powerpoint presentationpbk child 15 minutes audiologist hearing aid checklist parent 20 minutes...

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Elizabeth Walker, PhD, CCC-SLP/AAssistant ProfessorUniversity of Iowa, Iowa City, IA

Language, Psychosocial, and Theory of Mind Development in Children who are Hard of Hearing

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ARKANSAS SPEECH AND HEARING ASSOCIATION

Supported by NIDCD R01 DC009560

Iowa City, IA

Acknowledgements

Research reported in this presentation was supported by the National Institute On Deafness And Other Communication Disorders of the National Institutes of Health under Award Number

R01DC009560. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Acknowledgements

Mary Pat Moeller, PhD Ryan McCreery, PhD Bruce Tomblin, PhD Meredith Spratford, AuD

• Intro to OCHL

•Role of language input

•How sources of inconsistent access influence outcomes• Phonology and grammar• Narratives• Psychosocial• Theory of mind

Hearing loss is the most common birth condition affecting infants

Prevalence of mild or worse permanent bilateral childhood hearing loss is 0.9%; incidence in US is 1.1 per 1000 infants (Mehra et al., 2009)

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2009: 98% of all newborns in the US were screened for hearing loss; 1.6% did not pass the newborn hearing screen (CDC, 2011)

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In 2006, NIH convened a panel to discuss outcomes in children who are HH

Conclusion: need for prospective research to determine what factors influence success

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The OCHL study is a multicenter, longitudinal study focusing on outcomes of children with mild-severe hearing loss

SUBJECTS TOTAL

HH 317

NH 117

Study participants

Inclusion criteria

• 6 months to 7 years at entry

• English primary language

• No major secondary disabilities

• No cochlear implants

• Permanent mild to severe bilateral hearing loss

Domains of OCHL study

Child and Family

Outcomes

Background characteristics

of child/family

Hearing & Speech

Perception

Speech Production

Language Skills

Academic Abilities

Psychosocial and Behavioral

Interventions (clinical,

educational, audiological)

5 YEAR OLD VISIT (HL)

Test Type Test Name Given To Time Primary Responsibility

Academic: CTOPP Child 30 minutes SLP

TOPEL Print Knowledge Child 10 minutes SLP

Speech Production: Goldman Fristoe 2 Child 10 minutes SLP

BIT Child 15 minutes SLP

Language: PPVT-4 Child 30 minutes SLP

PLAI-2 Child 45 minutes SLP

Theory of Mind Measures Child 10 minutes SLP

CELF-4 Word Structure Subtest Child 15 minutes SLP

Hearing Function: Hx, Audiogram (Conventional) +

Tymps

Child 30 minutes Audiologist

Electroacoustic Analysis 60/90 Child 5 minutes Audiologist

Aided Speech Intelligibility Index

(Verefit SII)

Child 15 minutes Audiologist

PBK Child 15 minutes Audiologist

Hearing Aid Checklist Parent 20 minutes Audiologist

Psychosocial, Behavioral,

& Family:Adult Perceptions II Parent 20 minutes SLP; Audiologist

OCHL Family Interview Parent 60 minutes

OCHL SPS Audiology Service

Provider

30 minutes

OCHL SPS Preschool Service

Provider

30 minutes

SCBE Teacher 15 minutes SLP; Audiologist

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How do children who are hard of hearing compare to children with normal hearing?

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* p < .0001 CHH differed significantly from SES-matched age mates.

Tomblin et al., Ear & Hearing, 2015

. . . . .

Conclusion: Children who are hard of hearing are at risk for

language delays

Previous outcomes research

Degree of HL(PTA) Outcomes

Lan

guag

e sc

ore

s

Significant effect for degree of hearing loss.

Tomblin et al., 2015

Previous outcomes research

Timing of intervention Outcomes

Does age at HA fitting influence language?

Tomblin et al., 2015

Lan

guag

e sc

ore

Significant difference

No significant difference


AudibilityHearing aid useLinguistic input

Factors that influence relationship between PTA and outcomes.

