The Volta Reviexv, Volume 106(3) (monograph), 275-298

Family Empowerment:
Supporting Language
Development in Young
Children Who Are Deaf or
Hard of Hearing
jean L. Desjardin, Ph.D.

The current model of early intervention with children who are deaf or hard of
hearing emphasizes parental self-efficacy and involvement. The purpose of this study
was to investigate the relationships hetween mothers' self-efficacy beliefs and involve-
ment and childretj's language skills in a group of mothers of children who are deaf or
hard of hearing and wear hearing aids (N = 32). Mothers completed a questionnaire
(Scale of Parental Involvement and Self-Efficacy), and mother-child interactions were
videotaped. Mothers' self-efficacy beliefs related to developing their children's speech
and language were positively associated with higher level facilitative language tech-
niques (recast and open-ended question), and one lower level technique (closed-ended
question). Perceived involvement was also positively related to lower level techniques.
Regression analyses indicated that the same higher level techniques were associated
with children's language skills. Findings present early intervention implications for
professionals who zvork with families and children who are deaf or hard of hearing.

Introduction
Families of young children who are deaf or hard of hearing have many
more opportunities today than in years past to develop a child's spoken
language skills. In the past, parents may have felt isolated in their search for
resources related to hearing loss, with parent-professional partnerships tra-
ditionally marked by "power over" relationships that are defined by profes-
sionals presuming a higher sense of competence and greater knowledge than
parents (Turnbull, Turbiville, & TumbuU, 2000). The present model of early
intervention, referred to as the empowerment model (TumbuU & TumbuU,

lean Desjardin. Ph.D., is an adxmnced research associate in the Children's Research and
Evaluation (CARE) Center at House Ear Institute in Los Angeles, Calif.

Empowering Families of Young Children Who Are Deaf 275

2001), places an emphasis on parental involvement in an equal partnership
with the professional. In this professional-parent partnership, both work col-
laboratively to leam from eadi other about better ways to support the child's
language development.
Current recommended practices for children who are deaf or hard of hear-
ing emphasize the importance of not only parental involvement, but also
parental competence. Both the individuals with Disabilities Education Improve-
ment Act (IDEIA, 2004) and the Division of Early Childhood (DEC) Recommended
Practices in Early Intervention/Early Childhood Special Education (Sandall,
McLean, & Smith, 2000) specify that one desired outcome of early interven-
tion is for parents to perceive themselves as capable of supporting their
children's growth and development—parental self-efficacy. Parental beliefs
wiU, in tum, make an impact on the child's learning. The role of early inter-
vention professionals is to support parents as they seek to gain access to the
information they require to become competent and confident in the skills
necessary to support their children's development (McWilliam & Scott, 2001;
Turnbull et al., 2000). Parents' beliefs about their skills and involvement in
their children's early intervention program are critical components for chil-
dren's language learning.

Parental Self-Efficacy
Parental self-efficacy beliefs are defined as one's sense of knowledge and
abilities to perform or accomplish daUy parenting tasks and roles. According
to self-efficacy theory (Bandura, 1997), parental self-efficacy beliefs should
incorporate (1) the level of specific knowledge pertaining to the behaviors
involved in child-rearing and (2) the degree of confidence in one's own ability
to carry out the specific parental role. For example, Conrad, Gross, Fogg, and
Ruchala (1992) noted that mothers' increased knowledge alone did not result
in better interactions with their young children. Increased knowledge and
confidence together, however, resulted in more effective interactions with
their hearing toddlers.
A key component of self-efficacy theory states that parents' efficacy beliefs
are linked to the goals they have for their children (Bandura, 1989). These
goals may translate into parental practices that support their children's ability
and persist untU the goals are attamed (Brody, Flor, & Gibson, 1999; Desjar-
din, 2004). In other words, a person who is self-efficacious both knows about
and persists in atten:ipting a given task until success is achieved, whereas
self-inefficacious individuals may have the knowledge needed, but may be
unable to persist because of self-doubt. Thus, parents of children who are deaf
or hard of hearing need the knowledge and skills necessary to buUd their
children's spoken language abilities, but, to achieve confidence in those skills,
they also need to use those skills daily as they interact with their children.
Indeed, maternal self-efficacy beliefs may influence mother-child interac-
tions, ln a sample of mothers and their hearing infants, Teti and Gelfand

