Family Processes in Developmental Outcomes of Pediatric Hearing Loss

项目摘要/摘要 这项修订后的申请要求支持一项关于家庭影响的新研究计划 对听力损失儿童核心发育结果的影响。尽管随处可见 早在出生第一周就识别听力损失和重大信号处理的技术 在助听器和人工耳蜗方面的进步，巨大的个体差异仍然存在 儿童从这些医疗干预中充分受益的程度。实现最优的关键障碍 结果和开发新的干预措施是对相关知识和理解的缺乏 影响儿童发育结局变异性的影响因素和机制 听力损失。扩展对典型发育儿童和其他临床人群的工作，出现 研究表明，一个强大而又被忽视的差异来源--家庭环境--有助于 听力损失儿童的预后。然而，这些关联的程度、其潜在的 发育机制以及它们与听力正常儿童的家庭有何不同尚不清楚。 这一重大的知识差距将在拟议的研究中得到解决，该研究将使用多种来源 (家长、孩子和老师)、多特质(问卷、直接观察、孩子和照顾者 绩效测量)纵向研究设计，测量3至8岁正常儿童的听力和 听障儿童两年多的口语和执行功能发展 同时调查认知和语言发展中最相关的家庭因素 以揭示将听力损失风险与这些核心发育结果联系起来的家庭机制。这个 这项研究的具体目的是：1)确定家庭环境和父母教养方式的差异 不同听力病史幼儿家庭的影响因素；2)揭示儿童听力发育状况 家庭和父母教养因素影响口语和执行功能的机制 儿童早期听力损失儿童的发育。我们的发现将对发展具有重要意义 理解和解释听力、言语知觉和家庭动力在 儿童语言和执行功能的发展。我们的发现也将具有临床意义。 通过提供指导未来干预研究设计的新的、必要的基础知识 通过不仅确定哪些家庭环境构成与高危结果有关，而且还确定了他们的 行动机制。在未来的干预研究中，针对家庭已知方面的新疗法 负责保护或加剧口语累积风险的环境 听力损失儿童的执行功能能力将从根本上改变目前的模式 对儿童听力损失的干预。

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.