Language Outcomes In Children Research Articles

Associations of Specific Indicators of Adult–Child Interaction Quality and Child Language Outcomes: What Teaching Practices Influence Language?

ABSTRACT Research Findings: This study aims to extend our knowledge regarding contributions of educator–child interactions to child language outcomes by examining the extent to which specific dimensions of the CLASS observational tool of educator–child interactions are associated with child language abilities, utilizing data from an Australian longitudinal study of over 2,000 children attending formal Early Childhood Education and Care (ECEC). The analysis included a novel measurement model fitted to the data to allow each CLASS dimension to be modeled separately. Results showed that each CLASS dimension was associated with initial average language abilities. Small, negative effects of Emotional Support dimensions on growth of children’s average Understanding Directions score were found, but there were no associations between any of the dimensions and average growth in Verbal Ability. None of the Instructional Support dimensions (which are language focused) predicted growth in language abilities. These null findings are addressed in the discussion. Practice or Policy: Findings from this study illustrate that, typically, ECEC programs rate low on dimensions of quality developed to capture language-promoting educator–child interactions. Findings also suggest a selection effect related to equity of access to classroom quality with children with the highest initial language abilities in the highest quality classrooms.

313 Microstructural changes in the brainstem regions of the auditory pathway among children with hearing loss

OBJECTIVES/GOALS: Diffusion MRI can identify microstructural brain changes and can provide insight into neural development and to potentially prognosticate speech and language outcomes in children with SNHL. The goal of our study was to investigate MRI-based microstructural changes along the brainstem regions of the auditory pathway in pediatric patients with SNHL. METHODS/STUDY POPULATION: We reviewed cohort of pediatric patients with SNHL who obtained MRI at 3T between 2011 and 2019. We identified 16 pediatric patients (age RESULTS/ANTICIPATED RESULTS: We identified significant differences in FA values of the SON between the SNHL cohort and controls (0.377 ± 0.056 vs 0.422 ± 0.052; p=0.009). No other FA or MD values were significantly different between the two groups. Among younger children (ï‚£5 years), MD was significantly decreased in the SNHL cohort compared to controls in the IC (0.918 ± 0.051 vs 1.120 ± 0.142; p5 years), there were no significant differences in MD (1.124 ± 0.198 vs 0.997 ± 0.103; p = 0.119). There were no significant differences in MD or FA in the white matter fibers of the IC-SON tract. DISCUSSION/SIGNIFICANCE: This study is the first to assess microstructural changes in brainstem auditory pathway regions among children with SNHL. Longitudinal studies are warranted to assess the predictive value of these MRI-based findings for long-term outcomes and the efficacy of intervention.

Parent coaching from 6 to 18 months improves child language outcomes through 30 months of age.

Interventions focused on the home language environment have been shown to improve a number of child language outcomes in the first years of life. However, data on the longer-term effects of the intervention are still somewhat limited. The current study examines child vocabulary and complex speech outcomes (N=59) during the year following completion of a parent-coaching intervention, which was previously found to increase the quantity of parent-child conversational turns and to improve child language outcomes through 18 months of age. Measures of parental language input, child speech output, and parent-child conversational turn-taking were manually coded from naturalistic home recordings (Language Environment Analysis System, LENA) at regular 4-month intervals when children were 6- to 24-months old. Child language skills were assessed using the MacArthur-Bates Communicative Development Inventory (CDI) at four time-points following the final intervention session (at 18, 24, 27, and 30 months). Vocabulary size and growth from 18 to 30 months was greater in the intervention group, even after accounting for differences in child language ability during the intervention period. The intervention group also scored higher on measures of speech length and grammatical complexity, and these effects were mediated by 18-month vocabulary. Intervention was associated with increased parent-child conversational turn-taking in home recordings at 14 months, and mediation analysis suggested that 14-month conversational turn-taking accounted for intervention-related differences in subsequent vocabulary. Together, the results suggest enduring, positive effects of parental language intervention and underscore the importance of interactive, conversational language experience during the first 2 years of life. RESEARCH HIGHLIGHTS: Parent coaching was provided as part of a home language intervention when children were 6-18 months of age. Naturalistic home language recordings showed increased parent-child conversational turn-taking in the intervention group at 14 months of age. Measures of productive vocabulary and complex speech indicated more advanced expressive language skills in the intervention group through 30 months of age, a full year after the final intervention session. Conversational turn-taking at 14 months predicted subsequent child vocabulary and accounted for differences in vocabulary size across the intervention and control groups.

