Language Outcomes In Children Research Articles

Buffering negative effects of immigration on cognitive, social, and educational development: A multinational meta-analysis of child and adolescent prevention programmes.

Growing up in migrant families is a well-known distal risk factor related to poorer outcomes in child and adolescent health, academic, socioemotional and behavioural development. This article reviews the effects of various prevention measures such as early education programmes, cognitive and language training or parent and teacher training on child and adolescent developmental outcomes in immigration samples. Using several comprehensive literature searches, we found 138 research reports with 141 studies and 175 comparisons on preventing negative effects of immigration. Overall, programmes yielded an effect size of d= 0.26 at post-test using the random effect model. These effects decreased over time while still differing significantly from zero. A cross-tabulation of prevention approach/programme type by different outcome domains revealed several important results such as high effects of child cognitive and language training programmes on child academic and language outcomes and relatively low effects of all programmes on child socioemotional outcomes. In addition, individualised and culturally tailored programmes seems to be more effective. However, generalised effects on more distal educational outcomes (e.g., school degrees) were generally weak. Hence, it remains questionable whether individual psychosocial and educational programmes are able to counterbalance the multifaceted risks of immigration.

Relationship between sensitivity to temporal fine structure and spoken language abilities in children with mild-to-moderate sensorineural hearing loss.

Children with sensorineural hearing loss show considerable variability in spoken language outcomes. The present study tested whether specific deficits in supra-threshold auditory perception might contribute to this variability. In a previous study by Halliday, Rosen, Tuomainen, and Calcus [(2019). J. Acoust. Soc. Am. 146, 4299], children with mild-to-moderate sensorineural hearing loss (MMHL) were shown to perform more poorly than those with normal hearing (NH) on measures designed to assess sensitivity to the temporal fine structure (TFS; the rapid oscillations in the amplitude of narrowband signals over short time intervals). However, they performed within normal limits on measures assessing sensitivity to the envelope (E; the slow fluctuations in the overall amplitude). Here, individual differences in unaided sensitivity to the TFS accounted for significant variance in the spoken language abilities of children with MMHL after controlling for nonverbal intelligence quotient, family history of language difficulties, and hearing loss severity. Aided sensitivity to the TFS and E cues was equally important for children with MMHL, whereas for children with NH, E cues were more important. These findings suggest that deficits in TFS perception may contribute to the variability in spoken language outcomes in children with sensorineural hearing loss.

Towards a biopsychosocial understanding of neurodevelopmental outcomes in children with hypoxic-ischemic encephalopathy: A mixed-methods study

Objective Children with hypoxic-ischemic encephalopathy (HIE) are at high risk of neurodevelopmental delay despite the widespread adoption of therapeutic hypothermia. Thus, consideration of both biological and psychosocial factors is warranted to better predict outcomes. We examined the associations between various child neurodevelopmental outcomes and potentially influential factors such as brain imaging, parent mental health, previous intervention, and social risk. Qualitative themes in the parent experience were also identified from free-text questionnaire responses. Methods: Parents of 54 children with HIE (ages 6 months–6.5 years) completed questionnaires capturing sociodemographic factors, qualitative perceptions of clinical outcome, parent mental health, and ratings of child adaptive and psychosocial functioning. Neurodevelopmental assessment scores at 18 and 36 months were extracted retrospectively from the medical chart for a subset of children. Results: Linear regression analyses showed significant associations between poorer parent mental health and child psychosocial and language outcomes. In multivariable analyses, social risk served as a significant predictor of 18 and 36 month cognitive and language functioning. Qualitative analyses of parents’ written reflections revealed themes of hopefulness and ongoing concern. Conclusion: In children with HIE, social context and parent mental health are strong contributing factors in the pathway of neurodevelopmental outcomes.

Influential factor combinations leading to language outcomes following a home visiting intervention: A qualitative comparative analysis (QCA).

