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.

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 a Video-Based Intervention to Promote Parent Communication Strategies with a Deaf Infant: A Feasibility and Acceptability Study.

Infant-parent interaction forms the foundation for language learning. For the majority of deaf infants, hearing loss can impact access to, and the quality of communicative interactions, placing language development at risk. Support for families to meet the challenges faced during interaction is highly variable in the United Kingdom. In a step towards more standardized but tailorable family support, we co-produced an instructional, video-based intervention, testing for feasibility in terms of behavior change in seven communicative strategies and acceptability with 9 parents, forming study 1. Parents increased their use of the majority of behaviors and found content and delivery acceptable. However, further development was required to: (a) support use of semantically contingent talk and attention getting strategies to elicit infant attention, and (b) ensure the information was provided in a bite-size format that could be tailored to individual families. In study 2, the intervention was refined based on findings from study 1 and assessed for acceptability with 9 parents and 17 professionals, who reported similar high acceptability scores. Final refinements and modifications could be addressed in future interventions. The current studies provide a positive early step towards a standardized intervention to support communication that could be used in routine practice.

Evaluación y descripción del desarrollo del discurso narrativo en español / Evaluation and description of narrative development in Spanish

Antecedentes y objetivos: Las habilidades implicadas en la producción narrativa constituyen un buen indicador de la competencia lingüística infantil y permiten predecir el futuro desarrollo del lenguaje. Resulta importante, dentro del ámbito logopédico y pedagógico, contar con instrumentos de evaluación específicos en esta área; sin embargo, existen pocos sistemas de evaluación que valoren el desarrollo de la narración en español. Esta investigación tiene un doble objetivo: el primero es adaptar al español el Test of Narrative Production, y el segundo es describir el desarrollo de las habilidades narrativas a partir de la aplicación del test adaptado. Método: Un total de 146 niños de 4 a 11 años con lengua materna española fueron evaluados mediante la adaptación al español del Test of Narrative Production, valorándose las habilidades narrativas a nivel de macroestructura y microestructura. Resultados: Se observó una correlación fuerte y significativa entre la edad y el desempeño narrativo a nivel macroestructural y microestructural. No obstante, si bien se observó una estabilización a los 9 años del desarrollo de ambos niveles, en el nivel microestructural se manifestó una evolución de los mecanismos de cohesión hasta los 11 años. Conclusiones: La prueba se revela como un sistema de evaluación válido del desarrollo narrativo en español. Los resultados coinciden con investigaciones en niños angloparlantes, donde se ha demostrado que estos adquieren un nivel de desempeño narrativo similar al de los adultos a los 9 años en cuanto al nivel macroestructural, pero que continúan desarrollando y complejizando el nivel microestructural hasta la adolescencia.(AU)

Background and objectives: The skills involved in narrative production are a good indicator of children's current language competence and predict future linguistic performance. It is important in speech and language therapy and education research to have specific assessments of developing narrative abilities. To date, however, there are few tests that assess the development of narratives in Spanish. This research has a double objective: first, to adapt the Test of Narrative Production to Spanish; and second, to describe the development of narrative skills using the adapted test. Method: A total of 146 children aged 4-11 years with Spanish as their mother tongue were evaluated by the Test of Narrative Production adapted to Spanish, and were assessed for their narrative skills at the level of both macrostructure and microstructure. Results: A strong significant correlation between age and narrative performance was observed at the macrostructural and microstructural levels. However, although both levels showed a stabilization at age 9 years, at the microstructural level cohesive devices continued developing until age 11 years. Conclusions: The test can be considered a valid evaluation of narrative development in Spanish. The results are consistent with research in English-speaking children, where it has been shown that they acquire a similar level of narrative performance to that of adults at 9 years of age at the macrostructural level, but they continue to develop and refine the microstructural level until adolescence.(AU)

Does Sentinel Lymph Node Biopsy Accurately Stage the Clinically Negative Neck in Early Oral Cavity Squamous Cell Carcinoma?

