Communication Intervention for Toddlers With Hearing Loss

While children with hearing loss (HL) are experiencing greater gains in spoken language than
ever before, considerable variability exists and many children with HL continue to have
poorer language skills than their hearing peers. Critical to reducing this variability is the
identification of: (a) effective early communication interventions for children with HL and
(b) child and parent characteristics that influence intervention outcomes (moderators and
mediators). However, to date, only the pilot study for this proposed study has directly
examined the effects of an early communication intervention for children with HL within the
context of a randomized clinical trial. The overarching goals of the proposed study are to:
(a) evaluate the effects of teaching parents to use communication support strategies on child
communication outcomes and (b) examine parent and child characteristics that moderate and
mediate intervention outcomes. The central hypothesis is that systematic parent training will
result in greater parental use of communication support strategies, greater child
pre-symbolic communicative acts, and greater child spoken language outcomes. The specific
aims include: (a) comparing parent use of communication support strategies and child
pre-symbolic communicative acts between intervention and control groups during and
immediately following intervention (from 12 to 18 months of age), (b) examining parent
(identification of child communication) and child (sensitivity to social contingency;
attention to speech) moderators of intervention outcomes; (c) comparing parent use of
communication support strategies and child spoken language outcomes between intervention and
control groups after intervention (from 18 and 36 months of age); and (d) examining parent
(use of communication support strategies) and child (pre-symbolic communicative acts)
mediators of intervention outcomes. The proposed study will enroll 96 children with mild to
profound bilateral hearing loss. Children will enroll in the study around 12 months of age
and will be randomly assigned to either a parent-implemented communication intervention
(PICT) or a control group. Children in both groups will be assessed: (a) at 12 months of age
(immediately before intervention), (b) at 18 months of age (immediately after intervention),
and (c) at 36 months of age (18 months after the end of intervention). Children in the
intervention group will receive weekly, 1-hour intervention sessions for 6-months that: (a)
are delivered during an important prelinguistic period of language development, (b)
incorporate visual, interactive, responsive, and linguistically stimulating communication
support strategies that are associated with stronger language skills in children with HL, and
(c) include systematic parent training found to be effective in teaching parents to use
communication support skills in children with language delays. The proposed research is
significant because effective early communication intervention is likely to reduce persistent
language delays in children with HL, thereby advancing the field of childhood hearing loss,
where there is a striking paucity of rigorous communication intervention research.

Inclusion Criteria:

- have bilateral, congenital HL as measured by a review of medical records

- enrollment in the study between 10 and 14 months of age

- have no known additional disabilities (e.g., Down syndrome, cerebral palsy, seizure
disorder, blindness, etc.) as measured by review of medical records and parent report

- have English as the primary language spoken at home

- have one parent with normal hearing, and (f) are exposed to some degree of spoken
language by their parents (total communication, auditory/oral)