Quantifying Access to Speech in Children with Hearing Loss: The Influence of the Work of Pat Stelmachowicz on Measures of Audibility.

This article reviews the research of Pat Stelmachowicz on traditional and novel measures for quantifying speech audibility (i.e., pure-tone average [PTA], the articulation/audibility index [AI], the speech intelligibility index, and auditory dosage) as predictors of speech perception and language outcomes in children. We discuss the limitations of using audiometric PTA as a predictor of perceptual outcomes in children and how Pat's research shed light on the importance of measures that characterize high-frequency audibility. We also discuss the AI, Pat's work on the calculation of the AI as a hearing aid outcome measure, and how this work led to the application of the speech intelligibility index as a clinically utilized measure of unaided and aided audibility. Finally, we describe a novel measure of audibility-auditory dosage-that was developed based on Pat's work on audibility and hearing aid use for children who are hard of hearing.

Associations between responsive parental behaviours in infancy and toddlerhood, and language outcomes at age 7 years in a population-based sample.

A wealth of evidence supports the important role high-quality parent-child interactions play in children's early language acquisition. However, the impact on later language outcomes remains unclear. To examine the associations between responsive parental behaviours across the early years and child language outcomes at age 7 years with families from an Australian longitudinal cohort study (N = 1148, 50% female). At child ages 12, 24 and 36 months, parents completed a self-report measure of responsive parental behaviours. Child language was directly assessed at age 7 using the Clinical Evaluation of Language Fundamentals, 4th edition (CELF-4), Australian Standardisation. Linear regression was used to examine associations between responsive parental behaviours from 12 to 36 months (consistently high, inconsistent and consistently low responsive parental behaviours at the three time points) and language scores at age 7 years. Adjusted models were run, including the following potential confounders: child sex; birth weight; birth order; maternal education; socio-economic disadvantage; non-English-speaking background; family history of speech-language problems; mother's vocabulary score; maternal mental health score; and mother's age at birth of child. A final adjusted model was run, including the potential confounder variables as well as adjusting for children's earlier language skills. Linear regression results showed children with parents who rated high on responsive parental behaviours at all three time points had higher mean language scores at age 7 than children whose parents reported low responsive parental behaviours across early childhood. This association attenuated after adjusting for earlier child language skills. Findings support the consistent use of responsive parental behaviours across the very early years of childhood to support long-term language outcomes. Findings also suggest that models of surveillance and support which monitor and assist families at multiple time-points over the early years are likely to be most effective for preventing ongoing language difficulties. What is already known on this subject There is extensive evidence consistently demonstrating the important contribution of aspects of parent-child interaction, specifically responsive parental behaviours, to children's language development. What this paper adds to the existing knowledge Understanding the cumulative benefit of responsive parent-child interactions across the very early years may help to inform preventive interventions and service delivery models for supporting young children's language development. This study demonstrates in a large, population-based cohort the contribution of consistency of responsive parental behaviours during infancy and toddlerhood to school-age language outcomes, accounting for other child, family and environmental factors. Capturing regular parent behaviours via self-report during the early years may be a more efficient and less costly method than parent-child interaction observations to monitor the home language-learning environment during routine developmental checks. What are the potential or actual clinical implications of this work? Findings support the need for surveillance of children and families in the early years, ensuring that intervention occurs when families need it most, that is, support is responsive to changing needs and that nuanced advice and support strategies are provided to activate positive developmental cascades. Capturing both parent behaviours and child language may assist clinicians to identify those families who may benefit from parent-child interaction intervention.

Symbolic and deictic gestures as a tool to promote parent-child communication in the context of hearing loss: A systematic review.

