Assessment of Receptive and Expressive Language Skills Among Young Children With Prelingual Single-Sided Deafness Managed With Early Cochlear Implantation.

Importance: Pediatric single-sided deafness (SSD) can seriously affect development, causing impaired spatial hearing skills, speech-language delays, and academic underachievement. Early cochlear implantation likely improves hearing-related outcomes, but its association with language development remains unclear. Objective: To investigate whether early cochlear implantation is associated with language outcomes for children with prelingual SSD. Design, Setting, and Participants: The Cochlear Implant for Children and One Deaf Ear study was initiated in 2015 and recruited participants at 4 academic hospitals in Flanders, Belgium, through 2019. This cohort study included 3 groups of children aged 2 to 5 years: children with SSD and a cochlear implant, children with SSD without a cochlear implant, and a control group with normal hearing. Language and hearing skills were assessed 1 to 2 times per year until the age of 10 years. Study completion rates were high (82%). Data analysis was performed from October to December 2020. Exposure: Unilateral cochlear implant. Main Outcomes and Measures: Longitudinal vocabulary, grammar, and receptive language scores. The implanted group was hypothesized to outperform the nonimplanted group on all language tests. Results: During the recruitment period, 47 children with prelingual SSD without additional disabilities were identified at the participating hospitals. Fifteen of the 34 children with an intact auditory nerve received a cochlear implant (44%, convenience sample). Sixteen of the remaining children were enrolled in the SSD control group (50%). Data from 61 children (mean [SD] age at the time of enrollment, 2.08 [1.34] years; 26 girls [42%]) were included in the analysis: 15 children with SSD and a cochlear implant, 16 children with SSD without a cochlear implant, and 30 children with normal hearing. Children with SSD and a cochlear implant performed in line with their peers with normal hearing with regard to grammar. In contrast, children with SSD without a cochlear implant had worse grammar scores than the group with implants (-0.76; 95% CI, -0.31 to -1.21; P = .004) and the group with normal hearing (-0.53; 95% CI, -0.91 to -0.15; P = .02). The 3 groups had similar vocabulary and receptive language abilities. Conclusions and Relevance: These findings suggest that early cochlear implantation is associated with normal grammar development in young children with prelingual SSD. Although further follow-up will reveal the long-term outcomes of the cochlear implant for other skills, the current results will help clinicians and policy makers identify the best treatment option for these children.

Forum: Serving African American English Speakers in Schools Through Interprofessional Education & Practice.

Purpose African American English (AAE) speakers often face mismatches between home language and school language, coupled with negative attitudes toward AAE in the classroom. This forum, Serving African American English Speakers in Schools Through Interprofessional Education & Practice, will help researchers, parents, and school-based practitioners communicate in ways that are synergistic, collaborative, and transparent to improve educational outcomes of AAE speakers. Method The forum includes a tutorial offering readers instructions on how to engage in community-based participatory research (Holt, 2021). Through two clinical focus articles, readers will recognize how AAE develops during the preschool years and is expressed across various linguistic contexts and elicitation tasks (Newkirk-Turner & Green, 2021) and identify markers of developmental language disorder within AAE from language samples analyzed in Computerized Language Analysis (Overton et al., 2021). Seven empirical articles employ such designs as quantitative (Byrd & Brown, 2021; Diehm & Hendricks, 2021; Hendricks & Jimenez, 2021; Maher et al., 2021; Mahurin-Smith et al., 2021), qualitative (Hamilton & DeThorne, 2021), and mixed methods (Mills et al., 2021). These articles will help readers identify ways in which AAE affects how teachers view its speakers' language skills and communicative practices and relates to its speakers' literacy outcomes. Conclusion The goal of the forum is to make a lasting contribution to the discipline with a concentrated focus on how to assess and address communicative variation in the U.S. classroom.

An Integrative Review of Current Practice Models and/or Process of Family-Centered Early Intervention for Children Who Are Deaf or Hard of Hearing.

