Deaf/hard of hearing students' experiences with higher education's real-time captioning services.

Real-time captions appear to be an effective tool in assisting deaf and hard of hearing (DHH) college students' access information and communication in certain classroom settings. However, there is limited knowledge of DHH students' direct experiences with real-time captioning services. In this study, we gathered narratives from 15 DHH college students across the United States about their experiences with real-time captioning services in college. We analyzed the stories using thematic narrative analysis and uncovered 4 types that students told about their experiences. The story types were (a) stories of overcoming obstacles, (b) stories of resignation, (c) pragmatic stories, and (d) stories of personal connection. These story types reveal that although many students eventually experience effective communication access through real-time captioning services, they can initially struggle to overcome barriers to using the services successfully. Making time and space to listen to DHH students' narratives can teach educators and professionals how to support these students and resolve barriers before they arise.

Exploring the Stories of Parents' Experiences With Infant Hearing-Loss Screening and Diagnosis in the United States.

OBJECTIVES: For the past 20 years, birthing hospitals in the United States have required newborns to undergo a hearing-loss screening before leaving the hospital. Since the initial newborn hearing screening mandates, there has been much outcome research documenting the successes and barriers of the programs. However, we know little about the experiences of their parents during the time between screening and diagnosis. We propose that elucidating the parents' experiences with newborn hearing-loss screening and diagnosis-via their own stories-is a first step toward understanding their varied experiences and has the potential to ultimately improve hearing healthcare for both children and their families. Thus, to better understand the early hearing screening and detection experience from hearing parents' perspectives, we asked the following research question: what are parents' experiences with their newborns' hearing-loss screening and diagnosis in the United States? DESIGN: The present study employed a prospective, cross-sectional qualitative design. Specifically, we gathered stories from 13 hearing parents who each have a child born in the United States and diagnosed with hearing loss no later than 14 mo of age between the years of 2016 and 2020. We used thematic analysis to uncover common themes across parent narratives. Saturation was reached at interview no. 4; thus no further sampling was needed. FINDINGS: Two major themes emerged from the data: (1) hearing healthcare experiences and (2) parents' early experiences during the period between their child's newborn hearing-loss screening and diagnosis. Subthemes were also uncovered. Three emergent subthemes related to health-care experiences included: (1) downplayed newborn hearing screening referrals, (2) clinician-centered care, and (3) medical expenses and health coverage. The three subthemes of the second theme were as follows: (1) parent-to-parent support, (2) "mom guilt," and (3) a new reality. CONCLUSION: The present study's narrative accounts from parents about their infants' early hearing detection experiences revealed several, different subthemes that emerged from the same, mandated newborn experience in US families. These findings highlight important moments throughout the hearing-loss screening and detection process, which could benefit from more effective, family-centered hearing healthcare. This knowledge also facilitates the field's move toward improved education of future and current providers and regarding family-centered approach, which could address concerns and expectations of new parents at the very start of their newborns' hearing-loss journeys.

The Effect of Talker Familiarity on Sentence Recognition Accuracy in Complex Noise.

The familiar talker advantage is the finding that a listener's ability to perceive and understand a talker is facilitated when the listener is familiar with the talker. However, it is unclear when the benefits of familiarity emerge and whether they strengthen over time. To better understand the time course of the familiar talker advantage, we assessed the effects of long-term, implicit voice learning on 89 young adults' sentence recognition accuracy in the presence of four-talker babble. A university professor served as the target talker in the experiment. Half the participants were students of the professor and familiar with her voice. The professor was a stranger to the remaining participants. We manipulated the listeners' degree of familiarity with the professor over the course of a semester. We used mixed effects modeling to test for the effects of the two independent variables: talker and hours of exposure. Analyses revealed a familiar talker advantage in the listeners after 16 weeks (∼32 h) of exposure to the target voice. These results imply that talker familiarity (outside of the confines of a long-term, familial relationship) seems to be a much quicker-to-emerge, reliable cue for bootstrapping spoken language perception than previous literature suggested.

Exploring the Types of Stories Hearing Parents Tell About Rearing their Children Who Use Cochlear Implants.

