Enhancing social-emotional functioning in adolescents with developmental language disorder or deaf or hard of hearing through a Theory of Mind intervention.

BACKGROUND: This study examines the effect of a Theory of Mind (ToM) intervention on ToM abilities and social-emotional functioning in adolescents with developmental language disorder (DLD) or who are deaf/hard of hearing (D/HH). It emphasizes the importance of self-reflection and measurement for personal growth. The research design incorporates both subjective and objective measures to evaluate the intervention's efficacy. AIMS: To investigate the impact of the ToM intervention on ToM abilities and social-emotional functioning in adolescents with DLD or who are D/HH. It hypothesizes that participants in the intervention groups will show improved ToM and social-emotional functioning compared with those in the control groups. METHODS & PROCEDURES: Adolescents with DLD or who are D/HH were recruited through collaboration with educational institutions. The study utilized a pre-/post-test design, assigning participants to either the intervention or the control group. The ToM intervention involved targeted activities to enhance ToM abilities. ToM abilities and social-emotional functioning were assessed using standardized tests and self-report questionnaires. Statistical analyses compared outcomes between the intervention and no intervention groups. OUTCOMES & RESULTS: The findings reveal subjective improvements in social-emotional functioning among the D/HH intervention group. However, no significant effects on objective ToM measures were observed. These results highlight the need for further investigation and refinement of interventions in these areas. Future research should focus on improving intervention strategies and exploring additional objective measures to gain a comprehensive understanding of the intervention's impact on ToM and social-emotional functioning in this population. CONCLUSIONS & IMPLICATIONS: The ToM intervention shows subjective benefits in improving social-emotional functioning among D/HH adolescents. However, it does not yield significant effects on objective ToM measures. These findings emphasize the ongoing need to refine interventions targeting ToM abilities and social-emotional functioning in this population. Future studies should explore alternative strategies and incorporate additional objective measures to enhance understanding and outcomes. WHAT THIS PAPER ADDS: What is already known on this subject Before this study, it was known that ToM interventions have the potential to enhance ToM abilities. However, the specific effects of such interventions on subjective and objective measures for ToM and social-emotional functioning in adolescents with DLD or who are D/HH remained unclear, necessitating further research. What this paper adds to the existing knowledge This study adds to the existing knowledge by demonstrating subjective improvements in social-emotional functioning among adolescents who are D/HH and underwent a ToM intervention. However, no significant effects on objective ToM measures were observed. These findings highlight the need for refining interventions and exploring additional measures to better understand the intervention's impact. What are the potential or actual clinical implications of this work? The subjective improvements in social-emotional functioning observed in this study have important clinical implications. They suggest that ToM interventions can positively impact the social well-being of adolescents who are D/HH. However, the lack of significant effects on objective ToM measures emphasizes the need for further research and intervention refinement to address specific areas of improvement in this population.

Outcomes of Aural Rehabilitation Provided in Person or by Telehealth Among Deaf/Hard of Hearing Young Children with Cochlear Implants or Hearing Aids.

Background: Cochlear implants and hearing aids may facilitate the development of listening and spoken language (LSL) in deaf/hard of hearing young children, but they require aural rehabilitation therapy-often unavailable outside urban areas-for optimal outcomes. This trial assessed the relative effectiveness of LSL therapy delivered either in person or by interactive video. The hypothesis was that telehealth service delivery would be noninferior to in-person therapy. Methods: Most parents refused randomization of their children to telehealth or in-person conditions; therefore, randomization was impossible. In consultation with the funder (NIDCD), the study design was modified. Parents were allowed to select their preferred study condition, and the study team was blinded to group membership. Forty-two families were in the in-person group and 35 in telehealth (40 and 30, respectively, after attrition). Primary endpoints were total score, auditory comprehension, and expressive communication on the Preschool Language Scale, 5th edition. There were several secondary speech, hearing, and language outcome measures. Assessments occurred at baseline and at follow-up after 6 months of LSL therapy. Results: Propensity scores were used to create two matched groups. At baseline, groups did not differ on PLS-5 scores. Change from baseline to F/U on age-equivalents for all three scores was nearly identical for both groups, although the telehealth group was younger, on average, than the in-person group. Discussion: Telehealth was noninferior to in-person services for all primary endpoints. For secondary outcomes, neither group demonstrated a significant advantage. Magnitudes of estimated group differences were small, suggesting nonsignificant differences not predominantly because of sample size. The telehealth group showed greater improvement on 15/24 of secondary language outcome measures. The findings provide evidence that telehealth is equivalent to in-person care for providing LSL therapy to young children with cochlear implants and hearing aids.