276 Desjardin
(1991) found that maternal self-efficacy mediated the negative relationship
between mothers' depressive symptoms and mothers' behaviors reflecting
responsiveness (e.g., warmth and sensitivity) to their infants. Maternal self-
efficacy also remained positively associated with maternal responsiveness,
after controlling for all other factors (e.g., income level, perceptions of infant
difficulty and social-marital support). These findings suggest a link between
mothers' belief in their own abilities and maternal behavior.
The link between mothers' self-efficacy and maternal behaviors may need
to be tailored to the specific needs of children who are deaf or hard of hearing.
As suggested by Bandura (1989), parental perceived knowledge and confi-
dence of specific skills must be measured for a particular population. Al-
though there are parenting scales that tap into parents' self-efficacy for other
populations of children with disabilities (Akey, Marquis, & Ross, 2000; Triv-
ette & Dunst, 2003), ortly one has been specifically designed for parents of
young children who are deaf or hard of hearing (Scale of Parental Involve-
ment and Self-Efficacy [SPISE]; Desjardin, 2003). Using this particular mea-
sure, Desjardin (2004) examined a sample of 24 mothers with preschool
children with cochlear implants (mean age = 3.7 years). Mothers' perceived
self-efficacy in terms of developing their children's language at the first time-
point in data collection (Time 1) related positively to children's receptive and
expressive language skills one year later (even after controlling for their
child's language skills at Time 1).
In that same study at Time 2 (Desjardin, 2004; Time 2), with the inclusion
of eight more mother-child dyads (N = 32), mothers' sense of efficacy also was
related to specific facilitative language techniques employed during mother-
child interactions. Mothers who perceived themselves as more knowledge-
able and competent in developing their children's language skills provided
their children with higher level language techniques (recast and open-ended
questions). These same techniques were associated with better child language
outcomes. Conversely, mothers who perceived themselves as less knowl-
edgeable and competent in terms of developing their children's language
used lower level language techniques (linguistic mapping, directives and
imitations). Although there is evidence to suggest that lower level techniques
support language learning in hearing children with severe expressive lan-
guage delays (Girolametto, Weitzam, Wiigs, & Pearce, 1999), these techniques
did not seem to support preschool children with cochlear implants whose
language ages were approximately 2 1/2 years. Consistent with Bandura's
model, mothers' self-efficacy beliefs appear related to the developmental lan-
guage goals endorsed for their children that may link to the ways in which
parents interact with their children.
Parental Involvement
Parental involvement is another pivotal feature in present-day early inter-
vention programs. Over the past several years, researchers have found that

EmpoTvering Families of Young Children Who Are Deaf 277

family involvement strongly influences parent and child outcomes for chil-
dren who are deaf or hard of hearing (Calderon, Bargones, & Sidman, 1998;
Calderon, 2000; Moeller, 2000). Parent involvement has been shown to relate
positively to better parental communication exchanges with their children
(Calderon et al., 1998), more advanced language outcomes in kindergarten-
aged children (Moeller, 2000) and later educational development (Calderon,
2000; Calderon & Naidu, 2000; Yoshinaga-Itano, 2000). Moreover, Calderon
and Naidu (2000) found mothers' communication skills, rather than direct
parental involvement in their children's education programs, related signifi-
cantly to their children's language and early reading skills.
The way in which parents are involved is also important for children's
language learning. Young children learn new words in the contexts of their
daily experiences and, particularly, through interactions with their caregiv-
ers. According to the social-interactionist theory, the main emphasis is on
caregiver linguistic input (Hoff-Ginsberg, 1997). Variation observed in chil-
dren's language skills may strongly be linked to the quantity (e.g., number of
words) and quality (e.g., facilitative language techniques) of the caregiver's
linguistic input (Girolameto et al., 1999; Hart & Risley, 1999). For example,
language techniques, parallel talk and recasting have been reported to relate
positively to children's rapid language development (Fey, Krulik, Loeb, &
Proctor-Williams, 1999; Kaiser & Hancock, 2003).
The Guidelines in Division of Early Childhood (DEC) Recommended Practices in
Early Intervention emphasize parental responsiveness to children's linguistic
attempts for facilitating optimal language development (Cook, Tessier, Klein,
& Armbruster, 2000; Sandall et al., 2000). Facilitative language techniques,
such as imitation and expansion, may enhance language learning in young
children at the single-word stage of language development (Girolametto et
al., 1999). In contrast, language techniques such as parallel talk, recast and
open-ended questions may elicit better responses from children who are at
the two-to-three-word language level (Fey et al, 1999; Hulit & Howard, 1997;
McNeil & Fowler, 1999). hideed, language techniques that are "fine-tuned" to
children's language levels accelerate children's expressive language develop-
ment (Yoder & Warren, 1998).
Hearing mothers of children who are deaf may intuitively adapt their
language techniques to their children's language level. Koester, Papousek, &
Smith-Gray (2000) noted that "intuitive parenting is a proficient yet often
overlooked communication technique used by parents when interacting with
their deaf toddlers" (p. 56). For example, a mother may use a higher level
technique, such as an open-ended question and, if the child does not respond,
adapt her linguistic input to a lower level technique, such as a closed-ended
question. In fact, hearing mothers of children who are deaf may intuitively
make adaptations to their children's linguistic abilities and demonstrate re-
sponse-control behaviors (e.g., questioning) to compensate for their child's
deafness (Lederberg & Prezbindowski, 2000).

