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Purpose: We provide a case report of "Zoe," a 4-year-old deaf child from a deaf signing family, who presented with a possible case of Childhood Apraxia of Sign (CASign). Method: The description is based on reports from the child's speech-language pathologist, her Individualized Education Program report, and a clinician-created sign imitation task. Results: Zoe's sign articulation errors in American Sign Language differed from those reported for typically developing deaf children and were parallel to the types of errors observed for hearing children with childhood apraxia of speech. Specifically, Zoe produced inconsistent errors across signs, substituted more complex handshapes for simple handshapes, made errors on both unmarked (common) and marked (less common) forms, produced articulatory distortions (rather than substitutions), and exhibited "groping" behaviors (a sequence of attempts to move her hands into the correct position). In addition, Zoe sometimes self-corrected her errors by manipulating her own hands, for example, using her left hand to move the thumb of her right hand into the correct position. Conclusion: Zoe's pattern of sign errors is consistent with an underlying deficit in motor planning and/or programming and may constitute the first reported case of CASign. [ABSTRACT FROM AUTHOR]

Purpose: Many young children who are deaf/hard of hearing (D/HH) using listening and spoken language (LSL) demonstrate improved spoken language outcomes. Anecdotally, one cascading effect of these improved outcomes is that many children are not qualifying for continued services at the age of 3 years during the Individuals with Disabilities Education Act (IDEA) of 2004 Part C to Part B transition due to norm-referenced language performance within the average range. Although norm-referenced performance is one metric for determining language delay and is heavily relied on by educational teams, these siloed measures do not reflect listening, language, and learning demands of a typical preschool classroom. This tutorial highlights the research-to-practice gap currently existing in school-based contexts when evaluating a young child who is D/HH using LSL for special education services. Conclusions: An evidence-based framework for ecologically valid, schoolbased evaluations during the transition period from IDEA (2004) Part C to Part B for young children who are D/HH using LSL between 30 and 35 months of age is presented that balances sensitivity with feasibility. With a particular emphasis on assessment practices for spoken language, the framework connects the purpose of special education eligibility evaluations with evidencebased practice guidance from the literature. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate family resilience--defined as the capacity of a family to harness its collective strengths and resources to recover from and adapt to significant adversities or crises effectively--in primary care- givers of children who are deaf and hard of hearing (cDHH) and its association with quality of life, life satisfaction, perceived social support, and loneliness. Method: The study involved 108 primary caregivers of cDHH and 139 primary caregivers of children with normal hearing. Participants underwent psychometric evaluations including the Family Resilience Scale, World Health Organization Quality of Life Assessment--Brief Form, Satisfaction with Life Scale, UCLA Lone- liness Scale, and Multidimensional Scale of Perceived Social Support. Results: Significant differences were found in almost every scale and its subdi- mension between the two groups (p < .05). Correlation analysis revealed signifi- cant correlations between all scale total scores for both groups (p < .05, .153 < / r / < .737). Quality of life was found to be a significant predictor of family resil- ience, F(1, 139) = 41.824, R2 = .279, B = 0.495, t = 6.467, p < .001. Conclusions: Our study highlights the significant impact of having cDHH on caregivers' family resilience, quality of life, life satisfaction, feelings of loneliness, and perceived social support. The results underscore the importance of enhanc- ing caregivers' quality of life as a potential strategy to improve their family resil- ience. Further research is needed to understand the complex interplay of factors influencing these outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This pilot study aimed to examine the effects of a caregiversupported, narrative-based intervention program on the story retelling skills of a group of preschoolers who are deaf and hard of hearing (D/HH) using listening and spoken language (LSL). Method: A concurrent multiple baseline design across participants was used to determine the effect of a narrative intervention on the story retelling skills of three preschool-age participants who demonstrated complex language delays. Their primary caregivers also functioned as participants. The 6-week narrative intervention program was implemented using a caregiver coaching model during individual therapy sessions. The dependent variable probes were administered twice per week across phases to assess the preschool participants' story retelling skills, including story grammar, complexity, and completeness. Social validity was also evaluated using a caregiver questionnaire. Results: A functional relation was demonstrated between the intervention and story retelling across all three preschool participants with notable increases in the inclusion of story grammar elements and episodic completeness. All three participants maintained scores above baseline levels on dependent variable probes across the 6-week maintenance period. Social validity was strong according to the results of a caregiver questionnaire completed at the conclusion of the intervention. Conclusion: These findings offer preliminary support for the use of a caregiversupported, narrative-based intervention program to improve storytelling and retelling skills in preschoolers who are D/HH using LSL. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the auditory performance and speech perception of 104 children with isolated large vestibular aqueduct syndrome (LVAS) and 523 children with no inner ear malformation (IEM) for 5 years after cochlear implantation, in order to explore whether isolated LVAS can affect the long-term hearing and speech rehabilitation of deaf children after cochlear implantation. Method: A cohort study was established consisting of 627 children who underwent cochlear implantation at Beijing Tongren Hospital from 1999 to 2016. The children were examined at 0, 6, 12, 24, 36, 48, and 60 months after cochlear implantation to assess their auditory performance and speech perception using the Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) questionnaires. Results: The CAP scores of the isolated LVAS group increased significantly during the baseline to the 24th month, after which they gradually rose until reaching the plateau during the 24th to the 60th month. The CAP scores of the non-IEM group increased significantly during the baseline to the 36th month and then increased steadily. The SIR scores went up significantly during the baseline to the 48th month, and increased in a gradual manner in other stages of isolated LVAS evaluation. In comparison, The SIR scores of non-IEM group grew remarkably from the baseline to the 60th month. There were no significant differences in the CAP or SIR scores between isolated LVAS and non-IEM groups in each stage of evaluation, with the only exception being the CAP score at baseline month after cochlear implantation. Conclusions: The CAP and SIR questionnaires are helpful tools for quantifying the early hearing and speech skills of younger prelingually deafened cochlear implant recipients. This long-term follow-up study shows that the speech and hearing development of children in isolated LVAS and non-IEM groups follow similar patterns, and isolated LVAS does not affect the long-term rehabilitation of deaf children after cochlear implantation. [ABSTRACT FROM AUTHOR]