Increasing inclusivity in precision medicine research: Views of deaf and hard of hearing individuals.

PURPOSE: Deaf/hard of hearing (HoH) individuals can benefit from precision medicine research (PMR) but are underrepresented in mainstream health research and may experience barriers to participation. Understanding their views and concerns about PMR can inform processes to foster inclusion in future studies and reduce health disparities. METHODS: We administered an online disability-accessible survey to explore perceptions of PMR among, inter alia, deaf/HoH individuals. Questions included willingness to participate, interest in results, and barriers and facilitators to participation. Analyses describe results for participants who self-identified their primary condition as being deaf/HoH and compared results for key demographic characteristics. RESULTS: A total of 267 deaf/HoH participants completed the survey. Interest in PMR was high, although many reported inaccessible facilities and information about medical research; 51% reported that communication with health professionals is a barrier. Concerns about harm, lack of access to benefits, misinformed allocation decisions, and limited disability-relevant knowledge among researchers and health care providers were significant. Differences across racial, ethnic, and sex groups were observed and are discussed. CONCLUSION: Strategies to remove barriers to participation of deaf/HoH individuals in PMR are suggested. Distrust is a major challenge for cohort diversity, and research is needed to identify measures to increase the trustworthiness of PMR endeavors.

Technology assisted language intervention (TALI) for children who are deaf/hard of hearing: promising impact on pragmatic skills.

Children who are deaf and hard of hearing (DHH) often demonstrate pragmatic language difficulties which can impact academic and social outcomes. This randomized control trial for DHH children, ages 3-12 years, explored the Technology-Assisted Language Intervention (TALI), incorporating augmentative and alternative communication technology (AAC) into traditional speech/language therapy, compared to treatment-as-usual (TAU) to determine impact on pragmatics. Pragmatic outcome measures included parent reported Pragmatics Profile of the CELF-5 (for children age ≥5 years) and CELF-P Descriptive Pragmatics Profile (for children <5 years) in addition to parent reported Social and Communication domains of the Vineland Adaptive Behavior Scales,Third Edition (VABS). Over 24 weeks, children ≥5 years in the TALI made significantly more progress (increase in raw scores) on the Pragmatics Profile compared to children in TAU (12.7 points vs. -6.0 points; p = 0.04) and also showed significant gains on two of the three subscales. For children ≥5 years, no significant VABS changes were seen in either intervention group. For children <5 years, there were no statistically significant differences in growth on the CELF-P total pragmatics raw score or on any subdomain. However, children in TALI had significant increases in the mean VABS Communication (86.7-99.1) and Social domain standard scores (91.8-97.4;p = 0.01), while gains for children in TAU on the Communication and Social domain standard scores were not statistically significant. These promising results support the need for additional research exploring the effectiveness of AAC supported speech/language therapy to enhance DHH children's pragmatic language skills. Trial registration: ClinicalTrials.gov identifier: NCT02998164.

Assessing Autism in Deaf/Hard-of-Hearing Youths: Interdisciplinary Teams, COVID Considerations, and Future Directions.

