The Impact of Language Input on Deaf and Hard of Hearing Preschool Children Who Use Listening and Spoken Language
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| Title: | The Impact of Language Input on Deaf and Hard of Hearing Preschool Children Who Use Listening and Spoken Language |
|---|---|
| Language: | English |
| Authors: | Rufsvold, Ronda, Wang, Ye, Hartman, Maria C., Arora, Sonia B., Smolen, Elaine R. |
| Source: | American Annals of the Deaf. 2018 163(1):35-60. |
| Availability: | Gallaudet University Press. 800 Florida Avenue NE, Denison House, Washington, DC 20002-3695. Tel: 202-651-5488; Fax: 202-651-5489; Web site: http://gupress.gallaudet.edu/annals/ |
| Peer Reviewed: | Y |
| Page Count: | 26 |
| Publication Date: | 2018 |
| Document Type: | Journal Articles Reports - Research |
| Education Level: | Preschool Education |
| Descriptors: | Deafness, Hearing Impairments, Preschool Children, Vocabulary Development, Comprehension, Concept Formation, Speech Communication, Listening, Audio Equipment, Computer Software, Statistical Analysis, Comparative Analysis, Adults, Intelligence Tests, Vocabulary, Verbal Ability, Individual Characteristics, Assistive Technology, Special Schools |
| Geographic Terms: | New York, California, Missouri |
| Assessment and Survey Identifiers: | Boehm Test of Basic Concepts, Peabody Picture Vocabulary Test |
| ISSN: | 0002-726X |
| Abstract: | The researchers investigated the effects of adult language input on the quantity of language, vocabulary development, and understanding of basic concepts of deaf and hard of hearing (DHH) children who used listening and spoken language. Using audio recording and Language ENvironment Analysis (LENA) software, the study involved 30 preschool DHH children who used spoken language as their communication modality and 11 typically hearing same-age peers. The children's language and the language spoken to them during all waking hours over a 2-day period (16 hours per day) were recorded and analyzed quantitatively and were compared to the children's performance on the Boehm Test of Basic Concepts and the Peabody Picture Vocabulary Test. The results highlight the relationship between the quantity of adult language and the language, vocabulary, and basic concept knowledge of DHH preschool children who use listening and spoken language. |
| Abstractor: | As Provided |
| Number of References: | 56 |
| Entry Date: | 2018 |
| Access URL: | https://gupress.gallaudet.edu/annals/past.htm |
| Accession Number: | EJ1177850 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwE2TgEvbqjeYKnrwxfJ_x4wAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDIudDPdDBteuIkkMDgIBEICBm5YO8fYaU2vBJvvExOIqgENjHA2qi0tZ5YnKvHRHo75wLCk2wt7IdCEMDCvN-QuRg4XzdHq-2qfPAgFXCXQzOCVcA4xkkArD3L8ot-vLN3Bm-uHvuqRtyE1EucZe3lxiPp7VKD5IY_l4iPNFqhdf8BIZZD11wpKRLhxaLC-XwvFSh44e1XUSec7uzHhZDHfeZ_RBoazuDS9oZhye Text: Availability: 1 Value: <anid>AN0129587140;aod01apr.18;2018Aug28.08:39;v2.2.500</anid> <title id="AN0129587140-1">The Impact of Language Input on Deaf and Hard of Hearing Preschool Children Who Use Listening and Spoken Language </title> <p>ARRAY(0x562643151f48)</p> <p>Since the inception of federally mandated newborn hearing screening, there have been inevitable changes in already-existing early intervention programs as well as the overall field of deaf education. Two to three out of every 1,000 children born in the United States are diagnosed with permanent hearing loss every year; 90% of these children are born to hearing parents who use spoken language to communicate ([<reflink idref="bib37" id="ref1">37</reflink>] ). In addition to the legislative support for early detection of hearing loss, technological advances have intensified the pace of change. Assistive hearing technology, including digital hearing aids, cochlear and brainstem implants, and frequency modulation (FM) and Roger systems, are available to parents who choose spoken language as a communication modality for their child who is deaf or hard of hearing (DHH). Although the technology can greatly improve hearing and spoken-language understanding for these children, a discrepancy remains between the language acquisition of a child with normal hearing and that of a child with hearing loss ([<reflink idref="bib11" id="ref2">11</reflink>] ; [<reflink idref="bib46" id="ref3">46</reflink>] ; [<reflink idref="bib47" id="ref4">47</reflink>] ; [<reflink idref="bib51" id="ref5">51</reflink>] ). In the present study, we sought to examine the relationship between adult language input and the language, vocabulary, and knowledge of basic concepts of DHH preschool children who use listening and spoken language.</p> <hd id="AN0129587140-2">Adult Language Input for Children With Normal Hearing</hd> <p>Much of the research suggests that both the quality and quantity of adult language input influence a child's language. [<reflink idref="bib28" id="ref6">28</reflink>] provided the first direct evidence that the amount of exposure to speech is important to vocabulary growth and later to syntactic development. Their study was one of the first to question the notion that individual differences in vocabulary are dependent on a child's innate ability or unique learning capacity. Huttenlocher et al. measured the rate of vocabulary growth of 22 children ages 14–26 months at several points in time and found a significant relationship between the children's acquisition of vocabulary and the amount of talk mothers directed at the children, with mothers who talked more having children with larger, faster-growing vocabularies than children whose mothers talked less. Huttenlocher et al. concluded that this difference reflected the influential role of parental language input rather than child ability or hereditary factors alone.</p> <p>[<reflink idref="bib27" id="ref7">27</reflink>] also explored the relationship between maternal talk and child language, but advanced the discussion by noting associations between maternal education and the amount of talk mothers addressed to their children. Using a database of transcriptions, Hoff-Ginsberg studied mealtime conversations of 63 mother–child dyads (the children ranging in age from 18 to 24 months). The highest educational attainment of 30 of the mothers was completion of high school; the other 33 mothers had college degrees. Hoff-Ginsberg found that the college-educated mothers talked more to their children and produced more utterances on a single topic than the high school–educated mothers. However, overall, children of mothers who produced more utterances engaged in more verbal utterances themselves and regularly maintained the topics of their mothers' speech. Hoff-Ginsberg therefore surmised that the amount mothers talked to their children was influenced not only by maternal education but by individual children's conversational traits.</p> <p>Also in the mid-1990s, [<reflink idref="bib26" id="ref8">26</reflink>] were conducting their own comprehensive research on the early language environments of young children from 42 families they described as representing lower, middle, and upper socioeconomic backgrounds. The researchers collected 1-hour audio recordings and observations in the homes of the children, beginning when they were 7–9 months old and continuing through age 3 years. Hart and Risley found that the number of adult words spoken to the children from infancy to age 3 years predicted almost all of the variance in the children's language ability and IQ when they were in preschool. The researchers also found that educated parents of higher socioeconomic status spoke to their children at an average rate of 3,000 words per hour, while parents of lower socioeconomic status used fewer words per hour—an average rate of 500 words. Hart and Risley estimated that by age 3 years the first group of children had heard 33 million words, but that the second group had heard only 9 million. This research suggests that the quantity of parent talk can be regarded as a modifiable variable, causally related to children's language learning, vocabulary development, and school readiness.</p> <p>Numerous studies have validated and extended upon the findings of [<reflink idref="bib26" id="ref9">26</reflink>] . [<reflink idref="bib43" id="ref10">43</reflink>] did a prospective longitudinal study of the association between caregiver language input to infants at age 9 months and their subsequent language at ages 12, 18, and 30 months. At each of these points, mother–infant dyads were videotaped, and language comprehension was calculated by parent report and correlated with a separate language measure. Rollins found that the total number of words the mothers used when their infants were 9 months predicted later vocabulary; however, a particular type of language interaction yielded the greatest predictive power. Rollins referred to the mothers' use of caregivers' contingent comments, or talk about child-centered acts, in which the mother discussed an object on which joint attention was focused or narrated an ongoing activity in which the child was engaged. Rollins's work contributed to the idea that it was not only the amount of talk that influenced later language, but also the particular kind of talk that explained variations in early language development.</p> <p>In another longitudinal study, [<reflink idref="bib29" id="ref11">29</reflink>] examined the role of caregiver speech on children's syntactic development; their sample consisted of 47 parent–child pairs of diverse socioeconomic background in which the children were 14–46 months old. Employing a lagged correlation analysis, Huttenlocher et al. evaluated the variety of words and syntactic structures produced by caregivers and children. Their results showed sizable individual differences among children and indicated that variety of early caregiver speech significantly predicted corresponding diversity in later child speech. In terms of vocabulary, child speech also predicted caregiver speech, suggesting mutual influence. Socioeconomic background was also related to language growth, but this was partially mediated by differences in caregiver speech, demonstrating the general influence of caregiver speech on language growth.