Assessing parent-child interaction with deaf and hard of hearing infants aged 0-3 years: An international multi-professional e-Delphi.

INTRODUCTION: Most deaf babies are born to hearing families who do not yet have the skills to communicate effectively with their child. Adaptations to communication are important because the quality of parent-child interaction (PCI) predicts how a deaf child develops language. Teachers of Deaf children and Speech and Language Therapists support families with communication in the home. Currently, there are no assessments that appraise how a parent interacts with their deaf baby. Previous research has identified which parent behaviours and approaches are used in PCI assessments in research and practice. The current paper forms consensus on the core content and best practices of a new PCI tool for deaf children aged 0-3 years. METHODS: An international sample of expert academics and practitioners (n = 83) were recruited to take part in a two-round modified electronic Delphi study. Participants were presented with 69 statements focusing on (i) which parent behaviours were important in assessment (ii) the methods to be used in PCI assessment. Participants rated the extent to which they agreed or disagreed with each statement on a five-point Likert scale and gave comments to support their response. Consensus was defined as >80% of participants rating the statement as a (4) 'highly important' or a (5) 'essential'. If consensus was not reached, participant comments were used to generate new statements which were rated in the second round. This project involved a patient and public involvement (PPI) group of hearing and deaf parents and professionals to design and guide the study. RESULTS: Consensus was achieved on 52 statements and ranged from 80-99%. A further six statements were additionally included. Within the 58 statements included, 36 were parent behaviours which centred on the parent's observation of, and response to, their child's behaviour and/or language. The remaining 22 statements focused on methods used in the assessment such as parents having their PCI filmed, parents having the opportunity to review the video and assess themselves alongside a professional, and parents being involved in subsequent goal setting. CONCLUSIONS: This e-Delphi presented the parent behaviours and methods of assessment to be included in a new PCI tool for deaf children. Future co-production work and acceptability and feasibility testing are discussed.

"It doesn't matter if we're the most amazing professionals in the world " A qualitative study of professionals' perspectives on parent-child interaction assessment with deaf infants.

Introduction: Parent child interaction (PCI) is positively associated with deaf children's language development. However, there are no known, deaf-specific tools to observe how a parent interacts with their deaf child aged 0-3 years. Without a framework for professionals to use with families, it is unknown how professionals assess PCI, what they assess, why they assess, and how the assessment results relate to case management. Methods: Eighteen hearing and deaf professionals, who work with deaf and hard of hearing infants aged 0-3 years and their families, attended online focus groups. The aim of the study was to gain insight into the professional assessment of PCI. Data were analyzed using thematic analysis. Findings: Six themes were generated from the dataset. Professionals discussed how central parents were in the support offered to families in the home, the importance of knowing and understanding the individual family, and accounting for and supporting parental wellbeing. Descriptions on how to administer a best practice PCI assessment included which parent behaviors to assess and how to make adaptations for different populations. Professionals shared how the assessment and review process could be used to inform and upskill parents through video reflection and goal setting. Discussion: This study provides insight into the mechanisms and motivations for professionals assessing the interactive behaviors of parents who have deaf children aged 0-3. Professionals acknowledged that family life is multi-faceted, and that support is most meaningful to families when professionals worked with these differences and incorporated them into assessment, goal setting, and intervention plans.

Identifying Developmental Language Disorder in Deaf Children with Cochlear Implants: A Case Study of Three Children.

(1) Background: While spoken language learning delays are assumed for deaf and hard of hearing (DHH) children after cochlear implant (CI), many catch up with their hearing peers. Some DHH children with CIs, however, show persistent delays in language, despite protective factors being in place. This suggests a developmental language disorder (DLD). However, at present there is little consensus on how to diagnose DLD in DHH children. (2) Methods: Given the lack of consensus in this area, a set of case studies provides an appropriate first step. The goal of this paper is to show the plausibility of a DLD diagnosis, following careful analysis of protective and risk factors. A retrospective case study review was conducted for three children. Their long-term language outcomes up to four years after CI were considered in the context of access to sound, speech sound discrimination, social skills and non-verbal cognition. (3) Results: It was possible to posit DLD in one child who had experienced good access to sound, alongside good speech discrimination abilities and social development, and normal non-verbal cognition, but who presented with severe language learning difficulties. (4) Conclusions: Finding markers for DLD in DHH children is important for diagnosis and intervention. The implications for clinical practice are discussed.

Shared characteristics of intervention techniques for oral vocabulary and speech comprehensibility in preschool children with co-occurring features of developmental language disorder and a phonological speech sound disorder: protocol for a systematic review with narrative synthesis.