Language and communication outcomes in children with congenital sensorineural hearing loss (cSNHL) are highly variable, and some of this variance can be attributed to the quantity and quality of language input. In this paper, we build from the evidence that human language is inherently multimodal and positive scaffolding of children's linguistic, cognitive, and social-relational development can be supported by Parent Centered Early Interventions (PCEI), to suggest that the use of gestures in these interventions could be a beneficial approach, yet scarcely explored. This systematic review aimed to examine the literature on PCEI focused on gestures (symbolic and deictic) used to enhance the caregiver-child relationship and infant's language development, in both typically and atypically developing populations. The systematic review was conducted following the PRISMA guidelines for systematic reviews and meta-analyses. From 246 identified studies, 8 met PICO inclusion criteria and were eligible for inclusion. Two reviewers screened papers before completing data extraction and risk of bias assessment using the RoB2 Cochrane scale. Included studies measured the effect of implementing symbolic or deictic gestures in daily communication on the relational aspects of mother/parent-child interaction or on language skills in infants. The studies indicate that gesture-oriented PCEI may benefit deprived populations such as atypically developing children, children from low-income families, and children who, for individual reasons, lag behind their peers in communication. Although gesture-oriented PCEI appear to be beneficial in the early intervention for atypically developing populations, this approach has been so far scarcely explored directly in the context of hearing loss. Yet, symbolic gestures being a natural part of early vocabulary acquisition that emerges spontaneously regardless of hearing status, this approach could represent a promising line of intervention in infants with cSNHL, especially those with a worse head start.

Ten years' experience with bone conduction hearing aids in the Western Cape, South Africa.

Untreated conductive and mixed hearing losses as a result of middle ear pathology or congenital ear malformations can lead to poor speech, language and academic outcomes in children. Lack of access to centralised hearing healthcare in resource-constrained environments limits opportunities for children with hearing loss. Red Cross War Memorial Children's Hospital (RCWMCH) is one of only two dedicated paediatric hospitals in sub-Saharan Africa. Between 2016 and 2021, 29 children received implanted bone conduction hearing devices, and 104 children were fitted with bone conduction devices on softbands. The authors' experience at RCWMCH suggests that bone-anchored hearing devices, either fitted on softbands or on implanted abutments, can provide solutions in settings where patients have limited access to hearing healthcare and optimal classroom environments. Hearing healthcare should be accessible and delivered at the appropriate level of care to mitigate the adverse effects of hearing loss in children.Contribution:This article describes strategies employed at RCWMCH such as fitting bone conduction hearing devices on a softband immediately after hearing loss diagnosis and conducting follow-up via remote technology to make hearing healthcare more accessible to vulnerable populations.

Impact of Sociodemographic Disparities on Language Outcomes After Cochlear Implantation in a Diverse Pediatric Cohort.

We examined how sociodemographic and audiologic factors affect receptive and expressive language outcomes in children with cochlear implantation. Retrospective cohort study. A hearing loss (HL) clinic at a tertiary center. Sociodemographic variables, HLcharacteristics, age at implantation, and receptive language scores (Preschool Language Scale and the Clinical Evaluation of Language Fundamentals) were collected from patients with congenital HL who received their first implant by 4 years old after January 1, 2007. tTests, linear regression, Mann-Whitney, Cohen's d, and mediation analysis were used for descriptive statistics and hypothesis testing. Among 79 patients, 42 (53%) were females, 44 (56%) under-represented minorities, and 56 (71%) had public insurance. At least 1 year after implantation, the median receptive language score was 69 (range 50-117). Females (p = .005), having private insurance (p = .00001), having a Cochlear Implant Profile score below 4 (p = .0001), and receiving their implant at or before 12 months of age (p = .0009) were significantly associated with improved receptive language outcomes. Insurance type had a significant effect on receptive language outcomes, independent from age at first implantation (total effect: coef = -13.00, p = .02; direct effect: coef = -12.26, p = .03; indirect effect: coef = -0.75, p = .47). Sociodemographic variables had large effect sizes, with the Cochlear Implant Profile score having the largest effect size (d = 1.3). Sociodemographic factors have a large impact on receptive language outcomes. Public insurance is associated with worse receptive language, not mediated by later age at implantation, suggesting that other factors primarily impact language outcomes in publicly insured children with cochlear implants.

