Audiologic evaluations were completed by a certified audiologist with pediatric experience and a test assistant. The audiologist attempted to obtain air-conduction and bone-conduction thresholds at 500, 1000, 2000, and 4000 Hz at a minimum by using visual reinforcement audiometry or conditioned play audiometry, depending on the age of the child. All attempts were made to obtain ear-specific thresholds by using insert earphones, circumaural headphones, or the child’s own earmolds paired with insert earphones. If testing could not be completed, the child’s audiologist provided a copy of the most recent reliable audiogram. To estimate the proportion of the amplified speech spectrum that was audible to the children when they were wearing their HAs, real ear speechmapping measurements were completed using the Audioscan Verifit. The aided Speech Intelligibility Index (ANSI S3.5, 1997) for the standard male speech signal (carrot passage) at an input level of 65 dB SPL was calculated for both right and left ears, and the higher of these values is considered the better-ear aided Speech Intelligibility Index.
At the 18-month and 3-year visits, caregivers and children spent approximately 5 min engaged in the Art Gallery task, which has been used with CNH (Adamson et al. 2004) and children with HL (Quittner et al. 2004). Parents were given the following instructions, “You will notice that there are several pictures in the room. Try to attract your child’s attention to and talk about each of the pictures. After looking at all of the pictures, return to his/her favorite picture and to the picture that he/she seemed to like the least.” The majority of child–caregiver interactions (79%) included the mother as the sole caregiver. Fathers served as the sole caregiver in 13% of interactions, and grandmothers served as the sole caregiver in 1% of interactions. For the remaining 7% of the samples, two caregivers interacted with the child, either the mother and father (5%) or the mother and grandmother (2%).
Research assistants transcribed video recordings of the caregiver and child utterances in the Art Gallery interactions. Transcribers followed conventions that would allow for analysis of utterances using the Systematic Analysis of Language Transcripts software (Miller & Chapman 1998). The software was used to calculate the number of total utterances (NTU), number of total words (NTW), NDW, and mean length of utterances in morphemes (MLUm) for caregiver talk in the samples. A second research assistant independently transcribed 15% of samples for each group (CNH and CHH) at each time point (18-month and 3-year visits) so that interjudge reliability could be calculated. Intraclass correlation coefficients were computed separately for each of the four variables of interest to assess the absolute agreement between independent raters. For the 18-month samples, the estimated coefficient was 0.98 for number of utterances, 0.99 for NTW, 0.99 for NDW, and 0.96 for mean length of utterances in morphemes. For the 3-year samples, results indicated a coefficient of 0.85 for NTU, 0.97 for NTW, 0.97 for NDW, and 0.93 for MLUm. These values are considered to be acceptable, and they suggest that the largest part of the variability in the scores is related to differences between subjects rather than to systematic differences between judges or interactions between judges and subjects.
Using procedures designed for the OCHL project, each caregiver utterance that was fully intelligible and complete (mean: 93.78; SD: 22.81) was coded as serving 1 of 10 mutually exclusive functions: basic acknowledgements, clarification questions, informative statements, informative questions, simple social phrases, test questions, directing utterances, conversational-eliciting utterances that were open ended, conversational-eliciting utterances referencing topics outside the immediate context, and real utterances.† The latter four types of utterances (directing, two conversational-eliciting types, and real utterances) were chosen for analysis in this article because previous literature has indicated that these may specifically serve to hinder or support language development (Hoff-Ginsberg 1985; Taumoepeau & Ruffman 2006; DesJardin & Eisenberg 2007; Rowe 2008; Zimmerman et al. 2009; Cruz et al. 2013). Directing utterances served to direct the child’s attention, behavior, or actions (e.g., “Look right here,” “No, don’t touch that,” “Count the bugs,” and “Say elephant”). Conversational-eliciting utterances comprised two separate codes: open utterances, which invited the child to talk, and outside utterances, which required the child to think outside the immediate context to respond (e.g., “Can you tell me a story?” “What is fishing?” “Do you have a toy like this at home?”). Real utterances were either sincere requests for information to questions for which the caregiver did not know the answer (e.g., “Why do you think that?” and “Which one is your favorite?”) or questions or statements with internal state words, such as “want,” “believe,” and “dream” (e.g., “You think that is funny”). Conversational-eliciting utterances (open or outside) and real utterances were considered high-level functions based on the findings from previous literature (e.g., DesJardin & Eisenberg 2007; Cruz et al. 2013) and thus the counts for these utterance types were added together to calculate the number of high-level utterances.
