Teaching Caregivers to Implement the Caregivers Optimizing Achievement of Children With Hearing Loss (COACH) Intervention.

PURPOSE: This study examined the effectiveness of Caregivers Optimizing Achievement of Children With Hearing Loss (COACH), an intervention in which parents were taught naturalistic interaction strategies that addressed the unique linguistic input needs of their young children with hearing loss. METHOD: A single-subject multiple-baseline across-behaviors design was used with four caregiver-child dyads to determine the effects of COACH training on caregivers' use of the COACH language facilitation strategies and on their children's language abilities. RESULTS: A functional relation was demonstrated between teaching of strategies and caregivers' use of the strategies across three dyads with slower, consistent changes observed in a fourth dyad. Improvements in children's use of target-level language were observed for children in three dyads. CONCLUSIONS: Caregivers were able to implement COACH language facilitation strategies, although the pace of caregivers' learning differed across dyads. Caregivers reported high satisfaction with participating in the intervention. Future research using a randomized design and a longer intervention condition is needed for a more complete assessment of the effects of the intervention on children's language abilities. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22290082.

Language Exposure for Preterm Infants is Reduced Relative to Fetuses.

OBJECTIVE: To assess changes and deficits in language and auditory exposures consequent to preterm birth and neonatal intensive care unit stay compared with exposures in utero among typically developing fetuses. STUDY DESIGN: We analyzed over 23 000 hours of auditory exposure data in a cohort study of 27 typically-developing fetuses and 24 preterm infants. Extrauterine exposures for fetuses were captured by having pregnant women wear 24-hour audio recording devices. For preterm infants, recording devices were placed in the infant's crib. Multilevel linear regressions were conducted to test for group differences and effects of infant sex, maternal education, and mother' occupation. A linear mixed-effects model was used to test for an effect of speaker gender. RESULTS: Fetuses were exposed to an estimated 2.6 ± 1.8 hours/day of nearby, predominantly female language, nearly 5 times greater than 32 ± 12 minutes/day estimated for preterm infants (P < .001). Preterm infants had greater daily exposure to electronic sounds (5.1 ± 2.5 vs 1.3 ± 0.6 hours; P < .001) and noise (4.4 ± 2.1 vs 2.9 ± 2.8 hours; P < .05), with 4.7 ± 3.9 hours/day of silence. Language and extrauterine sound exposure for fetuses showed a marked day/night cyclical pattern, with low exposure during nighttime hours, but preterm infants' exposures showed significantly less change across the 24-hour cycle (P < .001). Maternal occupation requiring frequent communication predicted greater language exposure (P < .05). CONCLUSIONS: Our findings provide the first comparison of preterm infant auditory exposures to typically-developing fetuses. Some preterm infants may incur deficits of over 150 hours of language exposure over the preterm period. Given known effects of prenatal/preterm language exposure on neurobehavioral outcomes, this magnitude of deficit is alarming.

Evaluation of Parent-Researcher Agreement on the Vocal Development Landmarks Interview.

Purpose Parent report was compared to judgments made by a trained researcher to determine the utility of the Vocal Development Landmarks Interview (VDLI) for monitoring development of vocal behaviors in very young children. Method Parents of 40 typically developing children, ages 6-21 months, provided full-day naturalistic audio recordings of their children's vocalizations after completing the VDLI. Six 5-min segments of highly voluble periods were selected from each recording and were analyzed, coded, and scored by the researcher. These data were then compared to the parents' VDLI responses. Parent-researcher agreement was examined using two methods and a generalized linear mixed model. Patterns of disagreement were explored descriptively to gain insights regarding potential sources of parent-researcher differences. Finally, developmental patterns in the researcher-observed vocal behaviors were examined as a function of children's age. Results No significant differences in parent-researcher agreement were found for the Canonical and Word subscales of the VDLI; however, significant differences in agreement were found for the Precanonical subscale. Mean percentages of agreement were high overall for both scoring methods evaluated. Additionally, the researcher's categorization and quantification of vocal behaviors for each age group aligned well with developmental trajectories found in the literature. Conclusion Results provide further support for use of parent report to assess early vocal development and use of the VDLI as a clinical measure of vocal development in infants and toddlers ages 6-21 months.

Beliefs and Self-Efficacy of Parents of Young Children with Hearing Loss.

