Language Outcomes In Children Research Articles

How Audiologists Can Support EHDI Goals

How Audiologists Can Support EHDI Goals

Structural and pragmatic language in young children with sex chromosome trisomy (XXX, XXY, XYY): Predictive value for neurobehavioral problems one year later

Objective: To investigate pragmatic language abilities in young children with an increased risk for adverse neurobehavioral and neurocognitive outcomes due to an extra X or Y chromosome (sex chromosome trisomy; SCT) and to investigate to what degree early structural and pragmatic language abilities are predictive of neurobehavioral problems one year later. Method: In total, 72 children with SCT and 71 controls aged 3-7 years were included. Language assessments included parent-reported pragmatic language skills and direct assessment of structural language abilities. Parent-reported behavioral outcomes were measured one year after the initial language assessment. Results: Children with SCT demonstrated weaker pragmatic language skills compared to controls. These differences were not driven by karyotype, time of diagnosis, or ascertainment bias and irrespective of the presence of structural language impairment. Odds of having pragmatic difficulties was 23 times higher in the SCT group, with 25% of the children not meeting age-expectations. In addition, language, in particular pragmatic language, was an important predictor for later affective, oppositional defiant, pervasive developmental, attention deficit, and social-emotional problems in young children with SCT. Conclusions: This study is one of the first studies that directly illustrates the relationship between language and behavioral outcomes in children with SCT. Our results stress the importance to closely monitor pragmatic language in addition to structural language in clinical care of children with SCT, as pragmatic language abilities could serve as an early marker for children at risk for developing behavioral problems.

Associations between Early Childhood Education and Care (ECEC) attendance, adversity and language outcomes of 2-year-olds

Research evidence suggests children experiencing adversity are at risk of language disparities in early childhood. This puts these children at risk of poor language outcomes, perpetuating disadvantage in later development and academic life. This study aimed to investigate associations between Early Childhood Education and Care (ECEC) attendance, hours of attendance and quality in a cohort of 2-year-old children experiencing adversity with their language outcomes at age five. Pregnant women experiencing adversity, based on women meeting two or more of 10 factors on a brief risk factor survey, were recruited from maternity hospitals in Victoria and Tasmania, Australia. At age 2 years, ECEC data was collected via survey, including ECEC attendance, amount of time spent and ECEC quality (using the Australian government’s national measure of quality, the National Quality Standard assessment) ( n = 161). At age 5 years, child language outcomes were measured using a standardised language assessment. This data was analysed using logistic regressions and the non-parametric Kruskal–Wallis test to identify associations. After adjusting for potential confounders, we found language scores at age five were higher, on average, for children who attended ECEC at age two compared to those who did not attend. However, hours of attendance and ECEC quality, was not found to be associated with language outcomes. Findings suggest ECEC attendance in the early developmental years (birth to age 3 years) may be a protective factor against social disadvantage factors and contribute to positive language development for children experiencing adversity. This information is important for the ECEC sector, policymakers and families to advocate, enable and ensure high-quality ECEC is accessible, particularly for children experiencing adversity.

A Module-Based Telepractice Intervention for Parents of Children with Developmental Disabilities.

In the current study, we describe a study of the Internet-based Parent-implemented Communication Strategies-Storybook (i-PiCSS). I-PiCSS is an intervention program designed to train and coach parents to use evidence-based naturalistic communication teaching (NCT) strategies (i.e., modeling, mand-model, and time delay) and reading techniques while reading storybooks with their young children with disabilities. Three participating parents were trained via online modules and coached via telepractice technologies (videoconferences). Zoom videoconference software was used for all coaching sessions. Using a single case multiple-baseline design across NCT strategies within each family, we examined, (a) parents' fidelity use of the three NCT strategies, (b) parents' use of book reading techniques, and (c) child language and communication outcomes. After self-directed training and remote coaching, parents used modeling, mand-model, and time delay strategies with higher rates and fidelity (accuracy). Children initiated more communicative acts upon parents' use of time delay and increased their numbers of single-and multiple-word responses.

Building Sustainable Models of Research-Practice Partnerships Within Educational Systems.