Interjudge reliability was examined by having a second research assistant use the 10-level coding system to code caregiver utterances in 20% of the samples for each group and time point. The percent agreement ranged from 87 to 100% (mean: 94%) for the 18-month visit and from 83 to 97% (mean: 91%) for the 3-year visit.
At the 18-month visit, parents completed the Communication and Symbolic Behavior Scales Developmental Profile, caregiver questionnaire (Wetherby & Prizant 2002). The caregiver questionnaire queries the parent about the child’s abilities in seven areas within three domains: social communication (emotion and eye gaze, communication, and gestures), expressive speech and language (sounds and words), and symbolic functioning (understanding and object use), yielding a total standard score with a normative mean of 100 and an SD of 15. The manual for the test reports correlations of 0.55 and 0.63 with the receptive and expressive language scores of the Mullen Scales of Early Learning (Mullen 1995), a commonly used measure of communication abilities in infants and toddlers.
At the 3-year visit, children’s communication abilities were assessed via the Comprehensive Assessment of Spoken Language (CASL; Carrow-Woolfolk 1999). The CASL is a clinician-elicited standardized test that assesses children’s lexical/semantic, syntactic, and pragmatic knowledge. There are three core tests for children who are 3 years of age: basic concepts (receptive language/semantic knowledge), syntax construction (expressive language/syntactic knowledge), and pragmatics (expressive language/pragmatic knowledge). Age-normed standard scores were computed for each of the three core tests and were used to calculate a composite standard score with a normative mean of 100 and an SD of 15.
The two language outcome measures were chosen because they assessed both children’s receptive and expressive language abilities (see Table 1 for language outcome scores at both time points for the two groups [CNH and CHH]). SAS version 9.4 was used for all analyses. The statistical techniques that were used to answer each question are noted in the relevant areas of the results section.
We were interested in how caregiver linguistic input to CNH and CHH differed, how caregiver talk to CHH changed over time, which child and family characteristics contributed to variance in caregiver talk to CHH, and the longitudinal relationship between caregiver talk and CHH’s language outcomes. Six variables were selected to represent caregiver linguistic input: two to represent quantity and four to represent quality. Although the vast majority of caregiver–child interactions were between 4½ and 5½ min in length, 3% of the samples were shorter in length than 4½ min and 8% of the transcripts were greater than 5½ min in length (mean: 5.12 min; SD: 0.40; range: 3.52 to 8.25), thus the counts were divided by the number of minutes in the sample (rate per minute) and then multiplied by 5 to normalize all count variables to 5 min.
Before addressing the research questions, we sought to ensure that there was good internal consistency among the measures selected to represent each of the caregiver linguistic input constructs (quantity and quality). Quantity of caregiver talk was represented by NTU and NTW. The Pearson correlation coefficient between these two variables was 0.90 for the combined groups of CNH and CHH at the 18-month visit and 0.71 for the combined groups of CNH and CHH at the 3-year visit. These strong correlations indicate that the variables measured a similar construct. Quality of caregiver talk was represented by NDW, MLUm, proportion of utterances that were high level (High Level), and proportion of utterances that were directing (Directing). The Pearson correlation coefficients for the quality variables are presented in Table 3. A coefficient of alpha analysis provided an overall measurement of how correlated the group of quality variables were to one another. To perform the analysis, all pairwise correlations must be positive, thus Directing was multiplied by −1 to obtain a positive pairwise correlation with the other variables. The coefficient of alpha values were 0.73 and 0.74 for the 18-month visit and 3-year visit, respectively. A coefficient alpha above 0.70 indicates good internal consistency among the different variables. Thus, at both the 18-month and the 3-year visits, it can be concluded that the four variables were measuring a similar construct.