</p> <p>Taken together, these studies highlight specific behaviors in parents that positively influence children's early language development and later school readiness. In particular, the studies point to the importance of quantity of child-directed parent language that is diverse in word types and communicative functions, parent language that is contingently responsive to child utterances and follows the child's cues, and parent language that is grammatically complex and attuned to children's growing language skills. Children also play an important role in their own learning experiences, as exemplified by links between child characteristics and parenting behaviors. Children shape parents, just as parents shape children. In this way, the transactional nature of children's early language and learning experiences becomes apparent.</p> <hd id="AN0129587140-3">Adult Language Input for Children Who Are Deaf or Hard of Hearing</hd> <p>Fewer studies have explored the impact of quantity of adult language input for children who are DHH, but similar results have been reported. It should be noted that the focus of the present review of literature is on children who are DHH and use listening and spoken language, unless otherwise indicated. Using both quantitative and qualitative analyses, [<reflink idref="bib9" id="ref12">9</reflink>] investigated the spoken language of three hearing mothers directed at their 3-to-5-year-old deaf children. Cheskin found that, overall, all three mothers spoke in short sentences that were usually grammatically complete but used repetitious and restrictive vocabulary as well as repeated utterances far more frequently than mothers of typically hearing children. Cheskin noted that the mothers missed many opportunities to involve their children in verbal interaction.</p> <p>In a longitudinal study, [<reflink idref="bib32" id="ref13">32</reflink>] observed 20 deaf and 20 hearing children during free play with their hearing mothers when the children were 22 months and 3 years of age. Compared to the hearing children, the deaf children were severely language delayed, with deaf 3-year-olds using less language (speech or sign) than hearing 22-month-olds. The deaf children communicated primarily through nonlinguistic vocalizations, with increasing use of gestures from 22 months to 3 years of age. The mothers of the deaf children primarily communicated through speech, but they used more gestures than the mothers of the hearing children. The deaf children did not visually attend to much of their mothers' communication and were therefore exposed to much less communication than the hearing children. The researchers suggested that the results of the study could inform intervention efforts focused on increasing the quantity of perceived linguistic input by a deaf child.</p> <p>The studies by [<reflink idref="bib9" id="ref14">9</reflink>] and [<reflink idref="bib32" id="ref15">32</reflink>] occurred prior to the advent of newborn hearing screening and before widespread use of digital hearing aids and cochlear implants, so the amount of speech the children actually heard is unknown. This must be taken into account when these findings are being interpreted.</p> <p>[<reflink idref="bib17" id="ref16">17</reflink>] also explored the relationship between maternal contributions and oral expressive-language skills in young children with hearing loss, specifically those with cochlear implants. Thirty-two mothers (mean age = 36 years) and their children (mean age = 4.8 years) were videotaped during free play and storybook interactions. Mothers' and children's quantitative linguistic input (mean length of utterance, number of word types) and mothers' qualitative linguistic input (facilitative language techniques—recasts and open-ended questions) were analyzed through correlation and regression analysis. In general, the results showed that qualitative and quantitative maternal involvement was positively related to children's language skills. From these results, DesJardin and Eisenberg surmised that the performance of young cochlear implant users may vary in part because of their mothers' sense of involvement and self-efficacy, as well as the ways in which mothers interact with their children. The researchers suggested that these results might influence intervention efforts that enhance caregivers' involvement, self-efficacy, and linguistic input to better support the language development of young children after cochlear implantation.</p> <p>In another study, which compared joint book-reading behaviors (i.e. engagement, literacy strategies, adult teacher techniques, interactive reading, and guided reading) and facilitative language techniques (e.g. open-ended questions) of parents of children with hearing loss (n = 45) and parents of children with normal hearing (n = 60), [<reflink idref="bib16" id="ref17">16</reflink>] found a significant difference between the groups. The researchers developed a scale to code specific parent behaviors during analysis of parent–child videotapes, and children's oral language skills were assessed by means of the Preschool Language Scale (4th ed.; [<reflink idref="bib56" id="ref18">56</reflink>] ). The results showed that parents of children with hearing loss used more literacy strategies (e.g. pointing to and labeling pictures) and teacher techniques (e.g. elaborating on child ideas) than parents of children with normal hearing. Parents of children with normal hearing, though, used higher-level facilitative language techniques with their children who had higher language skills. Higher-level facilitative language techniques were positively related to children's oral language abilities. DesJardin et al. hypothesized that this was due to specific behaviors and techniques related to joint reading skills being taught by individual children's early interventionists. This suggests that with coaching, parents of children with hearing loss may use an increased quantity of adult words compared to parents of children with normal hearing during some activities.</p> <p>Most of the research on language input for children with hearing loss was conducted prior to the introduction of mandated newborn hearing screening, which has further emphasized the heterogeneous nature of this population. Recent advances in speech recognition technology, such as the Language ENvironment Analysis (LENA) device, have produced a small body of research on the quantity of language input for children with hearing loss, particularly ones who use listening and spoken language (e.g. [<reflink idref="bib2" id="ref19">2</reflink>] ).</p> <hd id="AN0129587140-4">Language Input Studies Using LENA</hd> <p>Language ENvironment Analysis (LENA) was developed by the LENA Research Foundation, Boulder, CO. A small device, the LENA recorder, is worn on the child's chest in a pouch on a specially designed vest. The LENA recorder is worn continuously for 16 hours while it records the auditory environment around the child. The audio recording from the LENA device is then downloaded into the LENA software, which uses statistical modeling and a series of advanced algorithms to automatically analyze and segment the audio data. The software outputs variables for adult word count (AWC), conversational turn count (CTC), and child vocalization count (CVC), which have been used to demonstrate quantity aspects of language input, essentially providing a pedometer for words ([<reflink idref="bib50" id="ref20">50</reflink>] ).</p> <p>In one of the first studies to use full-day LENA recordings, [<reflink idref="bib53" id="ref21">53</reflink>] examined whether 30 young hard of hearing (HH) children received amounts of exposure to adult words and conversational interactions similar to the amounts received by 30 age-matched peers with normal hearing, and found no difference in AWC and CTC. For the HH group, VanDam et al. did find, however, that audiological variables (pure tone average [PTA] and speech intelligibility index) were associated with levels of parental talk, with children with more auditory access engaging in a greater number of conversational turns. It is possible that parents may be sensitive to the degree to which their HH children are able to access environmental talk and thus alter their behavior accordingly. Interestingly, when VanDam et al.'s data were compared to that for the LENA normative sample (comprising children with normal hearing), they found that both of the groups in their study produced higher AWCs and CTCs than the normative sample. The researchers called for further studies using LENA to explore particular ways in which the linguistic environments of HH children may be modified to support language learning.</p> <p>In a later study ([<reflink idref="bib1" id="ref22">1</reflink>] ), the same three researchers used LENA to note quantity of adult words, adult–child conversational turns, and electronic media exposure in the auditory environments of toddlers who were HH and to examine whether these factors contributed to the variability in children's communication outcomes. The study found that HH children aged 2–3 years (N = 28) who engaged in more conversational turns demonstrated better linguistic outcomes on a standardized test than children who engaged in fewer conversational turns. Children who had greater electronic media exposure demonstrated reduced interactions. These data suggest that a large quantity of language input, along with less exposure to electronic media, had a positive influence on the language of these HH children. That is, optimal language-learning environments for HH toddlers in the study included frequent linguistic interactions between parents and children. It can be concluded from the study that to achieve the goal of optimal language-learning environments, parents should be encouraged to reduce their HH toddlers' exposure to electronic media.