The purpose of this study was to learn more about the beliefs and self-efficacy of parents of young children with hearing loss. Seventy-two parents completed the Scale of Parental Involvement and Self-Efficacy-Revised (SPISE-R), which queries parents about their child's hearing device use and their perceptions of their own beliefs, knowledge, confidence, and actions pertaining to supporting their child's auditory access and spoken language development. Two beliefs were identified that related to parents' action scores and one belief was identified that related to children's hearing device use. Knowledge and confidence scores were significantly correlated with action scores and children's hearing device use, whereas only confidence scores were related to scores on a measure of children's spoken language abilities. Results indicate the SPISE-R is a promising tool for use in early intervention to better understand parents' strengths and needs pertaining to supporting their young child's auditory access and spoken language development.

Using Technology to Monitor Hearing Device Use and Linguistic Environments: Early Intervention Providers' Perspectives.

To improve outcomes for children with hearing loss, early intervention professionals must work with families to optimize children's hearing device use and the linguistic and auditory features of children's environments. Two technologies with potential use in monitoring these domains are data logging and Language Environment Analysis (LENA) technology. This study, which surveyed early intervention providers, had two objectives: (a) to determine whether providers' experiences, perspectives, and current practices indicated there was a need for tools to better monitor these domains, and (b) to gain a better understanding of providers' experiences with and perspectives on use of the two technologies. Most providers reported that they used informal, subjective methods to monitor functioning in the two domains and felt confident that their methods allowed them to know how consistently children on their caseloads were wearing their hearing devices and what their environments were like between intervention visits. Although most providers reported limited personal experience with accessing data logging information and with LENA technology, many reported receiving data logging information from children's audiologists. Providers generally believed access to the technologies could be beneficial, but only if coupled with proper funding for the technology, appropriate training, and supportive administrative policies.

Aided Hearing Moderates the Academic Outcomes of Children With Mild to Severe Hearing Loss.

OBJECTIVES: There are very limited data regarding the spoken language and academic outcomes of children with mild to severe hearing loss (HL) during the elementary school years, and the findings of these studies are inconsistent. None of these studies have examined the possible role of aided hearing in these outcomes. This study used a large cohort of children to examine these outcomes and in particular to examine whether aided hearing moderates the effect of HL with regard to these outcomes. DESIGN: The spoken language, reading, writing, and calculation abilities were measured after second and fourth grades in children with mild to severe HL (children who are hard of hearing; CHH, n = 183) and a group of children with normal hearing (CNH, n = 91) after the completion of second and fourth grades. Also, among the CHH who wore hearing aids, aided better-ear speech intelligibility index values at the age of school entry were obtained. RESULTS: Oral language abilities of the CHH with mild and moderate HL were similar to the CNH at each grade. Children with moderately-severe HL (better-ear pure tone threshold >59 but <76 dB HL) had significantly poorer oral language and reading skills than the CNH at each grade. The children with mild and moderate HL did not differ from the CNH in oral language or reading. No differences were found between the CHH regardless of severity and CNH with regard to spelling, passage writing, or calculation. The degree to which hearing aids provided audible speech information played a moderating role in the oral language outcomes of CHH and this moderation of language mediated the relationship between the unaided hearing ability of the CHH and their academic outcomes. CONCLUSIONS: As a group, children with mild and moderate HL have good outcomes with regard to language and academic performance. Children with moderately-severe losses were less skilled in language and reading than the CNH and CHH children with mild and moderate losses. Audibility provided by hearing aids was found to moderate the effects of HL with respect to these outcomes. These findings emphasize the importance of including the effects of clinical interventions such as aided hearing when examining outcomes of CHH.

Early Literacy Predictors and Second-Grade Outcomes in Children Who Are Hard of Hearing.

This study contrasted the early literacy outcomes of children who are hard of hearing (CHH) with children with normal hearing (CNH). At age 5, prereading skills of oral language, phonological processing, and print knowledge were examined in CHH (N = 180) and CNH (N = 80). The CHH had poorer oral language and phonological processing abilities than the CNH but comparable knowledge of print. At age 8, measures of word reading, and reading comprehension yielded no differences between CHH (N = 108) and CNH (N = 62) except for reading comprehension for the moderately severe CHH. Reading achievement in CHH was found to exceed predictions based on prereading performance. This resilience was associated with gains in oral language during the early school years.

Effects of an Intervention Designed to Increase Toddlers' Hearing Aid Use.