Differences in Caregiver Linguistic Input by Hearing Status
The first research question explored whether quantity or quality of caregiver talk differed based on child hearing status (CNH versus CHH). Two-sample t tests were performed for each of the quantity and quality variables at the 18-month and 3-year visits. When variances were unequal between groups, a Satterthwaite adjustment was implemented. In assessing normality, it was determined that one subject in the CNH was an outlier for Directing and consequently the CNH data for this variable were highly skewed (skew = 1.12). Given the relatively small sample size, a decision was made to remove the subject’s data from analyses of the Directing variable. Summary statistics for the quality and quantity variables are included in Table 4. At the 18-month visit, neither of the quantity measurements differed significantly by group; the CNH and CHH were exposed to relatively similar numbers of total utterances and words by their caregivers. Of the quality measurements, only Directing differed significantly between the groups, with CHH being exposed to a greater proportion of directing utterances than were CNH. At the 3-year visit, the groups were exposed to relatively similar numbers of utterances. However, the groups differed significantly on NTW, with the CHH being exposed to significantly fewer total words than the CNH. All the quality variables differed significantly between groups, with the CHH being exposed to fewer different words, shorter utterances (lower MLUm), lower proportions of high-level utterances, and greater proportions of directing utterances.
Differences in Caregiver Linguistic Input to CHH at the 18-Month and 3-Year Visits
Our second research question explored whether quantity and quality of caregiver talk to CHH differed from the 18-month to the 3-year visit. We approached this question in two different ways, using both a cross-sectional analysis and a longitudinal analysis. In the cross-sectional analysis, only CHH observations were in the analysis, and there were no repeated observations between the 18-month visits and 3-year visits (Table 4). NTU did not differ between the 18-month and 3-year visits. However, NTW was significantly higher at the 3-year visit than at the 18-month visit, indicating that caregivers directed more total words to the 3-year-old children. All the quality variables differed significantly between visits; at the 3-year visit, the CHH were exposed to significantly more different words, longer utterances, greater proportions of high-level utterances, and lower proportions of directing utterances than at the 18-month visit.
The longitudinal analysis was completed on data from CHH who participated in the Art Gallery task at both the 18-month and 3-year visits and who had the same caregiver(s) in both samples (n = 26). As noted in the Materials and Methods section, these children were represented only in the 18-month visit data in the previous analyses. Table 5 contains the summary statistics for the paired t test analysis. Results generally matched those of the cross-sectional analysis. The only exception was that NTW did not reach significance in the longitudinal analysis but did so in the cross-sectional analysis. Thus, children were exposed to similar numbers of total utterances and words at the 18-month and 3-year visits. However, at the 3-year visit, the CHH were exposed to significantly more different words, longer utterances, greater proportions of high-level utterances, and lower proportions of directing utterances than they were exposed to at the 18-month visit.
Factors Contributing to Variability in Quantity and Quality of Caregiver Linguistic Input
For the third question, we were interested in whether child and family factors influenced the quantity or quality of linguistic input caregivers offered to CHH. Child and family factors were child sex (male or female), BEPTA, age at HA fit (<6 months or >6 months), child language abilities (represented by standard scores on the language outcome measures at each visit), and SES (represented by maternal education: high school education or less, some college, college graduate, or graduate education). For each time point (18 months and 3 years), linear regression analyses were used to examine the contributions of the five child and family factors to variability in each of the caregiver input variables, thus there were six regressions (one for each of the caregiver input variables) completed at each age point. All five child and family factors served as the independent variables in each regression. As can be seen in Tables 1 and 2, a small number of CHH had missing data for maternal education, language abilities, or age at HA fit, thus resulting in 7 CHH being excluded from the 18-month regression (n = 64) and 10 CHH being excluded from the 3-year regression (n = 75). Zero-order correlations between the child and family variables are reported in Table 6 for children included in the regression.
