Previous studies have demonstrated that communication outcomes for young

children using cochlear implants vary due to child (e.g. age at implant, duration of

hearing loss), family (e.g. socio-economic status and parental involvement) and

device factors (e.g. use of current speech processors). Recent research has also

suggested that optimal child developmental outcomes and language abilities for

young cochlear implant (CI) recipients can be achieved when early identification of

hearing loss and access to early intervention services are in place.

This study examined the delivery of services from three EI centres and

communication mode choices which may have influenced language outcomes for

young children using CI(s). Parent-reported communication mode preferences

were grouped into either speech and sign (including sign alone or sign together

with speech) or oral (auditory-oral or auditory-verbal) approaches.

Use of a Family and Educational Characteristics Questionnaire (FamEd-Q) to

predict language outcomes for children using cochlear implants:

Impact of early intervention services and communication mode choices

Shani Dettman 1,2,3, Dawn Choo 1,3 , Jennifer Holland 1, Jaime Leigh 1,3, Sandra Lettieri 3, Gabrielle Traeger 3, Denise Courtenay 3 1 The University of Melbourne, 2 The HEARing CRC, 3 Royal Victorian Eye & Ear Hospital

1. To describe communication mode preferences in Early Intervention

(EI) for paediatric cochlear implant recipients via a parent-report

questionnaire.

2. To determine whether variance in language performance could be

explained by the amount of time spent in individual EI sessions and/or

the communication mode (speech and sign versus oral).

The amount (frequency/ minutes per week) of individual sessions offered by the three EI centres varied but did not predict language outcomes for this

group of children.

Communication approach used in early intervention settings predicted language performance. Children who used an oral communication mode at their EI

centres had higher average language standard scores than children who used sign and speech.

Children from families with greater relative socio-economic advantage demonstrated better language outcomes.

Additional factors which may impact family engagement with EI services including parental decision-making, child and maternal characteristics, and

geographical access to EI services will be further investigated.

Between 2008 and 2014, the parents of 246 children (mean age at first CI=2.03

years; range=0.53 to 9.28; SD=1.47) completed 579 questionnaires (mean age at

FamEd-Q completion= 3.71 years; range=0.27 to 11.43; SD=2.46) during routine

reviews at the Cochlear implant Clinic (CIC), The Royal Victorian Eye and Ear

Hospital (RVEEH).

Family and Educational Characteristics Questionnaire (FamEd-Q)

The FamEd-Q consists of a two-page questionnaire developed by the CIC RVEEH

to collect family information alongside quantitative measures of CI efficacy.

The 39-item parent self-report questionnaire is comprised of 6 sections:

a. Demographic details

b. Hearing status of parents

c. Languages used at home

d. Communication mode(s) used at home and school

e. Early Intervention (type, frequency, minutes)

f. Participation in Family Activities [9 items derived from Geers & Brenner

(2003) Home Activities Questionnaire]

The present study focused on sections d and e of the FamEd-Q only;

communication mode(s) used in EI centres, and the amount (frequency/ minutes

per week) of individual EI sessions.

Preschool Language Scale and Peabody Picture Vocabulary Test

Children also completed standardised language assessments at intervals

determined by CIC’s protocol; pre-implant, 1 and 2 years post-implant, at 5 years

of age, and at 8 to 10 years of age. Child and family demographic information

were also collected.

Background

Methods and Materials

Summary and Conclusions

Results

Figure 1. Time (in minutes) spent per week in individual EI

sessions at annual intervals pre- and post-implant.

The University of Melbourne, Department of Audiology and Speech Pathology

Dawn.choo@unimelb.edu.au Acknowledgements to all the families and staff at the Royal Victorian Eye and Ear Hospital, Cochlear Implant Clinic who were involved in this study.

Contact

Study Aims

Pre-implant (years) Post-implant (years)

Most of the EI services (64.7%) were delivered between

the date of the first implant and the child’s one year

post-implant anniversary (Figure 1 right). The average

duration of individual EI sessions was 45.7 minutes per

week. When data from families who attended one of the

three main EI centres were analysed, 59% reported the

use of an oral communication mode at home. One-way

analysis of variance showed a significant difference in

the communication approach used at the three EI

centres. Children enrolled in EI Centre A predominantly

used a speech and sign communication mode, and this

was significantly different to children enrolled in EI

Centre B and EI Centre C, who mostly used an oral

communication mode [F(2,268)=117.67,p=0.000]

(Figure 2 below).

Figure 2. FamEd-Q responses to communication mode preferences at home and EI.

There was a significant difference in the frequency of individual EI sessions provided by EI centres A and C

[F(2,319)=4.9, p=0.008). Centre A which utilised a speech and sign approach provided more frequent individual EI

sessions compared to EI Centre C which emphasised on oral communication. On average, Centre C provided EI

sessions once a fortnight and Centre A provided more than one EI session a fortnight. No significant relationships

between EI centres and language outcomes were found, however.

Communication Mode and Language Outcomes

Figure 3. EI communication mode and language standard

scores.

T-tests revealed significant differences in the language

outcomes for children who used an oral communication

approach versus a sign and speech approach at their

EI centre (93 FamEd-Q responses). The mean

language standard score for children using an oral

mode of communication at the EI centre was 81

compared to 68.5 for children using a speech and sign

mode of communication (t=-2.88, p<0.05)

(Figure 3 right). Regression analyses showed that an

oral communication mode used at the EI centre was a

significant predictor of higher language scores (r=2.18,

p<0.05).

Analyses also showed that children from families in the

top 20th percentile for socio-economic advantage

demonstrated significantly higher language scores than

children from families in the lower 40th percentile of

socio-economic advantage [F(4,184)=4.01, p <0.05].

EI Service Delivery and Communication Mode Preferences

Communication Mode

6%

94% 74%

26%

59%