</p> <p>Meanwhile, in studies by [<reflink idref="bib2" id="ref23">2</reflink>] and [<reflink idref="bib54" id="ref24">54</reflink>] , the LENA technology was used to measure the language variables of parents and children involved in early hearing detection and intervention programs for children with hearing loss. The findings of the study by Aragon and Yoshinaga-Itano indicated that some Spanish-speaking families with DHH children had AWCs, CTCs, and CVCs that were comparable to these counts for English-speaking families with both DHH and typically developing children, even though the sample of Spanishspeaking families had a markedly lower level of maternal education. Similarly, in the study by [<reflink idref="bib54" id="ref25">54</reflink>] , there was no significant difference on the basis of hearing status in the characteristics of the children's language environment, a finding that suggests that the intervention might have helped foster a rich language environment for the families despite the communication issues that can arise as a result of hearing loss.</p> <p>Additionally, [<reflink idref="bib54" id="ref26">54</reflink>] found that higher AWCs were associated with higher CTCs and that an increase in CTC resulted in higher verbal comprehension scores. In contrast, a study by [<reflink idref="bib55" id="ref27">55</reflink>] on the effectiveness of an intervention program for parents of children with language deficits found no significant improvement in either AWC, CTC, or CVC from preintervention to postintervention. This finding perhaps could be attributed to the small sample (six children and their parents) and the brevity of the intervention program (4 weeks).</p> <p>The repeated theme in the studies discussed in the present literature review is that merely exposing children to a large quantity of linguistic input is not sufficient for optimal language development. In most cases, what matters is not the overall amount of adult talk, but the number of adult–child conversational turns or the amount of parental verbal responsiveness. Additionally, distant speech or electronic media exposure has little positive effect on language growth. Most important is the amount of comprehensible speech directed at the child in a context in which the child is invested. The role of the adult is to simplify and draw attention to what is said, which may aid children in comprehension and thus increase the rate of language learning.</p> <hd id="AN0129587140-5">Vocabulary and Basic Concepts Development of Children Who Are Deaf or Hard of Hearing</hd> <p>For children with hearing loss, access to sound, including spoken language, is achieved only after they receive and consistently wear their amplification. In the United States, the Food and Drug Administration has approved cochlear implantation in qualifying children at age 12 months and older. Thus, in many cases, these children have language delays of 12 months or more. Many struggle to close the gap with their hearing peers. Because of this auditory deprivation, children who are DHH are at a significant disadvantage when it comes to developing age-appropriate vocabulary and later skills related to literacy ([<reflink idref="bib35" id="ref28">35</reflink>] ). The literature suggests that children with hearing loss have smaller lexicons, acquire new words at a slower rate, and have a narrower range of conceptual understanding ([<reflink idref="bib11" id="ref29">11</reflink>] ; [<reflink idref="bib14" id="ref30">14</reflink>] ; [<reflink idref="bib19" id="ref31">19</reflink>] ; [<reflink idref="bib31" id="ref32">31</reflink>] ; [<reflink idref="bib33" id="ref33">33</reflink>] ; [<reflink idref="bib36" id="ref34">36</reflink>] ; [<reflink idref="bib41" id="ref35">41</reflink>] ; [<reflink idref="bib44" id="ref36">44</reflink>] ; [<reflink idref="bib46" id="ref37">46</reflink>] ; [<reflink idref="bib52" id="ref38">52</reflink>] ).</p> <p>Even with the perfect trifecta of opportunity—early identification, early implantation, and early intervention—many DHH children still struggle with spoken-language acquisition ([<reflink idref="bib12" id="ref39">12</reflink>] ; [<reflink idref="bib21" id="ref40">21</reflink>] ; [<reflink idref="bib49" id="ref41">49</reflink>] ; [<reflink idref="bib51" id="ref42">51</reflink>] ). For example, in a comparison study of age-matched, prelingually deaf cochlear implant users (n = 16) and hearing children (n = 16), the former group produced shorter sentences with fewer conjunctions and more usage errors than the latter group ([<reflink idref="bib49" id="ref43">49</reflink>] ). Another early study found that over 50% of DHH children (N = 70) remained severely delayed in language even after more than 2 years of experience with cochlear implantation ([<reflink idref="bib51" id="ref44">51</reflink>] ).</p> <p>Studies of vocabulary development often report slower rates of word learning by children with cochlear implants ([<reflink idref="bib12" id="ref45">12</reflink>] ; [<reflink idref="bib13" id="ref46">13</reflink>] ), with the most notable effect on language being delayed in the development of receptive and expressive vocabulary ([<reflink idref="bib12" id="ref47">12</reflink>] ; [<reflink idref="bib20" id="ref48">20</reflink>] ; [<reflink idref="bib40" id="ref49">40</reflink>] , [<reflink idref="bib41" id="ref50">41</reflink>] ), including basic concepts ([<reflink idref="bib8" id="ref51">8</reflink>] ; [<reflink idref="bib15" id="ref52">15</reflink>] ; [<reflink idref="bib25" id="ref53">25</reflink>] ). Whereas hearing children are expected to have 1 year of vocabulary growth in 1 year (mean rate of 1.0), children with cochlear implants have been shown to have 0.46–0.72 in 1 year ([<reflink idref="bib13" id="ref54">13</reflink>] ). In a study of 147 children, [<reflink idref="bib12" id="ref55">12</reflink>] found that children who utilized listening and spoken language and signs in English word order showed a rate of vocabulary growth less than that of a sample of normally hearing children; the researchers also found that the gap widened over time.</p> <p>[<reflink idref="bib22" id="ref56">22</reflink>] investigated language scores of 153 children (mean age = 5.10 years) with cochlear implants who used an auditory-oral approach. It was found that 50% of the children reached age-appropriate scores in receptive vocabulary, 58% in expressive vocabulary, 46% in verbal intelligence, 47% in receptive language, and 39% in expressive language. The data also suggested that children who received their cochlear implants earlier performed better on all language tests. However, judging from their scores, a large percentage of these children might be stiffly challenged by the academic language demands of an elementary curriculum.</p> <p>Meanwhile, a child's understanding of basic concepts, and the function words they comprise, has important implications for language development and later reading skills ([<reflink idref="bib6" id="ref57">6</reflink>] ). Basic concepts refers to words that indicate location (under, on top of), number (more than, less than), size (big, little), time (old, young), and feelings (happy, sad). These words help their users follow directions, describe objects and quantities, order events, and regulate emotions and behaviors. They are also essential for making comparisons, sequencing, and classifying, skills that facilitate higher-order thinking.</p> <p>Boehm and colleagues (see, e.g. [<reflink idref="bib4" id="ref58">4</reflink>] ) found basic concepts to be difficult for children because they have no constant referent. To compound the challenge, many basic concepts are function words or are syntactically combined with function words. For instance, "on top of the chair" comprises the function words on, top, of, and the, but require the noun chair to complete the prepositional phrase. When the prepositional phrase is presented as a command (e.g. "Put the ball on top of the chair") and the function words are omitted, the phrase is reduced to "put ball chair," which reduces precision and leaves out important spatial-referencing information.</p> <p>Very few studies have specifically investigated the application of basic concept knowledge separate from other language use by children. In an early study, [<reflink idref="bib8" id="ref59">8</reflink>] investigated the basic concept development of 17 deaf children and their age-matched hearing peers using the Bracken Basic Concept Scale ([<reflink idref="bib7" id="ref60">7</reflink>] ). Of the 17 deaf children (mean age 76.1 months), roughly half were reported to communicate using Total Communication; the others used oral communication. A trained examiner administered the test using each child's principal mode of communication. Though they did not break down their data by mode of communication, Bracken and Cato reported that the deaf children scored approximately two standard deviations below their matched peers without hearing loss. This suggested that children who were DHH had a significant disadvantage in learning basic concepts. In a later study, [<reflink idref="bib6" id="ref61">6</reflink>] used a single-participant design to determine whether an experimental "Basic Concept–Curriculum-Based Measure" (BC-CBM) could accurately assess and monitor progress in basic concept acquisition after a period of direct instruction. Four children who were DHH and used listening and spoken language as their primary mode of communication (mean age = 4 years 6 months) participated in the experiment. It was found that the BC-CBM scores improved during intervention. These results provided evidence to support additional, larger-scale field-testing of the BC-CBM.</p> <p>Noting the role of basic concepts as the academic building blocks in early education programs, as well their importance for academic success and higher-order thinking, [<reflink idref="bib38" id="ref62">38</reflink>] studied how nine preschool teachers of children who were DHH used specific strategies (i.e. positive examples, nonexamples, continuous conversion, and isolating the concept) during direct instruction of basic concepts. All nine educators taught in self-contained classrooms and used a listening and spoken-language approach. Results indicated that the teachers frequently used one strategy (positive examples) but did not consistently use the other three. This finding suggests that instruction specifically incorporating recommended strategies for teaching basic concepts is needed for DHH children in order to optimize their academic preparation for successful entry into mainstream kindergarten settings.