278 Desjardin
 Mothers' sense of involvement may also influence language techniques
whUe interacting with their children who are deaf. Findings from a longitu-
dinal study of 24 mothers of children with cochlear implants (Desjardin, 2004)
suggest that mothers' perceived involvement in their children's language
development at Time 1 was related to higher level faciUtative language tech-
niques (parallel talk, recast anci open-ended questions) one year later. Even
after controlling for their children's language ages at Time 1, these same
techniques were also associated with their chUdren's language outcomes.
Conversely, mothers who felt less involved in their children's language pro-
gram exhibited lower level language techniques (Unguistic mapping, imita-
tion and directive). Such lower level techniques, in tum, related negatively to
their chUdren's language skills for this population of mothers and preschool
children who are deaf and use cochlear implants. Furthermore, at Time 2, and
with the inclusion of eight more mother-child dyads (N = 32), higher level
language techniques, recast and open-ended questions remained predictor
variables for children's receptive and expressive language skills, respectively,
even after controlling for children's length of cochlear implant use for this
group of mothers and their young children who use cochlear implants (Des-
jardin, 2006).
Although there is theoretical and empirical support for self-efficacy and
involvement in parents of young children and, specifically, children with
cochlear implants, we do not know if the same holds true for mothers of
young children who use hearing aids. The goal of the present study was to
examine the relationships between mothers' perceived self-efficacy and in-
volvement, and children's language outcomes, in a group of mothers and
children who use hearing aids. This study addresses two research questions:
(1) Are perceived maternal self-efficacy and involvement associated with
facilitative language tecliniques during mother-chUd interactions? and (2)
What are the matemal predictor variables for children's language outcomes?

Method
Participants

The author recruited mothers and children from the Children's Auditory
Research and Evaluation (CARE) Center, located at House Ear Institute in Los
Angeles. The CARE Center serves chUdren ages birth to 18 years and their
famUies, providing a range of clinical services that include initial diagnosis of
hearing loss and audiological foUow-up services.

Mothers

Thirty-two mothers and children who are deaf or hard of hearing partici-
pated in this study. As shown in Table 1, mothers averaged 36 years of age

Empowering Families of Young Children Who Are Deaf 279

Table 1. Demographic Characteristics for Mothers (N = 32)

Mean; (SD)
Mothers' Characteristics Range: 23-53 years
Age 36.3; (6.25)
Education level Elementary: 0; (0.0%)
High School: 7; (21.9%)
Some Coiiege; 3; (9.4%)
Bachelor's Degree: 7; (21.9%)
Postgraduate: 15; (46.9%)
Household income <$15,000 = 5 (15.6%)
$15,000-$29,000 - 2 (6.3%)
$30,000-$49,000 = 5 (15.6%)
$50,000-$74,000 = 5 (15.6%)
$75,000-$100,000 = 5 (15.6%)
>$100,000 = 10 (31.3%)
Ethnicity Caucasian: 17; (53.1%)
Latino: 11; (34.4%)
Asian-American; 2; (6.3%)
Other: 2; (6.3%)
Primary home language English 31 (96.9%)
Spanish 1 (3.1%)
Marital status Married 29 (87.5%)
Single 2 (9.4%)
Divorced 1 (3.1%)

(range = 23-53), most had some level of college experience (78.2%) and the
majority was in the upper middle-income level (62.5%) or above, with an
average yearly income level of $50,000. Most of the mothers were Caucasian
(53.1%) and spoke EngUsh (96.9%).

Children

All of the children presented with bilateral sensorineural hearing loss, were
hearing aid users and had been enrolled in a family-centered intervention or
school-age program for at least three months. As noted in their medical
charts, none of the children had an additional disability or developmental
delay. As displayed in Table 2, this is a heterogeneous group of children who
ranged in age from 1.1-6.0 years (M = 3.0 years). As a group, the children were
identified with hearing loss and enrolled in a family-centered early interven-
tion program at approximately 12 months and received hearing aids at ap-
proximately 18 months. At the time of testing, 25 children used an auditory/
oral modality of communication and seven children used auditory/oral with
some sign support. As per the Reynell Developmental Language Scales, chil-
dren's mean receptive and expressive language skills were 29 months and 25
months, respectively.

