Postponement of the Newborn Hearing Screening during the COVID-19 Pandemic; Parental Experiences and Worries.

Early identification of hearing loss through newborn hearing screening followed by an early start of intervention has proven to be effective in promoting speech and language development in children with hearing loss. During the COVID-19 pandemic, newborn hearing screening was postponed for a group of newborns in the Netherlands. Therefore, meeting the guidelines for early identification was at risk. In this study, we examine parental attitudes, beliefs, and experiences concerning the hearing screening during the COVID-19 pandemic. Our results indicated that parents (n = 1053) were very positive about newborn hearing screening and their experiences with the screening, even during the COVID-19 pandemic. Parents' beliefs on the information provision around newborn hearing screening were more inconsistent. The results showed that parents with a postponed hearing screening felt less informed about the hearing screening than parents without a postponed screening. Furthermore, child and family characteristics affected how parents experienced newborn hearing screening. Parents with a premature child were more worried about the hearing abilities of their child before the screening took place. The results also indicate that deafness in the family might lead to parental worries around newborn hearing screening.

Socio-economic status and other potential risk factors for language development in the first year of life.

A wide variety of language skills has been shown to be compromised in children from low socioeconomic status (SES). However, few studies have investigated the effect of SES on language development in infants. The aim of this study is two-fold: to investigate when the first SES-effects on language can be observed and to explore the effects of three variables often claimed to be linked to SES - gestational duration, stress and parent-child interaction - on language development. Parents/caregivers of 539 Dutch-acquiring infants aged 8-13 months from mid to high SES backgrounds completed a questionnaire including the LENA Developmental Snapshot (Gilkerson et al., 2017a) and the Brigance Parent-Child Interaction Scale (Glascoe & Brigance, 2002). No association was found between SES and language development. However, the results suggest that corrected age and parent-child interaction positively influence language development at this early age.

Predictors of Early Language Outcomes in Children with Connexin 26 Hearing Loss across Three Countries.

GJB2-associated hearing loss (GJB2-HL) is the most common genetic cause of hearing loss in children. However, little is known about the clinical characteristics and early language outcomes in population-oriented samples including children with different degrees of hearing loss. Insight into these characteristics are relevant for the counselling of parents. Our sample consisted of 66 children at approximately 2 years of age (17-32 months) with bilateral hearing loss due to GJB2 from three population-based cohorts in Austria, Australia and the Netherlands. Predictors of early vocabulary, including demographic, audiological, genetic and intervention variables and the role of medical comorbidities and nonverbal cognition were examined. The vocabulary scores of children with GJB2-HL were approximately 0.7 standard deviations (SDs) below the norms of children with typical hearing. Age at access to family-centered early intervention and first-born position among siblings predicted language outcomes, whereas the degree of hearing loss and genetic subtype were not significantly correlated with expressive vocabulary. In children with GJB2-HL, early access to family-centered early intervention significantly affected language outcomes at the age of two.

Diversity of Child and Family Characteristics of Children with Hearing Loss in Family-Centered Early Intervention in The Netherlands.

BACKGROUND: Family-centered early intervention (FCEI) for children with hearing loss (HL) supports caregivers to promote their children's language development. To provide FCEI services that are relevant and accessible to meet diverse needs, insight into the characteristics of children with HL is important. In the current study, various characteristics of children with HL and intervention-related factors are examined in relation to spoken language outcomes. METHODS: Child and family characteristics, language outcomes and data on intervention were extracted from FCEI records for 83 children. Family involvement ratings were obtained from EI providers. Relations between characteristics, intervention, family involvement and language outcomes were analyzed and predictors for children's language outcomes were investigated. RESULTS: The characteristics of children with HL in FCEI are very diverse. Family involvement and the occurrence of additional disabilities were predictive for children's receptive and expressive language abilities; the start of FCEI was not. Maternal education was predictive for expressive language outcomes only. CONCLUSIONS: The current study showed the diversity in characteristics of children with HL and their families in the degree of HL, etiology, cultural background, home language, family involvement and additional disabilities. We conclude that 'one size does not fit all', and FCEI programs should acknowledge the unique strengths and challenges of every individual family.

Family-Centered Early Intervention (FCEI) Involving Fathers and Mothers of Children Who Are Deaf or Hard of Hearing: Parental Involvement and Self-Efficacy.