</p> <p>Overall, children who are DHH experience challenges developing basic concepts due to their abstract nature and their dynamic relationship to other words within utterances that influence the concepts' meaning. In particular, function words, which receive less stress in the flow of speech but are necessary to construct full syntactic structures, seem particularly difficult for children with hearing loss to acquire. Because these elements are of low perceptual salience, it is understandable that they pose a challenge for children with incomplete or degraded access to auditory signals. A foundation in basic concept knowledge is critical to the development of more complex language and academic success. Given the importance of vocabulary and basic concepts in the holistic development of reading and reading comprehension abilities, children with smaller vocabularies and less knowledge of basic concepts are at a disadvantage.</p> <hd id="AN0129587140-6">Purpose of the Study</hd> <p>In the present study, we sought to examine the influence of adult spoken language on the quantity of spoken language, vocabulary, and basic concept development of preschool children with hearing loss who used listening and spoken language. The data from this study can be applied to inform teaching and coaching practices with parents of children with hearing loss. Educators, speech-language pathologists, and auditory-verbal therapists coach parents to embellish everyday conversations to increase the frequency which with they talk to their children ([<reflink idref="bib11" id="ref63">11</reflink>] ). It is suggested to parents that the more they talk, the more their children will learn to talk ([<reflink idref="bib42" id="ref64">42</reflink>] ). More research is needed to demonstrate the impact of parents' language input on their child's language development, especially vocabulary development.</p> <hd id="AN0129587140-7">Research Questions</hd> <p>The present study was guided by four research questions:</p> <olist> <item> What demographic characteristics of the participants (i.e. age, gender, degree of hearing loss, type of hearing loss, type of amplification, aided hearing thresholds, hearing status of parents, presence of additional disability, socioeconomic status, and parent education) are related to the quantity of adult input, the quantity of child language, the child's vocabulary, and the child's understanding of basic concepts?</item> <item> Is the quantity of adult language input related to the quantity of child language, the child's vocabulary, and the child's understanding of basic concepts?</item> <item> Is there a difference in the quantity of adult language or in the quantity of the child's language based on hearing status (i.e. typical hearing vs. hearing loss)?</item> <item> Does the group variable (i.e. typical hearing vs. hearing loss) moderate the relationship between the quantity of parent language input and the child's quantity of language?</item> </olist> <hd id="AN0129587140-8">Method Participants</hd> <p>Forty-one children 36–59 months of age were studied (M = 46.93, SD = 7.56; see [<reflink idref="bib1" id="ref65">1</reflink>] and [<reflink idref="bib2" id="ref66">2</reflink>] ). The study included 30 DHH children, 60.00% of whom used bilateral cochlear implants, 30.00% of whom used unilateral or bilateral hearing aids, and 6.67% of whom used one or more hearing aids and one or more cochlear implants; 3.33% of the DHH children used no amplification. There were 11 children with normal hearing in the study, all of whom used listening and spoken English to communicate. The participants were recruited from three schools for children with hearing loss (in New York, California, and Missouri) that used a listening and spoken-language approach. Each school participated in reverse mainstreaming and included hearing children, though they were fewer in number than the children who were DHH. The teachers at these schools were certified teachers of the DHH who had received similar training on teaching children with hearing loss to listen and use spoken language. To ascertain the feasibility of the project, we secured permission from the executive directors or principals to recruit participants from the schools. The participants received school-based speech-language pathology services 1–5 days per week. Other related services included physical therapy, occupational therapy, and family counseling. More than half of the children with typical hearing</p> <p>(54.5%) were siblings of the DHH participants (n = 5) or relatives of the staff (n = 1) in the same school. Those who were not attended the school as a private parent-paid preschool (n = 5). Tuition for the typically hearing children varied, but it was comparable to that for local preschools in their locale. Only children from monolingual English-speaking families were recruited.</p> <hd id="AN0129587140-9">Procedure</hd> <p>Institutional review board approval for the present study was obtained from Teachers College, Columbia University. Participating teachers and associated staff provided written informed consent. The parents provided informed consent for themselves and on behalf of their preschool children. Families were recruited through the school their children attended. All children and families fitting the inclusion criteria were recruited and invited to participate in the study. Children with hearing loss of any degree or type and children with normal hearing aged 3 years to 4 years 11 months who used spoken English fit the inclusion criteria. Responses to a series of demographic questions were collected by cumulative file record review or parent interview, including questions about parent income, highest level of education attained by both parents, and members of the family living in the home.</p> <p>The Boehm Test of Basic Concepts and the Peabody Picture Vocabulary Test (4th ed.) were administered to all participants. The assessments were conducted in a child-friendly therapy room with reduced distractions. The parents and the child's primary therapist or teacher were invited to observe through a one-way mirror so as to not disrupt the assessment procedure. It took approximately 30 minutes to complete both assessments, which was the length of each child's scheduled daily therapy session.</p> <p>Spoken language was audio-recorded by means of the LENA system. The parents and teachers were trained on the proper technique and use to ensure proper recording. The child wore the device continuously for 16 hours on each of 2 days, including a weekday (including school hours) and a weekend day. [<reflink idref="bib48" id="ref67">48</reflink>] have found that there is almost twice as much child vocalization in the home environment during story time as in the day care environment, a finding that indicates differences between home and other settings such as school. No families returned the LENA device expressing concerns with the recording, but they were instructed that they could withdraw from the study if they desired. To ensure participant confidentiality and privacy, every piece of data was password protected and only accessible by the research team.</p> <hd id="AN0129587140-10">Measures</hd> <hd id="AN0129587140-11">Boehm Test of Basic Concepts</hd> <p>The Boehm Test of Basic Concepts 3–Preschool (BTBC-3; [<reflink idref="bib5" id="ref68">5</reflink>] ) is a criterion-referenced measure that assesses a child's understanding of 26 concepts, including size, direction, position in space, time, quantity, classification, and general concepts. Each concept is tested twice. The child points to one of four picture options when given verbal directions such as "Point to the dog that is on the box." Fifty-two items are tested for each of two age ranges: 3 years to 3 years 11 months and 4 years to 5 years 11 months. Results can be reported as a raw score, the percentage correct, a performance range, and a percentile. The assessment is normed on a standardized sample of 660 children aged 3 years to 5 years 11 months, evenly divided by gender and into six different age groups. The sample was stratified by age, gender, race/ethnicity, parental education level, and geographic region to replicate the U.S. population based on the 1998 U.S. Bureau of the Census demographics report. Although children with hearing loss were not specifically identified in the sample, 11% of the children were diagnosed with a disorder and/or were receiving special services.</p> <p>The BTBC-3 was chosen because it is a widely used and accepted measure of a child's understanding of basic concepts for the specific age range under study. The percentile rank was used as a variable in the present study.</p> <hd id="AN0129587140-12">Peabody Picture Vocabulary Test</hd> <p>The Peabody Picture Vocabulary Test (4th ed. PPVT-4; [<reflink idref="bib17" id="ref69">17</reflink>] ) was used to measure children's receptive vocabulary. The PPVT-4 has two parallel forms, A and B. Either form was used in the present study, on the basis of which school the participants attended. Each form contains training items and 228 test items, each consisting of four full-color pictures as response options on a page. The child points to a picture when given the prompt "Show me———." The test covers a range of vocabulary content areas, including actions, vegetables, tools, and parts of speech across all levels. The PPVT-4 is a norm-referenced standardized measure that is widely used in research and educational settings. The measure was standardized on a pool of 3,540 cases from ages 2 years 6 months through 90 years and older. The age-norm and grade-norm samples were designed to resemble the English-proficient U.S. population from ages 2 years 6 months to 90+ years and closely match 2004 U.S. Bureau of the Census data for demographic variables ([<reflink idref="bib17" id="ref70">17</reflink>] ).</p> <p>The PPVT-4 was chosen because it is a widely used and accepted measure of a child's receptive vocabulary for the specific age range that was studied. The percentile rank was used as a variable in the present study.