Progress in Helping Children Who are Deaf or Hard of Hearing Achieve Their Potential

Helping children who are deaf or hard of hearing (DHH) achieve their academic potential has been a priority in the United States since at least 1864, when President Abraham Lincoln signed the charter for what is now Gallaudet University, saying it would provide deaf people “a fair chance in the race of life.”¹  Since that time, arguments have raged about how to best educate children who are DHH. Well-known examples include the Milan Congress of 1880, which passed a controversial resolution banning the use of sign language in schools^2–4 ; the Babbidge Report commissioned by Congress in 1965 that stated, “The American people have no reason to be satisfied with their limited success in educating deaf children”⁵ ; and multiple recent articles in Pediatrics that have debated how to educate children who are DHH.^6–9 

With >150 years of often angry arguments about the “best way” to educate children who are DHH, it is refreshing and encouraging to read the article in this issue of Pediatrics by Meinzen-Derr et al,¹⁰  who demonstrate a different approach for making such decisions. Meinzen-Derr et al¹⁰  present the findings of a randomized controlled trial in which they examined two different approaches of providing speech-language therapy to children who are DHH. In their study, they examined the differences in expressive and receptive language outcomes for children who are DHH using a technology-assisted language intervention (TALI) that incorporated augmentative and alternative communication technology into speech-language therapy services delivered via an iPad, compared with a group of similar children who received treatment as usual (TAU) speech-language therapy services. Forty-one children (average age of 6.3 years) with mild to profound hearing loss were randomly assigned to the TALI or the TAU group and received once-a-week speech-language therapy services for 24 weeks. At the beginning and end of the 24 weeks, language samples were collected and analyzed for mean length of utterance in morphemes (MLU_m), mean turn length (MTL), and number of different words. Expressive and receptive language scores from the Clinical Evaluation of Language Fundamentals (CELF) were also collected.

Children in the TALI group made statistically significantly more progress on all of the measures compared with children in the TAU group. The clinical gains for children in the TALI group compared with the TAU group are particularly noteworthy. Scores for MLU_m and MTL are calibrated to reflect the child’s age. Thus, a score of 4.0 represents the MLU_m for a child who has just turned 4 years old. Children in the TALI group averaged 4.23 at baseline and 6.06 after 24 weeks: almost 2 years of progress in only 6 months! During that same 24 weeks, children in the TAU group went from 4.23 to 4.49, ∼3 months of growth. Other language sample measures (MTL and number of different words) had similar results.

The differences between children in the two groups on their CELF scores were also impressive. Although the authors did not report standardized mean difference effect sizes,¹¹  they are easily calculatable. Differences in CELF scores between the two groups were statistically significant in favor of the TALI group with standardized mean difference effect sizes over a 24 week period of 0.58 for receptive language and 0.34 for expressive language. These are sizable gains over a relatively short time. To illustrate in terms that may be more familiar, the magnitude of the differences between the TALI and the TAU groups are the same as if a third-grader had 1.2 years of progress in just 6 months’ time on a standardized reading comprehension test.¹² 

It is also important to note that the services in the TALI group are probably less expensive because the speech-language pathologist in the TALI group only did visits in the home during weeks 1 to 6 and 13 to 18. During weeks 7 to 12 and 19 to 24, parents in the TALI group implemented the lesson plans with the child using the iPad and techniques demonstrated during the previous weeks. In the TAU group, the speech-language pathologist made weekly visits all 24 weeks.

Before we get too excited about these findings, it is important to remember that this was a relatively small study with important limitations (most of which were noted by the authors). Notably:

1. No data were collected on the number of hours that parents in either group spent each week implementing the procedures demonstrated by the speech-language therapist during the visit.

2. Different speech-language pathologists implemented each treatment condition, and it is possible that those willing to use the TALI model were more innovative, self-confident, and energetic.

These limitations do not invalidate the findings of this important study, but they emphasize the importance of replication. This study is also valuable because the authors demonstrate that systematic, well-implemented research, rather than emotional arguments, is the better way to learn more about the best way to help children who are DHH to reach their potential.

CELF

Clinical Evaluation of Language Fundamentals

DHH

deaf or hard of hearing

MTL

mean turn length

MLU_m

mean length of utterance in morphemes

TALI

technology-assisted language intervention

TAU

treatment as usual