To describe the 9-year journey of a group of language and literacy researchers in establishing and cultivating Research-Practice Partnerships (RPPs). Those interested in incorporating implementation science frameworks in their research may benefit from reading our exploration into this type of work and our lessons learned. We showcase how a group of researchers, who are committed to collaboration with school practitioners, navigated building and scaling RPPs within educational systems necessary for our long-term implementation work. We provide details and illustrative examples for three, distinct, mutually beneficial, and sustainable partnerships. Three different practice organizations are represented: (1) a single metropolitan school, (2) a small metropolitan school district, and (3) a large metropolitan school district, highlighting specific priorities and needs depending on the type of practice organization. Each partnership has distinct research and practice goals related to improving language and literacy outcomes in children. We describe how the researchers assisted with meeting the partner practice organizations' goals and engaged in capacity building while producing rigorous scientific knowledge to inform clinical and educational practice. Additionally, we discuss how research priorities and strategies were pivoted in the past year due to the COVID-19 pandemic, illustrating our commitment to the partnerships and how to respond to challenges to guarantee long-term sustainability. By discussing three distinctive partnerships, we demonstrate the various ways researchers can approach RPPs and grow them into mutually beneficial collaborations and support implementation goals.

Auditory experience modulates fronto-parietal theta activity serving fluid intelligence.

Children who are hard of hearing are at risk for developmental language and academic delays compared with children with normal hearing. Some work suggests that high-order cognitive function, including fluid intelligence, may relate to language and academic outcomes in children with hearing loss, but findings in these studies have been mixed and to date, there have been no studies of the whole-brain neural dynamics serving fluid intelligence in the context of hearing loss. To this end, this study sought to identify the impact of hearing loss and subsequent hearing aid use on the neural dynamics serving abstract reasoning in children who are hard of hearing relative to children with normal hearing using magnetoencephalography. We found significant elevations in occipital and parietal theta activity during early stimulus evaluation in children who are hard of hearing relative to normal-hearing peers. In addition, we found that greater hearing aid use was significantly related to reduced activity throughout the fronto-parietal network. Notably, there were no differences in alpha dynamics between groups during later-stage processing nor did alpha activity correlate with hearing aid use. These cross-sectional data suggest that differences in auditory experience lead to widespread alterations in the neural dynamics serving initial stimulus processing in fluid intelligence in children.

A systematic review of speech, language and communication interventions for children with Down syndrome from 0 to 6 years

AbstractBackgroundSpeech and language acquisition can be a challenge for young children with Down syndrome (DS), and while early intervention is important, we do not know what early interventions exist and how effective they may be.AimsTo systematically review existing early speech, language and communication interventions for young children with DS from birth up to 6 years, and to investigate their effectiveness in improving speech, language and communication outcomes in children with DS. Other outcomes are changes in parental behaviour and their responsivenessMethods & ProceduresWe conducted a systematic search of relevant electronic databases to identify early intervention studies targeting speech, language and communication outcomes in children with DS published up to May 2020. A total of 11 studies that met the inclusion criteria were synthesized and appraised for quality using the PEDro‐P scale. There were a total of 242 children. We identified three types of intervention: communication training and responsive teaching, early stimulation programme, and dialectic–didactic approach.Main contributionThe findings from nine out of the 11 studies reported positive outcomes for children's language and communication up to 18 months following the intervention. All nine studies reported interventions that were co‐delivered by parents and clinicians. However, there was also a de‐accelerated growth in requesting behaviours in the intervention group reported by one study as well as a case of no improvement for the intervention group. Three studies provided some evidence of improvements to parent outcomes, such as increased parental language input and increased responsiveness. However, there was a moderate to high risk of bias for all studies included.ConclusionsThe findings from this review suggest that interventions that have high dosage, focus on language and communication training within a naturalistic setting, and are co‐delivered by parents and clinicians/researchers may have the potential to provide positive outcomes for children with DS between 0 and 6 years of age. Due to the limited number of studies, limited heterogeneous data and the moderate to high risk of bias across studies, there is an urgent need for higher quality intervention studies in the field to build the evidence base.WHAT THIS PAPER ADDSWhat is already known on the subjectSpeech and language acquisition is usually delayed in children with DS, yet there are currently no standard interventions for children under 6. A number of research‐based interventions exist in the literature, yet it is unknown how effective these are.What this study adds to existing knowledgeThis is the first systematic review that specifically and exclusively focuses on parent‐ and non‐parent‐mediated speech, language and communication interventions for children with DS between 0 and 6 years of age. It complements three existing recent reviews, each of which has a slightly different focus. The previously published reviews have covered only parent‐mediated interventions, excluding interventions not mediated by parents, have reviewed interventions including children and adults, without any mention of what early interventions may be like or how effective these may be for young children with DS, have not always assessed risk of bias or have focused specifically on language interventions excluding those focusing on speech articulation or pre‐linguistic skills. The findings from the current review suggest that interventions that have high dosage focus on language and communication training within a naturalistic setting and are co‐delivered by parents and clinicians/researchers may have the potential to provide positive outcomes for children with Diwn syndrome from 0 to 6. We acknowledge that the current evidence base comes from studies with moderate to high risk of bias, hence our conclusions are not definitive.What are the potential or actual clinical implications of this work?Speech and language therapists will have synthesized information and a quick reference point on what type of interventions exist for children with DS under the age of 6, and evidence of which intervention approaches may be promising in terms of providing positive outcomes. However, it is acknowledged that, due to the limited number of studies and the moderate to high risk of bias inherent in the evidence, there is an urgent need for higher quality intervention studies in the field to build the evidence base.

