Olof Sandgren

‘You sometimes get more than you ask for’: responses in referential communication between children and adolescents with cochlear implant and hearing peers

BACKGROUND This study investigates responses to requests for clarification in conversations between children/adolescents with cochlear implant (CI) and normally hearing peers. Earlier studies have interpreted a more frequent use of requests of confirmation (yes/no interrogatives) in the CI group as a conversational strategy used to prevent communication breakdowns and control the development of the conversation. This study provides a continuation of this line of research, now focusing on responses to requests for clarification. AIMS The aim was to examine the type and distribution of responses to requests for clarification in a referential communication task. In addition, we analysed the compliance between the type of response and the type of request as a measure of mutual adaptation. METHODS & PROCEDURES Twenty-six conversational pairs aged 10-19 years participated: 13 pairs consisting of a child/adolescent with CI (CI) and a conversational partner (CIP); and 13 pairs consisting of a normally hearing control (NH) and a conversational partner (NHP). The pairs performed a referential communication task requiring the description of faces. All occurrences of requests for clarification and their responses in the dialogues were identified and categorized. We also analysed how the different types of requests and responses were combined and the type-conformity of the responses to requests for confirmation. OUTCOMES & RESULTS The results showed no significant group differences regarding type, distribution or type-conformity of responses. In all four groups (CI, CIP, NH and NHP), a discrepancy between the request and the response was found, indicating that the response provided information that was not explicitly requested. Requests for confirmation constituted 78-90% of the requests, whereas only 54-61% of responses were confirmations. Conversely, the proportion of requests for elaboration was 6-15%, whereas the proportion of elaborated responses was 34-40%. CONCLUSIONS & IMPLICATIONS The children/adolescents with CI contribute equally to the conversation regarding type and distribution of responses to requests for clarification. The frequent use of elaborated responses indicates common ground for the conversational partners and a shared understanding of the objective of the task. The context creates facilitative conditions, with positive interactional consequences. The results have implications for the design of intervention, where tasks such as this can be used to make children with CI more aware of the role of questioning strategies in interaction.

Coordination of Gaze and Speech in Communication Between Children With Hearing Impairment and Normal-Hearing Peers

PURPOSE To investigate gaze behavior during communication between children with hearing impairment (HI) and normal-hearing (NH) peers. METHOD Ten HI-NH and 10 NH-NH dyads performed a referential communication task requiring description of faces. During task performance, eye movements and speech were tracked. Using verbal event (questions, statements, back channeling, and silence) as the predictor variable, group characteristics in gaze behavior were expressed with Kaplan-Meier survival functions (estimating time to gaze-to-partner) and odds ratios (comparing number of verbal events with and without gaze-to-partner). Analyses compared the listeners in each dyad (HI: n = 10, mean age = 12;6 years, mean better ear pure-tone average = 33.0 dB HL; NH: n = 10, mean age = 13;7 years). RESULTS Log-rank tests revealed significant group differences in survival distributions for all verbal events, reflecting a higher probability of gaze to the partners face for participants with HI. Expressed as odds ratios (OR), participants with HI displayed greater odds for gaze-to-partner (ORs ranging between 1.2 and 2.1) during all verbal events. CONCLUSIONS The results show an increased probability for listeners with HI to gaze at the speakers face in association with verbal events. Several explanations for the finding are possible, and implications for further research are discussed.

Impact of cognitive and linguistic ability on gaze behavior in children with hearing impairment

In order to explore verbal–nonverbal integration, we investigated the influence of cognitive and linguistic ability on gaze behavior during spoken language conversation between children with mild-to-moderate hearing impairment (HI) and normal-hearing (NH) peers. Ten HI–NH and 10 NH-NH dyads performed a referential communication task requiring description of faces. During task performance, eye movements and speech were tracked. Cox proportional hazards regression was used to model associations between performance on cognitive and linguistic tasks and the probability of gaze to the conversational partner’s face. Analyses compare the listeners in each dyad (HI: n = 10, mean age = 12; 6 years, SD = 2; 0, mean better ear pure-tone average 33.0 dB HL, SD = 7.8; NH: n = 10, mean age = 13; 7 years, SD = 1; 11). Group differences in gaze behavior – with HI gazing more to the conversational partner than NH – remained significant despite adjustment for ability on receptive grammar, expressive vocabulary, and complex working memory. Adjustment for phonological short term memory, as measured by non-word repetition, removed group differences, revealing an interaction between group membership and non-word repetition ability. Stratified analysis showed a twofold increase of the probability of gaze-to-partner for HI with low phonological short term memory capacity, and a decreased probability for HI with high capacity, as compared to NH peers. The results revealed differences in gaze behavior attributable to performance on a phonological short term memory task. Participants with HI and low phonological short term memory capacity showed a doubled probability of gaze to the conversational partner, indicative of a visual bias. The results stress the need to look beyond the HI in diagnostics and intervention. Acknowledgment of the finding requires clinical assessment of children with HI to be supported by tasks tapping phonological processing.

Monitoring progression of clinical reasoning skills during health sciences education using the case method – a qualitative observational study

BackgroundOutcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students’ progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method.MethodsIn this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions – problem-solving process, disciplinary knowledge, character of discussion and communication – was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed.ResultsThe results revealed the students’ transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone.ConclusionsOur observations revealed progression in several aspects of students’ clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

Working memory and referential communication—multimodal aspects of interaction between children with sensorineural hearing impairment and normal hearing peers

Whereas the language development of children with sensorineural hearing impairment (SNHI) has repeatedly been shown to differ from that of peers with normal hearing (NH), few studies have used an experimental approach to investigate the consequences on everyday communicative interaction. This mini review gives an overview of a range of studies on children with SNHI and NH exploring intra- and inter-individual cognitive and linguistic systems during communication. Over the last decade, our research group has studied the conversational strategies of Swedish speaking children and adolescents with SNHI and NH using referential communication, an experimental analog to problem-solving in the classroom. We have established verbal and non-verbal control and validation mechanisms, related to working memory capacity and phonological short term memory. We present main findings and future directions relevant for the field of cognitive hearing science and for the clinical and school-based management of children and adolescents with SNHI.

Executive functions in mono- and bilingual children with language impairment – issues for speech-language pathology

The clinical assessment of language impairment (LI) in bilingual children imposes challenges for speech-language pathology services. Assessment tools standardized for monolingual populations increase the risk of misinterpreting bilingualism as LI. This Perspective article summarizes recent studies on the assessment of bilingual LI and presents new results on including non-linguistic measures of executive functions in the diagnostic assessment. Executive functions shows clinical utility as less subjected to language use and exposure than linguistic measures. A possible bilingual advantage, and consequences for speech-language pathology practices and future research are discussed.