280 Desjardin
Table 2. Demographic Characteristics of Children (N = 32)

Mean; (SD)
Children's Characteristics (Range in months)

Gender Boys: 17; (53.1'5^,)

Girls: 15; (46.9"/,)
Age at testing 36 months (20.2)
(25-72)
Age at identification 11.7 months (15.9)
(<l-60)
Age at hearing aids 17.8 months (18.8)
(1-68)
Length of hearing-aid use 18.4 months (14.4)
(1-60)
Age of enrollment in early intervention 12.3 months (12.2)
(1-49)
Pure-tone average dB HL (in better ear) 65.2 (24.1)
(23-118.8 dB HL)
Aided pure-tone average dB HL 35.2 (17.4)
(in better ear) (15-88.8 dB HL)
Receptive language age 29 months (21.0)
(Reyneil Language Scales) (10-61)
Expressive language age 25 months (17.2)
(Reynell Language Scales) (9-61)
Cause of hearing loss Unknown: 24; (75.0)
Genetic: 6; (18.8)
Meningitis: 1; (3.1)
Other: 1; (3.1)
Primary mode of communication Auditory/oral: 25; (78.1%)
Auditory/oral with some signs: 7; (21.9%)

Measures

(1) The Scale of Parental Involvement and Maternal Self-Efficacy (SPISE)

(for a more thorough review of the SPISE, see Desjardin, 2003). The SPISE was
designed to measure parents' perceptions about their own knowledge and
competencies in relation to their children's sensory device use and develop-
ment of their children's speech and language skills. The SPISE consists of the
following three sections: (1) demographic iriJformation, (2) self-efficacy and (3)
parental involvement.
The demographic section consists of questions about the mother and child.
Maternal factors include marital status, ethnicity, primary language spoken in
the home, level of education, hours of work outside the home and household
income level. Child variables include child's age, age of identification, age of
amplification (hearing aids), length of hearing-aid use (hearing age), degree
of hearing loss, age of enrollment in a family-centered intervention program
and primary mode of communication.

Empowering Families of Young Children Who Are Deaf 281

 In the self-efficacy section, mothers rate 10 questions on a Likert-type scale
ranging from "not at all" (1) to "verif much" (7). Questions in this section relate
to mothers' perceptions about their level of influence on their child's auditory
development. The questions selected were derived from using exploratory
factor analysis. Two subscales emerged and Cronbach's alpha coefficients
suggested high internal consistency for each subscale: (1) Maternal Self-
Efficacy of Sensory Device Use, the extent to which a mother believes that she
has the knowledge and skills to following through with prescribed sensory
aid maintenance; and (2) Maternal Self-Efficacy of Child's Speech-Language
Development, the extent to which a mother believes that she has the knowl-
edge and skills to affect her child's speech and language development (see
Appendix for subscale items and Crochbach's [1951] alpha coefficients, rang-
ing from 0.80-0.87).
The involvement section consists of 11 questions on a Likert-type scale
ranging from "not at all" (1) to "very much" (7). The queries in this section
include items related to a mother's perception of her involvement in her
child's sensory device use and family-centered intervention or school-age
program. Using exploratory factor analysis, two subscales emerged: (1) Ma-
ternal Involvement of Sensory Device Use, the extent to which a mother
believes that she is involved in her child's use of sensory device and listening
development; and (2) Maternal Involvement of Child's Speech-Language De-
velopment, the extent to which a mother believes that she is involved in her
child's speech-language development and family-centered intervention pro-
gram or school-age program (e.g., therapy, home visits and IFSP/IEP meet-
ings) (see Appendix for subscale items and Cronbach's [1951] alpha
coefficients ranging from 0.76-0.83).
The SPISE was developed and pilot tested with a focus group that consisted
of three audiologists, a teacher of the deaf, a speech-language pathologist and
two parents of children with hearing loss (one child with hearing aids and
one child with a cochlear implant). Thus, the SPISE offers secure content
validity. Although the predictive validity of the SPISE is unknown at this
time, future avenues of research will investigate the relationships between
items on the SPISE and performance on a variety of observed tasks during
parent-child interactions.
(2) The Reynell Developmental Language Scales, Third Edition (RDLS 111)
(Reynell & Gruber, 1990). The RDLS-III are individually administered tests of
verbal comprehension and expressive language skills for young children. The
RDLS III uses toys (e.g., ball, doll), pictures of objects (e.g., window, flower)
and real objects (e.g., spoon, cup) to elicit responses from the child. The two
scales of the RDLS have been widely used both with hearing children and
children who are deaf (Stallings, Gao, & Svirsky, 2002; Svirsky, Robbins, Kirk,
Pisoni, & Miyamoto, 2000). The RDLS calculates raw scores and standard
scores and their age equivalents based on normative data from children with
normal hearing. The present investigation used auditory-oral raw scores in

