Family Processes in Developmental Outcomes of Pediatric Hearing Loss

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Project Summary/Abstract This revised application requests support for a new program of research on the influence of family processes on core developmental outcomes in children with hearing loss. Despite widely available technology to identify hearing loss as early as the first week of life and significant signal processing advancements in hearing aids and cochlear implants, enormous individual differences still remain in the degree to which children fully benefit from these medical interventions. A critical barrier to achieving optimal outcomes and developing new interventions is a lack of knowledge and understanding of the relevant contributing factors and mechanisms that affect variability in developmental outcomes in children with hearing loss. Extending the work on typically developing children and other clinical populations, emerging research suggests that a potent, yet ignored source of variance - the family environment - contributes to outcomes in children with hearing loss. However, the extent of these associations, their underlying developmental mechanisms, and how they differ from families of children with normal hearing are unknown. This significant knowledge gap will be addressed in the proposed study, which will use a multi-source (parent, child, and teacher), multi-trait (questionnaires, direct observation, and child and caregiver performance measures) longitudinal research design to measure 3- to 8-year-old normal-hearing and hearing-impaired children's spoken language and executive function development over two years and investigate the most relevant family factors in cognitive and linguistic development at the same time points to uncover the family mechanisms linking hearing loss risk to these core developmental outcomes. The specific aims of the proposed research are to: 1) identify differences in family environment and parenting factors in families of young children with different hearing histories; and 2) to uncover the developmental mechanisms through which family and parenting factors influence spoken language and executive function development in children with hearing loss in early childhood. Our findings will be significant for development of understanding and explaining the contributing role of hearing, speech perception and family dynamics in the children's development of language and executive function. Our findings also will be clinically significant by providing new, requisite, foundational knowledge that will guide the design of future intervention studies by identifying not only which family environment constructs are related to at-risk outcomes, but also their mechanisms of action. In future intervention studies, novel treatments that target known aspects of family environment responsible for protecting from or exacerbating cumulative risk to spoken language and executive function competence in children with hearing loss will fundamentally change current models of intervention for pediatric hearing loss.