Spanish-speaking caregivers' use of referential labels with toddlers is a better predictor of later vocabulary than their use of referential gestures.

Variation in how frequently caregivers engage with their children is associated with variation in children's later language outcomes. One explanation for this link is that caregivers use both verbal behaviors, such as labels, and non-verbal behaviors, such as gestures, to help children establish reference to objects or events in the world. However, few studies have directly explored whether language outcomes are more strongly associated with referential behaviors that are expressed verbally, such as labels, or non-verbally, such as gestures, or whether both are equally predictive. Here, we observed caregivers from 42 Spanish-speaking families in the US engage with their 18-month-old children during 5-min lab-based, play sessions. Children's language processing speed and vocabulary size were assessed when children were 25 months. Bayesian model comparisons assessed the extent to which the frequencies of caregivers' referential labels, referential gestures, or labels and gestures together, were more strongly associated with children's language outcomes than a model with caregiver total words, or overall talkativeness. The best-fitting models showed that children who heard more referential labels at 18 months were faster in language processing and had larger vocabularies at 25 months. Models including gestures, or labels and gestures together, showed weaker fits to the data. Caregivers' total words predicted children's language processing speed, but predicted vocabulary size less well. These results suggest that the frequency with which caregivers of 18-month-old children use referential labels, more so than referential gestures, is a critical feature of caregiver verbal engagement that contributes to language processing development and vocabulary growth. RESEARCH HIGHLIGHTS: We examined the frequency of referential communicative behaviors, via labels and/or gestures, produced by caregivers during a 5-min play interaction with their 18-month-old children. We assessed predictive relations between labels, gestures, their combination, as well as total words spoken, and children's processing speed and vocabulary growth at 25 months. Bayesian model comparisons showed that caregivers' referential labels at 18 months best predicted both 25-month vocabulary measures, although total words also predicted later processing speed. Frequent use of referential labels by caregivers, more so than referential gestures, is a critical feature of communicative behavior that supports children's later vocabulary learning.

Language and academic outcomes of children with cochlear implants in an inclusive setting: Evidence from 18 years of data

Objective This study examined outcomes in core and pragmatic language, receptive vocabulary, and academic skills in children with cochlear implants (CIs) enrolled in an inclusive educational setting. Methods Eighty-eight children with CIs were included in the analyses. Data was collected over an 18-year period, at six-month intervals for core language, vocabulary, and pragmatic skills and in kindergarten and second grade for academic skills. Kaplan-Meier analyses were used to estimate the median time to achieve age-appropriate scores. Results Results indicated the median time to obtain age-appropriate skills for children with CIs enrolled in our program was less than three years for core language and pragmatic skills and less than two years for vocabulary. Over 90% of the sample had academic skills in the average range in both kindergarten and second grade. Discussion This study shares outcomes of children with CIs who received consistent and intensive transdisciplinary intervention in an inclusive educational setting, revealing the trajectory required to obtain age-appropriate skills, when compared to normative data. Conclusion Results were favorable, indicating that children with CIs in an inclusive program, with intensive intervention and strong language and social models, can develop skills commensurate with typically developing peers across a variety of core skills.

Speech and Language outcomes in Auditory Neuropathy Spectrum Disorder (ANSD) children managed with amplification

ObjectiveTo evaluate speech and language outcomes in children with Auditory Neuropathy Spectrum Disorder (ANSD) without significant comorbidities who received hearing rehabilitation in the form of hearing aids and/or cochlear implantation. MethodsRetrospective chart review of pediatric ANSD patients at a large academic tertiary care institution from 2010 to 2019. Patients were included if they received a diagnosis of bilateral ANSD, had minimal to no comorbidities, and had speech and language testing (SLT) on at least two occasions. Results51 patients were reviewed and 7 met inclusion criteria. Average age at ANSD diagnosis was 1 year and 11 months, and average age of hearing aid fitting was 3 years and 3 months. Hearing loss ranged from mild to profound, with four of the children wearing behind (BTE) hearing aids and three eventually receiving cochlear implants. Four of five patients who received hearing aids prior to their first speech and language evaluation demonstrated a delay at their initial evaluation, and all five patients continued to demonstrate a delay at their most recent evaluation, despite appropriate audiologic management and speech and language therapy. There were two patients who were unaided at the time of their initial and latest evaluations; one patient showed a delay at both timepoints, and one patient showed no speech delay at either timepoint. ConclusionsPediatric ANSD patients, who are otherwise typically developing and received hearing rehabilitation and speech and language therapy, continue to show a speech and language delay (SLD). This outcome underscores the importance of close monitoring of speech and language development, providing early amplification and/or cochlear implantation, and promoting additional education and psychosocial support.