Purpose: Children who are deaf and hard of hearing (DHH) have documented deficits with complex syntax and vocabulary knowledge. Mental state verbs (MSVs) are necessary for some kinds of complex syntax use and communicate abstract concepts needed for academic language. The purpose of this study was to examine the frequency, diversity, and syntactic context of MSV use in children who are DHH compared to children with typical hearing (CTH). Method: Seventy-three preschool children (23 with cochlear implants, 22 with hearing aids, and 28 with typical hearing) completed a structured language sample as part of a larger assessment battery. Samples were analyzed and compared across groups for use of MSVs, diversity in MSV use, and syntactical context for MSVs. Results: Children who are DHH used significantly fewer MSV in complex syntax, a smaller diversity of MSV, and significantly fewer MSV in obligatory contexts compared to CTH. Results for the cochlear implants and hearing aid groups were not significantly different from one another despite differing levels of hearing loss. Conclusion: Children who are DHH demonstrate significant differences in the rate, diversity, and complexity of MSV use compared to peers with typical hearing. Supplemental Material: https://doi.org/10.23641/asha.24091860 [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to (a) compare outcomes between children who are deaf or hard of hearing (DHH) and children with typical hearing (CTH) on the Dynamic Indicators of Basic Early Literacy Skills (DIBELS), Eighth Edition assessment and (b) compare outcomes of children who are DHH on the DIBELS to other standardized literacy assessments. Method: Participants included 19 children who are DHH and 19 CTH in kinder-garten or first grade. All participants who are DHH had bilateral hearing loss and used listening technology. The participants completed timed and untimed standardized literacy assessments. Data were analyzed using independent-samples t test, chi-square analysis, and Pearson correlation analysis. Results: Only one of five subtests on the DIBELS, the Oral Reading Fluency subtest, revealed a significant difference in scores between children who are DHH and CTH. Despite this difference, there were no differences in the distribution of risk between the groups. The DIBELS scores of children who are DHH strongly correlated to their scores on other standardized literacy assessments. Conclusions: The results indicate that the DIBELS is an adequate measure to screen early literacy skills for children who are DHH. The DHH and CTH groups differ in reading comprehension using a standardized measure; however, the DIBELS does not measure this skill. Further assessments of reading comprehension along with the DIBELS are recommended when assessing these skills in children who are DHH. [ABSTRACT FROM AUTHOR]

Purpose: This study presents an exploration of facilitative language techniques (FLTs) used by fathers of children who are deaf or hard of hearing (DHH) in the natural environment. Method: This investigation utilized the Language ENvironment Analysis (LENA) to collect full-day audio samples from three families with children who were DHH and between 22 and 27 months of age. A total of 6 hr of audio recordings per participant was manually coded for the presence of 10 FLTs used by fathers in the natural environment. These data were compared with FLT use by mothers from the same samples. Results: Fathers of children who are DHH used fewer overall FLTs, fewer responsive FLTs, and more directives compared with mothers. Conclusions: Results of this analysis indicate that fathers provide less linguistic input to their children who are DHH in the natural environment. Furthermore, their input tends to be directive in nature rather than responsive to the child. Implications for clinical practice are discussed. Supplemental Material: https://doi.org/10.23641/asha.23511948 [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine whether and how learning American Sign Language (ASL) is associated with spoken English skills in a sample of ASL–English bilingual deaf and hard of hearing (DHH) children. Method: This cross-sectional study of vocabulary size included 56 DHH chil)dren between 8 and 60 months of age who were learning both ASL and spoken English and had hearing parents. English and ASL vocabulary were indepen)dently assessed via parent report checklists. Results: ASL vocabulary size positively correlated with spoken English vocabu)lary size. Spoken English vocabulary sizes in the ASL–English bilingual DHH children in the present sample were comparable to those in previous reports of monolingual DHH children who were learning only English. ASL–English bilingual DHH children had total vocabularies (combining ASL and English) that were equivalent to same-age hearing monolingual children. Children with large ASL vocabularies were more likely to have spoken English vocabularies in the aver)age range based on norms for hearing monolingual children. Conclusions: Contrary to predictions often cited in the literature, acquisition of sign language does not harm spoken vocabulary acquisition. This retrospective, correlational study cannot determine whether there is a causal relationship between sign language and spoken language vocabulary acquisition, but if a causal relationship exists, the evidence here suggests that the effect would be positive. Bilingual DHH children have age-expected vocabularies when consid)ering the entirety of their language skills. We found no evidence to support rec)ommendations that families with DHH children avoid learning sign language. Rather, our findings show that children with early ASL exposure can develop age-appropriate vocabulary skills in both ASL and spoken English. [ABSTRACT FROM AUTHOR]

Purpose: Unilateral cochlear implants (CIs) can restore binaural hearing in single-sided deafness (SSD). Direct stimulation of the CI can be obtained via the Bluetooth connection of a device to the CI, thus excluding the typical-hearing ear. This study aims to investigate the use of CI connectivity features as a rehabilitative strategy in a small cohort of children affected by SSD. Method: A newly developed training protocol was presented to children with SSD who have less than 2 years of experience with CI. We developed a user-friendly and short-term (six sessions within 20 days) training protocol for speech perception that patients themselves can manage independently at home using CI connectivity systems. Children were telematically tested before and after the training by trained speech and language therapists. Results: Four patients met the inclusion criteria. They all showed better results in the final online assessment, when compared with the initial one. Conclusions: To our knowledge, this is the first clinical focus article presenting an auditory training protocol for SSD patients with CI using the Bluetooth connectivity systems for teletherapy. The results, although preliminary, support the efficacy of this rehabilitative strategy. Further research is needed to support our findings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this longitudinal investigation was to compare the developmental trajectories of code-related emergent literacy skills of children who are deaf and hard of hearing (DHH) who use amplification and spoken language across the preschool years. Method: Thirty children who are DHH and 31 children with typical hearing completed a language and emergent literacy assessment at 6-month intervals from age 4 through 6 years. Growth curve analysis was used to compare developmental trajectories between groups of the code-related skills of phonological awareness, phonological memory, phonological recoding, alphabet knowledge, and conceptual print knowledge. Results: Growth across the preschool years was observed on all code-related emergent literacy skills across groups. Children who are DHH scored consistently lower than children with typical hearing on phonological awareness, phonological memory, and conceptual print knowledge; no group differences were observed for phonological recoding or alphabet knowledge. No interactions of time and group were significant. Conclusions: Children who are DHH exhibit consistent deficits in phonological awareness, phonological memory, and conceptual print knowledge across the preschool years and begin formal literacy instruction with a weaker foundation in emergent literacy skills. Future work should focus on optimizing emergent literacy interventions for children who are DHH during the preschool years. [ABSTRACT FROM AUTHOR]

Purpose: Best practices recommend promoting the use of the home language and allowing caregivers to choose the language(s) that they want to use with their child who is deaf or hard of hearing (DHH). We examined whether Spanishspeaking caregivers of children who are DHH receive professional recommendations on oral bilingualism that follow best practices. We also assessed whether professional recommendations, caregiver beliefs, and language practices had an impact on child language(s) proficiency. Method: Sixty caregivers completed a questionnaire on demographic questions, language(s) use and recommendations, beliefs on bilingualism, and child language proficiency measures in English, Spanish, and American Sign Language (ASL). Professional recommendations on oral bilingualism were reported descriptively, and linear regression was used to identify the predictors of child language(s) proficiency. Results: We found that only 23.3% of the caregivers were actively encouraged to raise their child orally bilingual. Language practices predicted child proficiency in each language (English, Spanish, and ASL), but professional recommendations and caregiver beliefs did not. Conclusions: Our results revealed that most caregivers received recommendations that do not follow current best practices. Professional training is still needed to promote bilingualism and increase cultural competence when providing services to caregivers who speak languages different from English. [ABSTRACT FROM AUTHOR]

