Purpose: Hearing loss is the most common birth abnormality, occurring in approximately 1–2 newborns per 1,000 births. Recent medical advances (e.g., cochlear implants/digital hearing aids) have brought auditory access to children with hearing loss, often at an early age. These advances have been associated with significantly improved academic achievement. However, children of low socio-economic status (SES) have continued to demonstrate significantly poorer outcomes, even with auditory access. Evidence suggests that this SES disparity may be due to a lack of critical rehabilitative services, especially in the early intervention (EI) system, including programs to enhance parental skills in supporting their children's listening and language development. To address this need, the research team for this study is developing a provider-guided, parent-directed multimedia intervention called Project ASPIRE (Achieving Superior Parental Involvement for Rehabilitative Excellence). The goal is to develop a standardized EI curriculum for providers to guide parents of children who are deaf or hard-of-hearing (D/HH) in becoming effective collaborators in their children's rehabilitation. The intervention is intended to improve listening and language, and ultimately the educational success, of students of low SES.

Project Activities: The research team will conduct three primary activities: develop the Project ASPIRE curriculum guide and multimedia program; assess the feasibility of implementation with early intervention professionals, parents, and children who are D/HH; and conduct a pilot study of the entire intervention to assess the promise of the intervention in improving parent and child outcomes related to language and literacy.

Products: Products will include a fully developed multi-media intervention with a curriculum guide for EI practitioners; data on the feasibility of the use of the intervention with low SES parents and children; and evidence of the potential impact of Project ASPIRE on parents' knowledge and behavior and on children's listening, language, and literacy outcomes. Additionally, products will include reports and presentations on the project.

Structured Abstract

Setting: The field test of the intervention will be conducted in participants' homes in Illinois.

Population: The sample for the iterative intervention development will consist of racially and ethnically diverse parents of low SES and their 12- to 36-month-old children who are deaf or hard of hearing. Early interventionists who work with this population will also be included in the iterative development of the ASPIRE curriculum.

Intervention: Project ASPIRE is a 9-week, listening and spoken language curriculum that incorporates formal instructional design strategies. With the aid of a curriculum guide, EI providers will lead parents through the intervention. The multimedia modules will incorporate animation and video of parents to transmit knowledge and skills so that parents may best help their children attain language and literacy. Parents will receive feedback via a language processor worn by the child that collects and analyzes data on the child's language environment, including parent-child interactions, which will help them modulate their language production.

Research Design and Methods: Project ASPIRE collaborators have developed a 'best-practices' curriculum that will serve as the basis for this project. In a three-stage process, the curriculum will be translated into modules consisting of a multimedia DVD and accompanying curriculum guide. In Stage 1, the curriculum will be adapted into modules that consist of a provider manual, storyboard, and script for animation and parent video. Principles of learning, instructional design, motivation, and presentation will guide module development. Stage 2 will be devoted to generating the multimedia content (i.e., animation, parent videos) and conducting a preliminary pilot on the first three modules. Stage 3 will be a pilot test in which families will be randomly assigned to Project ASPIRE and control conditions.

Control Condition: The control condition for the pilot study is a "business as usual" condition. Families in this group will receive the services that are typically provided through their early intervention programs.

Key Measures: During each phase, testing for acceptability, feasibility, changes in parent knowledge and behavior, and EI feedback will be used in the iterative development of the intervention. Pilot testing will include quantitative and qualitative assessments of parent and child behavioral outcomes. Key outcomes will include parent language output, conversational turns, child vocalizations, child speech imitation, and child language ability. Parents' knowledge of concepts covered in the curriculum and fidelity of implementation will also be assessed.

Data Analytic Strategy: The analytic approach will involve qualitative and quantitative analysis of feasibility, acceptability, and parent change data to inform iterative development efforts. Data from the full-scale pilot will be analyzed using an interrupted time series design that will allow the research team to model children's growth as a function of time and maturation. The analysis will assess the effects of participation in the Project ASPIRE intervention using outcome measures collected for parents and children at multiple time points in both the control and experimental condition. Separate analyses will be carried out for parents and children. Repeated measures analysis of variance will be carried out on data collected only at pre- and posttest.

Products and Publications

Book

Suskind, D., Suskind, B., and Lewinter-Suskind, L. (2015). Thirty Million Words: Building a Child's Brain. New York: Dutton.

Journal article, monograph, or newsletter

Leffel, K.R., and Suskind, D.L. (2013). Parent-Directed Approaches to Enrich the Early Language Environments of Children Living in Poverty. doi:10.1055/s-0033–1353443

Suskind D., Leffel, K.R., Hernandez, M.W., Sapolich, S.G., Suskind, E.S., Kirkham, E., and Meehan, P. (2013). An Exploratory Study of ‘Quantitative Linguistic Feedback': Effect of LENA Feedback on Adult Language Production. Communication Disorders Quarterly, 34: 199–209. doi:10.1177/1525740112473146

Suskind, D. L., Graf, E., Leffel, K. R., Hernandez, M. W., Suskind, E., Webber, R.,Tannenbaum, S., and Nevins, M. (2016). Project ASPIRE: Spoken Language Intervention Curriculum for Parents of Low-socioeconomic Status and Their Deaf and Hard-of-Hearing Children. Otology & Neurotology, 37(2): e110–e117. doi:10.1097/MAO.0000000000000931

Suskind, D., Leffel, K., Graf, E., Hernandez, M., Gunderson, E., Sapolich, S., Suskind, E., Leininger, L., Goldin-Meadow, S., Levine, S.C. (2015). A Parent-Directed Language Intervention for Children of Low Socioeconomic Status: A Randomized Controlled Pilot Study. Journal of Child Language, 43(2): 366–406. doi:10.1017/S0305000915000033?

Suskind, D.L., Suskind, E., Sapolich, S., Leffel, K., Repplinger, L., Shay, S., Sacks, C., and Singh, N. (2014). Pilot Testing of a Parent-Directed Intervention (Project ASPIRE) for Underserved Children who are Deaf or Hard of Hearing. Child Language Teaching and Therapy, 30(1). doi:10.1177/0265659013494873