Early interventions have the potential to improve language development in deaf children using cochlear implants (CIs); however, few interventions for this population have been developed or evaluated. Although CIs have improved speech perception and oral language in deaf children, there is great variability in these language outcomes, after accounting for child age and length of implant use. Recent studies have highlighted the critical role parents play in facilitating language in children with CIs. In particular, the quality of videotaped parent-child interactions, specifically maternal sensitivity (MS), has been shown to positively affect children's growth in oral language. Recent studies have also identified the facilitative language techniques (FLTs) used by parents that are most effective in promoting language in young children receiving CIs. To date, no parent- focused interventions have been developed to improve parent-child interactions in the context of language learning. The major purpose of this study is to develop and evaluate a pilot intervention that focuses on parent sensitivity training and the use of FLTs to improve parent-child interactions and communication in children with CIs (Parent-Child Early Approaches to Raising Language Skills; PEARLS). A draft manual for PEARLS has been developed and its feasibility has been tested in a handful of children. The efficacy of this pilot intervention will be tested in 44 parent-child dyads (12 to 36 months), with half randomly assigned to PEARLS or standard care; all children will be implanted before age 2. The intervention consists of 10, 1-hour sessions over 3 months and combines standard auditory-verbal therapy (AVT) with training in sensitive parenting and higher- level FLTs. During each session, therapists will model a new parenting or language technique, coaching parents in how to interact in positive, warm ways that encourage child autonomy. To increase mastery, parents will practice these skills with their child at home. Online video-clips demonstrating each parenting skill and higher-level FLT will available to parents. The PEARLS manual will be translated into Spanish to increase the generalizability. Our primary outcome will be improvements in maternal sensitivity; secondary endpoints will include utilization of FLTs in parent-child interactions, increased parental involvement, improvements in auditory skills, communicative intent, and oral language. Outcomes will be measured pre, post-intervention and at the 6-month follow-up. Parent interventions are cost-effective, ecologically valid, and can be translated to ?real world? clinical settings. This will be the first evidenced-based intervention to improve parent-child interactions and communication in children using CIs. PEARLS has several translational components, including its accessibility to bilingual families, hosting interventional materials online, implementation by therapists serving CI patients, and a manualized approach to facilitate dissemination. This intervention will optimize the benefits of cochlear implantation and guide pediatric cochlear implant programs nationally.
The purpose of this study is to develop and evaluate a manualized, bilingual (English and Spanish) parent- focused intervention to improve parent-child interactions and communication in deaf children with cochlear implants. This intervention is expected to improve maternal sensitivity and utilization of higher-level language strategies, with secondary benefits on parental involvement, auditory skills, and oral language. If successful, this translational effort will yield the first evidence-based intervention to optimize outcomes in cochlear implant recipients and could be utilized at pediatric cochlear implant centers across the U.S.