PURPOSE: Sentinel lymph node biopsy (SLNB) is being increasingly used worldwide as a minimally invasive option to stage the clinically node-negative neck (N0) in patients with early oral cavity squamous cell carcinomas (OCSCC). We performed this trial to assess the reliability and validity of the technique. METHODS: We did this prospective interventional nonrandomized study in patients with early (cT1-T2 OCSCC) and with negative neck. All patients underwent preoperative lymphoscintigraphy; SLNB was followed immediately by completion neck dissection (CND), thus each patient serving as their own control. The primary outcomes evaluated are sentinel lymph node (SLN) detection rate, SLN retrieval rate, and SLN status (positive or negative) compared with pathology of CND specimen to detect any false negatives. The secondary outcomes included SLN analyses (tumor burden, location in different levels of the neck, laterality, extracapsular spread, and total nodes positive) and overall survival. RESULTS: Of 60 patients, 59 (98%) had successful SLN detection with the lymphoscintigram failing to localize in 1 patient. Of the remaining 59 patients, 58 (96%) had all the SLNs retrieved, resulting in 96.4% sentinel node retrieval rate. In total, 24 (41%) SLNs were positive with 1 false negative. Using a combination of SLN and CND findings as the gold standard for lymph node involvement status, SLNB had a sensitivity of 96% (95% confidence interval [CI]: 80-100%), a specificity of 100% (95% CI: 90-100%), and negative predictive value of 97% (95% CI: 85-100%). CONCLUSION: The results of this study suggest that SLNB is an accurate technique to assess the nodal status in patients with cT1-T2 N0 OCSCC and should be considered for eligible patients.

Executive Function Training for Deaf Children: Impact of a Music Intervention.

Several studies have reported poor executive function (EF) development in deaf children with subsequent impacts on their social and academic attainment. This paper describes the results of a music-based EF intervention designed for deaf children and carried out in two sets of primary schools. This is the first classroom-based EF training study with deaf children, and it also incorporates a replication phase. The intervention was a within-subject crossover design, with 29 deaf children aged 7-11 years who participated in both an EF and an art class control activity, each lasting 10 hours over 5 weeks. Non-verbal EF skills were assessed at pre-test, the crossover point, and post-test. Findings indicated that the EF intervention led to an improvement in participants' working memory and inhibitory skills in comparison with their performance on the same tasks after the control activity. The findings were not uniform for all EFs targeted nor for all cognitive ability levels in the sample. We discuss the implications of our findings for deaf children with different ability levels and for how EF interventions can be further improved.

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.

The interplay between early social interaction, language and executive function development in deaf and hearing infants.

In this article, we review the influence of early social interaction on the development of executive function and language in infants. We first define social interaction, executive function and language and show how they are related in infant development. Studies of children born deaf are used to illustrate this connection because they represent cases where there has been a disruption to early social interaction and the development of intersubjectivity. Unlike other groups, the disturbance to development is known to be largely environmental rather than neuro-biological. This enables us to more accurately tease apart those impacts on EF that are associated with social interaction and language, since the potential confounds of disordered cognitive development are largely controlled for. The review offers a unifying model for how social, cognitive and linguistic development work together in early human development.

Dual thyroid ectopia with submental thyroid excision using Sistrunk procedure: A case report.

INTRODUCTION AND IMPORTANCE: Having two or more sites of simultaneous ectopic thyroid tissue is a rare phenomenon. Thyroid ectopia should be considered in congenital hypothyroidism where no eutopic thyroid gland is found. CASE PRESENTATION: This case describes an incidental finding of dual ectopic thyroid tissue on computer tomography scan in an adult with known congenital hypothyroidism that was previously attributed to thyroid agenesis. The decision was made to proceed with a Sistrunk procedure to excise the ectopic submental thyroid as it became more noticeable after weight loss following bariatric surgery, and to monitor the remaining lingual thyroid with a combination of clinical symptomology, imaging and thyroid function studies given its challenging location. CLINICAL DISCUSSION: The literature on pathophysiology, imaging modalities, and common considerations for surgical extirpation is reviewed. CONCLUSION: The utility of thyroid scintigraphy may be limited in patients with known thyroid ectopia; other investigative modalities are helpful. The Sistrunk procedure was used to excise an ectopic thyroid, based on its embryological migration from the foramen caecum to the usual pretracheal position along the thyroglossal tract, and is a suitable technique for excision of submental thyroid tissue causing an unsightly mass and where thorough histopathological examination is required to exclude malignancy.

Assessing parent-child interaction in infant deafness.

