Parent-delivered communication intervention for infants and toddlers who are DHH

If you’re an early intervention SLP, you’ve probably had a child who is deaf or hard of hearing (DHH) on your caseload at one time or another. Why? Well, advances in hearing aid and cochlear implant technology have certainly improved the speech and language outcomes of children who are DHH, but aided hearing isn’t the same as typical hearing. And even with early amplification, these children often still miss out on language stimulation pre-amplification, which can lead to delays.

In this study, they taught the parents of nine 6 to 24-month-olds with hearing loss to use four different strategies to promote and reinforce their communicative attempts. This included visual strategies such as moving toys in the child’s line of sight, and interactive strategies such as following the child’s lead and modeling target language to their actions. Parents were also taught responsive strategies like balancing the number of conversational turns that they took when communicating with their child, and linguistically stimulating strategies like expanding on their child’s spontaneous utterances.

The parents who participated in the training and delivered the intervention used more strategies that support communication compared to the parents in the control group. And, by the end of the study, the infants and toddlers who received the intervention demonstrated more prelinguistic communication skills compared to the children in the control group.  

The beauty of this study is twofold: 

First, the strategies that were included in the intervention are all things that we as EI providers are already well-versed in. {That’s because we’re all pretty darn familiar with enhanced milieu teaching (Hemmeter & Kaiser, 1993), prelinguistic milieu teaching (Yoder & Warren, 2002), and The Hanen Program (Girolametto, Pearce, & Weitzman, 1996)}. Second, if you’re an EI therapist, a big part of your job already involves parent training and coaching. This article provides a very simple, clear description of the key strategies that you can teach parents of infants and toddlers on your caseload who are DHH. Definitely the kind of article that you can read and then immediately apply to your practice, which is the best kind of article, am I right?!

 

Roberts, M. (2018). Parent-Implemented Communication Treatment for Infants and Toddlers With Hearing Loss: A Randomized Pilot Trial. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2018_JSLHR-L-18-0079

Parent training: vocabulary growth for toddlers with hearing loss

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Toddlers with hearing loss do not gain vocabulary at the same rate as toddlers with normal hearing. Some of the reasons for this delay are out of our control as therapists. We cannot change a child’s speech perception or the age at which the child received amplification. What we can do is manipulate the child’s environment to promote vocabulary growth.

Lund trained six parents of toddlers with hearing loss in two strategies: transparent naming and linguistic mapping.

Transparent naming is using a new vocabulary word while visually signaling (pointing) to the referent. This has been found to increase children’s vocabulary skills (groundbreaking, I know).  All six parents were able to increase their use of transparent naming with just two 45-minute training sessions.

Linguistic mapping is a little more complex. It involves overlaying words on a child’s communicative act after that child has initiated intentional communication. This is not simply narrating the actions of a child. It requires the communication partner to correctly interpret a child’s communicative attempt and quickly generate an appropriate utterance to go with it.  Only half of parents were able to adequately demonstrate linguistic mapping after two training sessions, which suggests that a little more time might be needed to teach parents this particular skill.

After training sessions were completed, four out of six children increased their rate of word learning. If you have any tots on your caseload with hearing loss, or who are struggling with word learning, you might consider training parents in transparent naming and linguistic mapping.

Lund, E. (2018). Effects of parent training on vocabulary scores of young children with hearing loss. American Journal of Speech-Language Pathology, 1–13. Advance online publication. doi: 10.1044/2018_AJSLP-16-0239