Children who experience adversity are more vulnerable to language difficulties. Early interventions beginning antenatally, such as home visiting, are provided to help prevent these problems. To improve the precision of early interventions, the impact of combinations of risk and protective factors over time must be explored and understood. There is, however, limited research investigating how such factors interact with intervention to change language outcomes over time. To explore the different paths that lead to Good and Poor language in a cohort of children experiencing adversity whose mothers received an optimal dose of the Maternal Early Childhood Sustained Home visiting (MECSH) intervention over 2.5 years. A total of 24 low socioeconomic status (SES) mothers experiencing adversity and their children who received more than half the scheduled dose of the MECSH intervention were followed over time: from before birth to school entry. Data were extracted from surveys and direct measurement over the study course. Child language outcome at school entry and the influence of seven key child, maternal and environmental factors, which have been shown in previous research to result in Good and Poor language outcomes, were explored through qualitative comparative analysis (QCA). QCA is a qualitative analytical technique that provides a deeper understanding of factor combinations influencing language development. Multiple paths to Good (six paths) and Poor language (seven paths) were found. Paths with mostly protective factors resulted in Good language, except when maternal antenatal distress was present. Paths with two or more influential risks usually resulted in Poor language outcomes. When children experiencing adversity received the MECSH home visiting intervention, there was no one risk or protective factor necessary for Good or Poor language outcomes; however, there were clear patterns of factor combinations. Mothers' antenatal psychological resources were a flag for future language concerns which can be used to improve the precision of the MECSH intervention. They were highly influential to their children's Good and Poor language outcomes by 5 years, when over time they were combined with characteristics such as early childhood education, poor maternal responsivity and/or the number of children in the home. Knowledge of early conditions associated with later Poor language can help clinicians identify and respond in preventative and promoting ways to improve language skills. What this paper adds What is already known on the subject Children experiencing adversity are more vulnerable to language difficulties. Both risk for language difficulties and protection against them in this group are via a complex combination of factors. It is unknown how intervention works with these complex factors to result in Good and Poor language outcomes. What this paper adds to existing knowledge There are multiple paths to both Good and Poor language outcomes for children experiencing adversity. Mothers' psychological resources antenatally in combination with other key factors were particularly influential to Good and Poor language outcomes. What are the clinical implications of this work? In this study, maternal antenatal distress together with poor maternal responsivity were present in children's paths to Poor language outcomes at school entry. An extra focus on responsivity is required in antenatally distressed mothers of children experiencing adversity in early interventions. Children of mothers with good psychological resources antenatally who received home visiting intervention had Good language outcomes at 5 years when combined with 3 years or more of early childhood education and if there were one to two children in the home. Knowledge of these influences on language development can improve the precision of home visiting interventions and help clinicians tailor their visits to individual families' needs.

Bilateral Cochlear Implants or Bimodal Hearing for Children with Bilateral Sensorineural Hearing Loss

This review describes speech perception and language outcomes for children using bimodal hearing (cochlear implant (CI) plus contralateral hearing aid) as compared to children with bilateral CIs and contrasts said findings with the adult literature. There is a lack of clinical evidence driving recommendations for bimodal versus bilateral CI candidacy and as such, clinicians are often unsure about when to recommend a second CI for children with residual acoustic hearing. Thus the goal of this review is to identify scientific information that may influence clinical decision making for pediatric CI candidates with residual acoustic hearing. Bilateral CIs are considered standard of care for children with bilateral severe-to-profound sensorineural hearing loss. For children with aidable acoustic hearing-even in just the low frequencies-an early period of bimodal stimulation has been associated with significantly better speech perception, vocabulary, and language development. HA audibility, however, is generally poorer than that offered by a CI resulting in interaural asymmetry in speech perception, head shadow, as well as brainstem and cortical activity and development. Thus there is a need to optimize "two-eared" hearing while maximizing a child's potential with respect to hearing, speech, and language while ensuring that we limit asymmetrically driven auditory neuroplasticity. A recent large study of bimodal and bilateral CI users suggested that a period of bimodal stimulation was only beneficial for children with a better-ear pure tone average (PTA) ≤ 73 dB HL. This 73-dB-HL cutoff applied even to children who ultimately received bilateral CIs. Though we do not yet have definitive guidelines for determining bimodal versus bilateral CI candidacy, there is increasing evidence that 1) bilateral CIs yield superior outcomes for children with bilateral severe-to-profound hearing loss and, 2) an early period of bimodal stimulation is beneficial for speech perception and language development, but only for children with better-ear PTA ≤ 73 dB HL. For children with residual acoustic hearing, even in just the low-frequency range, rapid sequential bilateral cochlear implantation following a trial period with bimodal stimulation will yield best outcomes for auditory, language, and academic development. Of course, there is also an increasing prevalence of cochlear implantation with acoustic hearing preservation allowing for combined electric and acoustic stimulation even following bilateral implantation.