PURPOSE OF REVIEW: To highlight the importance of parent-child interaction (PCI) in infant deafness and address the lack of robust assessment tools in clinical practice. RECENT FINDINGS: Most deaf babies are born to hearing parents with little experience in deafness. Deafness can reduce access to spoken language. Despite advancements in amplification technology, deaf children still present with delays in attention and communication skills at the start of nursery. Research reports that hearing parents of deaf infants can be more directive during interaction, spend less time following the child's focus of attention, and have more difficulty achieving successful turn-taking in conversation. Much research tells us that these factors impact on the quality and quantity of PCI. Good PCI, in all infants, but especially so in deafness, is a strong predictor of child language outcomes. Teachers of the Deaf and Speech and Language Therapists are the first professionals to support families in the home. For these professionals, having an objective way of assessing PCI would greatly assist and standardise their practice. However, to date, there are no deaf-specific assessments to observe and appraise a parent's communication behaviours when interacting with their deaf child. SUMMARY: Intervention studies with families of deaf children have shown success in improving parental sensitivity and facilitative language techniques. An observational assessment in parent-deaf child interaction would ensure that communication interventions are appropriately targeted on the individual family's needs.

Early Pragmatics in Deaf and Hard of Hearing Infants.

BACKGROUND AND OBJECTIVES: A set of important pragmatic skills emerge during infancy and pave the way for later language learning. It is thought these early social communication skills develop through infant-caregiver interaction. In a microanalysis, we tested whether deaf and hard of hearing (DHH) infants (typically at high risk of reduced access to rich communicative interaction in infancy) are less likely to engage in gestural and vocal pragmatic behaviors. METHODS: We coded the naturalistic communication of 8 DHH infants who had no additional needs, who were not preterm or low birth weight, whose parents were hearing, monolingual English speakers, and who had spoken English as their primary target language. The frequency of use of 5 types of infant communication known to positively predict later language development (show gestures, give gestures, index-finger pointing, communicative vocalizations, and early word use) was compared with that of 8 typically hearing infants matched for age, sex, and socioeconomic status. RESULTS: Hearing loss had a significant negative effect on the frequency with which infants engaged in all types of early communication that predict later language development. CONCLUSIONS: DHH infants are at high risk of delay in the gestural and vocal communicative skills that lay the foundations for later language. Delay in the gestural domain suggests this is not simply a consequence of difficulties in imitating auditory stimuli. There is significant potential to lift DHH infants onto a positive developmental trajectory by supporting caregivers to nurture interaction from the first year.

Smart Ageing: Digital Solutions for Future Care.

We propose a framework for discourse on digital solutions to support consumers and carers in delivery of health care and services for aged persons, based on a major needs analysis conducted across 56 diverse business entities in Australia. The resulting framework was based on two major identified domains: "Ageing in Place" for independent living situations, and "Ageing with Care" for managed aged care facilities. The paper describes the process used and the intermediate outcomes which enabled the framework to be synthesized. It is anticipated that the framework could be used to inform future scoping studies and to enable collaborative design, implementation and delivery of appropriate smart ageing digital solutions.

"El nen s'ha menjat una aranya": The development of narratives in Catalan speaking children.

The production of a well-constructed narrative is the culmination of several years of language acquisition and is an important milestone in children's development. There is no current description of narrative development for Catalan speaking children. This study collected elicited narratives in Catalan from 118 children aged 4;0-10;11. Narratives were scored for macrostructure and microstructure. Narrative scores improved with age with maximum performance for macrostructure by 9 years. Children's ability to use micro-structural components of Catalan is variable with some developments continuing beyond 9 years. The results are discussed in relation to theoretical arguments about universal and specific features of narrative development. We conclude by highlighting the usefulness of the new test for future language assessment of children acquiring Catalan.

Ancient DNA and high-resolution chronometry reveal a long-term human role in the historical diversity and biogeography of the Bahamian hutia.

Quaternary paleontological and archaeological evidence often is crucial for uncovering the historical mechanisms shaping modern diversity and distributions. We take an interdisciplinary approach using multiple lines of evidence to understand how past human activity has shaped long-term animal diversity in an island system. Islands afford unique opportunities for such studies given their robust fossil and archaeological records. Herein, we examine the only non-volant terrestrial mammal endemic to the Bahamian Archipelago, the hutia Geocapromys ingrahami. This capromyine rodent once inhabited many islands but is now restricted to several small cays. Radiocarbon dated fossils indicate that hutias were present on the Great Bahama Bank islands before humans arrived at AD ~800-1000; all dates from other islands post-date human arrival. Using ancient DNA from a subset of these fossils, along with modern representatives of Bahamian hutia and related taxa, we develop a fossil-calibrated phylogeny. We found little genetic divergence among individuals from within either the northern or southern Bahamas but discovered a relatively deep North-South divergence (~750 ka). This result, combined with radiocarbon dating and archaeological evidence, reveals a pre-human biogeographic divergence, and an unexpected human role in shaping Bahamian hutia diversity and biogeography across islands.