Autism spectrum disorders are more prevalent in children who are Deaf or Hard of Hearing (D/HH) than in the general population. This potential for diagnostic overlap underscores the importance of understanding the best approaches for assessing autism spectrum disorder in D/HH youths. Despite the recognition of clinical significance, youths who are D/HH are often identified as autistic later than individuals with normal hearing, which results in delayed access to appropriate early intervention services. Three primary barriers to early identification include behavioral phenotypic overlap, a lack of "gold-standard" screening and diagnostic tools for this population, and limited access to qualified clinicians. In the current article, we seek to address these barriers to prompt an appropriate identification of autism by providing recommendations for autism assessment in children who are D/HH from an interdisciplinary hearing and development clinic, including virtual service delivery during COVID-19. Strengths, gaps, and future directions for implementation are addressed.

Self-Reported Listening Abilities in Educational Settings of Typically Hearing Children and Those Who Are Deaf/Hard-of-Hearing.

Children who are deaf or hard-of-hearing (D/HH) learning in inclusive educational settings must be aware of how well they hear and understand spoken language to advocate for themselves. This study explored elementary-age children's self-reported listening abilities using thematic analysis of brief interviews. Participants were 16 D/HH and 16 typically hearing (TH) 7- to 12-year-old monolingual English speakers in Canada. Children were asked about their ability to hear and understand the teacher, other students, and people in different environments. Findings showed surprising similarities across groups in terms of numbers of "no difficulty" responses and awareness of listening barriers related to speaker and environmental characteristics. Unsurprisingly, children who are D/HH were more likely to discuss hearing technologies and to attribute difficulties to their hearing abilities. Findings suggest that children who are D/HH with poor speech discrimination in noise abilities require support in developing awareness of and expressing difficulties with listening abilities.

Mathematics anxiety in deaf, hard of hearing, and hearing college students.

While mathematics anxiety (MA) has been widely researched in recent decades, this study addresses significant gaps: namely, research that explores the relationship between MA and self-reported mathematics experiences; samples adults with a range of MA levels; and controls for general anxiety. Additionally, the study sampled deaf and hard of hearing (DHH) students, whose diverse life and educational experiences often differ from hearing students'. We investigated whether DHH students' experiences with mathematics (i.e., parental behaviors, school environment, and mathematics feelings) and demographic variables (i.e., hearing status, age, and gender) predict their MA, and whether these relationships differ from those in hearing students. Self-report questionnaires were completed by 296 DHH and hearing college students. Linear regression analyses controlling for general anxiety led to the following inference: DHH students who reported more positive attitudes toward mathematics and school environments demonstrated higher MA. Also, the relationships between mathematics feelings, parental behaviors, and MA differed between DHH and hearing students. Logistic regression analyses showed no contribution of MA to students' likelihood of pursuing STEM degrees in either DHH or between DHH and hearing groups. Overall, this work breaks new ground in the study of MA in DHH students and challenges standard views of the relationships between MA and individual experiences.

Family-Centered and School-Based Enhancement of Listening and Spoken Language.

Children who are deaf/hard of hearing, including those from varied cultural and linguistic backgrounds, can use hearing technology to develop listening and spoken language successfully if given appropriate support. This is best accomplished by interprofessional teams providing caregivers with family-centered support from early intervention through the school-aged years. This approach is best practice because development of listening, spoken language, literacy, and social skills is most effective when caregivers are the primary communication partners and intervention agents, supported by qualified professionals. Special considerations are needed for families who have low access to services.

Pictorial Phenomena Depicting the Family Climate of Deaf/Hard of Hearing Children and Their Hearing Families.

This mixed method study (Explanatory Design - the Participant Selection Model) investigated the use of joint drawing (the Family Squiggle) as a family climate assessment tool for hearing families who have a deaf/hard of hearing (D/HH) child. The goal was to evaluate the possibilities of applying a quantitative approach to characterize the pictorial phenomena produced by hearing families who have a D/HH child and then apply qualitative research approaches to better understand the meaning of these phenomena. Twenty-eight hearing families (parents and child) whose child was diagnosed as D/HH and used hearing devices (hearing aids and implant) were recruited along with 16 families with a hearing child of a similar age enrolled in a mainstream school. The sessions involved a joint drawing followed by a family interview. In the quantitative stage, pictorial phenomena for which there was a significant association between the phenomena and the group of families were defined. These were: (1) the number of dominant images, (2) images occupying less than a quarter of the page, (3) images with accentuated outlines, (4) moderate colorfulness with four to five colors in each drawing, (5) minimal representation of the face, (6) concrete rather than creative titles, (7) muting of conflictual themes, and (8) images reminiscent of hearing devices (hearing aids and implant). In the qualitative phase, interviews were conducted with the hearing families with a D/HH child to better understand the meaning of these pictorial phenomena. The findings suggest that each of these phenomena represent the preoccupation of the family with D/HH, capture a certain aspect of family dynamics, and together provide a broader and deeper picture of the family climate and the interactions between the children's family and hearing. This assessment tool may thus be utilized when verbal tools cannot be easily applied.