Purpose: More than 80% of children who are deaf/hard of hearing (DHH) receive services in mainstream school settings. This means they are often served as part of a broader caseload rather than by someone who has specific training in serving this population. While best practice outlines specific skills and expertise from highly qualified providers, in reality, many lack confidence related to hearing technology and resources related to serving children who are DHH. Method: This study surveyed 459 professionals within the American Speech- Language-Hearing Association who serve children who are DHH with the intent of comparing differences in confidence, training, and resource use between providers who have self-selected interest in working with children who are DHH (i.e., membership in Special Interest Group [SIG] 9, Pediatric Hearing and Hearing Disorders) and those who serve children who are DHH but are not part of the pediatric hearing--related SIG. Results: Results indicated that many providers, particularly those not in SIG 9, did not have confidence in serving young children who are DHH (particularly in early intervention or preschool). Graduate experiences (classes and practicum) played little role in providers' confidence working with children who are DHH. Conclusions: While most children who are DHH are enrolled in school settings, there is limited provider confidence in working with this population. Graduate training programs should explore opportunities to provide more intensive, comprehensive experiences to prepare providers in this area. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe the Language Access Profile Tool (LAPT) and its psychometric properties with the aim of evaluating its suitability as an alternative to the deaf or hard of hearing (DHH) Language Exposure Assessment Tool (D-LEAT) in clinical practice with DHH children age 12 years and younger.*** Method: We administered both the LAPT and D-LEAT to the caregivers of 105 DHH children 12 years old and younger from across the United States, 40% of whom were interviewed again after a delay of at least 1 month. Each interview resulted in a child-specific estimate of their cumulative experience with language input, expressed as a proportion divided across eight categories.*** Results: Participants in the sample reported experience with all eight input categories, but four categories were common and four were rare. Estimates for all input categories were consistent at both initial and follow-up interviews. Estimates for each input category were also strongly correlated with the corresponding estimates from the D-LEAT, although correlations for the rare categories should be interpreted cautiously.*** Conclusions: The LAPT demonstrates sufficient test-retest reliability and convergent validity to be a useful and more user-friendly alternative to the D-LEAT. We provide recommendations for how the LAPT and the D-LEAT can be best used in their current form. [ABSTRACT FROM AUTHOR]

Purpose: Children who are hard of hearing (CHH) are at risk for literacy difficulties. Speech sound production is related to literacy skills in typically hearing children. Speech sound production abilities can also be markedly weak in CHH due to inconsistent access to the speech signal. We longitudinally examined relations between auditory experience, speech sound production abilities, and literacy (i.e., nonword reading and spelling in second grade) in CHH.*** Method: Participants included 166 CHH. All participants used hearing aids (HAs). Auditory experience is a weighted measure of the number of hours of daily HA use and the amount of audibility with and without their HAs. Children's speech sound production was tested 2-3 times between the ages of 3 and 9 years. At age 5 years and again in second grade, children were tested on a battery of language and literacy measures.*** Results: Auditory experience was significantly correlated with speech sound production abilities, but age at HA fitting was not. Speech sound production abilities at age 5 years did not predict nonword reading in second grade but did predict spelling skills in second grade.*** Conclusions: Our results support the importance of auditory experience and speech sound production for later literacy abilities. Specifically, we found that speech sound production abilities and print knowledge at age 5 years are related to second grade spelling outcomes. Interestingly, we found that morphological knowledge at age 5 years was more predictive of decoding in second grade than was speech sound production. Although there are multiple factors that contribute to literacy success, our results underscore the unique contributions of speech sound production abilities in CHH. [ABSTRACT FROM AUTHOR]

Purpose: Responsive and dynamic aspects of father-child play are associated with behavioral and neurocognitive development in children and could represent an important contributor to executive function (EF) skills for children who are deaf and hard of hearing (DHH). This study examined associations between paternal behaviors during play and EF skills of DHH children and children with typical hearing (TH). Method: Father-child dyads in families with DHH children (n = 30) and TH children (n = 29) participated in a 15-min video-recorded free-play session that was coded for parental behaviors using Parent-Child Interaction Rating Scales and Rough and Tumble Play Quality. Families also completed an age-appropriate version of the Behavior Rating Index of Executive Function as a measure of child EF. Results: DHH children were rated as having significantly more everyday difficulties with working memory than TH children. Fathers of DHH children were rated as more intrusive during play than fathers of TH children; however, there were no other differences between paternal groups on coded dimensions of father child play. Paternal respect for child autonomy was associated with fewer child difficulties with planning and organization skills and paternal play engagement was associated with fewer child EF difficulties. Moderation analyses revealed that paternal sensitivity was associated with more working memory difficulties and paternal respect for child autonomy was associated with fewer working memory difficulties for DHH children only. Conclusions: Paternal play could be an important environmental context for DHH outcomes. Fathers supporting independent play might generally support EF. Paternal engagement in play might also benefit EF. Results highlight paternal behavioral attributes that could lead to potential father-embedded intervention models. [ABSTRACT FROM AUTHOR]

Purpose: This article provides evidence to refute an assumption often made regarding speech-language pathologists' (SLPs') role in developing language skills in children who are deaf. SLPs are experts in both speech and language development and disorders. When working with children who are deaf, their primary focus is often on developing speech and listening skills with the assumption that this will transfer to overall language development. The intent of this article is to provide evidence that language is dissociable from both speech and listening and that its development can be bolstered through exposure to robust linguistic input in both the oral and signed modalities. Encouraging the use of a signed language alongside a spoken language during the period of language acquisition can be highly beneficial for a child who is deaf for a multitude of reasons. Because these children may not fully access the ambient spoken language in their environment despite the consistent use of listening devices, providing an accessible signed language can help them attain language fluency in at least one language. Conclusion: The author suggests that SLPs should be educating parents of children who are deaf on the benefits of bimodal bilingualism and the complementary nature of simultaneous signed and spoken language acquisition. [ABSTRACT FROM AUTHOR]

Purpose: This case study describes the language evaluation and treatment of a 5-year-old boy, Lucas, who is Deaf, uses American Sign Language (ASL), and presented with a language disorder despite native access to ASL and no additional diagnosis that would explain the language difficulties. Method: Lucas participated in an evaluation where his nonverbal IQ, fine motor, and receptive/expressive language skills were assessed. Language assessment included both formal and informal evaluation procedures. Language intervention was delivered across 7 weeks through focused stimulation. Results: Evaluation findings supported diagnosis of a language disorder unexplained by other factors. Visual analysis revealed an improvement in some behaviors targeted during intervention (i.e., number of different verbs and pronouns), but not others. In addition, descriptive analysis indicated qualitative improvement in Lucas' language production. Parent satisfaction survey results showed a high level of satisfaction with therapy progress, in addition to a belief that Lucas improved in language areas targeted. Conclusions: This study adds to the growing body of literature that unexplained language disorders in signed languages exist and provides preliminary evidence for positive outcomes from language intervention for a Deaf signing child. The case described can inform professionals who work with Deaf signing children (e.g., speech-language pathologists, teachers of the Deaf, and parents of Deaf children) and serve as a potential starting point in evaluation and treatment of signed language disorders. [ABSTRACT FROM AUTHOR]