</p> <hd id="AN0129587140-13">Language ENvironment Analysis (LENA)</hd> <p>The LENA Pro software was used to measure the quantitative language input and outcome of the participants. A thorough natural language study ([<reflink idref="bib23" id="ref71">23</reflink>] ) was conducted over several phases and several years to contribute to product development and normative data. LENA researchers collected a large corpus of full-day spontaneous speech from households of infants and toddlers that were representative of the U.S. population. The reliability of the speech-processing algorithms was determined by comparing the segmentation of the LENA audio-processing algorithms to the segmentation of professional transcribers. The average difference from the criterion rater was 1.3% ([<reflink idref="bib23" id="ref72">23</reflink>] ), indicating strong reliability.</p> <p>The quantity of language input is a measure of the number of words spoken by the parent or caregiver in the near presence of the child (approximately 6–10 feet) measured as adult word counts (AWCs); number of linguistically relevant vocalizations (e.g. speech or babble, but excluding vegetative noises) produced by the child measured as child vocalizations (CVCs); and a count of the number of times an adult responded within 5 seconds of a child vocalization, or vice versa, measured as conversational turns (CTCs). These data are given in raw values and projected values, which reflect the variance in recordings due to timing challenges that could rise at the end of the day. For example, if a recording began later than scheduled on a particular day, it could continue into the early morning hours of the next day. The participants were recorded continuously for 16 hours; depending on the time when they activated their LENA device in the morning (often later on the weekend), the recording could, as we have noted, carry over to the following day. The projected values accounted for these differences to provide one value for both days, so the projected values were used in the analyses.</p> <hd id="AN0129587140-14">Reliability</hd> <p>After completing the assessments, the first author, a teacher of the deaf with about 10 years' experience, and the third author, a lecturer in the DHH program at Teachers College, independently scored the BTBC-3 and PPVT-4 assessments and coded the demographic questionnaire. Interrater reliability was calculated to be 100% on all assessments.</p> <hd id="AN0129587140-15">Data Analysis</hd> <p>IBM SPSS Statistics for Macintosh, Version 24, was used to analyze the data, and all statistical analyses were conducted at the.05 level of significance.</p> <p>For Research Question 1, the specific demographic attributes that were explored included age, gender, degree of hearing loss by ear (normal, mild, moderate, moderate-severe, severe, profound), type of hearing loss by ear (conductive, mixed, sensorineural, neural), type of amplification by ear (cochlear implant, hearing aid, bimodal, FM only), aided hearing thresholds for each ear (using PTA), hearing status of parents, presence of additional disability, family income, and parent education. For the demographic variables that were categorical (i.e. gender, hearing status of parents, presence of additional disability), an independent sample t test was conducted to compare the mean differences between the categories on the continuous variables: AWC, CVC, CTC, PPTV-4, and BTBC-3. For the demographic variables that were continuous (i.e. age and aided hearing thresholds), a Pearson correlation was conducted. For variables with three or more grouping factors (i.e. degree of hearing loss, type of hearing loss, type of amplification), a one-way ANOVA was conducted.</p> <p>For Research Question 2, to test the correlation between quantity of adult language input (AWC, CTC) and the child's quantity of language (CVC, PPVT-4, and BTBC-3), a Pearson correlation analysis was conducted because all of these measures are continuous variables.</p> <p>For Research Question 3, to compare the mean differences in adult language input (AWC, CTC) and child language (CVC, PPVT-4, and BTBC-3) between the groups (hearing vs. hearing loss), a oneway ANOVA was conducted. If there were covariates, an ANCOVA was conducted to control for them.</p> <p>For Research Question 4, if there were any significant differences between the quantity of adult language (AWC) and the child's quantity of language (CVC) as a function of the child's hearing loss, general linear models of ANOVAs and ANCOVAs would be conducted; if there were no significant differences, no further analysis would be necessary.</p> <hd id="AN0129587140-16">Results</hd> <p>[<reflink idref="bib3" id="ref73">3</reflink>] presents means, standard deviations, and ranges on all variables for children with hearing loss, children with normal hearing, and all participants.</p> <p>Research Question 1: What demographic characteristics of the participants (i.e. age, gender, degree of hearing loss, type of hearing loss, type of amplification, aided hearing thresholds, hearing status of parents, presence of additional disability, socioeconomicstatus, and parent education) are related to the quantity of adult language input, the quantity of child language, the child's vocabulary, and the child's understanding of basic concepts?</p> <p>In addressing Research Question 1, we collected demographic information on the participants, then further analyzed it to determine what characteristics or attributes might be linked to the quantitative aspects of language for both the adult(s) and the child, as well as the child's knowledge of basic concepts (BTBC-3) and vocabulary (PPVT- 4). AWC, CTC, and CVC were examined and reported under the three recording conditions: (a) weekday, (b) weekend day, and (c) weekday and weekend day combined, labeled "both."</p> <p>Seven demographic attributes were found to be related: age, gender, parental education, type of amplification, aided hearing thresholds, parental hearing status, and presence of additional disability.</p> <hd id="AN0129587140-17">Age</hd> <p>Participants' age indicates age at the time of recording and is reported in months. Results from a Pearson correlation test showed positive correlations between age and AWC both, r(<reflink idref="bib34" id="ref74">34</reflink>) =.383, p =.025, age and CTC weekday, r(<reflink idref="bib38" id="ref75">38</reflink>) =.325, p =.046, and age and AWC weekday, r(<reflink idref="bib38" id="ref76">38</reflink>) =.455, p =.004 (see [<reflink idref="bib4" id="ref77">4</reflink>] ). Furthermore, a positive Pearson correlation was found between age and BTBC-3, r(<reflink idref="bib41" id="ref78">41</reflink>) =.357, p =.022.</p> <hd id="AN0129587140-18">Gender</hd> <p>An independent t test indicated that there were significant differences between males and females for BTBC-3 scores: females (M = 49.2, SD = 34.2), males (M = 23.1, SD = 29.2), t(<reflink idref="bib39" id="ref79">39</reflink>) = -2.627, p =.012; and for PPVT-4 scores: females (M = 48.3, SD = 30.8), males (M = 26, SD = 31), t(<reflink idref="bib39" id="ref80">39</reflink>) = - 2.293, p =.027.</p> <hd id="AN0129587140-19">Parental Education</hd> <p>A one-way ANOVA was conducted to determine whether differences existed between the father's education, as well as the mother's education, and the quantity of adult language, quantity of child language, and percentile scores on the BTBC-3 and PPVT-4. There was a main effect of father's education on AWC weekend, F(<reflink idref="bib6" id="ref81">6</reflink>, 23) = 3.026, p =.025; AWC both, F(<reflink idref="bib6" id="ref82">6</reflink>, 22) = 3.986, p =.008; CTC weekend, F(<reflink idref="bib6" id="ref83">6</reflink>, 23) = 3.534, p =.0013; and CTC both, F(<reflink idref="bib6" id="ref84">6</reflink>, 22) = 5.550, p =.001. Additionally, regarding mother's education, the data indicated a main effect of education only for the PPVT- 4, F(<reflink idref="bib6" id="ref85">6</reflink>, 27) = 2.855, p =.028.</p> <hd id="AN0129587140-20">Type of Amplification, Right Ear</hd> <p>Specifically regarding the participants with hearing loss, results from a one-way ANOVA indicated that there was a main effect of right ear amplification on the BTBC-3, F(<reflink idref="bib3" id="ref86">3</reflink>, 26) = 6.679, p =.002, and PPVT-4, F(<reflink idref="bib3" id="ref87">3</reflink>, 26) = 7.770, p =.001. Although the groups did not have identical numbers of participants, post hoc analysis showed that hearing aid users (M = 20.75, SD = 27.64) performed better than cochlear implant users (M = 17.42, SD = 21.73) on the BTBC-3.</p> <hd id="AN0129587140-21">Type of Amplification, Left Ear</hd> <p>A one-way ANOVA revealed that there was a main effect of left ear amplification on the BTBC-3, F(<reflink idref="bib2" id="ref88">2</reflink>, 27) = 4.689, p =.018, and the PPVT- 4, F(<reflink idref="bib2" id="ref89">2</reflink>, 27) = 6.610, p =.005. Although the groups did not have identical numbers of participants, post hoc analysis revealed that hearing aid users (M = 36.00, SD = 36.54) performed better than cochlear implant users (M = 15.58, SD = 18.87) on the BTBC-3.</p> <hd id="AN0129587140-22">Aided Hearing Thresholds</hd> <p>The variable aided hearing threshold is labeled and referred to as PTAr (i.e. right ear pure tone average) and PTAl (i.e. left ear pure tone average). Results using a Pearson correlation on the participants with hearing loss found no significant correlations between PTAr and AWC, CTC, CVC, BTBC-3, and PPVT-4. Likewise, no significant correlations were found between PTAl and AWC, CTC, CVC, BTBC-3, and PPVT-4. A very strong positive relationship was found between PTAr and PTAl, r(<reflink idref="bib25" id="ref90">25</reflink>) =.974, p =.000 (see [<reflink idref="bib5" id="ref91">5</reflink>] ).</p> <hd id="AN0129587140-23">Parental Hearing Status</hd> <p>An independent t test indicated that there were no significant differences pertaining to father's hearing status. However, the data indicated that there were significant differences for mother's hearing status in regard to the BTBC-3: hearing (M = 22.410, SD = 26.933), hearing loss (M = 90, SD = 0); and PPVT-4: hearing (M = 21.920, SD = 24.375), hearing loss (M = 82, SD = 0). It should be noted that only two participants reported having a parent with hearing loss; therefore, the means for each variable were compared to the means of the total group of participants. These means were found to be comparable to those of the two participants' peers who had parents with no reported hearing loss.