Communication options for children with hearing loss

This article examines the communication options that are available for use within families of infants and young children who are hard-of-hearing or deaf. The need for language development, regardless of the specific communication mode, is stressed. The demands of the current environment of early identification and intervention often put families in a position of needing to decide among communication methods before they are fully knowledgeable and/or emotionally ready. Specific communication options are delineated and considered within a continuum of spoken and visual language. Available research related to early acquisition of language by infants and young children who are hard-of-hearing and deaf is reviewed; outcomes, when available, are presented for specific methods from reports of older children. Factors that influence families' decisions regarding the selection of a communication option are highlighted in the context of the existing literature. An ongoing evaluative process that respects the choices of families is advocated; a context in which change(s) in communication mode through childhood is viewed as a positive circumstance. The ultimate goal in the selection of any communication approach is to ensure that infants and young children who are hard of hearing or deaf and their families are language proficient and fluent communicators.     

The otolaryngologist's role in management of hearing loss in infancy and childhood

This article reviews the role of the otolaryngologist-head and neck surgeon-in the diagnosis and treatment of hearing loss in infants and young children. The otolaryngologist is well-versed in the anatomy, physiology, and pathophysiology of the auditory system, as well as the craniofacial syndromes that can involve the head and neck in combination with deafness. In this paper, the various causes of congenital hearing loss are described, as well as the steps required for proper diagnosis. Finally, surgeries used by otolaryngologists to treat childhood hearing loss, their indications, and outcomes, are discussed.     

Synchrony,complexity and directiveness in mothers’ interactions with infants pre- and post-cochlear implantation

This study investigated effects of profound hearing loss on mother–infant interactions before and after cochlear implantation with a focus on maternal synchrony, complexity, and directiveness. Participants included two groups of mother–infant dyads: 9 dyads of mothers and infants with normal hearing; and 9 dyads of hearing mothers and infants with profound hearing loss. Dyads were observed at two time points: Time 1, scheduled to occur before cochlear implantation for infants with profound hearing loss (mean age = 13.6 months); and Time 2 (mean age = 23.3 months), scheduled to occur approximately six months after cochlear implantation. Hearing infants were age-matched to infants with hearing loss at both time points. Dependent variables included the proportion of maternal utterances that overlapped infant vocalizations, maternal mean length of utterance, infant word use, and combined maternal directives and prohibitions. Results showed mothers’ utterances overlapped the vocalizations of infants with hearing loss more often before cochlear implantation than after, mothers used less complex utterances with infants with cochlear implants compared to hearing peers (Time 2), and mothers of infants with profound hearing loss used frequent directives and prohibitions both before and after cochlear implantation. Together, mothers and infants adapted relatively quickly to infants’ access to cochlear implants, showing improved interactional synchrony, increased infant word use, and levels of maternal language complexity compatible with infants’ word use, all within seven months of cochlear implant activation.     

The cultural bounds of maternal accommodation: how Chinese and American mothers communicate with deaf and hearing children

Children with special needs typically require family accommodation to those needs. We explore here the extent to which cultural forces shape the accommodations mothers make when communicating with young deaf children. Sixteen mother-child dyads (8 Chinese, 8 American) were videotaped at home. In each culture, 4 mothers interacted with their deaf children, and 4 interacted with their hearing children. None of the deaf children knew sign language, nor spoke at age level. We found that mothers adjusted their communicative behaviors to their deaf children, but in every case, those adjustments were calibrated to cultural norms. American mothers, for example, increased their use of gesture with deaf children but stopped far short of the Chinese range—despite the obvious potential benefits of gesturing to children who cannot hear. These findings provide the first cross-cultural demonstration that children are, first and foremost, inculcated into their cultures and, only within that framework, then treated as special cases.     

Parental decision-making: infant engagement with smartphones

Smartphones have become a ubiquitous part of life, and as a result, many children are engaging with smartphones beginning in infancy. Little is known regarding the thought processes used by parents in deciding when and how to allow their infants to engage with smartphones. Using a sample of twelve parents with infants younger than one year, this qualitative study examines parental smartphone use, their perspectives regarding use by their young children, and what sources informed their decision-making about allowing their infants to use a smartphone. Results found that the smartphone has become such a common part of everyday life that choices to use a smartphone around, and with, infants has become one that is nearly automatic. These research data showed that most parents are largely unaware of guidelines for childhood screen time provided by the American Academy of Pediatrics and the World Health Organization. Given our current knowledge that smartphone use can have a significant impact on the cognitive development of young children, this topic is an important area of future research.     

