A Technology-Assisted Language Intervention for Children Who Are Deaf or Hard of Hearing: A Randomized Clinical Trial

Abstract

Background and objectives: Children who are deaf or hard of hearing (DHH) often have persistent language delays despite early identification and interventions. The technology-assisted language intervention (TALI), which incorporates augmentative and alternative communication technology into a speech-language therapy model, was designed to support language learning. The study objective was to evaluate the impact of the TALI on spoken language outcomes in DHH children.

Methods: Children aged 3 to 12 years with mild to profound bilateral hearing loss were enrolled in a single-site randomized controlled trial. Children were randomly assigned to receive the TALI or treatment as usual (TAU) (with no change in current care) and were followed for 24 weeks. Primary outcomes included spoken language measures elicited from language samples. Secondary outcomes included standardized assessments. Intention-to-treat analyses were used.

Results: Analyses focused on 41 children randomly assigned to TALI (n = 21) or TAU (n = 20). Among all participants, mean age was 6.3 years (SD 2.5). Over 24 weeks, children in the TALI group, compared with those in the TAU group, had significantly greater increases in the length of phrases they used to express themselves (β = .91 vs .15, respectively; P< .0001). Similar findings were seen with conversational turn-taking and number of different words spoken.

Conclusions: Providing visual supports for language concepts that are typically challenging for DHH children to acquire allowed children to process and comprehend spoken language more fully. Such strategies can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings.

Trial registration: ClinicalTrials.gov NCT02998164.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2021 by the American Academy of Pediatrics.

Figures

FIGURE 1

Study diagram of the follow-up of children randomly assigned to either the TALI or TAU therapy groups. a Time points at which language samples were obtained.

FIGURE 2

Consolidated Standards of Reporting Trials flowchart. Longitudinal analyses included all available data from each subject through lost to follow-up or study completion.

FIGURE 3

Change in MLUm over the study period for children randomly assigned to the TALI group and children randomly assigned to the TAU group. Group by time interaction was statistically significant in the model (P < .0001), indicating that the trajectories for the 2 groups were statistically different.

FIGURE 4

Change in MTL during the study period for children randomly assigned to the TALI and children randomly assigned to the TAU group. Group by time interaction was statistically significant in the model (P = .004), indicating that the trajectories for the 2 groups were statistically different.

FIGURE 5

Change in NDW spoken in 50 utterances during study period for children randomly assigned to the TALI group and children randomly assigned to the TAU group. Group by time interaction was statistically significant in the model (P = .007), indicating that the trajectories for the 2 groups were statistically different.