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Parental Language Input to Children With Hearing Loss: Does It Matter in the End?

American Speech-Language-Hearing Association
Journal of Speech, Language, and Hearing Research
Authors:
Susan Nittrouer at University of Florida
Susan Nittrouer
Joanna H Lowenstein at University of Florida
Joanna H Lowenstein
Joseph Antonelli at University of Florida
Joseph Antonelli
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Abstract

Purpose Parental language input (PLI) has reliably been found to influence child language development for children at risk of language delay, but previous work has generally restricted observations to the preschool years. The current study examined whether PLI during the early years explains variability in the spoken language abilities of children with hearing loss at those young ages, as well as later in childhood. Participants One hundred children participated: 34 with normal hearing, 24 with moderate losses who used hearing aids (HAs), and 42 with severe-to-profound losses who used cochlear implants (CIs). Mean socioeconomic status was middle class for all groups. Children with CIs generally received them early. Method Samples of parent–child interactions were analyzed to characterize PLI during the preschool years. Child language abilities (CLAs) were assessed at 48 months and 10 years of age. Results No differences were observed across groups in how parents interacted with their children. Nonetheless, strong differences across groups were observed in the effects of PLI on CLAs at 48 months of age: Children with normal hearing were largely resilient to their parents' language styles. Children with HAs were most influenced by the amount of PLI. Children with CIs were most influenced by PLI that evoked child language and modeled more complex versions. When potential influences of preschool PLI on CLAs at 10 years of age were examined, those effects at preschool were replicated. When mediation analyses were performed, however, it was found that the influences of preschool PLI on CLAs at 10 years of age were partially mediated by CLAs at preschool. Conclusion PLI is critical to the long-term spoken language abilities of children with hearing loss, but the style of input that is most effective varies depending on the severity of risk for delay.
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JSLHR
Research Article
Parental Language Input to Children
With Hearing Loss: Does It Matter
in the End?
Susan Nittrouer,
a
Joanna H. Lowenstein,
a
and Joseph Antonelli
b
Purpose: Parental language input (PLI) has reliably been
found to influence child language development for children
at risk of language delay, but previous work has generally
restricted observations to the preschool years. The current
study examined whether PLI during the early years explains
variability in the spoken language abilities of children with
hearing loss at those young ages, as well as later in childhood.
Participants: One hundred children participated: 34 with
normal hearing, 24 with moderate losses who used hearing
aids (HAs), and 42 with severe-to-profound losses who
used cochlear implants (CIs). Mean socioeconomic status
was middle class for all groups. Children with CIs generally
received them early.
Method: Samples of parent–child interactions were analyzed
to characterize PLI during the preschool years. Child language
abilities (CLAs) were assessed at 48 months and 10 years
of age.
Results: No differences were observed across groups in how
parents interacted with their children. Nonetheless, strong
differences across groups were observed in the effects of PLI
on CLAs at 48 months of age: Children with normal hearing
were largely resilient to their parents’language styles.
Children with HAs were most influenced by the amount of
PLI. Children with CIs were most influenced by PLI that evoked
child language and modeled more complex versions. When
potential influences of preschool PLI on CLAs at 10 years of
age were examined, those effects at preschool were replicated.
When mediation analyses were performed, however, it was
found that the influences of preschool PLI on CLAs at 10 years
of age were partially mediated by CLAs at preschool.
Conclusion: PLI is critical to the long-term spoken language
abilities of children with hearing loss, but the style of input
that is most effective varies depending on the severity of
risk for delay.
Language acquisition is one of the most spectacular
achievements of childhood. Mastery of the skills
that permit a child to understand others when they
talk, produce language oneself, read, and write facilitates
the child’s success in social relationships, academic pursuits,
and, ultimately, career endeavors. Although most children
proceed through the language-learning process seemingly
without effort, a sizeable number of factors must all fall into
place at just the right times for this feat to be accomplished.
These factors are both genetic and epigenetic in nature.
Regarding the genetic bases of language, several genes have
been identified as critical to the development of language
(Hamdan et al., 2010; Onnis, Truzzi, & Ma, 2018), with
the most well known of these being the FOXP2 gene (Lai,
Fisher, Hurst, Vargha-Khadem, & Monaco, 2001; Nudel
& Newbury, 2013; Xu et al., 2018).
However, having the proper genes is just the first step.
In order for language to develop optimally, certain epigenetic
factors must also come into play at specific times in the
course of development. At the most basic level, that means
the child must simply have the opportunity to hear the
ambient language. In fact, language exposure begins to in-
fluence later language learning long before the child utters
her first words. For example, DeCasper and Fifer (1980)
observed that newborn infants attend longer to the speech
of their mothers than to that of other women, suggesting
that infants become familiar with their mothers’voices while
in utero. This awareness is thought to play a role in lan-
guage learning, by heightening the infant’s attention to her
mother’s speech, the very first teacher. De Boysson-Bardies,
Sagart, Halle, and Durand (1986) found that the long-term
average spectra of vocalizations from 10-month-old infants
resembled those of adults in their language communities,
suggesting that these infants had already focused their attention
a
Department of Speech, Language, and Hearing Sciences, University
of Florida, Gainesville
b
Department of Statistics, University of Florida, Gainesville
Correspondence to Susan Nittrouer: snittrouer@ufl.edu
Editor-in-Chief: Sean M. Redmond
Editor: Emily Lund
Received May 7, 2019
Revision received August 9, 2019
Accepted September 24, 2019
https://doi.org/10.1044/2019_JSLHR-19-00123
Disclosure: The authors have declared that no competing interests existed at the
time of publication.