AudiologicalIntervention

OCHL outcomes model: auditory-linguistic access

Educational Intervention

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• Intro to OCHL



Sources of inconsistent auditory access

Linguistic input

Predictors

Acknowledgements:

Supported by NIDCD R01DC009560

Sophie E. Ambrose BTNRH

Mark van DamWashington State

University

High rates of linguistic input (parent talk) especially important for children with hearing loss

Difficult to conduct this

research

We used two strategies to analyze quality and quantity of parent talk

Art Gallery LENA

Art Gallery was conducted at the 18 month visit

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And the 3 year old visit….

Goal:Elicit parent-child interaction

Research questions/predictions for the Art Gallery

1. Does the quantity or quality of caregiver input differ for children who are HH compared to children with NH?

Prediction

No difference in quantity

Quality will differ at 18 month and 3 years

Ambrose et al., 2015

• Coded 5-minute samples for quality features

HIGH LEVELM What are they doing?C They're fishing.M Oh have you ever been fishing?C Yeah.M When did you go fishing?C Before I born.M And did the place look like this?

LOW LEVEL – (Directives)M Look at this.M Come sit down.M Say, “Pooh.”

Quality of caregiver input?

28Ambrose, et al. (accepted)

Does quantity/quality of caregiver input differ for children who are HH vs children with NH?

Quantity

Number of total utterances

Number of total words

QualityAverage length of

utterance

Number of different words

Proportion of “high level” utterances

Proportion of “directing” utterances

M What are they do/ing?C They/'re fish/ing.M Oh have you ever been fishing?C Yeah.M When did you go fishing?C Before I born.M And did the place look like this?

M What is this?M Come sit down.M Say, “Pooh.”


Quality

Proportion of “directing” utterances

18 month visit

Parents of HH children used more “directing” utterances than parents of NH children

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3 year old visit

Quantity

Number of total words

NH > HH

QualityAverage length of

utterance; NH > HH

Number of different words; NH > HH

Proportion of “high level” utterances; NH > HH

Proportion of “directing” utterances; NH < HH

,n=53 ,n=123 QualityProportion of “high level”

utterances; NH > HH

Proportion of “directing” utterances; NH < HH

Research questions/predictions for the Art Gallery

2. Does quantity and quality of parent talk at 18 months influence language outcomes at 3 years?

Prediction


Higher quantity and quality of parent talk at 18 months

Higher child language skills at 3

Does quantity and quality of parent talk at 18 months influence language outcomes at 3 years?

Quality (esp. directiveness) at 18 months influences child language skills at 3 years

Poorer language scores

More directive

Big picture: quality and quantity of language input matter

• Parents of children who are HH tended to be more directive (but this is likely to be a bidirectional relationship)

• More directive communication at 18 months is correlated with lower language scores at age 3

• Caregivers may need support to provide children with optimal language learning environments

• Televisions serve as one

source of background noise

AND parents and children

talk less when the TV is on.

Auditory Environments influence access to linguistic input

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LENA subproject – Language Environment Analysis System

2 3Noise

TV

Distant

Meaningful

Silence/ Background

Is there a difference in input for children who are HH compared to children who are NH?

Van Dam, et al., 2012; Ambrose, et al., 2014

No significant differences between groups

There is a relationship between PTA/audibility and input

As hearing gets worse and audibility decreases, input and # turns decrease

Van Dam, et al., 2012; Ambrose, et al., 2014

There is a relationship between language scores and # conversational turns

As # turns increase, receptive and expressive language scores increase


Is there a relationship between amount of time TV is on and conversational turns?


On average, 8% of our LENA recordings were classified as electronic media (~ 58 min in 12 hr recording)

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t = -3.12p < 0.01

Van Dam, et al., 2012; Ambrose,

et al., 2014


Van Dam, et al., 2012; Ambrose,

et al., 2014

For every 1% increase in electronic media

Number of conversational turns decreased by 2.5 turns

Is ALL television exposure bad?Average US child is exposed to 232.2 minutes (3.87 hours) of background TV per day (Lapierre et al., 2012)

Increased exposure to background TV is correlated with poorer executive function skills in low- and high-risk children (Linebarger et al., 2014)….

https://www.youtube.com/watch?v=eT7nD02Im5E

But educational foreground TV can serve as a buffer for executive function skills.

Clinical Implications: Auditory Environments

Enhance child’s cumulative auditory experience! Increase meaningful conversational turns.

Reduce exposure to TV (background noise). Promote more frequent parent-child conversational interactions.