Does Where You Live Predict What You Say? Associations between Neighborhood Factors, Child Sleep, and Language Development.

Language ability is strongly related to important child developmental outcomes. Family-level socioeconomic status influences child language ability; it is unclear if, and through which mechanisms, neighborhood-level factors impact child language. The current study investigated the association between neighborhood factors (deprivation and disorder) assessed before birth and child language outcomes at age 5, with sleep duration as a potential underlying pathway. Secondary analysis was conducted on data collected between 2008 and 2018 on a subsample of 2444 participants from the All Our Families cohort study (Calgary, Canada) for whom neighborhood information from pregnancy could be geocoded. Neighborhood deprivation was determined using the Vancouver Area Neighborhood Deprivation Index (VANDIX), and disorder was assessed using crime reports. Mothers reported on their children’s sleep duration and language ability. Multilevel modeling indicated that greater neighborhood deprivation and disorder during pregnancy were predictive of lower scores on the Child Communication Checklist–2 (CCC–2) at 5 years. Path analyses revealed an indirect effect of neighborhood disorder on language through child sleep duration at 12 months. These results add to growing evidence that child development should be considered within the context of multiple systems. Sleep duration as an underlying link between environmental factors and child language ability warrants further study as a potential target for intervention.

Abstract WP173: Children’s Post-Stroke Expressive Language Outcomes Are Affected By Bilingual Exposure

Introduction: Approximately 2/3 of children face neurological deficits following arterial ischemic stroke (AIS). In neurotypical development, bilingualism is thought to confer certain linguistic and cognitive advantages. However, research on whether this may affect development in bilingual pediatric stroke patients is scarce. Objectives: To evaluate the effects of bilingual vs. monolingual exposure on language and cognitive outcomes in children following arterial ischemic stroke across two studies: (1) large-scale group analysis using the Pediatric Stroke Outcome Measure (PSOM); (2) exploratory case studies using neuropsychological measures. Methods: An institutional stroke registry and chart review were used to gather patient and stroke data, including the Pediatric Stroke Outcome Measure (PSOM) and standardized neuropsychological measures performed at several timepoints post-stroke in children with AIS. In Study 1, growth curve modeling based on PSOM subscales, predicted by age at stroke groups, language groups and their interactions was used. In Study 2, comparative case studies were conducted with a monolingual-bilingual pair, aged 7 and 8 at stroke onset. Results: In Study 1, 237 patients were identified (44%, bilingual patients). Patients were stratified based on age at stroke onset i.e. neonatal (<28 days of life), first-year (28 days-12 months) and childhood (13 months - 18 years). On the PSOM’s language expression subscale, an interaction revealed better post-stroke outcomes among bilingual children aged 1-12 months at stroke (beta = -0.32, t =-2.33, p = 0.02). In Study 2, the bilingual’s performance on neuropsychological assessments corroborated findings of Study 1, favoring a recovery of expressive language. Conclusion: Overall, we found no negative consequences of a bilingual environment on post-stroke outcomes. Additionally, it is possible that bilingualism has a faciliatory effect on expressive language development post-stroke. Further research should evaluate linguistic advantage effects prospectively in bilingual children with stroke and a control group.

