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OBJECTIVE: Stress levels among caregivers of children with hearing loss could influence caregiver-child interactions and ultimately, children's developmental outcomes. Given the limited understanding of stress levels among caregivers of Australian children with hearing loss, the present study aimed to examine stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants and to identify factors associated with greater stress levels. METHODS: A total of 99 caregivers of 70 hearing aid users and 29 cochlear implant users participated in the study. Caregivers' stress was measured using the 68-item Pediatric Hearing Impairment Caregiver Experience (PHICE) questionnaire that examines caregivers' context-specific stress levels in relation to caring for a child with hearing loss. Factors contributing to stress were identified in relation to eight domains including communication, education, emotional well-being, equipment, financial, healthcare, social, and support. RESULTS: Across domains, the three most common predictors of increased stress were the use of cochlear implants over hearing aids, use of sign and oral language (mixed) over oral language as the communication mode at home, and increased behavioural difficulties of the child. CONCLUSION: Overall, reported stress levels among Australian caregivers were low. Identified factors influencing stress levels can inform service provision improvement.

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OBJECTIVE: Examine the association between sociodemographic factors and Individualized Education Program (IEP) establishment. DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. METHODS: Participants included deaf or hard-of-hearing children who were eligible for an IEP with "deafness" or "hard of hearing" as a primary or secondary disability. Primary outcome measures were time intervals between initial referral for services and parental consent; parental consent to determination of eligibility; and initial referral to eligibility (the sum of the previous 2 intervals). Student's t tests and linear regression were used to examine the association between sociodemographic factors and the primary outcome variables. RESULTS: Of the 88 participants, 51 (58%) were male, 45 (51%) were from underrepresented minority (URM) groups, 35 (40%) spoke a primary language other than English, and 53 (60%) utilized public insurance. IEP establishment was significantly delayed in participants who required an English-language interpreter. Most of the delay occurred in the time between the initial referral and parental consent (mean: 115 vs 37 days, P = .02). There were also significant delays from the time of referral for services to eligibility in URM participants (mean: 159 vs 85 days, P = .04). Significant delays were also associated with Minority Status and Language within social vulnerability index percentile rankings. CONCLUSION: This study found that IEP establishment was delayed in both URM participants and those who required an English-language interpreter. These results highlight the importance of clear communication between the school system and caregivers in the IEP establishment process, particularly with families who require an English-language interpreter or identify as URM.

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This 2-year longitudinal study investigated the bidirectional relations between the development of theory of mind (ToM) and academic competences in a sample of 270 deaf and hard-of-hearing (DHH) children (Mage at Wave 1 = 7.52 years, SD = 0.99; 58.5% boys and 41.5% girls). Across three waves (10 months apart), children were assessed for their ToM abilities, using the ToM scale and a second-order false belief task, as well as for their language and mathematics skills. Cross-lagged correlational analysis revealed significant bidirectional associations between ToM and academic achievement (language and mathematics). That is, ToM predicted academic achievement with similar strength as ToM development itself was predicted by academic achievement. Our results highlight the bidirectional nature of the association between ToM and academic achievement, and they show that ToM development plays a crucial role in DHH children's school functioning.

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BACKGROUND: Deaf and hard-of-hearing (DHH) children may experience difficulties in word decoding development. AIMS: We aimed to compare and predict the incremental word decoding development in first grade in Dutch DHH and hearing children, as a function of kindergarten reading precursors. METHODS AND PROCEDURES: In this study, 25 DHH, and 41 hearing children participated. Kindergarten measures were phonological awareness (PA), letter knowledge (LK), rapid naming (RAN), and verbal short-term memory (VSTM). Word decoding (WD) was assessed at three consecutive time points (WD1, 2, 3) during reading instruction in first grade. OUTCOMES AND RESULTS: The hearing children scored higher than the DHH children on PA and VSTM only, although the distribution of WD scores differed between the groups. At WD1, PA and RAN predicted WD efficiency in both groups; but PA was a stronger predictor for hearing children. At WD2, LK, RAN, and the autoregressor were predictors for both groups. While at WD3, only the autoregressor was a significant predictor. CONCLUSIONS AND IMPLICATIONS: WD development in DHH children on average shows similar levels as in hearing children, though within the DHH group more variation was observed. WD development in DHH children is not as much driven by PA; they may use other skills to compensate.

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Mental health problems and lower Quality of Life (QoL) are more common in deaf and hard-of-hearing - (D)HH - children than in typically hearing (TH) children. Communication has been repeatedly linked to both mental health and QoL. The aims of this study were to compare mental health and QoL between signing deaf and hard-of-hearing (DHH), hard-of-hearing (HH) and TH children and to study associations between mental health/QoL and severity of hearing loss and communication. 106 children and adolescents (mean age 11;8; SD = 3.42), 59 of them DHH and 47 HH, and their parents reported child mental health and QoL outcomes. Parents also provided information about their children's communication, hearing loss and education while their children's cognitive ability was assessed. Although (D)HH and their parents rated their mental health similar to their TH peers, about twice as many (D)HH children rated themselves in the clinical range. However, (D)HH children rated their QoL as similar to their TH peers, while their parents rated it significantly lower. Associations between communicative competence, parent-reported mental health and QoL were found, whereas severity of hearing loss based on parent-report had no significant association with either mental health or QoL. These results are in line with other studies and emphasise the need to follow up on (D)HH children's mental health, QoL and communication.