• Children with poorer hearing and lower audibility engaged in fewer conversations and had less exposure to adult input.

• Adult word counts were not significantly correlated with language outcomes.

• Children who were frequently engaged in conversations demonstrated the strongest language outcomes.

• Conversational interactions were less frequent in homes with high rates of audible television weaker language skills.

Big picture: Language input

https://www.youtube.com/watch?v=eT7nD02Im5E

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• Intro to OCHL




AudibilityHearing aid useLinguistic input

Factors that influence relationship between PTA and outcomes.

AudiologicalIntervention

OCHL outcomes model: auditory-linguistic access

Educational Intervention

Cumulative auditory experience hypothesis


InterventionAudibility

Hearing aid useLinguistic input

Form Content

Use

Sources of inconsistent access

Limited perceptual salience + input

frequency

• Greater risk for domains that depend on access to phonetic structure?• HL reduces opportunities for perceiving elements that

are perceptually subtle

• Speech production

• She wants more cookies.

Differential Vulnerability?

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Phonology Outcomes by Degree of HL

n = 110 3 yr olds

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KEYS

Open & Closed Set Test (O&C)• Developed by: Ertmer, Miller, & Quesenberry,2004• Appropriate for ages 18 to 24 months• A measure of perception and production• 10 items using realistic pictures• Production followed by picture identification

O&C is available from MED-EL at http://www.medel-

bridge.com.

http://www.medel-bridge.com/

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Open and Closed task (2 year olds) O&C test can be used as an assessment by SLPs or audiologists

Differences in age at HA fit and degree of hearing loss on “Open” scores


O&C test can be used as an assessment by SLPs or audiologists

“Open” scores at age 2 predict speech production at age 3


Variability on Closed Set Task

McCreery et al., 2015

Higher scores on Open and Closed Task

Higher audibility

Greater hearing aid

use

Larger vocabulary

Higher maternal education

level

Model accounted for 35% of the variability.

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Grammar: Morphology Elicitation Task

Form Example

Auxiliary He’s mixing it.

Copula She’s a dancer

Progressive He is knocking on the door

Third singular Everyday she dances.He wants more milk.

Irregular past He fell off the chair

Regular past Sara walked fast

Possessive Dad’s shirt

Plural Three balls

This is dad’s coat. Whose dress is this? It’s ___________ (baby’s).

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Age 4: vocabulary and grammar development

Tomblin et al. 201562

Bound morphemes, especially in verbs, are less salient andless frequent in the input

• Typically sentence medial (He needs to find…)

• Often involve fricatives in English

• Complex phonetic contexts (It’s, Greg’s calling…)

Hearing loss effects processing of subtle acoustic cues important for morphosyntax

• Intro to OCHL



Narrative Performance in Children who are Hard of Hearing

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Narrative skills?

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Delayed relative to peers n Age (yr)

Status Like typical peers n Age(yr)

Status

Worsford et al. (2010) 89 11-15 D/HH Reuterskiold et al. (2010) 18 9-13 HH

Boons et al. (2013) 66 5-13 Deaf Asker-Arnason et al. (2012) 20 10-18 HH

Soares et al. (2010) 21 5-11 D/HH Arfe (2015) 42 7-15 D/HH

Note:• Focus on children who are deaf

or combined D/HH• Wide age range

Research questions

Are children who are hard of hearing at risk for delays in language acquisition?

Are certain aspects of language more vulnerable to the effects of hearing loss in the mild-severe range?

How do the narrative abilities of children who are HH compare to age-matched peers with NH?

What factors contribute to variability in spontaneous and retell narrative scores?

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Current study: Participants• 54 children with normal hearing (24 males, 30

females)

• 88 children who are hard of hearing (47 males, 41 females)• Average age = 7.1 months (2.5)

• 173 identified at NHS

• 43 later-identified

M SD

Demographic Characteristics

Better-ear PTA (dB

HL)46.4 16.2

Age at confirmation 9.1 11.8

Age at HA fit 11.4 11.9

Methods: Narrative task

Narrative task

Spontaneous

• Examiner presents story pictures one at a time

Spontaneous

• Repeat pictures, with child telling story

Retell

• Examiner tells story

Retell

• Child repeats back story

Narrative scoring scheme (NSS): adapted from Heilman et al. (2010)

to judge the quality of narrative performance (macrostructure). The

NSS consisted of seven story characteristics, rated on a scale from 0

(poor) to 5 (proficient).

