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Vocalizations of Infants with Hearing Loss Compared with Infants with Normal Hearing: Part I – Phonetic Development

Moeller, Mary Pat1; Hoover, Brenda1; Putman, Coille1; Arbataitis, Katie1; Bohnenkamp, Greta1; Peterson, Barbara1; Wood, Sharon1; Lewis, Dawna1; Pittman, Andrea2; Stelmachowicz, Pat1

doi: 10.1097/AUD.0b013e31812564ab
Research Articles

Objective: Infants with hearing loss are known to be slower to develop spoken vocabulary than peers with normal hearing. Previous research demonstrates that they differ from normal-hearing children in several aspects of prelinguistic vocal development. Less is known about the vocalizations of early-identified infants with access to current hearing technologies. This longitudinal study documents changes in prelinguistic vocalizations in early-identified infants with varying degrees of hearing loss, compared with a group of infants with normal hearing. It was hypothesized that infants with hearing loss would demonstrate phonetic delays and that selected aspects of phonetic learning may be differentially affected by restricted auditory access.

Design: The vocalizations and early verbalizations of 21 infants with normal hearing and 12 early-identified infants with hearing loss were compared over a period of 14 mo (from 10 to 24 mo of age). Thirty-minute mother-child interaction sessions were video recorded at 6- to 8-wk intervals in a laboratory playroom setting. Syllable complexity changes and consonantal development were quantified from vocalizations and early verbalizations. Early behaviors were related to speech production measures at 36 mo of age. Participants with hearing loss were recruited from local audiology clinics and early intervention programs. Participants with normal hearing were recruited through day care centers and pediatrician offices.

Results: Relative to age-matched, normal-hearing peers, children with hearing loss were delayed in the onset of consistent canonical babble. However, certain children with moderately-severe losses babbled on time, and infants with cochlear implants babbled within 2 to 6 mo of implantation. The infants with hearing loss had smaller consonantal inventories and were slower to increase syllable shape complexity than age-matched normal-hearing peers. The overall pattern of results suggested that consonant development in infants with hearing loss was delayed but not qualitatively different from children with normal hearing. Delays appeared to be less pronounced than suggested by previous research. However, fricative/affricate development progressed slowly in infants with hearing loss and divergence from the patterns of normal-hearing children was observed. Six children (2 with normal hearing; 4 with hearing loss) were identified as atypical, based on their rates of development. At 24 mo of age, these children persisted in producing a high proportion (0.59) of vocalizations lacking consonants, which was negatively correlated with Goldman-Fristoe scores at 36 mo (r = −0.60).

Conclusions: Results suggest that early-identified children are delayed in consonant and syllable structure development, which may influence early word learning rates. Fricative/affricate development appears to be challenging for some infants with hearing loss. This may be related to the effects of sensorineural hearing loss on high-frequency information, restricted bandwidth provided by amplification, and reduced audibility in contexts of noise and reverberation. Delayed fricative use may have implications for morphological development. Atypically slow rates of change in syllable development may indicate that a child is at risk for delayed speech development.

The present study explored relationships between phonetic development and later vocabulary and articulation skills in infants and toddlers with early-identified hearing loss. Children with normal and impaired hearing were compared on measures of syllable structure development and consonant inventory changes between 10 and 24 mo of age. Overall, the groups differed on age at production of true syllables, rate of syllable complexity changes, and consonant inventory expansion. Fricatives/affricates were particularly slow to emerge in the vocalizations of children with hearing loss. Early phonetic delays explained unique variance in vocabulary and speech outcomes at 36 mo of age. Individual differences analysis provided clinical insights about variables influencing these relationships.

1Boys Town National Research Hospital; Omaha, Nebraska; and 2Arizona State University, Tempe, Arizona.

Address for correspondence: Mary Pat Moeller, PhD, BTNRH, 555 N. 30th Street, Omaha, NE 68131. E-mail:

Received September 21, 2006; accepted April 11, 2007.

© 2007 Lippincott Williams & Wilkins, Inc.