Predicting variation in word decoding development in deaf and hard-of-hearing children.

BACKGROUND: Deaf and hard-of-hearing (DHH) children may experience difficulties in word decoding development. AIMS: We aimed to compare and predict the incremental word decoding development in first grade in Dutch DHH and hearing children, as a function of kindergarten reading precursors. METHODS AND PROCEDURES: In this study, 25 DHH, and 41 hearing children participated. Kindergarten measures were phonological awareness (PA), letter knowledge (LK), rapid naming (RAN), and verbal short-term memory (VSTM). Word decoding (WD) was assessed at three consecutive time points (WD1, 2, 3) during reading instruction in first grade. OUTCOMES AND RESULTS: The hearing children scored higher than the DHH children on PA and VSTM only, although the distribution of WD scores differed between the groups. At WD1, PA and RAN predicted WD efficiency in both groups; but PA was a stronger predictor for hearing children. At WD2, LK, RAN, and the autoregressor were predictors for both groups. While at WD3, only the autoregressor was a significant predictor. CONCLUSIONS AND IMPLICATIONS: WD development in DHH children on average shows similar levels as in hearing children, though within the DHH group more variation was observed. WD development in DHH children is not as much driven by PA; they may use other skills to compensate.

Capability of Children with Hearing Devices: A Mixed Methods Study.

We investigated 34 deaf and hard-of-hearing children with hearing devices aged 8-12 years and 30 typical hearing peers. We used the capability approach to assess well-being in both groups through interviews. Capability is "the real freedom people have to do and to be what they have reason to value." Speech perception, phonology, and receptive vocabulary data of the deaf and hard-of-hearing children, that were used retrospectively, showed a large variability. The analysis of the relation between clinical quantitative outcome measures and qualitative capability interview outcomes suggests that at this age, differences in clinical performance do not appear to translate into considerable differences in capability, including capability did offer insight into the factors that appeared to ensure this equivalence of capability. We argue that capability outcomes should be used to determine the focus of (auditory) rehabilitation and support, in line with the United Nations Convention on the Rights of the Child.

Effects in language development of young children with language delay during early intervention.

INTRODUCTION: In the Netherlands, early language intervention is offered to young children with Language Delay (LD). The intervention combines groupwise language intervention, individual speech and language therapy and parent-implemented language intervention. This study tests the hypothesis that children with LD show progress in their receptive and expressive language during intervention. Differences in language progress between age groups (< 36 months and ≥ 36 months at intervention start) were expected in favour of the younger group, which might be due to an earlier intervention start, a longer treatment duration or the potential presence of late talkers. METHODS: The study included 183 children with LD (45 children < 3 years of age at intervention start; mean age 32 months, 138 children ≥ 3 years; mean age 40 months). Receptive and expressive language was assessed with norm-referenced tests at intervention start and ending using Routine Outcome Monitoring. A repeated measures MANOVA was carried out to examine language progress and to compare the age groups on receptive syntax, receptive vocabulary, expressive syntax and expressive vocabulary. The Reliable Change Index was used to study individual progress. RESULTS: On average, children in both age groups showed significant improvement in all four language domains. The younger children showed more language progress than the older children in all four domains. When examining individual progress, most of the children displayed reliable improvement for expressive vocabulary. Most children developed in the same pace as their typically developing peers for receptive syntax, receptive vocabulary, and expressive syntax. CONCLUSIONS: Children stabilized or even improved language proficiency during the intervention, indicating that the language gap between these children and typically developing children did not widen further. Younger children displayed more language progress than older children in all four domains, but it is unclear what might explain this difference.

Wellbeing as Capability: Findings in Hearing-Impaired Adolescents and Young Adults With a Hearing Aid or Cochlear Implant.