282 Desjardin
the data analyses because almost all of the children had standard scores that
were below the floor of 63 or 64. There was, however, sufficient variability in
the raw scores for meaningful statistical analysis.
(3) Mother-Child interactions. Mothers and children engaged in free play
and storybooks together. During free play, mothers were asked to engage
their children with two Mr. Potato Head (Lerner, 1952) fun activity kits (one
kit designed to construct a female potato and one kit designed to construct a
male potato) for seven minutes. The Mr. Potato Head activity kits came with
various parts to engage the children in fantasy play (e.g., scuba goggles,
dress-up shoes, various hats). Mothers were instructed to "play with your
child as you would normally do at home when you have free time" and to
interact with their children using whatever mode or modes of communication
they use normally at home (auditory/oral or auditory/oral with sign sup-
port).
Following free play, mothers were provided two storybooks, What Next,
Baby Bear! by Jill Murphy (1983) and Frog, Where Are You? by Mercer Mayer
(1969). What Next, Baby Bear! is a relatively short, colorfully illustrated book
appropriate for preschoolers with a fantasy narrative about a little bear's
travel preparations for a trip to the moon. This book has been used in several
other mother-child interaction studies with young hearing children (Weiz-
man & Snow, 2001). Frog Where Are You? is a relatively short, wordless picture
book and has been used in more than 150 studies studying children acquiring
50 different languages and investigating children's narrative language devel-
opment (Berman & Slobin, 1994; Hoff-Ginsberg, 1997). Mothers were in-
structed to "read with your child as you would normally do at home when
you have time," choosing either book to begin and then continuing with the
other book when they were finished with the first book.

Procedures

Prospective participants received an invitation letter and stamped, self-

addressed postcard. Those interested in the study completed the postcard
and returned it to the CARE Center to schedule appointments. Mothers who
indicated interest in participating in the study received the SPISE question-
naire in the mail two weeks before their scheduled appointments and either
brought the completed questionnaire to the appointment or mailed it to the
House Ear Institute in a stamped, self-addressed envelope.
The mother-child interaction sessions were conducted in a comfortable
playroom at the CARE Center. The first seven minutes consisted of free play.
Following free play, the mothers and children interacted with the two books
described above for approximately 5 minutes each. Interactions were video-
taped using a digital camera (Canon Optura 30) hidden behind a one-way
mirror. Following the videotaping session, the children were administered

Empowering Families of Young Children Who Are Deaf 283

the Reynell Developmental Language Scales. All language assessments were
given in a child's primary mode of communication (auditory/oral or audi-
tory/oral with sign support). For this study, the analyses used auditory-oral
raw scores.

Data Preparation

Transcription and Reliability

All speech, vocalizations and signs produced by the mother and child were
transcribed in full by the author, using the Codes for the Human Analysis of
Transcripts (CHAT) transcription system. To establish inter-rater reliability of
transcription, a speech-language pathologist from the CARE Center tran-
scribed, in full, 10% of the randomly selected videotaped data. The calculation
of word-by-word correspondence yielded a high reliability between tran-
scribers, ranging from 95-98% agreement for mothers and children's intelli-
gible verbal utterances and 88-93% reliability for mothers' and children's
utterances that also contained some signs. The analyses used mother and
child vocal and signed utterances.
Each mother's transcribed utterance — linguistic phrase or sentence — was
coded for one higher level and lower level facilitative language technique
(during both free play and storybook conditions, as defined in Tables 3 and
4, respectively). Proportional scores of each facilitative language technique
were calculated and used in the analyses to avoid penalizing less talkative,
yet very responsive, n:iothers. Accordingly, proportional data were calculated
by dividing the total number of each language technique by the overall num-
ber of mothers' linguistic attempts. The CARE Center speech-language pa-
thologist coded 25% of the transcripts, randomly selected to establish test-
retest reliability. A line-by-line analysis revealed high agreement between
coders, ranging from 94-98% reliability.