</p> <hd id="AN0129587140-24">Presence of Additional Disability</hd> <p>The data indicated that there was a significant difference between reporting and not reporting an additional disability for the BTBC-3 scores: no additional disability, M = 28.2, SD = 30.6; additional disability, M = 6.6, SD = 7.8; t(<reflink idref="bib28" id="ref92">28</reflink>) = 1.552, p =.017. Furthermore, a significant difference was found for the PPVT-4 scores: no additional disability, M = 27.7, SD = 27.3; additional disability, M = 4.6, SD = 5.1; t(<reflink idref="bib28" id="ref93">28</reflink>) = 1.864, p =.014.</p> <p>The analyses discussed above that were found to be statistically significant were included as covariates in further analysis (see below, Research Question 3).</p> <p>Research Question 2: Is the quantity of adult language input related to the quantity of child language, the child's vocabulary, and the child's understanding of basic concepts?</p> <p>Pearson correlation tests were conducted to determine whether the variables of AWC, CTC, CVC, BTBC-3, and PPVT-4 were related (see [<reflink idref="bib6" id="ref94">6</reflink>] ). To address this research question, the significant correlations are reported to highlight that adult language variables (AWC and CTC) were related to child language variables (CVC, BTBC-3, and PPVT-4).</p> <p>Among the adult language variables, strong positive correlations were found between AWC weekday and CTC weekday, r(<reflink idref="bib38" id="ref95">38</reflink>) =.637, p =.000, and CTC both, r(<reflink idref="bib34" id="ref96">34</reflink>) =.561, p =.001. Additionally, AWC weekend was found to be positively related to CTC weekend, r(<reflink idref="bib35" id="ref97">35</reflink>) =.770, p =.000; CTC weekday, r(<reflink idref="bib34" id="ref98">34</reflink>) =.422, p =.013; and CTC both, r(<reflink idref="bib34" id="ref99">34</reflink>) =.729, p =.000.</p> <p>AWC weekend was found to be positively related to CVC weekend, r(<reflink idref="bib35" id="ref100">35</reflink>) =.347,</p> <p>p =.04, and CVC both, r(<reflink idref="bib34" id="ref101">34</reflink>) =.453, p =.007. A positive correlation was noted between AWC both and CVC weekday, r(<reflink idref="bib34" id="ref102">34</reflink>) =.407, p =.017. There was also a positive correlation between CVC both, r(<reflink idref="bib34" id="ref103">34</reflink>) =.413, p =.015; CTC weekday, r(<reflink idref="bib34" id="ref104">34</reflink>) =.648, p =.000; CTC weekend, r(<reflink idref="bib34" id="ref105">34</reflink>) =.626, p =.000; and CTC both, r(<reflink idref="bib34" id="ref106">34</reflink>) =.767, p =.000.</p> <p>CTC weekday was found to be positively related to CVC weekday, r(<reflink idref="bib38" id="ref107">38</reflink>) =.809, p =.000), and CVC both, r(<reflink idref="bib34" id="ref108">34</reflink>) =.610, p =.000. A marginal positive correlation was found between CTC weekend and CVC weekday, r(<reflink idref="bib34" id="ref109">34</reflink>) =.345, p =.045, whereas stronger positive correlations were found between CTC weekend and CVC weekend, r(<reflink idref="bib35" id="ref110">35</reflink>) =.766, p =.000, and CVC both, r(<reflink idref="bib34" id="ref111">34</reflink>) =.742, p =.000. Strong positive correlations were noted between CTC both and three other variables: CVC weekday, r(<reflink idref="bib34" id="ref112">34</reflink>) =.703, p =.000; CVC weekend, r(<reflink idref="bib34" id="ref113">34</reflink>) =.624, p =.000; and CVC both, r(<reflink idref="bib34" id="ref114">34</reflink>) =.820, p =.000.</p> <p>The participants' knowledge of basic concepts and vocabulary was not found to be related to the quantity of adult or child language; however, a strong positive correlation was observed between BTBC-3 and PPVT- 4, r(<reflink idref="bib41" id="ref115">41</reflink>) =.862, p =.000.</p> <p>Research Question 3: Is there a difference in the quantity of adult language or in the quantity of the child's language based on hearing status (i.e. typical hearing vs. hearing loss)?</p> <p>Based on the statistical analysis of the data, there did not appear to be differences in the quantity of adult or child language when the children with typical hearing and those with hearing loss were considered.</p> <hd id="AN0129587140-25">Weekday Recordings</hd> <p>No statistically significant difference was found between those with and without hearing loss on the quantity of adult language or in the quantity of child language (AWC, CTC, CVC) by weekday, as described below.</p> <hd id="AN0129587140-26">Adult Word Count Weekday</hd> <p>When age was controlled for, the ANCOVA revealed that there was no main effect of hearing status on the amount of adult words during the weekday recording, F(<reflink idref="bib1" id="ref116">1</reflink>,<reflink idref="bib35" id="ref117">35</reflink>) =.490, p = 489.</p> <hd id="AN0129587140-27">Conversational Turn Count Weekday</hd> <p>As was the case with AWC weekday, an ANCOVA controlling for age revealed that there was not a main effect of hearing status on the number of conversational turns during the weekday recording, F(<reflink idref="bib1" id="ref118">1</reflink>, 35) =.961, p =.334.</p> <hd id="AN0129587140-28">Child Vocalization Count Weekday</hd> <p>Results from an ANOVA indicated there was no main effect of hearing status on the amount the children vocalized during the weekday, F(<reflink idref="bib1" id="ref119">1</reflink>, 36) =.002, p =.965.</p> <hd id="AN0129587140-29">Weekend Recordings</hd> <p>Child vocalization during the weekend was the only variable that was found to be statistically different among those children with and without hearing loss. Additionally, data analysis revealed that there was no statistically significant difference between those with and without hearing loss on the variables of LENA (AWC and CTC) by weekday, as described below.</p> <hd id="AN0129587140-30">Adult Word Count Weekend</hd> <p>An ANCOVA controlling for father's education found that there was not a main effect of hearing status on the number of adult words recorded during the weekend, F(<reflink idref="bib1" id="ref120">1</reflink>, 27) = 2.962, p =.097.</p> <hd id="AN0129587140-31">Conversational Turn Count Weekend</hd> <p>In a similar analysis, an ANCOVA controlling for father's education found that there was no main effect of hearing status on the number of conversational turns, F(<reflink idref="bib1" id="ref121">1</reflink>, 27) = 1.998, p =.169.</p> <hd id="AN0129587140-32">Child Vocalization Count Weekend</hd> <p>Statistical analysis showed that there was a main effect of hearing status on the number of child vocalizations during the weekend recording, F(<reflink idref="bib1" id="ref122">1</reflink>, 33) = 4.194, p =.049. Participants with hearing loss made more vocalizations on the weekend (M = 2,880, SD = 1,165) than participants with normal hearing (M = 1,946, SD = 790). The size of this main effect was reported by the partial eta-squared value of η<sups>2</sups> =.113, which is considered small ([<reflink idref="bib10" id="ref123">10</reflink>] ).</p> <hd id="AN0129587140-33">Weekday and Weekend Recordings</hd> <p>Lastly, no statistically significant differences were found among the participants with and without hearing loss on the quantity of adult language or the quantity of child language between any of the variables (AWC, CTC, CVC) by weekday and weekend combined.</p> <hd id="AN0129587140-34">Adult Word Count Weekday and Weekend</hd> <p>Results from an ANCOVA that controlled for age and father's education revealed no main effect of hearing status on the AWC for both the weekday and weekend, F(<reflink idref="bib1" id="ref124">1</reflink>, 25) = 3.621, p =.069.</p> <hd id="AN0129587140-35">Conversational Turn Count Weekday and Weekend</hd> <p>Statistical examination that used an ANCOVA while controlling for father's education found no main effect of hearing status on the number of conversational turns during both the weekday and weekend recordings, F(<reflink idref="bib1" id="ref125">1</reflink>, 26) = 1.818, p =.189.</p> <hd id="AN0129587140-36">Child Vocalization Count Weekday and Weekend</hd> <p>Results from an ANOVA revealed no main effect of hearing status on the amount of child vocalizations that were recorded during the weekday and weekend, F(<reflink idref="bib1" id="ref126">1</reflink>, 32) =.1.253, p =.271. BTBC- 3. To assess whether there was a difference in the participants with and without hearing loss on their knowledge of basic concepts, an ANCOVA that controlled for age, gender, type of amplification (right ear), type of amplification (left ear), mother's hearing status, and presence of an additional disability was conducted. No main effect of hearing status on the BTBC-3 scores was found, F(<reflink idref="bib1" id="ref127">1</reflink>, 33) = 1.331, p =.257.</p> <p>PPVT-. An ANCOVA that controlled for gender, mother's education, type of amplification (right ear), type of amplification (left ear), mother's hearing status, and presence of an additional disability revealed no main effect of hearing status on the child's knowledge of vocabulary, F(<reflink idref="bib1" id="ref128">1</reflink>, 26) =.322, p =.575. BTBC-3 and PPVT-4. Previous analysis had revealed a strong correlation between the BTBC-3 and PPVT-4, which led to post hoc analysis to investigate the relationship between BTBC-3 and PPVT-4 scores. When vocabulary was controlled for, basic concept knowledge (BTBC-3 scores) appears not to have had any statistically significant correlations with the other variables (see [<reflink idref="bib6" id="ref129">6</reflink>] ).</p> <p>Research Question 4: Does the group variable (i.e. typical hearing vs. hearing loss) moderate the relationship between the quantity of parent language input and the child's quantity of language?