as an increase in emotional and behavioral problems, more authoritarian or permissive parenting attitudes, a decrease in parental self-efficacy, an increased risk of depression in parents in the presence of communication disorder, and studies that deal with these areas together are limited in the literature. Our findings will contribute to the literature regarding the assessment and planning of appropriate intervention programs for factors that are not only child-focused but also related to parental mental health and parenting skills in the presence of communication disorders.

NeonaTal Assisted TelerehAbilitation (T.A.T.A. Web App) for Hearing-Impaired Children: A Family-Centered Care Model for Early Intervention in Congenital Hearing Loss

Background: An early hearing detection and intervention program (EHDI) is the first step for the habilitation of children with permanent hearing impairment (PHI). Actually, early intervention programs have increasingly shifted toward family involvement, emphasizing that the child’s family should take an active role in the habilitation process. Therefore, familiar empowerment is the best way to improve a child’s emerging abilities. The aim of this study was to investigate parental self-efficacy beliefs and involvement as well as the language skills of deaf or hard of hearing DHH children who were habilitated with hearing aids and followed using the T.A.T.A web app (NeonaTal Assisted TelerehAbilitation), an example of asynchronous telepractice. Methods: The study describes the early stages of the habilitation program of 15 PHI children followed through the T.A.T.A. web app, which empowers families through a weekly questionnaire submitted during the first 270 to 360 days of their child’s life, for 14 weeks. The family involvement rate scale (FIRS) was used to evaluate parental compliance, and all children received in-person visits at the beginning and at the end of the training period. Results: The children showed greater auditory perceptual skills at the end of the training period on the basis of both the Infant Listening Progress Profile (ILiP) score and the Categories of Auditory Performance (CAP) and FIRS scales. In other words, the auditory skills improved with age as well as with parental participation. Conclusions: The T.A.T.A. web app promotes a proactive management and a tailored habilitation through an active familiar involvement, easily achieved in clinical routine and in emergency settings without additional costs.

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.

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.

Effects of Parents' Mealtime Conversation Techniques for Preschool Children With Hearing Loss Who Use Listening and Spoken Language

Purpose This mixed-methods study aimed to examine the conversation techniques used by parents of young children with hearing loss (HL) during dinnertime at home. Parents' usage rates of open- and closed-ended language elicitation, reformulation, imitation, directives, and explicit vocabulary instruction were examined in relation to children's receptive vocabulary and basic-concepts skills. Method Twenty-minute dinnertime segments were extracted from naturalistic, daylong recordings of 37 preschoolers with HL who used listening and spoken language. The segments were hand-coded for parents' use of conversation techniques. Children's receptive vocabulary and basic concepts were assessed using standardized measures. Results Parents' use of conversation techniques varied widely, with closed-ended elicitation and directives used most frequently during dinner. Explicit vocabulary instruction was correlated with general receptive vocabulary and basic-concepts skills. Thematic analysis of the conversations revealed common themes, including concrete topics and sibling speakers. In addition, parents who used many techniques often introduced abstract conversation topics; electronic media was present in all conversations with few techniques. Conclusions Parents of preschoolers with HL may benefit from specific coaching to elicit language and introduce new vocabulary during home routines. These techniques may help develop their children's receptive language.

Parents' views about factors facilitating their involvement in the oral early intervention services provided for their children with hearing loss in Kuwait

OBJECTIVES

Developed countries (such as the Unites States of America, the United Kingdom, and Australia) provide high-quality services to children with hearing loss and their parents, including universal newborn hearing screening, early fitting of hearing devices and access to high quality early, aural intervention. In contrast, many developing countries lack the resources to provide these services. Research evidence suggests that one way to compensate for delays in identification and rehabilitation for children with hearing loss is to involve the family in the early intervention process. However, evidence is deficient around the facilitation of parental involvement in early intervention for families from developing countries. The aim of this study was to investigate the perception of parents from a developing country who have a child with hearing loss to discover the factors that may influence their involvement in early intervention, identify facilitators/barriers for their involvement, and identify the specific needs of involved parents.

METHOD

A qualitative collective case study methodology was used in the form of semi-structured interviews with twenty-one participants.