The purpose of this study was to examine the effectiveness of Ears On, an intervention designed to increase toddlers' use of hearing devices. A single-case, multiple-baseline design across participants was used with three parent-child dyads who demonstrated low hearing aid use despite enrollment in traditional early intervention services. Data logging technology was used to objectively measure hearing aid use. A functional relationship was identified between participation in the intervention and the number of hours children utilized their hearing aids. Two dyads met the criterion set for completing the intervention: an average of 8 hr of daily hearing aid use. One dyad did not reach this criterion but did meet the parent's goal of full-time use in the child's educational setting. For all dyads, increases in use were maintained 1 month after completion of the intervention. Findings support use of this short-term, intensive, individualized intervention to improve hearing aid use for toddlers with hearing loss.

Validation of a Parent Report Tool for Monitoring Early Vocal Stages in Infants.

Purpose Tracking of infants' progression through early vocal stages supports the identification of children at risk for language delays and guides early intervention for children with disabilities. However, few clinical tools are available to support systematic assessment of infants' early vocal development. This study sought to develop and conduct a preliminary evaluation of the validity of a parent report tool designed for this purpose, the Vocal Development Landmarks Interview (VDLI). Method The participants were caregivers of 160 typically developing 6- to 21-month-old infants. Caregivers participated in the VDLI, which uses audio samples of authentic infant vocalizations to query parents regarding their children's vocal behaviors. The VDLI yields 3 subscale scores (Precanonical, Canonical, and Word) and a total score. Caregivers also completed sections of the Communication and Symbolic Behavior Scales Developmental Profile Caregiver Questionnaire that yielded a speech composite score. Results Cross-sectional analyses showed that the VDLI is sensitive to age and captures the expected developmental trajectories of vocal behaviors. A strong, positive correlation ( r = .93) was found between VDLI total scores and the Communication and Symbolic Behavior Scales Developmental Profile speech composite score, indicating concurrent validity. Subscales were found to be internally consistent. Conclusion Preliminary findings of sensitivity to age, concurrent validity, and internal consistency provide support for the eventual use of the VDLI as a clinical tool for tracking vocal and early verbal milestones. Future research will explore the level of concordance between parent report and researcher observations of child vocal behaviors. Supplemental Material https://doi.org/10.23641/asha.8330003.

False Belief Development in Children Who Are Hard of Hearing Compared With Peers With Normal Hearing.

Purpose: This study investigates false belief (FB) understanding in children who are hard of hearing (CHH) compared with children with normal hearing (CNH) at ages 5 and 6 years and at 2nd grade. Research with this population has theoretical significance, given that the early auditory-linguistic experiences of CHH are less restricted compared with children who are deaf but not as complete as those of CNH. Method: Participants included CHH and CNH who had completed FB tasks as part of a larger multicenter, longitudinal study on outcomes of children with mild-to-severe hearing loss. Both cross-sectional and longitudinal data were analyzed. Results: At age 5 years, CHH demonstrated significant delays in FB understanding relative to CNH. Both hearing status and spoken-language abilities contributed to FB performance in 5-year-olds. A subgroup of CHH showed protracted delays at 6 years, suggesting that some CHH are at risk for longer term delays in FB understanding. By 2nd grade, performance on 1st- and 2nd-order FBs did not differ between CHH and CNH. Conclusions: Preschool-age CHH are at risk for delays in understanding others' beliefs, which has consequences for their social interactions and pragmatic communication. Research related to FB in children with hearing loss has the potential to inform our understanding of mechanisms that support social-cognitive development, including the roles of language and conversational access.

Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions.

PURPOSE: This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL). METHOD: Ages at and delays between service delivery steps (first diagnostic evaluation, confirmation of HL, hearing aid [HA] fitting, entry into early intervention) were investigated for 113 children with mild HL. Comparisons were made to children with moderate-to-severe HL. Parents of children with mild HL reported reasons for delays and their perceptions of intervention and amplification for their children. RESULTS: Seventy-four percent of children with mild HL were identified through the newborn hearing screen; 26% were identified later due to passing or not receiving a newborn hearing screen. Ninety-four percent of children with mild HL were fit with HAs, albeit at significantly later ages than children with moderate-to-severe HL. Most parents indicated that their children benefited from HA use, but some parents expressed ambivalence toward the amount of benefit. CONCLUSIONS: Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

Gesture Use in 14-Month-Old Toddlers With Hearing Loss and Their Mothers' Responses.