Story Characteristics Definition

Introduction Presence, absence, and qualitative depiction of character and setting components

Character Development Acknowledgement of characters and their significance in the story

Mental States Frequency/diversity of mental state words

Conflict Resolution Presence/absence of conflicts and resolutions required to express the story

Referencing Consistent and accurate use of antecedents and clarifiers

Cohesion Sequencing and transitions between events

Conclusion Description of final event and story wrap-up

Candy Stealing StoryResults: Is hearing status related to narrative scores?

p = .046d = .358

p = .001d = .596

Spontaneous:20% NH > 1 SD below mean

27% HH > 1 SD below mean

Retell:18% NH > 1 SD below mean

35% HH > 1 SD below mean

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Grammatical MeasuresSpontaneous Retell

NH HH p d NH HH p d

MLUm 9.35 8.36 .004 0.49 11.53 10.03 .001 0.59

Omit Morph

.17 .61 .001 0.54 .48 1.21 .001 0.58

SubordIndex

1.36 1.19 .013 0.47 1.57 1.40 .002 0.50

Not different: # of utterances, NTW, mazes, error word codes, total mental states. NH children used more words on retell than HH (63.6 vs 56.6, p = .006)

Results: What factors influenced narrative performance?

• Better ear SII, syntax, and vocabulary were significantly

correlated with spontaneous narrative scores.

• Better ear SII, syntax, vocabulary, and nonword repetition were

significantly correlated with retell narrative scores.

Summary of findings

• On average, children who were hard of hearing demonstrated delays in spontaneous and retell narrative skills, both in terms of macrostructure and microstructure.

• A large percentage of children performed within the average range on the narrative task.

• Amount of aided audibility was associated with individual differences in the hard of hearing group.

• Future directions: examine performance on retelling of fables and Test of Narrative Language in 8-9 year olds

• Intro to OCHL



Psychosocial outcomes of toddlers and preschoolers who are hard of hearing Acknowledgements:



John KnutsonUniversity of Iowa

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• Does hearing status affect language abilities?• Do the auditory access variables contribute to variance in

language abilities?

Auditory access:Audibility (BESII)

HA useAge HA fit

Language Abilities

Psychosocial Outcomes

• Background on psychosocial development• Does hearing status affect psychosocial development?• Do the auditory access variables contribute to variance in

psychosocial development?

Auditory access:HA use

Age HA fitAudibility (BESII)

Language Abilities

Psychosocial Outcomes

Psychosocial development• Delayed communication and limited

access to conversational exchanges may lead to risk in psychosocial development (Moeller, 2007)

• Encompasses social participation, self-esteem, quality of life

• May be exhibited as • Internalizing behaviors (depression, anxiety,

withdrawal)

• Externalizing behaviors (aggression, rule-breaking)

Previous research on psychosocial outcomes

Small sample sizes

Children who are deaf or HH combined into one group

Measurement differences

“Predictors of Psychosocial Outcomes in Hard-of-Hearing Preschool Children” (Laugen et al.; 2016)

• 35 CHH tested at 4 years of age

• Strengths and Difficulties Questionnaire (SDQ) and the Social Skills Rating System (SSRS)

“Predictors of Psychosocial Outcomes in Hard-of-Hearing Preschool Children” (Laugen et al.; 2016)

• CHH displayed significantly more emotional, hyperactivity, and peer problems than CNH

• Age at detection and female gender were associated with better outcomes; degree of hearing loss and vocabulary were not.