At the 18-month visit, regression models were only significant for NTU and NTW (NDW: R 2 = 0.14, p = 0.11; MLUm: R 2 = 0.15, p = 0.09; High Level: R 2 = 0.05, p = 0.72; and Directing: R 2 = 0.15, p = 0.08) (see Table 7 for results of the significant regression models). Overall, the child and family factors accounted for 18% of the variance in NTU and 19% of the variance in NTW. For NTU, only sex and BEPTA accounted for significant, unique variance, with boys being exposed to fewer total utterances than girls and children with more HL being exposed to fewer total utterances than children with less HL. For NTW, only BEPTA and SES accounted for significant, unique variance, with children with more HL and children from lower SES homes being exposed to fewer total words.
At the 3-year visit, the model for NTW was not significant (R 2 = 0.08, p = 0.32), but models for the other five caregiver talk variables were significant (see Table 8 for results of the significant regression models). Neither sex nor SES accounted for any significant, unique variance. BEPTA accounted for significant, unique variance only in NDW, with children with more HL being exposed to fewer different words. Age at HA fit accounted for significant variance only in MLUm, with children fit at or after 6 months being exposed to slightly longer utterances than children fit before 6 months. Child language accounted for significant, unique variance in all five of the significant models, with stronger child language abilities being associated with fewer total utterances but higher quality input.
As a post hoc analysis to explore why the direction of the relationship differed for child language with NTU when compared with child language with the quality variables, Pearson correlation coefficients were calculated for the relationship between NTU and the quality variables at the 3-year visit. NTU had a significant, positive relationship with NDW and Directing, but a significant negative relationship with MLUm and High Level. Thus, caregivers who used more utterances were likely to also be using shorter utterances that were Directing and not High Level. For comparison purposes, the same correlations were calculated for caregiver linguistic input at the 18-month visit. At the earlier time point, NTU had a significant positive relationship with NDW and MLUm but a significant negative relationship with Directing. Note that the direction of the relationship for NTU with MLUm and Directing was reversed at the 18-month visit when compared with the 3-year visit. That is, at the 18-month visit, use of high numbers of utterances was associated with producing relatively long utterances and lower proportions of directing utterances, but at the 3-year visit, use of high numbers of utterances was associated with producing relatively short utterances and higher proportions of directing utterances.
Relationships Between Caregiver Linguistic Input at 18 Months and Language Outcomes at 3 Years
For the fourth research question, a longitudinal analysis of the relationships between caregiver linguistic input and CHH’s later language abilities was completed with data from 35 CHH who completed the Art Gallery task at the 18-month visit and who also contributed CASL scores at the 3-year visit. Linear regression analyses were used to separately examine the contributions of quantity and quality of caregiver linguistic input at 18 months to children’s language outcomes at 3 years. The variance inflation factor was used to measure multicollinearity, and since all values were less than 2, there was no cause for concern. The regression model for quantity of caregiver talk was not significant (R 2 = 0.09, p = 0.24). However, the regression model for quality of caregiver talk was significant, with the variables as a group accounting for 28.3% of variance in children’s CASL scores at 3 years (p = 0.04). Of the four quality variables, Directing contributed significant, unique variance to CASL scores at 3 years (β = −0.51, p = 0.01), whereas the other variables did not (NDW: β = −0.20, p = 0.32; MLUm: β = 0.39, p = 0.06; High Level: β = −0.24, p = 0.18). Figure 1 depicts the relationship between Directing at 18 months and CASL scores at 3 years (r = −0.41, p = 0.03). The direction of the relationship indicates that CHH who were exposed to greater proportions of directing utterances at the 18-month visit had weaker language skills at the 3-year visit than CHH who were exposed to lower proportions of directing utterances at the earlier time point (Fig. 1).
