Tech-Based Intervention Dramatically Improved Language Skills in Hearing Impaired Kids

Offering technology-based visual interventions to children who were deaf or hard of hearing (DHH) helped improve understanding of abstract language concepts and gave children a firmer understanding of spoken language, researchers found.

Language deficits are a major hurdle for DHH children—previous research estimated that approximately 40% of DHH children 6 years of age or younger might have significant language gaps, leading to poor social functioning and negative behavioral, academic, and employment outcomes, along with low literacy rates, Jareen Meinzen-Derr, PhD, MPH, and colleagues from the College of Medicine at the University of Cincinnati and Cincinnati Children’s Hospital Medical Center in Cincinnati explained in Pediatrics. And, according to Meinzen-Derr and colleagues, a technology-assisted language intervention (TALI) incorporating augmentative and alternative communication (AAC) strategies into speech language therapy might help to close these gaps.

“Providing visual supports for language concepts that are typically challenging for DHH children to acquire allowed children to process and comprehend spoken language more fully,” the study authors wrote. “Such strategies can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings.”

Karl R. White, PhD, director of the National Center for Hearing Assessment and Management, Emma Eccles Jones Endowed Chair in Early Childhood Education and professor of psychology at Utah State University in Logan, Utah, applauded the analysis by Meinzen-Derr and colleagues in a commentary accompanying the study, calling it a refreshing change from the typically emotion-based debates regarding how best to educate DHH children that have raged “since at least 1864.”

“With >150 years of often angry arguments about the ’best way’ to educate children who are DHH, it is refreshing and encouraging to read the article… by Meinzen-Derr et al, who demonstrate a different approach for making such decisions,” he wrote.

For their single-site randomized controlled trial, Meinzen-Derr and colleagues recruited a cohort of 41 children ages 3-12 years with mild to profound bilateral hearing loss. Children were randomly assigned to receive TALI (n=21) or treatment as usual (TAU; n=20) — delivered by licensed and trained speech language pathologists — after which they were followed up for 24 weeks. For this analysis, TAU was defined as whatever therapy the child was currently receiving at the time of the study.

The TALI incorporated evidence-based AAC strategies using the TouchChat HD-AAC with Word Power language program on iPads, the study authors explained. “The software is dynamic (grows in complexity with the child), provides visual support for abstract linguistic concepts, offers voice output for each selection, and provides a consistent model for verbalizations,” they wrote. The iPad was locked; the software was the only accessible application. The [speech language pathologist] uses AAC as a visual and audio tool to teach the child to construct longer and more complex messages. The child is encouraged to use the constructed message to verbalize the same message, actively self-monitor, and revise errors as needed. The TALI cycle included 6 [speech language pathologist] therapy weeks (hour-long, weekly sessions), 6 self-guided (at home) weeks, 6 [speech language pathologist] therapy weeks, and 6 self-guided weeks.”

Primary study outcomes were language skills, “specifically syntax, semantics, and discourse, analyzed from recorded language samples,” the study authors explained. “Syntax was measured by the mean length of utterances in morphemes (MLU_m), discourse by the child’s mean turn length (MTL) in words, and semantics by the number of different words (NDW) used in 50 consecutive and complete utterances. Secondary outcomes included receptive and expressive language standard scores taken from the Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5) or the preschool edition.”

The mean (SD) age of participants was 6.3 (2.5) years, 70% were White, 30% used a cochlear implant, and 48% of participants’ mothers had a college education. The mean (SD) non-verbal IQ (NVIQ) of the sample was 97 (18), and the receptive and expressive language scores were 81 (15) and 78 (17.5), respectively.

“Over 24 weeks, children in the TALI group, compared with those in the TAU group, had significantly greater increases in the length of phrases they used to express themselves (β= 0.91 vs 0.15, respectively; P<0.0001),” the study authors reported. Every 12 weeks, kids randomized to the TALI group increased their MLU_m by 0.91, compared to 0.15 in the TAU group; mean MLU_m increased from 4.23 at baseline to 6.06 at week 24 in the TALI group compared to 4.23 at baseline to 4.49 at week 24 in the TAU group.

Similar results were seen for MTL, with children in the TALI group seeing significantly more progress than TAU children (β= 1.21 vs 0.26; P=0.005; increase from 4.91 to 7.26 for TALI vs 4.90 to 5.42 for TAU). TALI also bested TAU for NDW spoken over time (β=11.04 vs 2.65; P=0.007; increase from 82 to 104 for TALI vs 82 to 87 for TAU).

As for secondary outcomes, the TALI group saw significant improvements, whereas the TAU group did not:

• TALI group: Mean (SD) receptive scores increased from 80.0 (15.2) at baseline to 90.6 (15.7; P=0.008) at 24 weeks; expressive scores increased from 77.6 (16.0) at baseline to 86.1 (15.8; P=0.01) at 24 weeks.
• TAU group: Receptive scores increased from 82.1 (14.5) at baseline to 83.6 (15.7; P=0.09) at 24 weeks; expressive scores increased from 77.5 (19.6) at baseline to 79.9 (18.5; P=0.21) at 24 weeks.

“By providing access to consistent vocabulary, sentence structures, and repeated listening opportunities, ACC technology enabled DHH children to more fully access and process information, thus improving spoken language, comprehension, and pragmatic skills,” Meinzen-Derr and colleagues wrote.

The marked improvements in language skills witnessed in this study highlight that DHH children have the capacity to develop better communication skills than we have historically expected,” they added. “With appropriate visual supports and language-teaching tools, as used in TALI, DHH children are capable of developing language skills more commensurate with their cognitive abilities and flourishing in previously challenging communicative situations. Effective language and communication skills are foundational for many areas of lifelong success; DHH children are in great need of evidence-based approaches that support robust language growth. Although our study findings require further exploration, they bring excitement to the potential for improved outcomes for DHH children.”

In his commentary, White noted that, while these results are exciting, “it is important to remember that this was a relatively small study with important limitations (most of which were noted by the authors). Notably:

1. “No data were collected on the number of hours that parents in either group spent each week implementing the procedures demonstrated by the speech language therapist during the visit.
2. “Different speech language pathologists implemented each treatment condition, and it is possible that those willing to use the TALI model were more innovative, self-confident, and energetic.”

However, White added that these limitations do not invalidate the study’s findings, but rather “emphasize the importance of replication. This study is also valuable because the authors demonstrate that systematic, well-implemented research, rather than emotional arguments, is the better way to learn more about the best way to help children who are DHH to reach their potential.”

1. A single-site randomized controlled trial found that a technology-assisted language intervention (TALI) incorporating augmentative and alternative communication (AAC) strategies dramatically improved language comprehension and communication skills among kids who are deaf or hard of hearing (DHH).

2. Incorporating TALI and AAC strategies into therapy programs for DHH kids can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings, according to the study authors.

John McKenna, Associate Editor, BreakingMED™

Cat ID: 138

Topic ID: 85,138,730,138,192,925