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• Child Behavior Checklist (CBCL)• Administered at 2,

4, and 6 years of age

OCHL Psychosocial MeasuresCBCL (Achenbach, 1992)

• Preschool version: parents rate child’s behavior on 3 point scale (not true; somewhat true; very true)

• Composite scores: Internalizing and Externalizing

• T-scores • Average = 50, lower is better

Psychosocial: Hearing status

Externalizing

2 year olds 4 year olds

n.s. correlated with BEPTA n.s. correlated with BEPTA

Psychosocial: Hearing status

Internalizing

2 year olds 4 year olds

p = .038

n.s. correlated with BEPTA

p = .038

Mean = 46.8 Mean = 41.93

Psychosocial: Auditory Access

• Externalizing • 2 yearsHA use

(hours)SII

Age at HA fit

(<6 mo, > 6 mo)

SII HA use (hours)

p = .04Fit earlier = better score

n.s. (p = .53)p = .08Less audibility =

better score

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• Externalizing • 4 yearsHA use

(hours)SII

Age at HA fit

(<6 mo, > 6 mo)

SII HA use (hours)

n.s. (p = .13)n.s. (p = .51) n.s. (p = .16)


• Internalizing• 2 yearsHA use

(hours)SII

Age at HA fit

(<6 mo, > 6 mo)

SII HA use (hours)

p = .02Less audibility =

better score

p = .01Fit earlier = better score

n.s. (p = .54)


• Internalizing• 4 yearsHA use

(hours)SII

Age at HA fit

(<6 mo, > 6 mo)

SII HA use (hours)

n.s. (p = .36) p = .06Fit earlier = better score

p = .04More use = better score

p = .038

Mean = 46.8 Mean = 41.93

When we look at hearing status in isolation, get significant difference…. But is hearing status a proxy for amount of hearing aid use?

Psychosocial: Summary

• On average, children who are hard of hearing display age-appropriate internalizing and externalizing behaviors (not in clinical range)

• Also show variability• Age at hearing aid fit contributes at 2 and 4 years (later

HA fit more anxiety and aggression)

• Amount of hearing aid use contributes at 4 years (less HA use more anxiety)

• Aided audibility contributes at 2 and 4 years, but in an unexpected direction (better audibility more anxiety and aggression). • Influence of early intervention?

Auditory access:HA use

Age HA fitAudibility (BESII)

Language Abilities

(CASL Composite)

Psychosocial Outcomes (CBCL Total Problems)

• Background on relationships between language and behavior outcomes

• For 4-year-old children who are HH:- Are language and psychosocial outcomes related to one another?- Are these relationships a result of shared variance in auditory access?

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Language and Psychosocial

• Early speech and language delays are associated with later behavior problems (Lindsay et al., 2007, St Clair et al., 2011)

• We use language internally to regulate our behavior (direct)

• Poor language skills may interfere with socialization (indirect)• Parents may reason more with children who have

better language skills and use more punishment with children with poor language skills

• Lower language associated with peer rejection(Peterson et al., 2013)

Language and Psychosocialr = -0.26**

Variance in Psychosocial Outcomes

R2= .04, F = 6.13, p = .015

n.s.

SII

n.s.

Age at HA fit

More use =

Betterbehavior

HA Use

Better language

= Better

behavior

Language

Summary• Language skills are related to psychosocial

outcomes

• More HA use, better language, contribute uniquely to better psychosocial outcomes

Summary on psychosocial outcomes

• Additional supports for psychosocial development may be warranted when children have low language skills

• Intro to OCHL



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Theory of Mind Development in Children who are Hard of Hearing: Understanding False Belief

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Acknowledgements:

Accepted manuscript: JSLHR


Mary Pat MoellerBTNRH


Jacob OlesonU of Iowa

Research Audiologists and SLPs

Merry Spratford Abby Bogatz

Meaghan Foody Sarah Al-Salim

Peter de VilliersSmith College

Overview

1. Background What is Theory of Mind?

Theory of Mind Stages: Typical development Theory of Mind: Children who are Deaf or Hard of Hearing

2. Research Questions & Study Methods 3. Results

Five and Six Year Olds (Cross Sectional) Three to Five and Five to Six (Longitudinal) Second Graders (Cross Sectional)

4. Implications and Future Directions Sarcasm Study

What is Theory of Mind?

Increasing awareness that self and others have feelings, thoughts, beliefs, dreams Our internal states guide our

behaviors Our understanding of self and

others supports reasoning about situations

Allows us to take the perspective of others (communication)

Astington, 1993; Wellman, 2002

Norman Rockwell

What do you

know about

the situation?

How do

you know?