This study examined the quantity and quality of caregiver talk directed to CHH and CNH in an effort to determine ways in which such input contributes to variance in children’s outcomes. In general, the results suggest that quantity of caregiver talk was fairly comparable across the two groups at both 18 months and 3 years. However, quality measures were sensitive to differences, especially at 3 years. In particular, directiveness was a more common feature in dyads involving CHH than CNH. Longitudinal analysis involving only the CHH revealed that caregivers increased the complexity of their talk over time. However, analyses also suggested that directing utterances were negatively associated with child language outcomes, which is consistent with past findings on children who are typically developing (Akhtar et al. 1991; Rowe 2008) and those who are deaf (Vohr et al. 2010; DesJardin et al. 2014). Data from the 3-year visit revealed associations between child language and caregiver talk, which may be reflecting the inherent bidirectionality of these influences.
The first research question examined whether the quantity or quality of caregiver talk directed to CHH differed from that directed to CNH. For quantity of talk, no differences between groups were predicted. Although this prediction was upheld at the 18-month visit and for NTU at the 3-year visit, caregivers did use significantly more total words with CNH than CHH at the 3-year visit. Given the similar number of utterances between groups and the differences observed in MLUm, this was indicative of the caregivers using longer utterances with the CNH. Differences in quality of talk to CNH versus CHH were predicted and subsequently indeed identified. At the 18-month visit, caregivers of CHH used a greater proportion of directing utterances than caregivers of CNH, and at the 3-year visit, the CHH were exposed to poorer quality input than the CNH. This fits with findings from previous work indicating that hearing parents use lower quality speech when communicating with their deaf children than do hearing parents of hearing children (Cross et al. 1980; Nienhuys et al. 1985).
The observed differences in this study may indicate that caregivers of the CHH were adapting their input to children’s linguistic levels. That is, if parents were attuned to the fact that children had limited receptive or expressive language abilities, parents may have adapted their own language level by using a more limited range of vocabulary, producing less complex sentences, or asking fewer open-ended questions. Although this may have allowed children to be more successful in processing and responding to the language input, it is unclear whether, in the long-term, this serves to support or hinder children’s language development. As Hoff-Ginsberg (1998) noted, although some simplification relative to adult-directed speech is needed in interactions with young children, the input to children must still be sufficiently complex to allow children to learn about the structure of the language. Oversimplified linguistic input, paired with frequent use of directing utterances and infrequent use of conversational-eliciting strategies, is likely to provide the child with a less than optimal language learning environment, regardless of the child’s stage of language development. Further research is needed to determine the levels or aspects of simplification that promote or hinder language development.
Longitudinal Changes in Caregiver Talk Directed to CHH
The second research question asked how caregiver talk to CHH changed over time. Data from both the cross-sectional and longitudinal analyses indicated that quantity is more stable over time than quality, which fits with the predictions outlined regarding this relationship and with findings of previous research (Cohen & Beckwith 1976; Olsen-Fulero 1982; Huttenlocher et al. 1991; D’Odorico et al. 1999). Changes in the quality variables from the 18-month visit to the 3-year visit indicated that caregivers provided the CHH with higher quality input at 3 years than at 18 months. Although caregivers may alter their linguistic input simply in response to the child’s age, it is also possible that these differences reflect caregivers’ sensitivity to changes in their children’s behavior and language abilities. As children expand their receptive lexicons and become more capable of processing complex sentences, caregivers may respond with increased use of quality features in their own talk. It is worth noting that although most caregivers increase their use of quality features of linguistic input over time, other research indicates that they also tend to maintain their positions relative to other parents in terms of the complexity of their speech (Huttenlocher et al. 2007). Thus, parents who provide their children with the least complex input relative to other parents at an early time point will continue to provide their children with the least complex input at later time points relative to other parents.