Results

Relationships Betzueen Maternal Perceived Self-E^cacy and Facilitative

Language Techniques

Pearson product correlations were conducted to examine the relationships

between the two self-efficacy subscale items (sensory device use and speech-
language development) and the 10 facilitative language techniques. As dis-
played in Table 5, statistically significant positive relationships emerged
between self-efficacy in terms of developing their children's speech-language
and two higher level facilitative language techniques, recast (r = 0.48; p < 0.05)
and open-ended question (r = 0.38; p < 0.05). A significant positive relation-
ship also emerged between this same self-efficacy subscale itenri and one

284 Desjardin
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286 Desjardiu
Table 5. Relationships Between Maternal Self-Efficacy Subscale Items and Mothers'
Language Techniques

Facilitative Lan^fuage Malernal Self-Efficacy: Maternal Self-Efficacy:

Tfchmqiies Sensory Device Speech and Language

Parallel talk 0.20 0.07

Expansion 0.07 0.33
Recast 0.04 0.48*
Open-ended question 0.33 0.38*
Linj^uistic mapping 0.08 0.09
Closed-ended question 0.24 0.46*
Imitation 0.12 0.24
Label -o.n -O.n
Directive -0.34 -0.57**
Comment -0.32 -0.16

*p < 0.05; " p < 0.01

lower level technique, closed-ended queshon (r = 0.46; p < 0.05), and a nega-
tive relationship emerged with the lower level technique, directive (r = -0.57;
p < 0.01).
Relationships Between Maternal Perceived Involvement and Fadlitatwe
Language Techniques
Two self-efficacy subscale items (sensory device use and speech-language
development) were correlated with the 10 facilitative language techniques. As
Table 6 illustrates, perceived involvement in terms of the child's sensory
device related positively with one higher level technique, open-ended ques-
tion (r - 0.41; p < 0.05), and had a negative association with one lower level
technique, directive (r = -0.65; p < 0.01). There were no statistically significant
associations between mothers' perceived involvement of their child's speech-
language development and any higher level techniques; however, perceived
involvement related positively to two lower level techniques, closed-ended
question (r = 0.48; p < 0.05) and imitation (r = 0.38; p < 0.05).
Further correlation item analyses with the questions pertaining to this par-
ticular parental involvement subscale revealed statistically significant posi-
tive and negative relationships between the subscale items and lower level
techniques. Mothers' perceived notion of difficulty to check and listen to the
children's hearing aids on a daily basis related positively to the use of the
imitation technique, {r = 0.37; p < 0.05). There were also positive relationships
between mothers' perception of how much speech-language therapists or
early interventionists demonstrate listening-language activities and mothers'
comfort level in performing listening-language techniques in their homes
without a professional present, and the use of the lower level technique,
closed-ended question (r = 0.40; p < 0.05 and r - 0.51; p < 0.01, respectively).

Empowering Families of Young Children Who Are Deaf 287

Table 6. Relationships Between Maternal Involvement Subscale Items and
Mothers' Facilitative Language Techniques.

Facilitative Language Maternal Involvement: Maternal Involvement:

Techniques Sensory Device Speech and Language

Parallel talk 0.25 -0.16

Expansion 0.19 0.7
Recast 0.25 0.19
Open-ended question 0.41* 0.26
Linguistic mapping 0.14 -0.12
Close-ended question 0.28 0.48*
imitation 0.15 0.38*
Label -0.15 -0.14
Directive -0.65*' -0.44*
Comment -0.25 0,24

*p < 0.05; **p < 0.01

Relationships Between Facilitative Language Techniques and Children's Receptive and

Expressive Language Skills

Pearson product correlations were conducted between the 10 facilitative

language techniques and children's receptive and expressive language raw
scores. Statistically significant positive relations emerged between two higher
level techniques, recast {r = 0.64; p < 0.01; r = 0.63; p < 0.01) and open-ended
question {r = 0.58; p < 0.01; r = 0.60; p < 0.01) for children's receptive and
expressive language respectively. Negative associations emerged between
two lower level techniques, label (r = -0.60; p < 0.01; r = -0.53; p < 0.01) and
directive (r = -0.54; p < 0.01; r = -0.50; p < 0.05) and children's receptive and
expressive language outcomes, respectively. Generally speaking, this pattern
of correlation is consistent with the view that mothers' use of higher level
facilitative language techniques tends to be associated with more advanced
development in children's language skills.
Stepwise regression analysis was performed, controlling for children's
pure-tone average and length of hearing aid use, to further explore the rela-
tionships between mothers' facilitative language techniques and children's
receptive and expressive language skills. The higher- and lower level facili-
tative techniques that related positively to mothers' self-efficacy and involve-
ment in the previous analyses were included in the regression analyses
(recast, open-ended question and closed-ended question). Children's pure-
tone average and length of hearing aid use was entered in block 1, and
facilitative techniques were entered sequentially in block 2 and block 3. As
shown in Table 7, pure-tone average and length of hearing aid use accounted
for a significant amount of the variance in children's receptive language skills
(45%). Mothers' use of recast and open-ended question were also significant
predictor variables of children's receptive language, for a total of 23.3% of the