The Structure of Emotion Dialogues: Maternal Reminiscing Factors Differentially Relate to Child Language and Socio-Emotional Outcomes

Mother-child reminiscing about past emotional experiences is one aspect of emotion socialization that facilitates child socio-emotional and cognitive outcomes. To advance understanding of the multidimensional nature of this clinically significant transdiagnostic process, the current investigation examined the structure of maternal reminiscing and how emergent factors related to child outcomes across two diverse samples (total N = 337). Sample one included 102 mothers and their preschool-aged children from community agencies, and sample two included 235 mothers and their preschool-aged children, the majority of whom had experienced substantiated maltreatment. Dyads completed a reminiscing task coded for multiple aspects of maternal reminiscing style (frequency and scale-based coding), assessments of child receptive language and internalizing and externalizing problems, and measures of parenting. Factor analyses confirmed that maternal reminiscing was best defined by three factors: (1) structural elaborations, (2) emotional attributions, and (3) sensitive guidance, and this three-factor structure was invariant across samples, maltreatment, maternal race, and child sex. When controlling for other dimensions of caregiver-reported parenting behavior, reminiscing sensitive guidance was significantly positively associated with child language and negatively with child internalizing and externalizing symptoms. In contrast, emotional elaborations were associated with higher child internalizing concerns. When controlling for caregiver-reported parenting and observed maternal sensitivity, structural elaborations negatively and emotional attributions positively related to child internalizing symptoms, whereas reminiscing factors did not significantly predict child externalizing symptoms nor child language. Distinct aspects of maternal reminiscing behavior are differentially related to child outcomes. Limitations and implications for understanding and measuring emotion socialization interactions are discussed.

A Framework for Understanding the Relation Between Spoken Language Input and Outcomes for Children with Cochlear Implants.

Spoken language outcomes after cochlear implantation are highly variable. Some variance can be attributed to individual characteristics. Research with typically hearing children suggests that the amount of language directed to children may also play a role. However, several moderating factors may complicate the association between language input and language outcomes in children with cochlear implants. In this article, I present a conceptual framework that posits that the association between total language input directed to children and language outcomes is moderated by factors that influence what is accessible, attended to, and coordinated with the child. The framework also posits that children with cochlear implants exhibit more variability on those moderating factors, which explains why the relation between language input and language outcomes may be more complex even if language input is more important for successful language outcomes in this population.

Production of Persian Morphosyntactic Structures Based on P-LARSP: Comparing Children With/Without Hearing Loss

Objective Despite all advancements in hearing amplification, screening, and interventions, concerns still exist about the language outcomes in children with mild to severe hearing loss. The present study aimed to investigate the production of inflectional morphemes, phrase, and clause structures of children with Moderately Severe Hearing Loss (MSHL) and compare with those of the children with Normal Hearing (NH). Materials & Methods The study participants were 88 NH children, aged 2-5 years, and 10 MSHL children, aged 5-6 years. They were recruited by a convenient sampling method. Speech therapists collected language samples in a free play context of the study children, and then the language samples were transcribed and segmented according to P-LARSP (language assessment, remedy, and screening procedure). Of 100 analyzable units, the speech therapists identified, allocated, and counted 14 inflectional morphemes and all clause and phrase structures in each language sample. Results Children with MSHL used significantly fewer numbers of inflectional morphemes (P=0.004), verb/complement+personal pronoun (P=0.009), and prefix/mi/as a tense marker (P=0.025), lower mean length of morpheme/analyzable utterances (P=0.003), higher percentages of one-word utterances (P=0.001), and lower numbers of clause structures in stage V (P=0.002) compared with NH children aged 4-5 years. While the types of clause structures in children with MSHL were similar to those in NH children aged 24-36 months. However, the types of produced inflectional morphemes were restricted compared with all groups of children with NH. Conclusion The present study revealed that children with MSHL are behind younger children with NH in grammatical aspects of the Persian language. They used simpler clauses, limited numbers, and types of inflectional morphemes, as well as clause and phrase structures, and mainly relied on one-word utterances. Continued monitoring of grammatical outcomes is warranted, considering that children who are MSHL are at increased risk for language problems.

Language Growth in Children with Mild to Severe Hearing Loss who Received Early Intervention by 3 Months or 6 Months of Age.

To evaluate the impact of hearing screening, diagnosis, and early intervention (EI) by 3 months or 6 months of age on language growth trajectories for children with hearing loss (HL) relative to children with normal hearing (NH). We recruited 133 children with mild to severe HL through universal newborn hearing screening records and referrals from audiologists in the United States and 116 children with NH who served as a comparison group. Examiners administered a battery of developmentally appropriate language measures between 12 months and 8 years of age. We constructed latent growth curve models of global language, grammar, and vocabulary using Bayesian statistics. Children with HL demonstrated no significant differences in initial language skills compared to children with NH. Children in the 1-3-6 group also showed no difference in language growth compared to children with NH. The slope for the 1-2-3 group was significantly steeper than children with NH for global language and grammar. This study documents the positive impact of EI on language outcomes in children with congenital HL. It is among the first to provide evidence to support the potential effects of very early intervention by 3 months of age.