In the Western world, for deaf and hard-of-hearing children, hearing aids or cochlear implants are available to provide access to sound, with the overall goal of increasing their wellbeing. If and how this goal is achieved becomes increasingly multifarious when these children reach adolescence and young adulthood and start to participate in society in other ways. An approach to wellbeing that includes personal differences and the relative advantages and disadvantages that people have, is the capability approach, as developed by Nobel Prize laureate Amartya Sen. Capability is the set of real opportunities people have to do and be things they have reason to value. We interviewed 59 young people, aged 13 through 25, with cochlear implants (37) or hearing aids (22) to capture their capability. We found that their hearing devices enabled them to actively participate in a predominantly hearing society, with few differences between cochlear implant and hearing aid recipients. They did, however, report challenges associated with prejudices and expectations, and with feeling poorly understood, all of which appeared to impact their capability. Through the lens of capability, alleged differences between hearing aid and cochlear implant recipients began to fade. We discuss the implications for initiatives focused on the long-term support young recipients of hearing devices to meet their specific requirements over time.

Predicting Early Literacy: Auditory and Visual Speech Decoding in Deaf and Hard-of-Hearing Children.

The current study investigated the relative contributions of auditory speech decoding (i.e., auditory discrimination) and visual speech decoding (i.e., speechreading) on phonological awareness and letter knowledge in deaf and hard-of-hearing (DHH) kindergartners (Mage = 6;4, n = 27) and hearing kindergartners (Mage = 5;10, n = 42). Hearing children scored higher on auditory discrimination and phonological awareness, with the DHH children scoring at chance level for auditory discrimination, while no differences were found on speechreading and letter knowledge. For DHH children, speechreading correlated with phonological awareness and letter knowledge, for the hearing children, auditory discrimination correlated with phonological awareness. Two regression analyses showed that speechreading predicted phonological awareness and letter knowledge in DHH children only. Speechreading may thus be a compensatory factor in early literacy for DHH children, at least for those who are exposed to spoken language in monolingual or in bilingual or bimodal-bilingual contexts, and could be important to focus on during early literacy instruction.

Measuring Theory of Mind in Adolescents With Language and Communication Problems: An Ecological Perspective.

We tested if the newly designed ToMotion task reflects a single construct and if the atypical groups differ in their performance compared to typically developing peers. Furthermore, we were interested if ToMotion maps a developmental sequence in a Theory of Mind (ToM) performance as exemplified by increasing difficulty of the questions asked in every item. The sample consisted of 13 adolescents that have been diagnosed with a developmental language disorder (DLD) and 14 adolescents that are deaf or hard of hearing (DHH). All of these adolescents were in special schools for secondary vocational education. The control group existed of 34 typical developing adolescents (TD) who were in regular intermediate vocational education, ranging from level 2 to 4. The ToMotion, available in a spoken Dutch version and in a version in Sign Language of the Netherlands (SLN), was used to map ToM abilities. An attempt has been made to fill the gap of missing studies of ToM in adolescents by developing a new measuring instrument. In conclusion, assessing ToM with the ToMotion results in a picture that DHH adolescents score lower than TD peers. However, their scores are as consistent as those of the TD peers. The picture of DLD adolescents is the reverse. They show no differences in ToM scores, but seem to be somewhat more inconsistent compared to TD peers. We provide a discussion on those results and its implications for future research. What this paper adds? The current study introduces a new visual Theory of Mind (ToM) task, ToMotion, designed specifically to assess ToM in adolescents in an ecologically valid way and adapted to the needs of adolescents with language and communication difficulties.

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.

Language development and behaviour problems in toddlers indicated to have a developmental language disorder.

