Children with communication disorders, such as language impairment (LI) and hearing loss (HL), are at elevated risk for reading difficulties. These difficulties reflect, in part, lags in the development of early literacy skills, especially print knowledge; print knowledge is a universal, causal prerequisite of reading acquisition (Bialystok & Luk, 2007). Evidence shows that a caregiver-implemented intervention, Sit Together and Read (STAR), positively affects the print knowledge growth and reading outcomes of children with LI. Children with HL also exhibit lags in print knowledge and reading acquisition (Werfel, 2017), yet no large-scale studies have examined early literacy interventions for children with HL. An important aim of this work is to extend previous research regarding the efficacy of STAR to include children with HL, a critically understudied population with respect to literacy interventions. In addition, this research will utilize implementation-science methods to focus on supporting caregiver implementation practices. This work will examine short- and long-term effects from two evidence-based behavior-change techniques, financial rewards and encouraging text messages, on caregivers? self-efficacy regarding reading with their child as well as implementation fidelity. To address these aims, a causally interpretable randomized controlled trial (RCT) will follow 260 children with LI and HL (130 per group) for one-year following a 15-week intervention. Participants will be randomized into one of four conditions (control, STAR, STAR + Reward, STAR + Encourage). Caregivers in intervention conditions will implement the intervention at home with their child; children?s print knowledge will be assessed prior to and following intervention completion. Two follow-up assessments at 6-months and 12-months post- intervention will examine children?s maintenance of print knowledge gains and reading skills. Caregivers will continue to document reading activity, and will complete questionnaires at the follow up testing points, to examine any changes in self-efficacy. Analyses for Aim 1 will employ multilevel growth models to test differential trajectories of growth in print knowledge and reading abilities between conditions. Analyses for Aim 2 will use a path model to estimate direct effects from the behavior-change techniques on caregivers? implementation fidelity, and the direct and indirect effects on children?s print knowledge and reading outcomes. Analyses for Aim 3 will employ regression models to examine differences in adult shared-reading behaviors at follow up testing points, as a function of receiving behavior-change techniques. Longitudinal effects on caregivers? self-efficacy will be examined via multilevel growth curve modeling, with four time points (pretest, posttest, 6-month follow-up, 12-month follow-up) nested within families. Findings will be relevant for children with communication disorders, particularly those with HL. Findings will directly inform clinical and educational practice regarding how to support and empower caregivers to effectively implement intervention activities at home.
Over 1.4 million children in the US have a diagnosed reading disorder, and children with language and hearing impairments are at highest risk. Children who experience early reading difficulties are likely to continue to struggle academically through high school and beyond, often requiring extensive school supports, which are often scarce. Caregiver-implemented interventions, such as the one examined in the current study, are critical to meeting the needs of young children at risk for reading disorders as early as possible in order to mitigate lifelong difficulties.