Over the past few decades, there has been an increasing shift toward emphasizing the importance of the child's family taking an active role in the habilitation process through family-centered early intervention (FCEI) programs. Accordingly, the Health Professions Council of South Africa recommends that early intervention services following confirmation of hearing loss must be family-centered within a community-based model of service delivery that is culturally congruent. The aim of this study was to explore and document current evidence reflecting trends in FCEI for children who are deaf or hard of hearing (DHH) by identifying and describing current practice models and/or processes of FCEI for these children. This study describes our first steps in formulating a framework for FCEI for children who are DHH in South Africa. An integrative literature review was conducted. Sage, Science Direct, PubMed, and Google Scholar databases were searched for studies published in English between January 2009 and January 2019 reporting on FCEI programs for children who are DHH. Studies that focused on the following were excluded from the study: speech and language outcomes of children, youth, and adults who are DHH; education for children who are DHH; universal newborn hearing screening; professionals' roles in early hearing detection and intervention; diagnosis of hearing loss; and sign language. Kappa statistics were performed to determine agreement between reviewers. Twenty-two studies were included in the review. Cohen's kappa revealed a substantial agreement (κ = 0.8) between reviewers for data extraction and synthesis in terms of the articles that met the criteria for inclusion in the review. Findings were discussed under 5 themes: caregiver involvement; caregiver coaching/information sharing; caregiver satisfaction; challenges with FCEI; and telehealth. Generally, there is sufficient evidence for FCEI, with caregivers indicating the need for full involvement in their children's care. Methods of caregiver involvement involving caregiver coaching/information sharing need to be culturally and linguistically appropriate, with sensitivities around time and manner. This increases caregiver satisfaction with intervention programs and improves outcomes for children who are DHH. Challenges identified by the studies raise implications for early hearing detection and intervention programs, as well as Departments of Health and Social Welfare. These included logistical challenges, professional-related challenges, and caregiver-related challenges. Various aspects of FCEI have been reported in the review. Findings of these studies have significant implications for the formulation of quality FCEI programs to ensure contextually relevant and contextually responsive care of children who are DHH.

Atuação fonoaudiológica em projeto social: estudo preliminar / Speech-language hearing performance in social project: preliminary study / Actuación fonoaudiológica en proyecto social: estudio preliminar

Introdução: Pesquisas vêm demonstrando a importância dos primeiros anos de vida no desenvolvimento do cérebro. Quando a criança não apresenta o desenvolvimento de linguagem esperado, poderá ter prejuízo em aquisições. Desta forma, a identificação precoce de alterações evita consequências educacionais e sociais desfavoráveis. Objetivo: propor projeto de intervenção fonoaudiológica em instituição de acolhimento de crianças; levantar dados acerca da linguagem das crianças antes e depois da intervenção fonoaudiológica; possibilitar a superação de alterações da linguagem. Métodos: Observação das crianças, em sala de atividades coletivas, por meio do formulário de observação. Em seguida, foram selecionadas crianças com risco para alteração de linguagem e estas foram submetidas a avaliação por meio da Avaliação do Desenvolvimento da Linguagem (ADL) e Avaliação Fonológica da Criança (AFC). As crianças foram estimuladas durante 12 encontros semanais, em grupos, e depois foram reavaliadas. Os dados foram tabulados e analisados comparando-se as avaliações antes e depois da estimulação e relatando-se os dados obtidos pelos questionários respondidos pelas cuidadoras. Resultados: As quatro crianças - 3 meninos e 1 menina - que participaram do estudo tiveram melhora nas avaliações da linguagem após o período de estimulação, 3 modificaram o grau de gravidade do distúrbio de linguagem, e uma superou as alterações de linguagem - "desenvolvimento normal da linguagem" - após a reavaliação. Conclusão: Os relatos das cuidadoras e resultados das reavaliações demonstraram que as intervenções surtiram efeitos positivos e foram relevantes para as crianças, caracterizando uma boa proposta de intervenção coletiva fonoaudiológica.