Supplemental Material for 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

Supplemental Material for 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

Maternal question use and child language outcomes: The moderating role of children's vocabulary skills and socioeconomic status

Question use is a key feature of high-quality language input and supports language development. The current study examined how different types of maternal questions were associated with children's language outcomes, and how the associations were moderated by children's existing vocabulary skills and family socioeconomic status. Participants were 165 mothers and their 2-year-olds from the study of Early Child Care and Youth Development. Mother-child interactions during book-reading and toy play were video-recorded and coded for three types of questions: Yes or No (Y/N; e.g., “Is that a doggy?”), referential (e.g., “What's that?”), and advanced questions (e.g., “What will happen next?”). Child vocabulary at age 2 and receptive and expressive language skills at age 3 were assessed using standardized measures. Results suggested that Y/N questions and referential questions uniquely contributed to children's receptive language 1 year later. Yet, the benefit of referential questions did not generalize to children with small vocabularies at age 2. The association between referential questions and children's receptive language was stronger for children from families with lower-socioeconomic status, highlighting the possibility for intervention in this area. Together, these findings reveal the critical role of individual and contextual factors in language-learning mechanisms.

Disparate Oral and Written Language Abilities in Adolescents With Cochlear Implants: Evidence From Narrative Samples.

In spite of improvements in language outcomes for children with hearing loss (HL) arising from cochlear implants (CIs), these children can falter when it comes to academic achievement, especially in higher grades. Given that writing becomes increasingly relevant to educational pursuits as children progress through school, this study explored the hypothesis that one challenge facing students with CIs may be written language. Participants were 98 eighth graders: 52 with normal hearing (NH) and 46 with severe-to-profound HL who used CIs. Oral and written narratives were elicited and analyzed for morphosyntactic complexity and global narrative features. Five additional measures were collected and analyzed as possible predictors of morphosyntactic complexity: Sentence Comprehension of Syntax, Grammaticality Judgment, Expressive Vocabulary, Forward Digit Span, and Phonological Awareness. For oral narratives, groups performed similarly on both morphosyntactic complexity and global narrative features; for written narratives, critical differences were observed. Compared with adolescents with NH, adolescents with CIs used fewer markers of morphosyntactic complexity and scored lower on several global narrative features in their written narratives. Adolescents with NH outperformed those with CIs on all potential predictor measures, except for Sentence Comprehension of Syntax. Moderately strong relationships were found between predictor variables and individual measures of morphosyntactic complexity, but no comprehensive pattern explained the results. Measures of morphosyntactic complexity and global narrative features were not well correlated, suggesting these measures are assessing separate underlying constructs. Adolescents with CIs fail to show writing proficiency at high school entry equivalent to that of their peers with NH, which could constrain their academic achievement. Interventions for children with CIs need to target writing skills, and writing assessments should be incorporated into diagnostic assessments. https://doi.org/10.23641/asha.17139059.

Speed of Information Processing and Working Memory in Children with Cochlear Implants

Background: Cochlear implants (CIs) restore partial hearing to deaf children, promoting the development of spoken language skills. However, because of reduced auditory and language experience, children who receive CIs are at risk for delays not only in language skills but also in language-related neurocognitive skills such as verbal working memory (VWM - the ability to retain language information in immediate memory concurrently with other cognitive processing). Although VWM delays in children with CIs are well-documented, the foundational processes underlying these delays are less clear. This study investigated the hypotheses that slower speed of information processing during VWM tasks contributes to VWM delays in CI users and that this slower information processing speed is associated with spoken language outcomes. 
 
 Methods: 25 early-implanted, prelingually-deaf children with CIs and 25 normal-hearing (NH) peers completed tests of VWM, neurocognitive, and speech-language functioning. Speed of information processing during the VWM test was assessed by measuring response latency and average pause duration. 
 
 Results: Children with CIs showed poorer VWM scores than NH peers, but the groups did not differ on response latencies or pause durations. Response latencies were significantly correlated with VWM capacity, speech, and language outcomes in both groups. 
 