Influence of Child and Family Factors
The third research question explored the relationships of child and family factors with caregiver talk. Contrary to predictions and in contrast with findings of previous studies (e.g., Hoff-Ginsberg 1991; Hart & Risley 1995), SES contributed significant, unique variance to only one caregiver input variable at the 18-month visit and no variables at the 3-year visit. This may be a result of the group being relatively advantaged for SES, thus resulting in an underestimation of the impact of SES on caregivers’ linguistic input. It is also possible that other measured and unmeasured factors were playing a more predominant role than SES. For example, all CHH were enrolled in early intervention services where their caregivers were likely coached regarding the types of linguistic input that would best support their child’s language development. This intervention may have resulted in lower SES families providing their children with higher quantity and quality caregiver talk than they would have provided without intervention. In addition, SES may have been related to child language abilities, which were controlled for in the analyses, potentially reducing the strength of the relationship between SES and the six caregiver linguistic input variables.
Findings also were mixed regarding the audiologic variables. BEPTA was found to contribute unique variance in both of the significant models at 18 months and one of the five significant models at 3 years. In each case, children with more HL were being exposed to poorer quantity or quality input. This is concerning given that these children are likely to have the most inconsistent access to linguistic input due to the severity of their HL. Inconsistent access, combined with exposure to fewer utterances, total words, or different words, will reduce these children’s language learning opportunities. Age at HA fit, which served as the other audiologic variable, was only found to contribute unique variance in one of the significant models. In addition, the finding was counterintuitive, with the later-fit group of children being exposed to more complex utterances. This finding may have been spurious and thus limited conclusions can be drawn without further research.
The findings regarding the relationships between caregiver talk and child language abilities were mixed, with these relationships only emerging at the 3-year visit. It is possible that the younger children were not far enough along in language development to demonstrate the benefit from the quality features of caregiver talk. Yet, as their communication development progressed, they may have become more capable of taking advantage of the beneficial effects of high-quality linguistic input, thus leading to the observed relationships between caregiver talk and child language at the 3-year visit. Another possibility is that the additional 18 months of time between the two visits simply allowed for the cumulative effects of caregivers’ linguistic input on children’s language development to become apparent. The changing relationship may have also been driven by changes in the parent as opposed to the child. That is, parents may have become more sensitive to children’s developing language abilities by the later time point, resulting in caregivers responding to children’s advancing language abilities by providing them with higher quality linguistic input.
Contributions to Child Language Outcomes
The fourth research question explored the longitudinal contributions of quantity and quality of caregiver talk to child language outcomes. Contrary to predictions, quantity of caregiver talk was not positively associated with children’s language outcomes at either time point. It is possible that this was related to the methodology used in this study, which included use of caregiver–child interactions that were restricted in length. It may be more valid to measure quantity of caregiver input in naturalistic settings, where the amount of time that children and caregivers interact is allowed to vary freely over a longer period of time. In contrast with the findings related to quantity, quality of caregiver talk was related to child language outcomes, with directing utterances being the one quality variable that contributed significant unique variance to outcomes. This fits with previous findings indicating that parental interaction styles that are directive, as opposed to responsive, are associated with poorer child language outcomes (McDonald & Pien 1982; Akhtar et al. 1991; Kloth et al. 1998). However, several authors have hypothesized that not all directive utterances or directive styles have a negative effect on child language (Akhtar et al. 1991; Pine 1992; Taylor et al. 2009); for example, Akhtar et al. (1991) found that use of directive utterances that followed the child’s focus of attention, such as directing the child to complete an action on a toy he or she is already playing with, was positively correlated with children’s vocabulary development. However, use of directive utterances that changed the child’s focus of attention was negatively related to outcomes. The coding for the current project did not differentiate between the two types of directing utterances.
In a recent international consensus statement on best practices for family-centered intervention for children who are deaf and hard of hearing, a panel of experts indicated that 1 of the 10 most important principles was “families and providers work together to create optimal environments for language learning” (Moeller et al. 2013, p. 436). This fits with recommendations from the Joint Committee on Infant Hearing (2013, p. e1343) that service providers have the knowledge and skills to “coach families in the use of strategies that promote a language-rich environment to facilitate language, thought, and early literacy.” The results of the present study support these recommendations and, specifically, the early intervention practices of coaching families to be sensitive to their child’s unique linguistic needs, while also providing their child with a language learning environment that is sufficiently complex to promote linguistic development. The standard practice of coaching parents to elicit conversations, as opposed to directing their child’s attention or behaviors during interactions, is also supported. Based on the current findings and previous research, it may be especially important to carefully monitor and support caregiver–child interactions for families from lower SES backgrounds and for those who have children with moderate-to-severe HL.
