Helping Children who are Deaf or Hard of Hearing Meet Their Full Potential
Through our research, we have learned that many factors can affect a child’s progress. Children who are DHH have the ability to develop better communication skills than we have expected of them in the past. They often underperform when they are not provided with appropriate and effective language supports and interventions. It is important to understand a child’s unique abilities and skills. Only then can we set appropriate therapy goals and help children meet their individual potential.
Effective language and communication skills are the foundation for children to be successful as adults. Children who are DHH need evidence-based therapy approaches that support language growth. The technology assisted language intervention (TALI) study is showing improvements in spoken language skills and standard language scores when AAC technology used in speech-language therapy. The improvements are greater than treatment as usual (no change in current therapy). These findings need to be explored more in some areas, but bring hope and excitement to our ability to help children who are DHH. Learn more about research efforts below.
Current Projects
Technology Assisted Language Intervention (TALI) Trial
Many children who are DHH struggle with word endings, vocabulary, pronouns (he, she, they, her, etc…), conjunctions (and, or, but), word order, using longer phrases and sentences, word order, time concepts, and social skills. To improve language skills, we are using augmentative and alternative communication (AAC) technology. AAC is typically used by children who have trouble communicating with verbal speech. AAC can include pictures, recorded speech devices, and electronic tablets.
In the Technology Assisted Language Intervention (TALI) trial, we are studying how to use AAC as a tool to teach language skills to children who are DHH. We are using language software on an electronic tablet (iPad). We use TALI during speech-language therapy with a speech-language pathologist. We partner with the Children’s Hospital of Colorado (CHCO) TALI team as a second study site. The studies that we have done before show that many children who are DHH need extra supports to catch up to same-age peers.
We are comparing speech language therapy with and without the use of the Technology Assisted Language Intervention. We want to identify which approach helps children with DHH meet their full potential more fully.
When children enter the study, we evaluate their language skills through testing and taking a language sample. Children are divided randomly into two groups. One group receives the Technology Assisted Language Intervention as part of speech language therapy. The second group continues to receive speech language therapy (without the use of TALI). After participating for 24 weeks, we evaluate language skills again.
Previous Projects
Language and Independent Functional Expectations (LIFE) Study
To better understand how language and nonverbal cognitive abilities in children who are DHH affect life-long skills. Children participated for two years and received neurocognitive, language, and functional-adaptive skill assessments, including parent and teacher-report measures once every 12 months. Unfortunately, there is limited research on factors that affect the participation of a child who is DHH in everyday activities. We would like to help children who are DHH early in life, so they will rely less on services and supports later in life.
Findings
We found that functional outcomes in children who are DHH are often below same-age peers. This study helped us to understand how to create effective interventions targeting improved language skills and functional independence.
Impact of Cognition on Language in Pediatric Hearing Loss and Cognitive Disabilities
Our goal was to improve language and communication in children with both hearing loss and cognitive or intellectual disabilities. We know that children who are DHH and have other disabilities are very likely to struggle with communication. We studied the effect of cognitive abilities and hearing loss on language skills and described the language interventions and strategies that were used with them in detail.
Findings
We found that cognitive abilities often affect language skills in children who are DHH. We also learned more about language interventions and strategies that are used with children who are DHH.
Understanding the Impact of Permanent Hearing Loss on Diagnosing Autism Spectrum Disorders
Our goal was to understand the presentation and diagnostic timelines of autism spectrum disorder (ASD) in children who are also DHH. Because there are limited tools to diagnose ASD in children who are also DHH, children who are DHH often experience delayed or missed diagnosis of also having ASD.
Findings
Children who are DHH with an autism spectrum disorder often had an early age of diagnosis of hearing loss (in infancy and young childhood) however a diagnosis of autism spectrum disorder came at a much later age, ranging from 3 years to 8 ½ year of age. This is much later than the age of diagnosis of autism spectrum disorders in the general population and only 25% of the group was diagnosed at an age similar to the general population. Children had a range of communication strategies including relying on spoken language, total communication, and sign language.
Outcomes of Children with Hearing Loss and Developmental Disabilities
Our goal was to understand what happens to a child’s language skills after getting a cochlear implant. We studied the language skills of children with developmental disabilities who had received cochlear implants at a young age. Children with cochlear implants were matched to a control group of children with typical hearing (similar ages and disabilities) to compare language skills between the two groups.
Findings
We found that language scores were higher when sign language was also used during testing. Also, the child’s cognitive abilities were the strongest predictor of language outcomes. Finally, children made progress with language after the cochlear implant. Yet, children with additional disabilities still performed well below their cognitive ability when compared to hearing children (similar ages and disabilities).
Cochlear Implant Outcomes in Children with Disabilities
Our goal was to evaluate language and functional outcomes of children who are deaf with additional disabilities who had received a cochlear implant. We worked to describe language development and functional skills in children who are deaf so we could better understand how a cochlear implant affects development in children with additional disabilities.
Findings
We confirmed that language plays a key role in social skills. We found that children with additional disabilities and a cochlear implant improved social communication skills, self-care skills, and mobility, but only if they also made improvements in language comprehension too. We have used the findings from this cochlear implant study to address the needs of children with all degrees of hearing loss.
Cochlear Implants for Children with Deaf-Blindness (CICDB) Project
Findings
115 children with dual sensory impairment who received cochlear implants received a language evaluation developed for vision impairment in children and adapted for children with dual sensory impairment post-implantation.
20% of children with dual sensory impairments reached higher level receptive (following simple and more complex directions) and expressive language abilities (speaking in simple or complex sentences) post-implant. The remainder performed at pre-linguistic levels of communication. Higher developmental quotients are strongly associated with higher levels of communication. Often children who are deaf-blind have neurologically or cognitively based limitations which can impact their language progress.
Perceived Qualitative Benefits of Cochlear Implants in Children with Multi-Handicaps
Our early studies focused on qualitative benefits of cochlear implants in children with complex medical and developmental needs. Through a series of parent interviews of 20 children who were deaf with an additional disability who received a cochlear implant, we had a better understanding of a broader range of positive cochlear implant outcomes for children with additional disabilities.
Findings
After receiving a cochlear implant, parents reported their children having improved awareness of the environment and connectedness, and communication skills. All families said that if they were to make the decision again, they would choose to have their child implanted.
