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148 JCPSLP Volume 17, Number 3 2015 Journal of Clinical Practice in Speech-Language Pathology
findings were consistent with those of the study conducted
by VanDam et al. (2012), providing further support for future
research to focus on the quality of the HLE in more detail.
Despite the current findings, a major limitation of this study
is the small number of participants, and the reduced ability
to closely control for variables likely to impact the results
(Szagun & Stumper, 2012). Though limiting the impact of
confounding variables was attempted through participant
matching and preliminary assessments, the severity of
hearing loss, the age at implantation or amplification, and
the nature of early intervention received, were not controlled
for in this study. The optimal age at implantation is younger
than 12 months, with language delays expected to increase
as provision of hearing technology is postponed (Quittner
et al., 2013). As shown in Table 1, there was variation in
the type of hearing technology provided; however, four
out of five D/HH participants received a form of hearing
technology before 8 months of age. The NH children were
matched to the children who were D/HH by hearing age
to control for spoken language experience and language
ability. However, the chronological ages of the children
varied from 28 months to 51 months. Due to the different
stages of language acquisition, parent–child interactions
were likely to vary accordingly; thus impacting the results
(Greenwood et al., 2010). All D/HH participants received
intervention through Telethon Speech and Hearing in
conjunction with the provision of hearing technology,
though the age at which intervention began and the service
delivery model used could not be controlled for.
The heterogeneity of the group is reflected in the large
ranges observed from the quantity of language measures in
particular, and may have contributed to the non-significant
results. Nonetheless, this study offers preliminary findings
justifying further consideration of the complex relationship
between hearing loss and the language environment. Future
studies should explore the quantity of language exposure,
but also include multiple measures of interaction quality.
Altogether, this and future research is underpinned by the
objective of improving the language abilities of children who
are D/HH.
References
Ambrose, S., VanDam, M., & Moeller, M. (2011). The role of
talk in outcomes of children who are hard of hearing.
Retrieved from
LENA-Conf-2011/Posters/LENA-Conference-
2011-Sophie-Ambrose-1.pdf
Aragon, M., & Yoshinaga-Itano, C. (2012). Using
language environment analysis to improve outcomes
for children who are deaf or hard of hearing.
Seminars in Speech and Language, 33, 340–353.
doi:10.1055/s-0032-1326918
Boons, T., De Raeve, L., Langereis, M., Peeraer, L.,
Wouters, J., & van Wieringen, A. (2013). Expressive
vocabulary, morphology, syntax and narrative skills in
profoundly deaf children after early cochlear implantation.
Research in Developmental Disabilities, 34, 2008–2022.
doi:10.1016/j.ridd.2013.03.003
Braungart-Rieker, J., Garwood, M., & Stifter, C. (1997).
Compliance and non-compliance: the roles of maternal
control and child temperament. Journal of Applied
Developmental Psychology, 18 , 411–428. Retrieved
from
garwood%20and%20stifter%201997.pdf
Chouinard, M., & Clark, E. (2003). Adult reformulations
of child errors as negative evidence. Journal of
who are NH and their caregivers. The need for this
exploration arises from studies describing the lack of
quantifiable research in this area (Quittner et al., 2013). The
data provides preliminary support for the hypothesis that
the quality of interaction in the HLE is influenced by the
behaviours and communication abilities of a child that is D/
HH. As predicted, the D/HH group was exposed to an
overall less supportive linguistic environment. The results
are strengthened by the use of multiple measures of
interaction quality, and the large effect sizes produced.
The D/HH children and their caregivers initiated
communication less often and there were fewer
connected interactions. This indicates the children had
fewer opportunities to acquire language (Harrigan &
Nikolopoulos, 2002). These findings are consistent with
literature demonstrating the population has a reduced
ability to initiate and continue successful interactions
(Morgan et al., 2014; Most et al., 2010). The children who
were D/HH also experienced less caregiver expansions;
suggesting exposure to language modeling was reduced.
As Ruter (2011) discovered, children who are D/HH benefit
enormously from caregiver expansions. Therefore these
results provide encouragement for future research to
explore intervention approaches.
Our findings also replicate those of Lederberg and
Everhart (2000), who found there were more behavioural
directives given to children who were D/HH compared to
children who were NH. This pattern was evident, despite
the children who were D/HH being older than the children
in the NH group. Braungart-Rieker, Garwood and Stifter
(1997) stated that child defiance and parental control peaks
at approximately two years of age, and steadily decreases
across the preschool years. Our results suggest that the
parents of children who are D/HH were more controlling
and directive; a parenting style cultivated by their child’s
aptitudes, though viewed as less supportive of language
development (Harrigan & Nikolopoulos, 2002).
Two measures did not support the hypothesis of a
decreased interaction quality in the D/HH dyad: the
number of failed utterances, and the ratio of successful
child to parent initiations. The non-significant difference in
the number of failed utterances contradicts the literature
indicating that decreased intelligibility and communicative
responsiveness results in less successful exchanges
(Morgan et al., 2014). Harrigan and Nikolopoulos (2002)
stated that parents of children who are D/HH are typically
the primary communicators, and exhibit increased
conversational control. Our results did not support this,
instead indicating the parents of children who were D/
HH did not initiate conversation significantly more than
their children when compared to the NH child–parent
dyad. One explanation for the non-significant results
is that the children were receiving intervention through
Telethon Speech and Hearing, a facility that engages in
auditory verbal therapy. Auditory verbal therapy promotes
child verbal communication, parent responsiveness, and
developing parental strategies to facilitate communicative
success (Chowdry, 2010). This may have increased child
initiations and reduced the controlling behaviours of the
parents, similar to the outcomes observed after the Hanen
program (Harrigan & Nikolopoulos, 2002). Taking this view,
the significant results for all other quality measures suggest
differences remain despite the intervention received.
Differences in the quantity of language exposure between
the groups were non-significant for the three measures. The