Considering the impact of universal newborn hearing screening and early intervention on language outcomes for children with congenital hearing loss

Objective In this paper, we draw on evidence to address the impact of earlier identification of congenital hearing loss through universal newborn hearing screening (UNHS) and the associated earlier access to interventions including cochlear implant (CI) technology on outcomes of children with hearing loss. Methods Data from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study were analysed to examine the impact of UNHS and earlier intervention on language outcomes. The LOCHI study includes more than 450 deaf and hard of hearing Australian children whose hearing losses were identified variously through newborn hearing screening or later paths to confirmation and intervention. Results Seventy-two percent of the screened group received hearing aid fitting before 6 months of age, which more than doubled the 32% in the non-screened group. On average, children who received earlier intervention achieved language at age 5 years commensurate with their typically developing peers. Children who do not have disabilities in addition to hearing loss and received their first CIs before age 12 months achieved language scores within the range of typically developing peers. Conclusion Newborn hearing screening led to earlier intervention. Children who received earlier intervention achieved better outcomes than those who received later intervention.

Receptive and Expressive Language in Hindi Speaking Children with Postcochlear Implantation at 6-Month Intervals.

Introduction Individual variability in the language outcomes of children with cochlear implantation (CI) is a major concern. In CI rehabilitation, there is lack of a protocol regarding uniform post-CI language assessment interval duration, which can ensure better understanding of the trajectory of language growth as well as optimize language outcomes by providing feedback in fine tuning the language intervention program. Objective To evaluate the receptive and expressive language in Hindi speaking children with up to 2 years of CI experience using revised receptive-expressive emergent language test-3ed. (REELT-3) at 6 months intervals and to compare it with that of children with normal hearing (NH). Methods The present study included 192 children divided in 2 groups, 96 children with CI (15.8 ± 6.7 months), and 96 age-matched children with NH (22.3 ± 7.9 months). A cross-sectional, prospective study design was used to measure the language ability score (LAS) at an interval of 6 months from the time of implantation (TIA), which is 0 to 6 months, 7 to 12 months, 13 to 18 months, and 19 to 24 months of CI usage. Results The two-way analysis of variance revealed that the LAS after 18 months of CI usage was similar to (F (3, 92) = 8.63, p = 0.19, ηp2 = 0.028) that of the children with NH. However, other demographic factors, for instance, gender (F (3, 92) = 1.73, p = 0.505, ηp2 = 0.002), parent's education, (F (3, 92) = 2.05, p = 0.937, ηp2 = 0.031), and financial background (F (3, 92) = 2.49, p = 0.351, ηp2 = 0.076) had no major impact on language. Conclusion Eighteen months of CI usage duration can potentially stimulate receptive and expressive language up to age-matched children with NH. A protocol of periodic assessment of language, at least of 6 months, may be developed to optimize language outcomes.

The Impact of Family Environment on Language Development of Children With Cochlear Implants: A Systematic Review and Meta-Analysis.

The authors conducted a systematic review of the literature and meta-analyses to assess the influence of family environment on language development in children with cochlear implants. The Pubmed, excerpta medica dataBASE (EMBASE), Education Research Information Center, cumulative index to nursing and allied health literature (CINAHL), Healthcare Literature Information Network, PubPsych, and Social SciSearch databases were searched. The search strategy included terms describing family environment, child characteristics, and language development. Studies were included that (a) assessed distal family variables (such as parental income level, parental education, family size, and parental stress) with child language outcomes, and/or more proximal correlates that directly affect the child (such as family engagement and participation in intervention, parenting style, and more specifically, the quantity and quality of parental linguistic input) on child language; (b) included children implanted before the age of 5 years; (c) measured child language before the age of 21 years with standardized instruments; (d) were published between 1995 and February 2018; and (e) were published as peer-reviewed articles. The methodological quality was assessed with an adaptation of a previously validated checklist. Meta-analyses were conducted assuming a random-effects model. A total of 22 study populations reported in 27 publications were included. Methodological quality was highly variable. Ten studies had a longitudinal design. Three meta-analyses on the correlations between family variables and child language development could be performed. A strong effect of the quality and quantity of parental linguistic input in the first 4½ years postimplantation on the child's language was found, r = 0.564, p ≤ 0.001, 95% confidence interval (CI) = 0.449 to 0.660, accounting for 31.7% of the variance in child language outcomes. Results demonstrated high homogeneity, Q(3) = 1.823, p = 0.61, I = 0. Higher-level facilitative language techniques, such as parental expansions of the child's utterances or the use of open-ended questions, predicted child language skills. Risk of publication bias was not detected. The results on the impact of family involvement/participation in intervention on child language development were more heterogeneous. The meta-analysis included mainly cross-sectional studies and identified low to moderate benefits, r = 0.380, p ≤ 0.052, 95% CI = -0.004 to 0.667, that almost attained significance level. Socioeconomic status, mainly operationalized by parental level of education, showed a positive correlation with child language development in most studies. The meta-analysis confirmed an overall low and nonsignificant average correlation coefficient, r = 0.117, p = 0.262, 95% CI = -0.087 to 0.312. A limitation of the study was the lack of some potentially relevant variables, such as multilingualism or family screen time. These data support the hypothesis that parental linguistic input during the first years after cochlear implantation strongly predicts later child language outcomes. Effects of parental involvement in intervention and parental education are comparatively weaker and more heterogeneous. These findings underscore the need for early-intervention programs for children with cochlear implants focusing on providing support to parents for them to increase their children's exposure to high-quality conversation.