OBJECTIVES: The majority of children born in the United States with hearing loss (HL) are born to parents with hearing. Many of these parents ultimately choose cochlear implantation for their children. There are now decades of research showing which these children's speech, language, listening, and education seem to benefit from cochlear implantation. To date, however, we know little about the experiences of the parents who guided these children throughout their journeys. We propose that elucidating the types of stories these parents tell is a first step toward understanding their varied experiences and has the potential to ultimately improve healthcare outcomes for both children and their families. Thus, to better understand parents' experience, we asked the following research question: what types of stories do parents with hearing tell about rearing their children with HL who use cochlear implants? DESIGN: In this prospective qualitative study, we used a narrative approach. Specifically, we conducted narrative interviews with 20 hearing parents who are rearing young children (mean age = 5.4 years) born with HL who use cochlear implants. We then used thematic narrative analysis to identify recurring themes throughout the narratives that coalesced into the types of stories parents told about their experiences. FINDINGS: Thematic narrative analysis revealed five story types: (1) stories of personal growth, (2) proactive stories, (3) stories of strain and inundation, (4) detached stories, and (5) stories of persistence. CONCLUSIONS: In the present study, different types of stories emerged from parents' experiences that share common events-a family's baby is identified at birth with unexpected permanent HL, the family chooses to pursue cochlear implantation for their child, and then the family raises said pediatric cochlear implant user into adulthood. Despite these similarities, the stories also varied in their sensemaking. Some parents told stories in which a positive life narrative turned bad, whereas others told stories in which a narrative of surviving turned into one of thriving. These findings specifically contribute to the field of hearing healthcare by providing professionals with insight into parents' sensemaking via the types of stories they shared centered on their perceptions and experiences following their child's diagnosis of HL and their decision to pursue cochlear implantation.

"I Have to Social Norm This": Making Meaning of Hearing Loss from the Perspective of Adults Who Use Hearing Aids.

Framed by relational dialectics theory, the present study takes a critical approach to interrogating the social structures that promote and resist hearing loss and hearing aid-related stigma. Specifically, this study explores the ways the meaning of hearing loss is constructed in 30 narrative interviews with adults who use hearing aids. Contrapuntal analysis revealed that two discourses compete to illuminate meanings of hearing loss. Four interrelated themes that emphasize (a) expectations of zero hearing and for disability, (b) assumptions of cognitive deficit, (c) mistaken rudeness and resulting isolation, and (d) conflation with old age constitute the Discourse of Hearing Loss as a Personal Short-coming (DHLPS). Three interrelated themes that emphasize (a) collective responsibility, (b) a part of (my) life, and (c) (re)education constitute the Discourse of Hearing Loss as a Relational Reality (DHLRR) and resist the DHLPS. The competition of these discourses, in the form of diachronic separation, synchronic interplay, and an aesthetic moment coalesce to make meaning of hearing loss and hold implications for both theory and practice.

Using attribution theory to explore the reasons adults with hearing loss do not use their hearing aids.

Hearing aids are an effective treatment for individuals with hearing loss that have been shown to dampen (and sometime ameliorate) the negative effects of hearing loss. Despite the devices' efficacy, many reject hearing aids as a form of treatment. In the present qualitative study, we explored the reasons for hearing aid non-use in the United States that emerged from the stories of adults with hearing loss who do not to utilize hearing aids. We specifically used thematic analysis in concert with an attribution theory framework to identify and analyze recurring themes and reasons throughout these individuals' narratives. A total of nine themes describing reasons of hearing aid non-use emerged. Four reasons were internally motivated: (1) non-necessity, (2) stigmatization, (3) lack of integration into daily living, and (4) unreadiness due to lack of education; five reasons were externally motivated: (5) discomfort, (6) financial setback, (7) burden, (8) professional distrust, and (9) priority setting. These findings contribute to the field of hearing healthcare by providing professionals with insight into reasons that people across the provided when recounting their experiences following the diagnosis of hearing loss, prescription for hearing aids, and their hearing aid non-use. These findings are an important step toward the development of more effective, person-centered hearing healthcare that can best address these individuals' concerns and expectations surrounding hearing loss and hearing aids.

Narratives of identity: understanding the experiences of adults with hearing loss who use hearing aids.

Objective: We aimed to determine the identities that adults with hearing loss construct when telling stories about their experiences with hearing loss and hearing aids. Determining and understanding these identities is important because research shows that who a person believes themselves to be has implications for how they approach their healthcare, along with their emotional and physical wellbeing.Design: We employed a qualitative narrative approach. We then used thematic narrative analysis to identify emergent identities across stories gathered from hearing aid users. These themes allowed us to assign emergent identities to the hearing-aid users.Study Sample: Thirty adults with hearing loss who reported using their hearing aids during all waking hours.Results: Five identities emerged from the hearing-aid users' narratives: (1) the satisfied user, (2) the overcomer, (3) the dispassionate user, (4) the frustrated and resigned user, and (5) the griever.Conclusion: These findings are a first step to improving theoretical and clinical insights into the perspectives and experiences of satisfied hearing-aid users following diagnosis of their hearing loss and their hearing aid fittings. Such insights could ultimately improve hearing healthcare providers' abilities to employ person-centered care while helping adults with hearing loss seek out, implement, and adhere to treatment.