BACKGROUND: There is empirical evidence that a developmental language disorder (DLD) in early childhood leads to behaviour problems. However, it is still not clear how changes in language proficiency in these children influence the presence of behaviour problems. AIMS: The aim of this study is to examine if changes in language proficiency are related to changes in behaviour problems in toddlers indicated to have DLD. METHODS & PROCEDURES: This study included 185 toddlers indicated to have DLD (mean age 38 months at pretest). Scores on receptive and expressive language domains and internalizing and externalizing behaviour were gathered on Wave 1 and Wave 2 using Routine Outcome Monitoring. The Reliable Change Index was used to categorize children into two groups: children improving in receptive and expressive language domains and children not improving. OUTCOMES & RESULTS: For receptive syntax, receptive vocabulary and expressive syntax, 30% or less of the children improved. Only for expressive vocabulary, most children improved (63%). Behaviour problems were present in 17% (internalizing) and 23% (externalizing) of the children. Changes in language proficiency did not lead to changes in internalizing or externalizing behaviour problems, not for the total sample, nor for children displaying behaviour problems at Wave 1. CONCLUSIONS & IMPLICATIONS: Professionals working with toddlers indicated to have DLD need to be aware of the co-occurrence of language problems and behaviour problems, and have to realize that behaviour problems might not immediately decrease when language proficiency improves. If behaviour problems are present in toddlers indicated to have DLD, interventions should not only focus on language, but also on behaviour problems. WHAT THIS PAPER ADDS: What is already known on the subject There is empirical evidence that a developmental language disorder (DLD) in early childhood leads to behaviour problems. However, it is still not clear how changes in language proficiency in children with DLD influence the presence of behaviour problems. What this paper adds to existing knowledge This study addresses if a change in language proficiency is related to changes in child behaviour problems in toddlers indicated to have DLD. The results of our study showed that most of the children did not show a positive reliable change in receptive syntax, receptive vocabulary and expressive syntax at this young age, but most of the children did in expressive vocabulary. Furthermore, changes in language proficiency did not lead to changes in the presence of internalizing or externalizing behaviour problems. What are the potential or actual clinical implications of this work? Therefore, professionals working with toddlers indicated to have DLD should be aware of the co-occurrence of language problems and behaviour problems, and have to realize that behaviour problems might not decrease as a result of improved language proficiency. If behaviour problems are present and need to be treated, other interventions, apart from the language intervention, might be necessary.

The Interplay Between Theory of Mind and Social Emotional Functioning in Adolescents With Communication and Language Problems.

Adolescents with developmental language disorders (DLDs) and adolescents who are deaf or hard of hearing (D/HH) are at greater risk of social emotional problems. These problems may not only be attributed to communication and language problems but, at least in part, to Theory of Mind (ToM) deficits as well. In this mini review, an overview is provided of studies on social emotional functioning and ToM performance in adolescents with DLD and D/HH adolescents. A possible interplay between social emotional functioning and Theory of Mind is discussed. There is empirical evidence for social emotional problems and ToM problems in both adolescents with DLD and D/HH. We hypothesized that language deficits as seen in adolescents with DLD and impoverished exposure to language and communication, as seen in adolescents who are D/HH can explain differences in social emotional functioning and ToM performance. The present mini review provides a possible framework for the relation between ToM and social emotional functioning in adolescents with communication and language problems, which is mediated by their limited linguistic ability or restricted language exposure and gives suggestions for future research.

Effects of Signs on Word Learning by Children With Developmental Language Disorder.

Purpose This study investigated the effects of signs on word learning by children with developmental language disorder (DLD), in comparison with typically developing (TD) children, and the relation between a possible sign effect and children's linguistic and cognitive abilities. Method Nine- to 11-year-old children with DLD ( n = 40) and TD children ( n = 26) participated in a word learning experiment. Half of the spoken pseudowords were taught with a pseudosign with learning outcomes being assessed in accuracy and speed. To investigate whether sign effects would hold for children with varying linguistic and cognitive abilities, we measured children's linguistic (vocabulary, syntax) and cognitive (divided attention, working memory [WM], lexical access) skills. Results The children with DLD showed a positive sign effect in both accuracy and speed. For the TD children, there was no effect of signs on word learning. Principal component analyses of the linguistic and cognitive measures evidenced a 4-component solution (language skills, visual WM, verbal WM, and executive attention). Repeated-measures analyses of covariance with the component scores as covariates yielded no significant interactions with the linguistic and cognitive components. Conclusions Our results suggest that children with DLD benefit from signs for word learning, regardless of their linguistic and cognitive abilities. This implies that using sign-supported speech as a means to improve the vocabulary skills of children with DLD is effective, even still at the age of 9-11 years.

Executive control in language production by children with and without language impairment.