(1) Background: Studies related to family-centered early intervention (FCEI) for children who are deaf or hard of hearing (DHH) have largely focused on mothers, at the exclusion of fathers. Yet, understanding fathers' experiences with FCEI is also important and may inform service delivery. The present study explores self-efficacy and involvement with FCEI in both fathers and mothers. (2) Methods: Dutch fathers and mothers completed questionnaires about their parental self-efficacy, involvement in FCEI, perceived support from their primary EI provider, and the impact of raising a child who is DHH on parenting. (3) Results: Both fathers and mothers reported relatively high levels of self-efficacy. Mothers reported higher levels than fathers on some domains of self-efficacy and tended to be more involved in their child's FCEI than fathers. In fathers, but not mothers, higher levels of self-efficacy were related to higher levels of involvement and higher levels of perceived support. (4) Conclusions: Similarities and differences were found between fathers and mothers in their perspectives on self-efficacy and involvement. This points to potential differences related to their FCEI needs. EI providers need to address both the needs of fathers and mothers to promote optimal development among child who are DHH.

Joint Attention in the Context of Hearing Loss: A Meta-Analysis and Narrative Synthesis.

Joint attention is important for children's language development. We report two meta-analyses that demonstrate that the congruency in hearing status between parent and child affects the establishment and maintenance of joint attention. Dyads consisting of hearing parents and children with hearing loss, achieve fewer and briefer moments of joint attention in comparison to dyads of hearing parents and hearing children and dyads of deaf parents and deaf children. The theoretical and practical implications of these differences are discussed and placed in the context of two narrative syntheses. The first one focusing on parental strategies used to achieve and maintain moments of joint attention and the second one on the relation between joint attention and spoken language proficiency. We also expect that this review may serve as the start of quest towards a more detailed description (taxonomy) and operationalization of joint attention in the context of hearing loss.

Assessing Parent Behaviours in Parent-Child Interactions with Deaf and Hard of Hearing Infants Aged 0-3 Years: A Systematic Review.

BACKGROUND: Despite early identification and advancements in cochlear implant and hearing aid technology, delays in language skills in deaf children continue to exist. Good-quality parent-child interaction (PCI) is a key predictor for the successful development of deaf children's signed and/or spoken language. Though professionals have standard assessments to monitor child language, a clinical tool to observe the quality of parental interaction is yet to be developed. AIMS AND METHODS: This systematic review with narrative synthesis aims to uncover which parent behaviours are assessed in PCI studies with deaf infants aged 0-3 years, how these behaviours are assessed, and which are correlated with higher scores in child language. RESULTS: Sixty-one papers were included, spanning 40 years of research. Research included in the review assessed parents' skills in gaining attention, joint engagement, emotional sensitivity, and language input. PCI was mostly assessed using coding systems and frame-by-frame video analysis. Some of the parent behaviours mentioned previously are associated with more words produced by deaf children. CONCLUSION: The results of the review provide the evidence base required to develop the content of a future clinical assessment tool for parent-child interaction in deafness.

The School Career of Children With Hearing Loss in Different Primary Educational Settings-A Large Longitudinal Nationwide Study.

Children with hearing loss (HL) are at risk for a lower educational achievement. This longitudinal study compared the school career of a nationwide Dutch cohort with and without HL based on descriptive data of the governmental authority Statistics Netherlands. From 2008 to 2018, 3,367,129 children, of whom 1,193 used cochlear implants (CIs) and 8,874 used hearing aids (HAs), were attending primary and/or secondary education. Sixty-one percent of children with HL attended mainstream and 31% special primary education. Compared to mainstreamed pupils without HL, mainstreamed pupils with HL achieved lower levels for language and mathematics in primary education but eventually attended comparable types of secondary education. Children with HL attending special primary education attained lower types of secondary education compared to mainstreamed peers with and without HL. These findings suggest that future educational (and as a result professional) attainment of a child with HL depends on the type of primary educational setting.

Correction: Low Empathy in Deaf and Hard of Hearing (Pre)Adolescents Compared to Normal Hearing Controls.

[This corrects the article DOI: 10.1371/journal.pone.0124102.].

Fathers of Young Deaf or Hard-of-Hearing Children: A Systematic Review.

Much of the literature exploring the role of parents of children who are deaf or hard of hearing (DHH) has focused on mothers; yet, the involvement and perspectives of fathers is valuable and warrants attention. Following the PRISMA guidelines, this systematic literature review examined the peer-reviewed research that has differentially explored the experiences of fathers and mothers of young DHH children. Utilizing three databases (Web of Science, PsychINFO, Scopus) and spanning 50 years (1969-2019), 457 non-duplicated articles were identified that included the fathers of DHH children, birth to six years. Independent review of the titles, abstracts, and keywords by the authors limited these to 119. Full manuscripts were assessed for eligibility; 37 were deemed appropriate for inclusion in this systematic review. The papers included have been organized into the following themes: perspectives on parenting, parental stress and coping, parent-child interaction, involvement in early intervention, parental self-efficacy, and benefits of fathers' inclusion. Recommendations for future research include: (a) actively recruiting fathers in research, (b) differentially analyzing fathers' and mothers' experiences in research studies, (c) using information gleaned from research regarding father-child and mother-child interactions to guide interventions/programming, (d) recognizing the bidirectional influences of fathers and their DHH children, (e) moving beyond descriptive studies to explore fathers' influences on child outcomes, and (f) recognizing diverse family constellations.

