15th ANNUAL EARLY HEARING DETECTION & INTERVENTION MEETING
March 13-15, 2016 • San Diego, CA
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3/13/2016 | 1:00 PM - 3:00 PM | Pacific Salon 3
Family-Based Interventions for Children with Hearing Loss
Primary caregivers are critical in facilitating appropriate early interaction patterns, developing language, and promoting overall social-emotional development of their children. Parent-Child Interaction Therapy (PCIT) can support such growth. PCIT is an empirically supported treatment that works with parents and children together to promote child development and positive parent-child relationships.
Summary
The importance of early intervention for children with a hearing difference, especially for fostering language, has been well documented (Moeller, 2000; Mayberry 2007). While professionals play a critical role in early intervention services, there is increasing evidence that interventions that facilitate parent engagement often result in improved child development (DesJardin & Eisenberg, 2007; Moeller, 2000; Zaidman-Sait & Young, 2007). Houston and Bradham (2011) note that while early identification of a hearing difference and hearing technology are important for spoken language development, appropriate intervention, with the active participation of parents, is critical.
Parents serve as primary language models for their children, and supporting parents in providing enriching language environments will support overall development. Fleming, Sawyer, and Campbell (2007) advocate for a model that includes parent participation in audiologic habilitation. While related service interventions should continue to strive for parent participation, several studies show that most early intervention settings actually use traditional child-centered services (Peterson et al., 2007; Campbell & Sawyer, 2007).
Encouraging parents’ engagement and participation in intervention can take many forms. Through parent-infant programs, parent workshops, presentations, panels, or parent groups, providers can provide direct teaching and education about how to best include learning strategies in activities and routines that parents experience with their children on a daily basis.
In addition to didactic training and interventions that utilize modeling, educational systems may consider using structured therapeutic techniques to educate and coach parents on effective child-parent interaction. While including parents in audiologic habilitation intervention has been examined and supported (Fleming, Sawyer & Campbell, 2007), the impact of parents’ everyday interactions with their children also serves an important role in development. Quittner et al. (2013) found that maternal sensitivity predicted significant increases in language growth for children with cochlear implants, and that linguistic stimulation for the child was only related to language growth in the context of high maternal sensitivity. Notably, the effects of both maternal sensitivity and cognitive stimulation were similar to the effects found for age of implantation, which has long been considered one of the most powerful predicators of CI outcomes (Quittner et al., 2013). This study has important implications for the impact of parent behavior on overall development for children with hearing loss. Other studies have also supported the importance of emotional availability and maternal responsiveness on language learning and developmental play for children with a hearing difference (Pressman et al., 1999; Spencer & Meadow-Orlans, 1996).
Quittner et al. (2013) suggest that cochlear implant programs can likely improve outcomes if maternal sensitivity training were incorporated into the intervention. There are several parent interaction training programs that incorporate didactic and/or hands-on experiential coaching to guide parents in effective interaction with their children. One such program is Parent-Child Interaction Therapy (PCIT; Zisser & Eyberg, 2010), an empirically supported treatment that works with parents and children together, along with a therapist, to promote child development and foster parent-child relationships (Eyberg, 1988). In PCIT, parents are taught skills they can apply in the home to promote child development (Bell & Eyeberg, 2002; Allen & Marshall, 2011), establish a nurturing and secure relationship with their child, increase their child’s prosocial behavior, and decrease negative behavior. The treatment is structured in two parts: Child Directed Interaction (CDI), which is similar to play therapy and engages parents and children in play situations; and Parent Directed Interaction (PDI), which teaches parents consistent and effective behavior management techniques as they play with their child (Schuhmann et al., 1998). The therapist serves as a “coach” for the parent, providing live, real-time feedback.
PCIT has been utilized with a range of populations. The approach was initially developed to support children with behavioral difficulties, but has since been used children with various presenting concerns (Storch & Floyd, 2005). Children with behavioral concerns, anxiety, oppositional behavior and difficulty following parent’s instructions can benefit from PCIT. PCIT has also been shown to improve language and prosocial behavior, as well as help increase positive interactions between the parent and child as oppositional behavior decreases (Allen & Marshall, 2011). Given the specific behavioral and social development difficulties of many children with a hearing difference, this intervention can be an excellent fit for this population. PCIT has demonstrated statistically and clinically significant improvements in the oppositional behavior of participating children (Rich, Querido & Eyberg, 2002). In addition to significant changes on child behavior, studies have demonstrated important changes in the interactional style of the fathers and mothers in play situations with the child. Parents show increases in key interaction patterns such as reflective listening, physical proximity, and prosocial verbalization, and decreases in criticism of the child after completion of PCIT. These outcomes relate to improvements in child’s behavior and also help to support healthy child development through effective play (Rayfield, Monaco & Eyberg, 1999). Outcome studies have demonstrated significant changes on parents’ self-reported measures of personal distress and parenting locus of control (Ross et al., 1998). Previous research suggests that PCIT can be a successful and important intervention for parent-child dyads in which the child has a hearing difference. Children with hearing loss may benefit from additional time in play that helps promote development (Spencer & Meadow-Orlans, 1996). Research has also shown that positive interaction and play between parents, and specifically participation in PCIT, may help to improve language growth, particularly in the area of pragmatic language (Allen & Marshall, 2011). Further, our ongoing program of research implementing PCIT with a diverse group of families of children with a hearing difference, including those who communicate via spoken language and those who communicate via sign language, shows pre- to post-treatment changes in parent communication, child behavior, and child language growth. PCIT teaches parents strategies to apply at home in a way that is enjoyable and educational, and is likely to improve maternal sensitivity, parental responsiveness and emotional availability.
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Presenters/Authors
Elizabeth Adams Costa
(Primary Presenter), The River School/RiverREACH Clinic, elizabeth.bourque.adams@gmail.com;
Elizabeth Adams received her bachelor's degree from the University of Virginia in Psychology and her Ph.D. in Clinical Psychology from Gallaudet University. She completed her clinical predoctoral fellowship at Children's National Medical Center and the River School for her postdoctoral fellowship. Elizabeth is Licensed to practice psychology in D.C., and is a certified PCIT therapist.
ASHA DISCLOSURE:
Financial -
Receives Salary for Employment from The River School/RiverREACH Clinic.
Nonfinancial -
Has a Professional (Employment )
relationship for Volunteer teaching and speaking.
Lori Day
(Author), Gallaudet University, lori.day@gallaudet.edu;
Lori Day received her bachelor’s degree from Allegheny College in Psychology and Neuroscience and her Ph.D. in Clinical Psychology from Gallaudet University. She completed her clinical predoctoral fellowship at Baylor College of Medicine and completed a postdoctoral fellowship in Pediatric Neuropsychology at the Kennedy Krieger Institute. Lori is licensed to practice psychology in D.C. and Maryland, and she is a certified PCIT therapist.
ASHA DISCLOSURE:
Financial -
Nonfinancial -
Colleen Caverly
(Co-Presenter), Gallaudet University , colleen.caverly@gallaudet.edu;
Colleen Caverly is a Clinical Psychology doctoral student at Gallaudet University. Her interests include understanding the intersections of environmental and developmental influences on child and family functioning, and providing services within a family-centered framework. She is a certified PCIT therapist and has conducted therapy with families who use ASL and/or spoken English.
ASHA DISCLOSURE:
Financial -
Nonfinancial -