Early Communication Intervention for Toddlers with Hearing Loss

项目概要 虽然有听力的儿童 (HL) 在口语方面的进步比以往任何时候都要大， 存在相当大的变异性，许多 HL 儿童的语言技能仍然比他们的孩子差 听同龄人。减少这种变异性的关键是确定：(a) 有效的早期沟通 对 HL 儿童的干预措施以及 (b) 影响干预结果的儿童和家长特征 （主持人和调解员）。然而，迄今为止，只有这项拟议研究的试点研究直接 研究了早期沟通干预对 HL 儿童的影响 随机临床试验。拟议研究的总体目标是：（a）评估 教导家长对儿童沟通结果使用沟通支持策略，并 (b) 检查 调节和调节干预结果的父母和儿童特征。中心假设是 系统的家长培训将导致家长更多地使用沟通支持策略， 儿童前语言行为，以及更好的儿童口语结果。具体目标包括： (a) 比较父母对沟通支持策略的使用和孩子的语言前结果 干预期间和干预后立即干预组和对照组，(b) 检查家长 （沟通洞察力）和儿童（对社会偶然事件的敏感性；对口语的关注） 干预结果的调节因素； (c) 比较父母和孩子对沟通支持策略的使用 干预后干预组和对照组之间的口语结果（从 18 个月到 36 个月） 年龄）； (d) 检查父母（沟通支持策略的使用）和儿童（语言前技能） 干预结果的中介因素。拟议的研究将招募 96 名患有轻度至重度双边双侧疾病的儿童 听力损失。儿童将在 12 个月左右报名参加研究，并被随机分配到 家长实施的沟通干预 (PICT) 或对照组。两组儿童都将 评估：(a) 12 个月大时（干预前），(b) 18 个月大时（干预后立即） (c) 36 个月时（干预结束后 18 个月）。参与干预的儿童 小组将接受为期 6 个月的每周 1 小时的干预课程，其中： (a) 在重要的时期进行 语言发展的前语言时期，(b) 结合了视觉、交互、响应和语言学 刺激与更强的语言能力相关的沟通支持策略 HL，以及 (c) 包括系统的家长培训，发现可以有效地教导家长使用沟通 支持语言发育迟缓儿童的技能。拟议的研究意义重大，因为早期有效 沟通干预可能会减少 HL 儿童持续的语言发育迟缓，从而 推进儿童听力损失领域的发展，该领域严重缺乏严格的沟通 干预研究。

PROJECT SUMMARY While children with hearing (HL) are experiencing greater gains in spoken language than ever before, considerable variability exists and many children with HL continue to have poorer language skills than their hearing peers. Critical to reducing this variability is the identification of: (a) effective early communication interventions for children with HL and (b) child and parent characteristics that influence intervention outcomes (moderators and mediators). However, to date, only the pilot study for this proposed study has directly examined the effects of an early communication intervention for children with HL within the context of a randomized clinical trial. The overarching goals of the proposed study are to: (a) evaluate the effects of teaching parents to use communication support strategies on child communication outcomes and (b) examine parent and child characteristics that moderate and mediate intervention outcomes. The central hypothesis is that systematic parent training will result in greater parental use of communication support strategies, greater child prelinguistic behaviors, and greater child spoken language outcomes. The specific aims include: (a) comparing parent use of communication support strategies and child prelinguistic outcomes between intervention and control groups during and immediately following intervention, (b) examining parent (communicative insightfulness) and child (sensitivity to social contingency; attention to spoken language) moderators of intervention outcomes; (c) comparing parent use of communication support strategies and child spoken language outcomes between intervention and control groups after intervention (from 18 and 36 months of age); and (d) examining parent (use of communication support strategies) and child (prelinguistic skills) mediators of intervention outcomes. The proposed study will enroll 96 children with mild to profound bilateral hearing loss. Children will enroll in the study around 12 months of age and will be randomly assigned to either a parent-implemented communication intervention (PICT) or a control group. Children in both groups will be assessed: (a) at 12 months of age (immediately before intervention), (b) at 18 months of age (immediately after intervention), and (c) at 36 months of age (18 months after the end of intervention). Children in the intervention group will receive weekly, 1-hour intervention sessions for 6-months that: (a) are delivered during an important prelinguistic period of language development, (b) incorporate visual, interactive, responsive, and linguistically stimulating communication support strategies that are associated with stronger language skills in children with HL, and (c) include systematic parent training found to be effective in teaching parents to use communication support skills in children with language delays. The proposed research is significant because effective early communication intervention is likely to reduce persistent language delays in children with HL, thereby advancing the field of childhood hearing loss, where there is a striking paucity of rigorous communication intervention research.