The Role of Early Intervention in Parental Self-Efficacy for Parents of Deaf and Hard-of-Hearing Children

Purpose: To investigate the effects of age at enrollment in early intervention (EI) and dosage of EI services (frequency and intensity) on parental self-efficacy (PSE) and to determine whether parents with better PSE demonstrate more involvement in deciding Individualized Family Service Plan goals (IFSP), services, and amount of services. Method: Sixty-five parent-child dyads were included in this retrospective between-subjects study. PSE was measured using the Scale of Parental Involvement and Self-Efficacy (DesJardin, 2003). Dosage of EI services and parent/professional involvement in IFSP decision-making were measured using a Child Demographic Questionnaire. Results: Statistically significant correlations were not found between age at EI enrollment and SPISE subscales. Statistically significant correlations were not found based on frequency or intensity of EI services. Mixed results were found regarding level of parent involvement in decision-making of IFSP goals, kinds of services, and amount of services. Conclusions: Findings demonstrate the complexities in determining the effects of age at EI enrollment, EI dosage, and central elements of the IFSP on self-efficacy in parents of children who are deaf/hard-of-hearing. Future studies are needed to validate these findings and further the knowledge base about the role of EI in supporting parents’ sense of self-efficacy in supporting their child’s development

Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants

Background To learn words and acquire language, children must be able to discriminate and correctly perceive phonemes. Although there has been much research on the general language outcomes of children with cochlear implants (CIs), little is known about the development of speech perception with regard to specific speech processes, such as speech discrimination. Purpose The purpose of this study was to investigate the development of speech discrimination in infants with CIs and identify factors that might correlate with speech discrimination skills. Research Design Using a Hybrid Visual Habituation procedure, we tested infants with CIs on their ability to discriminate the vowel contrast /i/-/u/. We also gathered demographic and audiological information about each infant. Study Sample Children who had received CIs before 2 yr of age served as participants. We tested the children at two post cochlear implantation intervals: 2–4 weeks post CI stimulation (N = 17) and 6–9 mo post CI stimulation (N = 10). Data Collection and Analysis The infants’ mean looking times during the novel versus old trials of the experiment were measured. A linear regression model was used to evaluate the relationship between the normalized looking time difference and the following variables: chronological age, age at CI stimulation, gender, communication mode, and best unaided pure-tone average. Results We found that the best unaided pure-tone average predicted speech discrimination at the early interval. In contrast to some previous speech perception studies that included children implanted before 3 yr of age, age at CI stimulation did not predict speech discrimination performance. Conclusions The results suggest that residual acoustic hearing before implantation might facilitate speech discrimination during the early period post cochlear implantation; with more hearing experience, communication mode might have a greater influence on the ability to discriminate speech. This and other studies on age at cochlear implantation suggest that earlier implantation might not have as large an effect on speech perception as it does on other language skills

Family Environment in Children With Hearing Aids and Cochlear Implants: Associations With Spoken Language, Psychosocial Functioning, and Cognitive Development

Objectives: To examine differences in family environment and associations between family environment and key speech, language, and cognitive outcomes in samples of children with normal hearing and deaf and hard-of-hearing (DHH) children who use hearing aids and cochlear implants. Design: Thirty families of children with normal hearing (n = 10), hearing aids (n = 10), or cochlear implants (n = 10) completed questionnaires evaluating executive function, social skills, and problem behaviors. Children's language and receptive vocabulary were evaluated using standardized measures in the children's homes. In addition, families were administered a standardized in-home questionnaire and observational assessment regarding the home environment. Results: Family environment overall was similar across hearing level and sensory aid, although some differences were found on parental responsivity and physical environment. The level of supportiveness and enrichment within family relationships accounted for much of the relations between family environment and the psychosocial and neurocognitive development of DHH children. In contrast, the availability of objects and experiences to stimulate learning in the home was related to the development of spoken language. Conclusions: Whereas broad characteristics of the family environments of DHH children may not differ from those of hearing children, variability in family functioning is related to DHH children's at-risk speech, language, and cognitive outcomes. Results support the importance of further research to clarify and explain these relations, which might suggest novel methods and targets of family-based interventions to improve developmental outcomes

Assistive Hearing Technology for Deaf and Hard-of-Hearing Spoken Language Learners

Radical advancements in hearing technology in the last 30 years have offered some deaf and hard-of-hearing (DHH) children the adequate auditory access necessary to acquire spoken language with high-quality early intervention. However, meaningful achievement gaps in reading and spoken language persist despite the engineering marvel of modern hearing aids and cochlear implants. Moreover, there is enormous unexplained variability in spoken language and literacy outcomes. Aspects of signal processing in both hearing aids and cochlear implants are discussed as they relate to spoken language outcomes in preschool and school-age children. In suggesting areas for future research, a case is made for not only expanding the search for mechanisms of influence on outcomes outside of traditional device- and child-related factors, but also for framing the search within Biopsychosocial systems theories. This theoretical approach incorporates systems of risk factors across many levels, as well as the bidirectional and complex ways in which factors influence each other. The combination of sophisticated hearing technology and a fuller understanding of the complex environmental and biological factors that shape development will help maximize spoken language outcomes in DHH children and contribute to laying the groundwork for successful literacy and academic development

Differential At-Risk Pediatric Outcomes of Parental Sensitivity Based on Hearing Status

Purpose: The aim of this study was to investigate the role of parental sensitivity in language and neurocognitive outcomes in children who are deaf and/or hard of hearing (DHH). Method: Sixty-two parent–child dyads of children with normal hearing (NH) and 64 of children who are DHH (3–8 years) completed parent and child measures of inhibitory control/executive functioning and child measures of sentence comprehension and vocabulary. The dyads also participated in a video-recorded, free-play interaction that was coded for parental sensitivity. Results: There was no evidence of associations between parental sensitivity and inhibitory control or receptive language in children with NH. In contrast, parental sensitivity was related to children's inhibitory control and all language measures in children who are DHH. Moreover, inhibitory control significantly mediated the association between parental sensitivity and child language on the Clinical Evaluation of Language Fundamentals–Fifth Edition Following Directions subscale (6–8 years)/Clinical Evaluation of Language Fundamentals Preschool–Second Edition Concepts and Following Directions subscale (3–5 years). Follow-up analyses comparing subgroups of children who used hearing aids (n = 29) or cochlear implants (CIs; n = 35) revealed similar correlational trends, with the exception that parental sensitivity showed little relation to inhibitory control in the group of CI users. Conclusions: Parental sensitivity is associated with at-risk language outcomes and disturbances in inhibitory control in young children who are DHH. Compared to children with NH, children who are DHH may be more sensitive to parental behaviors and their effects on emerging inhibitory control and spoken language. Specifically, inhibitory control, when scaffolded by positive parental behaviors, may be critically important for robust language development in children who are DHH