Limitations and Future Research Directions
One potential limitation of this study is that caregiver talk was examined in relatively brief caregiver–child interactions, with an average length of just over 5 min. Longer samples may present a more stable picture of caregivers’ linguistic input. However, it should be noted that, on average, the samples included around 100 caregiver utterances, which is generally deemed sufficient for language sample analysis (Leadholm & Miller 1992). Another potential limitation of the methodology is that the Art Gallery format may have encouraged a more adult-directed context than other formats, such as free play. However, despite the somewhat structured format, caregivers displayed substantial variance in their communicative styles. Future work should look at the stability of the features of caregiver talk in samples of varying length and samples collected with a variety of methodologies.
Another limitation of this study was that the coding system did not directly examine caregivers’ responses to children’s communication attempts, thus limiting the conclusions that could be drawn regarding caregivers’ sensitivity and responsiveness to children’s language abilities. Additional investigation in these areas may be warranted, including examination of caregiver use of linguistic features such as expansions and recasts, given the extensive literature documenting the importance of these caregiver behaviors. Models that more globally examine interactions for caregiver characteristics such as sensitivity, responsivity, and positivity could also be applied in future investigations of how caregivers interact with CHH, allowing for a more comprehensive picture of dynamics within these dyads. A further limitation of this study is that the design did not allow for specifying the directionality of the relationship between caregiver input and child language outcomes. Although it is suspected that this relationship is bidirectional, future investigations could shed further light on directionality by making comparisons between caregiver talk to CHH versus caregiver talk to other conversational partners with varying linguistic skill levels.
Future work may also benefit from better or differently matched groups. Specifically, the 18-month and 3-year CHH differed in age at HA fitting and should be better aligned on this variable in future studies. In addition, matching groups based on the child’s language age as opposed to chronological age may further our understanding of the relationship between caregiver input and child language. Future longitudinal work should also make use of the same language measure at each time point and should compare longitudinal changes in talk to CHH to changes in talk to CNH.
In the introduction to this OCHL Supplement, we hypothesized that HL interferes with the consistency and/or quality of children’s access to linguistic input, which over time results in an overall reduction in cumulative auditory-linguistic experience. This process has the potential to impede language learning, although there are factors that can increase risk or protect against risk. The relationships that were identified between features of caregiver linguistic input and children’s language abilities support inclusion of this variable in the model and the importance of providing CHH with optimal input as one means of protecting against risk. Currently, linguistic input may not be optimized for all CHH, as evidenced by the large variance in the caregiver linguistic input variables for the CHH and the CHH being exposed to linguistic input that was more directive at the 18-month visit and more limited in quantity and quality at the 3-year visit than the talk directed to the CNH. To ensure that all CHH are exposed to optimal input, it is important that we encourage early intervention practices of coaching caregivers to provide CHH with high amounts of quality linguistic input and to adopt an interaction style that is conversational eliciting as opposed to directive.
This research was supported by three grants from the National Institutes of Health/National Institute on Deafness and Other Communication Disorders: R01DC009560, R01DC013591, and R03DC012647.
* Although eligibility criteria for the hard of hearing group included a better-ear three- or four-frequency pure-tone average no better than 25 dB HL and no poorer than 75 dB HL, exceptions to this criterion were made to allow for inclusion of children with bilateral, high-frequency HL (n = 3). In addition, children who initially fit this eligibility criterion but later progressed beyond 75 dB HL were retained in the study (n = 4), unless they received a cochlear implant.
† For additional information on the 10-level coding system, contact the first author.
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Caregiver talk; Hard of hearing; Hearing loss; Language development; Linguistic input
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