Use of pointing in parent-child interactions by hearing children of deaf and hearing parents: A follow-up from 1- to 3-years of age.

Pointing plays a significant role in communication and language development. However, in spoken languages pointing has been viewed as a non-verbal gesture, whereas in sign languages, pointing is regarded to represent a linguistic unit of language. This study compared the use of pointing between seven bilingual hearing children of deaf parents (Kids of Deaf Adults [KODAs]) interacting with their deaf parents and five hearing children interacting with their hearing parents. Data were collected in 6-month intervals from the age of 1;0 to 3;0. Pointing frequency among the deaf parents and KODAs was significantly higher than among the hearing parents and their children. In signing dyads pointing frequency remained stable, whereas in spoken dyads it decreased during the follow-up. These findings suggested that pointing is a fundamental element of parent-child interaction, regardless of the language, but is guided by the modality, gestural and linguistic features of the language in question.

Social-Emotional and Behavioural Difficulties in Children with Neurodevelopmental Disorders: Emotion Perception in Daily Life and in a Formal Assessment Context.

Children with neurodevelopmental disorders often have social-emotional and behavioural difficulties. The present study explored these difficulties in children (n = 50, aged 6-10 years) with autism spectrum disorder, attention-deficit/hyperactivity disorder and developmental language disorder. Parents, teachers and therapists evaluated children's social-emotional and behavioural difficulties through a self-devised questionnaire and the Strengths and Difficulties Questionnaire. Additionally, the children, along with their typically developing age peers (n = 106), completed six emotion discrimination tasks. Analysis revealed some impaired emotion discrimination skills that were predictive for behavioural challenges in daily life and associated with the parent-reported existence of friends. Timely intervention in these children is needed, and it should also include emotion perception training.

Newborn Hearing Screening and Intervention in Children with Unilateral Hearing Impairment: Clinical Practices in Three Nordic Countries.

Studies have limitedly considered children with early-identified unilateral hearing impairment (UHI), and clinical practices regarding screening, diagnostics and habilitation in this group are rarely documented. In this study, routines for newborns with UHI from screening to diagnostics and habilitation were explored in Norway, Sweden and Finland. An online survey was sent to hospitals responsible for the hearing diagnostics of children requesting information about their practices regarding congenital UHI. Responses covered 95% of the children born in the three included countries. The results revealed large variations in ways of organising healthcare and in clinical decisions regarding hearing screening, diagnostics and habilitation of children with congenital UHI. Finally, implications for policy making and research are also discussed.

Effects of Humidification of the Vocal Tract and Respiratory Muscle Training in Women With Voice Symptoms-A Pilot Study.

OBJECTIVE: The aim of this study was to determine the efficacy of a 4-week breathing exercise intervention in participants with voice symptoms. METHODS: Six nonsmoking women (mean age 49) experiencing voice symptoms used a novel device WellO2 for respiratory exercises that provides counter pressure during both inspiration and expiration and warms and humidifies the breathing air. Speech samples were acoustically (Acoustic Voice Quality Index) and perceptually (grade, roughness, breathiness, asthenia, and strain scale) analyzed, and perceived voice symptoms and self-reported effort in breathing and phonation were obtained. Respiratory measurements included breathing frequency and pattern, peak expiratory flow, forced vital capacity, and forced expiratory volume in 1 minute. RESULTS: The total scores of Acoustic Voice Quality Index and some of its subcomponents (shimmer and harmonic-to-noise ratio), and the grade, roughness, and strain of the GRBAS scale indicated significantly improved voice quality. However, neither the nature or frequency of the experienced voice symptoms nor the perceived phonatory effort changed as the function of intervention. According to the participants, their breathing was significantly less effortful after the intervention, although no significant changes were observed in the objective respiratory measurements with a spirometer. CONCLUSION: Training with the WellO2 device has the potential to improve voice quality. The combination of inspiratory and expiratory training and warmed, humidified air is a multifaceted entity influencing several parts in the physiology of voice production. The effects of using WellO2 need to be confirmed by further studies with a larger number of participants.

The role of linguistic and cognitive factors in emotion recognition difficulties in children with ASD, ADHD or DLD.