Early intervention after universal neonatal hearing screening: impact on outcomes

This article summarizes the developmental outcomes of Colorado children with significant hearing loss. Some of the research compares children born in hospitals that have implemented universal newborn hearing screening programs for newborns. Other research compares the developmental outcomes of children who have been early-identified with hearing loss. Early-identification is defined as identification of hearing loss within the first six months of life. Late identification in the Colorado studies is defined as age of identification of hearing loss after the age of six months. In a few of the Colorado studies, age at initiation of intervention was used. Within the Colorado system, age of identification can be interpreted as almost synonymous with age of intervention, as the vast majority of children enter intervention services with two months after the identification of the hearing loss. Children who were early-identified and had early initiation of intervention services (within the first year of life) had significantly better vocabulary, general language abilities, speech intelligibility and phoneme repertoires, syntax as measured by mean length of utterance, social-emotional development, parental bonding, and parental grief resolution. Two other studies (Nebraska and Washington state) of early- versus later-initiation of intervention services report findings similar to the Colorado studies. Direct comparisons with the historical literature are not possible because the developmental delays of what would now be termed "later-identified" were too low to report developmental ages for the birth through five-year-old population.     

Deaf and hearing children's plural noun spelling

The present study examines deaf and hearing children's spelling of plural nouns. Severe literacy impairments are well documented in the deaf, which are believed to be a consequence of phonological awareness limitations. Fifty deaf (mean chronological age 13;10 years, mean reading age 7;5 years) and 50 reading-age-matched hearing children produced spellings of regular, semiregular, and irregular plural nouns in Experiment 1 and nonword plurals in Experiment 2. Deaf children performed reading-age appropriately on rule-based (regular and semiregular) plurals but were significantly less accurate at spelling irregular plurals. Spelling of plural nonwords and spelling error analyses revealed clear evidence for use of morphology. Deaf children used morphological generalization to a greater degree than their reading-age-matched hearing counterparts. Also, hearing children combined use of phonology and morphology to guide spelling, whereas deaf children appeared to use morphology without phonological mediation. Therefore, use of morphology in spelling can be independent of phonology and is available to the deaf despite limited experience with spoken language. Indeed, deaf children appear to be learning about morphology from the orthography. Education on more complex morphological generalization and exceptions may be highly beneficial not only for the deaf but also for other populations with phonological awareness limitations.     

Infant-directed speech supports phonetic category learning in English and Japanese

Across the first year of life, infants show decreased sensitivity to phonetic differences not used in the native language [Werker, J. F., & Tees, R. C. (1984). Cross-language speech perception: evidence for perceptual reorganization during the first year of life. Infant Behaviour and Development, 7, 49-63]. In an artificial language learning manipulation, Maye, Werker, and Gerken [Maye, J., Werker, J. F., & Gerken, L. (2002). Infant sensitivity to distributional information can affect phonetic discrimination. Cognition, 82(3), B101-B111] found that infants change their speech sound categories as a function of the distributional properties of the input. For such a distributional learning mechanism to be functional, however, it is essential that the input speech contain distributional cues to support such perceptual learning. To test this, we recorded Japanese and English mothers teaching words to their infants. Acoustic analyses revealed language-specific differences in the distributions of the cues used by mothers (or cues present in the input) to distinguish the vowels. The robust availability of these cues in maternal speech adds support to the hypothesis that distributional learning is an important mechanism whereby infants establish native language phonetic categories.     

`Babbling' and social context in infant monkeys: parallels to human infants

Although only humans use spoken language, the vocal communication of many animals shares some features with language. Within the context of their family, normal children and young non-human primates develop proficiency in the nuances of their species-specific vocal communication system. Engaging in speech-like phonetic activity, or babbling, occurs in all normal children regardless of their native language. Similar periods of vocal development have not been described previously for non-human primates. However, in the pygmy marmoset, a South American monkey, we found that the primary vocal behavior of infants parallels many characteristics of human infant babbling. These analogous features include universality, repetition, use of a subset of the adult vocal repertoire, recognizably adult-like vocal structure and lack of a clear vocal referent. Also, like human infants, young marmosets develop in a closely knit family unit that includes both parents and often older siblings. In this context, the babbling-like behavior of the marmoset infant stimulates interaction with caregivers, thereby serving a key role in the infant's own development. These developmental and social processes indicate that the study of vocal development in non-human primate species can provide insights into the function of babbling in humans.     