Purpose: This study examined the gesture use of 14-month-old toddlers with hearing loss (HL) and mothers' responses to children's early gesture use. Comparisons were made to symbolic language and to dyads in which the toddler had normal hearing (NH). Method: Participants were 25 mother-toddler dyads in which the child had HL and a socioeconomic-status matched group of 23 mother-toddler dyads in which the child had NH. Thirty-minute mother-child interactions were video-recorded, transcribed for spoken language, sign, and gesture use, and coded for maternal responses to children's gestures. Mothers also reported on children's gestural and spoken language abilities. Results: Toddlers with HL used gesture similarly to their peers with NH, but demonstrated delays in spoken language. Spoken language and gesture were not significantly related for either group. Hearing levels were related to spoken language, but not gesture for the HL group. Maternal and child gesture were only related for signing mothers. Mothers of children with HL were more likely than their counterparts to provide no response to children's gestures. Conclusion: Although toddlers' gesture abilities remain intact in the presence of HL, mothers were not maximally responsive to those gestures and thus should be coached to increase their provision of contingent feedback.

Assessing Vocal Development in Infants and Toddlers Who Are Hard of Hearing: A Parent-Report Tool.

The main purpose of the current investigation was to determine whether the Vocal Development Landmarks Interview-Experimental Version (VDLI-E) was sensitive to variation in the vocal development of infants and toddlers who are hard of hearing. The VDLI-E is an interactive parent interview that uses audio samples of authentic infant vocalizations to make targeted vocal behaviors clear and understandable to parents without the need for technical terms, verbal descriptions, or adult modeling of infant productions. The VDLI-E was found to be sensitive to age and hearing and was related to performance on concurrent measures of early auditory skills, expressive vocabulary, and overall expressive language abilities. These findings provide preliminary support for the utility of this measure in monitoring the impact of early auditory experiences on vocal development for 6- to 18-month-old children who are hard of hearing.

Automated Vocal Analysis of Children With Hearing Loss and Their Typical and Atypical Peers.

OBJECTIVES: This study investigated automatic assessment of vocal development in children with hearing loss compared with children who are typically developing, have language delays, and have autism spectrum disorder. Statistical models are examined for performance in a classification model and to predict age within the four groups of children. DESIGN: The vocal analysis system analyzed 1913 whole-day, naturalistic acoustic recordings from 273 toddlers and preschoolers comprising children who were typically developing, hard of hearing, language delayed, or autistic. RESULTS: Samples from children who were hard of hearing patterned more similarly to those of typically developing children than to the language delayed or autistic samples. The statistical models were able to classify children from the four groups examined and estimate developmental age based on automated vocal analysis. CONCLUSIONS: This work shows a broad similarity between children with hearing loss and typically developing children, although children with hearing loss show some delay in their production of speech. Automatic acoustic analysis can now be used to quantitatively compare vocal development in children with and without speech-related disorders. The work may serve to better distinguish among various developmental disorders and ultimately contribute to improved intervention.

Language Outcomes in Young Children with Mild to Severe Hearing Loss.

OBJECTIVES: This study examined the language outcomes of children with mild to severe hearing loss during the preschool years. The longitudinal design was leveraged to test whether language growth trajectories were associated with degree of hearing loss and whether aided hearing influenced language growth in a systematic manner. The study also explored the influence of the timing of hearing aid fitting and extent of use on children's language growth. Finally, the study tested the hypothesis that morphosyntax may be at particular risk due to the demands it places on the processing of fine details in the linguistic input. DESIGN: The full cohort of children in this study comprised 290 children who were hard of hearing (CHH) and 112 children with normal hearing who participated in the Outcomes of Children with Hearing Loss (OCHL) study between the ages of 2 and 6 years. CHH had a mean better-ear pure-tone average of 47.66 dB HL (SD = 13.35). All children received a comprehensive battery of language measures at annual intervals, including standardized tests, parent-report measures, and spontaneous and elicited language samples. Principal components analysis supported the use of a single composite language score for each of the age levels (2, 3, 4, 5, and 6 years). Measures of unaided (better-ear pure-tone average, speech intelligibility index) and aided (residualized speech intelligibility index) hearing were collected, along with parent-report measures of daily hearing aid use time. Mixed modeling procedures were applied to examine the rate of change (227 CHH; 94 children with normal hearing) in language ability over time in relation to (1) degree of hearing loss, (2) aided hearing, (3) age of hearing aid fit and duration of use, and (4) daily hearing aid use. Principal components analysis was also employed to examine factor loadings from spontaneous language samples and to test their correspondence with standardized measures. Multiple regression analysis was used to test for differential effects of hearing loss on morphosyntax and lexical development. RESULTS: Children with mild to severe hearing loss, on average, showed depressed language levels compared with peers with normal hearing who were matched on age and socioeconomic status. The degree to which CHH fell behind increased with greater severity of hearing loss. The amount of improved audibility with hearing aids was associated with differential rates of language growth; better audibility was associated with faster rates of language growth in the preschool years. Children fit early with hearing aids had better early language achievement than children fit later. However, children who were fit after 18 months of age improved in their language abilities as a function of the duration of hearing aid use. These results suggest that the language learning system remains open to experience provided by improved access to linguistic input. Performance in the domain of morphosyntax was found to be more delayed in CHH than their semantic abilities. CONCLUSION: The data obtained in this study largely support the predictions, suggesting that mild to severe hearing loss places children at risk for delays in language development. Risks are moderated by the provision of early and consistent access to well-fit hearing aids that provide optimized audibility.