BACKGROUND: Many children with neurodevelopmental disorders such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) or developmental language disorder (DLD) have difficulty recognizing and understanding emotions. However, the reasons for these difficulties are currently not well understood. AIMS: To compare the emotion recognition skills of children with neurodevelopmental disorders as well as those children's skills with the skills of their typically developing (TD) age peers. Also, to identify the role of underlying factors in predicting emotion recognition skills. METHODS & PROCEDURES: The 6-10-year-old children (n = 50) who participated in the study had either ASD, ADHD or DLD and difficulties recognizing emotions from face and/or in voice. TD age peers (n = 106) served as controls. Children's skills were tested using six forced-choice tasks with emotional nonsense words, meaningful emotional sentences, the FEFA 2 test, photographs, video clips and a task in which facial expressions and tones of voice had to be matched. Expressive vocabulary, rapid serial naming, auditory and visual working memory and Theory of Mind skills were explored as possible explanatory factors of the emotion recognition difficulties of the diagnosed children. OUTCOMES & RESULTS: Children with ASD, ADHD or DLD did not significantly differ from each other in their linguistic or cognitive skills. Moreover, there were only minor differences between children with these diagnoses in recognizing facial expressions and emotional tone of voice and matching the two. The only significant difference was that children with ADHD recognized facial expressions in photographs better than children with DLD. The participants with diagnoses scored significantly lower than the controls in all but one emotion recognition tasks presented. According to the linear regression analysis, first-order Theory of Mind skills predicted the delay relative to typical development in the recognition of facial expressions in the FEFA 2 test, and expressive vocabulary and working memory skills together predicted the delay in the recognition of emotions in the matching task. CONCLUSIONS & IMPLICATIONS: Children with ASD, ADHD or DLD showed very similar emotion recognition skills and were also found to be significantly delayed in their development of these skills. Some predictive factors related to linguistic and cognitive skills were found for these difficulties. Information about impaired emotion recognition and underlying linguistic and cognitive skills helps to select intervention procedures. Without this information, therapy might unnecessarily focus on only symptoms.

The impact of permanent early-onset unilateral hearing impairment in children - A systematic review.

BACKGROUND: Decision-making on treatment and (re)habilitation needs to be based on clinical expertise and scientific evidence. Research evidence for the impact of permanent unilateral hearing impairment (UHI) on children's development has been mixed and, in some of the reports, based on fairly small, heterogeneous samples. Additionally, treatment provided has been highly variable, ranging from no action taken or watchful waiting up to single-sided cochlear implantation. Published information about the effects of treatment has also been heterogeneous. Moreover, earlier reviews and meta-analyses published on the impact of UHI on children's development have generally focused on select areas of development. OBJECTIVES: This systematic review aimed to summarize the impact of children's congenital or early onset unilateral hearing impairment on listening and auditory skills, communication, speech and language development, cognitive development, educational achievements, psycho-social development, and quality of life. METHODS: Literature searches were performed to identify reports published from inception to February 16th, 2018 with the main electronic bibliographic databases in medicine, psychology, education, and speech and hearing sciences as the data sources. PubMed, CINALH, ERIC, LLBA, PsychINFO, and ISI Web of Science were searched for unilateral hearing impairment with its synonyms and consequences of congenital or early onset unilateral hearing impairment. Eligible were articles written in English, German, or Swedish on permanent unilateral hearing impairments that are congenital or with onset before three years of age. Hearing impairment had to be of at least a moderate degree with PTA ≥40 dB averaged over frequencies 0.5 to 2 or 0.5-4 kHz, hearing in the contralateral ear had to have PTA0.5-2 kHz or PTA0.5-4 kHz ≤ 20 dB, and consequences of unilateral hearing impairment needed to be reported in an unanimously defined population in at least one of the areas the review focused on. Four researchers independently screened 1618 abstracts and 566 full-text articles for evaluation of study eligibility. Eligible full-text articles were then reviewed to summarize the results and assess the quality of evidence. Additionally, data from 13 eligible case and multi-case studies, each having less than 10 participants, were extracted to summarize their results. Quality assessment of evidence was made adapting the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) process, and reporting of the results adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. RESULTS: Three articles with the quality of evidence graded as very-low to low, fulfilled the eligibility criteria set. Due to the heterogeneity of the articles, only a descriptive summary could be generated from the results. Unilateral hearing impairment was reported to have a negative impact on preverbal vocalization of infants and on sound localization and speech perception both in quiet and in noise. CONCLUSIONS: No high-quality studies of consequences of early-onset UHI in children were found. Inconsistency in assessing and reporting outcomes, the relatively small number of participants, low directness of evidence, and the potential risk of confounding factors in the reviewed studies prevented any definite conclusions. Further well-designed prospective research using larger samples is warranted on this topic.

