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Recent changes in treatment of pre-lingual deafness and technological advancements have impacted linguistic outcomes for children who are deaf or hard-of-hearing (Figueras et al., 2007; Papsin & Gordon, 2007). Most children who are identified early, amplified by one year-of-age, and receive quality Listening and Spoken Language (LSL) intervention services can achieve levels comparable to peers in regard to language ability and cognitive function (Figueras et al., 2007; Papsin & Gordon, 2007). While current LSL programs promote spoken language development and higher cognitive function, critical aspects influence performance levels. Specific factors most responsible for accelerating or impeding language development and future cognitive capability are:
• Newborn hearing screenings and early amplification (Moog & Geers, 2010)
• Daily use of hearing aids or cochlear implants (Moog & Geers, 2010)
• Ongoing advancements in hearing technology (Moog & Geers, 2010)
• Effective coaching and language strategies (Moog & Geers, 2010)
• Parent involvement, maternal sensitivity, and quality of linguistic interactions (Gilkerson & Richards, 2008; Weir et al., 2007; Quittner et al., 2013; Zimmerman et al. 2009)
The greatest influential factor affecting spoken language outcomes in any early intervention program is early amplification and immediate and ongoing linguistic stimulation for children who are deaf or heard-of-hearing (Papsin & Gordon, 2007; Moog & Geers, 2010; Zimmerman et al., 2009). Early amplification and linguistic stimulation, such as continuous language input and output, takes advantage of neuroplasticity within the auditory cortex region of the brain (Fallon, Irvin, & Shepard, 2008; Peterson, Miyomato, & Pisoni, 2010). The later a child with deafness is amplified the more unused portions of the auditory system are re-organized and occupied by other sensory information (Peterson et al., 2010). As unused portions of the auditory cortex are occupied by other sensory systems, the ability to decipher transmitted sound diminishes (Fallon et al., 2008; Peterson et al., 2010). As a child matures organization of neurons within the auditory system become more permanent and progressively difficult to rework (Fallon et al., 2008; Peterson et al., 2010). This phenomenon also occurs in regard to factors such as maternal sensitivity and cognitive stimulation (Knudsen, 2004).
Maternal sensitivity refers to a mother’s ability to perceive their infant’s behavioral cues and respond promptly and appropriately (Knudsen, 2004; Quittner, 2013). A caregiver’s ability to respond positively to behavioral signals is essential for language acquisition and cognitive development (Knudsen, 2004; Quittner et al., 2013), especially for children who are deaf or hard-of-hearing (DesJardin & Eisenberg, 2007; Quittner et al.
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Many elements of cognitive, perceptual, and emotional capabilities are developed by experiences during limited periods in early childhood and during these stages children require sophisticated linguistic interactions (Knudsen, 2004). Furthermore, a child’s capacity to form strong social relationships and typical responses to stress require early positive interactions with a primary caregiver. These positive communicative experiences involve high levels of maternal sensitivity, linguistic and cognitive stimulation, as well as an adequate auditory environment (Zimmerman et al., 2009; Gilkerson, & Richards, 2008).
Acquiring early words and gaining communicative intelligence is most meaningful to an infant when presented through daily experiences and routines (Zimmerman et al., 2007; Vaala et al., 2010). Overexposure to television adversely effects language acquisition for children under two years due to limited opportunities for parental language input and output. Television viewing decreases a parent’s sensitivity to their child’s behaviors and communicative attempts, due to the negative affect on parent-child interactions (Gilkerson, & Richards, 2008; Zimmerman et al., 2007; Zimmerman et al., 2009). Although moderate exposure to television may not hinder language acquisition for children over two years, exposure still poses a problem and reduces the necessary opportunities for social learning of language (Gilkerson, & Richards, 2008; Zimmerman et al., 2009). Overexposure to television adversely effect the quality of cognitive and linguistic stimulation as daily interactions are critical for adequate communicative development and provide opportunities for incidental learning of language (Vaala et al., 2010; Zimmerman et al., 2009).
A meaningful learning environment is critical for the acquisition of language. Artificial representations are not significant to a young child, because Infants lack the intent to learn from synthetic demonstrations. Real-life experiences promote curiosity, which drive motivation to increase communicative competence (Courage & Setliff, 2009; Quittner, 2013; Zimmerman et al., 2009). Reading is still crucial for linguistic development, however, interacting with an infant and allowing for parent-child conversational turns during story time and daily routines promotes a greater range of linguistic and cognitive stimulation. Overexposure to television or excessive noise within a child’s auditory environment only creates language barriers within the home (Gilkerson, & Richards, 2008; Robb et al., 2009; Zimmerman et al., 2009).
These language barriers created within a child’s auditory environment limit opportunities for meaningful parent-infant interactions and reduce the quality of language exposure (Fender et al., 2010; Fenstermacher et al., 2010; Gilkerson, & Richards, 2008; Zimmerman et al., 2007; Zimmerman et al., 2009). An infant’s language success is also susceptible to environmental factors, such as parent’s vocabulary size and ability to employ expressive and receptive language (Gilkerson, & Richards, 2008). In addition to expressive and receptive vocabulary, a parent’s level of cognitive stimulation and maternal sensitivity also effects language acquisition. When maternal sensitivity and cognitive stimulation levels are both high, so is and conversely, when maternal responsiveness and cognitive stimulation is low, so is linguistic stimulation (Quittner, 2013). Television decreases an infant’s exposure to expressive and receptive vocabulary, which negatively impacts a wide range of higher-order language skills (Kirkorian et al., 2009). While not all infants frequently watch early educational videos, they may still be susceptible to televised background noise within their environment and this has a negative effect on language development (Kirkorian et al., 2009).
Many factors contribute to successful language acquisition, such as