Long-Term Language Development in Children With Early Simultaneous Bilateral Cochlear Implants.

Objectives:This longitudinal study followed the language development of children who received the combination of early (5 to 18 months) and simultaneous bilateral cochlear implants (CIs) throughout the first 6 years after implantation. It examined the trajectories of their language development and identified factors associated with language outcomes.Design:Participants were 21 Norwegian children who received bilateral CIs between the ages of 5 and 18 mo and 21 children with normal hearing (NH) who were matched to the children with CIs on age, sex, and maternal education. The language skills of these two groups were compared at 10 time points (3, 6, 9, 12, 18, 24, 36, 48, 60, and 72 months after implantation) using parent reports and standardized measures of general language skills, vocabulary, and grammar. In addition, assessments were made of the effects of age at CI activation, speech recognition abilities, and mothers’ education on language outcomes 6 years after implantation.Results:During the first 4 years after implantation, the gap in general expressive and receptive language abilities between children with CIs and children with NH gradually closed. While at the initial five to six assessments (3 to 36 months after implantation), significant differences between children with CIs and children with NH were observed; at 4 years after implantation, there were no longer any significant group differences in general language skills and most children with CIs achieved scores within 1 SD of the tests’ normative means. From 2 to 3 years after implantation onward, expressive vocabulary and receptive grammar skills of children with CIs were similar to those of the reference group. However, from 4 years after implantation until the end of the observation period, 6 years after implantation, expressive grammar skills of children with CIs were lower than those of children with NH. In addition, a gap in receptive vocabulary appeared and grew increasingly larger from 4 to 6 years postimplantation. At the final assessment, the children with CIs had an average receptive vocabulary score around 1 SD below the normative mean. Regression analysis indicated that the children’s language outcomes at 6 years after implantation were related to their speech recognition skills, age at CI activation, and maternal education.Conclusions:In the first 4 years after implantation, the language performance of children with CIs became increasingly similar to that of their NH peers. However, between 4 and 6 years after implantation, there were indications of challenges with certain aspects of language, specifically receptive vocabulary and expressive grammar. Because these challenges first appeared after the 4-year assessment, the findings underline the importance of long-term language intervention to increase the chances of a continued language development comparable to that of NH peers. They also indicate that there is a need for comprehensive longitudinal studies of the language development of children with CIs beyond 4 years after implantation.

Predictors of one-year language and seizure outcomes in children with epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS)

PurposeEpileptic encephalopathy with continuous spike-and-wave during sleep (CSWS), with its associated impact on language, is an important cause of morbidity with epilepsy in children. The effects of various treatment-approaches and the aetiological/electrophysiological factors affecting therapeutic response are not fully understood. MethodA retrospective study of patients admitted to the institute and diagnosed to have CSWS pattern on EEG was conducted. Spike and Wave Frequency/100 s(SWF) was calculated from sleep-EEG records. Language development and seizure outcomes were assessed at baseline and 1 year. ResultsFifty-two children were included (idiopathic CSWS, N = 19; symptomatic CSWS N = 33).The 2 groups differed in terms of younger age at seizure onset in symptomatic CSWS (p = 0.006), early age at language regression (p = 0.046), history of neonatal seizures (p = 0.038) and slowing of background activity on EEG (p = 0.024). Language regression was noted in 63.5 % of the cohort. Twenty-five (48%) patients received steroids with improvement in seizures (p < 0.001). Twenty-one (40.3 %) received steroids and intravenous immunoglobulin (IVIG) with improvement in seizure score (p = 0.002) at 1 year. Both immune-modulation arms irrespective of etiological subgroups had comparable proportions of children with expressive and receptive language gains. On 1 year follow-up, seizure remission was noted in 13(25 %) patients, with improved seizure score in 32/39 (61.5 %) patients and language improvement in 32 children (60.8 %). Patients with normal background on baseline EEG, generalised spikes, absent frontal-negative spikes and SWF < 170 were found to have improved language estimates on follow-up. ConclusionsDespite clinical and therapeutic outcome differences between idiopathic and symptomatic CSWS, immune-modulation appears effective irrespective of aetiology. Analysis of EEG variables enables prediction of language outcomes at 1 year follow-up.