Relationship between the linguistic environments and early bilingual language development of hearing children in deaf-parented families.

We explored variation in the linguistic environments of hearing children of Deaf parents and how it was associated with their early bilingual language development. For that purpose we followed up the children's productive vocabulary (measured with the MCDI; MacArthur Communicative Development Inventory) and syntactic complexity (measured with the MLU10; mean length of the 10 longest utterances the child produced during videorecorded play sessions) in both Finnish Sign Language and spoken Finnish between the ages of 12 and 30 months. Additionally, we developed new methodology for describing the linguistic environments of the children (N = 10). Large variation was uncovered in both the amount and type of language input and language acquisition among the children. Language exposure and increases in productive vocabulary and syntactic complexity were interconnected. Language acquisition was found to be more dependent on the amount of exposure in sign language than in spoken language. This was judged to be related to the status of sign language as a minority language. The results are discussed in terms of parents' language choices, family dynamics in Deaf-parented families and optimal conditions for bilingual development.

How children with normal hearing and children with a cochlear implant use mentalizing vocabulary and other evaluative expressions in their narratives.

This study explored the use of mental state and emotion terms and other evaluative expressions in the story generation of 65 children (aged 2-8 years) with normal hearing (NH) and 11 children (aged 3-7 years) using a cochlear implant (CI). Children generated stories on the basis of sets of sequential pictures. The stories of the children with CI were obtained over the 5-year follow-up period. The children with NH continued to show an increased story length (number of words) with age. In the children with a CI, the increase was similar initially, but plateaued after 3 years of using a CI. In children with NH, the spontaneous use of mental state vocabulary in narratives increased significantly between the ages of three and six. The delayed use of mental state terms in the children with a CI was related to a reduced amount of linguistic production overall. The theoretical and clinical implications were discussed.

Perceptions of parents and speech and language therapists on the effects of paediatric cochlear implantation and habilitation and education following it.

BACKGROUND: During the process of implantation, parents may have rather heterogeneous expectations and concerns about their child's development and the functioning of habilitation and education services. Their views on habilitation and education are important for building family-centred practices. AIMS: We explored the perceptions of parents and speech and language therapists (SLTs) on the effects of implantation on the child and the family and on the quality of services provided. Their views were also compared. METHODS & PROCEDURES: Parents and SLTs of 18 children filled out questionnaires containing open- and closed-ended questions at 6 months and annually 1-5 years after activation of the implant. Their responses were analysed mainly using data-based inductive content analysis. OUTCOMES & RESULTS: Positive experiences outnumbered negative ones in the responses of both the parents and the SLTs surveyed. The parents were particularly satisfied with the improvement in communication and expanded social life in the family. These were the most prevalent themes also raised by the SLTs. The parents were also satisfied with the organization and content of habilitation. Most of the negative experiences were related to arrangement of hospital visits and the usability and maintenance of speech processor technology. Some children did not receive enough speech and language therapy, and some of the parents were dissatisfied with educational services. The habilitation process had generally required parental efforts at an expected level. However, parents with a child with at least one concomitant problem experienced habilitation as more stressful than did other parents. CONCLUSIONS & IMPLICATIONS: Parents and SLTs had more positive than negative experiences with implantation. As the usability and maintenance of speech processor technology were often compromised, we urge implant centres to ensure sufficient personnel for technical maintenance. It is also important to promote services by providing enough information and parental support.

Effect of cognitive load on articulation rate and formant frequencies during simulator flights.

It was explored how three types of intensive cognitive load typical of military aviation (load on situation awareness, information processing, or decision-making) affect speech. The utterances of 13 male military pilots were recorded during simulated combat flights. Articulation rate was calculated from the speech samples, and the first formant (F1) and second formant (F2) were tracked from first-syllable short vowels in pre-defined phoneme environments. Articulation rate was found to correlate negatively (albeit with low coefficients) with loads on situation awareness and decision-making but not with changes in F1 or F2. Changes were seen in the spectrum of the vowels: mean F1 of front vowels usually increased and their mean F2 decreased as a function of cognitive load, and both F1 and F2 of back vowels increased. The strongest associations were seen between the three types of cognitive load and F1 and F2 changes in back vowels. Because fluent and clear radio speech communication is vital to safety in aviation and temporal and spectral changes may affect speech intelligibility, careful use of standard aviation phraseology and training in the production of clear speech during a high level of cognitive load are important measures that diminish the probability of possible misunderstandings.