Used with permission of the Norman Rockwell foundation

Typical Developmental StagesSocial cognition/theory of mind

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Social-Cognitive Development

18 monthsJoint AttentionSymbolic Play

2 - 3 years• Wants/Desires

• Feelings• Past events• Mental words

4 - 5 years • False Belief

• Dual representations

Wellman & Liu, 2004; Schick, 2005

Diverse desires – people want different things

5-6 years• Real-Apparent

Emotion

True feelings can be masked

3-4 years

• Deception• Mental talk

Social Cognitive Development

6 - 8 years• Reality vs.

imagination• Second-order

false belief

• Throughout childhood and early adulthood

• Verbal reasoning• Moral reasoning• Irony and sarcasm

• Narrative skills• Pragmatic skills

I thought he knew that I already found

out about the surprise party.

Adapted from Schick, 2005

Factors Supporting ToM Development

CHILD LANGUAGE ABILITIES

CONVERSATIONS ABOUT THOUGHTS AND FEELINGS

CONVERSATIONAL ACCESS (SHARING OF VIEWPOINTS)

SIBLINGS AND CONFLICT RESOLUTION

RECALLING PAST EVENTS

EXECUTIVE FUNCTION

PRETEND PLAY

MATERNAL EDUCATION/SES

ToM: Children who are D/HH

Late Signing Deaf Children

Marked delays (as in autism)

Due to language delays and limited communication access(deVilliers, 2005; Peterson, 2004)


Native Signing Deaf Children

Achieve ToM/False Belief on schedule (Courtin, 2000; Schick et al., 2007; Woolfe et al., 2002)


Children with CIsMixed findings = Delayed, not delayed, less delayed(Ketelaar et al., 2012; Peterson, 2004; Peters et al., 2009, Remmel & Peters, 2006; Sundqvist et al., 2014)

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Children who are HH

Netten et al. (2017) = delayed compared to hearing peers in spite of language match

Focus of Current Study (Walker et al., in press)

3 years • Parent

mental talk

5 years • False Belief

6 years (non-pass) • False Belief

6 years (all)• Pragmatic

Language

Second grade• False Belief (1st

and 2nd order)

• Irony/Sarcasm

In children who are hard of hearing compared to matched peers with normal hearing

Research Questions: 5 and 6 years

1. How do CHH compare to CNH in their understanding of first-order FB concepts at 5 and 6 years of age?

2. What factors influence children’s performance on FB tasks at 5 and 6 years of age?

3. Are mental state input and child language abilities at age 3 years related to children’s FB understanding at age 5 years?

4. Is FB understanding at age 5 years related to social-pragmatic language skills at age 6 years?

Research Questions: Second Grade

5. How do CHH compare to CNH in their understanding of FB concepts at second grade?

6. What factors influence children’s performance on FB tasks at second grade?

MethodsParticipants, Assessing False belief and predictive factors

Participants

• Five-year olds:• 142 children with mild-to-severe HL from OCHL study

• 57 children with normal hearing, matched on age and maternal education

• Six-year olds (subgroup of non-passers at 5 who returned at 6 yr)• 50 CHH

• 6 CNH

• Second graders:• 80 CHH

• 43 CNH

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Procedures at 5 and 6 years

Measures at 5 years

Audiological Measures

4 False Belief Tasks (scores = 0 to 4)

CELF-4 Word Structure (syntax)

Peabody Picture Vocabulary Test

Preschool Language Assessment Instrument (verbal reasoning)

Measures at 6 years (non-passers)


Repeat 4 False Belief Tasks

Matrix Reasoning – WASI-2 (cognition)

Heads-to-toes Task (Executive function)

CASL Syntax

False Belief: Unexpected Contents

Now, let’s bring your

friend Joey in the room.

What will Joey think is

in this box?

Crayons Spoon

What do you think

is in the box?

Crayons

Oh look what’s

really in the

box!

A spoon

1 2 3

FB: Change of Location Stories CASL: Pragmatic Judgment

Mary walks over to her friends who are playing dolls. Mary wants to play with them. What does Mary say?

Results – Research Q1 comparison of CNH to CHH on first-order FB concepts at

5 and 6 years of age

84%

41%

Χ2 = 30.34, p < .001

CNH outperform CHH at age 5 on FB

Note: CHH differed significantly from matched peers on all language measures (effect sizes = 0.62 –0.85)

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67%

54%

Fisher’s Exact = n.s.

