Sophie E. Ambrose

Language Outcomes in Young Children with Mild to Severe Hearing Loss

Objectives: This study examined the language outcomes of children with mild to severe hearing loss during the preschool years. The longitudinal design was leveraged to test whether language growth trajectories were associated with degree of hearing loss and whether aided hearing influenced language growth in a systematic manner. The study also explored the influence of the timing of hearing aid fitting and extent of use on children’s language growth. Finally, the study tested the hypothesis that morphosyntax may be at particular risk due to the demands it places on the processing of fine details in the linguistic input. Design: The full cohort of children in this study comprised 290 children who were hard of hearing (CHH) and 112 children with normal hearing who participated in the Outcomes of Children with Hearing Loss (OCHL) study between the ages of 2 and 6 years. CHH had a mean better-ear pure-tone average of 47.66 dB HL (SD = 13.35). All children received a comprehensive battery of language measures at annual intervals, including standardized tests, parent-report measures, and spontaneous and elicited language samples. Principal components analysis supported the use of a single composite language score for each of the age levels (2, 3, 4, 5, and 6 years). Measures of unaided (better-ear pure-tone average, speech intelligibility index) and aided (residualized speech intelligibility index) hearing were collected, along with parent-report measures of daily hearing aid use time. Mixed modeling procedures were applied to examine the rate of change (227 CHH; 94 children with normal hearing) in language ability over time in relation to (1) degree of hearing loss, (2) aided hearing, (3) age of hearing aid fit and duration of use, and (4) daily hearing aid use. Principal components analysis was also employed to examine factor loadings from spontaneous language samples and to test their correspondence with standardized measures. Multiple regression analysis was used to test for differential effects of hearing loss on morphosyntax and lexical development. Results: Children with mild to severe hearing loss, on average, showed depressed language levels compared with peers with normal hearing who were matched on age and socioeconomic status. The degree to which CHH fell behind increased with greater severity of hearing loss. The amount of improved audibility with hearing aids was associated with differential rates of language growth; better audibility was associated with faster rates of language growth in the preschool years. Children fit early with hearing aids had better early language achievement than children fit later. However, children who were fit after 18 months of age improved in their language abilities as a function of the duration of hearing aid use. These results suggest that the language learning system remains open to experience provided by improved access to linguistic input. Performance in the domain of morphosyntax was found to be more delayed in CHH than their semantic abilities. Conclusion: The data obtained in this study largely support the predictions, suggesting that mild to severe hearing loss places children at risk for delays in language development. Risks are moderated by the provision of early and consistent access to well-fit hearing aids that provide optimized audibility.

The Influence of Hearing Aids on the Speech and Language Development of Children With Hearing Loss

IMPORTANCE Hearing loss (HL) in children can be deleterious to their speech and language development. The standard of practice has been early provision of hearing aids (HAs) to moderate these effects; however, there have been few empirical studies evaluating the effectiveness of this practice on speech and language development among children with mild-to-severe HL. OBJECTIVE To investigate the contributions of aided hearing and duration of HA use to speech and language outcomes in children with mild-to-severe HL. DESIGN, SETTING, AND PARTICIPANTS An observational cross-sectional design was used to examine the association of aided hearing levels and length of HA use with levels of speech and language outcomes. One hundred eighty 3- and 5-year-old children with HL were recruited through records of Universal Newborn Hearing Screening and referrals from clinical service providers in the general community in 6 US states. INTERVENTIONS All but 4 children had been fitted with HAs, and measures of aided hearing and the duration of HA use were obtained. MAIN OUTCOMES AND MEASURES Standardized measures of speech and language ability were obtained. RESULTS Measures of the gain in hearing ability for speech provided by the HA were significantly correlated with levels of speech (ρ179 = 0.20; P = .008) and language: ρ155 = 0.21; P = .01) ability. These correlations were indicative of modest levels of association between aided hearing and speech and language outcomes. These benefits were found for children with mild and moderate-to-severe HL. In addition, the amount of benefit from aided hearing interacted with the duration of HA experience (Speech: F4,161 = 4.98; P < .001; Language: F4,138 = 2.91; P < .02). Longer duration of HA experience was most beneficial for children who had the best aided hearing. CONCLUSIONS AND RELEVANCE The degree of improved hearing provided by HAs was associated with better speech and language development in children. In addition, the duration of HA experience interacted with the aided hearing to influence outcomes. These results provide support for the provision of well-fitted HAs to children with HL. In particular, the findings support early HA fitting and HA provision to children with mild HL.

