Peer Interactions of Preschoolers With Hearing Loss The preschool years are characterized by many developmental changes, including language, social, motor, and cognitive growth. Promising outcomes in the development of oral language have been reported for young children with hearing loss who are identified early and receive early intervention (Duchesne, Sutton, & Bergeron, 2009; Geers, Nicholas, & Sedey, ... Features
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Features  |   September 01, 2011
Peer Interactions of Preschoolers With Hearing Loss
Author Notes
  • Joanne DeLuzio, PhD, is an assistant professor in the Department of Speech-Language Pathology at the University of Toronto. Contact her at jo.deluzio@utoronto.ca.
    Joanne DeLuzio, PhD, is an assistant professor in the Department of Speech-Language Pathology at the University of Toronto. Contact her at jo.deluzio@utoronto.ca.×
  • Luigi Girolametto, PhD, CCC-SLP, is a professor in the Department of Speech-Language Pathology at the University of Toronto. Contact him at l.girolametto@utoronto.ca.
    Luigi Girolametto, PhD, CCC-SLP, is a professor in the Department of Speech-Language Pathology at the University of Toronto. Contact him at l.girolametto@utoronto.ca.×
Article Information
Hearing Disorders / Features
Features   |   September 01, 2011
Peer Interactions of Preschoolers With Hearing Loss
The ASHA Leader, September 2011, Vol. 16, 22-24. doi:10.1044/leader.FTR3.16112011.22
The ASHA Leader, September 2011, Vol. 16, 22-24. doi:10.1044/leader.FTR3.16112011.22
The preschool years are characterized by many developmental changes, including language, social, motor, and cognitive growth. Promising outcomes in the development of oral language have been reported for young children with hearing loss who are identified early and receive early intervention (Duchesne, Sutton, & Bergeron, 2009; Geers, Nicholas, & Sedey, 2003; Nicholas & Geers 2006, 2007). Increasingly, these children are integrated into regular classrooms with typically hearing children. Yet little is known about how young children with hearing loss use their speech and language skills in natural interactions with their peers. Insights into the development of peer interaction skills in preschoolers with hearing loss is important to understanding how they develop meaningful social relationships (Antia, 1994; Ladd, 2005).
Early Social Skills
Two key skills are necessary for the development of peer interaction—the abilities to initiate and respond. Preschool children typically initiate by approaching a peer group and joining the ongoing activity or making a comment on the peer’s play (Corsaro, 1979, 1981, 1985; Dodge, Pettit, Gregory, McClaskey, & Brown, 1986; Putallaz & Gottman, 1981). This strategy of simply “joining in” has greater success in achieving peer group entry than other strategies, such as making a direct verbal request to join ongoing activities, waiting and hovering (i.e., positioning oneself beside a peer to wait for an invitation), or disrupting play (e.g., grabbing a toy; Corsaro, 1985; Dodge et al., 1986; Putallaz & Wasserman, 1989). In the preschool age range, typically hearing children are generally not very successful at responding to their peers (Corsaro, 1979, 1981, 1985; Tremblay, Strain, Hendrickson, & Shores, 1981). Large increases in verbal responding occur between and 24 and 30 months of age. By 5 years of age, 50% of children may be able to respond on certain topics for up to a dozen turns (Owens, 2008).
Initiatives to encourage early identification of hearing loss, coupled with widespread use of cost-effective hearing screening techniques, have resulted in earlier diagnoses of children with hearing loss (Dettman, Pinder, Briggs, Dowell, & Leigh, 2007; Thompson et al., 2001) and better outcomes in speech and spoken language (Geers, Nicholas, & Sedey, 2003; Nicholas & Geers, 2006, 2007). However, the effects of these improved outcomes on peer interaction skills of preschool children with hearing loss are not fully understood. To date, research on peer interactions of preschool children with hearing loss has been inconclusive because studies have grouped children who use sign language and those who use oral communication. In addition, studies have examined children with wide ranges of hearing losses and very different identification ages.
To examine peer interaction skills, DeLuzio and Girolametto (2011) recruited 12 preschoolers with congenital severe-to-profound hearing loss (SPHL) that was identified by 24 months. Six of the children had cochlear implants and six had bilateral hearing aids. Each child with SPHL was matched with a typically hearing child from the same classroom who had no known or suspected disabilities according to parent and educator reports. The two groups of children did not differ in nonverbal IQ. In addition, 10 of the children with SPHL had oral language scores in the normal range. However, as a group, the children with SPHL achieved significantly lower scores on language, vocabulary, social maturity, and speech intelligibility measures. The pairs of children were videotaped twice in small-group play sessions for a total of 30 minutes of play. The videotapes were coded to provide data on the quantity and quality of the initiations, responses, and any resulting conversations. Specific initiation and response strategies used were identified.