Introduction: Research has shown the importance of early life in brain development. When the child does not have the expected language development, may have impairment in acquisitions. Thus, early identification of changes avoids unfavorable educational and social consequences. Objective: to propose a speech-language intervention project in a childcare institution; collect data about children's language before and after speech therapy intervention; enable overcoming language changes. Methods: Observation of children, in the collective activity room, through the observation form. Then, children at risk for language impairment were selected and were submitted to assessment through the Language Development Assessment (ADL) and the Child Phonological Assessment (CFA). The children were stimulated during 12 weekly group meetings and then reevaluated. Data were tabulated and analyzed by comparing the evaluations before and after stimulation and reporting the data obtained from the questionnaires answered by the caregivers. Results: The four children - 3 boys and 1 girl - who participated in the study had improved language assessments after the stimulation period, 3 modified the severity of the language disorder, and one outperformed the language disorders - "normal development of language "- after reevaluation. Conclusion: The caregivers' reports and reassessment results showed that the interventions had positive effects and were relevant for the children, characterizing a good proposal for collective speech therapy intervention.

Introducción: la investigación ha demostrado la importancia de la vida temprana en el desarrollo del cerebro. Cuando el niño no tiene el desarrollo del lenguaje esperado, puede tener un impedimento en las adquisiciones. Por lo tanto, la identificación temprana de los cambios evita consecuencias educativas y sociales desfavorables. Objetivo: proponer un proyecto de intervención de habla y lenguaje en una institución de cuidado infantil; recopilar datos sobre el lenguaje de los niños antes y después de la intervención de terapia del habla; permitir la superación de los cambios de idioma. Métodos: Observación de niños, en la sala de actividades colectivas, a través del formulario de observación. Luego, se seleccionaron los niños con riesgo de discapacidad del lenguaje y se los sometió a evaluación a través de la Evaluación del desarrollo del lenguaje (ADL) y la Evaluación fonológica del niño (AFC). Los niños fueron estimulados durante 12 reuniones grupales semanales y luego reevaluados. Los datos se tabularon y analizaron comparando las evaluaciones antes y después de la estimulación e informando los datos obtenidos de los cuestionarios respondidos por los cuidadores. Resultados: Los cuatro niños (3 niños y 1 niña) que participaron en el estudio mejoraron las evaluaciones del lenguaje después del período de estimulación, 3 modificaron la gravedad del trastorno del lenguaje y uno superó los trastornos del lenguaje: "desarrollo normal de lenguaje "- después de la reevaluación. Conclusión: Los informes de los cuidadores y los resultados de la reevaluación mostraron que las intervenciones tuvieron efectos positivos y fueron relevantes para los niños, caracterizando una buena propuesta para la intervención colectiva de terapia del habla.

Levers for Language Growth: Characteristics and Predictors of Language Trajectories between 4 and 7 Years.

BACKGROUND: Evidence is required as to when and where to focus resources to achieve the greatest gains for children's language development. Key to these decisions is the understanding of individual differences in children's language trajectories and the predictors of those differences. To determine optimal timing we must understand if and when children's relative language abilities become fixed. To determine where to focus effort we must identify mutable factors, that is those with the potential to be changed through interventions, which are associated with significant differences in children's language scores and rate of progress. METHODS: Uniquely this study examined individual differences in language growth trajectories in a population sample of children between 4 and 7 years using the multilevel model for change. The influence of predictors, grouped with respect to their mutability and their proximity to the child (least-mutable, mutable-distal, mutable-proximal), were estimated. RESULTS: A significant degree of variability in rate of progress between 4 and 7 years was evident, much of which was systematically associated with mutable-proximal factors, that is, those factors with evidence that they are modifiable through interventions with the child or family, such as shared book reading, TV viewing and number of books in the home. Mutable-distal factors, such as family income, family literacy and neighbourhood disadvantage, hypothesised to be modifiable through social policy, were important predictors of language abilities at 4 years. CONCLUSIONS: Potential levers for language interventions lie in the child's home learning environment from birth to age 4. However, the role of a family's material and cultural capital must not be ignored, nor should the potential for growth into the school years. Early Years services should acknowledge the effects of multiple, cascading and cumulative risks and seek to promote child language development through the aggregation of marginal gains in the pre-school years and beyond.