What leads to coordinated attention in parent–toddler interactions? Children's hearing status matters

Coordinated attention between children and their parents plays an important role in their social, language, and cognitive development. The current study used head‐mounted eye‐trackers to investigate the effects of children's prelingual hearing loss on how they achieve coordinated attention with their hearing parents during free‐flowing object play. We found that toddlers with hearing loss (age: 24–37 months) had similar overall gaze patterns (e.g., gaze length and proportion of face looking) as their normal‐hearing peers. In addition, children's hearing status did not affect how likely parents and children attended to the same object at the same time during play. However, when following parents' attention, children with hearing loss used both parents' gaze directions and hand actions as cues, whereas children with normal hearing mainly relied on parents' hand actions. The diversity of pathways leading to coordinated attention suggests the flexibility and robustness of developing systems in using multiple pathways to achieve the same functional end.     

The interaction between acoustic salience and language experience in developmental speech perception: evidence from nasal place discrimination

Previous research suggests that infant speech perception reorganizes in the first year: young infants discriminate both native and non‐native phonetic contrasts, but by 10–12 months difficult non‐native contrasts are less discriminable whereas performance improves on native contrasts. In the current study, four experiments tested the hypothesis that, in addition to the influence of native language experience, acoustic salience also affects the perceptual reorganization that takes place in infancy. Using a visual habituation paradigm, two nasal place distinctions that differ in relative acoustic salience, acoustically robust labial‐alveolar [ma]–[na] and acoustically less salient alveolar‐velar [na]–[?a], were presented to infants in a cross‐language design. English‐learning infants at 6–8 and 10–12 months showed discrimination of the native and acoustically robust [ma]–[na] (Experiment 1), but not the non‐native (in initial position) and acoustically less salient [na]–[?a] (Experiment 2). Very young (4–5‐month‐old) English‐learning infants tested on the same native and non‐native contrasts also showed discrimination of only the [ma]–[na] distinction (Experiment 3). Filipino‐learning infants, whose ambient language includes the syllable‐initial alveolar (/n/)–velar (/?/) contrast, showed discrimination of native [na]–[?a] at 10–12 months, but not at 6–8 months (Experiment 4). These results support the hypothesis that acoustic salience affects speech perception in infancy, with native language experience facilitating discrimination of an acoustically similar phonetic distinction [na]–[?a]. We discuss the implications of this developmental profile for a comprehensive theory of speech perception in infancy.     

Language Development and Assessment in the Preschool Period

Most young children make significant progress in learning language during the first 4?years of life. Delays or differences in patterns of language acquisition are sensitive indicators of developmental problems. The dynamic, complex nature of language and the variability in the timing of its acquisition poses a number of challenges for the assessment of young children. This paper summarises the key developmental milestones of language development in the preschool years, providing a backdrop for understanding difficulties with language learning. Children with specific language impairment (SLI) are characterised illustrating the types of language difficulties they exhibit. Genetic evidence for language impairment suggests complex interactions among multiple genes of small effect. There are few consistent neurobiological abnormalities and currently there is no identified neurobiological signature for language difficulties. The assessment of young children??s language skills thus focuses on the evaluation of their performances in comparison to typically developing peers. Assessment of language abilities in preschool children should involve an evaluation of both expressive and receptive skills and should include an evaluation of more than one dimension of language. The use of a single measure of a language component, such as vocabulary, is considered inadequate for determining whether preschool children have typical language or language impairment. Available evidence supports the inclusion of measures of phonological short-term memory in the assessment of the language abilities of preschool children. Further study of genetic, neurobiological and early behavioural correlates of language impairments in preschool children is needed.     