The Role of Talker Familiarity in Auditory Distraction.

The current research employed a classic irrelevant sound effect paradigm and investigated the talker-specific content of the irrelevant speech. Specifically, we aimed to determine if the participants' familiarity with the irrelevant speech's talker affected the magnitude of the irrelevant sound effect. Experiment 1 was an exploration of talker familiarity established in a natural listening environment (i.e., a university classroom) in which we manipulated the participants' relationships with the talker. In Experiment 2, we manipulated the participants' familiarity with the talker via 4 days of controlled exposure to the target talker's audio recordings. For both Experiments 1 and 2, a robust effect of irrelevant speech was found; however, regardless of the talker manipulation, talker familiarity did not influence the size of the effect. We interpreted the results within the processing view of the auditory distraction effect and highlighted the notion that talker familiarity may be more vulnerable than once thought.

Exploring the Identities of Hearing Parents who Chose Cochlear Implantation for their Children with Hearing Loss.

We aimed to determine the types of identities hearing parents construct when telling online stories about their children with hearing loss (HL) who use cochlear implants (CIs). To do so, we employed a qualitative design and sampled 20 different blogs United States origins and written by parents of children who use CIs. We then used thematic narrative analysis (Braun & Clarke, 2006; Riessman, C. K. (2008). Narrative methods for the human sciences. Thousand Oaks, CA: Sage Publications.) to uncover recurring themes from these parents' blogs. The themes then allowed us to assign identities to the parents. Four identities emerged in the parents' stories: (1) advocates, (2) resilient parents, (3) obedient worriers, and (4) matter-of-fact narrators. Identifying and understanding these parent identities is a first step toward improving theoretical and clinical insights into parents' perspectives and experiences following their children's diagnosis of HL. Such insights could ultimately improve audiologists' abilities to help families seek out, implement, and follow-through with family-centered hearing healthcare.

Using Rasch Analysis to Examine the Item-Level Psychometrics of the Infant-Toddler Meaningful Auditory Integration Scales.

The Infant-Toddler Meaningful Auditory Integration Scales (IT-MAIS; Zimmerman-Phillips et al. 2001) is a popular assessment designed to measure listening skills in children with hearing loss aged 0-3 years. For this study we analyzed the item-level psychometric properties of the IT-MAIS via Rasch analysis to gain further understanding about its validity and reliability. We chose to analyze the psychometric properties of the IT-MAIS because very little information exists regarding its development and validation, although it is widely used to assess listening skills in children with SNHL ages 0 to 3 years pre- and post-CI. Our results indicated that the IT-MAIS items demonstrated less than ideal psychometric properties and the IT-MAIS item order did not reflect the order in which children are expected to develop functional listening skills. Our findings suggest that there is a pressing need for further discussion among researchers and clinicians about 1) how the IT-MAIS is used, and 2) what other valid and reliable outcome measures could be used alongside, or in place of, the IT-MAIS to determine CI candidacy, establish treatment goals, or track progress in listening development in very young children with hearing loss.

How we do it: employment of listening-development criteria during assessment of infants who use cochlear implants.

There are currently no formal, standardized procedures for assessing speech processing and perception during infancy. This lack of tools makes interpretation of infant data challenging. This article describes how our clinical research center established listening-development criteria for infants with cochlear implants. The listening-development criteria incorporate programming, audiometric, and parent-report measures to estimate adequate audibility of the speech signal prior to the infants' inclusion in research protocols. This paper operationally defines the listening-development criteria, discusses its importance, and presents data from 10 infants who met the listening criteria on average after 6 months of device use.

Developmental constraints on language development in children with cochlear implants.

Research on pediatric cochlear implantation has frequently shown that speech perception, speech production, and language outcomes are better for children who are implanted earlier in life than later. These findings are often explained on the grounds that earlier implantation takes advantage of a critical or sensitive period. This paper reviews the literature concerning sensitive periods within the framework of speech and language development. It particularly emphasizes two alternate mechanisms proposed for these periods: an experience-independent mechanism, and an experience-dependent mechanism. Based on this literature review we proposed that research in the field of pediatric cochlear implantation needs to carefully define what kind of evidence is needed to reflect a sensitive period for speech and language learning. The field also needs to consider designing studies that allow the viability of these two mechanisms to be tested. An example of such a study is provided within.