Purpose: To qualitatively explore parent and professional perspectives regarding the content of select Hear to Learn tutorials to identify usefulness and meaningfulness of the tutorials, and to inform regarding key components to enhance usefulness of eHealth platforms. Method: This study used a qualitative design with two stakeholder focus groups. Stakeholder groups included four parents of children who are deaf or hard-of-hearing, and six professionals serving children who are deaf or hard-of-hearing. Results: Findings indicate that both stakeholders valued the tutorials generally as helpful; however, areas for improvement were suggested. Conclusion: Use of visuals, step-by-step instructions, and depth of content were identified as key elements that may be considered to optimize benefits of eHealth material for parents. [ABSTRACT FROM AUTHOR]

Purpose: Speechreading (lipreading) is a correlate of reading ability in both deaf and hearing children. We investigated whether the relationship between speechreading and singleword reading is mediated by phonological awareness in deaf and hearing children. Method: In two separate studies, 66 deaf children and 138 hearing children, aged 5-8 years old, were assessed on measures of speechreading, phonological awareness, and single-word reading. We assessed the concurrent relationships between latent variables measuring speechreading, phonological awareness, and single-word reading. Results: In both deaf and hearing children, there was a strong relationship between speechreading and singleword reading, which was fully mediated by phonological awareness. Conclusions: These results are consistent with ideas from previous studies that visual speech information contributes to the development of phonological representations in both deaf and hearing children, which, in turn, support learning to read. Future longitudinal and training studies are required to establish whether these relationships reflect causal effects. [ABSTRACT FROM AUTHOR]

Purpose: A group of 10 prelingually deafened children with cochlear implants (CIs) formed a choir and received 21 months of formal music training. The purpose of this study was to evaluate the singing proficiency of these children. Method: The participants included all choir members (7 girls and 3 boys, mean age of 9.5 years old) who were unilateral CI users. Meanwhile, 8 age-matched children with normal hearing were recruited as controls and were trained on 1 song for 2 weeks. Individual singing samples without instrument accompaniment were recorded from all participants. The singing samples were subject to acoustic analysis in which the fundamental frequency (F0) of each note was extracted and the duration was measured. Five metrics were developed and computed to quantify the accuracy of their pitch and rhythm performance. The 5 metrics included (a) percent correct of F0 contour direction of adjacent notes, (b) mean deviation of the normalized F0 across the notes, (c) mean deviation of the pitch intervals, (d) mean deviation of adjacent note duration ratio, and (e) mean absolute deviation of note duration. Results: The choir members with CIs demonstrated high accuracy in both pitch and tempo measures and performed on par with the children with normal hearing. Early start of music training after implantation and use of bimodal hearing contributed to the development of better music ability in these children with CIs. Conclusion: These findings indicated that rigorous music training could facilitate high singing proficiency in prelingually deafened children with CIs. [ABSTRACT FROM AUTHOR]

Purpose: Despite advances in cochlear implant and hearing aid technology, many children with hearing loss continue to exhibit poorer language skills than their hearing peers. This randomized pilot trial tested the effects of a parentimplemented communication treatment targeting prelinguistic communication skills in infants and toddlers with hearing loss. Method: Participants included 19 children between 6 and 24 months of age with moderate to profound, bilateral hearing loss. Children were randomly assigned to the parent-implemented communication treatment group or a "usual care" control group. Parents and children participated in 26, hour-long home sessions in which parents were taught to use communication support strategies. The primary outcome measures were the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 2003), a measure of child prelinguistic skills, and parental use of communication support strategies during a naturalistic play session. Results: Parents in the treatment group increased their use of communication support strategies by 17%. Children in the treatment group made statistically significant more gains in speech prelinguistic skills (d = 1.09, p = .03) as compared with the control group. There were no statistically significant differences in social and symbolic prelinguistic skills; however, the effect sizes were large (d = 0.78, p = .08; d = 0.91, p = .10). Conclusions: This study provides modest preliminary support for the short-term effects of a parent-implemented communication treatment for children with hearing loss. Parents learned communication support strategies that subsequently impacted child prelinguistic skills. Although these results appear promising, the sample size is very small. Future research should include a larger clinical trial and child-level predictors of response to treatment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine if an objective measure of speech production could serve as a vocal biomarker for the effects of high-frequency hearing loss on speech perception. It was hypothesized that production of voiceless sibilants is governed sufficiently by auditory feedback that high-frequency hearing loss results in subtle but significant shifts in the spectral characteristics of these sibilants. Method: Sibilant production was examined in individuals with mild to moderately severe congenital (22 children; 8-17 years old) and acquired (23 adults; 55-80 years old) hearing losses. Measures of hearing level (pure-tone average thresholds at 4 and 8 kHz), speech perception (detection of nonsense words within sentences), and speech production (spectral center of gravity [COG] for /s/ and /∫/) were obtained in unaided and aided conditions. Results: For both children and adults, detection of nonsense words increased significantly as hearing thresholds improved. Spectral COG for /∫/ was unaffected by hearing loss in both listening conditions, whereas the spectral COG for /s/ significantly decreased as high-frequency hearing loss increased. The distance in spectral COG between /s/ and /∫/ decreased significantly with increasing hearing level. COG distance significantly predicted nonsense-word detection in children but not in adults. Conclusions: At least one aspect of speech production (voiceless sibilants) is measurably affected by high-frequency hearing loss and is related to speech perception in children. Speech production did not predict speech perception in adults, suggesting a more complex relationship between auditory feedback and feedforward mechanisms with age. Even so, these results suggest that this vocal biomarker may be useful for identifying the presence of high-frequency hearing loss in adults and children and for predicting the impact of hearing loss in children. [ABSTRACT FROM AUTHOR]

