title: Quantity and Quality of Caregivers' Linguistic Input to 18-Month and 3-Year-Old Children Who Are Hard of Hearing.
abstract: OBJECTIVE
  The primary objective of this study was to examine the quantity and quality of caregiver talk directed to children who are hard of hearing (CHH) compared with children with normal hearing (CNH). For the CHH only, the study explored how caregiver input changed as a function of child age (18 months versus 3 years), which child and family factors contributed to variance in caregiver linguistic input at 18 months and 3 years, and how caregiver talk at 18 months related to child language outcomes at 3 years.
  
  
  METHODS
  Participants were 59 CNH and 156 children with bilateral, mild-to-severe hearing loss. When children were approximately 18 months and/or 3 years of age, caregivers and children participated in a 5-min semistructured, conversational interaction. Interactions were transcribed and coded for two features of caregiver input representing quantity (number of total utterances and number of total words) and four features representing quality (number of different words, mean length of utterance in morphemes, proportion of utterances that were high level, and proportion of utterances that were directing). In addition, at the 18-month visit, parents completed a standardized questionnaire regarding their child's communication development. At the 3-year visit, a clinician administered a standardized language measure.
  
  
  RESULTS
  At the 18-month visit, the CHH were exposed to a greater proportion of directing utterances than the CNH. At the 3-year visit, there were significant differences between the CNH and CHH for number of total words and all four of the quality variables, with the CHH being exposed to fewer words and lower quality input. Caregivers generally provided higher quality input to CHH at the 3-year visit compared with the 18-month visit. At the 18-month visit, quantity variables, but not quality variables, were related to several child and family factors. At the 3-year visit, the variable most strongly related to caregiver input was child language. Longitudinal analyses indicated that quality, but not quantity, of caregiver linguistic input at 18 months was related to child language abilities at 3 years, with directing utterances accounting for significant unique variance in child language outcomes.
  
  
  CONCLUSIONS
  Although caregivers of CHH increased their use of quality features of linguistic input over time, the differences when compared with CNH suggest that some caregivers may need additional support to provide their children with optimal language learning environments. This is particularly important given the relationships that were identified between quality features of caregivers' linguistic input and children's language abilities. Family supports should include a focus on developing a style that is conversational eliciting as opposed to directive.
authors.affiliation: 1Center for Childhood Deafness, Boys Town National Research Hospital, Omaha, Nebraska, USA; 2Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA; and 3Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Ambrose
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Walker
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Unflat-Berry
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Oleson
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Moeller
mesh_terms: D017028:Caregivers; D016022:Case-Control Studies; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D000066502:Grandparents; D006312:Hearing Loss, Bilateral / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007804:Language Development; D008297:Male; D010287:Parent-Child Relations; D010290:Parents; D012720:Severity of Illness Index; D013060:Speech