[Evaluation of current assessment tools in early detection of developmental deviations in speech and language in the German preventive paediatric examination (Kindervorsorgeuntersuchung U8)]. / Analyse aktueller Untersuchungsinstrumente zur Früherkennung von Auffälligkeiten in Sprechen und Sprache in der pädiatrischen Vorsorgeuntersuchung U8.

OBJECTIVE: The current analysis is a contribution to application information and quality assurance. It is intended to evaluate and optimise the use of German developmental screening instruments to identify deficits in speech, speech fluency and language during the early paediatric toddler check-up Kindervorsorgeuntersuchung U8 in the age of 43-50 months. METHODS: A systematic literature search was conducted seeking current specific, standardised, norm-referenced assessment tools, particularly those relevant to the early detection of developmental speech and language retardation. They were subsequently evaluated quantitatively and qualitatively with specific regard to 15 psychometric criteria and construction features. RESULTS: 4 assessment tools (ETS 4-8; KiSS; SSV; TSVK-Screen) resulted from literature search. They were subjected to a detailed and rigorous comparative analysis. Quantitatively they met 7-12 of the 15 psychometric criteria whose quality was partly low or demonstrated survey standard to a lesser degree. CONCLUSION: These developmental screening instruments utilised in the paediatric toddler check-up U8 cannot be recommended without reservation with regard to a dichotomous decision (suspected disorder versus no suspected disorder). More qualificatory research focusing specifically on the existing screenings and the construction of new screening tools is required in order to gain vital developmental psychological information of the speech/language status of a child during the preventive paediatric examination U8. Alternatively, it should be evaded to the approach of taking diagnostic language developmental tests.

Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI).

UNLABELLED: Levels of evidence differ according to the audience addressed. Implementation of universal newborn hearing screening requires responses to a complex myriad of diverse groups: the general public, families with children who are deaf or hard of hearing, the deaf and hard of hearing communities, hospital administrators, physicians (pediatricians, general practitioners, ear nose and throat physicians, geneticists), managed care, Medicaid, insurance agencies, and politicians. The level of evidence required by medical/health agencies and task forces may differ from the levels of evidence available in education and intervention. Issues related to the low incidence of the disability, the lack of a normal distribution within the disability study, the obstacles to random assignment to treatment, and designs that include a control group with "no treatment" have implications legally and ethically for the professional providing services to families and children who are deaf or hard of hearing. This session will discuss issues related to "convenience samples," number of subjects included in research studies, and the population required to obtain a large enough sample of children with low-incidence disabilities. The level of evidence required to demonstrate sensitive periods of development, which are a critical element for justification of implementing a universal newborn hearing screening includes both behavioral and neurological information. Sensitive periods may have different duration for different aspects of development, such as social-emotional development, auditory and speech development, or language development. Further complicating the question of sensitive periods of development are the distinct possibility that different sensitive periods exist for development of age-level vocabulary, for establishing English phonology, or for mastering English syntax. Research outcomes provide evidence that age of identification of hearing loss is reduced, that age of intervention initiation is lowered, and that the outcomes of intervention are better because of the establishment of a screening program. Most professionals in communication disorders believe that screening is not the actual cause of better developmental outcomes but that the age when children begin to have access to language and communication and the characteristics of the intervention are the primary cause of better outcomes. Screening is the avenue through which access to quality intervention is made available. The research still remains at an infant level of development such that there is very little evidence for the efficacy of specific characteristics of the intervention provided. LEARNING OUTCOMES: (1) The learner will be able to identify the obstacles in conducting research on the effectiveness of intervention of children identified through universal newborn hearing screening programs. (2) The learner will be able to identify the type of research on developmental outcomes of children with early-identified hearing loss.