Purpose: Statistical learning--the ability to learn patterns in environmental input--is increasingly recognized as a foundational mechanism necessary for the successful acquisition of spoken language. Spoken language is a complex, serially presented signal that contains embedded statistical relations among linguistic units, such as phonemes, morphemes, and words, which represent the phonotactic and syntactic rules of language. In this review article, we first review recent work that demonstrates that, in typical language development, individuals who display better nonlinguistic statistical learning abilities also show better performance on different measures of language. We next review research findings that suggest that children who are deaf and use cochlear implants may have difficulties learning sequential input patterns, possibly due to auditory and/or linguistic deprivation early in development, and that the children who show better sequence learning abilities also display improved spoken language outcomes. Finally, we present recent findings suggesting that it may be possible to improve core statistical learning abilities with specialized training and interventions and that such improvements can potentially impact and facilitate the acquisition and processing of spoken language. Method: We conducted a literature search through various online databases including PsychINFO and PubMed, as well as including relevant review articles gleaned from the reference sections of other review articles used in this review. Search terms included various combinations of the following: sequential learning, sequence learning, statistical learning, sequence processing, procedural learning, procedural memory, implicit learning, language, computerized training, working memory training, statistical learning training, deaf, deafness, hearing impairment, hearing impaired, DHH, hard of hearing, cochlear implant(s), hearing aid(s), and auditory deprivation. To keep this review concise and clear, we limited inclusion to the foundational and most recent (2005-2018) relevant studies that explicitly included research or theoretical perspectives on statistical or sequential learning. We here summarize and synthesize the most recent and relevant literature to understanding and treating language delays in children using cochlear implants through the lens of statistical learning. Conclusions: We suggest that understanding how statistical learning contributes to spoken language development is important for understanding some of the difficulties that children who are deaf and use cochlear implants might face and argue that it may be beneficial to develop novel language interventions that focus specifically on improving core foundational statistical learning skills. [ABSTRACT FROM AUTHOR]

Purpose: Deaf children are frequently reported to be at risk for difficulties in executive function (EF); however, the literature is divided over whether these difficulties are the result of deafness itself or of delays/deficits in language that often co-occur with deafness. The purpose of this study is to discriminate these hypotheses by assessing EF in populations where the 2 accounts make contrasting predictions. Method: We use a between-groups design involving 116 children, ages 5-12 years, across 3 groups: (a) participants with normal hearing (n = 45), (b) deaf native signers who had access to American Sign Language from birth (n = 45), and (c) oral cochlear implant users who did not have full access to language prior to cochlear implantation (n = 26). Measures include both parent report and performance-based assessments of EF. Results: Parent report results suggest that early access to language has a stronger impact on EF than early access to sound. Performance-based results trended in a similar direction, but no between-group differences were significant. Conclusions: These results indicate that healthy EF skills do not require audition and therefore that difficulties in this domain do not result primarily from a lack of auditory experience. Instead, results are consistent with the hypothesis that language proficiency, whether in sign or speech, is crucial for the development of healthy EF. Further research is needed to test whether sign language proficiency also confers benefits to deaf children from hearing families. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine fatigue associated with sustained and effortful speech-processing in children with mild to moderately severe hearing loss. Method: We used auditory P300 responses, subjective reports, and behavioral indices (response time, lapses of attention) to measure fatigue resulting from sustained speech-processing demands in 34 children with mild to moderately severe hearing loss (M = 10.03 years, SD = 1.93). Results: Compared to baseline values, children with hearing loss showed increased lapses in attention, longer reaction times, reduced P300 amplitudes, and greater reports of fatigue following the completion of the demanding speech-processing tasks. Conclusions: Similar to children with normal hearing, children with hearing loss demonstrate reductions in attentional processing of speech in noise following sustained speech-processing tasks—a finding consistent with the development of fatigue. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to assess Cantonese word recognition and the discrimination of Cantonese tones with manipulated contours by child and adolescent cochlear implant (CI) users and a group of peers with normal hearing (NH). It was hypothesized that the CI users would perform more poorly than their counterparts with NH in both tasks and that CI users implanted before 2 years of age would perform better than those implanted after 2 years. Method: Forty-one participants were recruited from hospitals, schools, and kindergartens in Hong Kong: Ten CI users implanted at or before 2 years of age ("early" CI group), 13 CI users implanted after 2 years of age ("late" CI group), and 18 individuals with NH. The mean age at implantation of the early CI group was 1.5 years (SD = 0.3), and for the late CI group, it was 4.3 years (SD = 2.1). Participants were a mean of 13.3 years of age (SD = 3.7) at time of testing. Participants completed a Cantonese word recognition test and a discrimination task using Cantonese tones with modified fundamental frequency trajectories. Results: Both CI user groups obtained significantly lower scores than the group with NH on the word recognition test. Mean percent correct scores for the word recognition test were 79% for the early CI group, 69% for the late CI group, and 97% for the group with NH. The group with NH consistently achieved higher scores than the CI user groups when discriminating manipulated Cantonese tones. Increasing the acoustic difference between tones improved discrimination performance for CI users for level tone contrasts only. CI users implanted at or before 2 years of age obtained higher scores than those implanted later. Conclusions: The results of this study add further evidence that children using CIs do not perform as well as peers in perceiving Cantonese tones. Modification of tones to increase pitch range did not consistently improve the ability of children with implants to perceive the difference between tones. Further research is required to fully assess potential benefits of early implantation for speakers of tonal languages. [ABSTRACT FROM AUTHOR]

Purpose: The authors investigated the ability of deaf children with cochlear implants (CIs) to use sentence context to facilitate the perception of spoken words. Method: Deaf children with CIs (n = 24) and an age-matched group of children with normal hearing (n = 31) were presented with lexically controlled sentences and were asked to repeat each sentence in its entirety. Performance was analyzed at each of 3 word positions of each sentence (first, second, and third key word). Results: Whereas the children with normal hearing showed robust effects of contextual facilitation—improved speech perception for the final words in a sentence—the deaf children with CIs on average showed no such facilitation. Regression analyses indicated that for the deaf children with CIs, Forward Digit Span scores significantly predicted accuracy scores for all 3 positions, whereas performance on the Stroop Color and Word Test, Children’s Version (Golden, Freshwater, & Golden, 2003) predicted how much contextual facilitation was observed at the final word. Conclusions: The pattern of results suggests that some deaf children with CIs do not use sentence context to improve spoken word recognition. The inability to use sentence context may be due to possible interactions between language experience and cognitive factors that affect the ability to successfully integrate temporal–sequential information in spoken language. [ABSTRACT FROM AUTHOR]