Auditory Screening

The high prevalence of hearing loss in newborns and preschoolers around the world leads to audiology to design “auditory screening protocols” and “audiological follow-up”. These programs, based on scientific evidence and clinical experience, were modified over time to optimize time and minimize errors in test results implemented for detection. Their objectives are to reduce the age of identification, diagnosis, and effective interventions to improve language and social-emotional outcomes in children who are deaf or hard of hearing.

An Integrative Review of Current Practice Models and/or Process of Family-Centered Early Intervention for Children Who Are Deaf or Hard of Hearing.

Over the past few decades, there has been an increasing shift toward emphasizing the importance of the child's family taking an active role in the habilitation process through family-centered early intervention (FCEI) programs. Accordingly, the Health Professions Council of South Africa recommends that early intervention services following confirmation of hearing loss must be family-centered within a community-based model of service delivery that is culturally congruent. The aim of this study was to explore and document current evidence reflecting trends in FCEI for children who are deaf or hard of hearing (DHH) by identifying and describing current practice models and/or processes of FCEI for these children. This study describes our first steps in formulating a framework for FCEI for children who are DHH in South Africa. An integrative literature review was conducted. Sage, Science Direct, PubMed, and Google Scholar databases were searched for studies published in English between January 2009 and January 2019 reporting on FCEI programs for children who are DHH. Studies that focused on the following were excluded from the study: speech and language outcomes of children, youth, and adults who are DHH; education for children who are DHH; universal newborn hearing screening; professionals' roles in early hearing detection and intervention; diagnosis of hearing loss; and sign language. Kappa statistics were performed to determine agreement between reviewers. Twenty-two studies were included in the review. Cohen's kappa revealed a substantial agreement (κ = 0.8) between reviewers for data extraction and synthesis in terms of the articles that met the criteria for inclusion in the review. Findings were discussed under 5 themes: caregiver involvement; caregiver coaching/information sharing; caregiver satisfaction; challenges with FCEI; and telehealth. Generally, there is sufficient evidence for FCEI, with caregivers indicating the need for full involvement in their children's care. Methods of caregiver involvement involving caregiver coaching/information sharing need to be culturally and linguistically appropriate, with sensitivities around time and manner. This increases caregiver satisfaction with intervention programs and improves outcomes for children who are DHH. Challenges identified by the studies raise implications for early hearing detection and intervention programs, as well as Departments of Health and Social Welfare. These included logistical challenges, professional-related challenges, and caregiver-related challenges. Various aspects of FCEI have been reported in the review. Findings of these studies have significant implications for the formulation of quality FCEI programs to ensure contextually relevant and contextually responsive care of children who are DHH.

The Relation Between Classroom Age Composition and Children's Language and Behavioral Outcomes: Examining Peer Effects.

Grouping children of different ages in the same preschool classroom (i.e., mixed age) is widespread, but the evidence supporting this practice is mixed. A factor that may play a role in the relation between classroom age composition and child outcomes is peer skill. This study used a sample of 6,338 preschoolers (ages 3-5) to examine the influence of both classroom age composition and peer skill on children's behavioral and language outcomes. Results supported the growing literature indicating preschoolers' skills are higher when peer skill is higher, but differences related to classroom age composition were not found. These findings further support the view that peer skill plays an important role in preschool children's outcomes.

Multimedia Input and Bilingual Children's Language Learning.