BACKGROUND: Accumulating evidence suggests that the updating, inhibiting and shifting abilities underlying executive control are important for spoken language production in adults. However, little is known about this in children. AIMS: To examine whether children with and without language impairment differ in all or only some of these executive abilities, and whether they show corresponding differences when these abilities are engaged in language production. METHODS & PROCEDURES: Thirty-three children with specific language impairment (SLI) and 41 typically developing (TD) children (age matched, aged 8-12 years) completed standard executive control tests that measure the updating, inhibiting and shifting abilities. All children were native speakers of Dutch. Moreover, they performed a noun-phrase production task involving picture description within a picture-word interference paradigm. We measured their production accuracy and speed to assess length, distractor and switch effects, which reflect the updating, inhibiting and shifting abilities underlying executive control. OUTCOMES & RESULTS: Compared with TD children, the children with SLI had lower scores on all executive control tests. Moreover, they were overall slower and made more errors in the noun-phrase production task. Additionally, the magnitude of the distractor and switch effects was larger for the SLI than for the TD group. CONCLUSIONS & IMPLICATIONS: The results suggest that children with SLI have impaired language production and executive control abilities, and that some of the differences in the executive control abilities between SLI and TD groups were reflected in their language production.

Association of language, behavior, and parental stress in young children with a language disorder.

BACKGROUND: Several studies show that language problems, child behavior problems, and parental stress can co-occur in children. Still, little is known about how these domains are related in toddlers with a language disorder (LD). AIMS: This study examined relations between language problems, child behaviour problems, and parental stress in toddlers with LD and if these relations differ for children with different types of LD. METHOD: Data of 185 children with LD (mean age 38 months) were collected using Routine Outcome Monitoring. Children were divided into two groups: presence of receptive and expressive problems (REP) and expressive problems only (EP). Relations were analyzed using Structural Equation Modeling. RESULTS: A better receptive language was associated with less teacher-reported internalizing and externalizing problems. A better expressive vocabulary was associated with more parent-reported internalizing problems and more teacher-reported externalizing problems. No relation was found between language and parental stress. Associations between language, behavior, and parental stress did not differ for children with REP or children with EP. CONCLUSIONS: Our study shows that when specific language domains are examined, the pattern of associations between language and behavior becomes more complex, because relations exist between specific language domains and behavior, but not between all of them.

Assessing Autism Spectrum Disorder in People with Sensory Impairments Combined with Intellectual Disabilities.

People with sensory impairments combined with intellectual disabilities show behaviours that are similar to Autism Spectrum Disorder (ASD). The instrument Observation of Autism in people with Sensory and Intellectual Disabilities (OASID) was developed to diagnose ASD in this target group. The current study focuses on the psychometric properties of OASID. Sixty individuals with intellectual disabilities in combination with visual impairments and/or deafblindness participated in this study. The OASID assessment was administered and rated by three independent observers. By means of expert consensus cut-off scores for OASID were created. To determine the concurrent validity OASID was compared with the Pervasive Developmental Disorder for People with Mental Retardation (PDD-MRS) and the Childhood Autism Rating Scale second edition (CARS-2). The intra-rater reliability, the inter-rater reliability, internal consistency and concurrent validity of OASID were good to excellent. Cut-off scores were established based on criteria from the DSM-5. OASID was able to differentiate between four severity levels of ASD.

Developmental Associations Between Working Memory and Language in Children With Specific Language Impairment: A Longitudinal Study.

Purpose: This longitudinal study examined differences in the development of working memory (WM) between children with specific language impairment (SLI) and typically developing (TD) children. Further, it explored to what extent language at ages 7-8 years could be predicted by measures of language and/or WM at ages 4-5 years. Method: Thirty children with SLI and 33 TD children who were previously examined on measures of WM and language at ages 4-5 years (T1) were reexamined at ages 7-8 years (T2). Results: The developmental course of WM was mostly similar for the two groups; only the development of the verbal storage component differed. At T1, children with SLI performed significantly below their TD peers on all components of WM (verbal storage, verbal central executive [CE], visuospatial storage, and visuospatial CE), whereas at T2, the differences for the visuospatial components were no longer significant when age and intelligence were taken into account. Hierarchical regression showed language and verbal CE at T1 to be significant predictors of language at T2, with no differences in the developmental associations between language and WM for the two groups. Conclusions: The results of this study suggest that particularly verbal CE is of importance for the acquisition of linguistic skills.

Semantic Processing of Sentences in Preschoolers With Specific Language Impairment: Evidence From the N400 Effect.