INTRODUCTION: Evidence suggests that over one-third of young children with developmental language disorder (DLD) or speech sound disorder (SSD) have co-occurring features of both. A co-occurring DLD and SSD profile is associated with negative long-term outcomes relating to communication, literacy and emotional well-being. However, the best treatment approach for young children with this profile is not understood. The aim of the proposed review is to identify intervention techniques for both DLD and SSD, along with their shared characteristics. The findings will then be analysed in the context of relevant theory. This will inform the content for a new or adapted intervention for these children. METHODS AND ANALYSIS: This search will build on a previous systematic review by Roulstone et al (2015) but with a specific focus on oral vocabulary (DLD outcome) and speech comprehensibility (SSD outcome). These outcomes were identified by parents and speech and language therapists within the prestudy stakeholder engagement work. The following databases will be searched for articles from January 2012 onwards: Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, Communication Source and ERIC. Two reviewers will independently perform the title/abstract screening and the full-text screening with the exclusion criteria document being revised in an iterative process. Articles written in languages other than English will be excluded. Data will be extracted regarding key participant and intervention criteria, including technique dosage and delivery details. This information will then be pooled into a structured narrative synthesis. ETHICS AND DISSEMINATION: Ethical approval is not needed for a systematic review protocol. Dissemination of findings will be through peer-reviewed publications, social media, and project steering group networks. PROSPERO REGISTRATION NUMBER: CRD4202237393.

Executive Function in Deaf Native Signing Children.

The aim of this study is twofold: To examine if deafness is invariably associated with deficits in executive function (EF) and to investigate the relationship between sign language proficiency and EF in deaf children of deaf parents with early exposure to a sign language. It is also the first study of EF in children acquiring Polish Sign Language. Even though the mothers of the deaf children (N = 20) had lower levels of education compared with the mothers of a hearing control group, the children performed similarly to their hearing peers (N = 20) on a variety of EF task-based assessments. Only in the Go/No-go task were weaker inhibition skills observed in younger deaf children (6-9 years) compared with hearing peers, and this difference was not seen in older children (10-12 years). Hence, deafness does not necessarily impair EF; however, attentional and inhibition abilities may be acquired via a different route in deaf children. Sign language receptive skills predicted EF in deaf children. In conclusion, we highlight the importance of deaf parenting building the scaffolding for EF in deaf children.

Assessing parent interaction with deaf infants: A quantitative survey of UK professional practice.

BACKGROUND: Between 90% and 95% of deaf children are born to hearing parents who often need support with how to adapt their communication. Parent-child interaction (PCI) is an important predictor of deaf children's future language development. It is therefore necessary for professionals to assess parents' strengths and needs to identify areas for intervention. Qualified teachers of the deaf (QToDs), speech and language therapists (SLTs), psychologists, and national deaf child and adolescent mental health (NDCAMHS) professionals regularly support families with deaf children. With no current evidence-based tool available to assist with the assessment of PCI in deafness, it is important to gather information on current professional practice as this may differ from known practices within research. AIMS: To survey the practices of UK-based professionals in the assessment of PCI where the deaf infant is aged 0-3 years. Professionals were QToDs, SLTs, psychologists or psychiatrists and professionals working at NDCAMHS services. METHODS & PROCEDURES: After a pilot phase, an 85-item survey was distributed electronically through a range of professional and social media networks. Survey items were based on a systematic review of PCI with deaf infants. Survey questions were focused on parent behaviours that were assessed, methods of assessment, goal planning and service provision. Analysis was conducted using descriptive and inferential statistics. OUTCOMES & RESULTS: A total of 190 professionals from across the UK completed part 1 of the survey; this decreased to 148 in part 4. Respondents were primarily female, hearing, used spoken English and had 16 years or more experience. Results indicate that PCI is routinely assessed by a large proportion of professionals and there is a substantial overlap in which parent behaviours are assessed. Some parent behaviours are assessed that do not feature in the research. Methods of assessment are informal and predominantly consist of observation and note making, with professionals using their own skills and experience to analyse interaction. Goal setting practices were largely similar between professionals, with many jointly deciding goals with parents. CONCLUSIONS & IMPLICATIONS: This survey highlights the range of parent behaviours assessed by UK professionals in PCI with deaf children aged 0-3. This survey provides valuable information about and for professionals who assess PCI and set intervention goals with parents. Information from research and professional practice is important to consider in the design of a future PCI assessment. Implications are included for future research in this area. WHAT THIS PAPER ADDS: What is already known on this subject Parental involvement is one of the greatest predictors of deaf children's language outcomes. With many deaf children born to hearing parents, parents often need guidance with how to facilitate effective communication. A recent systematic review identified the range of parent behaviours and methods used to analyse PCI in international research studies, but little evidence or guidance exists on how professionals assess this phenomenon in practice. What this study adds This is the first survey to generate large, valuable practice-based evidence for the assessment of parents' communication behaviours as they interact with their deaf infants aged 0-3. The survey recruited a range of multidisciplinary professionals working on interaction within this field: SLTs, qualified teachers of the deaf, psychologists or psychiatrists, and professionals working within deaf child and adolescent mental health services. The study reports on which behaviours these professionals assess and how, and includes information on the goal setting behaviours of practitioners. Most respondents were highly experienced; the survey, therefore, reveals expert practice within the field. What are the potential or actual clinical implications of this work? We recommend the following practice: (1) incorporate a range of parent-based behaviours in PCI assessments, including establishing joint engagement and parental sensitivity, as well as communication-focused behaviours; (2) video record PCI assessments where possible to enable professionals and parents to watch and reflect together; (3) following assessment, set parent-focused goals in collaboration with families, ensuring parents' skills, particularly their strengths, are considered. All primary caregivers should be included in the process where possible; and (4) reassess PCI regularly (at least termly) to monitor and encourage families' progress. The timing of reviews should be discussed between parent and professional.