Early intervention critical to autism treatment.

It is still not universally accepted within the scientific community that the habilitation of autistic children is possible, or that their ability to function without supports in regular education by third, fourth, or fifth grade happens as a direct result of EIBI. However, using the outcome studies that have been reported, the rate of children reaching a best-outcome status appears to be between about 10% and 47%. There is a more global way to look at the effects of EIBI or behavioral intervention. Even if the child retains many characteristics of autism, the usual outcome of treatment is that the child learns useful skills. Behavioral intervention results in effective and efficient learning, which is precisely what it aims to accomplish and what behavioral techniques have been developed to do. Children and families have been able to achieve much more than many would ever have believed before EIBI became a realistic possibility.

[Health profile of children cared for in nurseries and the prevention of communication disorders]. / Caracterização da saúde de crianças atendidas em creches e prevenção dos distúrbios de comunicação.

For the purpose of characterizing the health of the population assisted by the Nursery Program (Programa Creche) at the three units financed by the city authorities of S. Paulo, Brazil, an enquiry was undertaken. A questionnaire consisting of both open and closed question concerning personal identification, personal antecedents, development and health was prepared and 133 of them were applied. Results indicated that children whose living conditions were unsatisfactory (humid and overcrowded housing) have presented respiratory infections and otitis in greater numbers. Most of the children were breast-fed at first but started being nursed artificially when two months old. Salty and varied texture foods were introduced at the appropriate ages and well accepted. Language delay is related predominantly to ages 3 to 7. Parents act properly lin communication situations. It is considered that the systematic use of the questionnaire proposed will permit not only better knowledge of the health of the children, benefitting the multidisciplinary attendance and integration of the child, as also the improvement of preventive practices and make the surveillance of difficulties in communication possible.

Identifying speech and language delay.

Publication of the Hall report has prompted many health authorities to cut back on the range of routine child health screening programmes. In some areas health visitors are playing a less central role in child health surveillance. James Law and Carrie Pollard argue the need for routine screening of all children for speech and language delay, and that health visitors--with more adequate specialist training--should carry out these checks. Problems may persist for many years if not tackled in the pre-school years, they warn.

Caracterizaçäo da saúde de crianças atendidas em creches e prevençäo dos distúrbios de comunicaçäo / Health profile of children cared for in nurseries and the prevention of communication disturbs

Com o objetivo de caracterizar a saúde da populaçäo atendida pelo Programa Creche, desenvolvido em três unidades conveniadas com a Prefeitura do Município de Säo Paulo (Brasil), foi feito um inquérito junto a essa populaçäo. Foram aplicados 133 questionários com perguntas abertas e fechadas relativas à identificaçäo e antecedentes pessoais, desenvolvimento e saúde. Os resultados mostraram que as crianças residentes em moradias desfavoráveis, com umidade e grande número de pessoas na casa apresentaram maior número de infecçöes respiratórias e de otite. A maioria das crianças foi aleitada naturalmente, passando para amamentaçäo artificial com dois meses. Os alimentos salgados e de texturas variadas foram introduzidos na idade adequada e bem aceitos. Atraso de linguagem é referido predominantemente dos 3 aos 7 anos. Os pais atuam adequadamente em situaçöes de comunicaçäo. Concluiu-se que a aplicaçäo sistemática do questionário proposto permitirá näo somente obter maior conhecimento das condiçöes de saúde das crianças, favorecendo o atendimento multidisciplinar e integrado da criança, como otimizar condutas preventivas e possibilitar a realizaçäo de vigilância de distúrbios da comunicaçäo