But more CHH than CNH remain at risk

84%

41%

Results – Research Q2What factors influence children’s performance on FB tasks at 5 and 6 years of age?

Logistic Regression Results: Age 5

False Belief (pass/fail)

Variable Wald Chi-Square Pr>Chi- Square Odds Ratio

CELF-4 Word Structure SS 5.959 .015 1.050

PLAI-2 Reasoning SS 5.191 .023 1.191

PPVT-4 SS 0.173 .678 0.990

Maternal education 0.000 .996 1.000

Hearing status (NH, HH) 9.505 .002 5.139

c = 0.88

Linear regression verified results: 47% of variance explained

CHH only (auditory factors at age 5)

Passers > non-passers on BESII (0.81 vs. 0.75; p = .008)

Matched on BEPTA, age of confirmation, age of HA fitting

BESII correlated with language and false belief measures (r = 0.35; r = 0.23)

Regression model: Maternal ed, language scores, BESII explain 45% of variancein FB at age 5

Only Grammar and Verbal Reasoning were unique predictors (effect of audibility mediated by child language)

BESII LanguageFalse Belief

Results: Predictors at Age 6

Passers of FB at 6 Non-passers of FB at 6 Between Groups

Variable n Mean (SD) Range n Mean (SD) Range p d

Maternal education (years) 31 14.71 (2.7) 9-20 24 14.83 (2.2) 9-18 .852

Heads to Toes (Raw) 29 31.5 (5.4) 19-39 24 20.5 (14.3) 0-38 .001 1.02

WASI Matrix Reasoning (T) 29 54.9 (8.3) 41-74 25 47.6 (7.9) 37-74 .002 0.90

CASL Syntax (SS) 31 98.0 (16.6) 69-133 25 74.0 (15.6) 50-110 .001 1.49

c = 0.88; Predictors = matrix reasoning, grammar, executive functionSyntax was the only significant predictor

Research Q3 (Longitudinal)Are mental state input and child language abilities at age 3 years related to children’s FB understanding at age 5 years?

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Participants and Methods

Subgroup of 46 CHH and 19 CNH

Interactive language samples at age 3 (Ambrose et al., 2015) + FB at age 5 years

Transcribed and Coded for parent use of mental terms (think, know, remember, etc.)

Language Measures: CASL basic concepts, pragmatic judgment

Results - Research Q3

CHH = CNH (at age 3 years) CASL Basic Concepts (p = .09)

CASL Pragmatic Judgment (p = .52) p = .004

Conclusion: Parents addressing CHH used significantly fewer mental terms than parents

addressing CNH; Not fully explained by language

Logistic regression (c = 0.875)• Hearing status• Language (CASL Pragmatics)Parental mental state talk not significant in model (although correlated with FB at 5 yrs, r = 0.33)

Research Q4 (Longitudinal)Is FB understanding at age 5 years related to social-pragmatic language skills at age 6 years?

• Does FB relate to daily social communication?

Results – Research Q4

Linear Regression Model (Maternal Education controlled)

Predictors: Age 5 Child Language (syntax) and FB Scores

Dependent Variable: Social-Pragmatic Language Ability at Age 6

Model explains 61.5% of variance [F (3, 152) = 83.56, p = .001]

Significant independent predictors: Syntax (CELF word structure)

FB Scores (small but unique contribution over language)

Research Q5How do CHH compare to CNH in their understanding of FB concepts at second grade?

Procedures at Second Grade


False Belief Stories Knowledge/ignorance = 4 items, 1st FB = 8 items, 2nd FB = 4 items

Total of 16 points

CELF-4 Word Structure (syntax)

WJTA Picture Vocabulary

AWMA backward digit recall

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Advanced FB: The Bake SaleTwo Story Narratives with Cartoon Illustrations• First Order – What does the character know or believe?• Second Order - What does one character know or believe about another?

Hollenbrandse et al, 2007; Perner & Wimmer, 1985

Picture 4: On her way back, Maria meets the mailman. “I bought brownies and I am going to share them with my brother, Sam. It is a surprise. “That is nice of you,” says the mailman. Then he asks, “What does Sam think you are buying at the bake sale?”