Quantity and Quality of Caregivers' Linguistic Input to 18-Month and 3-Year-Old Children Who Are Hard of Hearing.

OBJECTIVES: The primary objective of this study was to examine the quantity and quality of caregiver talk directed to children who are hard of hearing (CHH) compared with children with normal hearing (CNH). For the CHH only, the study explored how caregiver input changed as a function of child age (18 months versus 3 years), which child and family factors contributed to variance in caregiver linguistic input at 18 months and 3 years, and how caregiver talk at 18 months related to child language outcomes at 3 years. DESIGN: Participants were 59 CNH and 156 children with bilateral, mild-to-severe hearing loss. When children were approximately 18 months and/or 3 years of age, caregivers and children participated in a 5-min semistructured, conversational interaction. Interactions were transcribed and coded for two features of caregiver input representing quantity (number of total utterances and number of total words) and four features representing quality (number of different words, mean length of utterance in morphemes, proportion of utterances that were high level, and proportion of utterances that were directing). In addition, at the 18-month visit, parents completed a standardized questionnaire regarding their child's communication development. At the 3-year visit, a clinician administered a standardized language measure. RESULTS: At the 18-month visit, the CHH were exposed to a greater proportion of directing utterances than the CNH. At the 3-year visit, there were significant differences between the CNH and CHH for number of total words and all four of the quality variables, with the CHH being exposed to fewer words and lower quality input. Caregivers generally provided higher quality input to CHH at the 3-year visit compared with the 18-month visit. At the 18-month visit, quantity variables, but not quality variables, were related to several child and family factors. At the 3-year visit, the variable most strongly related to caregiver input was child language. Longitudinal analyses indicated that quality, but not quantity, of caregiver linguistic input at 18 months was related to child language abilities at 3 years, with directing utterances accounting for significant unique variance in child language outcomes. CONCLUSIONS: Although caregivers of CHH increased their use of quality features of linguistic input over time, the differences when compared with CNH suggest that some caregivers may need additional support to provide their children with optimal language learning environments. This is particularly important given the relationships that were identified between quality features of caregivers' linguistic input and children's language abilities. Family supports should include a focus on developing a style that is conversational eliciting as opposed to directive.

The influence of hearing aids on the speech and language development of children with hearing loss.

IMPORTANCE Hearing loss (HL) in children can be deleterious to their speech and language development. The standard of practice has been early provision of hearing aids (HAs) to moderate these effects; however, there have been few empirical studies evaluating the effectiveness of this practice on speech and language development among children with mild-to-severe HL. OBJECTIVE To investigate the contributions of aided hearing and duration of HA use to speech and language outcomes in children with mild-to-severe HL. DESIGN, SETTING, AND PARTICIPANTS An observational cross-sectional design was used to examine the association of aided hearing levels and length of HA use with levels of speech and language outcomes. One hundred eighty 3- and 5-year-old children with HL were recruited through records of Universal Newborn Hearing Screening and referrals from clinical service providers in the general community in 6 US states. INTERVENTIONS All but 4 children had been fitted with HAs, and measures of aided hearing and the duration of HA use were obtained. MAIN OUTCOMES AND MEASURES Standardized measures of speech and language ability were obtained. RESULTS Measures of the gain in hearing ability for speech provided by the HA were significantly correlated with levels of speech (ρ179 = 0.20; P = .008) and language: ρ155 = 0.21; P = .01) ability. These correlations were indicative of modest levels of association between aided hearing and speech and language outcomes. These benefits were found for children with mild and moderate-to-severe HL. In addition, the amount of benefit from aided hearing interacted with the duration of HA experience (Speech: F4,161 = 4.98; P < .001; Language: F4,138 = 2.91; P < .02). Longer duration of HA experience was most beneficial for children who had the best aided hearing. CONCLUSIONS AND RELEVANCE The degree of improved hearing provided by HAs was associated with better speech and language development in children. In addition, the duration of HA experience interacted with the aided hearing to influence outcomes. These results provide support for the provision of well-fitted HAs to children with HL. In particular, the findings support early HA fitting and HA provision to children with mild HL.