 Conclusion: Speed of information processing in VWM was similar for children with CIs and NH. In both groups, shorter response latencies (faster speed of execution of the cognitive operations of working memory) were associated with better neurocognitive and spoken language outcomes. In the CI sample, pause durations were inconsistently associated with VWM and language outcomes. 
 
 Clinical Policy Impact and Implications: Speed of information processing for VWM is associated with core neurocognitive and spoken language outcomes for children with CIs and should be a routine target of assessment and intervention post-implantation.

The effects of maternal input on language in the absence of genetic confounds: Vocabulary development in internationally adopted children

Previous studies have found correlations between parent input and child language outcomes, providing prima facie evidence for a causal relation. However, this could also reflect the effects of shared genes. The present study removed this genetic confound by measuring English vocabulary growth in 29 preschool-aged children (21girls) aged 31-73months and 17 infants (all girls) aged 15-32months adopted from China and Eastern Europe and comparing it to speech produced by their adoptive mothers. Vocabulary growth in both groups was correlated with maternal input features; in infants with mean-length of maternal utterance, and in preschoolers with both mean-length of utterance and lexical diversity. Thus, input effects on language outcomes persist even in the absence of genetic confounds.

Parenting Stress, Self-Efficacy, and Involvement: Effects on Spoken Language Ability Three Years After Cochlear Implantation.

This study evaluated associations among parenting stress, self-efficacy, and involvement in relation to spoken language outcomes in young children 3 years following cochlear implantation. Cross-sectional. Six university tertiary medical centers. One hundred sixty-four young children with bilateral, severe-to-profound sensorineural hearing loss who had 3 years of experience with a CI; children with substantial cognitive impairments were excluded from the study. Family Stress Scale (FSS), Scale of Parental Involvement and Self-Efficacy (SPISE), Oral and Written Language Scales (OWLS). Correlations were of moderate strength between FSS scores and SPISE scores (Parental Self-Efficacy, r = -0.45, p < 0.01, Parental Involvement r = -0.32, p < 0.01). As hypothesized, parents reporting higher levels of stress reported lower perceptions of self-efficacy and involvement. In addition, results showed that family stress had a direct, negative effect on spoken language (-4.43 [95% confidence interval: -6.97; -1.89]). After controlling for maternal education and activation age, parental self-efficacy mediated the negative effect between family stress and spoken language (indirect effect = -1.91 [3.45; -0.69]; proportion mediated = 0.43). No mediating effects were found for parental involvement. These findings highlight the need for parenting interventions that focus on reducing stressors and increasing parents' perceptions of self-efficacy in families of children using cochlear implants. Integration of mental health screening and tailored parenting interventions in CI clinics may increase parental self-efficacy and involvement, with measurable benefits in the child's use of spoken language.

Family Environmental Dynamics Differentially Influence Spoken Language Development in Children With and Without Hearing Loss.

The aim of this study was to evaluate whether families of children with sensorineural hearing loss (SNHL) are organized similarly to those of typically developing, typically hearing (TH) children and whether the dimensions of family dynamics and environment are related to spoken language development similarly in children with and without SNHL. Primary caregivers of children with SNHL (n = 63) or TH (n = 65) completed the Family Environment Scale-Fourth Edition (FES-4) to assess multiple dimensions of family environment. Children's receptive vocabulary was assessed with the Peabody Picture Vocabulary Test-Fourth Edition, and their receptive language was assessed by an age-appropriate version of the Concepts and Following Directions subtest of the Clinical Evaluation of Language Fundamentals and the Sentence Comprehension subscale of the Comprehensive Assessment of Spoken Language-Second Edition. Principal component analysis was used to examine the dimensional structure of the family environment. Three higher order components were derived from FES-4 subscales for both families of children with SNHL and with TH: Supportive, Controlling, and Conflicted. However, the composition of the factors themselves differed between the two groups. For the TH group, most family environment measures on the FES-4 were not associated with language outcomes. In contrast, for children with SNHL, families who were more supportive, less controlling, and less conflicted had children with better language skills. Three well-accepted dimensions of family dynamics and functioning apply to families of children with SNHL, but their composition differs from those of families with TH children. Family environmental dynamics were much more strongly associated with language outcomes in children with SNHL than in their TH peers. The spoken language development of children with SNHL, in particular, is better in families that provide high levels of support for each other and, in particular, low levels of control, disorganization, and conflict, reflecting the fragile nature of their spoken language development.