Healthcare providers' and deaf patients' interpreting preferences for critical care and non-critical care: Video remote interpreting.

BACKGROUND: While Video Remote Interpreting services provides prompt services for emergency care and is cheaper than in-person interpreting services, there have been several issues, such as poor connection and limited flexibility to maneuver. OBJECTIVES: This study proposes three research questions and four hypotheses to identify healthcare providers and deaf/hard of hearing (DHH) patients' preferences for VRI and in-person interpreting on critical care and non-critical care. METHODS: The study utilizes a mixed methods design incorporating both an online survey and qualitative interviews. A total of 103 participants responded to the online survey. This included 36 healthcare providers who worked with limited English proficiency (LEP) patients, 26 healthcare providers who worked with DHH patients, and 41 DHH patients. Qualitative interviews were also conducted with eight healthcare providers and eight DHH patients to explore the online survey findings. RESULTS: In the Part I study, healthcare providers (n = 62) included 16 males and 45 females; most professions were dentists, nurse practitioners, and students. DHH patients (n = 41) included 17 males and 22 females; most education was graduate or professional degrees. There was no statistical difference in their preference uses for critical care (p = 1.000), but there was a statistical difference for non-critical care (p = .035). In the Part II study, both healthcare providers and DHH patients preferred in-person interpreting for critical care to obtain effective communication, translation accuracy, and better treatment. CONCLUSIONS: Recommendation to improve VRI equipment and training with healthcare providers, hospital administrators, VRI companies, VRI interpreters, and DHH patients to improve healthcare communication.

Enhancing language in children who are deaf/hard-of-hearing using augmentative and alternative communication technology strategies.

BACKGROUND: Despite early identification and intervention, many children who are deaf/hard of hearing (D/HH) demonstrate significant gaps in language development which can directly impact social interactions. AIMS: The objective of this pilot study was to determine whether integrating augmentative and alternative communication (AAC) core word language strategies into a speech-language therapy program for young children who are D/HH improves spoken language outcomes. METHODS: Eleven young children, median age 5 years 7 months (range 3y;11 m to 10y;8 m) with bilateral hearing loss were enrolled in a single-case experimental design and completed a 24-week intervention that incorporated high-tech AAC strategies into a traditional speech-language therapy model (technology-assisted language intervention or TALI). The goal of the TALI was to improve spoken language development in children who were D/HH. Language samples were collected throughout the study and pragmatic language was assessed pre and post intervention. RESULTS: At the end of 24 weeks, children demonstrated a significant increase in their mean length of utterance, number of words spoken, and mean turn length according to language samples. Children also made gains in their pragmatic skills pre to post intervention. CONCLUSIONS: Results of this study suggest that using AAC core word language strategies delivered via iPad technology may support continued and rapid spoken language skill growth among young school-age children who are D/HH. By leveraging AAC technology, we are pioneering a structured and dynamic approach to language learning, building an effective foundation for concepts and grammar for children who are D/HH.

Telepractice delivery of family-centred early intervention for children who are deaf or hard of hearing: A scoping review.