Purpose: Cochlear implants (CIs) can facilitate the acquisition of spoken language for deaf children, but challenges remain. Language skills dependent on phonological sensitivity are most at risk for these children, so having an effective way to diagnose problems at this level would be of value for school speech-language pathologists. The goal of this study was to assess whether a nonword repetition (NWR) task could serve that purpose. Method: Participants were 104 second graders: 49 with normal hearing (NH) and 55 with CIs. In addition to NWR, children were tested on 10 measures involving phonological awareness and processing, serial recall of words, vocabulary, reading, and grammar. Results: Children with CIs performed more poorly than children with NH on NWR, and sensitivity to phonological structure alone explained that performance for children in both groups. For children with CIs, 2 audiological factors positively influenced outcomes on NWR: being identified with hearing loss at a younger age and having experience with wearing a hearing aid on the unimplanted ear at the time of receiving a 1st CI. NWR scores were better able to rule out than to rule in such language deficits. Conclusions: Well-designed NWR tasks could have clinical utility in assessments of language acquisition for school-age children with CIs. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate joint engagement (JE) in age-matched children with and without hearing and its relationship to oral language skills. Method: Participants were 180 children with severe-to-profound hearing loss prior to cochlear implant surgery, and 96 age-matched children with normal hearing; all parents were hearing. JE was evaluated in a 10-minute videotaped free play task with parents. Engagement states ranged from the lowest (unengaged) to the highest level (symbol-infused coordinated). Standardized language measures were administered. Results: Multivariate analyses were conducted between the groups, stratified by chronological and language age. Children who were deaf (Deaf) spent less time in total symbol-infused JE than children with normal hearing (NH) across all ages. The majority of the Deaf group (83%) fell in the lowest language age group, in comparison to 35% of the NH group, and spent significantly less time in symbol-infused JE than hearing children. These delays were also observed in the Deaf group, who fell into the 18-36 month language age. No children in the Deaf group had achieved a language age of > 36 months. Conclusions: Young children with and without hearing had different developmental trajectories of JE, which were related to oral language skills. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated psychometric properties of 2 phonological awareness (PA) tests normed for hearing children when used with deaf and hard-of-hearing (DHH) children with functional hearing. It also provides an in-depth description of these children's PA. Method: One hundred and eight DHH children (mean age = 63.3 months) with cochlear implants or hearing aids were assessed in the fall and spring of the school year. Sixty-three percent communicated only with spoken language; 37% communicated with both sign and speech. Examiners administered PA subtests from the Phonological Awareness Test-2 and the Test of Preschool Early Literacy, along with assessments of speech perception and early literacy. Results: Item analyses indicated that both tests showed good psychometric properties (e.g., high item discriminations and internal consistencies). DHH children scored higher on subtests and items that measured words, rhymes, and syllables than those that assessed phonemes. Although subtest difficulty influenced the factor structure in the fall, spring PA was best characterized as a single factor. PA correlated concurrently and predictively with early literacy. Conclusions: This study suggests that these 2 standardized tests are valid for use with DHH children with functional hearing. Although delayed, these children's PA was structurally similar to that of hearing children. [ABSTRACT FROM AUTHOR]

Purpose: In this article, the authors sought to determine whether the precise age of implantation (AOI) remains an important predictor of spoken language outcomes in later childhood for those who received a cochlear implant (CI) between 12 and 38 months of age. Relative advantages of receiving a bilateral CI after age 4.5 years, better pre-CI-aided hearing, and longer CI experience were also examined. Method: Sixty children participated in a prospective longitudinal study of outcomes at 4.5 and 10.5 years of age. Twenty-nine children received a sequential second CI. Test scores were compared with normative samples of hearing age mates, and predictors of outcomes were identified. Results: Standard scores on language tests at 10.5 years of age remained significantly correlated with age of first cochlear implantation. Scores were not associated with receipt of a second, sequentially acquired CI. Significantly higher scores were achieved for vocabulary as compared with overall language, a finding not evident when the children were tested at younger ages. Conclusion: Age-appropriate spoken language skills continued to be more likely with younger AOI, even after an average of 8.6 years of additional CI use. Receipt of a second implant between ages 4 and 10 years and longer duration of device use did not provide significant added benefit. [ABSTRACT FROM AUTHOR]

Purpose: In this article, the authors describe the development of a new instrument, the Test of Child Speechreading (ToCS), which was specifically designed for use with deaf and hearing children. Speechreading is a skill that is required for deaf children to access the language of the hearing community. ToCS is a deaf-friendly, computer-based test that measures child speechreading (silent lipreading) at 3 psycholinguistic levels: (a) Words, (b) Sentences, and (c) Short Stories. The aims of the study were to standardize the ToCS with deaf and hearing children and to investigate the effects of hearing status, age, and linguistic complexity on speechreading ability. Method: Eighty-six severely and profoundly deaf children and 91 hearing children participated. All children were between the ages of 5 and 14 years. The deaf children were from a range of language and communication backgrounds, and their preferred mode of communication varied. Results: Speechreading skills significantly improved with age for both groups of children. There was no effect of hearing status on speechreading ability, and children from both groups showed similar performance across all subtests of the ToCS. Conclusion: The ToCS is a valid and reliable assessment of speechreading ability in school-age children that can be used to measure individual differences in performance in speechreading ability. [ABSTRACT FROM AUTHOR]

Purpose: To determine the concurrent validity of the Conditioned Assessment of Speech Production (CASP; Ertmer & Stoel-Gammon, 2008) and data obtained from speech samples recorded at the same intervals. Method: Nineteen children who are deaf who received cochlear implants before their 3rd birthdays participated in the study. Speech samples and CASP scores were gathered at 6, 12, 18, and 24 months postactivation. Correlation analyses were conducted to assess the concurrent validity of CASP scores and data from samples. Results: CASP scores showed strong concurrent validity with scores from speech samples gathered across all recording sessions (6-24 months). Conclusions: The CASP was found to be a valid, reliable, and time-efficient tool for assessing progress in vocal development during young cochlear implant recipients' first 2 years of device experience. [ABSTRACT FROM AUTHOR]

The primary goal of infant hearing screening is, of course, the improved outcome of speech and language in those identified early. There is, however, another major advantage in the early detection of hearing loss. Hearing loss identified by newborn screening can prompt an early investigation into the etiology of the loss. Most cases of hearing loss detected by newborn screening have a genetic etiology. A genetics evaluation can provide the family and providers with several critical pieces of information. For many families, simply knowing the "why" is an important question. Identifying an etiology can also answer questions about recurrence risks for the immediate and extended family. In addition, many of the causes of childhood hearing loss have associated medical conditions, some of which can be medically serious. Knowledge of these risk factors can lead to interventions that prevent morbidity and mortality. All health care providers who work with children with a hearing loss should be aware of the details of a genetic evaluation. They should be prepared to share with the family information regarding the process, the diagnostic yield, and the risks and benefits of such an evaluation. [ABSTRACT FROM AUTHOR]

Widespread realization of newborn hearing screening has made it possible to routinely identify hearing loss shortly after birth, expanding opportunities for children born with permanent hearing loss. For children to reach their full potential, high-quality comprehensive services need to be provided in a timely manner. Because the roles of the audiologist and speech-language pathologist vary significantly from family to family in an American Sign Language approach, this article focuses primarily on the roles these professionals serve within a listening and spoken language communication approach. An overview of components of quality assessment and intervention for audiology and speech-language pathology are discussed, as are the benefits and opportunities of interdisciplinary collaboration. Newborn hearing screenings, advanced hearing technology, and early education have the potential to affect the lives of children with hearing loss and their families; however, successful families and children rely on quality, collaborative intervention from their service providers. Together, speech-language pathologists and audiologists can better understand a child's responses to sound, more effectively set hearing technology to maximize access to sound, and support parents in their ability to help their children reach their full potential. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students. Method: A total of 555 children (6-12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools. Results: The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice. Conclusions: The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools. [ABSTRACT FROM AUTHOR]