RESULTS

Two global themes emerged. Firstly, factors influencing parental involvement. This included five subthemes: better communication as the key to building rapport and providing support; disappointment with the service; physical and human resources make a difference; consideration of life beyond the habilitation sessions; and my child matters the most. The second global theme-parental needs-included four subthemes: building trust; ensuring generalization; improving child outcomes; and managing needs of parents versus services. All the discussed themes are supported by quotations from the interviews.

CONCLUSION

The findings suggest that parents of children with hearing loss in developing countries perceive the services provided for their children to be disjointed and not well coordinated. Based on the parent perceptions a set of guidelines that provide a scaffold for service providers working with children with hearing loss in developing countries is outlined. The guidelines are designed to assist services for children with hearing loss in developing countries improve the delivery of their services and increase family involvement, which in turn; will assist in improving their child and family related outcomes.

Predictors of Vocabulary Outcomes in Children Who Are Deaf or Hard of Hearing From Spanish-Speaking Families

Purpose

The goal of this study was to identify predictors of expressive vocabulary in young Spanish-speaking children who are deaf or hard of hearing living in the United States.

Method

This cross-sectional study considered 53 children with bilateral hearing loss between 8 and 34 months of age ( M = 24, SD = 6.9). Demographic variables, variables related to the hearing loss, and intervention variables were included in a hierarchical regression analysis to predict expressive vocabulary quotients from the MacArthur Inventario del Desarrollo de Habilidades Comunicativas (Communicative Development Inventories; Jackson-Maldonado et al., 2003 ).

Results

Chronological age, degree of hearing loss, functional hearing ability ratings, age of enrollment in early intervention, and the interaction between chronological age and age of intervention accounted for 61.5% of the vocabulary variance. Children who received intervention by 6 months of age achieved significantly higher vocabulary outcomes than children who started intervention later.

Conclusion

The children's mean vocabulary outcomes were below average when compared with hearing peers. This was especially true for older children, children with moderately-severe-to-profound hearing loss, and children who began intervention after 6 months of age. This delay in vocabulary outcomes has the potential to interfere with future reading and academic outcomes.

Relations Between Teacher Talk Characteristics and Child Language in Spoken-Language Deaf and Hard-of-Hearing Classrooms

PURPOSE

The aim of this study was to examine relations between teachers' conversational techniques and language gains made by their deaf and hard-of-hearing students. Specifically, we considered teachers' reformulations of child utterances, language elicitations, explicit vocabulary and syntax instruction, and wait time.

METHOD

This was an observational, longitudinal study that examined the characteristics of teacher talk in 25 kindergarten through second-grade classrooms of 68 deaf and hard-of-hearing children who used spoken English. Standardized assessments provided measures of child vocabulary and morphosyntax in the fall and spring of a school year. Characteristics of teacher talk were coded from classroom video recordings during the winter of that year.

RESULTS

Hierarchical linear modeling indicated that reformulating child statements and explicitly teaching vocabulary were significant predictors of child vocabulary gains across a school year. Explicitly teaching vocabulary also significantly predicted gains in morphosyntax abilities. There were wide individual differences in the teachers' use of these conversational techniques.

CONCLUSION

Reformulation and explicit vocabulary instruction may be areas where training can help teachers improve, and improvements in the teachers' talk may benefit their students.

Maternal Perception of Self-Efficacy and Involvement in Young Children with Prelingual Hearing Loss

Appropriate intervention needs to support families and consider them as a part of rehabilitation program. Parents who have high self-efficacy are more likely to put their knowledge and skills into action and have positive interactions with their children. In addition, there has been a positive relation between parental involvement and child educational success. The aim of present study was evaluating maternal perception of both self-efficacy and involvement between mothers of children with hearing aid and cochlear implant via Scale of Parental Involvement and Self Efficacy (SPISE) and exploring relationship between maternal self-efficacy and parental involvement and child factors. 100 mothers of children with hearing loss were available. 49 mothers participated in study, filled SPISE, and return it on time. SPISE consisted of three sections (1) demographic information, (2) maternal self-efficacy, (3) parental involvement. All cases had received at least 6 months auditory training and speech therapy. Participants included 30 (61.2%) mothers of children with hearing aid, 19 (38.8%) mothers of children with cochlear implant. ANOVA analysis showed that there is no significant difference between hearing aid (HA) and cochlear implant (CI) groups in term of self-efficacy and parent-involvement except for question 21 (comfortable in participating in individualized program) that score in HA group was significantly higher than CI group. Results of present study has practical implications for early interventionists working with families. Every early intervention program should consider families to reach maximum outcome. Early interventionists can use SPISE to evaluate parental selfefficacy and involvement and work on parents with low score to achieve the best results.

