Differential At-Risk Pediatric Outcomes of Parental Sensitivity Based on Hearing Status

Abstract

Purpose The aim of this study was to investigate the role of parental sensitivity in language and neurocognitive outcomes in children who are deaf and/or hard of hearing (DHH). Method Sixty-two parent-child dyads of children with normal hearing (NH) and 64 of children who are DHH (3-8 years) completed parent and child measures of inhibitory control/executive functioning and child measures of sentence comprehension and vocabulary. The dyads also participated in a video-recorded, free-play interaction that was coded for parental sensitivity. Results There was no evidence of associations between parental sensitivity and inhibitory control or receptive language in children with NH. In contrast, parental sensitivity was related to children's inhibitory control and all language measures in children who are DHH. Moreover, inhibitory control significantly mediated the association between parental sensitivity and child language on the Clinical Evaluation of Language Fundamentals-Fifth Edition Following Directions subscale (6-8 years)/Clinical Evaluation of Language Fundamentals Preschool-Second Edition Concepts and Following Directions subscale (3-5 years). Follow-up analyses comparing subgroups of children who used hearing aids (n = 29) or cochlear implants (CIs; n = 35) revealed similar correlational trends, with the exception that parental sensitivity showed little relation to inhibitory control in the group of CI users. Conclusions Parental sensitivity is associated with at-risk language outcomes and disturbances in inhibitory control in young children who are DHH. Compared to children with NH, children who are DHH may be more sensitive to parental behaviors and their effects on emerging inhibitory control and spoken language. Specifically, inhibitory control, when scaffolded by positive parental behaviors, may be critically important for robust language development in children who are DHH.

Figure 1.

Top: Mediation analyses results for children with normal hearing (NH). Bottom: Mediation analyses results for children who are deaf and/or hard of hearing (DHH). βa = estimate of the effect of parental sensitivity on the mediator measure, the National Institutes of Health Toolbox Flanker Inhibitory Control and Attention Test (Child NIH Flanker), given in a standardized (Z-transformed) coefficient; βi = estimate of the indirect effect of parental sensitivity on each language outcome measure, given in standardized (Z-transformed) coefficients; 95% CI = 95% confidence interval that contains βi; βb = standardized estimate of the effect of the mediator, Child NIH Flanker, on each language outcome measure, given in standardized (Z-transformed) coefficients; PPVT-4 = Peabody Picture Vocabulary Test–Fourth Edition; CASL-2 = Comprehensive Assessment of Spoken Language, Second Edition Sentence Comprehension subtest; CELF-5/CELF Preschool-2 = Clinical Evaluation of Language Fundamentals–Fifth Edition/Clinical Evaluation of Language Fundamentals Preschool–Second Edition (children ages 6–8 years were assessed using the Following Directions subtest from the CELF-5 and children ages 3–5 years were assessed using the Concepts and Following Directions subtest for the CELF Preschool-2). *p < .05, **p < .01.