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Spoken language outcomes after cochlear implantation are highly variable. Some variance can be attributed to individual characteristics. Research with typically hearing children suggests that the amount of language directed to children may also play a role. However, several moderating factors may complicate the association between language input and language outcomes in children with cochlear implants. In this article, I present a conceptual framework that posits that the association between total language input directed to children and language outcomes is moderated by factors that influence what is accessible, attended to, and coordinated with the child. The framework also posits that children with cochlear implants exhibit more variability on those moderating factors, which explains why the relation between language input and language outcomes may be more complex even if language input is more important for successful language outcomes in this population.

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BACKGROUND: Previous research reveals relations between theory of mind (ToM) and cognitive outcomes, but mostly among typically developing children. AIM: To study these relations in children with developmental difficulties, this longitudinal study investigated the cognitive consequences of ToM in deaf or hard-of-hearing (DHH) children. METHODS AND PROCEDURES: One hundred and thirty-four (X = 9.2 years) participants were assessed in three waves, i.e., one wave every ten months. The participants completed the ToM scale, language and literacy skills (LLS) tests, the academic self-concept in language (ASC-L) questionnaire, and the sensitivity to criticism measure. OUTCOMES AND RESULTS: The results revealed that high levels of children's ToM ability predicted higher levels of LLS 20 months later. Mediators of this association were sensitivity to criticism and ASC-L. Controlling for LLS at T1, ASC-L at T2 mediated the relations between ToM and LLS at T3. Moreover, sensitivity to criticism predicted ASC-L, and sensitivity to criticism and ASC-L mediated the relation between ToM and LLS at T3. That is, children who were sensitive to criticism and held positive views of their academic self were also better skilled in ToM and in LLS. CONCLUSIONS AND IMPLICATIONS: Our results can help improve the education of DHH students.

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Children who are deaf or hard of hearing (DHH) are likely to exhibit difficulties in development of psychosocial skills, pragmatic language skills, and use of hearing for social communication in real-world environments. Some evidence suggests that pragmatic language use affects peer-relationships and school engagement in these children. However, no studies have investigated the influence of functional auditory performance and use of language and speech in real-world environments on children's behavior and emotion, and on their health-related quality of life. This study explored the relationship in DHH children at 9 years of age. Data from 144 participants of the Longitudinal Outcomes of Children with Hearing Impairment study were analyzed. Parent reports were obtained on quality of life, behavior and emotion, pragmatic language skills, and auditory functional performance of children in real life. Children's spoken language abilities and speech intelligibility were assessed by research speech pathologists. On average, performance of children in all domains was within the range of typically developing peers. There were significant associations among functional auditory performance, use of speech and language skills, psychosocial skills, and quality of life. Multiple linear regression analyses revealed that better auditory functional performance and pragmatic language skills, rather than structural language abilities, were associated with better psychosocial abilities and quality of life. The novel findings highlight the importance of targeted intervention for improving functional hearing skills and social communication abilities in DHH children, and emphasize the importance of collaborative approaches among medical, audiology, allied health, and educational professionals to identify those at risk so that timely referral and intervention can be implemented for improving psychosocial health and well-being in DHH children.

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The present study investigates the development of advanced theory of mind (AToM) among typically developing (TD) children, children with mild intellectual disability (MID), and deaf or hard of hearing (DHH) children. The 2-year longitudinal study comprised three waves and included a large sample of children from Poland in middle childhood aged around 7.5-9.5 years (N = 779; M = 7.7, SD = 0.92 at wave 1). The analysis of children's understanding of second-order false belief and the Faux-Pas Recognition Test showed that TD children outperformed children with MID and DHH children on both measures. At 7.5 years, almost 60% of the TD children correctly solved the second-order false belief task; correct performance at 7.5 years in children with MID and DHH children was 27 and 38% respectively. Two years later, correct performance rose to 80% (TD children), 45% (children with MID), and 63% (DHH children). Despite these differences, the speed of AToM development did not differ across the groups. The development of faux-pas recognition followed a non-linear pattern, with TD children showing no further significant development after mid-elementary school. Our findings show differences in AToM development between TD children, children with MID, and DHH children, and they suggest that children's development of AToM may follow different developmental pathways, depending on the aspect of AToM under study.

