1. Dr Sarah Collinson NatSIP discussion event Autumn 2017
Early years language and development in deaf children: findings from a best evidence review
Dr Sarah Collinson
NatSIP discussion event
Autumn 2017

2. Purpose
To survey recent research literature on young deaf children’s language and communication & associated cognitive and social skills
To provide an evidence base to inform implementation of the new NDCS strategy
A ‘scoping’ review: mapping the best available evidence across a wide spectrum of relevant literature

3. Methodology
~ 300 references initially identified on the basis of the title and the abstracts and scanned for potential relevance
Approximately 200 references were selected for closer reading and grouped according to main focus.
Final sample of 65 journal articles and book chapters selected for the final review

4. Context
Early identification and access to digital hearing aids and CIs have improved overall outcomes, but still significant variation
The main factors that account for this variation (‘predictors’) fall into three main categories:
Auditory
Child-related
Environmental
These interact to account for individual differences

5. Environmental factors
These have the greatest impact in the early years (positively or negatively)
They are also the most amenable to being influenced through family-focused advice and interventions
The review focused on what happens and what can be done within the family, especially in day-to-day parent-child interaction

6. Environmental factors – main themes
Factors affecting early speech perception
Factors affecting early attention to speech and language
The quality and quantity of parents / carers’ language input:
..... affecting *language development
AND
*cognitive & psychosocial development

7. Early speech perception
Auditory AND visual perception
go hand-in-hand
Early speech perception
Deaf infants and young children should be encouraged and helped to lip-read as well as to listen to speech (audio-visual speech perception / integration)
Evidence on audio-visual speech perception presents a challenge to AVT which prioritises listening only
Cued Speech can be used to enhance / enable deaf children’s visual (and audio-visual) perception of speech from infancy – this is particularly relevant for children with little or no or uncertain auditory speech perception abilities
For children with ANSD, language development should be supported visually

8. Early speech perception
Parents need support with device use and the listening environment
Early speech perception
Parents need specific guidance about the importance of HA and implant use
Variation in device use at home and in aided audibility among infants and young children underlines the importance of supporting families to optimise the acoustic / noise environment
Parents should be encouraged to reduce their children’s exposure to electronic media, and could be supported to use an ALD

9. Infant’s / child’s attention to speech and language
Parents should be encouraged and supported to use ‘motherese’ / IDS; those experiencing anxiety or depression may need additional support with this.
Hearing parents may need targeted support to establish early joint attention and responsive two-way interactions with their deaf child
Special attention may need to be given to helping parents to follow their child’s attention lead

10. Parents’ language input for good language outcomes
Deaf children are particularly sensitive to the influences of their language environment
Early exposure to a rich fluent language model is critically important for all later language learning;
Hearing parents can provide this most easily in their native spoken language

11. Parents’ language input for good language outcomes (2)
There seems to be a positive correlation between parents’ use of spoken communication and good language outcomes for CI-users
There is no conclusive evidence that adding sign language interferes with spoken language development ...
.... but nor is there evidence that adding sign language supports spoken language acquisition
A child’s early acquisition of a first spoken language can support their later learning of sign language

12. Parents’ language input for good language outcomes (3)
Hearing parents of deaf children tend to use less complex language structures and less high-quality talk than parents who share the same hearing status with their children
Parents’ use of oversimplified language combined with less responsive communication strategies may impoverish the language learning environment for many deaf children
Both QUALITY and QUANTITY of language input matters!

13. Parents’ language input for good language outcomes (4)
Higher-level facilitative language techniques (FLTs), such as parallel talk and open-ended questions, predict language growth whereas lower-level FLTs don’t
Parents of deaf children have been found to use more lower-level FLTs than higher-level FLTs.
A ‘coaching model’ focused on using higher-level FLTs could help empower parents to support and enhance their children’s language development
Help parents with higher-level FLTs

14. Parents’ language input for good cognitive & psychosocial outcomes: Theory of Mind
Deaf children with hearing parents often display a delayed development of ‘Theory of Mind’ (ToM)
ToM development is affected by parents’ ‘mental talk’ and connected conversation turns; hearing parents of deaf children tend to use less mental state language and less turn-taking
A small increase mental states talk could make a big difference
Young children’s early habilitation to hearing aids and CIs could emphasise aspects of speech that help with emotion perception

15. Language input affecting cognitive & psychosocial outcomes: social skills
Language development has been found to be closely correlated with the development of social competence
Studies demonstrate lower social competence and more social behaviour / psychosocial problems in HI children overall compared to children with normal hearing, e.g. delayed pragmatic skills
Poor conversational ability may adversely affect a child’s capacity to interactively engage the parents, which in turn reduces the quantity and quality of parents’ language input

16. Language input affecting cognitive & psychosocial outcomes: social skills (2)
Psychosocial development risk should be considered for all preschool children with hearing loss, including those who perform well on traditional language measures and children with lesser degrees of hearing loss.
A number of recent studies point to the importance of early intervention programmes that target social skills development as well as language for deaf pre-schoolers.

17. Language input affecting cognitive & psychosocial outcomes: executive function skills
Early sensory deprivation can cause delays in deaf children’s neurocognitive development but there is also strong evidence for social influences, including the home language environment
Children who experience higher levels of maternal sensitivity, maternal cognitive stimulation and access to stimulating resources in the home have been shown to score much higher on sustained attention, impulsivity, and memory
Families can be helped to optimise children’s development of executive function skills

18. Programmes and interventions helping parents to help their children
Not all parents are aware of ‘best language input practices’ for their children
Early intervention should seek to enhance both the competence and confidence of children’s parents: parents with higher self-efficacy are more likely to put their knowledge and skills into action
Providing information may not be enough for some parents – they might need to be explicitly taught the relevant skills

19. Programmes and interventions helping parents to help their children
Parents need to understand that they can enhance their child’s intelligence and cognition through good language communication strategies (incremental theory of intelligence)
Experience from programmes such as ‘Project ASPIRE’ in the US suggests that parents’ uptake can be supported by matching language-enhancing strategies with routine daily activities
Continuing support is likely to be needed to help parents to maintain the gains made from any parenting intervention