How English-Medium Instruction affects language and learning outcomes of children in the Maldives

Abstract Whilst the vast majority of the Maldivian population speak Dhivehi at home, English typically serves as the only medium of instruction (MoI) starting from primary school. Teachers have expressed their concerns regarding educational quality, as many children are taught in a language they do not master sufficiently. The present study aimed to investigate the level of second language (L2) proficiency in relation to reading abilities and mathematical skills in 25 ten- to twelve-year-old children living in the Maldives. The results showed relatively low performance on all tasks, despite normal nonverbal intelligence. Moreover, we found a significant relation between English vocabulary knowledge and reading accuracy. Our findings contribute to a growing body of research suggesting that using an L2 as the only MoI may be detrimental to literacy development and learning outcomes. Considering the objectives of educational quality, language maintenance of Dhivehi and the pragmatic value assigned to English, we argue in favour of a bilingual model of education, in which the importance of native language development is emphasized.

Associations Between Caregiver Stress and Language Outcomes in Infants With Autistic and Non-Autistic Siblings: An Exploratory Study.

Caregivers of autistic children present with high stress levels, which have been associated with poorer child outcomes in several domains, including language development. However, prior to this study, it was unknown whether elevated caregiver stress was associated with language development in infant siblings of autistic children (Sibs-autism), who are at increased likelihood of receiving a future diagnosis of autism and/or language impairment compared to infant siblings of non-autistic children. This study explored the degree to which, as well as the mechanisms by which, caregiver stress was linked with later language outcomes of Sibs-autism and infant siblings of non-autistic children (Sibs-NA). Participants were 50 infants (28 Sibs-autism; 22 Sibs-NA) aged 12-18 months at the first time point in this study (Time 1). Infants were seen again 9 months later, at 21-27 months of age (Time 2). Caregiver stress was measured via a validated self-report measure at Time 1. Caregiver language input, the putative mechanism by which caregiver stress may influence later language outcomes, was collected via two daylong recordings from digital recording (Language ENvironment Analysis) devices worn by the child at this same time point. Child language outcomes were measured via standardized and caregiver report measures at Time 2. Several models testing hypothesized indirect effects of caregiver stress on later child language outcomes through caregiver language input were statistically significant. Specifically, significant indirect effects suggest that (a) caregivers with increased stress tend to speak less to their infants, and (b) this reduced language input tends to covary with reduced child language outcomes later in life for Sibs-autism and Sibs-NA. This study provides new insights into links between caregiver stress, caregiver language input, and language outcomes in Sibs-autism and Sibs-NA. Further work is necessary to understand how to best support caregivers and optimize the language learning environments for infants. https://doi.org/10.23641/asha.21714368.

Predictors in language proficiency of young children with presumed developmental language disorder within the setting of early language intervention

IntroductionIn the Netherlands, early language intervention is offered to children with presumed Developmental Language Disorder (DLD). The intervention is a combination of group language intervention, individual speech and language therapy and parent-implemented language intervention. During the intervention, some children show more language progress than others. It is unclear what might explain this variation. In this study, we therefore explored to what extent child, parental, and treatment factors were predictive for receptive and expressive language outcomes of young children with presumed DLD during early language intervention.MethodsFour multiple regression analyses were conducted with four child factors [pre-test receptive syntax, behavior (internalizing and externalizing), non-verbal cognitive ability and gender], one parental factor (parental stress) and one treatment factor (treatment duration) as predictors and receptive and expressive language post-test scores as outcomes. For each language post-test, the corresponding pre-test language measure was also added. Data of 183 children with presumed DLD were included.ResultsReceptive syntax problems were an important predictor of expressive language outcomes. Findings also showed a longer treatment duration to be a predictor of progress in expressive vocabulary. Internalizing behavior, externalizing behavior, non-verbal cognitive ability, gender and parental stress did not contribute to predicting language outcomes. Lower pre-intervention language scores led to lower corresponding post-intervention language scores.ConclusionsProfessionals may need to be aware that children with receptive problems may be indicative of more pervasive impairment and that it can be more difficult to improve their language problems. In fact, children with receptive language problems may need both more and different approaches. The finding that the level of the pre-intervention score has an essential influence on language outcomes underlines the importance of early diagnosis and early intervention, to prevent language problems increasing.

