Long-Term Outcomes of Early Communication Intervention for Deaf/Hard of Hearing Toddlers

Hearing loss is one of the most prevalent congenital conditions. Recent advances in early detection and technology have contributed to significant improvements in long-term outcomes for deaf/hard-of-hearing (DHH) children. Despite this progress, language and literacy outcomes for school-age DHH children are inconsistent, and many DHH children do not "catch up" to their hearing peers. Closing this gap requires the implementation of effective early communication interventions. Yet, until recently, there was a significant paucity of research on early communication interventions for DHH children. Parent-mediated interventions (PMIs), which involve teaching parents strategies to enhance their child's language learning experiences, are a promising form of early intervention for DHH toddlers. During the previous project period (NCT03803943), 96 DHH children, between 12 and 18 months of age and their parents, were enrolled. Parent-child dyads were randomly assigned to receive either the PMI or business-as-usual control group. The investigators examined the effects of the intervention on (a) parent strategy use and (b) child communication outcomes during and after the 6-month intervention period. The follow-up period of the clinical trial is outlined here.

This trial will be the first large-scale evaluation of the long-term effects of an early communication intervention on school-age language and literacy outcomes for DHH children. The study enrolled 96 parent-child dyads, 88 of whom remain involved and consented to contact for the follow-up period. The investigators will complete follow-up assessments during early elementary school. The investigators plan to examine the long-term effects of the intervention on school-age outcomes and characterize the intermediary mechanisms of these effects. The investigators consider not only how early communication interventions affect subsequent child outcomes, but also how involving parents early in their child's development may lay the foundation for sustained parent engagement as children transition to school-based services. Taken together, the investigators plan to integrate child and parent outcomes to fully characterize how early language learning experiences shape long-term language and literacy outcomes. Understanding the pathways through which early interventions affect the developmental trajectory of DHH children will have widespread implications for research and clinical practice.

• Parent-Mediated Intervention (PMI) (Behavioral), also known as Parent-Implemented Communication Intervention (PICT), Parent-Implemented Communication Treatment (PICT): The PMI consisted of weekly, 1-hour intervention sessions via Zoom for 6 months. In total, the intervention consisted of 26 intervention sessions.

Primary outcomes

• Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5) [7 - 8 years old]: The Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5) is a standardized assessment of language development. The Core Language Standard Score (M = 100, SD = 15) reflects the child's global language ability, with higher scores indicating better language skills.
• Peer-Peer Interaction, Pragmatic Observational Measure (POM) [7 - 8 years old]: The Pragmatic Observational Measure (POM), a rating scale of pragmatic skills, will be scored during a naturalistic peer-peer interaction. The POM includes 27 items, capturing a range of pragmatic skills, rated on a 4-point scale (1 = rarely or never observed; 4 = almost always observed). The POM Total Raw Score (Min = 27, Max = 108) reflects the child's pragmatic skills, with higher scores indicating better pragmatic skills.
• Woodcock Reading Mastery Tests, Third Edition (WRMT-III) [7 - 8 years old]: The Woodcock Reading Mastery Tests, Third Edition (WRMT-III) is a standardized assessment of reading development. The Total Reading Cluster Standard Score (M = 100, SD = 15) reflects the child's global reading ability, with higher scores indicating better reading skills.

Secondary outcomes

• Parent-Child Interaction, Keys to Interactive Parenting Scale (KIPS) [5 - 6 years old]: The Keys to Interactive Parenting Scale (KIPS), a rating scale of parenting behaviors, will be scored during a naturalistic parent-child interaction.The KIPS includes 12 items, capturing a range of parenting behaviors, rated on a 5-point scale, with higher scores reflecting higher quality parent behaviors. The KIPS Total Mean Score (Min = 1.0, Max = 5.0), calculated as the average of all 12 items, reflects the overall quality of parenting behaviors.
• Parent Empowerment and Efficacy Measure (PEEM) [5 - 6 years old]: The Parent Empowerment and Efficacy Measure (PEEM) is a self-report questionnaire assessing parents' confidence in their role and their ability to support their child's development. The measure includes 20 items rated on a 10-point scale (1 = no agreement; 10 = complete agreement). The PEEM Total Raw Score (Min = 20, Max = 200) reflects overall parenting self-efficacy, with higher scores indicating greater self-efficacy.
• Parental Involvement Survey in Their Child's Elementary Studies (PISCES) [5 - 6 years old]: The Parental Involvement Survey in Their Child's Elementary Studies (PISCES) is a parent-report questionnaire that assesses parent involvement in school-related activities. The measure includes 56 items rated on a 4-point Likert scale (1 = strongly disagree; 4 = strongly agree). The PISCES Total Raw Score (Min = 56, Max = 224) reflects the extent of parent involvement in their child's education, with higher scores indicating greater involvement.
• The Parent Advocacy Skills and Comfort Survey [5 - 6 years old]: The Parent Advocacy Skills and Comfort Survey is a parent-report questionnaire assessing caregivers' ability to advocate for their child's educational needs. The survey includes 10 items rated on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). The Total Raw Score (Min = 10, Max = 50) reflects overall advocacy skills and confidence, with higher scores indicating greater advocacy skills and confidence.
• Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5) [5 - 6 years old]: The Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5) is a standardized assessment of language development. The Core Language Standard Score (M = 100, SD = 15) reflects the child's global language ability, with higher scores indicating better language skills.

Sex: All, ages: 5 Years to 8 Years

Eligibility for the follow-up period of the clinical trial is dependent on enrollment in the initial period of the clinical trial.

Child inclusion criteria were:

* between 12-18 months
* diagnosed with bilateral hearing loss
* no additional diagnoses (e.g., Down syndrome, cerebral palsy, seizure disorder, blindness, etc.)
* one parent with typical hearing
* exposed to some degree of spoken language by their parents.

• Informed Consent Form (PDF, 2025-08-05)

• Megan Y Roberts, PhD, CCC-SLP, Principal investigator, Northwestern University