</p> <p>Based on the results from the preliminary analysis (see Research Question 3), further analysis for this specific question was not pursued given that there were no statistically significant differences among the participants with normal hearing and those with hearing loss in regard to the quantity of the adult and child's language.</p> <hd id="AN0129587140-37">Discussion</hd> <p>The present study found strong positive correlations between the quantity of adult language exposure and several demographic variables, including the child's age and paternal education level. Other demographic variables were found to correlate significantly with the child's receptive vocabulary (as measured by PPVT-4 score) or comprehension of basic concepts (as measured by BTBC-3 score). Females and children without a reported additional disability scored higher on both language measures, while participants who used hearing aids achieved higher BTBC-3 scores than those with cochlear implants. Receptive vocabulary was positively correlated with maternal education levels, while AWC and CTC on both weekdays and weekends and on weekends alone were positively correlated with paternal education. No significant relations were found between the quantity of adult and child language and family income level or degree of hearing loss. Analysis of data collected by the LENA system found strong correlations among AWC, CVC, and CTC across weekends and weekdays. Scores on the PPVT-4 and the BTBC-3 were also strongly correlated. Finally, no significant differences in AWC, CTC, or language scores were found between participants with hearing loss and those with typical hearing. Children who were DHH vocalized more than those with typical hearing on the weekend, with a small effect size reported.</p> <p>As expected, several demographic variables, including age and the reported presence of an additional disability, related strongly to the quantity of adult language input as well as the quantity of child language output (i.e. CVC). That older children and those without a reported concomitant disability scored higher on tests of receptive vocabulary and basic concepts is not surprising given the research base in these areas (e.g. [<reflink idref="bib3" id="ref130">3</reflink>] ). Somewhat surprising, though, are the results concerning the participants' degree of hearing loss and type of amplification. In contrast with the finding by [<reflink idref="bib53" id="ref131">53</reflink>] that the quantity of adult language input varied with the child's degree of hearing loss, the present study found no significant difference in AWC based on the participants' PTA or degree of hearing loss. Regardless of the severity of the child's hearing loss, parents spoke to their children at the same rate.</p> <p>Interestingly, the type of amplification used was significantly related to children's comprehension of basic concepts, with hearing aid users scoring significantly higher on the BTBC-3 than cochlear implant users. Although not measured in the present study, age of implantation might be a mitigating factor, as the cochlear implant users received their implants at or after 12 months of age (per U.S. Food and Drug Administration regulation). It may be that those with lower language levels (due, in part, to having had to wait 12 or more months for a cochlear implant) would have more difficulty with the sentence-level prompts full of function words on the BTBC-3 than the short, repetitive carrier phrases on the PPVT-4. If the children using hearing aids received and benefited from amplification prior to 12 months of age, they may have had a greater cumulative listening age and access to language for a longer period than those who waited 12 months or more to gain access to sound by means of a cochlear implant. As noted by [<reflink idref="bib34" id="ref132">34</reflink>] , language abilities acquired by typically hearing children during that first year of life are numerous and include understandings related to speech segmentation, vocabulary, syntax, and verbal and nonverbal communication. These language competencies in infants are significant predictors of later language development ([<reflink idref="bib39" id="ref133">39</reflink>] ). This difference warrants further investigation.</p> <p>[<reflink idref="bib26" id="ref134">26</reflink>] found strong correlations between parents' socioeconomic status and education level and the quantity of language input provided to their children. In contrast with Hart and Risley's findings, maternal education correlated only with PPVT-4 scores in the present study. The number of adult words, child vocalizations, and conversational turns recorded by the LENA did not differ as a function of maternal education level, though AWC and CTC on the weekend were correlated with paternal education level. It is possible that interactions between professional fathers (who often work during the week) and their children increased on weekends, leading to higher AWC and CTC levels. Surprisingly, higher family income level was not correlated with higher language scores or increased AWC, CVC, or CTC. Perhaps the lack of significance of socioeconomic factors among our sample relates to the fact that all participants were enrolled in auditory-oral preschools that emphasized listening and spoken language. Although Hart and Risley found significant differences in auditory environment between working-class and professional families who had not received intervention, other researchers have found that family-centered intervention in listening and spoken language can help close the language gap between historically disadvantaged families and professional families ([<reflink idref="bib2" id="ref135">2</reflink>] ; [<reflink idref="bib45" id="ref136">45</reflink>] ).</p> <p>The present study underscores the central role of the auditory environment in children's language growth. The number of words spoken by adults on weekdays and the number they spoke on weekends were highly correlated, suggesting that parents and caregivers were providing consistent linguistic input in both the structured setting of school and the natural setting of home. This adult input, in turn, positively related to the numbers of conversational turns and child vocalizations recorded by the LENA. In short, more adult talking was associated with more child talking and more linguistic interactions between caregivers and children. This finding is consistent with the work of [<reflink idref="bib26" id="ref137">26</reflink>] , as well as research specifically focused on the linguistic environments of children with hearing loss (e.g. [<reflink idref="bib1" id="ref138">1</reflink>] ; [<reflink idref="bib54" id="ref139">54</reflink>] ).</p> <p>Comparison of children with and without hearing loss found no significant differences in either auditory environment or language outcomes. In contrast with the language delays found by many researchers who have studied young children who are DHH (e.g. [<reflink idref="bib12" id="ref140">12</reflink>] ; [<reflink idref="bib21" id="ref141">21</reflink>] ; [<reflink idref="bib22" id="ref142">22</reflink>] ), the present study found no differences in receptive vocabulary and comprehension of basic concepts between participants with hearing loss and those with normal hearing. Perhaps the similar educational environments of the participants—all of whom attended auditory-oral schools—contributed to the lack of difference in language level. It should also be noted that more than half of the children with typical hearing (54.4%) were siblings of the DHH participants, a condition that suggests that home environments for the children were also similar. The PPVT-4 and BTBC-3 both measure receptive language with an emphasis on single-word comprehension. It is possible that differences between the two groups would have emerged in more comprehensive expressive- and receptive-language assessments.</p> <p>That the quantity of adult language did not differ in the auditory environments of participants with and without hearing loss supports the work of [<reflink idref="bib30" id="ref143">30</reflink>] and extends their findings from infants to preschoolers. With research pointing to DHH children's slower rate of vocabulary acquisition (e.g. [<reflink idref="bib12" id="ref144">12</reflink>] ), however, similar rates of exposure to adult talk may not lead to similar language outcomes. In contrast, in the present study, five children with normal hearing were siblings of DHH children and shared similar auditory environments, yet language outcomes showed no significant difference between groups—a finding that suggests that those DHH children were acquiring language within their environment similarly to their hearing siblings. [<reflink idref="bib2" id="ref145">2</reflink>] suggest that families of children with hearing loss may need to create a super language environment with greater exposure to adult words and increased participation in conversational turns in order to close the gap in language outcomes. Findings from the present study suggest that many parents of children with hearing loss have created language environments that resemble but do not surpass those experienced by children with typical hearing.</p> <hd id="AN0129587140-38">Limitations of the Study</hd> <p>Several limitations of the research design used in the present study must be acknowledged. First, the number of participants in the analysis was relatively low. Although participants were actively recruited from sites across the United States, only 41 children met the inclusion criteria and completed the study protocol. Hearing loss is a low-incidence condition, and the pool of potential participants was further limited by the requirement that the children speak only English at home. This requirement especially affected recruitment in urban areas with large populations of families who are culturally and linguistically diverse. Future studies might include these families and investigate similarities and differences among language groups.