Contingent conversations build more than language: How communicative interactions in toddlerhood relate to preschool executive function skills.

High-quality communicative interactions between caregivers and children provide a foundation for children's social and cognitive skills. Although most studies examining these types of interactions focus on child language outcomes, this paper takes another tack. It examines whether communicative, dyadic interactions might also relate to child executive function (EF) skills and whether child language might mediate this relation. Using a subset of data from the NICHD Study of Early Child Care and Youth Development, dyadic interactions between 2-year-olds and their mothers were coded for three behaviors: symbol-infused joint engagement, routines and rituals, and fluency and connectedness. Child language was assessed at age 3 and three facets of EF (self-regulation, sustained attention, and verbal working memory) were assessed at age 4.5. Structural equation modeling showed that dyadic interaction related to later child sustained attention and verbal working memory, indirectly through child language and directly related with child self-regulation. This suggests that communicative interactions with caregivers that include both verbal and non-verbal elements relate to child EF, in part through child language. Our findings have implications for the role of caregiver interactions in the development of language and cognitive skills more broadly. RESEARCH HIGHLIGHTS: Using structural equation modeling, we examined how communicative interactions between caregivers and toddlers relate to preschool executive function skills Communicative interactions relate to later language which in turn relates to sustained attention and verbal working memory in preschool Communicative interactions relate directly to self-regulation in preschool Associations between communicative interactions, language, and executive function vary across facets of executive function and may not be unidirectional.

Hearing, Speech and Language Outcomes in Children with Cochlear Implants: a Comparison between ADIP Scheme and Self-Financed Scheme

Disability, CBR and Inclusive Development aims to enhance knowledge in the field of disability and inclusive development, addressing the needs of practitioners, policy makers, DPOs and the scientific community.

Pathways between family SES, parent characteristics, early experiences, and child language outcomes in South Korea: A combined analysis of the family stress model and the family investment model.

Whereas previous research has examined the role that parenting and home environments play in explaining the relation between family socioeconomic status and children's language development in the United States, relatively little is known about the associations between these constructs in other cultures. This study tested an integrated model of language development within a longitudinal data set of 1,894 socioeconomically diverse Korean children (48.35% girls; > 99% native-born Korean citizens) from the first year of life (age 3-8 months) to ages 3 and 6 years. A model integrating parent and environmental characteristics from the family stress model and the family investment model that also included maternal self-efficacy and knowledge of child development was shown to adequately explain the associations between family socioeconomic status and children's language development. Implications for applying similar integrated models in international contexts are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Joint attention episodes during interactions with fathers but not mothers at age 2 years is associated with expressive language at 3 years

Joint Attention (JA) in parent–infant interaction has been demonstrated to contribute to infants’ language outcomes. A limited number of studies have investigated the characteristics of JA episodes during parent–toddler interaction in relation to toddlers’ language development. The majority of these studies were conducted with mothers, whereas JA with fathers remains understudied. The current study investigated JA episodes during interactions with mothers and fathers separately as well as longitudinal associations with child language outcomes. A total of 31 toddlers (18 girls) and their mothers and fathers participated in the study at ages 2 years (M = 24.07 months, SD = 1.45) and 3 years (M = 37.44 months, SD = 1.72). JA episodes were observed during free play interactions at age 2 and were coded microanalytically; receptive and expressive language skills were assessed by Bayley Scales of Infant and Toddler Development–Third Edition at ages 2 and 3. No significant differences in JA episodes were found between mother–toddler and father–toddler dyads. Whereas JA characteristics with mothers were not found to be significantly associated with toddlers’ language outcomes, multiple linear regression analyses showed that paternal education and parent-followed JA episodes during father–toddler interaction at age 2 explained a significant amount of variance in toddlers’ expressive language skills at age 3. Findings suggest that JA episodes during interactions with fathers might benefit toddlers’ expressive language development.