Speech sound production in 2-year-olds who are hard of hearing.

PURPOSE: The purpose of the study was to (a) compare the speech sound production abilities of 2-year-old children who are hard of hearing (HH) to children with normal hearing (NH), (b) identify sources of risk for individual children who are HH, and (c) determine whether speech sound production skills at age 2 were predictive of speech sound production skills at age 3. METHOD: Seventy children with bilateral, mild-to-severe hearing loss who use hearing aids and 37 age- and socioeconomic status-matched children with NH participated. Children's speech sound production abilities were assessed at 2 and 3 years of age. RESULTS: At age 2, the HH group demonstrated vowel production abilities on par with their NH peers but weaker consonant production abilities. Within the HH group, better outcomes were associated with hearing aid fittings by 6 months of age, hearing loss of less than 45 dB HL, stronger vocabulary scores, and being female. Positive relationships existed between children's speech sound production abilities at 2 and 3 years of age. CONCLUSION: Assessment of early speech sound production abilities in combination with demographic, audiologic, and linguistic variables may be useful in identifying HH children who are at risk for delays in speech sound production.

Linguistic input, electronic media, and communication outcomes of toddlers with hearing loss.

OBJECTIVES: The objectives of this study were to examine the quantity of adult words, adult-child conversational turns, and electronic media in the auditory environments of toddlers who are hard of hearing (HH) and to examine whether these factors contributed to variability in children's communication outcomes. DESIGN: Participants were 28 children with mild to severe hearing loss. Full-day recordings of children's auditory environments were collected within 6 months of their second birthdays by using Language ENvironment Analysis technology. The system analyzes full-day acoustic recordings, yielding estimates of the quantity of adult words, conversational turns, and electronic media exposure in the recordings. Children's communication outcomes were assessed via the receptive and expressive scales of the Mullen Scales of Early Learning at 2 years of age and the Comprehensive Assessment of Spoken Language at 3 years of age. RESULTS: On average, the HH toddlers were exposed to approximately 1400 adult words per hour and participated in approximately 60 conversational turns per hour. An average of 8% of each recording was classified as electronic media. However, there was considerable within-group variability on all three measures. Frequency of conversational turns, but not adult words, was positively associated with children's communication outcomes at 2 and 3 years of age. Amount of electronic media exposure was negatively associated with 2-year-old receptive language abilities; however, regression results indicate that the relationship was fully mediated by the quantity of conversational turns. CONCLUSIONS: HH toddlers who were engaged in more conversational turns demonstrated stronger linguistic outcomes than HH toddlers who were engaged in fewer conversational turns. The frequency of these interactions was found to be decreased in households with high rates of electronic media exposure. Optimal language-learning environments for HH toddlers include frequent linguistic interactions between parents and children. To support this goal, parents should be encouraged to reduce their children's exposure to electronic media.

Quantity of parental language in the home environments of hard-of-hearing 2-year-olds.

Automated analyses of full-day recordings were used to determine whether young children who are hard-of-hearing (HH) received similar levels of exposure to adult words and conversational interactions as age-matched peers with normal-hearing (NH). Differences in adult input between children in this study and in a normative database were considered. Finally, factors were examined that may have contributed to individual differences in the input characteristics of families. Results indicated that the NH and HH groups were exposed to similar numbers of adult words and conversational turns. However, both the NH and HH groups were exposed to more adult words and engaged in more conversational turns than the NH children in the normative sample. Considering only the HH group, both quantity of adult words and conversational exchanges were correlated with children's auditory characteristics. Children's receptive language ability was correlated with conversational exchanges but not with adult word counts.