The effect of age at cochlear implant initial stimulation on expressive language growth in infants and toddlers.

This study examined the growth of expressive language skills in children who received cochlear implants (CIs) in infancy. Repeated language measures were gathered from 29 children who received CIs between 10 and 40 months of age. Both cross-sectional and growth curve analyses were used to assess the relationship between expressive language outcomes and CI experience. A beneficial effect of earlier implantation on expressive language growth was found. Growth curve analysis showed that growth was more rapid in children implanted as infants than those implanted as toddlers. Age at initial stimulation accounted for 14.6% of the variance of the individual differences in expressive language growth rates.

Listen to your mother! The role of talker familiarity in infant streaming.

Little is known about the acoustic cues infants might use to selectively attend to one talker in the presence of background noise. This study examined the role of talker familiarity as a possible cue. Infants either heard their own mothers (maternal-voice condition) or a different infant's mother (novel-voice condition) repeating isolated words while a female distracter voice spoke fluently in the background. Subsequently, infants heard passages produced by the target voice containing either the familiarized, target words or novel words. Infants in the maternal-voice condition listened significantly longer to the passages containing familiar words; infants in the novel-voice condition showed no preference. These results suggest that infants are able to separate the simultaneous speech of two women when one of the voices is highly familiar to them. However, infants seem to find separating the simultaneous speech of two unfamiliar women extremely difficult.

Bimodal speech perception in infant hearing aid and cochlear implant users.

OBJECTIVES: To determine the feasibility of replicating prior bimodal perception findings with hearing-impaired infants during their preimplant, hearing aid trial, and postimplant experiences; secondarily, to determine the point in development at which these infants were able to match phonetic information in the lips and voice for the vowels /a/ and /i/. METHODS: A total of 10 infants with hearing loss, aged 4 to 24 months, were assessed at least once prior to cochlear implantation and previous to implant stimulation. The Split-Screen Preferential Looking Procedure was used to evaluate the bimodal perception skills of these infants. RESULTS: Examples of individual bimodal perception data and preliminary group data are presented. A difference in performance across preimplant and postimplant test sessions was noted for the individuals and the group. CONCLUSION: These data provide evidence that the infants' audibility levels were improved by their cochlear implants, which may have contributed to their evolving ability to match phonetic information in the lips and voice.

Exploring the language and literacy outcomes of pediatric cochlear implant users.

OBJECTIVE: The principal goal of this study was to investigate the relationship between language and literacy (i.e., reading and writing) skills in pediatric cochlear implant users. A peripheral objective was to identify the children's skills that were in need of remediation and subsequently to provide suggestions for remedial programming. It was predicted that the robust language skills often associated with children who have cochlear implant experience would facilitate the development of literacy skills. It was further proposed that the language and literacy skills of pediatric cochlear implant users would approximate the language and literacy skills of children with normal hearing. DESIGN: Sixteen pediatric cochlear implant users' language and literacy skills were evaluated and then compared with a reference group of 16 age-matched, normal-hearing children. All 32 participants were educated in mainstream classes within the public school system in the Midwest. The "Sentence Formulation" and "Concepts and Directions" subtests of the Clinical Evaluation of Language Fundamentals-3 test were used to evaluate receptive and expressive language skills. Reading comprehension was evaluated with the "Paragraph Comprehension" subtest of the Woodcock Reading Mastery Test. Performance measures for the writing analyses included productivity, complexity and grammaticality measures. RESULTS: Children with cochlear implants performed within 1 SD of the normal-hearing, age-matched children on measures of language comprehension, reading comprehension and writing accuracy. However, the children with cochlear implants performed significantly poorer than the children with normal hearing on the expressive "Sentence Formulation" subtest. The cochlear implant users also produced fewer words on the written narrative task than did the normal-hearing children, although there was not a significant difference between groups with respect to total words per clause. Furthermore there was a strong correlation between language performance and reading performance, as well as language performance and total words produced on the written performance measure for the children using cochlear implants. CONCLUSIONS: The results of this study suggest that the language skills of pediatric cochlear implant users are related to and correlated with the development of literacy skills within these children. Consequently, the performance of the cochlear implant users, on various language and literacy measures, compared favorably to an age-matched group of children with normal hearing. There were significant differences in the ability of the cochlear implant users to correctly utilize grammatical structures such as conjunctions and correct verb forms when they were required to formulate written and oral sentences. Given this information, it would be appropriate for their educational or remedial language programs to emphasize the use and development of these structures.