Early Communication Intervention for Deaf/Hard of Hearing Toddlers: A Randomized Clinical Trial

OBJECTIVE To maximize outcomes for deaf and hard-of-hearing (DHH) children, it is essential to develop effective early interventions. Parent-mediated interventions (PMIs) are a promising form of early communication interventions for DHH toddlers. The current study tests the effect of the PMI by evaluating (1) the effect of the PMI on parent strategy use and child communication and (2) the extent to which communication mode moderates these effects. METHODS This single-site parallel stratified clinical trial (2 × 2; hearing device, communication mode) enrolled 96 parent-child dyads. Child inclusion criteria were as follows: (1) between 12 to 18 months old, (2) diagnosed with bilateral hearing loss, (3) no additional diagnoses, (4) had at least 1 parent with typical hearing, and (5) exposed to some degree of spoken language by their parents. Communication mode (ie, how a language is conveyed) was measured as exposure or no exposure to sign. Dyads were randomized to the PMI or control group. The PMI occurred weekly via telehealth over 6 months. Outcomes were measured before, during, and immediately after intervention. RESULTS Parent strategy use (Cohen’s d = 1.57) and child communication (Cohen’s d = 0.59) were greater for participants in the PMI group, indicating a statistically and clinically significant intervention effect. The intervention effect on child communication was significantly greater for children exposed to signs than children not exposed to signs (Regression Coefficient (B) = 18.93, SE = 8.09, P = .02). CONCLUSION The PMI effectively facilitates parent strategy use and child communication outcomes. Moreover, this early communication intervention seems particularly beneficial for parent-child dyads who use sign.