1. Social Validity of Technology Assisted Language Intervention
for Children who are Deaf or Hard-of-Hearing
Stephen Hill MA , Heather Innis BS , Molly Murrison BS, Sandra Grether PhD, Lisa Hunter PhD, Jareen Meinzen-Derr PhD
Leadership Education in Neurodevelopmental and related Disabilities (LEND) Program
The Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center
The University of Cincinnati University Center for Excellence in Developmental Disabilities
Abstract: The purpose of this research study was to investigate the social validity of the Technology Assisted Language Intervention (TALI) for children who are Deaf or hard-of-hearing (DHH).   Family interviews and a community focus group were conducted to determine feasibility of implementing across other settings that work with children who are DHH. Group level assessment was used to identify common trends in responses. Results indicated that TALI was viewed positively by parents and professionals for use in expanding vocabulary and verbal communication skills. The children in the TALI study found the intervention to be enjoyable and motivating. Reported barriers were adoption by school settings and modification of TALI to keep up with child’s advancing language skills.
Background
Children who are Deaf or Hard-of-Hearing (DHH) are at-risk for language delays and possible language impairments which can impact social and communication functioning (Meinzen-Derr et al., Coch Imp Intl; 2014 J Dev Behav Pediatr).
Technology Assisted Language Intervention (TALI) is a novel approach that focuses on the feasibility of using augmentative and alternative communication (AAC) as an intervention for children who are DHH.
TALI combines AAC strategies with up-to-date and socially acceptable technology (iPads®) to enhance and support language development in children who are DHH and continue to display clinically significant gaps in language.
TouchChat HD AAC with WordPower is a language system on the iPad® that varies in the number of buttons per page. It has a keyboard and is predictive in its automatic navigation, offering grammatically appropriate options of what to say next.
Method
Participants:
Audiologists
Speech-Language Pathologists
Educators of DHH children
Representatives of the Audiology Family Advisory Council
Families of children who are DHH
Data Collection:
Interviews were conducted with families by telephone using structured questions. Different questions were used with professionals and community partners in the focus group. Parents of children in the study were invited to attend the focus group as well. Examples of questions and responses are shown below in Figures 2 and 3.
Data Analysis:
Group level assessment approach was used to group comments into common themes. This was done through group discussion and consensus.
Results: Family Interviews
Positive Feedback
Enhanced attention and perseverance
Enjoyment and excitement with devices
Expanded language and vocabulary
Involves a variety of communication partners
Relatively easy to use
To Work On
Difficulty coming regularly to therapy location
Getting school on board with device use
Prioritizing time for TALI use at home
Needing assistance to match child’s developmental level
Results: Focus Group
What are strengths of children who are DHH?
Strong visual perceptual skills
Just like typical kids; can do everything but hear
How would you describe communication needs of children who are DHH?
Supportive communication partners
Supportive communication environment
What are some obstacles that children who are DHH face?
Communication limitations
Socio-economic obstacles
Social-emotional difficulties
Difficulty in diagnosis and recommendations
What are your expectations for children who are DHH?
Same as hearing children
Able to communicate with everyone
What behaviors would you expect for children who are DHH?
Positive behaviors with appropriate intervention
Negative behaviors without appropriate intervention
Appropriate expectations are needed
What are your reactions to using AAC to develop language with our children?
Positive: exciting, easy, builds on strength, ownership
Negative: complicated
A child comes into your setting with an iPad with a communication application. What are your concerns and what are the positives?
Concerns: usage, care, appropriateness, consistency
Positives: supports for learning, use in writing lessons
Based on our discussion so far, how can you incorporate this into your daily practice?
Speech/Language: incorporate into lesson, augment goals
School: teaching writing and sentence structure
Discussion
Families reported that TALI was successful in general.
Some positive themes noted were: ease of use, enjoyment, enhanced attention and perseverance. Language improvements and expanded vocabulary led to communication with more partners.
Parents cited inconvenient location of therapy, prioritization among other therapies, difficulty working with the school, and assistance needed for child’s developmental age.
Focus group participants indicated excitement about the TALI intervention and its potential to help children with hearing loss.
Focus group participants conceded that implementation of the devices may be complicated due to classroom transition, unfamiliarity with the technology and updating the technology to meet the child’s advancing communicative needs.
Fig 2 and 3: Discussions with professional partners are displayed. Responses to each of the focus group questions were recorded and matriculated to general responses and trends.
Conclusions
TALI was viewed positively by parents and professionals for use in expanding vocabulary and verbal communication skills.
Children found use of TALI enjoyable and motivating.
Barriers were adoption by school settings and modification of TALI to keep up with child’s advancing language skills.
Next Steps
Include additional community partners and parents in future studies of social validity
Investigate if TALI would have a significant impact on language development for children with additional disabilities
Consider training and support programs necessary to support families, schools, and other partners
Fig 1: TouchChat HD with WordPower with 60-cell overlay
Aims
The purpose of this research study was to investigate the social validity of the Technology Assisted Language Intervention (TALI) for children who are DHH.
It is important to investigate the feasibility of this new intervention across varied settings.  Success of an intervention depends on the ability to generalize it to other environments.
While results were positive in individual therapy sessions, we investigated the feasibility of using this intervention in the child’s natural environments (home and school).
We gathered qualitative data from the parents of children enrolled in this study to better understand their perspective on the use of this intervention outside of therapy.
We also gathered qualitative data from professionals and community partners who work with children who are DHH to better understand their perspective on the use of this intervention in their setting.
Acknowledgements
This project is funded by Maternal and Child Health Bureau Grant T73MC The Schmidlapp Women’s Scholar Fund and the March of Dimes. Families who make this work possible through participation.