</p> <p>Second, the small number of participants with normal hearing (n = 11) relative to those with hearing loss (n = 30) made comparison between the groups difficult and may have contributed to the insignificant results for the third and fourth research questions. The disproportionate representation of typically hearing peers was mostly due to the limited number of these reverse-mainstreamed students in classrooms where there were typically one or two hearing students for every eight DHH students. Furthermore, hearing children were recruited from the same schools as the DHH students because many of the hearing children were siblings who were exposed to the same or similar language inputs at home and at school as the DHH students. The DHH participants overwhelmingly had sensorineural hearing loss; the small number of children with mixed and conductive losses limited the conclusions that could be drawn from comparisons among groups with different types of hearing loss.</p> <p>Finally, LENA recordings were captured over just 2 days for each participant, and thus offer merely a snapshot of the children's auditory environments and vocalization rates. Although families were offered the option of re-recording on a different day if they felt uncomfortable with any aspect of the LENA recording process, none requested that another recording be done for any reason. However, the recordings captured by the LENA device cannot be assumed with certainty to represent typical days in the lives of the participants. Indeed, the very presence of the device may have influenced the amount of adult talk around the child. As the use of LENA becomes more widespread, the effect of this limitation may be reduced in future studies.</p> <hd id="AN0129587140-39">Conclusion</hd> <p>The present study highlights the important relationship between the quantity of adult language and child language outcomes, including the development of receptive vocabulary and basic concepts. Since the findings suggest that the number of adultchild interactions, or parental verbal responsiveness, was related to parent talk and child vocalizations, increasing and improving interactions may improve child vocalizations. Additionally, the results of this study appear to indicate that children with hearing loss enrolled in preschools that teach listening and spoken language experience auditory environments similar to those of their hearing peers who are also enrolled in these schools, with similarities both at home and at school. That the families of children with hearing loss had not created the super language environments that research suggests are needed to close the gap with children with typical hearing ([<reflink idref="bib2" id="ref146">2</reflink>] ) points to the continued need for parent-centered early intervention as well as training for the professionals who support families.</p> <p>Interestingly, the results indicate a difference between the language development of children with hearing aids and that of children with cochlear implants, particularly in regard to knowledge of basic concepts. This difference might be attributed to the children's listening age, as children with hearing aids may have more exposure to their auditory environments than those with cochlear implants. However, further investigation into the type of amplification used by the child and its potential impact on aspects of language development is warranted. Among the participants in the present study, two mothers self-reported a hearing loss, which appeared to correspond to differences in language development relative to the rest of the sample. While the small sample of such mothers does not allow for significant interpretation, it does present an avenue for further investigation. 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| Items | – Name: Title Label: Title Group: Ti Data: The Impact of Language Input on Deaf and Hard of Hearing Preschool Children Who Use Listening and Spoken Language – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Rufsvold%2C+Ronda%22">Rufsvold, Ronda</searchLink><br /><searchLink fieldCode="AR" term="%22Wang%2C+Ye%22">Wang, Ye</searchLink><br /><searchLink fieldCode="AR" term="%22Hartman%2C+Maria+C%2E%22">Hartman, Maria C.</searchLink><br /><searchLink fieldCode="AR" term="%22Arora%2C+Sonia+B%2E%22">Arora, Sonia B.</searchLink><br /><searchLink fieldCode="AR" term="%22Smolen%2C+Elaine+R%2E%22">Smolen, Elaine R.</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22American+Annals+of+the+Deaf%22"><i>American Annals of the Deaf</i></searchLink>. 2018 163(1):35-60. – Name: Avail Label: Availability Group: Avail Data: Gallaudet University Press. 800 Florida Avenue NE, Denison House, Washington, DC 20002-3695. Tel: 202-651-5488; Fax: 202-651-5489; Web site: http://gupress.gallaudet.edu/annals/ – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 26 – Name: DatePubCY Label: Publication Date Group: Date Data: 2018 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Audience Label: Education Level Group: Audnce Data: <searchLink fieldCode="EL" term="%22Preschool+Education%22">Preschool Education</searchLink> – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Deafness%22">Deafness</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Vocabulary+Development%22">Vocabulary Development</searchLink><br /><searchLink fieldCode="DE" term="%22Comprehension%22">Comprehension</searchLink><br /><searchLink fieldCode="DE" term="%22Concept+Formation%22">Concept Formation</searchLink><br /><searchLink fieldCode="DE" term="%22Speech+Communication%22">Speech Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Listening%22">Listening</searchLink><br /><searchLink fieldCode="DE" term="%22Audio+Equipment%22">Audio Equipment</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Software%22">Computer Software</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+Analysis%22">Statistical Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+Analysis%22">Comparative Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Intelligence+Tests%22">Intelligence Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Vocabulary%22">Vocabulary</searchLink><br /><searchLink fieldCode="DE" term="%22Verbal+Ability%22">Verbal Ability</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Characteristics%22">Individual Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Assistive+Technology%22">Assistive Technology</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Schools%22">Special Schools</searchLink> – Name: Subject Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22New+York%22">New York</searchLink><br /><searchLink fieldCode="DE" term="%22California%22">California</searchLink><br /><searchLink fieldCode="DE" term="%22Missouri%22">Missouri</searchLink> – Name: SubjectThesaurus Label: Assessment and Survey Identifiers Group: Su Data: <searchLink fieldCode="SU" term="%22Boehm+Test+of+Basic+Concepts%22">Boehm Test of Basic Concepts</searchLink><br /><searchLink fieldCode="SU" term="%22Peabody+Picture+Vocabulary+Test%22">Peabody Picture Vocabulary Test</searchLink> – Name: ISSN Label: ISSN Group: ISSN Data: 0002-726X – Name: Abstract Label: Abstract Group: Ab Data: The researchers investigated the effects of adult language input on the quantity of language, vocabulary development, and understanding of basic concepts of deaf and hard of hearing (DHH) children who used listening and spoken language. Using audio recording and Language ENvironment Analysis (LENA) software, the study involved 30 preschool DHH children who used spoken language as their communication modality and 11 typically hearing same-age peers. The children's language and the language spoken to them during all waking hours over a 2-day period (16 hours per day) were recorded and analyzed quantitatively and were compared to the children's performance on the Boehm Test of Basic Concepts and the Peabody Picture Vocabulary Test. The results highlight the relationship between the quantity of adult language and the language, vocabulary, and basic concept knowledge of DHH preschool children who use listening and spoken language. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: Ref Label: Number of References Group: RefInfo Data: 56 – Name: DateEntry Label: Entry Date Group: Date Data: 2018 – Name: URL Label: Access URL Group: URL Data: <link linkTarget="URL" linkTerm="https://gupress.gallaudet.edu/annals/past.htm" linkWindow="_blank">http://gupress.gallaudet.edu/annals/past.htm</link> – Name: AN Label: Accession Number Group: ID Data: EJ1177850 |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1177850 |
| RecordInfo | BibRecord: BibEntity: Languages: – Text: English PhysicalDescription: Pagination: PageCount: 26 StartPage: 35 Subjects: – SubjectFull: Deafness Type: general – SubjectFull: Hearing Impairments Type: general – SubjectFull: Preschool Children Type: general – SubjectFull: Vocabulary Development Type: general – SubjectFull: Comprehension Type: general – SubjectFull: Concept Formation Type: general – SubjectFull: Speech Communication Type: general – SubjectFull: Listening Type: general – SubjectFull: Audio Equipment Type: general – SubjectFull: Computer Software Type: general – SubjectFull: Statistical Analysis Type: general – SubjectFull: Comparative Analysis Type: general – SubjectFull: Adults Type: general – SubjectFull: Intelligence Tests Type: general – SubjectFull: Vocabulary Type: general – SubjectFull: Verbal Ability Type: general – SubjectFull: Individual Characteristics Type: general – SubjectFull: Assistive Technology Type: general – SubjectFull: Special Schools Type: general – SubjectFull: New York Type: general – SubjectFull: California Type: general – SubjectFull: Missouri Type: general – SubjectFull: Boehm Test of Basic Concepts Type: general – SubjectFull: Peabody Picture Vocabulary Test Type: general Titles: – TitleFull: The Impact of Language Input on Deaf and Hard of Hearing Preschool Children Who Use Listening and Spoken Language Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Rufsvold, Ronda – PersonEntity: Name: NameFull: Wang, Ye – PersonEntity: Name: NameFull: Hartman, Maria C. – PersonEntity: Name: NameFull: Arora, Sonia B. – PersonEntity: Name: NameFull: Smolen, Elaine R. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2018 Identifiers: – Type: issn-print Value: 0002-726X Numbering: – Type: volume Value: 163 – Type: issue Value: 1 Titles: – TitleFull: American Annals of the Deaf Type: main |
| ResultId | 1 |
