Coaching Caregivers of Children who are Deaf or Hard of Hearing.

This study explored the impact of a caregiver training intervention on caregivers' use of individually selected facilitative language techniques (FLTs) with their children (ranging from 14 to 27 months of age) who were deaf or hard of hearing. In addition, the study sought to identify real-time relationships between caregiver input and child output. Finally, the Language ENvironment Analysis (LENA) system was used to assess generalization of intervention gains to the natural environment. Intervention was delivered via a telehealth approach to train four caregivers to utilize a targeted FLT with their child. Pre-baseline LENA recordings guided selection of treatment targets, and post-intervention LENA recordings were used to assess generalization to the natural environment. All caregivers demonstrated increases in use of their targeted FLT in structured intervention sessions and maintained them 2-6 weeks after the conclusion of intervention. All children demonstrated an increase in their developmentally appropriate vocalizations in tandem with caregiver FLT increases. Results indicate that coaching can be used to increase caregiver responsiveness, changes which were found to carry over into the home environment.

A clinical demonstration of the application of audiovisual biofeedback in the treatment of puberphonia.

PURPOSE: The objective of this study was to demonstrate the effect of vocal audiovisual biofeedback in the treatment of puberphonia. METHOD: This is a report of a single subject research study encompassing intervention and observation of results, involving three phases: baseline, treatment, and follow-up. Therefore, this study applied an A-B case study experimental design with follow-up for observation of treatment outcomes. Self-reported complementary data regarding feelings of voice usage included comparisons between pre and post intervention scores of the Voice Handicap Index (VHI) survey. RESULTS: In this study, acoustic voice parameters measured revealed changes in vocal performance in the desired direction, as demonstrated by visual inspection and estimation of effect size of the data; changes were maintained during the follow-up phase. Examination of VHI results suggested post intervention improvement in functional and psychosocial aspects related to voice use. CONCLUSIONS: Based on the results of this study, audiovisual feedback approaches are effective in the treatment of puberphonia. Results will apply to future considerations in the application of technology support for treatment of puberphonia and other voice related disorders.

The relationship of audibility and the development of canonical babbling in young children with hearing impairment.

This article investigated the relationship between age at onset of canonical babbling and audibility of amplified speech in children with hearing impairment. Thirteen children with severe-profound hearing impairment and two children with normal hearing participated in a longitudinal investigation of vocalization development. A nonconcurrent multiple baseline design was used to analyze vocalization recordings obtained during two phases (hearing aid [HA] and cochlear implant [CI]). Audibility during HA and CI use was calculated using the Speech Intelligibility Index (SII). Earlier ages of canonical babble onset were related to greater audibility of the speech signal during HA use. Children who developed canonical babble had an SII of .35 or greater. SII was a statistically significant predictor of age of onset of canonical babble. Results support the concept of an "essential" level of audibility for onset of canonical babble. Findings are discussed relative to their methodological and clinical implications regarding treatment decision making.

Evaluation of a pre-treatment assessment to select mand topographies for functional communication training.

Recent research has suggested that variables related to specific mand topographies targeted during functional communication training (FCT) can affect treatment outcomes. These include effort, novelty of mands, previous relationships with problem behavior, and preference. However, there is little extant research on procedures for identifying which mand topographies to incorporate into FCT. In the current study, a mand topography assessment was conducted following functional analyses to identify the proficiency with which individuals used several different mand topographies. Two mand topographies (high and low proficiency) were then compared during FCT-based treatments. FCT was more effective when the mand topography identified as high proficiency was incorporated into FCT as compared to FCT that included the lower proficiency response. The results are discussed in terms of the need for individualized assessment procedures for selecting mand topographies that are targeted during FCT.

Babbling complexity and its relationship to speech and language outcomes in children with cochlear implants.

OBJECTIVE: To investigate if babbling complexity in early childhood is related to speech and language outcomes in later childhood in children with cochlear implants (CIs). STUDY DESIGN: Retrospective. SETTING: Tertiary care hospital. PATIENTS: Nineteen infants with CIs participated. INTERVENTION: Infants received multichannel CIs. MAIN OUTCOME MEASURES: Infant vocal recordings were taken during pre- and post-CI visits up to 13 months post-CI. Vocalizations were measured using a scoring system that takes into account the phonetic complexity of infant vocalizations. Outcome variables included articulation and language measures collected at 4 years of age. Data were analyzed using correlational and regression analyses. RESULTS: : For infants with at least 6 to 9 months of CI experience, the phonetic complexity of babbling is significantly correlated with receptive vocabulary, articulation abilities, and global language skills at 4 years of age. CONCLUSION: The phonetic complexity of prelinguistic vocalizations is related to later speech and language outcomes in children with CIs. This information may be valuable in terms of tracking progress in pediatric CI users.

An Evolution of Communication Modalities: Very Young Cochlear Implant Users who Transitioned from Sign to Speech During the First Years of Use.

The communication modalities used, and the articulation and aural-only receptive vocabulary skills were investigated in 19 prelingually profoundly deaf infants who initially utilized Total Communication and who were implanted between the ages of 12 and 29m. Results revealed the children overwhelmingly tended to use voice only modality for an expressive task. Additionally articulation and receptive vocabulary skills approached those of normal hearing peers. Implications of these findings and suggestions for future studies are provided.

Tympanometry in newborn infants--1 kHz norms.

With the rapid implementation of universal newborn hearing screening (UNHS) programs, a test of middle-ear function for infants is urgently needed. Recent evidence suggests that 1 kHz tympanometry may be effective. Normative data are presented for newborn intensive care unit (NICU) graduates tested at a mean age of 3.9 weeks (Study 1) and full-term infants tested at 2-4 weeks (Study 2) who passed an otoacoustic emissions (OAE) screen. Nearly all infants tested had single-peaked tympanograms. The norms are evaluated for a group of full-term infants who were screened with OAE (Study 3) and two groups of infants (NICU patients and well babies) who were not screened by OAE (Study 4). The 5th percentile for static admittance for NICU and full-term babies was identical, allowing a sinngle pass-fail criterion. Using that criterion, well babies who passed an OAE screen (Study 3) yielded a 91% pass rate. Those who passed the OAE screen had substantially higher 1 kHz static admittance than those who failed, suggesting a strong relationship between middle-ear transmission characteristics and OAE responses. The pass rate was lower for newborn well babies and NICU graduates who were not screened by OAE (Study 4).

Role of infant vocal development in candidacy for and efficacy of cochlear implantation.

Previous research has documented the importance of audition in the development of typical infant vocalization. Of particular interest is the development of canonical babbling, which is related to mastery of the timing elements of speech. Children with severe to profound hearing loss who use hearing aids have demonstrated both delayed and deviant canonical babbling. The vocal development of 12 children has been followed as they have been considered for cochlear implantation. Nine of these children have undergone implantation, and 5 of these children have been followed for more than 1 year after implantation. On average, canonical babbling emerged at 6.5 months after implantation. The time frame in which some children developed words was accelerated in terms of length of auditory experience as compared with normal-hearing peers. Mature oral-motor development is likely the primary contributing factor in this time course. One child who received a cochlear implant began to babble with hearing aids. It is not known whether normal canonical babbling is sufficient evidence on which to base candidacy decisions; however, our data suggest that children who produce canonical babbling maintain and build upon those skills after implantation.