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This study set out to explore the cognitive and linguistic correlates of orthographic learning in a group of 32 deaf and hard of hearing children with cochlear implants, to better understand the factors that affect the development of fluent reading in these children. To date, the research about the mechanisms of reading fluency and orthographic learning in this population is scarce. The children were between 6:0 and 10:11 years of age and used oral language as their primary mode of communication. They were assessed on orthographic learning, reading fluency and a range of cognitive and linguistic skills including working memory measures, word retrieval and paired associate learning. The results were analyzed in a set of correlation analyses. In line with previous findings from children with typical hearing, orthographic learning was strongly correlated with phonological decoding, receptive vocabulary, phonological skills, verbal-verbal paired-associate learning and word retrieval. The results of this study suggest that orthographic learning in children with CI is strongly dependent on similar cognitive and linguistic skills as in typically hearing peers. Efforts should thus be made to support phonological decoding skill, vocabulary, and phonological skills in this population.

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PURPOSE: Parental involvement in the rehabilitation process of deaf and hard of hearing (DHH) children is considered vital to children's progress. Today, fathers are more likely to be involved in their children's care. Nevertheless, father involvement has been understudied and relatively little is known about their involvement in families with children who are deaf or hard of hearing. In addition, there are scant data on the correlates of parents' involvement. This study explored similarities and differences in parental involvement between mothers and fathers in intervention programs for their D/HH children and tested a set of personal and social contextual variables that posited to affect parental involvement in a unique socio-cultural group. METHODS: Thirty Israeli-Arab couples (mothers and fathers) of young D/HH children took part. Each parent completed four self-report measures of parental involvement, parenting stress, parental self-efficacy, and social support. RESULTS: Mothers were significantly more involved than fathers in their child's intervention. Specifically, they report on higher interest and attendance and overall being more actively engaged with professionals in the child's intervention. Both mothers and fathers had a rather passive style of involvement in their child's intervention. Parental self-efficacy and informal and formal social support were associated with father involvement. For mothers, only formal social support was associated with involvement. CONCLUSION: For the Israeli-Arab population, the findings underscore the differences between mothers' and fathers' multiple dimensions of involvement in the intervention program of their D/HH children and their predictors. The results suggest important avenues for prevention and intervention activities when working with families of children who are D/HH. Implications for rehabilitation Parental involvement in intervention programs for children who are deaf or hard of hearing (D/HH) is vital to children's progress and an essential component of implementing family-centered service provision. Understanding of both mothers and fathers multiple dimensions of involvement and the factors that facilitate or hinder their parental involvement in their children's intervention programs, will equip professionals to better support parents of D/HH children aligned with the principles of family centered care service delivery. Mothers and fathers style of involvement reflects on gaps between the goals of family centered care and their implementation in the realities of everyday practice. The experiences and behaviors of mothers and fathers should not be seen as interchangeable.

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OBJECTIVES: The aim of the present study was to evaluate whether the arithmetic achievement of children with cochlear implants (CI) was lower or comparable to that of their normal hearing peers and to identify predictors of arithmetic achievement in children with CI. In particular we related the arithmetic achievement of children with CI to nonverbal IQ, reading skills and hearing variables. METHODS: 23 children with CI (onset of hearing loss in the first 24 months, cochlear implantation in the first 60 months of life, atleast 3 years of hearing experience with the first CI) and 23 normal hearing peers matched by age, gender, and social background participated in this case control study. All attended grades two to four in primary schools. To assess their arithmetic achievement, all children completed the "Arithmetic Operations" part of the "Heidelberger Rechentest" (HRT), a German arithmetic test. To assess reading skills and nonverbal intelligence as potential predictors of arithmetic achievement, all children completed the "Salzburger Lesetest" (SLS), a German reading screening, and the Culture Fair Intelligence Test (CFIT), a nonverbal intelligence test. RESULTS: Children with CI did not differ significantly from hearing children in their arithmetic achievement. Correlation and regression analyses revealed that in children with CI, arithmetic achievement was significantly (positively) related to reading skills, but not to nonverbal IQ. Reading skills and nonverbal IQ were not related to each other. In normal hearing children, arithmetic achievement was significantly (positively) related to nonverbal IQ, but not to reading skills. Reading skills and nonverbal IQ were positively correlated. Hearing variables were not related to arithmetic achievement. CONCLUSIONS: Children with CI do not show lower performance in non-verbal arithmetic tasks, compared to normal hearing peers.

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BACKGROUND/AIMS: This study described the first language (L1) and second language (L2) skills of a group of Spanish deaf/hard of hearing (DHH) children who were bilingual. METHODS: Participants included parents of 51 DHH children from Spain. Parents completed an electronic survey that included questions on background, details on child's hearing loss, and bilingual status and L2 exposure. Parents also completed the Student Oral Language Observation Matrix, a rating scale that describes language skills. RESULTS: DHH bilingual children demonstrated L1 skills that were stronger than their monolingual DHH peers. Bilingual children demonstrated a wide range of L2 proficiency, and most were exposed to an L2 through parents and/or schooling. The majority of parents reported that their children demonstrated L2 skills that were either better than or at the level they had expected. CONCLUSION: These results correspond with earlier studies that indicate the DHH children are capable of becoming bilingual. Implications for clinical practice are discussed.

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