288 Desjardin
Table 7. Summary of Regression Models for Mothers' Linguistic Input and
Childrt'n's Receptive Language Skills
Significance in
Regression Models R R' Change in R^ F Change

Model 1 0.674 0.454 0.000

Model 2 0.771 0.594 0.140 0.005
Model 3 0.829 0.687 0.093 0.010
Predictors P P
Pure tone average in better ear -0.295 0.016
Length of hearing aid use 0.230 0.094
Open-ended question 0.348 0.007
Recast 0.370 0.010

variance. Similarly, children's pure-tone average and length of hearing aid

use also accounted for 44% of the variance in children's expressive language
skills, with the use of recast and open-ended question accounting for art
additional 24.3% (see Table 8).

Discussion
Early intervention practices for young children focus on empowering fami-
lies and building their sense of self-efficacy and involvement as they support
their children's early development (Desjardin, 2005; McWilliam & Scott, 2002;
Sandall et al., 2000; Turnbull & Turnbull, 2001). Despite these recommended
practices, few studies have investigated parents' sense of self-efficacy and
involvement in their children's early intervention program for families of
children who are deaf or hard of hearing. Of particular interest were the
relationships between maternal facilitative techniques and children's recep-
tive and expressive language skills. Results from this study generally confirm
previous findings among young children who are deaf (Desjardin, 2004) in
terms of the positive associations between maternal perceived self-efficacy
and involvement, and facilitative language techniques. In essence, early in-
tervention implications may be further generalized to a larger population of
young children who are deaf or hard of hearing.
Similar to the Desjardin (2004) study on preschool children with cochlear
implants, findings from this study provide evidence that maternal perceived
self-efficacy and involvement in terms of developing children's speech-
language development (rather than sensory device use) relates to specific
higher level facilitative techniques during mother-child interactions for chil-
dren with hearing aids. These same techniques are also associated with chil-
dren's language skills. Furthermore, these higher level techniques have been
noted in prior research to facilitate later language skills in preschool hearing
children (Baumwell, Tamis-LeMonda, & Bornstein, 1997; Kaiser & Hancock,
2003).

Empowering Families of Young Children Who Are Deaf 289

Table 8. Summary of Regression Models for Mothers' Linguistic Input and
Children's Expressive Language Skills

Significance in
Regression Models R R' Change in R~ F Change

Model 1 0.666 0,444 0.000

Model 2 0.771 0.595 0.151 0.004
Model 3 0.829 0.688 0.092 0.010
Predictors P P
Pure tone average in better ear -0.315 0.010
Length of hearing aid use 0.197 0.149
Open-ended question 0.364 0,005
Recast 0.369 0,010

Maternal beliefs about their children's language learning, however, also

were positively associated with one lower level technique (closed-question).
It could be that mothers in this study were intuitively adapting their language
techniques to their children's linguistic attempts. As prior research has sug-
gested (Lederberg & Prezbindowski, 2000), hearing mothers of children who
are deaf may intuitively make adaptations to their children's linguistic abili-
ties and demonstrate response-control behaviors (e.g., questioning) to com-
pensate for their children's deafness. Mothers in this study who felt more
knowledgeable and confident in developing their children's language also
may have been tailoring the language techniques to their children's linguistic
attempts.
Contrary to the findings in the Desjardin (2004) study, no significant rela-
tionships emerged between mothers' perceived involvement and any of the
higher level facilitative language techniques for the mothers in this study. On
the other hand, perceived involvement in developing their children's speech
and language skills related positively to two out of the six lower level tech-
niques (imitation and closed-ended questions). These same techniques were
not related to their children's language abilities. These findings suggest that
mothers of children with hearing aids may be receiving varied information
regarding how to support their children's language learning. Furthermore, it
is plausible that early intervention professionals working with these mothers
and children may be providing inaccurate information regarding language
techniques to support the children's language skills. In fact, further subscale
item analyses revealed that there was a positive relationship between two
items on the SPISE questionnaire; (1) mothers' sense of comfort when con-
ducting listening-language activities at home without the presence of the
professional and (2) the frequency with which early intervention profession-
als demonstrated listening-language techniques to mothers and mothers' use
of a lower level technique (closed-ended question).
Facilitative language techniques must be tailored to children's language