Quality of life of children with hearing loss in special and mainstream education: A longitudinal study.

OBJECTIVES: To compare the quality of life (QoL) of children with hearing loss (HL) and children with normal hearing (NH) and to examine how the QoL of children with HL changes over time, considering language skills, type of hearing device, degree of HL, and type of education. METHODS AND MATERIALS: This longitudinal study included 62 children with HL and their parents. Developmental outcome data were collected at two time points, when the mean ages of the children were 4 and 11 years. The Pediatric Quality of Life (PedsQL™) questionnaire, which includes assessments of Physical, Emotional, Social, and School functioning, was completed by parents at both time points and by the children with HL at the second time point. Receptive and expressive language skills at 4 years were assessed by the Reynell Developmental Language Scale. Results were compared with a Dutch normative sample. RESULTS: The QoL of children with HL was similar to that of children with NH at both time points on two of the four QoL scales, Emotional and Physical functioning. On the other two scales, Social and School functioning, children with HL who attended special education and children who switched to mainstream education showed lower scores than children with HL who were consistently in mainstream education and lower scores than children with NH. The School QoL of children with HL decreased over time, as did the School QoL of children with NH. Social QoL of children with cochlear implants decreased over time, but this was not the case in children with hearing aids. Language skills and the degree of HL did not clinically improve the QoL over time of preschool children with HL. CONCLUSIONS: The QoL of children with HL in mainstream education and the Physical and Emotional QoL of all children with HL were satisfactory. It is essential to develop specific guidance regarding school activities for children with HL in special education and for children with HL who switch to mainstream education in order to increase their social QoL.

Talk with me! Parental linguistic input to toddlers with moderate hearing loss.

This study examined the quantity and quality of parental linguistic input to toddlers with moderate hearing loss (MHL) compared with toddlers with normal hearing (NH). The linguistic input to eighteen toddlers with MHL and twenty-four toddlers with NH was examined during a 10-minute free-play activity in their home environment. Results showed that toddlers with MHL were exposed to an equivalent amount of parental linguistic input compared to toddlers with NH. However, parents of toddlers with MHL used less high-level facilitative language techniques, used less mental state language, and used shorter utterances than parents of toddlers with NH. Quantity and quality measures of parental linguistic input were positively related to the expressive language abilities of toddlers with MHL.

Are You There for Me? Joint Engagement and Emotional Availability in Parent-Child Interactions for Toddlers With Moderate Hearing Loss.

OBJECTIVES: This study examined joint engagement and emotional availability of parent-child interactions for toddlers with moderate hearing loss (MHL) compared with toddlers with normal hearing (NH) and in relation to children's language abilities. DESIGN: The participants in this study were 25 children with MHL (40 to 60 dB hearing loss) and 26 children with NH (mean age: 33.3 months). The children and their parents were filmed during a 10-minute free play session in their homes. The duration of joint engagement and success rate of initiations were coded next to the level of emotional availability reflected by the Emotional Availability Scales. Receptive and expressive language tests were administered to the children to examine their language ability. RESULTS: Groups differed in joint engagement: children with MHL and their parents were less successful in establishing joint engagement and had briefer episodes of joint engagement than children with NH and their parents. No differences between groups were found for emotional availability measures. Both joint engagement and emotional availability measures were positively related to children's language ability. CONCLUSIONS: Children with MHL and their parents are emotional available to each other. However, they have more difficulties in establishing joint engagement with each other and have briefer episodes of joint engagement compared with children with NH and their parents. The parent-child interactions of children with better language abilities are characterized with higher levels of emotional availability and longer episodes of joint engagement. The results imply that interactions of children with MHL and their parents are an important target for family-centered early intervention programs.

It Takes Two to Read: Interactive Reading with Young Deaf and Hard-of-Hearing Children.

Interactive storybook reading is an important activity to enhance the emergent literacy skills of young deaf and hard-of-hearing (DHH) children. Parents have a crucial role to play in promoting their children's literacy development. However, parents often do not read in an interactive way; therefore guidance is recommended in applying these interactive reading strategies. In the present study we examined how parent reading behavior was affected by implementing an interactive reading training program for parents of young DHH children. Parents of 18 DHH toddlers in the Netherlands participated in a series of group training sessions and their interactive reading behavior was compared to that of 10 parents who did not participate. The results showed that parents' interactive reading behavior tended to increase after they participated in the interactive reading program. After the program, they applied the interactive reading strategies more often than parents who had not participated in the program. The findings suggest that interactive reading programs should be incorporated into early intervention programs for DHH children.