Journal of Speech, Language, and Hearing Research •Vol. 63 •234–258 •January 2020 •Copyright © 2019 American Speech-Language-Hearing Association234
... Quantity of CDS Exposure • High quantity of speech in direct child-caregiver interactions, as opposed to overheard speech, is associated with higher gains in language development in children with normal hearing (Hoff & Naigles 2002;Rowe 2012;Weisleder & Fernald 2013). For children with hearing loss, these associations are attested as well (Nittrouer et al. 2020;Yoshinaga-Itano et al. 2020). For example, caregiver language-input to children with hearing loss during preschool years predicts these children's language outcomes even at around 10 years of age (Nittrouer et al. 2020). ...
... For children with hearing loss, these associations are attested as well (Nittrouer et al. 2020;Yoshinaga-Itano et al. 2020). For example, caregiver language-input to children with hearing loss during preschool years predicts these children's language outcomes even at around 10 years of age (Nittrouer et al. 2020). These findings are the more important, given that within the first year(s) after technical intervention, children with hearing loss seem to be exposed to a highly variable amount of caregiver speech. ...
... Current recommendations for family-centered at-home interventions for children with hearing loss encourage caregivers to create a language-rich environment for their children and adopting a responsive style of communication JCIH 2019;WHO 2021). The communicative strategies so far mainly target speech quantity and lexico-structural enrichment of caregiver speech, such as the use of high-level facilitative language techniques during interactions from around 2 years onward (Nittrouer et al. 2020;Curtin et al. 2021). With decreasing age of diagnosis, however, at-home intervention strategies need to be adapted for younger children. ...
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... However, these factors account for approximately 50% of the variability in spoken language outcomes among DHH children, leaving a significant amount of variability unexplained (Geers et al., 2003;Miyamoto et al., 1994). Additional variability has been partially explained by demographic factors, the linguistic environment in the child's home, and family characteristics (e.g., Geers et al., 2003Geers et al., , 2011Hart & Risley, 1995;Holt et al., 2012Holt et al., , 2013Holt et al., , 2022Nittrouer et al., 2020). Identifying the remaining underlying factors contributing to this variability is of great importance to researchers, clinicians, and families alike and is likely to have important implications for intervention practices for DHH children. ...
... Indeed, recent research has reported that linguistic input may have a greater impact on the language abilities of DHH children than TH children, suggesting that TH children's language development tends to be robust and more resilient to differences in their linguistic environments (Nittrouer et al., 2020). For example, DHH children tend to have better language outcomes when their parents talk more to them compared to when they talk less (DesJardin & Eisenberg, 2007). ...
... Although all children benefit from this family influence on language development, such a positive effect may be especially valuable for DHH children, who are at risk for delayed language development and are in need of compensatory linguistic experiences to improve their language outcomes. Indeed, in previous research, language development of DHH children is reported to be more sensitive to various family factors (e.g., parental language input, organization, environmental confusion), suggesting that language outcomes of TH children are more resilient to differences in family environment than DHH children (Bowdrie et al., 2022;Holt et al., , 2022Nittrouer et al., 2020). Language development in DHH children may be less resilient to differences in family environment in part because of a reduced auditory access compared to their TH peers, despite appropriate use of HAs or CIs (Geers et al., 2003(Geers et al., , 2011Niparko et al., 2010;Nittrouer et al., 2020;Stiles et al., 2012;Tomblin et al., 2015). ...
Longitudinal Influence of Family Environment on Language Outcomes of Deaf and Hard of Hearing Children
Article
Full-text available
Purpose Many child-, hearing-, and device-related factors contribute to spoken language outcomes in children who are deaf and hard of hearing (DHH). Recently, the family environment has been implicated as another contributing factor in language development. However, most studies on the role of families in language outcomes of children who are DHH are cross-sectional in nature and fail to draw directional conclusions. This study investigated the bidirectional relationship between attributes of the family environment and the spoken language outcomes of DHH children by examining data collected over approximately 1 year. Method Caregiver–child dyads composed of 57 typically hearing (TH) children and 53 DHH children and their primary caregiver completed a standardized, self-report family environment assessment, along with three standardized measures of receptive language at two separate home visits, separated by approximately 1 year. Results Family environments of DHH and TH children did not differ significantly. In the DHH and TH groups, families that reported placing a greater emphasis on intellectual and cultural pursuits at the initial visit (T1) had children with better language outcomes at the second visit (T2), above and beyond the contribution of T1 language. Additionally, in the DHH group only, families that reported a greater emphasis on achievement and competition at T1 had children with poorer language skills at T2. Conclusions Families that emphasize intellectual–cultural environments had DHH and TH children with better language skills 1 year later, whereas those that deemphasized competition and perfection had DHH children with better language skills 1 year later. These findings highlight the importance of family environment and dynamics in contributing to language development in all children, but particularly DHH children, who are at a heightened risk for language delays.