Effect of cognitive load on speech prosody in aviation: Evidence from military simulator flights.

Mental overload directly affects safety in aviation and needs to be alleviated. Speech recordings are obtained non-invasively and as such are feasible for monitoring cognitive load. We recorded speech of 13 military pilots while they were performing a simulator task. Three types of cognitive load (load on situation awareness, information processing and decision making) were rated by a flight instructor separately for each flight phase and participant. As a function of increased cognitive load, the mean utterance-level fundamental frequency (F0) increased, on average, by 7 Hz and the mean vocal intensity increased by 1 dB. In the most intensive simulator flight phases, mean F0 increased by 12 Hz and mean intensity, by 1.5 dB. At the same time, the mean F0 range decreased by 5 Hz, on average. Our results showed that prosodic features of speech can be used to monitor speaker state and support pilot training in a simulator environment.

Parents' views on changes in their child's communication and linguistic and socioemotional development after cochlear implantation.

Our aim was to obtain versatile information on the communication and socioemotional development of implanted children in their everyday environment. We studied 18 children implanted unilaterally at the mean age of 3 years 4 months. All had normal nonverbal intelligence, but 8 (44%) had concomitant problems. Their parents filled out semistructured questionnaires at 6 months and then annually 1-5 years after activation. Parents reported a change from use of signs to speech, and changes in the children's vocal behavior and spoken language development. They also reported that children had calmed down and showed an increased sense of self-confidence and safety with an expanded social life. The greatest changes started to take place 1 year after implantation. Five years after implantation, two thirds of children were judged to be as independent as their age peers. We conclude that changes in communication pave the way to benefits in psychosocial development after implantation.

Radio speech communication problems reported in a survey of military pilots.

INTRODUCTION: Despite technological advances in conveying information, speech communication is still a key safety factor in aviation. Effective radio communication is necessary, for example, in building and maintaining good team situation awareness. However, little has been reported concerning the prevalence and nature of radio communication problems in everyday working environments in military aviation. METHODS: We surveyed Finnish Defense Forces pilots regarding the prevalence of radio speech communication problems. RESULTS: Of the 225 pilots contacted, 75% replied to our survey. Altogether 138 of the respondents were fixed-wing pilots and 31 were helicopter pilots. Problems in radio communication occurred, on average, during 14% of flight time. The most prevalent problems were multiple speakers on the same radio frequency band causing overlapping speech, missing acknowledgments, high background noise especially during helicopter operations, and technical problems. Of the respondents, 18% (31 pilots) reported having encountered at least one potentially dangerous event caused by problems in radio communication during their military aviation career. If the employer were to offer extra hearing protection, such as custom-made ear plugs, 93% of the pilots indicated that they would use it. DISCUSSION: Communication can be a flight safety factor especially during intense air combat exercises and other information-loaded flights. During these situations, communication should be clear and focused on the most essential information. So, training and technical improvements are necessary for better communication. High quality radio speech communication also improves operational effectiveness in military aviation.

Development of speech intelligibility and narrative abilities and their interrelationship three and five years after paediatric cochlear implantation.

This study sought to determine the level of speech intelligibility, narrative abilities, and their interrelationship in 18 Finnish children implanted at the average age of three years, four months. Additionally, background factors associated with speech intelligibility and storytelling ability were examined. Speech intelligibility was examined by means of an item identification task with five listeners per child. Three and five years after activation of the implant, the children reached average intelligibility scores of 53% and 81%, respectively. The story generation abilities of the implanted children exceeded their hearing age by one year, on average. This was found after comparing their results with those of normally-hearing two- to six-year-olds (N = 49). According to multiple regression analysis, comorbidity (number of additional needs), chronological age, and/or age at activation usually explained from 46% to 70% of the variation in speech intelligibility and narrative abilities. After controlling for age, communication mode, and number of additional needs, speech intelligibility and ability to narrate were statistically significantly associated with each other three years after activation, but not anymore five years after activation.

Comparison between artificial neural network and multilinear regression models in an evaluation of cognitive workload in a flight simulator.