Children with cochlear implant and additional disabilities benefit from consistent device use.

Although the prevalence of additional disabilities (AD) in children with a cochlear implant (CI) is high, children with such disabilities are often excluded from clinical studies, or their specific characteristics are only partially included. The literature shows that several factors need to be considered in evaluating auditory and language development in CI children with AD, including demographic variables as well as the severity and type of disability. Current findings on device use in children show correlations with auditory and language outcome, but little is known about device use specifically in children with AD. The purpose of this study was to determine the auditory and language outcome of CI children with AD and to analyse their datalogging-based daily device use, both 1 year and 2 years after implantation. In addition, any potential correlations between outcome and device use were to be identified. A cohort of 32 CI children with 5 different types of AD were included in this retrospective analysis. The children's auditory and language outcome was assessed by the parental questionnaires LittlEARS and ELFRA and by the professional observation tool CAP (Categories of Auditory Performance) 1 and 2 years after implantation. Longitudinal device use was analysed by using the CI system-integrated data-logging; daily duration of CI use, number of coil disconnections and exposure to different listening scenes were recorded. Overall, the cohort's auditory and language performance showed significant progress over time, while reduced abilities became more obvious after 2 years of CI experience. The mean daily duration of CI use increased significantly from 7.8±2.8 to 8.2±2.7h after 2 years. High numbers of daily coil disconnections were detected, with a significant mean decrease from 83.4±73.1 to 66.3±54.6 whereas the percentage exposure to different listening environments was widely stable over time. Significant rank correlations were identified between outcomes measured by ELFRA and CAP with daily duration of CI use, numbers of coil disconnections and percentage of exposure to speech-characterised listening scenes. The auditory and language outcome in CI children with AD is variable, but it progresses over time. Children benefit from a consistent daily device use as well as from a high exposure to speech-characterised environments. Device use should be monitored constantly, with particular focus on daily duration of CI use and, in particular, on the number of coil disconnections if children have a severe motor impairment. Objective data-logging is an important addition to outcome assessment by testing, observations and parental questionnaires. Although assessment in children with AD is a major challenge for professionals, comprehensive assessment is needed to improve cochlear implant services with special adaption to children with AD, and this should include audiological, development-related and psychosocial information. A unified system to classify types of disabilities could help to improve procedures for analysing different outcomes.

Family and Caregiver Characteristics Contribute to Caregiver Change in Use of Strategies and Growth in Child Spoken Language in a Parent-Implemented Language Intervention in Fragile X Syndrome.

This study examined relationships among family characteristics, caregiver change in use of strategies, and child growth in spoken language over the course of a parent-implemented language intervention (PILI) that was developed to address some of the challenges associated with the fragile X syndrome (FXS) phenotype. Participants were 43 parent-child dyads from two different PILI studies, both of which taught parents various language facilitation strategies to support child language. Before starting the intervention, parents reported on their mental health, parenting stress, and parenting competence. This study focused on potential barriers to treatment gains by examining correlations between the measures of parent well-being and (a) parent change in use of intervention strategies taught in the PILI and (b) changes in child language outcomes from preto post-intervention. Parents in this study had elevated mental health symptoms across several domains and increased rates of parenting stress. Furthermore, although PILI resulted in treatment gains for both parents and children, a variety of parent mental health symptoms were found to be significantly and negatively associated with change in use of strategies and growth in child language over the course of the intervention. Some inconsistent findings also emerged regarding the relationships between parenting stress and competence and change in parent strategy use and growth in child language. This study provides preliminary evidence that parents who are experiencing significant mental health challenges may have a more difficult time participating fully in PILIs and that there may be subsequent effects on child outcomes. Future PILIs could benefit from addressing parent well-being as a substantial part of the intervention program.