Bilingual toddlers’ comprehension of mixed sentences is asymmetrical across their two languages

In bilingual language environments, infants and toddlers listen to two separate languages during the same key years that monolingual children listen to just one and bilinguals rarely learn each of their two languages at the same rate. Learning to understand language requires them to cope with challenges not found in monolingual input, notably the use of two languages within the same utterance (e.g., Do you like the perro? or ¿Te gusta el doggy?). For bilinguals of all ages, switching between two languages can reduce the efficiency in real‐time language processing. But language switching is a dynamic phenomenon in bilingual environments, presenting the young learner with many junctures where comprehension can be derailed or even supported. In this study, we tested 20 Spanish–English bilingual toddlers (18‐ to 30‐months) who varied substantially in language dominance. Toddlers’ eye movements were monitored as they looked at familiar objects and listened to single‐language and mixed‐language sentences in both of their languages. We found asymmetrical switch costs when toddlers were tested in their dominant versus non‐dominant language, and critically, they benefited from hearing nouns produced in their dominant language, independent of switching. While bilingualism does present unique challenges, our results suggest a united picture of early monolingual and bilingual learning. Just like monolinguals, experience shapes bilingual toddlers’ word knowledge, and with more robust representations, toddlers are better able to recognize words in diverse sentences.     

Perspectives on multisensory experience and cognitive development in infants with cochlear implants

Infants learn about their environment through sensory exploration, acquiring knowledge that is important for cognitive development. However, little is known about the sensory exploration of infants with profound hearing loss before or after they receive cochlear implants. This paper reviews aspects of sensory perception and cognitive development in hearing infants, discusses the implications of delayed access to auditory information for multisensory perception and cognitive development in infants who use cochlear implants, and suggests several new directions for research addressing multisensory exploration and cognitive development in infants with cochlear implants.     

Intuitive identification of infant vocal sounds by parents

Parents are remarkably accurate observers of their infants’‘canonical babbling’, the production of well‐formed syllables. With very little training, many parents across a wide range of socioeconomic status make flawless judgments of canonical stage onset. The results of concordance studies between parental and trained‐observer judgments support the idea that recognition of canonical babbling may be intuitive. Without instruction, parents identify the onset of canonical babbling when it occurs, and thereafter they begin to interpret sounds produced by children in ways that may encourage word learning. The fact that parents can provide accurate information about stage of vocal development, along with the fact that late onset of canonical babbling has been shown to be an extremely important indicator of risk for hearing loss and language‐related disabilities, suggests the possibility of using a brief interview to identify infants at risk.     

What do bilingual infants actually hear? Evaluating measures of language input to bilingual‐learning 10‐month‐olds

Examining how bilingual infants experience their dual language input is important for understanding bilingual language acquisition. To assess these language experiences, researchers typically conduct language interviews with caregivers. However, little is known about the reliability of these parent reports in describing how bilingual children actually experience dual language input. Here, we explored the quantitative nature of dual language input to bilingual infants. Furthermore, we described some of the heterogeneity of bilingual exposure in a sample of French–English bilingual families. Participants were 21 families with a 10‐month‐old infant residing in Montréal, Canada. First, we conducted language interviews with the caregivers. Then, each family completed three full‐day recordings at home using the Language Environment Analysis recording system. Results showed that children’s proportion exposure to each language was consistent across the two measurement approaches, indicating that parent reports are reliable for assessing a bilingual child’s language experiences. Further exploratory analyses revealed three unique findings: (a) there can be considerable variability in the absolute amount of input among infants hearing the same proportion of input, (b) infants can hear different proportions of language input when considering infant‐directed versus overheard speech, (c) proportion of language input can vary by day, depending on who is caring for the infant. We conclude that collecting naturalistic recordings is complementary to parent‐report measures for assessing infant’s language experiences and for establishing bilingual profiles.     

The narrative worlds of what is and what if

This paper advances the hypothesis that young children use narrative play and stories to construct two types of fiction, the worlds of what is and what if. Heinz Werner's conceptualization of children's spheres of reality, in which actions, symbols, and events are constructed in particular ways, is used as a theoretical framework for understanding children's play and stories. Drawing on examples of children's spontaneous pretend play and story telling, the paper argues that, beginning in their second year, children use pretend play to differentiate the worlds of everyday-lived reality from an alternative pretend sphere; the world of as if. By their third year, children engage in play which hangs on a narrative framework. Such pretend play offers children further options: the fictional world of plausible make believe which simulates everyday life, what is, and the fictional world of more fantastic possibilities, what if. While the child's use of a narrative framework in her pretend play expands her range of psychological worlds, the developmental shift to purely verbal stories, sometimes during the child's third year, significantly adds to her ability to explore such worlds. An examination of the language young children use to accompany their narrative play and to tell stories demonstrates the ways in which children exploit the narrative form to contrast, compare, and traverse the constructed worlds of what is and what if.