Linguistic input, electronic media, and communication outcomes of toddlers with hearing loss.

Objectives: The objectives of this study were to examine the quantity of adult words, adult–child conversational turns, and electronic media in the auditory environments of toddlers who are hard of hearing (HH) and to examine whether these factors contributed to variability in children’s communication outcomes. Design: Participants were 28 children with mild to severe hearing loss. Full-day recordings of children’s auditory environments were collected within 6 months of their second birthdays by using Language ENvironment Analysis technology. The system analyzes full-day acoustic recordings, yielding estimates of the quantity of adult words, conversational turns, and electronic media exposure in the recordings. Children’s communication outcomes were assessed via the receptive and expressive scales of the Mullen Scales of Early Learning at 2 years of age and the Comprehensive Assessment of Spoken Language at 3 years of age. Results: On average, the HH toddlers were exposed to approximately 1400 adult words per hour and participated in approximately 60 conversational turns per hour. An average of 8% of each recording was classified as electronic media. However, there was considerable within-group variability on all three measures. Frequency of conversational turns, but not adult words, was positively associated with children’s communication outcomes at 2 and 3 years of age. Amount of electronic media exposure was negatively associated with 2-year-old receptive language abilities; however, regression results indicate that the relationship was fully mediated by the quantity of conversational turns. Conclusions: HH toddlers who were engaged in more conversational turns demonstrated stronger linguistic outcomes than HH toddlers who were engaged in fewer conversational turns. The frequency of these interactions was found to be decreased in households with high rates of electronic media exposure. Optimal language-learning environments for HH toddlers include frequent linguistic interactions between parents and children. To support this goal, parents should be encouraged to reduce their children’s exposure to electronic media.

Quantity and Quality of Caregivers' Linguistic Input to 18-Month and 3-Year-Old Children Who Are Hard of Hearing.

Objectives: The primary objective of this study was to examine the quantity and quality of caregiver talk directed to children who are hard of hearing (CHH) compared with children with normal hearing (CNH). For the CHH only, the study explored how caregiver input changed as a function of child age (18 months versus 3 years), which child and family factors contributed to variance in caregiver linguistic input at 18 months and 3 years, and how caregiver talk at 18 months related to child language outcomes at 3 years. Design: Participants were 59 CNH and 156 children with bilateral, mild-to-severe hearing loss. When children were approximately 18 months and/or 3 years of age, caregivers and children participated in a 5-min semistructured, conversational interaction. Interactions were transcribed and coded for two features of caregiver input representing quantity (number of total utterances and number of total words) and four features representing quality (number of different words, mean length of utterance in morphemes, proportion of utterances that were high level, and proportion of utterances that were directing). In addition, at the 18-month visit, parents completed a standardized questionnaire regarding their child’s communication development. At the 3-year visit, a clinician administered a standardized language measure. Results: At the 18-month visit, the CHH were exposed to a greater proportion of directing utterances than the CNH. At the 3-year visit, there were significant differences between the CNH and CHH for number of total words and all four of the quality variables, with the CHH being exposed to fewer words and lower quality input. Caregivers generally provided higher quality input to CHH at the 3-year visit compared with the 18-month visit. At the 18-month visit, quantity variables, but not quality variables, were related to several child and family factors. At the 3-year visit, the variable most strongly related to caregiver input was child language. Longitudinal analyses indicated that quality, but not quantity, of caregiver linguistic input at 18 months was related to child language abilities at 3 years, with directing utterances accounting for significant unique variance in child language outcomes. Conclusions: Although caregivers of CHH increased their use of quality features of linguistic input over time, the differences when compared with CNH suggest that some caregivers may need additional support to provide their children with optimal language learning environments. This is particularly important given the relationships that were identified between quality features of caregivers’ linguistic input and children’s language abilities. Family supports should include a focus on developing a style that is conversational eliciting as opposed to directive.

Automated Vocal Analysis of Children With Hearing Loss and Their Typical and Atypical Peers.