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... Quantity of CDS Exposure • High quantity of speech in direct child-caregiver interactions, as opposed to overheard speech, is associated with higher gains in language development in children with normal hearing (Hoff & Naigles 2002;Rowe 2012;Weisleder & Fernald 2013). For children with hearing loss, these associations are attested as well (Nittrouer et al. 2020;Yoshinaga-Itano et al. 2020). For example, caregiver language-input to children with hearing loss during preschool years predicts these children's language outcomes even at around 10 years of age (Nittrouer et al. 2020). ...
... For children with hearing loss, these associations are attested as well (Nittrouer et al. 2020;Yoshinaga-Itano et al. 2020). For example, caregiver language-input to children with hearing loss during preschool years predicts these children's language outcomes even at around 10 years of age (Nittrouer et al. 2020). These findings are the more important, given that within the first year(s) after technical intervention, children with hearing loss seem to be exposed to a highly variable amount of caregiver speech. ...
... Current recommendations for family-centered at-home interventions for children with hearing loss encourage caregivers to create a language-rich environment for their children and adopting a responsive style of communication JCIH 2019;WHO 2021). The communicative strategies so far mainly target speech quantity and lexico-structural enrichment of caregiver speech, such as the use of high-level facilitative language techniques during interactions from around 2 years onward (Nittrouer et al. 2020;Curtin et al. 2021). With decreasing age of diagnosis, however, at-home intervention strategies need to be adapted for younger children. ...
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  • Dec 2024
  • Ear Hear
Language outcomes of children with hearing loss remain heterogeneous despite recent advances in treatment and intervention. Consonants with high frequency, in particular, continue to pose challenges to affected children’s speech perception and production. In this review, the authors evaluate findings of how enriched child-directed speech and song might function as a form of early family-centered intervention to remedy the effects of hearing loss on consonant acquisition already during infancy. First, they review the developmental trajectory of consonant acquisition and how it is impeded by permanent pediatric hearing loss. Second, they assess how phonetic-prosodic and lexico-structural features of caregiver speech and song could facilitate acquisition of consonants in the high-frequency range. Last, recommendations for clinical routines and further research are expressed.
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... Some works have examined the importance of the quantity and quality of early language received by children with hearing loss in their family surroundings and the influence of this linguistic input on the development of language (Lee et al., 2022;Nittrouer et al., 2019). In this context, another language intervention commonly employed is parent-child interaction therapy, a behavioral intervention that focuses on enhancing parent-child interactions and promoting indirect language stimulation (Costa et al., 2019). ...
... The meta-analysis analyses yielded positive results for all of these, with a high effect size for the programs that included caregivers in their interventions. These results corroborate other findings (Lee et al., 2022;Nittrouer et al., 2019), which support the importance of developing educational programs for parents in early interventions for young children with prosthetic adaptations. As suggested by Šantić and Bonetti (2023) and Boons, Brokx, Dhooge, et al. (2012), this training should be geared toward generous stimulation of spoken language and education for family members by teams of experts. ...
The Effectiveness of Linguistic Intervention in Children With Hearing Loss: A Systematic Review and Meta-Analysis
Article
Full-text available
Purpose Vocabulary, grammar, and discourse skills represent distinct dimensions of language ability in young children. Research suggests that individuals with hearing loss often have difficulties with language skills as compared to their hearing counterparts. The aim of this systematic review and meta-analysis is to analyze the effectiveness of linguistic interventions aimed at improving oral discourse in children with hearing loss. Method A systematic review was conducted according to the PRISMA 2020 statement in five databases. A total of 23 studies were included in the systematic review. From this sample unit, 12 studies were included in the meta-analysis since they had sufficient data for analysis from a meta-analytic approach. Two meta-analyses were performed, one for each dimension of oral discourse skills, differentiating between macrostructure and microstructure and calculating the effects of the intervention and potential moderating variables. Results The results suggest positive effects of the interventions with effect sizes of d = 1.01 (95% confidence interval [CI; 0.58, 1.45], p < .001) for macrostructure and d = 0.87 (95% CI [0.02, 0.60], p < .001) for microstructure. Moderator variable analyses showed that the number of participants was the only significant factor identified for the microstructure dimension. Conclusions Linguistic intervention programs improve the language of children with hearing loss. Most of these interventions include therapies that use visual supports and grammar instruction. However, these results should be interpreted with caution given the small number of studies and their high heterogeneity.
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... 41 Although parental language input and child-directed language have been shown to have a positive influence on speech development, how SES exactly plays into this dynamic remains unclear. [53][54][55] Based on the findings of this study, racial disparities may additionally impact access to health hearing services regardless of insurance status. Examining the cumulative impact of race and insurance type in access to pediatric HL management is particularly relevant, as identifying disparities can help close structural and systemic gaps in health care provision. ...
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