Pre-linguistic social communication skills and post implant language outcomes in deaf children with cochlear implants.

PURPOSE: This study investigates the relationship between pre-linguistic social communication skills and age of cochlear implant for future language outcomes in a large sample of deaf children. METHOD: A retrospective cohort study of records from 75 children. Pre-implant data included Age at Implant, pre-linguistic communication (social, symbolic and speech) skills, and non-verbal ability. Receptive and expressive language development data at 1 year, 2 years and 4 years post implant were analysed to investigate the relationships between pre-implant factors and language outcomes, in particular pre-linguistic social communication skills in early and late implanted children. RESULTS: Age at Implant was the strongest correlate of post implant expressive and receptive language outcomes. The sample was divided into early implanted (<18 month) and late implanted (>18 months) children. In the early implanted group, pre-linguistic social communication skills were the strongest pre-implant correlate of language outcomes four years post-implant. In the late implanted group, there were no significant pre-implant correlates of language outcomes. CONCLUSIONS: Long term language outcomes after cochlear implantation are the product of a set of communicative, cognitive and environmental factors. Early pre-implant social communication skills are an important consideration for clinicians who guide parents as to likely long-term outcomes post cochlear implantation. Social communication skills are particularly important for children who receive implants before the age of 18 months.

Assessing Parent Behaviours in Parent-Child Interactions with Deaf and Hard of Hearing Infants Aged 0-3 Years: A Systematic Review.

BACKGROUND: Despite early identification and advancements in cochlear implant and hearing aid technology, delays in language skills in deaf children continue to exist. Good-quality parent-child interaction (PCI) is a key predictor for the successful development of deaf children's signed and/or spoken language. Though professionals have standard assessments to monitor child language, a clinical tool to observe the quality of parental interaction is yet to be developed. AIMS AND METHODS: This systematic review with narrative synthesis aims to uncover which parent behaviours are assessed in PCI studies with deaf infants aged 0-3 years, how these behaviours are assessed, and which are correlated with higher scores in child language. RESULTS: Sixty-one papers were included, spanning 40 years of research. Research included in the review assessed parents' skills in gaining attention, joint engagement, emotional sensitivity, and language input. PCI was mostly assessed using coding systems and frame-by-frame video analysis. Some of the parent behaviours mentioned previously are associated with more words produced by deaf children. CONCLUSION: The results of the review provide the evidence base required to develop the content of a future clinical assessment tool for parent-child interaction in deafness.

Lexical organization in deaf children who use British Sign Language: evidence from a semantic fluency task.

We adapted the semantic fluency task into British Sign Language (BSL). In Study 1, we present data from twenty-two deaf signers aged four to fifteen. We show that the same 'cognitive signatures' that characterize this task in spoken languages are also present in deaf children, for example, the semantic clustering of responses. In Study 2, we present data from thirteen deaf children with Specific Language Impairment (SLI) in BSL, in comparison to a subset of children from Study 1 matched for age and BSL exposure. The two groups' results were comparable in most respects. However, the group with SLI made occasional word-finding errors and gave fewer responses in the first 15 seconds. We conclude that deaf children with SLI do not differ from their controls in terms of the semantic organization of the BSL lexicon, but that they access signs less efficiently.