In this study, the performances of artificial neural network (ANN) analysis and multilinear regression (MLR) model-based estimation of heart rate were compared in an evaluation of individual cognitive workload. The data comprised electrocardiography (ECG) measurements and an evaluation of cognitive load that induces psychophysiological stress (PPS), collected from 14 interceptor fighter pilots during complex simulated F/A-18 Hornet air battles. In our data, the mean absolute error of the ANN estimate was 11.4 as a visual analog scale score, being 13-23% better than the mean absolute error of the MLR model in the estimation of cognitive workload.

Effect of caffeine on simulator flight performance in sleep-deprived military pilot students.

Caffeine has been suggested to act as a countermeasure against fatigue in military operations. In this randomized, double-blind, placebo-controlled study, the effect of caffeine on simulator flight performance was examined in 13 military pilots during 37 hours of sleep deprivation. Each subject performed a flight mission in simulator four times. The subjects received either a placebo (six subjects) or 200 mg of caffeine (seven subjects) 1 hour before the simulated flights. A moderate 200 mg intake of caffeine was associated with higher axillary temperatures, but it did not affect subjectively assessed sleepiness. Flight performance was similar in both groups during the four rounds flown under sleep deprivation. However, subjective evaluation of overall flight performance in the caffeine group tended to be too optimistic, indicating a potential flight safety problem. Based on our results, we do not recommend using caffeine pills in military flight operations.

Voice problems experienced by Finnish comprehensive school teachers and realization of occupational health care.

A survey was conducted among teachers to explore 1) risk factors of voice disorders, 2) the number and nature of problems experienced, 3) the need for medical help, and 4) how occupational health care reacts to this need. Additionally, the knowledgeability of occupational health care physicians and the way treatment of voice disorders is currently organized was explored. Of the 181 teachers who responded, 42% reported voice symptoms occurring daily or weekly. Every tenth teacher also had vocal nodules, and 40% of those with recurring voice problems had been on sick-leave. The respondents suggested improvements in occupational health care: it should also cover prevention, waiting times need to be shortened and care chains established, and resources need to be allocated for voice therapy services.

Solutions to electromagnetic interference problems between cochlear implants and GSM phones.

For persons using cochlear implants, electromagnetic compatibility (EMC) problems may sometimes be an obstacle to using digital cellular telephones. This study aimed at exploring the benefit of three new assistive listening device prototypes that eliminate or diminish EMC problems. Ten experienced cochlear implant users listened in quiet to running speech samples and a sentence test on a landline phone, a digital cellular phone with and without three prototypes. The subjects' performance was assessed using a sentence test, a subjective visual analog scale, and by ranking the best and the poorest listening condition. Compared to the other test conditions, listening to a digital cellular phone alone revealed, on average, the poorest sentence recognition scores (29%) and the poorest results in four different subjective judgments (the amount of disturbances, the clarity of the message, the quality of the sound, overall judgment) with all three implant systems tested. The prototypes generally helped the implantees to recognize speech better on the cellular telephone (by 10-21 percent units, on average). Use of assistive listening devices and further development of EMC of both cochlear implant systems and digital cellular phones needs to take place to enable smooth use of digital cellular phones for all implantees.

Methodological aspects of assessing speech intelligibility among children with impaired hearing.

OBJECTIVE: In the assessment of speech intelligibility, procedures that are easy to use, but also valid and reliable, are needed. The aim of this study was to explore the reliability and concurrent validity of two scaling methods for assessing the speech intelligibility of children with impaired hearing. MATERIAL AND METHODS: A total of 51 children aged 4-17 years with a mild to profound hearing impairment performed a naming task comprising 62 single words. Altogether, 85 inexperienced listeners, divided into 17 panels, assessed the speech production of the children. A percent correct score (for identification of the words) was obtained from every listener. The listeners were also asked to judge the overall intelligibility of each child using a visual analogue scale (VAS) and a four-point ordinal level rating scale with verbal descriptors. RESULTS: The percent correct score correlated significantly both with the VAS and the rating scale with verbal descriptors (Pearsons' coefficient 0.90 and Spearman's coefficient 0.78, respectively). Also, the VAS and the scale with verbal descriptors were significantly intercorrelated (Spearman's rho 0.85). Moderate to high correlations were usually obtained for all grades of hearing impairment, both sexes, different age groups and main communication modes. CONCLUSIONS: Especially for assessing the need for remediation of speech and in monitoring its effectiveness, a quick overall estimate of speech intelligibility can be obtained quite reliably using the above rating scales. Item identification is more time-consuming but is often needed in research and therapy planning, where acoustic and linguistic phenomena that reduce intelligibility need to be traced.