The current study seeks to explore the impact of multimedia input at home on bilingual children’s language outcomes. Two hundred and two Singaporean English-Mandarin kindergarteners’ multimedia experience (i.e., the resources and the amount of multimedia input) and conventional language exposure (e.g., language use with family members) were investigated with a parental questionnaire. A series of English and Mandarin tests were conducted to assess children’s proficiency (i.e., in receptive vocabulary, receptive grammar, verbal fluency) by standardized measures. Results demonstrated that the diversity of multimedia input is more important than the amount of multimedia input in promoting children’s Mandarin language maintenance, while controlling for children’s conventional language exposure, SES, and language aptitude. The number of multimedia sources is significantly and positively related to children’s general Mandarin proficiency. In contrast, English multimedia exposure at home exerts little impact on children’s general English proficiency. The findings indicate the unique contribution of multimedia diversity to children’s early heritage language maintenance. The strong social relevance of the study is discussed at the end of the paper.

Natural Language Input: Maternal Education, Socioeconomic Deprivation, and Language Outcomes in Typically Developing Children.

Purpose The current study was designed to investigate the differences in language input related to family factors (maternal level of education [MLE] and socioeconomic level of deprivation [SLD]) and their association with language outcomes in preschoolers. Method This study used New Zealand SLD and MLE classification systems to examine differences in language input related to these factors among 20 typically developing preschool children aged 2-5 years. The quantity of children's language input (adult words [AWs], conversational turns [CTs]) was calculated using the Language ENvironment Analysis audiotaping technology for two typical weekend days. Four 5-min Language ENvironment Analysis recording segments were transcribed and coded, and parental language strategies were classified as optimal language strategy, moderate language strategy, or sub-optimal language strategy (S-OLS) for child language outcomes. The receptive and expressive language of each child was assessed using the Preschool Language Scales-Fifth Edition. Results Mann-Whitney U tests showed significant differences between the quantity of language input (AWs/hr, CTs/hr) for high and low MLE and high and low SLD groups. Consistent with the literature, the use of S-OLSs was significantly lower for families with high MLE (Mdn = .25, IQR = .14) and low SLD (Mdn = .22, IQR = .13) than for families with low MLE (Mdn = .41, IQR = .24) and high SLD (Mdn = .41, IQR = .26). Spearman correlation coefficients indicated significant associations between language input (AWs/hr, CTs/hr, S-OLSs) and language outcomes. Conclusions Reduced language input and the frequent use of S-OLSs associated with low maternal education and high deprivation and low language outcomes for these children highlight the importance for all parents/families to learn optimal language strategies to support the development of strong language skills in their children in young age.

Family Environment in Children With Hearing Aids and Cochlear Implants: Associations With Spoken Language, Psychosocial Functioning, and Cognitive Development.

To examine differences in family environment and associations between family environment and key speech, language, and cognitive outcomes in samples of children with normal hearing and deaf and hard-of-hearing (DHH) children who use hearing aids and cochlear implants. Thirty families of children with normal hearing (n = 10), hearing aids (n = 10), or cochlear implants (n = 10) completed questionnaires evaluating executive function, social skills, and problem behaviors. Children's language and receptive vocabulary were evaluated using standardized measures in the children's homes. In addition, families were administered a standardized in-home questionnaire and observational assessment regarding the home environment. Family environment overall was similar across hearing level and sensory aid, although some differences were found on parental responsivity and physical environment. The level of supportiveness and enrichment within family relationships accounted for much of the relations between family environment and the psychosocial and neurocognitive development of DHH children. In contrast, the availability of objects and experiences to stimulate learning in the home was related to the development of spoken language. Whereas broad characteristics of the family environments of DHH children may not differ from those of hearing children, variability in family functioning is related to DHH children's at-risk speech, language, and cognitive outcomes. Results support the importance of further research to clarify and explain these relations, which might suggest novel methods and targets of family-based interventions to improve developmental outcomes.

Aided Hearing Moderates the Academic Outcomes of Children With Mild to Severe Hearing Loss.