Initiations
The two groups of children did not differ in the number or type of initiations they used during the small-group play sessions. However, the children with SPHL received significantly fewer answers to their initiations compared to the children with typical hearing. A startling finding was that children with SPHL received answers to 17% of their initiations; children with typical hearing received answers to 38% of their initiations. This finding indicates that the children with SPHL in this study had 83% of their initiations ignored, compared to 52% for the children with typical hearing.
Moreover, the children with SPHL received significantly fewer initiations from others (i.e., invitations to interact or play) relative to their typically hearing peers. Therefore, these children were not sought out as play partners at the same rate as their typically hearing peers, resulting in fewer peer interaction opportunities overall. These results suggest that children with SPHL may have reduced opportunities to practice their developing speech, language, and peer interaction skills even within an integrated preschool environment.
Responses
The two groups did not differ significantly in the proportion of responses they provided to their peers. Nor were there significant differences between the two groups for the length of their interactions as measured by successive responses following an initiation. Despite the reported finding that the children with SPHL in this study were not receiving as many interaction invitations from their peers, the results indicated that when they did receive an invitation to interact, the children with SPHL were at least as likely to respond to it as the other children. In fact, examination of individual data reveals that three of the children with SPHL responded to interaction invitations 100% of the time, but none of the typically hearing children responded to 100% of their interaction invitations. Thus, the children with SPHL in this study used speech and language to respond to interaction invitations, even though they had significantly fewer peer interaction opportunities in which to practice this skill.
Influence of Speech Intelligibility
Why is it that the children with SPHL in this study did not receive as many responses to their initiations or as many interaction invitations as their typically hearing peers? One possible explanation is that the speech intelligibility of the children with SPHL was significantly poorer relative to the children with typical hearing. Earlier literature speculated that delay in speech development in children with hearing loss creates the greatest barrier to establishing and maintaining social relationships (Antia & Stinson, 1999; Stinson & Whitmire, 1991).
Implications
Our study contributes to the literature on the peer interaction abilities of preschool children with SPHL in two important ways. First, it suggests areas for further assessment of and intervention strategies for initiation and response skills in children with hearing loss. Study results suggest that it may not be sufficient to place children with SPHL—even those with language skills within normal limits—into integrated preschools and assume peer interactions will flourish. Treatment should focus on the development and practice of peer interaction skills and support to generalize these skills into peer groups of different sizes within integrated preschool contexts. For example, children with SPHL who frequently wait and hover outside of a peer group may be encouraged to join in the play activity by using similar toys in the same way as the peer and/or commenting on the peer’s ongoing play activity. In addition, activities to improve the children’s speech intelligibility may focus on vocabulary specific to play themes within the preschool.
Second, because some typically hearing peers may ignore the initiations of children with SPHL, peers with typical hearing also may benefit from interventions that encourage them to integrate children with SPHL into their play. In particular, peer-mediated models of intervention may be well-suited for this objective. In this model of intervention, the peer mediator (i.e., a typically developing child with high social skills) is taught strategies to include the children with a disability in play activities (e.g., Goldstein, English, Schafer, & Kascmarek, 1997). For example, the speech-language pathologist or educator could teach the peer strategies, such as inviting the child with SPHL to play (e.g., “Do you want to play with the farm?”), providing praise or approval (e.g., “I like that”), joining in the child’s play (e.g., adding a car to the farm set), or asking a question (e.g., “What is your horse doing?”). Teaching peer strategies has shown promise with typically developing preschoolers who interact with children with autism (e.g., Lawshey & Heflin, 2000) and may increase the responsivity of typically hearing children to their peers with SPHL.
A key point emerging from this study is that barriers to preschool peer interaction development also may be attitudinal. Even though the children with typical hearing were familiar with the children with hearing loss, they were not responsive to their initiations nor did they seek them out for interactions as often as they did their other playmates. More research needs to be conducted to identify whether early biases against children with hearing loss exist at the preschool level and how best to prevent such biases from developing. Although the threshold for what constitutes sufficient interaction is not known, an underlying assumption is that more interaction opportunities lead to more practice with initiation and response skills. Intervention programs to facilitate positive peer interactions must involve children with typical hearing as well as children with hearing loss, with the aim of including all children in social interactions at the preschool level.
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September 2011
Volume 16, Issue 11