INTRODUCTION: The use of telepractice, a method of delivering services through telecommunications technologies that provides two-way, synchronous audio and video signals in real-time, is becoming increasingly commonplace in early childhood education and intervention for children who are deaf or hard of hearing. Although the use of telepractice has been validated in the health sector as a viable and effective alternative to in-person service provision, evidence to support its use in the delivery of family-centred early intervention is still emerging. The purpose of this scoping review was to describe the current use of telepractice in the delivery of family-centred early childhood intervention for children who are deaf or hard of hearing, and their families. METHOD: The review followed the framework outlined by the Joanna Briggs Institute (2015), including an iterative three-step search strategy. Specific inclusion criteria and data extraction fields were outlined in advance. RESULTS: A total of 23 peer-reviewed publications were included in the review. Most publications (70%) provided anecdotal evidence of the challenges and benefits associated with telepractice. The remaining publications (30%) reported on research studies evaluating the effectiveness of early intervention delivered through telepractice. Of the 23 included papers, 18 viewed the use of telepractice positively while the remaining 5 reported mixed conclusions and the need for more data. DISCUSSION: Current evidence in the literature indicates that telepractice can be an effective model for delivering family-centred early intervention for children who are deaf or hard of hearing. However, more research is needed to substantiate the use of telepractice as a viable alternative to traditional in-person services, rather than being seen as supplemental to such services.

Bilingual skills of deaf/hard of hearing children from Spain.

BACKGROUND/AIMS: This study described the first language (L1) and second language (L2) skills of a group of Spanish deaf/hard of hearing (DHH) children who were bilingual. METHODS: Participants included parents of 51 DHH children from Spain. Parents completed an electronic survey that included questions on background, details on child's hearing loss, and bilingual status and L2 exposure. Parents also completed the Student Oral Language Observation Matrix, a rating scale that describes language skills. RESULTS: DHH bilingual children demonstrated L1 skills that were stronger than their monolingual DHH peers. Bilingual children demonstrated a wide range of L2 proficiency, and most were exposed to an L2 through parents and/or schooling. The majority of parents reported that their children demonstrated L2 skills that were either better than or at the level they had expected. CONCLUSION: These results correspond with earlier studies that indicate the DHH children are capable of becoming bilingual. Implications for clinical practice are discussed.

Parental Support for Language Development During Joint Book Reading for Young Children With Hearing Loss.

Parent and child joint book reading (JBR) characteristics and parent facilitative language techniques (FLTs) were investigated in two groups of parents and their young children; children with normal hearing (NH; n = 60) and children with hearing loss (HL; n = 45). Parent-child dyads were videotaped during JBR interactions, and parent and child behaviors were coded for specific JBR behaviors using a scale developed for this study. Children's oral language skills were assessed using the Preschool Language Scale-4 (PLS-4). Parents of children with HL scored higher on two of the four subscales of JBR: Literacy Strategies and Teacher Techniques. Parents of children with NH utilized higher level FLTs with their children who had higher language skills. Higher level FLTs were positively related to children's oral language abilities. Implications are discussed for professionals who work with families of very young children with HL.

Measuring Costs and Outcomes of Tele-Intervention When Serving Families of Children who are Deaf/Hard-of-Hearing.

BACKGROUND: Optimal outcomes for children who are deaf/hard-of-hearing (DHH) depend on access to high quality, specialized early intervention services. Tele-intervention (TI), the delivery of early intervention services via telehealth technology, has the potential to meet this need in a cost-effective manner. METHOD: Twenty-seven families of infants and toddlers with varying degrees of hearing loss participated in a randomized study, receiving their services primarily through TI or via traditional in-person home visits. Pre- and post-test measures of child outcomes, family and provider satisfaction, and costs were collected. RESULTS: The TI group scored statistically significantly higher on the expressive language measure than the in-person group (p =.03). A measure of home visit quality revealed that the TI group scored statistically significantly better on the Parent Engagement subscale of the Home Visit Rating Scales-Adapted & Extended (HOVRS-A+; Roggman et al., 2012). Cost savings associated with providing services via TI increased as the intensity of service delivery increased. Although most providers and families were positive about TI, there was great variability in their perceptions. CONCLUSIONS: Tele-intervention is a promising cost-effective method for delivering high quality early intervention services to families of children who are DHH.