Pediatric Audiology Report: Assessment and Revision of an Audiology Report Written to Parents of Children With Hearing Impairment

OBJECTIVE

The purpose of this study was twofold: first, to evaluate a typical pediatric diagnostic audiology report to establish its readability and comprehensibility for parents and, second, to revise the report to improve its readability, as well as the comprehension, sense of self-efficacy, and positive opinions of parent readers.

METHOD

In Experiment 1, a mock audiology report was evaluated via a readability analysis and semistructured interviews with 5 parents. In Experiment 2, the report was revised using best practice guidelines and parental recommendations from Experiment 1. The revision was verified by randomly assigning 32 new parent participants to read either the revised or unrevised report before their comprehension, self-efficacy, and opinions were assessed.

RESULTS

In Experiment 1, results confirmed that the report was difficult to read and understand. In Experiment 2, parents who read the revised report had significantly greater comprehension, self-efficacy, and opinion ratings than those who read the unrevised report. In addition, the readability of the revised report was markedly improved compared with the unrevised report.

CONCLUSIONS

This study shows that pediatric diagnostic audiology reports can be revised to adhere to best practice guidelines and yield improved readability, in addition to improving the comprehension, sense of self-efficacy, and positive opinions of parents of children with hearing impairment.

Parental Support for Language Development During Joint Book Reading for Young Children With Hearing Loss

Parent and child joint book reading (JBR) characteristics and parent facilitative language techniques (FLTs) were investigated in two groups of parents and their young children; children with normal hearing (NH; n = 60) and children with hearing loss (HL; n = 45). Parent-child dyads were videotaped during JBR interactions, and parent and child behaviors were coded for specific JBR behaviors using a scale developed for this study. Children's oral language skills were assessed using the Preschool Language Scale-4 (PLS-4). Parents of children with HL scored higher on two of the four subscales of JBR: Literacy Strategies and Teacher Techniques. Parents of children with NH utilized higher level FLTs with their children who had higher language skills. Higher level FLTs were positively related to children's oral language abilities. Implications are discussed for professionals who work with families of very young children with HL.

Addressing Qualified Personnel Shortages for Children Who Are Deaf or Hard of Hearing With an Interdisciplinary Service Learning Program

Purpose

To describe the student training benefits for speech-language pathology graduate students involved in an interdisciplinary, community-based intervention program at a Midwestern university for families of preschool children who were deaf or hard of hearing (DHH) and auditory-based spoken language users.

Method

The Auditory and Language Enriched Program was developed to provide graduate students with a clinically relevant service learning opportunity that also met some unique community needs of families in the community. Specifically, students learned to provide families with imaginative ways to expose their children who were DHH to language and literacy and nurture their natural curiosity and zest for learning.

Results

Statistically significant improvement was noted between pre- and postintervention questionnaires of knowledge and skill related to intervention for this population by a single group of students.

Conclusions

An interdisciplinary service learning approach to intervention might provide opportunities for university graduate programs to address the immediate and long-term needs of families who have chosen a spoken language outcome for their young children who are DHH while simultaneously providing invaluable experience with low-incidence populations for their preservice graduate students.

The Importance of the Home Literacy Environment for Developing Literacy Skills in Young Children Who Are Deaf or Hard of Hearing

Four-year-old Olivia, who is deaf and has used a cochlear implant for 3 years, and her mother, Laura, enjoy looking at storybooks together at home. During storybook reading, Laura notices that Olivia tries to imitate some words that she reads to her yet does not seem to understand many words or story events. Laura is unsure whether to stop the storybook interaction and encourage Olivia’s attempts at word imitation and directly teach her the new vocabulary or continue reading the story for pleasure. Olivia’s preschool teacher, Ms. Lynn, also notices that Olivia displays a keen interest in storybook reading but is not able to answer or ask simple questions about the story. What can Laura and Ms. Lynn do collaboratively to support Olivia’s emerging language and literacy skills to better prepare Olivia for her upcoming transition into kindergarten?