2FB: What does Maria tell him? (cookies, brownie, pie, other)Why does she say that?___________________________

1FB: What does Sam think they are selling at the bake sale?(pie, brownies, cookies, other)Why does he think that? __________________________

Results – Research Q5

No significant differences between groups on total score

or subtest scores

Between group comparison on subtest

scores

67%

54%

60.5%

50%

2nd Order FBΧ2 =7.38, p = .12

84%

41%

67%

54%

Summary of FB:• CHH Delayed at 5

years• Over half CHH

resolve delay at age 6

• CNH = CHH at grade 2

Note: Although the groups differ on language abilities, effects are small (0.33-0.37)

Research Q6What factors influence children’s performance on FB tasks at second grade?

Logistic Regression Results: 2nd Order FB

c = 0.76 False Belief (pass/fail)

Variable Wald Chi-Square Pr>Chi- Square Odds Ratio

Hearing category 0.437 .932 0.728-1.014 a

Maternal education 2.920 .088 1.167

AWMA Backward Digits SS 1.733 .188 1.020

CELF-4 Word Structure SS 9.244 .002 1.071

WJTA Picture Vocabulary SS 1.305 .252 0.971

For CHH only, effect of BESII on FB is mediated by language abilities.

Summary (5 and 6 years)

Majority of CNH (84%) passed FB at age 5, consistent with literature

Majority of CHH (59%) demonstrated delay – CHH 5 times less likely than CNH to pass Partially confirms Netten et al (in press)

Results on 6 year olds suggests delays resolving, but some CHH remain at risk Non-passers at age 6 had combined disadvantages of lower language, cognitive, and EF

Language is a major contributing factor explaining individual differences Audibility contributes, but mediated by language

Strong audibility + strong language may lead to resilience in complex listening situations

Parental talk at age 3 differed between groups; not unique predictor

FB at 5 related to social language abilities at age 6 years (deRosnay et al., 2014)

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Summary (Second Grade)

CHH performed like hearing peers at second grade Language was the primary predictor of outcome

Does this mean that CHH “catch up” in FB understanding by ages 6to 8 years? Possibly due to resolving language delays?

Greater access to conversation than deaf children with hearing parents?

Will both groups proceed to mastery on same schedule?

FB may be “too narrow a lens?”

Widening the lens: IRONY/SARCASM

Method

• 9 Picture-Supported Stories• de Villiers & de Villiers

• Presented in standard A-V format

• Child answered questions requiring interpretation or reasoning

147 148

1. What did the big brother mean when he said that?

2. Did the brother think that the little boy was a bad hitter or a good hitter?

Bad _____ Good _____

Sarcasm (Grade 2)

Main effect of hearing category p = .004

Positive Predictors: (36% of variance)• Language• Social Cognition

Sweet Spot?

Implications

Need to support families in engaging in talk and conversations that promotesocial-cognitive abilities Do parents make assumptions about child’s readiness to engage in “abstract” talk?

Do parents limit exposure that is not within “earshot?”

Studies demonstrate that training helps children develop these concepts Value in targeting ToM skills in intervention

Opportunities to innovate methods for measuring social-cognitive skills,especially advanced abilities

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Conclusions

• HL does have an effect on speech and language development during the preschool years• Even the mild group was significantly poorer

• Children with moderate to severe HL were in the low average to poor range

• Audibility provided by HAs resulted in improved language growth

• Early identification and clinical management including well-fit HAs that are worn consistently improved outcomes

151

Theoretical Implications

• Results have implications for theories about sensitive periods and role of experience in language development

• The language development system appears to remain open to experience

• Possibly at a lower level of learning efficiency

152

Future Research Directions

1. Cascading effects of early delays (literacy, psychosocial)?

2. Impact of complex listening environments on learning and listening effort?

3. Protection offered by working memory & linguistic knowledge?

4. Can strategic interventions protect against risk and better support families at risk?

153

Are children who are hard of hearing still forgotten?

155

Thank you to NIDCD and to the families who have been dedicated participants.

www.ochlstudy.orgFree access to OCHL supplement in Ear &

Hearing

156

http://www.ochlstudy.org/

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Pediatric Audiology Biostatistics, Linguistics, & Psychology

Child Language

Project Management

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powerpoint presentationpbk child 15 minutes audiologist hearing aid checklist parent 20 minutes...

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