Video analysis of mother-child interactions: The role of experienced clinicians in post cochlear implantation habilitation

Dawn Choo1 and Shani Dettman1,2,3

1 The University of Melbourne, Department of Audiology & Speech Pathology, 2 The HEARing Cooperative Research Centre, 3 Royal Victorian Eye & Ear Hospital

Background In post-implant habilitation, clinicians guide parents in facilitating their child’s

speech and language developmental growth1. Parent and child interactions

provide opportunities for early language learning and the focus on parenting

behaviours has been highlighted by recent literature as an essential intervention

target 2. In habilitation sessions, mother and child play interactions are video

recorded by clinicians who would provide feedback and coach parents in using

appropriate communicative strategies according to the family’s choice of

communication mode.

Experienced clinicians in paediatric aural habilitation settings possess a wide

range of expertise and knowledge, yet different and specific skill sets are required

when working with families in either signing or auditory-oral only communication

approaches3. It is important that clinicians are familiar with defining techniques for

enhancing auditory-based learning and spoken language in very young children

with cochlear implants.

Previous studies have found that the quality of intervention services, family

participation and socio-economic advantage influence speech and language

outcomes for children with cochlear implants2,4

.There are, however, few studies

documenting the reliability of clinical observations as well as mother and child

characteristics identified through video recorded play interactions for habilitation

purposes.

Aims 1. To explore inter-rater reliability differences in observations made by

experienced clinicians and inexperienced individuals when viewing mother- child

play samples.

2. To determine if experienced clinicians and inexperienced individuals are able to

identify the communication approach used by mothers in the play interactions.

3. To analyse the recorded interactions for child behaviour traits and specific

maternal strategies which correlate with greater language rate of growth at one to

four years post-implant.

Materials and Methods Subjects Demographic information and language scores were collected for twelve children

who received their first multichannel CochlearTM implant before 2.1 years of age

(mean= 1.27, range= 0.84-2.08, SD= 0.56). They were diagnosed with bilateral

several to profound sensorineural hearing loss by 1.6 years of age, did not have

developmental or medical disabilities, English was the predominant language

used at home and they were also recorded in play with their mothers at their one

year post-implant assessment point. All the children were enrolled in early

intervention centres providing either an auditory-oral only approach (n=7) or a

sign and oral communication approach (n=5).

Measures Family Involvement: Moeller’s (2000) Family Participation Rating Scale

5.

Socioeconomic advantage: Socio-Economic Indexes for Areas (2006).

Rates of Language Growth: The Rossetti Infant Toddler Language Scale and

The Peabody Picture Vocabulary Test were administered at 1 and 4 years post-

implant intervals. A language growth slope was plotted for each child using their

respective assessment and age-equivalent scores.

Mother and Child Interaction Characteristics: Mother and Child Interaction

Analysis (MACIA) Rating Form. The MACIA Rating Form which was developed

for this study contains 4 specific items pertaining to the child’s behaviour, 8 items

relating to maternal behaviour and 4 items describing the mother’s use of

linguistic strategies.

Rating Procedure Raters (n=23) were recruited and categorised either as an experienced clinician

(n=5) or inexperienced (naïve) rater (n=18). An experienced clinician was defined

as having worked with paediatric cochlear implant users for more than 5 years.

All the raters watched and rated 13 five minute mother-child interaction play

samples (one repeated clip was included for intra-rater reliability) using the

MACIA rating form.

Conclusion The current study offers preliminary insights into the role that experience plays in

making reliable and accurate clinical observations when coaching mothers using

different communication approaches. Specialised training would be valuable for

clinicians working in paediatric aural habilitation settings. Furthermore, identifying key

maternal strategies and child behaviours observed in play interactions would facilitate

better language outcomes in children with cochlear implants.

Acknowledgements to all the families and staff at the Royal Victorian Eye and Ear Hospital, Cochlear

Implant Clinic who were involved in this study. The authors would also like to thank the staff and

former students at The University of Melbourne who participated in the study as raters.

dawn.choo@unimelb.edu.au

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Met intra-rater reliability criteria (K>0.4)Did not meet intra-rater reliability criteria (K<0.4)

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33.3%

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Results 1. Intra-rater reliability for all 23 raters was

assessed using Cohen’s Kappa.

A higher proportion of experienced

clinicians (60%) as compared to

inexperienced raters (33.3%) met the

intra-rater reliability requirement (Figure 1).

Raters (n=14) who did not meet the intra-

rater reliability criteria were excluded from

further analyses.

2. The accuracy of included raters (n=9)

was measured based on responses to a

communication mode identification item

on the MACIA. Experienced clinicians

(n=3) were able to identify the

communication mode used by mothers

with an accuracy of 77.7% as compared to

inexperienced raters (n=6) who obtained a

combined percentage accuracy of 68.1%.

This difference was not significant (Figure

2).

This result might be attributed to the size

of the sample. It was also observed that

all raters had difficulty identifying when

mothers were using a sign and oral

approach as maternal signs were used

infrequently in the play interactions.

3. Fleiss’ Multi-rater Kappa was used to

evaluate inter-rater agreement on mother

and child characteristics observed. The

most reliable raters (n=9) rated 4 items on

the MACIA consistently, and these 4 items

were significantly correlated to the child

participant’s receptive language growth

slopes on the RI-TLS Comprehension

subtest and the PPVT (Figure 3).

Figure 1. Proportion of observers who rated items

reliably (K<0.4) on the MACIA while viewing the

mother-child play samples.

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InexperiencedRaters

Incorrect Responses Correct ResponsesNu

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68.1% Accuracy

77.7% Accuracy

Figure 2. Number of correct and incorrect responses

on the Communication Mode Identification MACIA

item by included raters watching mother-child play

interactions.

Characteristics observed in the play interactions which were significantly correlated to

child receptive language outcomes included:

• Child’s capacity for emotional self-regulation (r=0.323, p=0.01)

• Mother’s ability to maintain her child’s interest (r=0.423, p=0.063)

• Use of maternal stress and pitch (r=0.213, p=0.036)

• Frequency of conflict exchanges between mother and child (r=-0.38, p=0.00)

References

1 Barker, E. J., Dettman, S. J., & Dowell, R. C. (1997). Habilitation: Infants and young children. In G. Clark, R. S. C. Cowan, & R. C. Dowell (Eds.), Cochlear implantation for infants and

children (Chapter 10, pp. 171- 188). San Diego: Singular Publishing Group, Inc.

2 Quittner, A.L., Cruz, L., Barker, D. H., Tobey, L.S., Eisenberg, L. S., & Niparko, J. L. (2013). Effects of maternal sensitivity and cognitive and linguistic stimulation on cochlear implant

users language development over four years. Journal of Pediatrics, 162(2), 343-348.

3 Comptom, M. V., Tucker, D., A., & Flynn, P. F. (2009). Preparation and perceptions of speech-language pathologists working with children with cochlear implants. Communication

Disorders Quarterly, 30(3),142-154.

4 Yoshinaga-Itano, C. (2004). Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). Journal of Communication

Disorders, 37, 451-465.

5 Moeller, M.P. (2000). Early intervention and language development in children who are deaf and hard of hearing. Pediatrics,106(3),1-9.

Figure 3. Mean ratings given on 4 MACIA items which were significantly correlated to rate of language

growth slopes derived from the children’s assessment scores at 1 to 4 years post implant.

Frequency of ConflictMother's Voice (Stress & Pitch)Maintaining InterestChild's Emotional Regulation

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Key Mother and Child Characteristics Observed in the Play Interactions