There are very limited data regarding the spoken language and academic outcomes of children with mild to severe hearing loss (HL) during the elementary school years, and the findings of these studies are inconsistent. None of these studies have examined the possible role of aided hearing in these outcomes. This study used a large cohort of children to examine these outcomes and in particular to examine whether aided hearing moderates the effect of HL with regard to these outcomes. The spoken language, reading, writing, and calculation abilities were measured after second and fourth grades in children with mild to severe HL (children who are hard of hearing; CHH, n = 183) and a group of children with normal hearing (CNH, n = 91) after the completion of second and fourth grades. Also, among the CHH who wore hearing aids, aided better-ear speech intelligibility index values at the age of school entry were obtained. Oral language abilities of the CHH with mild and moderate HL were similar to the CNH at each grade. Children with moderately-severe HL (better-ear pure tone threshold >59 but <76 dB HL) had significantly poorer oral language and reading skills than the CNH at each grade. The children with mild and moderate HL did not differ from the CNH in oral language or reading. No differences were found between the CHH regardless of severity and CNH with regard to spelling, passage writing, or calculation. The degree to which hearing aids provided audible speech information played a moderating role in the oral language outcomes of CHH and this moderation of language mediated the relationship between the unaided hearing ability of the CHH and their academic outcomes. As a group, children with mild and moderate HL have good outcomes with regard to language and academic performance. Children with moderately-severe losses were less skilled in language and reading than the CNH and CHH children with mild and moderate losses. Audibility provided by hearing aids was found to moderate the effects of HL with respect to these outcomes. These findings emphasize the importance of including the effects of clinical interventions such as aided hearing when examining outcomes of CHH.

Individual Differences in Mothers' Spontaneous Infant-Directed Speech Predict Language Attainment in Children With Cochlear Implants.

Purpose Differences across language environments of prelingually deaf children who receive cochlear implants (CIs) may affect language acquisition; yet, whether mothers show individual differences in how they modify infant-directed (ID) compared with adult-directed (AD) speech has seldom been studied. This study assessed individual differences in how mothers realized speech modifications in ID register and whether these predicted differences in language outcomes for children with CIs. Method Participants were 36 dyads of mothers and their children aged 0;8-2;5 (years;months) at the time of CI implantation. Mothers' spontaneous speech was recorded in a lab setting in ID or AD conditions before ~15 months postimplantation. Mothers' speech samples were characterized for acoustic-phonetic and lexical properties established as canonical indices of ID speech to typically hearing infants, such as vowel space area differences, fundamental frequency variability, and speech rate. Children with CIs completed longitudinal administrations of one or more standardized language assessment instruments at variable intervals from 6 months to 9.5 years postimplantation. Standardized scores on assessments administered longitudinally were used to calculate linear regressions, which gave rise to predicted language scores for children at 2 years postimplantation and language growth over 2-year intervals. Results Mothers showed individual differences in how they modified speech in ID versus AD registers. Crucially, these individual differences significantly predicted differences in estimated language outcomes at 2 years postimplantation in children with CIs. Maternal speech variation in lexical quantity and vowel space area differences across ID and AD registers most frequently predicted estimates of language attainment in children with CIs, whereas prosodic differences played a minor role. Conclusion Results support that caregiver language behaviors play a substantial role in explaining variability in language attainment in children receiving CIs. Supplemental Material https://doi.org/10.23641/asha.12560147.

Clinician Proposed Predictors of Spoken Language Outcomes for Minimally Verbal Children with Autism Spectrum Disorder.

Our aim was to explore insights from clinical practice that may inform efforts to understand and account for factors that predict spoken language outcomes for children with Autism Spectrum Disorder who use minimal verbal language. We used a qualitative design involving three focus groups with 14 speech pathologists to explore their views and experiences. Using the Framework Method of analysis, we identified 9 themes accounting for 183 different participant references to potential factors. Participants highlighted the relevance of clusters of fine-grained social, communication, and learning behaviours, including novel insights into prelinguistic vocal behaviours. The participants suggested the potential value of dynamic assessment in predicting spoken language outcomes. The findings can inform efforts to developing clinically relevant methods for predicting children's communication outcomes.

A Practical Approach to Genetic Testing for Pediatric Hearing Loss

Our goal is to provide a practical approach to the genetic evaluation of children with sensorineural hearing loss for use by practicing clinicians. We present the most recent research in the field followed by our recommended diagnostic algorithm incorporating genetic testing. We then provide case examples of commonly encountered patient presentations as further guidance. Genetic testing has the highest diagnostic yield of any single test in the evaluation of children with congenital bilateral severe-to-profound hearing loss. For unilateral or asymmetric hearing loss, imaging is typically more informative initially than genetic testing. Recent data show that syndromic forms of hearing loss are more common than previously appreciated. A thorough and systematic evaluation of children with hearing loss that incorporates genetic testing leads to earlier diagnosis and treatment. This in turn leads to improved speech and language outcomes for children with hearing loss.