Spoken_Lang


Spoken Language Development in Oral Preschool Children With Permanent Childhood Deafness.



Directions:


Dr. Julia Z. Sarant/ East Melbourne, Victoria, Australia was available from 11/03/08 until 11/23/08 to answer questions and share ideas concerning her research and its implications for parents of children who are deaf/hard of hearing, their teachers and other professionals who work with them.
  • You are encouraged to read the research summary below and review the attached discussion.


Abstract
This study documented spoken language outcomes for preschool children with hearing loss, and examined the relationships between language abilities and characteristics of children such as degree of hearing loss, cognitive abilities, age at entry to early intervention, and parent involvement in children’s intervention programs. Participants were evaluated using a combination of the Child Development Inventory, the Peabody Picture Vocabulary Test, and the Preschool Clinical Evaluation of Language Fundamentals, depending on their age at the time of assessment. Maternal education, cognitive ability, and family involvement were also measured. Over half of the children who participated in this study had poor language outcomes overall. No significant differences were found in language outcomes on any of the measures for children who were diagnosed early and those diagnosed later. Multiple regression analyses showed that family participation, degree of hearing loss and cognitive ability significantly predicted language outcomes, and together accounted for almost 60% of the variance in scores. This study highlights the importance of family participation in intervention programs to enable children to achieve optimal language outcomes. Further work may clarify the effects of early diagnosis on language outcomes for preschool children.

Background
Despite advances in hearing aid and cochlear implant technology, intervention services, and a greater awareness of the effects of deafness amongst educators, language delay remains a problem for many children with hearing loss. Research to date has shown that children with hearing loss learn language at only 50-60% of the rate of children with normal hearing, and this can affect their long-term academic achievement and opportunities in life. A greater understanding of factors affecting language development, and the most effective methods of improving language outcomes, is needed to enhance the educational and career prospects, and therefore the quality of life, of children with hearing loss. There is also a need for more substantial evidence regarding whether earlier diagnosis leads to significantly better long term language and educational outcomes for children with hearing loss.

This study examined the spoken language outcomes of preschool children with hearing loss in Australia, which had not been documented previously. We used language assessment measures that allowed the direct comparison of Australian results with those from previous studies in the U.S.


Methods
Fifty-seven children, aged 3-6 years, participated in this study. They were all attending the Taralye Oral Language Center for Deaf Children, the largest early intervention service provider for preschool children with impaired hearing in the state of Victoria, Australia. Language development was assessed using a either a parent questionnaire, a combination of the parent questionnaire and two standardized language tests, or the two standardized language tests only, depending on the age of the child. Non-verbal cognitive abilities (IQ) and family participation in children’s early intervention programs were also assessed.

Main Findings
Language delay was a significant problem for these children. Although close to 60% of the children in this study had been diagnosed, fitted with hearing aids or a cochlear implant, and enrolled in early intervention by the age of 12 months, language development was delayed for around 1/2 of the children. For approximately 1/3 of the children aged 1-3 years, this delay was severe (ie. scores were more than 2 standard deviations below the mean for children with normal hearing). Children with significant hearing loss and/or low cognitive ability showed greater language delays, as is commonly reported in the literature.

The majority of the school entry group, which comprised the older children in the study, was not linguistically ready for school. Most of these children had been diagnosed with hearing loss around the age of 2 years, and the intervention they had received had not been sufficient for them to ‘catch up’ in order to enter school with adequate language skills.

Family participation in children’s intervention programs was a significant predictor of spoken language abilities for children in this study. This finding supports previous research in suggesting that the best outcomes are achieved when there is strong family involvement in children’s learning. The results of this study (despite the fact that language was delayed for around half of these children, no family in this study was rated as below average in their involvement in their child’s intervention program) suggest that an ‘average’ level of support from parents for their child’s intervention program may not be sufficient for children to achieve normal language outcomes.

Contrary to the findings of other studies, language abilities did not differ significantly between children who entered early intervention early (prior to 6 months of age) and later (after 6 months of age) in this study. Given that family participation was such a strong predictive factor of language outcomes in this study, and primary caregivers of early and later-diagnosed children were equally involved in their children’s intervention programs, it is possible that the support provided by families of later-diagnosed children provided a buffer against the effects of late diagnosis on language development. (In other studies, mothers of children diagnosed before 6 months of age have been reported to be more involved in their child’s intervention program than mothers of children diagnosed later).

Language development of these Australian children was progressing at a similar rate to that of children in the U.S. when age at assessment was taken into account. Overall language outcomes in the two countries are very similar at young ages.

Conclusion
The fact that age at diagnosis was not a significant predictor of language outcomes in this study could be explained by several limitations of the study itself, the primary one being the relatively small number of participants, and in particular, the low number (around 30%) of children whose hearing loss was diagnosed before 12 months of age. Further data collection continues, with a greater number of children (a greater proportion of whom have been diagnosed early through neonatal hearing screening) to clarify whether or not early diagnosis in the Australian population has a significant effect on language outcomes.

This study highlights the importance of family participation in intervention programs to enable children to achieve optimal language outcomes. It is important to closely examine and compare the effectiveness of program elements and teaching techniques used in early intervention programs with children and their families, in order to maximize parent participation and effectiveness in early intervention.

Although many children with hearing loss have achieved a high standard of education through independent learning, these successes still represent the minority, not the majority. It is imperative that we work out how we can better assist all children with hearing loss to attain age-appropriate language during their early years, so that they have all the opportunities in life they deserve.

Reference:
Julia Z. Sarant; Colleen M. Holt; Richard C. Dowell; Field W. Rickards; Peter J. Blamey. Spoken Language Development in Oral Preschool Children With Permanent Childhood Deafness. The Journal of Deaf Studies and Deaf Education 2008; doi: 10.1093/deafed/enn034