Can You Hear What I Think? Theory of Mind in Young Children With Moderate Hearing Loss.

OBJECTIVES: The first aim of this study was to examine various aspects of Theory of Mind (ToM) development in young children with moderate hearing loss (MHL) compared with hearing peers. The second aim was to examine the relation between language abilities and ToM in both groups. The third aim was to compare the sequence of ToM development between children with MHL and hearing peers. DESIGN: Forty-four children between 3 and 5 years old with MHL (35 to 70 dB HL) who preferred to use spoken language were identified from a nationwide study on hearing loss in young children. These children were compared with 101 hearing peers. Children were observed during several tasks to measure intention understanding, the acknowledgement of the other's desires, and belief understanding. Parents completed two scales of the child development inventory to assess expressive language and language comprehension in all participants. Objective language test scores were available from the medical files of children with MHL. RESULTS: Children with MHL showed comparable levels of intention understanding but lower levels of both desire and belief understanding than hearing peers. Parents reported lower language abilities in children with MHL compared with hearing peers. Yet, the language levels of children with MHL were within the average range compared with test normative samples. A stronger relation between language and ToM was found in the hearing children than in children with MHL. The expected developmental sequence of ToM skills was divergent in approximately one-fourth of children with MHL, when compared with hearing children. CONCLUSION: Children with MHL have more difficulty in their ToM reasoning than hearing peers, despite the fact that their language abilities lie within the average range compared with test normative samples.

Interactive Reading with Young Deaf and Hard-of-Hearing Children in eBooks Versus Print Books.

Interactive storybook reading is effective in enhancing deaf and hard-of-hearing (DHH) children's emergent literacy skills. The current digital era gives parents more opportunities to read books with their child. From an early age on, interaction between parent and child during literacy activities is very important for the development of emergent literacy skills. The purpose of the present study was to explore the opportunities of eBooks on a tablet for interactive reading with young DHH children. Parent and child interactive behavior in reading print books was compared to eBooks in 18 parents and their 1- to 3-year-old DHH child. All parents followed an interactive reading program after which their interactive reading behaviors were observed while reading print books and eBooks with their child. Results mainly showed similar interactive reading behaviors in parents and children when reading print books or eBooks, except for a lower occurrence of pointing to pictures/objects in the parent behavior when reading the eBooks. These results give parents and professionals even more opportunities for interactive storybook reading with DHH children, and thus more opportunities to enhance their language and literacy skills. Tablets can be easily taken with you making eBooks accessible for interactive reading wherever you are.

Concern for Others: A Study on Empathy in Toddlers with Moderate Hearing Loss.

Empathy, the ability to feel the emotions of others and respond affectively to these emotions, is an important factor in the development of social competence. The purpose of this study was to examine empathy levels in toddlers with moderate hearing loss (MHL) compared to toddlers with no hearing loss (nHL), and to explore the relation between language ability and empathy. We focused on affective empathy and the precursors of cognitive empathy. A total of 23 toddlers with MHL and 21 toddlers with nHL participated in the study. Parent report (ITSEA) and observation measures were used to rate the toddlers' levels of empathy. The results showed that the levels of affective empathy in toddlers with MHL and with nHL were similar on both measures. Toddlers with MHL lagged behind their peers with nHL on some precursors of cognitive empathy (intention understanding and joint attention). Language ability was unrelated to empathy levels in both groups of toddlers. In conclusion, toddlers with MHL seem to be at risk for problems in their empathy development. Although they are aware of the emotions of others, the development of more complex skills needed for an adequate empathic response is delayed in comparison with their hearing peers.

Parental stress among parents of toddlers with moderate hearing loss.

BACKGROUND: The purpose of this study was to examine parental stress in parents of toddlers with moderate hearing loss compared to hearing controls. Furthermore, the associations between parental stress and child- and parent-related factors such as language, social-emotional functioning and social support were examined. DESIGN: The study sample consisted of 30 toddlers with moderate hearing loss and 30 hearing children (mean age 27.4 months). The two groups were compared using the Nijmegen Parenting Stress Index (NPSI) and parent-reports to rate the amount of social support and the children's social-emotional functioning. Receptive and expressive language tests were administered to the children to examine their language ability. RESULTS: Parents of toddlers with moderate hearing loss reported comparable levels of parental stress to parents of hearing children. Individual differences in parental stress were related to child- and parent-related factors. Poorer social-emotional functioning and language ability of the child were related to higher stress levels in parents. Parents who experienced less social support reported higher stress levels. CONCLUSIONS: Parents of toddlers with moderate hearing loss experience no more parental stress than parents of hearing children on average. Given parental stress was found to be related to poorer child functioning, early interventionists should be aware of signs of elevated stress levels in parents.