Adapting the Assessing British Sign Language Development: Receptive Skills Test into American sign language.

Signed languages continue to be a key element of deaf education programs that incorporate a bilingual approach to teaching and learning. In order to monitor the success of bilingual deaf education programs, and in particular to monitor the progress of children acquiring signed language, it is essential to develop an assessment tool of signed language skills. Although researchers have developed some checklists and experimental tests related to American Sign Language (ASL) assessment, at this time a standardized measure of ASL does not exist. There have been tests developed in other signed languages, for example, British Sign Language, that can serve as models in this area. The purpose of this study was to adapt the Assessing British Sign Language Development: Receptive Skills Test for use in ASL in order to begin the process of developing a standardized measure of ASL skills. The results suggest that collaboration between researchers in different signed languages can provide a valuable contribution toward filling the gap in the area of signed language assessment.

Identifying specific language impairment in deaf children acquiring British Sign Language: implications for theory and practice.

This paper presents the first ever group study of specific language impairment (SLI) in users of sign language. A group of 50 children were referred to the study by teachers and speech and language therapists. Individuals who fitted pre-determined criteria for SLI were then systematically assessed. Here, we describe in detail the performance of 13 signing deaf children aged 5-14 years on normed tests of British Sign Language (BSL) sentence comprehension, repetition of nonsense signs, expressive grammar and narrative skills, alongside tests of non-verbal intelligence and fine motor control. Results show these children to have a significant language delay compared to their peers matched for age and language experience. This impaired development cannot be explained by poor exposure to BSL, or by lower general cognitive, social, or motor abilities. As is the case for SLI in spoken languages, we find heterogeneity within the group in terms of which aspects of language are affected and the severity of the impairment. We discuss the implications of the existence of language impairments in a sign language for theories of SLI and clinical practice.

Early vocabulary development in deaf native signers: a British Sign Language adaptation of the communicative development inventories.

BACKGROUND: There is a dearth of assessments of sign language development in young deaf children. This study gathered age-related scores from a sample of deaf native signing children using an adapted version of the MacArthur-Bates CDI (Fenson et al., 1994). METHOD: Parental reports on children's receptive and expressive signing were collected longitudinally on 29 deaf native British Sign Language (BSL) users, aged 8-36 months, yielding 146 datasets. RESULTS: A smooth upward growth curve was obtained for early vocabulary development and percentile scores were derived. In the main, receptive scores were in advance of expressive scores. No gender bias was observed. Correlational analysis identified factors associated with vocabulary development, including parental education and mothers' training in BSL. Individual children's profiles showed a range of development and some evidence of a growth spurt. Clinical and research issues relating to the measure are discussed. CONCLUSIONS: The study has developed a valid, reliable measure of vocabulary development in BSL. Further research is needed to investigate the relationship between vocabulary acquisition in native and non-native signers.

Language impairments in sign language: breakthroughs and puzzles.

BACKGROUND: Specific language impairment has previously solely been documented for children acquiring spoken languages, despite informal reports of deaf children with possible sign language disorder. The paper reports the case of a deaf child exposed to British Sign Language (BSL) from birth, who has significant developmental deficits in the comprehension and production of BSL grammar based on formal assessment and linguistic analyses of his sign communication in comparison with age-matched unimpaired signers. RESULTS: It is shown that linguistic difficulties with BSL verb morphology underlie the child's poor performance compared with same-age native signers. CONCLUSIONS: The appearance of linguistic impairments in sign and spoken languages in comparable domains supports cross-linguistic and modality free theories of specific language impairment.

The development of complex verb constructions in British Sign Language.

This study focuses on the mapping of events onto verb-argument structures in British Sign Language (BSL). The development of complex sentences in BSL is described in a group of 30 children, aged 3;2-12;0, using data from comprehension measures and elicited sentence production. The findings support two interpretations: firstly, in the mapping of concepts onto language, children acquiring BSL overgeneralize the use of argument structure related to perspective shifting; secondly, these overgeneralizations are predicted by the typological characteristics of the language and modality. Children under age 6;0, in attempting to produce sentences encoded through a perspective shift, begin by breaking down double-verb constructions (AB verbs) into components, producing only the part of the verb phrase which describes the perspective of the patient. There is also a prolonged period of development of non-manual features, with the full structure not seen in its adult form until after 9;0. The errors in the use of AB verbs and the subsequent protracted development of correct usage are explained in terms of the conceptual-linguistic interface.