Purpose: Given the complexity of sentence processing and the specific problems that children with specific language impairment (SLI) experience, we investigated the time course and characteristics of semantic processing at the sentence level in Dutch preschoolers with SLI. Method: We measured N400 responses to semantically congruent and incongruent spoken sentences (e.g., "My father is eating an apple/*blanket") in a group of 37 Dutch preschoolers with SLI and in a group of 25 typically developing (TD) peers. We compared the time course and amplitude of the N400 effect between the two groups. Results: The TD group showed a strong posterior N400 effect in time windows 300-500 ms and 500-800 ms. In contrast, the SLI group demonstrated only a reliable N400 effect in the later time window, 500-800 ms, and did not show a stronger presence at posterior electrodes. Conclusion: The findings suggest that the neuronal processing of semantic information at sentence level is atypical in preschoolers with SLI compared with TD children.

Hypertext comprehension of deaf and hard-of-hearing students and students with specific language impairment.

This paper provides insight into the reading comprehension of hierarchically structured hypertexts within D/HH students and students with SLI. To our knowledge, it is the first study on hypertext comprehension in D/HH students and students with SLI, and it also considers the role of working memory. We compared hypertext versus linear text comprehension in D/HH students and students with SLI versus younger students without language problems who had a similar level of decoding and vocabulary. The results demonstrated no difference in text comprehension between the hierarchically structured hypertext and the linear text. Text comprehension of D/HH students and students with SLI was comparable to that of the students without language problems. In addition, there was a similar positive predictive value of visuospatial and not verbal working memory on hypertext comprehension for all three groups. The findings implicate that educational settings can make use of hierarchically structured hypertexts as well as linear texts and that children can navigate in the digital world from young age on, even if language or working memory problems are present.

Benefits of augmentative signs in word learning: Evidence from children who are deaf/hard of hearing and children with specific language impairment.

BACKGROUND: Augmentative signs may facilitate word learning in children with vocabulary difficulties, for example, children who are Deaf/Hard of Hearing (DHH) and children with Specific Language Impairment (SLI). Despite the fact that augmentative signs may aid second language learning in populations with a typical language development, empirical evidence in favor of this claim is lacking. AIMS: We aim to investigate whether augmentative signs facilitate word learning for DHH children, children with SLI, and typically developing (TD) children. METHODS AND PROCEDURES: Whereas previous studies taught children new labels for familiar objects, the present study taught new labels for new objects. In our word learning experiment children were presented with pictures of imaginary creatures and pseudo words. Half of the words were accompanied by an augmentative pseudo sign. The children were tested for their receptive word knowledge. OUTCOMES AND RESULTS: The DHH children benefitted significantly from augmentative signs, but the children with SLI and TD age-matched peers did not score significantly different on words from either the sign or no-sign condition. CONCLUSIONS AND IMPLICATIONS: These results suggest that using Sign-Supported speech in classrooms of bimodal bilingual DHH children may support their spoken language development. The difference between earlier research findings and the present results may be caused by a difference in methodology.

Auditory and verbal memory predictors of spoken language skills in children with cochlear implants.

BACKGROUND: Large variability in individual spoken language outcomes remains a persistent finding in the group of children with cochlear implants (CIs), particularly in their grammatical development. AIMS: In the present study, we examined the extent of delay in lexical and morphosyntactic spoken language levels of children with CIs as compared to those of a normative sample of age-matched children with normal hearing. Furthermore, the predictive value of auditory and verbal memory factors in the spoken language performance of implanted children was analyzed. METHODS & PROCEDURES: Thirty-nine profoundly deaf children with CIs were assessed using a test battery including measures of lexical, grammatical, auditory and verbal memory tests. Furthermore, child-related demographic characteristics were taken into account. OUTCOMES & RESULTS: The majority of the children with CIs did not reach age-equivalent lexical and morphosyntactic language skills. Multiple linear regression analyses revealed that lexical spoken language performance in children with CIs was best predicted by age at testing, phoneme perception, and auditory word closure. The morphosyntactic language outcomes of the CI group were best predicted by lexicon, auditory word closure, and auditory memory for words. CONCLUSIONS: Qualitatively good speech perception skills appear to be crucial for lexical and grammatical development in children with CIs. Furthermore, strongly developed vocabulary skills and verbal memory abilities predict morphosyntactic language skills.