Purpose: The goal was to assess the effects of maturation and phonological development on performance, by normally hearing children, on an imitative test of auditory capacity (On-Line Imitative Test of Speech-Pattern Contrast Perception [OlimSpac]; Boothroyd, Eisenberg, & Martinez, 2006; Eisenberg, Martinez, & Boothroyd, 2003, 2007). Method: Thirty-four hearing children (aged between 1;8 [years;months] and 6;7) were asked to imitate nonword utterances. Responses were evaluated by a blinded listener in an 8-alternative forced-choice task, giving information on the children's ability to convey, by imitation, information about 6 binary phonemic contrasts. Results: Four children declined participation. Among 30 children aged 2;7 or older, performance improved significantly with age and varied with contrast. All children 3 years of age or older attained passing scores (7 or 8 correct responses in 8 binary trials) on at least 5 of the 6 contrasts. Post-alveolar consonant place was the contrast most often failed. Conclusions: When evaluated on a pass/fail basis, normally hearing children 3 years of age or older are likely to demonstrate auditory perception of most phonemic contrasts using this imitative test. Phonological development and other task-related factors have only a modest effect on performance by normally hearing children after 3 years of age. The effects of hearing loss, hearing age, sensory assistance, and listening experience in children with hearing loss remain to be determined. [ABSTRACT FROM AUTHOR]

Purpose: Family members' perceptions of their quality of life were examined following early identification of deafness in children. Method: A questionnaire was used to solicit ratings of satisfaction from the family members of 207 children who were deaf and younger than 6 years of age. Results: Results indicated that families were generally satisfied with the areas of family life surveyed. Descriptive analysis suggested lower satisfaction ratings in the area of emotional wellbeing. Families also reported that their child's deafness had the largest impact on their emotional well-being. Family members of children using oral communication with a cochlear implant reported higher satisfaction with their child's speech production and perception outcomes than family members of children using hearing aids alone. Implications: We recommend that service providers and early hearing detection and intervention program coordinators consider additional supports for family well-being following the early identification of deafness in children. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to examine the long-term consequences of early-life otitis media (OM) and the associated hearing loss ( HL) on language skills of school-aged children. Method: In a prospective study, the middle-ear status of 65 Dutch healthy-born children was documented every 3 months during their first 2 years of life; language comprehension and production were evaluated at 27 months and again at 7 years. Results: The positive relation that was found between OM-related HL and language development at 27 months could no longer be discerned at school age. Accordingly, parent-reported HL between 2 and 7 years had no effect on scores at school age. Conclusion: The present study shows that negative consequences of early-life OM or the underlying HL on language comprehension and production appear to be resolved by the age of 7. It also shows that parent-reported HL between 2 and 7 years is not related to language skills at school age. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the effects of feedback training, familiarization training, and no training on naïve listeners' word identification (WI) and magnitude estimation scaling (MES) judgments of the speech intelligibility of children with severe-to profound hearing impairments. Method: Depending on the training group, listeners received a pretest, an immediate posttest, and/or a delayed posttest. Results: Results indicated that repeated exposure, with or without training, led to improved WI scores. Beyond the effects of repeated exposure, listeners' WI judgments of the intelligibility of speech significantly increased immediately after training in which listeners received feedback regarding the accuracy of their WI responses. The MES results were less straightforward--listeners in the feedback group perceived speech samples as less intelligible after the training, perceptions of speech intelligibility stayed almost the same for the familiarization training group, and participants in the control group perceived speech samples as more intelligible at the posttest. For the training groups that were not pretested, perceptions improved from the immediate to delayed posttest. Discussion: Results may have both theoretical and clinical significance, particularly as they relate to contrasting theories of perceptual learning and the extent to which listener characteristics may be reflected in intelligibility judgments. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare speech production at 12 months of age for children with hearing loss (HL) who were identified and received intervention before 6 months of age with those of children with normal hearing (NH). Method: The speech production of 10 children with NH was compared with that of 10 children with HL whose losses were identified ( better ear pure-tone average at 0.5, 1, and 2 kHz poorer than 50 dB HL) and whose intervention started before 6 months of age. These children were recorded at 12 months of age interacting with a parent. Three properties of speech production were analyzed: (a) syllable shape, (b) consonant type, and (c) vowel formant frequencies. Results: Children with HL had (a) fewer multisyllable utterances with consonants, (b) fewer fricatives and fewer stops with alveolar-velar stop place, and (c) more restricted front-back tongue positions for vowels than did the children with NH. Conclusion: Even when hearing loss is identified shortly after birth, children with HL do not develop speech production skills as their peers with NH do at 12 months of age. This suggests that researchers need to consider their approaches to early intervention carefully. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate the need for standardized data definitions and reporting for early hearing detection and intervention (EHDI) programs collecting information on newborn hearing screening and follow-up, and types of information best collected in a standardized manner. Method: A hypothetical birth cohort was used to show the potential effects of nonstandardized definitions and data classifications on rates of hearing screening, audiologic follow-up, and hearing loss. Results: The true screening rate in this cohort was 92.4%. The calculated rate was between 90.0% and 96.5%, depending on the measure used. Among children documented as screened and referred for follow-up, 61.0% received this testing. Only 49.0% were documented to have been tested. Despite a true prevalence of 3.7 per 1,000 births, only 1.5 per 1,000 children were documented with a hearing loss. Conclusion: Ensuring that children receive recommended follow-up is challenging. Without complete reporting by audiologists to EHDI programs, accurate calculation of performance measures is impossible. Lack of documentation can lead to the overstatement of "loss to follow-up." Also, standardization of measures is essential for programs to evaluate how many children receive recommended services and assess progress toward national goals. A new survey has been implemented to collect more detailed and standardized information about recommended services. [ABSTRACT FROM AUTHOR]

Purpose: Appropriate support for families of children diagnosed with hearing impairment may have a direct impact on the success of early hearing detection and intervention programs in reducing the negative effects of permanent hearing loss. We conducted a qualitative study to explore parents' needs after learning of their child's hearing loss to better understand the important components of service delivery from families' perspectives. Method: Semistructured interviews were conducted with 17 families (21 parents) of preschool children in 4 centers in Ontario, Canada. Parents of children identified by neonatal screening as well as those identified through traditional referral routes participated. We asked parents to share their perceptions of the strengths and gaps in the care system. Results: Although the majority of parents were satisfied with the range and quality of audiology and therapy services available, they identified gaps in the areas of service coordination, availability of information, and the integration of social service and parent support into the system. Access to audiology services appears to have been facilitated for children who were systematically screened. Conclusions: The findings provide insights into the services most valued by families. These findings highlight the importance of eliciting parents' perspectives in designing optimal care models for children and families. [ABSTRACT FROM AUTHOR]