Objectives: This study investigated automatic assessment of vocal development in children with hearing loss compared with children who are typically developing, have language delays, and have autism spectrum disorder. Statistical models are examined for performance in a classification model and to predict age within the four groups of children. Design: The vocal analysis system analyzed 1913 whole-day, naturalistic acoustic recordings from 273 toddlers and preschoolers comprising children who were typically developing, hard of hearing, language delayed, or autistic. Results: Samples from children who were hard of hearing patterned more similarly to those of typically developing children than to the language delayed or autistic samples. The statistical models were able to classify children from the four groups examined and estimate developmental age based on automated vocal analysis. Conclusions: This work shows a broad similarity between children with hearing loss and typically developing children, although children with hearing loss show some delay in their production of speech. Automatic acoustic analysis can now be used to quantitatively compare vocal development in children with and without speech-related disorders. The work may serve to better distinguish among various developmental disorders and ultimately contribute to improved intervention.

Speech sound production in 2-year-olds who are hard of hearing

PURPOSE The purpose of the study was to (a) compare the speech sound production abilities of 2-year-old children who are hard of hearing (HH) to children with normal hearing (NH), (b) identify sources of risk for individual children who are HH, and (c) determine whether speech sound production skills at age 2 were predictive of speech sound production skills at age 3. METHOD Seventy children with bilateral, mild-to-severe hearing loss who use hearing aids and 37 age- and socioeconomic status-matched children with NH participated. Childrens speech sound production abilities were assessed at 2 and 3 years of age. RESULTS At age 2, the HH group demonstrated vowel production abilities on par with their NH peers but weaker consonant production abilities. Within the HH group, better outcomes were associated with hearing aid fittings by 6 months of age, hearing loss of less than 45 dB HL, stronger vocabulary scores, and being female. Positive relationships existed between childrens speech sound production abilities at 2 and 3 years of age. CONCLUSION Assessment of early speech sound production abilities in combination with demographic, audiologic, and linguistic variables may be useful in identifying HH children who are at risk for delays in speech sound production.

Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions

Purpose This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL). Method Ages at and delays between service delivery steps (first diagnostic evaluation, confirmation of HL, hearing aid [HA] fitting, entry into early intervention) were investigated for 113 children with mild HL. Comparisons were made to children with moderate-to-severe HL. Parents of children with mild HL reported reasons for delays and their perceptions of intervention and amplification for their children. Results Seventy-four percent of children with mild HL were identified through the newborn hearing screen; 26% were identified later due to passing or not receiving a newborn hearing screen. Ninety-four percent of children with mild HL were fit with HAs, albeit at significantly later ages than children with moderate-to-severe HL. Most parents indicated that their children benefited from HA use, but some parents expressed ambivalence toward the amount of benefit. Conclusions Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

Assessing Vocal Development in Infants and Toddlers Who Are Hard of Hearing: A Parent-Report Tool

The main purpose of the current investigation was to determine whether the Vocal Development Landmarks Interview-Experimental Version (VDLI-E) was sensitive to variation in the vocal development of infants and toddlers who are hard of hearing. The VDLI-E is an interactive parent interview that uses audio samples of authentic infant vocalizations to make targeted vocal behaviors clear and understandable to parents without the need for technical terms, verbal descriptions, or adult modeling of infant productions. The VDLI-E was found to be sensitive to age and hearing and was related to performance on concurrent measures of early auditory skills, expressive vocabulary, and overall expressive language abilities. These findings provide preliminary support for the utility of this measure in monitoring the impact of early auditory experiences on vocal development for 6- to 18-month-old children who are hard of hearing.

Spoken and Written Communication Development Following Pediatric Cochlear Implantation

To appreciate fully the significance of language development for deaf children who receive a cochlear implant, one must understand the intricacies involved with language development for those with normal hearing. Language refers to the unique human capacity of using a rule-bound system of sounds, words, and symbols to communicate within a like-speaking community. Whereas language may be expressed in a manual form (e.g., American Sign Language (ASL)), for children with normal hearing, language more commonly is expressed in a spoken or written form. Language can be considered relative to two main aspects, reception and expression. Receptive language refers to an individual’s ability to understand what others say to him or her. Expressive language refers to an individual’s ability to use words, sentences, and conversation to express one’s needs, thoughts, and wishes to others. Barring impeding factors, children with normal hearing develop spoken language seamlessly. The first section of this chapter will provide a general description of the processes involved in normal speech and spoken language development. Literacy skill development will also be discussed as an extension of language.