JCPSLP Vol 17 No 3 2015

Fresh science and pioneering practice

Caregiver–child interaction in children who are deaf or hard of hearing and children who are normally hearing: Preliminary data Michelle Saetre-Turner, Cori Williams, and Michelle Quail

This pilot study investigated differences in the quality and quantity of caregiver–child interaction in the home language environment of children who are deaf or hard of hearing ( N = 5) and normally hearing ( N = 5) children. The language environment was analysed from audio recordings collected using the Language Environment Analysis (LENA) system on seven measures of interaction quality and three measures of language quantity. Measures of interaction quality were the number of: successful child and caregiver initiations, connected utterances, failed utterances, behavioural directives, caregiver expansions, and the ratio of successful child to caregiver initiations. Measures of language quantity were adult word count, conversational turn count, and child vocalisation count. This study is founded on emergentism theory, with the outcome measures selected to indicate the hypothesised relationship between hearing loss and the language environment. The interaction quality was less supportive of language development in the deaf or hard of hearing group on all but two measures: the number of failed utterances and the ratio of successful child to caregiver initiations. Language quantity was not significantly different between the groups. The findings have implications for intervention strategies for children who are deaf or hard of hearing, and support further analysis of the home language environment. C aregivers are critical facilitators of a child’s cognitive, linguistic, and social development (Vohr, Topol, Watson, St Pierre & Tucker, 2014). A hearing loss disrupts the typical trajectory of communication development, increasing the importance of an environment that is supportive of language growth (VanDam, Ambrose & Moeller, 2012). Yet, it is noted that caregivers of children who are deaf or hard of hearing (D/HH) display behaviours traditionally viewed as non-supportive of language

development, such as intrusiveness and unresponsiveness, as an “intuitive response to the effects of hearing impairment on infant behaviour” (Lam & Kitamura, 2010, p. 545). The language outcomes of children who are D/HH continue to fall behind normally hearing (NH) peers, despite early identification of hearing loss, early intervention, and improvements in hearing technology (Vohr et al., 2014). There have been relatively few investigations regarding the quality of the home language environment (HLE) involving children who are D/HH, particularly compared with research exploring the quantity of language received. This is despite studies voicing the need for such explorations (Aragon & Yoshinaga-Itano, 2012; Vohr et al., 2014). Language development in the home language environment Children learn language by attaching meaning to the individual words and sounds they have segmented when hearing the speech stream (Chiat, 2001). The number of words and communicative opportunities a child is exposed to significantly impacts language acquisition (Leffel & Suskind, 2013; Zimmerman et al., 2009), with talkative parents providing more opportunities for mapping meaning onto words (VanDam et al., 2012). Impaired auditory processing has a flow-on effect on the ability to store, understand, and produce language (Claessen, Leitão, Kane & Williams, 2013). As a result, children who are D/HH often have marked language delays, influenced by factors including the severity of hearing loss, age of amplification or implantation, and socioeconomic factors such as parental education (Szagun & Stumper, 2012). In terms of typical language acquisition, a review of the literature by Suskind et al. (2013) noted the relationship between the quality of a child’s language exposure and their linguistic outcomes and academic success later in life. Qualitative features of the HLE, such as the complexity of speech to the child, the responsiveness of the caregivers, and the nature of caregiver–child interactions, were associated with academic performance (Suskind et al., 2013). Caregiver-directed interventions stem from research highlighting the impact of the HLE on language outcomes (Vigil, Hodges & Klee, 2005). Current interventions, such as the Hanen Parent Training Program (Manolson, 1992), involve teaching caregivers strategies that facilitate language development. This includes an interaction style that is less directive and more responsive to their child’s communication. The program appreciates that caregivers have a unique opportunity to cultivate their child’s language learning through supportive communicative

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS HEARING IMPAIRMENT LANGUAGE DEVELOPMENT LANGUAGE ENVIRONMENT ANALYSIS (LENA)

Michelle Saetre- Turner (top), Cori Williams (centre), and Michelle Quail

144

JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology