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I have visions of

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doing the Running Man on the way up,

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but I decided not to endanger myself.

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And anyway, I’m Alyson Ward,

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This is my thirteenth EHDI conference.

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The first one

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was here in Jacksonville,

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so I feels like coming full circle.

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And I do need to apologize.

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I have a very hoarse voice.

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I think the dance party last night

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and hollering at people

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really just took me over the edge.

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So apologies. I'll do my best.

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So as, Stephanie Vickers so nicely,

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outlined and of some of the stuff

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and I really appreciate that.

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I am a senior researcher

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with the Institute for Disability

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and Research, Policy and Practice

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and at the National Center

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for hearing, Assessment and Management,

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both at Utah State University,

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and I'm so excited to be here

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and joined

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by my friend and colleague,

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Allison Sedey,

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from the University of Colorado, Boulder.

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We like to call ourselves the A-Team

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because obviously both

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our names are Alyson,

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it gets a little confusing

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we will bouncing back and forth between each other.

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So, today

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we're going to talk about findings

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from a literature review

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that we conducted looking at language

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outcomes for children

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who are deaf or hard

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of hearing up to age five,

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and what we found as the trends,

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predictors, and implications.

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All right.

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I wanna start off by acknowledging

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that this project was funded

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through a cooperative agreement

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between the Centers

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for Disease Control and Prevention

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and the Council for State

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and Territorial Epidemiologists.

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And it was one of three

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funded and reviewed projects

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that were sought out

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to look at different

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elements of equity.

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And we were only allowed to collect,

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to look at secondary data.

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So there was no interviews or surveys

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to bolster the finding.

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I do just want to emphasize that as well.

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And if you are interested

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in the other scoping reviews,

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you can look at this CSTE website.

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And I also ran into Sara

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from the Public Health

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Informatics Institute,

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and they ran another one of those,

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or one of those, reviews alongside

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Allison and I.

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So just a little bit about what

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we're going to be heading on today.

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We're just going to be looking

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at the project background

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and going over the methods

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of how we kind of got to where we were,

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and then looking at the results

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that be coming from the different

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articles, specifically,

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the language assessments

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that were used,

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the language

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outcomes, the factors

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that predicted the outcomes,

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and then looking at, gaps in research

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as well as what we would like

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to see in future research.

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And then, importantly,

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what does all that mean in terms

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of translating that research

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into practice for different programs and for families.

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So we have an amazing team,

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of course, added on to the A-Team.

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We had, Linda Hazard

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with the Vermont EHDI program.

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She was an essential asset to the team

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as well

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as Mandy Jay at Utah State

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University, also with NCHAM,

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and she was invaluable.

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And then we were helped

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by a student researcher, Tia Zebe,

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who was

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the software helper because we were all

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learning new software 

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and she was familiar with it.

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Okay, a little bit about the background.

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And there's often really complex,

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and contradictory evidence

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regarding language outcomes

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for children who are deaf or hard of hearing.

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So synthesizing the findings

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across multiple studies

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provided us

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a more reliable picture

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than one study does

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in and of itself.

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And it strengthens

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our confidence

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in the conclusions and recommendations

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that came out of the review,

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as well as it extends

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what we find to a broader geographic,

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a larger area to begin the findings,

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more generalizable.

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So people are often unfamiliar

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with the benefits of literature reviews.

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They save a tremendous amount of time.

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And if you find one

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that is relevant to your field

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and it helps you make that information

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succinct  and gives you

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all the information in one place

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so you don't have to assess

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through the articles on your own.

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So a little bit more

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about the rationale and benefits

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of conducting

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a literature

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review is specific to our review

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is we wanted to identify language assessments

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most frequently used in studies

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looking at language

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for children

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who are deaf or hard of hearing.

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We wanted to summarize the state

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of our knowledge about language

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outcomes,

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determine factors that lead

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to our successful language outcomes,

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and then identify gaps in that

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in our understanding

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of language development,

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as well as guide evidence based practices

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for families and programs

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and early intervention providers.

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Okay, so

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this is where we ended up

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with our research questions.

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So that's kind of guided our whole project

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and our research question was

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“What is the current state of literature

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exploring language

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outcomes of children

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who are deaf or hard of hearing

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up to age five,”

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which we had to hold really close

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to four years

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11 months in the United States.

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So how we got our

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how we did what did we really wanted,

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we really had to have,

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an extremely rigorous methodology

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to make work what we needed to work.

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So we followed the preferred

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reporting items

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for systematic reviews

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and Meta analysis for scoping reviews.

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A very long word.

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I prefer PRISMA-ScR

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that the benefits

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of following this framework

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is it allows the readers

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to follow how we did what we did.

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It helps us determine

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how conclusions were made

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and it stream,

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It reduces the risk of omitting articles,

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which is something

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you have to be very careful with

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when you're conducting a scoping, review

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or any type of literature review.

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And then it streamlines publication.

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And we used up the Covidence software

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management system for scoping reviews.

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Actually, you can use it

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for any type of review, Meta analysis

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or different types of literature reviews.

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And if you ever do

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any type of literature review,

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I highly recommend

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using organized software

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such as Covidence,

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because it does get complex

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and it’s easy

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to kind of get lost in what you're doing,

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and it helps really streamline that.

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And then we end up with

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a research librarian

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at Utah State University

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to help us identify

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the databases that are most likely going

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to contain the types of articles

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we were looking for.

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So we ended up

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searching PubMed, PsychINFO, CINHAL Complete

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and Education Source.

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So one of the most

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important things that we did before we,

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before we set off on our review is we set,

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our inclusion and exclusion criteria.

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So we set it up through

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what was called the Picos

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framework.

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It's population, implications,

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let’s see conclusions.

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I can't remember all of it.

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I think somebody said earlier

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that they can't even remember

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what the acronyms 

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that they come up with actually stand for.

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So I know

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so anyway, so population again

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looking at children up to age,

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four years eleven moths,

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any level of bilateral hearing difference.

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We wanted to have children

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that in the samples

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that had no additional disabilities

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because we knew that would also influence

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language outcomes.

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So that was a parameter

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that we set for our specific review.

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And then the use of any

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hearing technology

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or networking technologies.

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We wanted to link accessibility

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for both spoken language and sign language.

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And then the language outcomes 

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that we were particularly interested in

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for anything around vocabulary,

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morpho-syntax and grammar,

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discourse

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and pragmatics.

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And then some of the additional inclusion

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and exclusion criteria

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where we wanted

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children that were in

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naturally occurring groups of children

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that were already in early intervention 

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services,

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and they weren't assigned

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to a specific treatment.

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So we didn't want something

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like a treatment

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kind of randomized control

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trial where some kids receive

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specific

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intervention other kids didn’t.

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We wanted to look

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at more naturally occurring, situations,

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and then we wanted articles

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that had

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at least ten  in the sample size,

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which is really,

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you know,

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when you look at research,

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that’s not very many in and of itself,

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but you'd be surprised how many,

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research articles

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for children who are deaf

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or hard of hearing have a sample less than ten.

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So which makes the results

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less generalizable.

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And so we set a parameter

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of at least ten

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in the sample size 

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to be considered in the review.

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And then we didn't want to use

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any national databases

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like the National Study

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00:08:28.407 --> 00:08:29.622
for Children's Health,

294
00:08:29.642 --> 00:08:30.323
which does have

295
00:08:30.343 --> 00:08:32.291
information around hearing.

296
00:08:32.311 --> 00:08:33.860
And it also has some information

297
00:08:33.880 --> 00:08:35.628
about the progression of children.

298
00:08:35.648 --> 00:08:38.464
But we wanted to look at studies that

299
00:08:38.484 --> 00:08:41.033
collected primary data.

300
00:08:41.053 --> 00:08:43.536
And then a couple of the other factors

301
00:08:43.556 --> 00:08:44.203
that we wanted to

302
00:08:44.223 --> 00:08:44.971
consider is

303
00:08:44.991 --> 00:08:45.805
we wanted children

304
00:08:45.825 --> 00:08:48.007
that were living in the US.

305
00:08:48.027 --> 00:08:49.308
Part of the rationale for

306
00:08:49.328 --> 00:08:50.610
that is

307
00:08:50.630 --> 00:08:52.612
that we knew that the EHDI system

308
00:08:52.632 --> 00:08:54.747
was unique in the US,

309
00:08:54.767 --> 00:08:57.517
as well as the early intervention system.

310
00:08:57.537 --> 00:08:59.519
So we wanted to look at studies

311
00:08:59.539 --> 00:09:01.087
that really were in the communities

312
00:09:01.107 --> 00:09:02.588
that the kids that were serving are in.

313
00:09:02.608 --> 00:09:05.358
And, and then we looked at,

314
00:09:05.378 --> 00:09:06.726
primary language in the home,

315
00:09:06.746 --> 00:09:08.227
either being English

316
00:09:08.247 --> 00:09:12.198
or ASL the article written in English

317
00:09:12.218 --> 00:09:15.868
and then published between 2010 and 2025.

318
00:09:15.888 --> 00:09:17.036
And the reason for that is

319
00:09:17.056 --> 00:09:18.671
we felt like the,

320
00:09:18.691 --> 00:09:20.206
newborn screening system

321
00:09:20.226 --> 00:09:21.541
had several years

322
00:09:21.561 --> 00:09:24.176
to be fully implemented across the US.

323
00:09:24.196 --> 00:09:26.212
So we would see the benefits of that

324
00:09:26.232 --> 00:09:28.180
as well as some of the improvements

325
00:09:28.200 --> 00:09:29.415
in hearing

326
00:09:29.435 --> 00:09:32.451
technology advancement.

327
00:09:32.471 --> 00:09:33.219
Okay, a little bit

328
00:09:33.239 --> 00:09:34.253
more about

329
00:09:34.273 --> 00:09:36.989
the PRISMA for scoping reviews.

330
00:09:37.009 --> 00:09:39.058
And this is kind of the flowchart

331
00:09:39.078 --> 00:09:40.259
of how we screen.

332
00:09:40.279 --> 00:09:44.830
So we screened 8810 articles.

333
00:09:44.850 --> 00:09:46.632
That is a lot of articles

334
00:09:46.652 --> 00:09:47.900
Let me just tell you.

335
00:09:47.920 --> 00:09:49.669
And the way that our screening

336
00:09:49.689 --> 00:09:50.970
protocol is set up again,

337
00:09:50.990 --> 00:09:53.539
this was set up in the Covidence software.

338
00:09:53.559 --> 00:09:55.641
So it would flag things like this

339
00:09:55.661 --> 00:09:57.877
one has been reviewed or this hasn't,

340
00:09:57.897 --> 00:09:59.011
that kind of thing.

341
00:09:59.031 --> 00:10:00.446
We what we did

342
00:10:00.466 --> 00:10:03.449
is each and that initial review,

343
00:10:03.469 --> 00:10:06.319
each article, the abstract from the title

344
00:10:06.339 --> 00:10:08.220
were reviewed by two reviewers.

345
00:10:08.240 --> 00:10:10.289
And then if there was an,

346
00:10:10.309 --> 00:10:11.924
like a yes for one article

347
00:10:11.944 --> 00:10:13.492
and no, for that same article

348
00:10:13.512 --> 00:10:14.961
that we would have a third

349
00:10:14.981 --> 00:10:15.962
reviewer come in

350
00:10:15.982 --> 00:10:16.862
and be the tiebreaker

351
00:10:16.882 --> 00:10:19.732
between those first two.

352
00:10:19.752 --> 00:10:21.968
And then we moved into full text review

353
00:10:21.988 --> 00:10:24.470
which was 250 articles.

354
00:10:24.490 --> 00:10:26.138
Also a lot of articles

355
00:10:26.158 --> 00:10:26.806
when you really need

356
00:10:26.826 --> 00:10:29.008
to like piece out that information.

357
00:10:29.028 --> 00:10:30.710
And we went through that same process

358
00:10:30.730 --> 00:10:32.011
of having the abstract

359
00:10:32.031 --> 00:10:33.779
reviewed by two people

360
00:10:33.799 --> 00:10:36.382
with the third as the tiebreaker.

361
00:10:36.402 --> 00:10:37.550
And then in the end,

362
00:10:37.570 --> 00:10:39.752
we ended up with 24 articles

363
00:10:39.772 --> 00:10:40.286
that met

364
00:10:40.306 --> 00:10:42.588
every single version of our inclusion

365
00:10:42.608 --> 00:10:44.390
and exclusion criteria.

366
00:10:44.410 --> 00:10:46.759
24 articles, it doesn’t seem like a lot.

367
00:10:46.779 --> 00:10:47.693
But when you're pulling out

368
00:10:47.713 --> 00:10:48.828
the depth of information

369
00:10:48.848 --> 00:10:50.296
that we were looking for,

370
00:10:50.316 --> 00:10:52.898
it really is big time consuming.

371
00:10:52.918 --> 00:10:55.901
So once we figured out those 24 articles,

372
00:10:55.921 --> 00:10:58.137
we came up with an extraction template

373
00:10:58.157 --> 00:10:59.405
that really charted

374
00:10:59.425 --> 00:11:00.506
what the outcomes were,

375
00:11:00.526 --> 00:11:02.108
what the predictors were,

376
00:11:02.128 --> 00:11:04.076
and some other contextual information

377
00:11:04.096 --> 00:11:05.044
within those studies

378
00:11:05.064 --> 00:11:06.779
to make sure that they were collecting

379
00:11:06.799 --> 00:11:08.381
the same or similar information

380
00:11:08.401 --> 00:11:10.516
for each of those 24 articles.

381
00:11:10.536 --> 00:11:12.218
And in the,

382
00:11:12.238 --> 00:11:13.119
EHDI website,

383
00:11:13.139 --> 00:11:15.054
if you look under our presentation,

384
00:11:15.074 --> 00:11:16.322
you can see a handout of

385
00:11:16.342 --> 00:11:17.923
all the 24 articles

386
00:11:17.943 --> 00:11:19.058
that were included in this review.

387
00:11:19.078 --> 00:11:21.260
So if you want to go back and look at any of them.

388
00:11:21.280 --> 00:11:24.030
They're right there for you.

389
00:11:24.050 --> 00:11:25.598
I'm going to turn the time over

390
00:11:25.618 --> 00:11:27.099
to, Allison.

391
00:11:27.119 --> 00:11:28.734
And she is going to go over

392
00:11:28.754 --> 00:11:30.503
some of the results of the studies.

393
00:11:30.523 --> 00:11:31.370
She lives and breathes 

394
00:11:31.390 --> 00:11:32.605
language outcomes for kids

395
00:11:32.625 --> 00:11:34.173
who are not deaf or hard of hearing.

396
00:11:34.193 --> 00:11:36.842
So she's perfect to go over the results

397
00:11:36.862 --> 00:11:42.481
with you.

398
00:11:42.501 --> 00:11:43.149
Well,

399
00:11:43.169 --> 00:11:44.250
let me just say my quick word

400
00:11:44.270 --> 00:11:45.751
of welcome to everyone.

401
00:11:45.771 --> 00:11:48.054
And thank you, Alyson.

402
00:11:48.074 --> 00:11:49.989
So in the last few years,

403
00:11:50.009 --> 00:11:50.322
I am

404
00:11:50.342 --> 00:11:51.490
just really thrilled

405
00:11:51.510 --> 00:11:52.525
to see

406
00:11:52.545 --> 00:11:54.160
so much of an increase

407
00:11:54.180 --> 00:11:54.960
in interest

408
00:11:54.980 --> 00:11:57.163
in measuring language outcomes.

409
00:11:57.183 --> 00:11:58.197
And that's in part

410
00:11:58.217 --> 00:11:59.398
due to the momentum

411
00:11:59.418 --> 00:12:01.567
both of the LEAD-K legislation

412
00:12:01.587 --> 00:12:03.369
that many states have adopted,

413
00:12:03.389 --> 00:12:04.203
which requires

414
00:12:04.223 --> 00:12:06.238
the collection of language outcomes.

415
00:12:06.258 --> 00:12:08.441
And it's also related in part

416
00:12:08.461 --> 00:12:11.844
to the current HRSA grant cycle, which lists

417
00:12:11.864 --> 00:12:13.679
collection of language outcomes

418
00:12:13.699 --> 00:12:15.781
as a required EHDI activity.

419
00:12:15.801 --> 00:12:17.483
So with the legislation,

420
00:12:17.503 --> 00:12:18.751
with federal agencies

421
00:12:18.771 --> 00:12:20.152
mandating monitoring

422
00:12:20.172 --> 00:12:22.054
and collecting language outcomes,

423
00:12:22.074 --> 00:12:23.789
a lot of questions have arisen

424
00:12:23.809 --> 00:12:25.891
and have been posed about

425
00:12:25.911 --> 00:12:27.960
which language assessments

426
00:12:27.980 --> 00:12:30.930
should we be using to do that work?

427
00:12:30.950 --> 00:12:32.298
And one of the benefits

428
00:12:32.318 --> 00:12:33.199
of the scoping

429
00:12:33.219 --> 00:12:34.200
literature review

430
00:12:34.220 --> 00:12:37.169
was that it gives us an opportunity to see

431
00:12:37.189 --> 00:12:37.837
what would were

432
00:12:37.857 --> 00:12:39.138
the language assessments

433
00:12:39.158 --> 00:12:41.073
that are being used by researchers

434
00:12:41.093 --> 00:12:43.008
here in the United States.

435
00:12:43.028 --> 00:12:43.776
And so that's what

436
00:12:43.796 --> 00:12:45.311
I want to share with you

437
00:12:45.331 --> 00:12:48.347
first is what we found in that regard.

438
00:12:48.367 --> 00:12:50.349
So the word flow here

439
00:12:50.369 --> 00:12:54.120
gives you a little bit of a preview of,

440
00:12:54.140 --> 00:12:55.688
what we found.

441
00:12:55.708 --> 00:12:56.222
The ones that are

442
00:12:56.242 --> 00:12:56.789
the biggest

443
00:12:56.809 --> 00:12:58.124
are the ones that are used

444
00:12:58.144 --> 00:12:59.692
the most frequently.

445
00:12:59.712 --> 00:13:00.659
But we'll look at that

446
00:13:00.679 --> 00:13:02.294
in a little bit more detail.

447
00:13:02.314 --> 00:13:04.964
But before I dive into the specific tests

448
00:13:04.984 --> 00:13:06.132
that were used,

449
00:13:06.152 --> 00:13:07.533
I want to talk about

450
00:13:07.553 --> 00:13:09.401
the domains of language

451
00:13:09.421 --> 00:13:10.970
that were examined

452
00:13:10.990 --> 00:13:13.072
in these various studies.

453
00:13:13.092 --> 00:13:16.008
Because I think that's important, partly,

454
00:13:16.028 --> 00:13:18.444
it's knowing what are we doing, but also

455
00:13:18.464 --> 00:13:19.812
where are there areas may be 

456
00:13:19.832 --> 00:13:21.080
that are understudied.

457
00:13:21.100 --> 00:13:23.115
So are we looking

458
00:13:23.135 --> 00:13:24.583
at a particular area of language

459
00:13:24.603 --> 00:13:25.017
a lot

460
00:13:25.037 --> 00:13:27.553
are we ignoring other aspects of language?

461
00:13:27.573 --> 00:13:29.488
This is an important question

462
00:13:29.508 --> 00:13:31.457
for us to know the answer to.

463
00:13:31.477 --> 00:13:32.992
So I'll give you just a moment

464
00:13:33.012 --> 00:13:38.982
to take a look at the pie chart.

465
00:13:39.002 --> 00:13:44.470


466
00:13:44.490 --> 00:13:45.971
So if you add up

467
00:13:45.991 --> 00:13:47.907
the number of studies, you'll see that

468
00:13:47.927 --> 00:13:49.775
it adds up to more than 24.

469
00:13:49.795 --> 00:13:51.110
And you might be thinking, wait,

470
00:13:51.130 --> 00:13:52.645
I thought Alyson just said

471
00:13:52.665 --> 00:13:54.613
they only looked at 24 studies.

472
00:13:54.633 --> 00:13:57.082
That many studies actually will employ

473
00:13:57.102 --> 00:13:58.617
several language assessments.

474
00:13:58.637 --> 00:13:59.852
So they look at

475
00:13:59.872 --> 00:14:01.320
various aspects of language

476
00:14:01.340 --> 00:14:03.289
so that some studies only focus

477
00:14:03.309 --> 00:14:04.890
on, say, vocabulary,

478
00:14:04.910 --> 00:14:06.692
but others might do general language test,

479
00:14:06.712 --> 00:14:09.061
they also do a vocabulary test,

480
00:14:09.081 --> 00:14:10.129
that sort of thing.

481
00:14:10.149 --> 00:14:13.999
And you can see a pretty obviously that,

482
00:14:14.019 --> 00:14:14.433
the vast

483
00:14:14.453 --> 00:14:16.802
majority of the studies are using

484
00:14:16.822 --> 00:14:20.673
tests of general language.

485
00:14:20.693 --> 00:14:21.941
These tests

486
00:14:21.961 --> 00:14:22.374
try

487
00:14:22.394 --> 00:14:25.144
kind of be everything to everyone.

488
00:14:25.164 --> 00:14:26.212
And in doing so,

489
00:14:26.232 --> 00:14:27.346
really are only able

490
00:14:27.366 --> 00:14:28.948
to take a little snipped 

491
00:14:28.968 --> 00:14:30.516
of different parts of language

492
00:14:30.536 --> 00:14:32.952
so that they don't have 500 items.

493
00:14:32.972 --> 00:14:34.453
But a general language test

494
00:14:34.473 --> 00:14:36.589
might have a few vocabulary items.

495
00:14:36.609 --> 00:14:37.556
So it might have things

496
00:14:37.576 --> 00:14:41.360
like does the child use at least ten words?

497
00:14:41.380 --> 00:14:44.597
Can they tell you the opposite of words?

498
00:14:44.617 --> 00:14:46.732
It might have some grammar items.

499
00:14:46.752 --> 00:14:48.767
So things like child

500
00:14:48.787 --> 00:14:51.070
can use the past tense.

501
00:14:51.090 --> 00:14:54.607
The child uses conditional clauses.

502
00:14:54.627 --> 00:14:56.408
It might have some pragmatic items

503
00:14:56.428 --> 00:14:57.610
also thrown in there.

504
00:14:57.630 --> 00:15:00.779
Things like can tell directions for a game,,

505
00:15:00.799 --> 00:15:01.347
can use

506
00:15:01.367 --> 00:15:03.282
politeness forms like please

507
00:15:03.302 --> 00:15:05.251
and thank you.

508
00:15:05.271 --> 00:15:08.387
So it’s an amalgamation

509
00:15:08.407 --> 00:15:09.688
of a number of different

510
00:15:09.708 --> 00:15:10.890
areas of language

511
00:15:10.910 --> 00:15:13.359
or just not looking super in-depth.

512
00:15:13.379 --> 00:15:15.027
Obviously it being one aspect

513
00:15:15.047 --> 00:15:15.861
because it just wouldn't

514
00:15:15.881 --> 00:15:18.397
be time to do that in one given test.

515
00:15:18.417 --> 00:15:20.666
That's the most commonly used assessment

516
00:15:20.686 --> 00:15:22.101
in research.

517
00:15:22.121 --> 00:15:25.404
That's followed by a test of vocabulary.

518
00:15:25.424 --> 00:15:27.139
Those are also very common

519
00:15:27.159 --> 00:15:28.240
of both vocabulary

520
00:15:28.260 --> 00:15:31.343
comprehension and vocabulary production.

521
00:15:31.363 --> 00:15:33.879
And then what we see less of,

522
00:15:33.899 --> 00:15:34.313
which is,

523
00:15:34.333 --> 00:15:35.314
you know, unfortunate

524
00:15:35.334 --> 00:15:38.050
because it does tend to be

525
00:15:38.070 --> 00:15:39.318
two areas of language that

526
00:15:39.338 --> 00:15:40.986
can be challenging

527
00:15:41.006 --> 00:15:41.520
for children

528
00:15:41.540 --> 00:15:43.055
who are deaf or hard of hearing,

529
00:15:43.075 --> 00:15:44.423
is grammar

530
00:15:44.443 --> 00:15:47.092
so morpho-syntax grammar either

531
00:15:47.112 --> 00:15:48.193
in

532
00:15:48.213 --> 00:15:49.561
English or American

533
00:15:49.581 --> 00:15:51.297
Sign Language in the case of studies

534
00:15:51.317 --> 00:15:52.197
we looked at it

535
00:15:52.217 --> 00:15:53.565
because, again, we did not

536
00:15:53.585 --> 00:15:54.800
look at studies that were done

537
00:15:54.820 --> 00:15:56.635
outside of the United States.

538
00:15:56.655 --> 00:15:58.137
So we don't have studies looking

539
00:15:58.157 --> 00:16:01.974
say of Norwegian or Italian.

540
00:16:01.994 --> 00:16:04.310
So that area is somewhat understudied,

541
00:16:04.330 --> 00:16:07.880
but even more so you can see pragmatics.

542
00:16:07.900 --> 00:16:10.249
So out of the 24 studies of language,

543
00:16:10.269 --> 00:16:12.651
only one of those studies examined

544
00:16:12.671 --> 00:16:14.820
the pragmatic aspect of language.

545
00:16:14.840 --> 00:16:15.788
So that's, you know,

546
00:16:15.808 --> 00:16:17.356
if you are looking for research ideas

547
00:16:17.376 --> 00:16:19.391
or applying for grants

548
00:16:19.411 --> 00:16:22.895
that’s an area that’s definitely of need.

549
00:16:22.915 --> 00:16:25.931
So these are the general areas of like kids are assessed 

550
00:16:25.951 --> 00:16:28.534
let's look at what tests they use

551
00:16:28.554 --> 00:16:32.071
to test those areas, most commonly.

552
00:16:32.091 --> 00:16:33.005
And I'll give you a minute with

553
00:16:33.025 --> 00:16:38.995
this slide.

554
00:16:39.015 --> 00:16:43.949


555
00:16:43.969 --> 00:16:44.350
So you can

556
00:16:44.370 --> 00:16:47.386
see in the top bar that

557
00:16:47.406 --> 00:16:48.654
the majority of studies

558
00:16:48.674 --> 00:16:50.789
relied on the preschool language scale

559
00:16:50.809 --> 00:16:52.191
so, the PLS.

560
00:16:52.211 --> 00:16:54.526
It's a very common test used by speech

561
00:16:54.546 --> 00:16:56.528
pathologist, so the speech pathologist here

562
00:16:56.548 --> 00:16:58.263
 PLS

563
00:16:58.283 --> 00:17:00.165
know it, use it,

564
00:17:00.185 --> 00:17:02.468
or love it, hate it whatever.

565
00:17:02.488 --> 00:17:04.737
So a very commonly used test in general.

566
00:17:04.757 --> 00:17:06.839
These are all for general language.

567
00:17:06.859 --> 00:17:09.541
The Mullen scales were frequently used.

568
00:17:09.561 --> 00:17:13.746
The castle, CASL, castle,

569
00:17:13.766 --> 00:17:16.015
the test for the language development,

570
00:17:16.035 --> 00:17:17.449
and then the remaining six

571
00:17:17.469 --> 00:17:19.318
studies of general language

572
00:17:19.338 --> 00:17:20.986
used a variety like so,

573
00:17:21.006 --> 00:17:22.354
you know, there will be one in one study

574
00:17:22.374 --> 00:17:26.358
one in another, so it wasn't really a pattern per se.

575
00:17:26.378 --> 00:17:27.693
Let's look at vocabulary

576
00:17:27.713 --> 00:17:33.683
what people used to assess vocabulary.

577
00:17:33.703 --> 00:17:38.704


578
00:17:38.724 --> 00:17:40.172
So again,

579
00:17:40.192 --> 00:17:41.240
for speech pathologist in the room

580
00:17:41.260 --> 00:17:43.308
I am sure all of these are familiar

581
00:17:43.328 --> 00:17:43.709
tests

582
00:17:43.729 --> 00:17:44.109
to you,

583
00:17:44.129 --> 00:17:45.010
the Peabody picture

584
00:17:45.030 --> 00:17:46.545
vocabulary test is like

585
00:17:46.565 --> 00:17:47.012
it has

586
00:17:47.032 --> 00:17:50.716
been around for decades, many decades.

587
00:17:50.736 --> 00:17:51.550
Very common

588
00:17:51.570 --> 00:17:54.219
to test vocabulary comprehension.

589
00:17:54.239 --> 00:17:56.422
The MacArthur-Bates, I’ll put a plug

590
00:17:56.442 --> 00:17:58.123
my personal favorite,

591
00:17:58.143 --> 00:17:59.358
communicative development

592
00:17:59.378 --> 00:18:01.894
inventories is another commonly used,

593
00:18:01.914 --> 00:18:03.862
birth to 3 test.

594
00:18:03.882 --> 00:18:04.596
And let me just say,

595
00:18:04.616 --> 00:18:05.431
all of these ones

596
00:18:05.451 --> 00:18:06.732
that are used in research,

597
00:18:06.752 --> 00:18:08.600
both on the previous slide

598
00:18:08.620 --> 00:18:10.135
and on the current one,

599
00:18:10.155 --> 00:18:11.370
none of these are designed

600
00:18:11.390 --> 00:18:12.604
specifically for children

601
00:18:12.624 --> 00:18:14.339
who are deaf or hard of hearing.

602
00:18:14.359 --> 00:18:16.442
So that's another sort of interesting aspect

603
00:18:16.462 --> 00:18:17.810
I thought of the literature review

604
00:18:17.830 --> 00:18:19.711
where we have all these people,

605
00:18:19.731 --> 00:18:21.046
researchers around the country

606
00:18:21.066 --> 00:18:22.681
studying language acquisition

607
00:18:22.701 --> 00:18:23.582
in children who are deaf

608
00:18:23.602 --> 00:18:25.417
and hard of hearing.

609
00:18:25.437 --> 00:18:26.552
Very seldom

610
00:18:26.572 --> 00:18:27.186
are they actually

611
00:18:27.206 --> 00:18:28.353
using a test designed

612
00:18:28.373 --> 00:18:30.989
for a child who is deaf or hard hearing.

613
00:18:31.009 --> 00:18:32.357
Now that's part of the logistics.

614
00:18:32.377 --> 00:18:35.461
There's not a lot of those tests.

615
00:18:35.481 --> 00:18:38.497
But something to keep in mind

616
00:18:38.517 --> 00:18:39.998
that these are these

617
00:18:40.018 --> 00:18:41.600
were test designed for children

618
00:18:41.620 --> 00:18:42.634
who are hearing

619
00:18:42.654 --> 00:18:45.070
who and their test really of English.

620
00:18:45.090 --> 00:18:48.841
And people adapt them and use with signs

621
00:18:48.861 --> 00:18:52.211
allow signs to count as responses.

622
00:18:52.231 --> 00:18:53.245
But just be aware

623
00:18:53.265 --> 00:18:54.746
they're not designed specifically

624
00:18:54.766 --> 00:18:58.584
for children deaf or hard of hearing.

625
00:18:58.604 --> 00:19:00.853
So language sample analysis.

626
00:19:00.873 --> 00:19:03.222
So again one of my favorites.

627
00:19:03.242 --> 00:19:05.057
May be next to the MacArthur

628
00:19:05.077 --> 00:19:07.025
five of the 24 studies

629
00:19:07.045 --> 00:19:08.994
used language sampling

630
00:19:09.014 --> 00:19:10.996
to examine the children's language,

631
00:19:11.016 --> 00:19:12.197
which is fantastic

632
00:19:12.217 --> 00:19:15.000
because now we're not relying on the test

633
00:19:15.020 --> 00:19:16.535
and not relying on a test

634
00:19:16.555 --> 00:19:18.170
it wasn't really designed

635
00:19:18.190 --> 00:19:18.804
with children

636
00:19:18.824 --> 00:19:19.471
who are deaf or hard

637
00:19:19.491 --> 00:19:20.706
of hearing in mind,

638
00:19:20.726 --> 00:19:21.373
but rather we’re 

639
00:19:21.393 --> 00:19:22.141
looking at the child's

640
00:19:22.161 --> 00:19:24.543
spontaneous use of language,

641
00:19:24.563 --> 00:19:26.078
whether the spoken language

642
00:19:26.098 --> 00:19:27.279
or sign language

643
00:19:27.299 --> 00:19:29.882
during an adult child interaction,

644
00:19:29.902 --> 00:19:32.885
and then analyzing that language to see

645
00:19:32.905 --> 00:19:34.820
what the children were doing

646
00:19:34.840 --> 00:19:37.422
with their language,

647
00:19:37.442 --> 00:19:37.856
where their

648
00:19:37.876 --> 00:19:38.624
strengths were

649
00:19:38.644 --> 00:19:39.158
and maybe

650
00:19:39.178 --> 00:19:41.827
where some of their challenges were.

651
00:19:41.847 --> 00:19:45.130
And so let's take a look now here

652
00:19:45.150 --> 00:19:47.299
at this slide.  In terms

653
00:19:47.319 --> 00:19:47.966
how did it

654
00:19:47.986 --> 00:19:48.901
how were the children

655
00:19:48.921 --> 00:19:50.502
doing in these various

656
00:19:50.522 --> 00:19:51.737
aspects of language

657
00:19:51.757 --> 00:19:53.505
that were being looked at in

658
00:19:53.525 --> 00:19:55.474
spontaneous language samples?

659
00:19:55.494 --> 00:19:57.509
So four of the things that are often

660
00:19:57.529 --> 00:19:58.911
looked at when you take a language

661
00:19:58.931 --> 00:19:59.978
sample from a child

662
00:19:59.998 --> 00:20:01.413
and then analyze it,

663
00:20:01.433 --> 00:20:04.249
one is how long sentences do they use?

664
00:20:04.269 --> 00:20:06.084
Do they put a couple words together?

665
00:20:06.104 --> 00:20:06.685
By typically

666
00:20:06.705 --> 00:20:08.654
putting 3 or 4 words together.

667
00:20:08.674 --> 00:20:09.621
And so that's measured

668
00:20:09.641 --> 00:20:11.690
often what we call MLU

669
00:20:11.710 --> 00:20:13.192
the mean length of their utterance 

670
00:20:13.212 --> 00:20:15.894
so the average length of their sentences

671
00:20:15.914 --> 00:20:17.162
and then

672
00:20:17.182 --> 00:20:19.731
100% of the comparisons that were done

673
00:20:19.751 --> 00:20:21.800
across these five studies,

674
00:20:21.820 --> 00:20:24.536
the children who were hearing had longer

675
00:20:24.556 --> 00:20:25.704
MLUs

676
00:20:25.724 --> 00:20:26.338
than the children

677
00:20:26.358 --> 00:20:27.639
who were deaf or hard of hearing,

678
00:20:27.659 --> 00:20:31.109
significantly longer. it’s not

679
00:20:31.129 --> 00:20:32.544
you know, as high a proportion,

680
00:20:32.564 --> 00:20:34.046
but still a very high proportion

681
00:20:34.066 --> 00:20:35.447
of the comparisons

682
00:20:35.467 --> 00:20:37.182
found that there was a higher,

683
00:20:37.202 --> 00:20:39.518
higher diversity of vocabulary

684
00:20:39.538 --> 00:20:41.453
among the hearing children in the study.

685
00:20:41.473 --> 00:20:43.422
So they used more different words

686
00:20:43.442 --> 00:20:45.190
more of different vocabulary words.

687
00:20:45.210 --> 00:20:46.992
More word types.

688
00:20:47.012 --> 00:20:49.294
They used more grammatical endings

689
00:20:49.314 --> 00:20:51.597
if they were using spoken language,

690
00:20:51.617 --> 00:20:53.999
and they used more complex sentences

691
00:20:54.019 --> 00:20:55.200
and that could be an either

692
00:20:55.220 --> 00:20:57.436
spoken language or sign language.

693
00:20:57.456 --> 00:20:57.903
So, in

694
00:20:57.923 --> 00:21:00.105
100% of the comparisons children

695
00:21:00.125 --> 00:21:02.341
who were hearing in the study

696
00:21:02.361 --> 00:21:04.810
used more complex sentences

697
00:21:04.830 --> 00:21:05.210
than children

698
00:21:05.230 --> 00:21:05.978
who were deaf or hard

699
00:21:05.998 --> 00:21:06.845
of hearing relied more

700
00:21:06.865 --> 00:21:10.082
on simple sentences from a grammatical 

701
00:21:10.102 --> 00:21:12.117
standpoint.

702
00:21:12.137 --> 00:21:13.352
So moving away now

703
00:21:13.372 --> 00:21:14.786
from language sampling,

704
00:21:14.806 --> 00:21:17.222
let's go back to our more reference test,

705
00:21:17.242 --> 00:21:18.857
because that was what was most common.

706
00:21:18.877 --> 00:21:21.126
Only five of the 24 studies used language

707
00:21:21.146 --> 00:21:22.461
sampling, most of them

708
00:21:22.481 --> 00:21:23.362
also actually did

709
00:21:23.382 --> 00:21:25.297
use norm reference tests as well.

710
00:21:25.317 --> 00:21:26.098
So they did language

711
00:21:26.118 --> 00:21:27.799
sampling and administer

712
00:21:27.819 --> 00:21:29.434
the standardized test.

713
00:21:29.454 --> 00:21:32.671
So just a little brief

714
00:21:32.691 --> 00:21:35.340
review of a norm-referenced test.

715
00:21:35.360 --> 00:21:36.341
We're going to be talking about this

716
00:21:36.361 --> 00:21:37.542
for the next few minutes.

717
00:21:37.562 --> 00:21:41.947
So when a test publisher develops a test

718
00:21:41.967 --> 00:21:44.449
and they want to norm it

719
00:21:44.469 --> 00:21:47.352
they will get a large sample of children

720
00:21:47.372 --> 00:21:48.020
who they believe

721
00:21:48.040 --> 00:21:50.889
are developing their language, typically,

722
00:21:50.909 --> 00:21:52.891
and give them the test.

723
00:21:52.911 --> 00:21:56.762
So often hopefully thousands of children

724
00:21:56.782 --> 00:21:58.330
are given the test

725
00:21:58.350 --> 00:22:00.132
before it goes out on the market.

726
00:22:00.152 --> 00:22:01.333
And so they get all the data

727
00:22:01.353 --> 00:22:02.467
from these children

728
00:22:02.487 --> 00:22:03.802
which ones do they get right?

729
00:22:03.822 --> 00:22:05.671
Which ones do they get wrong.

730
00:22:05.691 --> 00:22:07.306
And they get averages

731
00:22:07.326 --> 00:22:08.540
for all that and develop

732
00:22:08.560 --> 00:22:10.942
standard scores and percentiles

733
00:22:10.962 --> 00:22:12.978
to see how the children kind of distribute

734
00:22:12.998 --> 00:22:14.880
in terms of their scores

735
00:22:14.900 --> 00:22:16.248
that they got on the test.

736
00:22:16.268 --> 00:22:17.282
And then when they put it

737
00:22:17.302 --> 00:22:18.550
out on the market

738
00:22:18.570 --> 00:22:19.384
and you purchase the test,

739
00:22:19.404 --> 00:22:21.453
and you give it to your individual child.

740
00:22:21.473 --> 00:22:21.953
You are then

741
00:22:21.973 --> 00:22:24.222
gonna take your individual child scores,

742
00:22:24.242 --> 00:22:26.091
and you're gonna to compare it to that

743
00:22:26.111 --> 00:22:27.259
normative sample,

744
00:22:27.279 --> 00:22:28.226
to that larger group

745
00:22:28.246 --> 00:22:29.761
that they tested before

746
00:22:29.781 --> 00:22:31.830
the test went out to market.

747
00:22:31.850 --> 00:22:33.298
And in pretty much

748
00:22:33.318 --> 00:22:35.033
all the tests that are used

749
00:22:35.053 --> 00:22:36.668
in these research studies,

750
00:22:36.688 --> 00:22:40.472
they use standard scores to represent the

751
00:22:40.492 --> 00:22:42.407
scores of the normative group.

752
00:22:42.427 --> 00:22:45.110
And 100 is the mean of

753
00:22:45.130 --> 00:22:46.044
that group thought

754
00:22:46.064 --> 00:22:48.380
to be developing language typically.

755
00:22:48.400 --> 00:22:50.315
And people, you know,

756
00:22:50.335 --> 00:22:51.817
what's the average range?

757
00:22:51.837 --> 00:22:53.652
And that's somewhat arbitrary.

758
00:22:53.672 --> 00:22:54.553
And then different people

759
00:22:54.573 --> 00:22:55.921
will cut it in different places.

760
00:22:55.941 --> 00:22:57.155
School districts will say,

761
00:22:57.175 --> 00:22:58.223
oh, we're going to consider

762
00:22:58.243 --> 00:22:59.057
the average range

763
00:22:59.077 --> 00:23:00.959
to be above the seven percentile.

764
00:23:00.979 --> 00:23:02.361
Somebody else might say no

765
00:23:02.381 --> 00:23:04.262
plus or minus the standard deviation.

766
00:23:04.282 --> 00:23:05.297
somebody else might say no 

767
00:23:05.317 --> 00:23:07.566
a ten percentile above this average.

768
00:23:07.586 --> 00:23:10.502
So again it's somewhat arbitrary.

769
00:23:10.522 --> 00:23:12.437
But I would say there is a common metric

770
00:23:12.457 --> 00:23:13.305
that people use.

771
00:23:13.325 --> 00:23:13.972
Is this idea

772
00:23:13.992 --> 00:23:15.374
of plus or minus

773
00:23:15.394 --> 00:23:17.743
a standard deviation from the mean

774
00:23:17.763 --> 00:23:19.411
would be considered the average

775
00:23:19.431 --> 00:23:20.011
range,

776
00:23:20.031 --> 00:23:23.315
68% of children in the normative sample

777
00:23:23.335 --> 00:23:27.152
would fall in that range, and only 16%

778
00:23:27.172 --> 00:23:28.153
will fall below it,

779
00:23:28.173 --> 00:23:29.588
because the other 60%

780
00:23:29.608 --> 00:23:32.057
are going to be above that average

781
00:23:32.077 --> 00:23:34.126
plus or minus one standard deviation.

782
00:23:34.146 --> 00:23:35.927
So a standard deviation on these tests

783
00:23:35.947 --> 00:23:37.329
is typically 15.

784
00:23:37.349 --> 00:23:38.397
So that would mean scores

785
00:23:38.417 --> 00:23:39.664
between 85

786
00:23:39.684 --> 00:23:41.266
and 115

787
00:23:41.286 --> 00:23:41.767
are going to be

788
00:23:41.787 --> 00:23:43.835
considering the average range.

789
00:23:43.855 --> 00:23:45.837
So let's take a look at the studies.

790
00:23:45.857 --> 00:23:46.505
Let's take a look

791
00:23:46.525 --> 00:23:48.006
at some of the outcomes

792
00:23:48.026 --> 00:23:49.441
where the children who were deaf

793
00:23:49.461 --> 00:23:50.642
or hard of hearing fall

794
00:23:50.662 --> 00:23:52.477
in terms of their standard scores

795
00:23:52.497 --> 00:23:54.479
relative to the average range.

796
00:23:54.499 --> 00:23:55.480
Where did the children who

797
00:23:55.500 --> 00:23:57.249
are hearing fall?

798
00:23:57.269 --> 00:23:59.217
And I'm going to give you a minute.

799
00:23:59.237 --> 00:24:00.786
Well, let me summarize

800
00:24:00.806 --> 00:24:01.787
just briefly first

801
00:24:01.807 --> 00:24:02.788
what we're going to see.

802
00:24:02.808 --> 00:24:03.588
then I'll give you a minute

803
00:24:03.608 --> 00:24:04.322
with the table

804
00:24:04.342 --> 00:24:06.825
to take a look at the actual numbers.

805
00:24:06.845 --> 00:24:10.262
So in general, the mean for the deaf

806
00:24:10.282 --> 00:24:11.930
or hard of hearing children

807
00:24:11.950 --> 00:24:15.333
was typically within the average range.

808
00:24:15.353 --> 00:24:17.135
But interestingly it was

809
00:24:17.155 --> 00:24:18.270
typically at the lower

810
00:24:18.290 --> 00:24:20.172
end of that average range.

811
00:24:20.192 --> 00:24:20.605
So remember

812
00:24:20.625 --> 00:24:22.073
they have a range, let’s say it goes 

813
00:24:22.093 --> 00:24:24.176
from 85 to 115.

814
00:24:24.196 --> 00:24:27.279
They were closer to the 85 end of that.

815
00:24:27.299 --> 00:24:30.182
Whereas the children who were hearing

816
00:24:30.202 --> 00:24:31.583
you would

817
00:24:31.603 --> 00:24:33.652
theoretically and intuitively expect

818
00:24:33.672 --> 00:24:34.486
maybe get

819
00:24:34.506 --> 00:24:36.354
100 because

820
00:24:36.374 --> 00:24:37.823
you think they’re developing language 

821
00:24:37.843 --> 00:24:40.158
typically, we include them in the study

822
00:24:40.178 --> 00:24:41.326
the knowledge of samples

823
00:24:41.346 --> 00:24:42.694
thought to be developing language

824
00:24:42.714 --> 00:24:43.495
typically 

825
00:24:43.515 --> 00:24:45.163
they get about the same scores,

826
00:24:45.183 --> 00:24:46.932
maybe around 100.

827
00:24:46.952 --> 00:24:50.769
But interestingly, in every single study

828
00:24:50.789 --> 00:24:51.803
they are not at 100

829
00:24:51.823 --> 00:24:54.973
they're well above 100.

830
00:24:54.993 --> 00:24:56.641
And this becomes a problem

831
00:24:56.661 --> 00:24:57.175
in children

832
00:24:57.195 --> 00:24:58.643
who are deaf or hard of hearing

833
00:24:58.663 --> 00:25:00.111
are a bit below 100.

834
00:25:00.131 --> 00:25:02.047
If the children who are hearing

835
00:25:02.067 --> 00:25:03.548
are way above 100.

836
00:25:03.568 --> 00:25:04.950
And let's take a look at the numbers.

837
00:25:04.970 --> 00:25:06.117
And again I'll give you a minute.

838
00:25:06.137 --> 00:25:07.853
These are the four different studies,

839
00:25:07.873 --> 00:25:09.721
Pro is a different study

840
00:25:09.741 --> 00:25:11.189
from the 24.

841
00:25:11.209 --> 00:25:17.179
Just take a bit of a look.

842
00:25:17.199 --> 00:25:27.305


843
00:25:27.325 --> 00:25:28.340
And I just want to point

844
00:25:28.360 --> 00:25:29.441
out that, you know, anytime

845
00:25:29.461 --> 00:25:30.442
you're looking at a study,

846
00:25:30.462 --> 00:25:31.676
you're looking at averages,

847
00:25:31.696 --> 00:25:32.143
you're not looking

848
00:25:32.163 --> 00:25:33.545
at an individual child.

849
00:25:33.565 --> 00:25:35.146
So of course there are children

850
00:25:35.166 --> 00:25:37.682
who are scoring below these numbers,

851
00:25:37.702 --> 00:25:38.383
and there's children

852
00:25:38.403 --> 00:25:39.851
who are scoring above these numbers.

853
00:25:39.871 --> 00:25:40.385
So it's not that

854
00:25:40.405 --> 00:25:41.987
every single child who got the score.

855
00:25:42.007 --> 00:25:43.822
This is the mean or the average

856
00:25:43.842 --> 00:25:45.757
for this group of children

857
00:25:45.777 --> 00:25:47.292
and the pattern that you can see.

858
00:25:47.312 --> 00:25:50.095
And these are four of the 24 studies

859
00:25:50.115 --> 00:25:51.530
but they're very representative.

860
00:25:51.550 --> 00:25:52.931
This is what we saw

861
00:25:52.951 --> 00:25:55.567
basically across all 24 of the studies.

862
00:25:55.587 --> 00:25:57.402
Is that column two

863
00:25:57.422 --> 00:25:57.969
there

864
00:25:57.989 --> 00:25:58.937
the mean for children

865
00:25:58.957 --> 00:25:59.704
who are deaf or hard of

866
00:25:59.724 --> 00:26:02.374
hearing is in the average range.

867
00:26:02.394 --> 00:26:04.609
It is 85 or better,

868
00:26:04.629 --> 00:26:07.078
but it's at the lower end,  it’s below

869
00:26:07.098 --> 00:26:10.448
100 and it's at the lower half of the average range.

870
00:26:10.468 --> 00:26:10.916
Whereas

871
00:26:10.936 --> 00:26:12.417
every single time

872
00:26:12.437 --> 00:26:14.185
the group of children who are hearing

873
00:26:14.205 --> 00:26:18.156
are well above the mean of 100.

874
00:26:18.176 --> 00:26:19.357
And so they're at the high

875
00:26:19.377 --> 00:26:21.226
end of the average range.

876
00:26:21.246 --> 00:26:22.928
So that means if you have a score

877
00:26:22.948 --> 00:26:26.898
of, say, 91 on a test,

878
00:26:26.918 --> 00:26:27.465
you think, okay,

879
00:26:27.485 --> 00:26:28.533
that's only nine points

880
00:26:28.553 --> 00:26:29.734
off of the mean it’s well

881
00:26:29.754 --> 00:26:30.602
within

882
00:26:30.622 --> 00:26:32.771
plus or minus one standard deviation.

883
00:26:32.791 --> 00:26:34.873
That seems very acceptable

884
00:26:34.893 --> 00:26:36.474
but is not as acceptable

885
00:26:36.494 --> 00:26:39.277
if you think this child peers

886
00:26:39.297 --> 00:26:39.778
the children,

887
00:26:39.798 --> 00:26:40.912
they're going to school with,

888
00:26:40.932 --> 00:26:41.346
the children

889
00:26:41.366 --> 00:26:43.081
they're playing the neighborhood

890
00:26:43.101 --> 00:26:46.351
with, are scoring 1 to 2

891
00:26:46.371 --> 00:26:48.286
standard deviations higher than that

892
00:26:48.306 --> 00:26:50.055
because they're actually not getting 100

893
00:26:50.075 --> 00:26:51.356
they're getting 115,

894
00:26:51.376 --> 00:26:52.891
they’re getting 118,

895
00:26:52.911 --> 00:26:54.693
they're getting 120.

896
00:26:54.713 --> 00:26:57.929
So that's really quite a bit above

897
00:26:57.949 --> 00:26:58.530
that lower end 

898
00:26:58.550 --> 00:27:02.834
of the average range, 85, 90 kind of score.

899
00:27:02.854 --> 00:27:05.003
So how often does this pattern happen.

900
00:27:05.023 --> 00:27:05.937
The process of looking

901
00:27:05.957 --> 00:27:07.372
for more representative studies.

902
00:27:07.392 --> 00:27:08.873
But you might be thinking like really is

903
00:27:08.893 --> 00:27:09.808
that representative

904
00:27:09.828 --> 00:27:11.142
or this really happening in

905
00:27:11.162 --> 00:27:13.311
all the studies or most of the studies?

906
00:27:13.331 --> 00:27:14.779
And that's what we're showing here

907
00:27:14.799 --> 00:27:16.414
with these bar graphs.

908
00:27:16.434 --> 00:27:18.316
So the blue bar

909
00:27:18.336 --> 00:27:18.984
are the children

910
00:27:19.004 --> 00:27:21.252
who are deaf or hard of hearing,

911
00:27:21.272 --> 00:27:22.387
that group,

912
00:27:22.407 --> 00:27:25.123
the red bar are the children in the studies

913
00:27:25.143 --> 00:27:26.558
who we're hearing.

914
00:27:26.578 --> 00:27:27.959
And what we're looking at

915
00:27:27.979 --> 00:27:30.729
is, is on the left hand side.

916
00:27:30.749 --> 00:27:33.331
What percentage of the children were

917
00:27:33.351 --> 00:27:36.868
the means in that low average range?

918
00:27:36.888 --> 00:27:37.836
And then on the

919
00:27:37.856 --> 00:27:39.638
two right bars,

920
00:27:39.658 --> 00:27:41.806
in what percentage of the studies

921
00:27:41.826 --> 00:27:42.941
were the group scores

922
00:27:42.961 --> 00:27:45.610
and the high end of the average range.

923
00:27:45.630 --> 00:27:46.344
And I'll give you a minute

924
00:27:46.364 --> 00:27:52.334
just to kind of take a look at it.

925
00:27:52.354 --> 00:27:57.355


926
00:27:57.375 --> 00:27:58.556
So what we see is

927
00:27:58.576 --> 00:28:00.458
across the 24 studies

928
00:28:00.478 --> 00:28:03.228
in 80% of the comparisons,

929
00:28:03.248 --> 00:28:04.162
the mean for the deaf

930
00:28:04.182 --> 00:28:05.030
hard of hearing group

931
00:28:05.050 --> 00:28:08.099
was in the low end of the average range.

932
00:28:08.119 --> 00:28:08.433
That hardly

933
00:28:08.453 --> 00:28:09.901
ever happened for the hearing

934
00:28:09.921 --> 00:28:11.903
that we have in 99% of the comparisons.

935
00:28:11.923 --> 00:28:13.605


936
00:28:13.625 --> 00:28:17.208
Conversely, in 90% of the

937
00:28:17.228 --> 00:28:18.576
the comparisons that were done

938
00:28:18.596 --> 00:28:20.779
across these 24 studies,

939
00:28:20.799 --> 00:28:21.312
the children

940
00:28:21.332 --> 00:28:23.415
in the hearing group were in the high

941
00:28:23.435 --> 00:28:25.083
end of the average range,

942
00:28:25.103 --> 00:28:26.885
and that almost never happened for

943
00:28:26.905 --> 00:28:27.452
the children

944
00:28:27.472 --> 00:28:30.422
who were deaf or hard of hearing.

945
00:28:30.442 --> 00:28:31.456
So let's take a look

946
00:28:31.476 --> 00:28:31.690
at what

947
00:28:31.710 --> 00:28:33.458
this kind of looks like graphically.

948
00:28:33.478 --> 00:28:35.026
And I 

949
00:28:35.046 --> 00:28:36.795
just picked out one study

950
00:28:36.815 --> 00:28:38.630
that wasn't extreme

951
00:28:38.650 --> 00:28:40.365
in its means,  this is pretty

952
00:28:40.385 --> 00:28:42.701
it was pretty typical and,

953
00:28:42.721 --> 00:28:43.234
can't really

954
00:28:43.254 --> 00:28:45.336
put all 24 studies on the bell curve

955
00:28:45.356 --> 00:28:46.071
because it would have so many lines.

956
00:28:46.091 --> 00:28:48.840
wouldn’t  be able to distinguish

957
00:28:48.860 --> 00:28:50.041
one from the next.

958
00:28:50.061 --> 00:28:52.277
But the gray area here in the bell

959
00:28:52.297 --> 00:28:53.344
curve is representing

960
00:28:53.364 --> 00:28:57.148
that average range from 85 to 115.

961
00:28:57.168 --> 00:29:00.452
And the line that cuts it right in half is

962
00:29:00.472 --> 00:29:03.555
the mean for the test is at 100. 

963
00:29:03.575 --> 00:29:05.790
That’s the way they set the standard scores.

964
00:29:05.810 --> 00:29:07.025
And in this particular

965
00:29:07.045 --> 00:29:08.860
representative sample,

966
00:29:08.880 --> 00:29:09.861
the children who were deaf

967
00:29:09.881 --> 00:29:10.628
or hard of hearing

968
00:29:10.648 --> 00:29:13.264
that group scored at 91.

969
00:29:13.284 --> 00:29:16.367
And so that's the redish.

970
00:29:16.387 --> 00:29:17.802
Yes, it's red on the screen,

971
00:29:17.822 --> 00:29:19.738
the left hand side

972
00:29:19.758 --> 00:29:21.639
the vertical line

973
00:29:21.659 --> 00:29:24.342
that's the deaf and hard of hearing group.

974
00:29:24.362 --> 00:29:26.845
And then on the right hand side that green

975
00:29:26.865 --> 00:29:28.213
vertical bar,

976
00:29:28.233 --> 00:29:30.181
that was the mean for the hearing group

977
00:29:30.201 --> 00:29:32.183
in that same study,

978
00:29:32.203 --> 00:29:34.519
when children are together in a study,

979
00:29:34.539 --> 00:29:35.420
they typically live

980
00:29:35.440 --> 00:29:37.021
in the same geographic area

981
00:29:37.041 --> 00:29:38.623
because they're coming to the same place

982
00:29:38.643 --> 00:29:41.526
to get tested. And for this study.

983
00:29:41.546 --> 00:29:42.494
So again,

984
00:29:42.514 --> 00:29:44.295
these are the deaf and hard of hearing

985
00:29:44.315 --> 00:29:45.964
children peers.

986
00:29:45.984 --> 00:29:46.297
These are

987
00:29:46.317 --> 00:29:48.032
the children in their neighborhood.

988
00:29:48.052 --> 00:29:48.833
These are the children

989
00:29:48.853 --> 00:29:50.769
that they go to school with.

990
00:29:50.789 --> 00:29:53.404
This is what teachers, that

991
00:29:53.424 --> 00:29:54.839
green vertical bar, is

992
00:29:54.859 --> 00:29:56.641
what teachers are used to in terms

993
00:29:56.661 --> 00:29:58.343
of when the children come to them

994
00:29:58.363 --> 00:29:58.877
and they see

995
00:29:58.897 --> 00:30:00.545
what their language skills are

996
00:30:00.565 --> 00:30:01.179
and that's

997
00:30:01.199 --> 00:30:03.047
what they're probably teaching to

998
00:30:03.067 --> 00:30:04.349
is that level.

999
00:30:04.369 --> 00:30:07.152
So having this sort of separation,

1000
00:30:07.172 --> 00:30:08.720
between the two groups

1001
00:30:08.740 --> 00:30:10.688
could be very problematic

1002
00:30:10.708 --> 00:30:15.360
for the child when they get to school.

1003
00:30:15.380 --> 00:30:18.229
So an individual child, let's say,

1004
00:30:18.249 --> 00:30:18.763
you know,

1005
00:30:18.783 --> 00:30:19.264
you give this

1006
00:30:19.284 --> 00:30:20.665
just one individual child

1007
00:30:20.685 --> 00:30:23.835
and they score in that low average range

1008
00:30:23.855 --> 00:30:24.869
on the one hand,

1009
00:30:24.889 --> 00:30:26.805
you know, you might feel comforted

1010
00:30:26.825 --> 00:30:28.673
that they're in the average rate.

1011
00:30:28.693 --> 00:30:29.174
However,

1012
00:30:29.194 --> 00:30:30.041
if they are in the low

1013
00:30:30.061 --> 00:30:31.643
end of the average range,

1014
00:30:31.663 --> 00:30:33.611
that may actually be masking

1015
00:30:33.631 --> 00:30:36.481
some very meaningful gaps relative

1016
00:30:36.501 --> 00:30:39.517
to their actual true hearing peers.

1017
00:30:39.537 --> 00:30:43.221
And unfortunately, if you're at the table

1018
00:30:43.241 --> 00:30:44.689
for an IEP meeting,

1019
00:30:44.709 --> 00:30:47.091
transition meeting,

1020
00:30:47.111 --> 00:30:50.795
a child with a standard score of 85 to 95

1021
00:30:50.815 --> 00:30:52.497
is likely not going to qualify

1022
00:30:52.517 --> 00:30:54.966
for a lot of services, if any,

1023
00:30:54.986 --> 00:30:56.901
because that is the average

1024
00:30:56.921 --> 00:30:58.403
range, technically.

1025
00:30:58.423 --> 00:30:59.671
However,

1026
00:30:59.691 --> 00:31:02.507
their true peers are typically scoring

1027
00:31:02.527 --> 00:31:06.511
not at 100 but around 150 to 120,

1028
00:31:06.531 --> 00:31:10.048
so 1 to 2 standard deviations higher.

1029
00:31:10.068 --> 00:31:12.550
So this is a very important gap

1030
00:31:12.570 --> 00:31:13.618
that has been identified

1031
00:31:13.638 --> 00:31:15.253
in the research literature.

1032
00:31:15.273 --> 00:31:17.222
And obviously the goals

1033
00:31:17.242 --> 00:31:18.990
want to close that gap.

1034
00:31:19.010 --> 00:31:19.991
And we need to do that

1035
00:31:20.011 --> 00:31:21.993
not by bringing the two points together,

1036
00:31:22.013 --> 00:31:23.228
because we're not going to take

1037
00:31:23.248 --> 00:31:24.629
the children who are hearing

1038
00:31:24.649 --> 00:31:25.230
and then

1039
00:31:25.250 --> 00:31:26.297
somehow deteriorate

1040
00:31:26.317 --> 00:31:27.732
their language skills.

1041
00:31:27.752 --> 00:31:28.533
We need to do that

1042
00:31:28.553 --> 00:31:31.035
by bringing the left hand vertical line

1043
00:31:31.055 --> 00:31:32.971
up to where the line is

1044
00:31:32.991 --> 00:31:34.873
for the children who are hearing.

1045
00:31:34.893 --> 00:31:37.508
And how do we do that, in part is by

1046
00:31:37.528 --> 00:31:38.776
identifying factors

1047
00:31:38.796 --> 00:31:40.912
that lead to better language outcomes.

1048
00:31:40.932 --> 00:31:41.880
What can we do?

1049
00:31:41.900 --> 00:31:43.982
What are the things that one can do

1050
00:31:44.002 --> 00:31:44.616
that will lead?

1051
00:31:44.636 --> 00:31:45.850
The research shows

1052
00:31:45.870 --> 00:31:46.384
that does

1053
00:31:46.404 --> 00:31:48.152
lead to better language outcomes.

1054
00:31:48.172 --> 00:31:49.888
So I'm going to turn it back to Alyson

1055
00:31:49.908 --> 00:31:51.289
now to talk about what

1056
00:31:51.309 --> 00:31:53.324
this literature review revealed.

1057
00:31:53.344 --> 00:31:54.425
In that regard,

1058
00:31:54.445 --> 00:31:55.426
what were the factors

1059
00:31:55.446 --> 00:32:01.416
associated with higher language scores.

1060
00:32:01.436 --> 00:32:04.102


1061
00:32:04.122 --> 00:32:06.104
Thanks Allison.

1062
00:32:06.124 --> 00:32:07.639
Okay, I get to

1063
00:32:07.659 --> 00:32:08.940
share some of the stuff

1064
00:32:08.960 --> 00:32:11.042
that shows that factors that do,

1065
00:32:11.062 --> 00:32:11.910
do not

1066
00:32:11.930 --> 00:32:13.578
and possibly contribute

1067
00:32:13.598 --> 00:32:15.480
to better language outcomes.

1068
00:32:15.500 --> 00:32:16.881
So what characteristics are

1069
00:32:16.901 --> 00:32:18.249
in the child's environment

1070
00:32:18.269 --> 00:32:19.183
that are helping them

1071
00:32:19.203 --> 00:32:21.219
achieve higher language outcomes?

1072
00:32:21.239 --> 00:32:22.687
And while we're putting them at risk

1073
00:32:22.707 --> 00:32:24.355
for language delays,

1074
00:32:24.375 --> 00:32:25.223
I want to start out

1075
00:32:25.243 --> 00:32:27.292
that there is a lot of variability

1076
00:32:27.312 --> 00:32:28.860
among these settings

1077
00:32:28.880 --> 00:32:30.194
with some studies for

1078
00:32:30.214 --> 00:32:31.095
for an example,

1079
00:32:31.115 --> 00:32:32.664
with some studies saying yes,

1080
00:32:32.684 --> 00:32:34.599
hearing level is a predictor,

1081
00:32:34.619 --> 00:32:35.533
and another saying

1082
00:32:35.553 --> 00:32:36.868
no, hearing level is

1083
00:32:36.888 --> 00:32:38.569
not doesn't make a difference.

1084
00:32:38.589 --> 00:32:40.038
So that can be confusing.

1085
00:32:40.058 --> 00:32:41.072
Why is it yes

1086
00:32:41.092 --> 00:32:42.974
in some and no in others?

1087
00:32:42.994 --> 00:32:44.742
But in research studies

1088
00:32:44.762 --> 00:32:46.878
there are so many different factors

1089
00:32:46.898 --> 00:32:48.413
that you have to consider

1090
00:32:48.433 --> 00:32:50.481
that can lead to different outcomes.

1091
00:32:50.501 --> 00:32:53.584
Perhaps one study was looking at mild

1092
00:32:53.604 --> 00:32:54.619
to moderate loss,

1093
00:32:54.639 --> 00:32:55.887
and another study

1094
00:32:55.907 --> 00:32:57.622
could be more of a severe

1095
00:32:57.642 --> 00:32:59.357
or profound loss.

1096
00:32:59.377 --> 00:33:00.692
And it's not that one

1097
00:33:00.712 --> 00:33:02.160
study is right or wrong,

1098
00:33:02.180 --> 00:33:02.660
it's just that

1099
00:33:02.680 --> 00:33:03.594
they may have different

1100
00:33:03.614 --> 00:33:04.996
research questions,

1101
00:33:05.016 --> 00:33:06.864
such as looking at different outcomes.

1102
00:33:06.884 --> 00:33:08.700
Let's say some are looking at pragmatics,

1103
00:33:08.720 --> 00:33:10.902
maybe some are looking at syntax.

1104
00:33:10.922 --> 00:33:13.171
They may be using different assessments

1105
00:33:13.191 --> 00:33:15.106
or using a different sample.

1106
00:33:15.126 --> 00:33:16.407
And they may be looking

1107
00:33:16.427 --> 00:33:17.675
at different predictors

1108
00:33:17.695 --> 00:33:18.843
or looking at the same

1109
00:33:18.863 --> 00:33:20.211
predictor differently,

1110
00:33:20.231 --> 00:33:22.146
such as looking at a child

1111
00:33:22.166 --> 00:33:23.448
at maybe three and six

1112
00:33:23.468 --> 00:33:25.183
and nine months of age

1113
00:33:25.203 --> 00:33:28.252
or beyond versus every two weeks.

1114
00:33:28.272 --> 00:33:28.920
And looking at that

1115
00:33:28.940 --> 00:33:30.822
change progression over time.

1116
00:33:30.842 --> 00:33:32.557
So it really is variable

1117
00:33:32.577 --> 00:33:33.791
and I'll talk a little bit more about

1118
00:33:33.811 --> 00:33:36.561
that as the as we go on.

1119
00:33:36.581 --> 00:33:38.596
So of the 24 studies

1120
00:33:38.616 --> 00:33:41.799
we reviewed 22 investigative variables

1121
00:33:41.819 --> 00:33:43.334
potentially associated

1122
00:33:43.354 --> 00:33:44.869
with language outcomes.

1123
00:33:44.889 --> 00:33:45.370
And some

1124
00:33:45.390 --> 00:33:46.170
pictures showed

1125
00:33:46.190 --> 00:33:47.672
consistent associations

1126
00:33:47.692 --> 00:33:49.173
across the studies.

1127
00:33:49.193 --> 00:33:52.110
Some showed mixed across the studies

1128
00:33:52.130 --> 00:33:53.511
and some didn't show

1129
00:33:53.531 --> 00:33:57.682
that they were predictive at all.

1130
00:33:57.702 --> 00:33:59.017
So starting with the ones

1131
00:33:59.037 --> 00:34:00.618
that were not predictors.

1132
00:34:00.638 --> 00:34:01.686
So intuitively,

1133
00:34:01.706 --> 00:34:02.553
you may think that

1134
00:34:02.573 --> 00:34:04.122
some of these on this slide

1135
00:34:04.142 --> 00:34:06.691
are predictive of language outcomes.

1136
00:34:06.711 --> 00:34:08.393
But across all of the studies that we

1137
00:34:08.413 --> 00:34:09.127
reviewed

1138
00:34:09.147 --> 00:34:10.461
these factors consistently 

1139
00:34:10.481 --> 00:34:12.397
were not predictors

1140
00:34:12.417 --> 00:34:13.898
of language outcomes.

1141
00:34:13.918 --> 00:34:14.932
So one is sex,

1142
00:34:14.952 --> 00:34:16.901
whether the child is born as a boy

1143
00:34:16.921 --> 00:34:18.636
or girl did not result

1144
00:34:18.656 --> 00:34:19.470
in any difference

1145
00:34:19.490 --> 00:34:20.938
between looking at language outcomes.

1146
00:34:20.958 --> 00:34:22.006


1147
00:34:22.026 --> 00:34:23.574
Race was another one,

1148
00:34:23.594 --> 00:34:25.610
family income was another,

1149
00:34:25.630 --> 00:34:27.211
and then residing in an urban

1150
00:34:27.231 --> 00:34:27.812
or rural

1151
00:34:27.832 --> 00:34:29.213
area was another,

1152
00:34:29.233 --> 00:34:31.516
which we actually found surprising

1153
00:34:31.536 --> 00:34:33.151
because we often hear that children

1154
00:34:33.171 --> 00:34:34.685
in rural communities

1155
00:34:34.705 --> 00:34:37.822
have, reduced access to services.

1156
00:34:37.842 --> 00:34:39.424
But that wasn't actually a predictor

1157
00:34:39.444 --> 00:34:41.793
in any of the studies that we reviewed.

1158
00:34:41.813 --> 00:34:42.493
And then child

1159
00:34:42.513 --> 00:34:44.028
behavior was another factor

1160
00:34:44.048 --> 00:34:45.463
that was not a predictor

1161
00:34:45.483 --> 00:34:48.599
among the studies that we reviewed.

1162
00:34:48.619 --> 00:34:49.500
So the

1163
00:34:49.520 --> 00:34:50.902
ones that were a little bit

1164
00:34:50.922 --> 00:34:53.504
contradictory with half of them saying

1165
00:34:53.524 --> 00:34:54.872
half of the study saying yes,

1166
00:34:54.892 --> 00:34:56.574
these were predictors and the other half

1167
00:34:56.594 --> 00:34:58.709
saying no, they weren't.

1168
00:34:58.729 --> 00:34:59.911
A resounding message

1169
00:34:59.931 --> 00:35:01.746
is that these factors

1170
00:35:01.766 --> 00:35:03.247
are potential contributors

1171
00:35:03.267 --> 00:35:04.816
to language outcomes.

1172
00:35:04.836 --> 00:35:07.618
So for child and family characteristics,

1173
00:35:07.638 --> 00:35:08.186
looking at maternal

1174
00:35:08.206 --> 00:35:10.555
or caregiver education,

1175
00:35:10.575 --> 00:35:13.057
half said yes, half said no.

1176
00:35:13.077 --> 00:35:13.458
in terms

1177
00:35:13.478 --> 00:35:15.560
of looking at parental well-being

1178
00:35:15.580 --> 00:35:17.095
specifically

1179
00:35:17.115 --> 00:35:19.063
looking at parental stress,

1180
00:35:19.083 --> 00:35:21.099
those were based on questionnaires

1181
00:35:21.119 --> 00:35:22.533
given to the parents

1182
00:35:22.553 --> 00:35:23.968
saying if they were stressed

1183
00:35:23.988 --> 00:35:24.635
or not,

1184
00:35:24.655 --> 00:35:25.870
and it didn't have to do with

1185
00:35:25.890 --> 00:35:27.805
whether the child

1186
00:35:27.825 --> 00:35:29.173
had anything to do with the child

1187
00:35:29.193 --> 00:35:29.974
hearing level

1188
00:35:29.994 --> 00:35:32.643
just their stress level in general.

1189
00:35:32.663 --> 00:35:33.544
And then,

1190
00:35:33.564 --> 00:35:36.247
in terms of audiological variables

1191
00:35:36.267 --> 00:35:36.948
hearing levels

1192
00:35:36.968 --> 00:35:38.382
such as mild to moderate

1193
00:35:38.402 --> 00:35:40.518
or moderate to severe levels

1194
00:35:40.538 --> 00:35:42.120
and similar to the one example,

1195
00:35:42.140 --> 00:35:44.122
I just provided were also

1196
00:35:44.142 --> 00:35:45.957
led to mixed results.

1197
00:35:45.977 --> 00:35:47.258
And then quantity,

1198
00:35:47.278 --> 00:35:48.693
or how much the parents

1199
00:35:48.713 --> 00:35:50.528
communicated with their child

1200
00:35:50.548 --> 00:35:52.396
did not make a consistent difference.

1201
00:35:52.416 --> 00:35:53.464
So we'll talk a little bit more

1202
00:35:53.484 --> 00:35:56.767
about that in just a minute.

1203
00:35:56.787 --> 00:35:58.002
So these are factors

1204
00:35:58.022 --> 00:35:58.436
I just want

1205
00:35:58.456 --> 00:35:58.936
to emphasize

1206
00:35:58.956 --> 00:36:02.206
these are factors that were predictors

1207
00:36:02.226 --> 00:36:03.875
of spoken language.

1208
00:36:03.895 --> 00:36:07.578
So after closely reviewing 24 studies

1209
00:36:07.598 --> 00:36:09.680
we are confident that these factors

1210
00:36:09.700 --> 00:36:10.581
are consistently

1211
00:36:10.601 --> 00:36:13.684
linked to improved language development.

1212
00:36:13.704 --> 00:36:15.486
And these factors really helped us

1213
00:36:15.506 --> 00:36:17.021
build a larger circle

1214
00:36:17.041 --> 00:36:18.823
around our collective effort,

1215
00:36:18.843 --> 00:36:20.925
uniting us in our focus

1216
00:36:20.945 --> 00:36:21.959
in supporting children

1217
00:36:21.979 --> 00:36:23.528
who are deaf or hard of hearing

1218
00:36:23.548 --> 00:36:24.328
and strengthening

1219
00:36:24.348 --> 00:36:26.030
their language outcomes.

1220
00:36:26.050 --> 00:36:28.166
So again, this first of the factors

1221
00:36:28.186 --> 00:36:30.368
were significantly associated

1222
00:36:30.388 --> 00:36:32.370
with spoken language outcomes.

1223
00:36:32.390 --> 00:36:35.406
So looking at aided hearing thresholds

1224
00:36:35.426 --> 00:36:37.341
for those that use hearing technology,

1225
00:36:37.361 --> 00:36:39.510
their aided thresholds matter.

1226
00:36:39.530 --> 00:36:41.445
So meaning how much of the speech signal

1227
00:36:41.465 --> 00:36:42.880
a child can hear

1228
00:36:42.900 --> 00:36:43.614
when they're using

1229
00:36:43.634 --> 00:36:44.649
their technology

1230
00:36:44.669 --> 00:36:47.051
is significantly related to language.

1231
00:36:47.071 --> 00:36:47.752
So well fitted

1232
00:36:47.772 --> 00:36:48.953
hearing aids

1233
00:36:48.973 --> 00:36:50.655
and well mapped cochlear implants

1234
00:36:50.675 --> 00:36:51.989
are extremely important

1235
00:36:52.009 --> 00:36:54.158
for better language outcomes.

1236
00:36:54.178 --> 00:36:54.892
And the percentage

1237
00:36:54.912 --> 00:36:57.028
of audibility of the speech signal

1238
00:36:57.048 --> 00:36:57.828
when wearing

1239
00:36:57.848 --> 00:36:59.897
hearing technology was a significant

1240
00:36:59.917 --> 00:37:01.632
factor consistently,

1241
00:37:01.652 --> 00:37:02.767
as was duration

1242
00:37:02.787 --> 00:37:04.869
of hearing technology use.

1243
00:37:04.889 --> 00:37:06.804
So this is how long the child

1244
00:37:06.824 --> 00:37:08.906
has been wearing hearing technology.

1245
00:37:08.926 --> 00:37:10.875
So whether they were,

1246
00:37:10.895 --> 00:37:11.209
you know,

1247
00:37:11.229 --> 00:37:13.211
using hearing aids at a young age

1248
00:37:13.231 --> 00:37:16.981
versus older.

1249
00:37:17.001 --> 00:37:18.583
And then some additional factors,

1250
00:37:18.603 --> 00:37:20.051
and these were across all the studies,

1251
00:37:20.071 --> 00:37:22.520
and we're not specific to spoken language,

1252
00:37:22.540 --> 00:37:23.854
but the parent

1253
00:37:23.874 --> 00:37:25.756
psychosocial factors,

1254
00:37:25.776 --> 00:37:28.292
one was looking at the child

1255
00:37:28.312 --> 00:37:29.160
nonverbal

1256
00:37:29.180 --> 00:37:32.129
cognitive skills or nonverbal IQ.

1257
00:37:32.149 --> 00:37:34.799
So the performance on different cognitive

1258
00:37:34.819 --> 00:37:35.666
tasks.

1259
00:37:35.686 --> 00:37:38.669
So tasks like theory of mind tasks or

1260
00:37:38.689 --> 00:37:41.072
executive functioning tasks,

1261
00:37:41.092 --> 00:37:42.440
and children who do better on

1262
00:37:42.460 --> 00:37:43.741
those tasks

1263
00:37:43.761 --> 00:37:45.109
tend to develop better

1264
00:37:45.129 --> 00:37:46.277
language outcomes.

1265
00:37:46.297 --> 00:37:48.412
This is also true for the children

1266
00:37:48.432 --> 00:37:49.947
that were hearing in these samples.

1267
00:37:49.967 --> 00:37:51.782
So keep that in.

1268
00:37:51.802 --> 00:37:53.251
And then the parents’

1269
00:37:53.271 --> 00:37:55.386
positive perception of their ability

1270
00:37:55.406 --> 00:37:57.455
to raise their child who is 

1271
00:37:57.475 --> 00:37:58.756
deaf or hard of hearing.

1272
00:37:58.776 --> 00:38:00.658
And this is a modifiable factor.

1273
00:38:00.678 --> 00:38:01.592
Allison, we'll talk

1274
00:38:01.612 --> 00:38:03.527
more about that in just a few minutes.

1275
00:38:03.547 --> 00:38:04.262
But parents that

1276
00:38:04.282 --> 00:38:07.932
felt confident in their ability the child did better.

1277
00:38:07.952 --> 00:38:09.300
And so working with parents

1278
00:38:09.320 --> 00:38:09.934
again, they know

1279
00:38:09.954 --> 00:38:10.901
that in the EHDI world,

1280
00:38:10.921 --> 00:38:13.971
we know how important parent training

1281
00:38:13.991 --> 00:38:14.839
and parent leadership

1282
00:38:14.859 --> 00:38:17.008
and parent understanding and confidence

1283
00:38:17.028 --> 00:38:19.644
really helps

1284
00:38:19.664 --> 00:38:21.479
that child in many, many ways

1285
00:38:21.499 --> 00:38:22.480
in language, social,

1286
00:38:22.500 --> 00:38:25.016
emotional health, etc..

1287
00:38:25.036 --> 00:38:27.551
And then the EHDI factor, one of the reasons

1288
00:38:27.571 --> 00:38:28.119
we're all here

1289
00:38:28.139 --> 00:38:28.953
right

1290
00:38:28.973 --> 00:38:31.722
is meeting the 3 or 6 month markers.

1291
00:38:31.742 --> 00:38:33.891
Of course, we know this, right?

1292
00:38:33.911 --> 00:38:36.827
Because this is just re-emphasized and,

1293
00:38:36.847 --> 00:38:38.362
and this literature review,

1294
00:38:38.382 --> 00:38:39.664
the median that a three month

1295
00:38:39.684 --> 00:38:41.132
diagnosis marker

1296
00:38:41.152 --> 00:38:41.999
and then rolling

1297
00:38:42.019 --> 00:38:43.701
into early intervention by six month

1298
00:38:43.721 --> 00:38:45.903
benchmark were extremely important

1299
00:38:45.923 --> 00:38:47.838
and signifying whether that child

1300
00:38:47.858 --> 00:38:48.272
is going

1301
00:38:48.292 --> 00:38:50.474
to have better language outcomes.

1302
00:38:50.494 --> 00:38:52.743
And this is specifically true,

1303
00:38:52.763 --> 00:38:53.744
or

1304
00:38:53.764 --> 00:38:54.779
kids getting enrolled

1305
00:38:54.799 --> 00:38:55.880
into early intervention

1306
00:38:55.900 --> 00:38:57.515
by six months of age.

1307
00:38:57.535 --> 00:38:59.050
And we did not see a difference

1308
00:38:59.070 --> 00:39:00.117
in any of the studies

1309
00:39:00.137 --> 00:39:01.886
that looked at the six month

1310
00:39:01.906 --> 00:39:03.654
early intervention enrollment

1311
00:39:03.674 --> 00:39:04.021
versus

1312
00:39:04.041 --> 00:39:04.922
the more ambitious

1313
00:39:04.942 --> 00:39:06.090
three month early

1314
00:39:06.110 --> 00:39:08.192
and early intervention enrollment.

1315
00:39:08.212 --> 00:39:09.794
There was not a significant difference

1316
00:39:09.814 --> 00:39:10.861
between that three months

1317
00:39:10.881 --> 00:39:12.296
and that six month in terms

1318
00:39:12.316 --> 00:39:13.864
of enrollment

1319
00:39:13.884 --> 00:39:14.865
to early intervention.

1320
00:39:14.885 --> 00:39:17.802
So that was interesting as well.

1321
00:39:17.822 --> 00:39:18.102
And there are

1322
00:39:18.122 --> 00:39:19.637
some additional so language input

1323
00:39:19.657 --> 00:39:21.605
and environmental factors.

1324
00:39:21.625 --> 00:39:23.708
So quality,

1325
00:39:23.728 --> 00:39:25.476
So this isn’t the quantity variable

1326
00:39:25.496 --> 00:39:27.812
that we just talked about but quality

1327
00:39:27.832 --> 00:39:28.979
the word parents

1328
00:39:28.999 --> 00:39:30.981
communicated with their kids.

1329
00:39:31.001 --> 00:39:32.850
But their effects on young children,

1330
00:39:32.870 --> 00:39:34.785
the more variety of language

1331
00:39:34.805 --> 00:39:36.354
that the parents use,

1332
00:39:36.374 --> 00:39:38.222
the number of words used by the adults

1333
00:39:38.242 --> 00:39:40.191
or the types of questions,

1334
00:39:40.211 --> 00:39:41.992
question facilitation techniques

1335
00:39:42.012 --> 00:39:44.095
that the parents used with their children

1336
00:39:44.115 --> 00:39:45.629
made a difference.

1337
00:39:45.649 --> 00:39:47.665
So keeping that in mind helps and we’ll hit on that

1338
00:39:47.685 --> 00:39:49.200
again, in just a minute.

1339
00:39:49.220 --> 00:39:50.601
And then the amount of time

1340
00:39:50.621 --> 00:39:52.737
parents of children spent reading books,

1341
00:39:52.757 --> 00:39:53.604
I think we

1342
00:39:53.624 --> 00:39:54.038
we know

1343
00:39:54.058 --> 00:39:56.273
reading is important for all children,

1344
00:39:56.293 --> 00:39:58.008
but that consistently shows

1345
00:39:58.028 --> 00:39:59.243
better language outcomes

1346
00:39:59.263 --> 00:40:00.411
is reading your child

1347
00:40:00.431 --> 00:40:02.446
who is deaf or hard of hearing.

1348
00:40:02.466 --> 00:40:03.414
And then for families

1349
00:40:03.434 --> 00:40:05.116
using spoken language,

1350
00:40:05.136 --> 00:40:06.117
a noisy home

1351
00:40:06.137 --> 00:40:07.618
environment makes a difference

1352
00:40:07.638 --> 00:40:09.320
it leads to poorer language

1353
00:40:09.340 --> 00:40:10.454
outcomes for the children.

1354
00:40:10.474 --> 00:40:13.824
So especially to, electronic noise

1355
00:40:13.844 --> 00:40:15.860
from the TV, computer,

1356
00:40:15.880 --> 00:40:18.429
tablets, iPads, smartphones,

1357
00:40:18.449 --> 00:40:19.730
all of those

1358
00:40:19.750 --> 00:40:21.298
electronic technologies

1359
00:40:21.318 --> 00:40:23.567
that we're creating noise in the home

1360
00:40:23.587 --> 00:40:25.436
consistently were related to

1361
00:40:25.456 --> 00:40:29.740
poorer language outcomes.

1362
00:40:29.760 --> 00:40:31.809
Well, I think I did the drag thing,

1363
00:40:31.829 --> 00:40:35.813
okay, sorry, my screen went blank for a second.

1364
00:40:35.833 --> 00:40:37.782
Allison warned me, I still did it, classic.

1365
00:40:37.802 --> 00:40:38.516
Okay.

1366
00:40:38.536 --> 00:40:39.617
So

1367
00:40:39.637 --> 00:40:41.352
thinking about research gaps

1368
00:40:41.372 --> 00:40:42.653
and future directions.

1369
00:40:42.673 --> 00:40:43.154
Some of these

1370
00:40:43.174 --> 00:40:45.423
we had a little bit already,

1371
00:40:45.443 --> 00:40:47.091
but there was a distinct

1372
00:40:47.111 --> 00:40:49.660
lack of diversity in the study samples.

1373
00:40:49.680 --> 00:40:51.796
So most of the children involved in

1374
00:40:51.816 --> 00:40:52.797
the studies

1375
00:40:52.817 --> 00:40:53.464
were primarily

1376
00:40:53.484 --> 00:40:55.232
white, middle to upper class

1377
00:40:55.252 --> 00:40:57.268
and highly educated families.

1378
00:40:57.288 --> 00:40:58.202
This is a challenge

1379
00:40:58.222 --> 00:40:59.804
in a lot of research studies,

1380
00:40:59.824 --> 00:41:01.172
because they're often conducted

1381
00:41:01.192 --> 00:41:02.740
out of universities

1382
00:41:02.760 --> 00:41:05.075
who tend to do more convenient sampling.

1383
00:41:05.095 --> 00:41:05.709
So children

1384
00:41:05.729 --> 00:41:08.479
that may already be enrolled in their clinics

1385
00:41:08.499 --> 00:41:09.747
and so that really reduces

1386
00:41:09.767 --> 00:41:11.348
the diversity in the families

1387
00:41:11.368 --> 00:41:13.050
that getting in these studies.

1388
00:41:13.070 --> 00:41:14.919
So keep that in mind

1389
00:41:14.939 --> 00:41:16.287
and then limited descriptions

1390
00:41:16.307 --> 00:41:16.887
of the sample

1391
00:41:16.907 --> 00:41:18.389
characteristics was an issue

1392
00:41:18.409 --> 00:41:19.590
we found as we were

1393
00:41:19.610 --> 00:41:20.357
trying to look

1394
00:41:20.377 --> 00:41:22.560
at those predictive factors.

1395
00:41:22.580 --> 00:41:25.362
So here in technology use was not well

1396
00:41:25.382 --> 00:41:26.263
aligned out

1397
00:41:26.283 --> 00:41:28.499
in all of the studies, particularly

1398
00:41:28.519 --> 00:41:30.601
hearing amount or wear time

1399
00:41:30.621 --> 00:41:32.603
which we know is a significant predictor.

1400
00:41:32.623 --> 00:41:33.838
But that was not something

1401
00:41:33.858 --> 00:41:34.939
that was described well

1402
00:41:34.959 --> 00:41:35.906
in any of the studies

1403
00:41:35.926 --> 00:41:37.341
that we reviewed.

1404
00:41:37.361 --> 00:41:39.143
Amount and type of intervention

1405
00:41:39.163 --> 00:41:40.444
was also not described

1406
00:41:40.464 --> 00:41:41.078
well,

1407
00:41:41.098 --> 00:41:42.246
the types of trainings

1408
00:41:42.266 --> 00:41:43.314
that the interventions

1409
00:41:43.334 --> 00:41:45.416
had received, the types of activities

1410
00:41:45.436 --> 00:41:46.250
they were doing with the

1411
00:41:46.270 --> 00:41:48.319
children was not well described

1412
00:41:48.339 --> 00:41:50.521
in any of the studies that we reviewed.

1413
00:41:50.541 --> 00:41:52.189
And then the communication approach

1414
00:41:52.209 --> 00:41:54.225
and language history was often

1415
00:41:54.245 --> 00:41:54.925
kind of a

1416
00:41:54.945 --> 00:41:56.794
either a brief little mention

1417
00:41:56.814 --> 00:41:58.529
of or not mentioned at all.

1418
00:41:58.549 --> 00:42:00.130
And we know that that provides

1419
00:42:00.150 --> 00:42:00.998
more context

1420
00:42:01.018 --> 00:42:02.299
for what we're actually reading

1421
00:42:02.319 --> 00:42:03.501
in the outcomes.

1422
00:42:03.521 --> 00:42:04.869
And so,

1423
00:42:04.889 --> 00:42:06.470
leads me into some more,

1424
00:42:06.490 --> 00:42:08.105
more of the limitations,

1425
00:42:08.125 --> 00:42:10.274
and then I'll go into future directions.

1426
00:42:10.294 --> 00:42:12.243
So there was as Allison mentioned before

1427
00:42:12.263 --> 00:42:14.645
a really strong reliance on

1428
00:42:14.665 --> 00:42:16.313
a standardized language test,

1429
00:42:16.333 --> 00:42:18.349
that often showed, those, left

1430
00:42:18.369 --> 00:42:19.049
big gaps

1431
00:42:19.069 --> 00:42:19.917
in understanding

1432
00:42:19.937 --> 00:42:21.051
what the language really looked

1433
00:42:21.071 --> 00:42:22.786
like for those children.

1434
00:42:22.806 --> 00:42:24.088
And then most studies

1435
00:42:24.108 --> 00:42:25.990
just really relied on the general

1436
00:42:26.010 --> 00:42:27.558
omnibus language

1437
00:42:27.578 --> 00:42:28.692
skills of the children,

1438
00:42:28.712 --> 00:42:30.528
and not really looking at some of that

1439
00:42:30.548 --> 00:42:31.862
deeper level of language

1440
00:42:31.882 --> 00:42:33.564
like amorphous syntax

1441
00:42:33.584 --> 00:42:35.966
and pragmatics, like Allison mentioned.

1442
00:42:35.986 --> 00:42:37.868
And then substantially more studies

1443
00:42:37.888 --> 00:42:38.936
examined spoken

1444
00:42:38.956 --> 00:42:40.104
language specifically

1445
00:42:40.124 --> 00:42:40.804
with few

1446
00:42:40.824 --> 00:42:42.373
investigating the development

1447
00:42:42.393 --> 00:42:43.941
of sign language skills.

1448
00:42:43.961 --> 00:42:45.743
And we found that there's another,

1449
00:42:45.763 --> 00:42:49.046
another gap in the literature.

1450
00:42:49.066 --> 00:42:50.180
And then considerations

1451
00:42:50.200 --> 00:42:51.215
for future research.

1452
00:42:51.235 --> 00:42:52.850
And this is just based on,

1453
00:42:52.870 --> 00:42:54.618
on the gaps that I just cited.

1454
00:42:54.638 --> 00:42:57.688
So really using spontaneous language

1455
00:42:57.708 --> 00:42:59.189
samples to bolster findings

1456
00:42:59.209 --> 00:43:00.991
from any standardized tests,

1457
00:43:01.011 --> 00:43:02.326
but offer a better picture

1458
00:43:02.346 --> 00:43:04.128
of what was really occurring

1459
00:43:04.148 --> 00:43:05.629
for the child's language.

1460
00:43:05.649 --> 00:43:08.532
And I imagine that with the use of AI

1461
00:43:08.552 --> 00:43:10.267
it might make language sampling

1462
00:43:10.287 --> 00:43:11.101
more feasible

1463
00:43:11.121 --> 00:43:12.870
for a lot of the early interventionists

1464
00:43:12.890 --> 00:43:14.505
to add more information to

1465
00:43:14.525 --> 00:43:17.074
what is the child's true,

1466
00:43:17.094 --> 00:43:18.409
picture of the language.

1467
00:43:18.429 --> 00:43:19.710
This

1468
00:43:19.730 --> 00:43:21.946
a more detailed analysis of lexical,

1469
00:43:21.966 --> 00:43:23.414
and grammatical skills,

1470
00:43:23.434 --> 00:43:25.382
measurement of pragmatics.

1471
00:43:25.402 --> 00:43:26.951
also as Allison said it before

1472
00:43:26.971 --> 00:43:27.985
There was only one study

1473
00:43:28.005 --> 00:43:29.219
that looked at that

1474
00:43:29.239 --> 00:43:30.487
and then investigation

1475
00:43:30.507 --> 00:43:32.122
of the influence of interventionist

1476
00:43:32.142 --> 00:43:34.291
characteristics on language outcomes.

1477
00:43:34.311 --> 00:43:35.359
Again, that's the training

1478
00:43:35.379 --> 00:43:36.994
and activities.

1479
00:43:37.014 --> 00:43:38.228
The training of the providers

1480
00:43:38.248 --> 00:43:39.229
as well as the activities

1481
00:43:39.249 --> 00:43:40.931
in conjunction with the children

1482
00:43:40.951 --> 00:43:43.400
and then increasing inclusion of children

1483
00:43:43.420 --> 00:43:45.970
who use sign either exclusively or

1484
00:43:45.990 --> 00:43:48.906
alongside spoken language.

1485
00:43:48.926 --> 00:43:49.673
Okay, I’m gonna turn it

1486
00:43:49.693 --> 00:43:52.943
back over to Allison,

1487
00:43:52.963 --> 00:43:53.978
which is good because I think

1488
00:43:53.998 --> 00:43:54.778
I think my voice

1489
00:43:54.798 --> 00:43:56.847
just slowly getting more and more.

1490
00:43:56.867 --> 00:43:58.148


1491
00:43:58.168 --> 00:44:00.084
So for many years now,

1492
00:44:00.104 --> 00:44:01.719
there's been a push from professionals

1493
00:44:01.739 --> 00:44:04.822
to employ evidence based practices.

1494
00:44:04.842 --> 00:44:07.524
So that's a key term we've heard a lot,

1495
00:44:07.544 --> 00:44:10.260
over really the last couple of decades.

1496
00:44:10.280 --> 00:44:11.962
And we can achieve this

1497
00:44:11.982 --> 00:44:13.864
by supporting families

1498
00:44:13.884 --> 00:44:15.332
to increase strategies

1499
00:44:15.352 --> 00:44:17.101
that have been found in

1500
00:44:17.121 --> 00:44:18.802
in this literature review

1501
00:44:18.822 --> 00:44:19.937
and in other studies

1502
00:44:19.957 --> 00:44:21.472
that you might come across

1503
00:44:21.492 --> 00:44:22.439
that are associated

1504
00:44:22.459 --> 00:44:23.974
with stronger language outcomes.

1505
00:44:23.994 --> 00:44:25.943
That's what evidence based practice is.

1506
00:44:25.963 --> 00:44:27.444
Let’s look at the literature,

1507
00:44:27.464 --> 00:44:29.880
what's associated with better outcomes.

1508
00:44:29.900 --> 00:44:32.249
Let's do those things.

1509
00:44:32.269 --> 00:44:33.917
So child,

1510
00:44:33.937 --> 00:44:35.953
family, demographic characteristics

1511
00:44:35.973 --> 00:44:37.221
were the factors actually

1512
00:44:37.241 --> 00:44:38.822
that were the least likely

1513
00:44:38.842 --> 00:44:40.658
to be consistently associated

1514
00:44:40.678 --> 00:44:42.092
with language outcomes.

1515
00:44:42.112 --> 00:44:43.727
And that's pretty encouraging

1516
00:44:43.747 --> 00:44:45.529
because we can't really change

1517
00:44:45.549 --> 00:44:48.065
those things most of the time.

1518
00:44:48.085 --> 00:44:50.334
And it reinforces the importance

1519
00:44:50.354 --> 00:44:52.903
on focusing on modifiable factors

1520
00:44:52.923 --> 00:44:53.971
that were the things

1521
00:44:53.991 --> 00:44:54.538
that were found

1522
00:44:54.558 --> 00:44:56.173
to be significant predictors

1523
00:44:56.193 --> 00:44:57.808
of language outcomes.

1524
00:44:57.828 --> 00:44:58.442
And we saw

1525
00:44:58.462 --> 00:45:00.511
from what Alyson just presented,

1526
00:45:00.531 --> 00:45:02.980
that really there is a role for all of us.

1527
00:45:03.000 --> 00:45:04.615
in this because for spoken

1528
00:45:04.635 --> 00:45:05.983
language outcomes,

1529
00:45:06.003 --> 00:45:07.051
hearing technology

1530
00:45:07.071 --> 00:45:10.421
plays a big role as a predictor

1531
00:45:10.441 --> 00:45:12.956
audiologist there.

1532
00:45:12.976 --> 00:45:16.427
For communication with children.

1533
00:45:16.447 --> 00:45:18.162
Parents play a huge role there.

1534
00:45:18.182 --> 00:45:19.897
The interventionists

1535
00:45:19.917 --> 00:45:22.199
and teachers can support that.

1536
00:45:22.219 --> 00:45:25.669
And so this is definitely EHDI together,

1537
00:45:25.689 --> 00:45:28.372
kind of activity.

1538
00:45:28.392 --> 00:45:30.174
So what are some of the evidence

1539
00:45:30.194 --> 00:45:31.241
based recommendations

1540
00:45:31.261 --> 00:45:32.342
based on this literature

1541
00:45:32.362 --> 00:45:34.545
review of the 24 studies?

1542
00:45:34.565 --> 00:45:36.346
One is that even though there

1543
00:45:36.366 --> 00:45:36.780
were equivocal 

1544
00:45:36.800 --> 00:45:40.017
findings about the amount of input,

1545
00:45:40.037 --> 00:45:41.985
it was 100% consistent

1546
00:45:42.005 --> 00:45:43.320
that if a study examined

1547
00:45:43.340 --> 00:45:45.723
the quality of communication

1548
00:45:45.743 --> 00:45:46.824
with the child

1549
00:45:46.844 --> 00:45:48.058
that was found to be

1550
00:45:48.078 --> 00:45:50.027
a significant predictor.

1551
00:45:50.047 --> 00:45:51.595
So what are the kinds of things

1552
00:45:51.615 --> 00:45:52.830
we want to encourage

1553
00:45:52.850 --> 00:45:54.965
based on these research studies?

1554
00:45:54.985 --> 00:45:57.134
Reducing directives

1555
00:45:57.154 --> 00:46:00.137
and that includes requesting imitation.

1556
00:46:00.157 --> 00:46:02.439
So studies are findings that look at

1557
00:46:02.459 --> 00:46:03.273
word learning

1558
00:46:03.293 --> 00:46:05.342
and what influences word learning

1559
00:46:05.362 --> 00:46:07.478
is that asking a child to imitate

1560
00:46:07.498 --> 00:46:09.646
you doesn't really help.

1561
00:46:09.666 --> 00:46:10.681
And in some studies

1562
00:46:10.701 --> 00:46:12.082
they actually find

1563
00:46:12.102 --> 00:46:13.417
reverse production

1564
00:46:13.437 --> 00:46:14.251
of that

1565
00:46:14.271 --> 00:46:15.552
meaning asking the child

1566
00:46:15.572 --> 00:46:17.287
to imitate a new word

1567
00:46:17.307 --> 00:46:19.256
actually reduces how quickly

1568
00:46:19.276 --> 00:46:20.624
they're going to learn that word.

1569
00:46:20.644 --> 00:46:21.658
At least in this

1570
00:46:21.678 --> 00:46:22.960
birth to 3 period.

1571
00:46:22.980 --> 00:46:24.728
For an older school-aged child,

1572
00:46:24.748 --> 00:46:26.730
the findings might be different.

1573
00:46:26.750 --> 00:46:28.265
Asking instead open

1574
00:46:28.285 --> 00:46:30.300
ended questions, pausing,

1575
00:46:30.320 --> 00:46:32.369
giving expectant looks

1576
00:46:32.389 --> 00:46:34.571
to hopefully have the child imitate you

1577
00:46:34.591 --> 00:46:36.440
without asking them to imitate

1578
00:46:36.460 --> 00:46:38.408
you.  Increase time

1579
00:46:38.428 --> 00:46:39.610
in book reading

1580
00:46:39.630 --> 00:46:42.279
and increasing conversational turns.

1581
00:46:42.299 --> 00:46:44.848
That was one of the quality indicators.

1582
00:46:44.868 --> 00:46:46.884
The more conversational turns

1583
00:46:46.904 --> 00:46:47.851
which means

1584
00:46:47.871 --> 00:46:49.319
that the parent responds

1585
00:46:49.339 --> 00:46:51.722
promptly and relevantly

1586
00:46:51.742 --> 00:46:53.891
to what the child has either said,

1587
00:46:53.911 --> 00:46:58.228
sign or done.

1588
00:46:58.248 --> 00:47:00.097
You don't have to create materials

1589
00:47:00.117 --> 00:47:00.998
yourself.

1590
00:47:01.018 --> 00:47:02.633
There are so many fantastic

1591
00:47:02.653 --> 00:47:03.700
materials out there,

1592
00:47:03.720 --> 00:47:03.934
and I

1593
00:47:03.954 --> 00:47:04.601
just picked up

1594
00:47:04.621 --> 00:47:06.403
a few of the organizations

1595
00:47:06.423 --> 00:47:08.038
that have these materials.

1596
00:47:08.058 --> 00:47:09.840
And of course, there's many more.

1597
00:47:09.860 --> 00:47:11.141
But one thing I want to highlight

1598
00:47:11.161 --> 00:47:13.210
with these organizations is,

1599
00:47:13.230 --> 00:47:15.112
the ones I selected,

1600
00:47:15.132 --> 00:47:16.513
half of them are not specific

1601
00:47:16.533 --> 00:47:16.980
to children

1602
00:47:17.000 --> 00:47:18.148
who are deaf or hard of hearing.

1603
00:47:18.168 --> 00:47:20.884
So as we're looking for tip sheets,

1604
00:47:20.904 --> 00:47:23.353
how do we increase quality communication

1605
00:47:23.373 --> 00:47:24.121
with children?

1606
00:47:24.141 --> 00:47:25.589
Quality input

1607
00:47:25.609 --> 00:47:27.124
look beyond those websites

1608
00:47:27.144 --> 00:47:28.592
that are specific to children, deaf

1609
00:47:28.612 --> 00:47:29.626
or hard of hearing,

1610
00:47:29.646 --> 00:47:30.260
because there's some

1611
00:47:30.280 --> 00:47:31.261
great early childhood

1612
00:47:31.281 --> 00:47:32.095
sites out there

1613
00:47:32.115 --> 00:47:33.197
that have very relevant

1614
00:47:33.217 --> 00:47:35.766
information for us

1615
00:47:35.786 --> 00:47:37.501
also based on the evidence,

1616
00:47:37.521 --> 00:47:39.403
but those families who are focusing

1617
00:47:39.423 --> 00:47:40.838
on spoken language,

1618
00:47:40.858 --> 00:47:42.673
identifying and reducing

1619
00:47:42.693 --> 00:47:45.609
noises at home, is critical.

1620
00:47:45.629 --> 00:47:47.744
And I want to go to our

1621
00:47:47.764 --> 00:47:48.612
next point here,

1622
00:47:48.632 --> 00:47:51.748
which was about parent confidence,

1623
00:47:51.768 --> 00:47:54.318
of studies that we saw. Several of the studies

1624
00:47:54.338 --> 00:47:56.687
did measures of how confident does

1625
00:47:56.707 --> 00:47:58.121
the parents feel

1626
00:47:58.141 --> 00:48:00.324
in raising their child generally

1627
00:48:00.344 --> 00:48:01.725
and in raising their child,

1628
00:48:01.745 --> 00:48:04.361
because given that that child is deaf

1629
00:48:04.381 --> 00:48:06.029
or hard of hearing.

1630
00:48:06.049 --> 00:48:06.930
And so I just

1631
00:48:06.950 --> 00:48:08.665
I have to bring in the Academy Awards.

1632
00:48:08.685 --> 00:48:10.067
because this was just on last night.

1633
00:48:10.087 --> 00:48:11.535
It's my favorite show of the year.

1634
00:48:11.555 --> 00:48:13.403
So I don't know if any of you caught it

1635
00:48:13.423 --> 00:48:15.505
that probably most of you were dancing.

1636
00:48:15.525 --> 00:48:16.740
But Jessie Buckley,

1637
00:48:16.760 --> 00:48:19.209
who won best Actress for Hamnet,

1638
00:48:19.229 --> 00:48:19.843
which, by the way,

1639
00:48:19.863 --> 00:48:21.511
is a really excellent film

1640
00:48:21.531 --> 00:48:23.814
about a mother's love for her children.

1641
00:48:23.834 --> 00:48:27.184
So it's has nothing to do with deaf

1642
00:48:27.204 --> 00:48:28.051
rendering children.

1643
00:48:28.071 --> 00:48:30.420
But it's a beautiful family film

1644
00:48:30.440 --> 00:48:31.722
looking at a mother’s love.

1645
00:48:31.742 --> 00:48:32.155
And she

1646
00:48:32.175 --> 00:48:33.624
dedicated her award

1647
00:48:33.644 --> 00:48:35.158
to the beautiful

1648
00:48:35.178 --> 00:48:38.161
chaos of the mother's heart.

1649
00:48:38.181 --> 00:48:40.097
And as a mother herself of an

1650
00:48:40.117 --> 00:48:41.131
eight month old child,

1651
00:48:41.151 --> 00:48:42.332
she could speak from her

1652
00:48:42.352 --> 00:48:44.034
lived experience.

1653
00:48:44.054 --> 00:48:46.503
But I would say, and I believe

1654
00:48:46.523 --> 00:48:48.472
that too much chaos in your heart

1655
00:48:48.492 --> 00:48:51.208
maybe is not so beautiful after all.

1656
00:48:51.228 --> 00:48:53.410
So feeling confident in your ability

1657
00:48:53.430 --> 00:48:56.013
to raise your child is

1658
00:48:56.033 --> 00:48:58.815
probably gonna reduce that chaos

1659
00:48:58.835 --> 00:49:01.018
of love in the mother's heart.

1660
00:49:01.038 --> 00:49:03.620
And that's something that we can help

1661
00:49:03.640 --> 00:49:04.988
the family too.

1662
00:49:05.008 --> 00:49:07.624
So some of the just obviously there's

1663
00:49:07.644 --> 00:49:09.359
so many ways to do that.

1664
00:49:09.379 --> 00:49:10.761
Just some thoughts

1665
00:49:10.781 --> 00:49:12.930
is doing videotaped interactions

1666
00:49:12.950 --> 00:49:14.064
not to gather a language

1667
00:49:14.084 --> 00:49:15.198
sample necessarily,

1668
00:49:15.218 --> 00:49:17.034
although that could be a side benefit.

1669
00:49:17.054 --> 00:49:18.835
But then watching that with the family

1670
00:49:18.855 --> 00:49:21.038
and showing all the great places

1671
00:49:21.058 --> 00:49:23.073
where the adult is using

1672
00:49:23.093 --> 00:49:24.408
language facilitation

1673
00:49:24.428 --> 00:49:25.943
techniques and is using high

1674
00:49:25.963 --> 00:49:27.010
quality language,

1675
00:49:27.030 --> 00:49:29.313
pointing out additional opportunities

1676
00:49:29.333 --> 00:49:31.481
where they can do even more of that,

1677
00:49:31.501 --> 00:49:32.683
and then connecting, you know,

1678
00:49:32.703 --> 00:49:34.351
with other parents of children

1679
00:49:34.371 --> 00:49:35.919
who are deaf or hard of hearing.

1680
00:49:35.939 --> 00:49:37.821
This is going to raise their confidence

1681
00:49:37.841 --> 00:49:40.123
and hopefully reduce the chaos of,

1682
00:49:40.143 --> 00:49:41.458
in their heart,

1683
00:49:41.478 --> 00:49:42.526
highlighting the child's

1684
00:49:42.546 --> 00:49:44.261
progress and successes

1685
00:49:44.281 --> 00:49:45.662
and finding out what it is

1686
00:49:45.682 --> 00:49:46.630
they want to learn

1687
00:49:46.650 --> 00:49:47.965
rather than always going in

1688
00:49:47.985 --> 00:49:49.399
with a predetermined idea

1689
00:49:49.419 --> 00:49:50.934
of what you want to work on,

1690
00:49:50.954 --> 00:49:52.369
because that's going to build people's

1691
00:49:52.389 --> 00:49:53.971
confidence too,

1692
00:49:53.991 --> 00:49:55.739
because they're going to ask you

1693
00:49:55.759 --> 00:49:58.709
for strategies and support in areas

1694
00:49:58.729 --> 00:49:59.543
that are going to make them

1695
00:49:59.563 --> 00:50:02.312
feel more confident.

1696
00:50:02.332 --> 00:50:02.879
Some other

1697
00:50:02.899 --> 00:50:05.949
things, just in general, is supplementing

1698
00:50:05.969 --> 00:50:07.017
standardized language

1699
00:50:07.037 --> 00:50:08.352
tests with analysis

1700
00:50:08.372 --> 00:50:10.387
and spontaneous language samples.

1701
00:50:10.407 --> 00:50:11.655
It doesn't have to be

1702
00:50:11.675 --> 00:50:12.723
a full 30 minute

1703
00:50:12.743 --> 00:50:14.891
sample that you sit down and transcribe

1704
00:50:14.911 --> 00:50:16.560
go get an MLU of 

1705
00:50:16.580 --> 00:50:18.161
100 utterances.

1706
00:50:18.181 --> 00:50:20.297
You can take short little clips of you

1707
00:50:20.317 --> 00:50:21.832
in a sentence here, a sentence

1708
00:50:21.852 --> 00:50:24.267
there,  jut them down as you go.

1709
00:50:24.287 --> 00:50:24.901
Have a little

1710
00:50:24.921 --> 00:50:26.970
notebook go old school

1711
00:50:26.990 --> 00:50:29.039
and then look at those and see like what’s

1712
00:50:29.059 --> 00:50:30.173
the child doing.

1713
00:50:30.193 --> 00:50:31.608
And how are they improving

1714
00:50:31.628 --> 00:50:33.744
and increasing their language over time?

1715
00:50:33.764 --> 00:50:35.178
And what are the areas of things

1716
00:50:35.198 --> 00:50:36.279
they're not doing yet

1717
00:50:36.299 --> 00:50:37.714
that you want to be encouraging

1718
00:50:37.734 --> 00:50:39.383
and exposing them to.

1719
00:50:39.403 --> 00:50:40.484
And then just of course,

1720
00:50:40.504 --> 00:50:42.552
because here we are and it's EHDI

1721
00:50:42.572 --> 00:50:44.521
continue your efforts in

1722
00:50:44.541 --> 00:50:46.189
increasing the percentage of children

1723
00:50:46.209 --> 00:50:47.491
that we meet 136,

1724
00:50:47.511 --> 00:50:50.327
because the evidence does say that

1725
00:50:50.347 --> 00:50:54.598
this makes a difference.

1726
00:50:54.618 --> 00:50:55.766
So thank you so much

1727
00:50:55.786 --> 00:50:56.933
for joining us today.

1728
00:50:56.953 --> 00:50:58.402
We feel very fortunate

1729
00:50:58.422 --> 00:51:00.804
to have the opportunity to share our work

1730
00:51:00.824 --> 00:51:02.072
with such a knowledgeable

1731
00:51:02.092 --> 00:51:04.574
and dedicated group of parents,

1732
00:51:04.594 --> 00:51:06.743
friends, professionals.

1733
00:51:06.763 --> 00:51:08.445
And so thank you so much for coming.

1734
00:51:08.465 --> 00:51:16.204
I'm going to hand it back to Stephanie.