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IES Grant

Title: Training-Induced Language and Literacy Improvement in Children with Cochlear Implants
Center: NCSER Year: 2016
Principal Investigator: Ingvalson, Erin Awardee: Florida State University
Program: Cognition and Student Learning in Special Education      [Program Details]
Award Period: 4 years (7/1/2016-6/30/2020) Award Amount: $3,499,939
Type: Efficacy and Replication Award Number: R324A160193
Description:

Co-Principal Investigators: Megan Roberts (Northwestern University) and Christopher Schatschneider

Purpose: In an effort to address the deficits in language and literacy development commonly experienced by children with cochlear implants (CIs), the current project will test the efficacy of phonological awareness (PA) and verbal working memory (WM) interventions—Earobics and Cogmed—for improving language and literacy outcomes for children who use CIs. Increasing numbers of children with hearing impairments are receiving CIs. Children who use CIs have been shown to have performance delays on measures of receptive and expressive spoken language, reading ability, and writing ability relative to children with typical hearing, which hinder their ability to succeed in a mainstream academic environment. Previous research with children who are typically developing suggests that PA and verbal WM skills support language and literacy development and can be improved with existing commercialized interventions. However, there has been little research to determine the efficacy of these interventions in children who use CIs. Thus, the purpose of the current project is to test the efficacy of PA training alone (Earobics), verbal WM training alone (specific portions of both Earobics and Cogmed that focus on verbal WM), and combined PA-WM training for improving PA and WM skills and subsequent language and literacy outcomes for children ages 5-7 who use CIs.

Project Activities: During each of the first 3 years of the project, the researchers will recruit 40 children with CIs and randomly assign them to one of four conditions—PA training, verbal WM training, PA-WM training, or comparison condition. Training will take place in each of the first 3 years along with pre- and post-intervention data collection in the fall and spring, respectively. Maintenance testing will occur 6 months post-training, beginning at the end of Year 1. The final year of the project involves maintenance testing as well as data analysis and dissemination activities.

Products: The products of this project will include evidence of the efficacy of PA and verbal WM interventions for improving language and literacy in children who use CIs; peer-reviewed publications; and presentations.

Structured Abstract

Setting: The intervention will be implemented primarily in schools specialized for children who are deaf and hard of hearing in Illinois and Florida. Caregivers will also be given the option for their child to participate outside of school hours in a lab or clinic setting.

Sample: Approximately 120 children (40 children per year for 3 years) will participate in this research. Children will be prelingually deafened CI recipients ages 5 to 7 years who have been using their devices for at least 1 year. The teachers of the participating children will complete ratings of the children's executive functioning skills.

Intervention: Interventions will include PA training, verbal WM training, and a combined PA-WM training. Both commercial training products, Earobics and Cogmed, are computerized programs with tasks to train specific cognitive skills. The interventions will be auditory and children will make their responses by touching the computer monitor, eliminating the need to make a verbal response. The PA intervention will be implemented in Earobics and will target the following skills: sound blending, rhyme, phoneme identification, and sound discrimination. The WM intervention will incorporate portions of Earobics (i.e., games that target verbal WM storage) and Cogmed, with tasks related to verbal storage and processing. The combined PA-WM intervention will incorporate the intervention components from both the PA and WM interventions, but at one-half of the dosage to keep time on the training programs equivalent. All children will train for 8 weeks at a rate of 3 sessions per week (25 minutes per session). Children will receive feedback on each trial and all interventions will be individually adaptive to ensure that each child is receiving treatment that is optimized in difficulty.

Research Design and Methods: The research team will conduct a randomized controlled trial in which children will be randomly assigned to one of three intervention groups (PA training, verbal WM training, combined PA-WM training) or the comparison condition using a blocked randomization design. Approximately 40 children with CIs will participate in the study annually for each of the 3 years of data collection. Children in all conditions will train for 8 weeks. Data on proximal (PA and WM skills) and distal (language and literacy skills) outcomes will be collected for all groups immediately before and after training and 6 months after training. The researchers will analyze the data to investigate the effects of PA and verbal WM interventions on student outcomes, the long-term maintenance of effects, and the potential moderating effect of speech perception ability on improvements in child outcomes.

Comparison Condition: Children in the comparison condition will complete a non-adaptive version of the combined PA-WM training that will fully mimic the intervention condition but does not increase in difficulty, preventing children from making training gains. All students in the comparison condition will be offered the most efficacious intervention after the study ends.

Key Measures: Outcome measures include proximal measures of PA and WM and distal measures of language and literacy. To assess PA, the Phonological Awareness Test and the Comprehensive Test of Phonological Processing (CTOPP) will be used. To assess working memory, children will be tested using the Automated Working Memory Assessment and the Children's Test of Nonword Repetition. The Behavior Rating Inventory of Executive Function (BRIEF) will be used to measure teacher ratings of executive function. Measures of distal language outcomes will include the Expressive One Word Picture Vocabulary Test and Receptive One Word Picture Vocabulary Test to assess receptive vocabulary and the Oral Written Language Scales (OWLS) to assess language skills. Measures of distal literacy outcomes will include the I to assess expressive (writing) and receptive (reading) language ability and the Woodcock Reading Mastery Test (WRMT) to further assess reading ability. Data on training trajectories in both Cogmed and Earobics will also be collected to assess children's progress and determine whether gains on individual training components correspond to gains on standardized measures of these skills. Potential moderators will include measures of speech perception obtained through audiological records and demographic information (e.g., duration of hearing loss, age of implantation, non-verbal IQ, parents' socioeconomic status, quality and frequency of speech habilitation, and access to an oral-aural education). For fidelity of the interventions, automatically generated training logs will document adherence to the training schedule and records related to the volume of each session will indicate whether stimuli are audible.

Data Analytic Strategy: Using standardized scores to eliminate performance differences by developmental ability level, a mixed effect models framework that employs maximum likelihood estimation will be used to answer the primary research questions. All analyses will use an intent-to-treat model.


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