Purpose: This investigation explored the utility of an acoustic measure, called the discreteness of voicing category (DOVC), in identifying voicing errors in stop consonants produced by children with cochlear implants. Another objective was to examine the perceptual relevance of the DOVC measure and 2 commonly used voice onset time (VOT)-based measures, namely, mean VOT and DVOT (e.g., VOT /t/ - VOT /d/). Method: Phonetic transcription and acoustic analyses were carried out on syllable-initial /t/ and /d/ produced by 10 children with cochlear implants. The DOVC was calculated as the difference between the shortest VOT value of a voiceless stop and the longest VOT value of a voiced stop across several productions of each. Results: Phonetic transcription revealed that 4 of the 10 talkers demonstrated atypical voicing distinctions. Acoustic analyses indicated that the DOVC measure identified these same 4 talkers as producing atypical values, whereas mean VOT and DVOT identified a different set of talkers as demonstrating values outside the normal ranges. Conclusion: Preliminary findings suggest that the DOVC measure corresponded with perceptual data better than the other acoustic measures examined in the present study. Data indicate that the DOVC measure may provide perceptually relevant information concerning the production of voicing distinctions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine children's head orientation relative to the arrival angle of competing signals and the sound source of interest in actual school settings. These data were gathered to provide information relative to the potential for directional benefit. Method: Forty children, 4-17 years of age, with and without hearing loss, completed the study. Deviation in head angle and elevation relative to the direction of sound sources of interest were measured in 40 school environments. Measurements were made on the basis of physical data and videotapes from 3 cameras placed within each classroom. Results: The results revealed similarly accurate head orientation across children with and without hearing loss when focusing on the 33% proportion of time in which children were most accurate. Orientation accuracy was not affected by age. The data also revealed that children with hearing loss were significantly more likely to orient toward brief utterances made by secondary talkers than were children with normal hearing. Conclusions: These data are consistent with the hypothesized association between hearing loss and increased visual monitoring. In addition, these results suggest that age does not limit the potential for signal-to-noise improvements from directivity-based interventions in noisy environments. [ABSTRACT FROM AUTHOR]

Purpose: The contribution of audible high-frequency information to speech-understanding performance in listeners with varying degrees of high-frequency sensorineural hearing loss was examined. Method: Thirty-six elderly hearing-impaired (EHI) and 24 young normal-hearing (YNH) listeners were tested in quiet (+20 dB speech-to-noise ratio [SNR]) and noise (+5 dB SNR) and under different bandpass conditions (narrow, 200-1600 Hz; midband, 200-3200 Hz; broadband, 200-6400 Hz), both without and with spectral shaping of the stimuli. Monosyllabic word-recognition performance was examined through use of both whole-word scoring and phoneme scoring. The 36 EHI listeners were divided into 3 groups of 12 listeners each, with the groups differing in the amount of high-frequency hearing loss. The 24 YNH participants were separated into 2 groups, each serving as a reference group for either the unshaped or spectrally shaped speech listening conditions. Results: Results for spectrally shaped speech, in both quiet and noise, revealed that the 3 EHI groups performed equivalently in the different bandwidth conditions and demonstrated no change (increase or decrease) in word-recognition performance between the midband and broadband conditions. The YNH groups, however, demonstrated improved speech understanding attributable to the higher frequencies for the broadband condition in both the unshaped and shaped conditions. Conclusions: Data from the EHI listeners revealed that performance for unshaped speech was correlated moderately and negatively with degree of high-frequency hearing loss. Alternatively, recognition performance for shaped speech was related to neither the performance for unshaped speech nor the amount of high-frequency hearing loss. [ABSTRACT FROM AUTHOR]

Purpose: The authors examined the benefits of younger cochlear implantation, longer cochlear implant use, and greater pre-implant aided hearing to spoken language at 3.5 and 4.5 years of age. Method: Language samples were obtained at ages 3.5 and 4.5 years from 76 children who received an implant by their 3rd birthday. Hierarchical linear modeling was used to identify characteristics associated with spoken language outcomes at the 2 test ages. The Preschool Language Scale (I. L. Zimmerman, V. G. Steiner, & R. E. Pond, 1992) was used to compare the participants' skills with those of hearing age-mates at age 4.5 years. Results: Expected language scores increased with younger age at implant and lower pre-implant thresholds, even when compared at the same duration of implant use. Expected Preschool Language Scale scores of the children who received the implant at the youngest ages reached those of hearing age-mates by 4.5 years, but those children implanted after 24 months of age did not catch up with hearing peers. Conclusion: Children who received a cochlear implant before a substantial delay in spoken language developed (i.e., between 12 and 16 months) were more likely to achieve age-appropriate spoken language. These results favor cochlear implantation before 24 months of age, especially for children with aided pure-tone average thresholds greater than 65 dB prior to surgery. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have examined how parents personalize the possibility of genetic hearing loss in their children and whether they actually intend to pursue testing for their child. This article addresses the audiologist's important role in the genetic testing referral and follow-up processes. Method: Twenty-four parents whose children were referred to genetic testing for hearing loss were interviewed in depth. Parents were selected to include a diverse range of races, ethnicities, and socioeconomic levels. Interviews were coded and analyzed using qualitative methods. Results: Parental associations with genetic testing included feeling personally responsible, feeling relief, and considering metaphysical attributions for their child's hearing loss. Parental attitudes were related to perceptions and experiences with deafness. Many misconceptions about genetics were also found. Conclusions: Audiologists need to be sensitized to parents' personal and sociocultural contexts when discussing genetic testing and should tailor informational and emotional support to parents' requirements when confronting the possibility of their child having a genetic hearing loss. [ABSTRACT FROM AUTHOR]

Purpose: This investigation reports on quantitative and qualitative follow-up information obtained from a preschool audiologic screening program covering a 10-year period (1995 to 2004). Method: The audiologic screening consisted of a hearing (pure tone) and tympanometry screening. A total of 34,979 children, 3 to 5 years of age, were screened. Results: Eighteen percent (6,337) of the children were referred for further hearing and/or medical ear evaluation. Of 1,421 follow-up responses received, 93% complied with the follow-up recommendations while 7% did not. Of 1,316 children in the follow-up group, outer and/or middle ear disorder in one or both ears was medically confirmed for 37%. Unilateral or bilateral hearing loss was diagnosed in 18% as conductive (12%), sensorineural (1%), mixed (0.4%), or unspecified (5%). Overall, hearing loss and/or otologic disorder was confirmed in 49% of the follow-up group, suggesting a prevalence of 1.8% in a preschool-age population. A small (n = 32) sample of unsolicited comments indicated that physicians most influenced noncompliance with hearing evaluation follow-up. Conclusions: The quantitative hearing and otologic follow-up outcome data affirm the importance of audiologic screening in the preschool population. Qualitative data suggest that some physicians may not be advocating appropriate screening follow-up services. [ABSTRACT FROM AUTHOR]