The prelexical development in children implanted by 16 months compared with normal hearing children

OBJECTIVE

Few studies exist which document the early speech development of German-speaking children or German-speaking children who are deaf and using cochlear implants. The current study aims to: (1) document the pre-canonical and canonical speech development of German-speaking children who are deaf and receive cochlear implants by the age of 16 months and (2) compare these children's results with those of children with normal hearing.

DESIGN

This longitudinal study included 5 German-speaking children with normal hearing and 5 with sensorineural deafness. All children from the deaf group received hearing amplification before cochlear implantation, received their first implant by 16 months of age, and became bilateral implant users by 31 months of age. The pre-canonical and canonical vocalisations of each child were recorded on video- and audiotapes in a semi-standardised playing situation every 4 weeks over a span of 1 year. In the cochlear implant group, the recording started 4-5 days postoperatively (first implant); in the normal hearing group it began between the ages of 4 and 5 months. The video and audio recordings were analysed using EUDICO Linguistic Annotator version 2.4 (Nijmegen, The Netherlands) and International Phonetic Alphabet transcription.

RESULTS

Both groups showed individual patterns of babbling acquisition, though the groups' patterns of acquisition were similar when analysed for consonant manner and place. Some children started with plosives and others, with nasals, but all acquired fricatives and laterals next. Onset of canonical babbling for children in the cochlear implant group began 0-4 months after first fitting of the first device, while children from the normal hearing group demonstrated an onset of canonical babbling between 4 and 9 months of age.

CONCLUSION

Our results show that deaf children who receive cochlear implants at an early age are capable of reaching the canonical babbling milestone in a shorter time than children with normal hearing typically do and that their consonant phoneme acquisition follows a similar sequence to normal hearing peers'. These results are consistent with the literature indicating that early identification and intervention are important for allowing children with cochlear implants the opportunity to catch up to hearing peers.

Relationships between speech perception abilities and spoken language skills in young children with hearing loss

The goal of this study was to examine the relationships between scores obtained from measures of speech perception and language in a group of young children with hearing loss (HL). Eighteen children (mean age = 4.3 years) and their mothers participated in this study. Speech perception was measured using the online imitative test of speech pattern contrast perception (OLIMSPAC). Standardized language age equivalent scores were obtained using the Reynell developmental language scales-III. Number of word tokens, word types, and mean length of utterance (MLU) were extracted from the children's spontaneous language samples. Significant positive relationships were observed between children's OLIMSPAC scores and both standardized language scores (r ranging from 0.60 to 0.69; p <0.01) and all measures derived from children's spontaneous language samples (r ranging from 0.80 to 0.86; p<0.01). After controlling for child age, OLIMSPAC scores explained 34.1% of the variance in children's MLU. Using a new speech perception measure with reduced language demands, strong positive correlations were evident between speech perception and language skills for a young group of children with HL.

Literacy skills in children with cochlear implants: the importance of early oral language and joint storybook reading

The goal of this study was to longitudinally examine relationships between early factors (child and mother) that may influence children's phonological awareness and reading skills 3 years later in a group of young children with cochlear implants (N = 16). Mothers and children were videotaped during two storybook interactions, and children's oral language skills were assessed using the "Reynell Developmental Language Scales, third edition." Three years later, phonological awareness, reading skills, and language skills were assessed using the "Phonological Awareness Test," the "Woodcock-Johnson-III Diagnostic Reading Battery," and the "Oral Written Language Scales." Variables included in the data analyses were child (age, age at implant, and language skills) and mother factors (facilitative language techniques) and children's phonological awareness and reading standard scores. Results indicate that children's early expressive oral language skills and mothers' use of a higher level facilitative language technique (open-ended question) during storybook reading, although related, each contributed uniquely to children's literacy skills. Individual analyses revealed that the children with expressive standard scores below 70 at Time 1 also performed below average (<85) on phonological awareness and total reading tasks 3 years later. Guidelines for professionals are provided to support literacy skills in young children with cochlear implants.