290 Deslardin
level. As children approach the two-to-three-word stage of language devel-
opment, particular techniques are essential for them to develop more complex
language. Facilitative language techniques such as parallel talk (Yoder, Mc-
Cathrcn, Warren, & Watson, 2001), recast (Fey et al., 1999) and open-ended
questions (Lilly & Green, 2004) encourage conversation, eliciting more com-
plex grammar and syntactic skills. These techniques are used more frequently
after children achieve a more advanced level of lexical and grammatical un-
derstanding (Hulit & Howard, 1997). Conversely, techniques such as linguis-
tic mapping, imitation and closed-ended questions are more didactic in
nature and necessary for children who are at the prelinguistic and one-word
level of language development (Yoder et al., 2001).
Implications far Family-Centered Early Intervention
Early intervention programs emphasize the importance of supporting fam-
ily strengths and collaborating with caregivers to facilitate better interactions
with their children (Chidress, 2004; Roper &: Dunst, 2003). By tailoring their
behaviors to the strengths of individual families, interventionists hope to
provide caregivers with a sense of confidence and competence — self-
efficacy — about their children's current and future learning and develop-
ment (Dunst, 2000; Sonnenstrahl-Benedict & Raimondo, 2003). In tum, pa-
rental self-efficacy of certain skills (e.g., facilitative language techniques) may
enhance children's language learning (Desjardin, 2006). Thus, encouraging a
mother's sense of efficacy in developing her child's language skills is an
important goal in early intervention and should be taken into consideration
when formulating an Individual Family Service Plan (IFSP) or individual
Education Plan (IEP).
One way to enhance parents' self-efficacy is to employ a mentorship ap-
proach. In a mentorship model, parents receive hands-on training and prac-
tice with constructive and encouraging feedback based on the parent's
strengths and needs. Providing caregivers continual feedback er\hances their
generalization of newly learned techniques across various activities and set-
tings (Woods, Kashinath, & Goldstein, 2004). Ultimately, the goal of any
mentorship relationship is for parents to achieve independent, confident use
of techniques that will enhance their children's language development.
Through a mentorship model, parents would also receive ongoing demon-
strations of skills. A finciing of great concem from this study was the signifi-
cant positive relationship between mothers' sense of involvement in their
children's speech-language development and lower level language tech-
niques. Further analyses of the data suggested that mothers' perception of
how much early intervention professionals or therapists demonstrate listen-
ing-language activities was related to mothers' use of lower level language
techniques. Early intervention programs highlight the importance of embed-
ding language tecliniques in naturally occurring interactions with children
within daily routines and activities (Dunst, 2000; Fewell & Deutscher, 2004;

Empowering Families of Young Children Who Are Deaf 291

Roper & Dunst, 2003). Everyday occurrences such as mealtime, hand wash-
ing, playing with toys and bedtime routines are common in most families.
Parents may benefit from a visual reminder of leaming opportunities and
activities they can use during the week {Dunst et al., 2001). Moreover, pro-
fessionals working with families of children with hearing aids must demon-
strate how to embed facilitative language techniques in everyday natural
language leaming experiences (Woods et al., 2004).
Language techniques also should be further tailored to a child's language
level. According to Vygotskian theory (1962), children develop linguistically
through caregiver interactions that reflect children's zone of proximal devel-
opment (ZPD). A child's ZPD is defined as the distance between a child's
current level of development and the level in which the child can function
with adult assistance. For example, for a child who is deaf or hard of hearing
whose language age is at the prelinguistic stage of development, parents' use
of lower level language techniques (e.g., imitations and expansions) that have
been shown to facilitate language learning in younger hearing children reflect
the child's zone of proximal development. For preschool children who are at
the two- to three-word linguistic stage, however, higher level language tech-
niques (recast and open-ended questions) best facilitate children's language
development. When parents use this form of support, they are helping their
children gain communicative competence and confidence (Vygotsky, 1978;
White, 1985).

Study Limitations

A few limitations of the present study should be mentioned. First, the

sample of mothers in this study may not be a true reflection of mothers and
children in the general population of families of children who are deaf or hard
of hearing. Although many families from lower socioeconomic status and
diverse cultures come to the CARE Center for services, mothers in this study
were all in the middle- to above-average income range with some college
experience. Consequently, the results of this study must be viewed cautiously
when applied to mothers of lower socioeconomic status and mothers in other
geographical locations. Furthermore, the facilitative language techniques ex-
amined in this study may not be consistent with the child interactions that
typify parenting styles in other cultures (van Kleeck, 1994).
Second, the various kinds of family-centered early intervention programs
were not investigated in this study. The families who participated in this
study came from various states and public and/or private family-centered
intervention programs. Within the kinds of programs offered, early interven-
tion professionals may employ various teaching and communication meth-
odologies (Auditory-Verbal, Total Communication, etc.). It is most probable

292 Desjardin
that the mothers received different services and, possibly, different instruc-
tions, regarding intervention language techniques. Future work controlling
for the different types of family-centered intervention programs will be fruit-
ful.
Third, the SPISE is a self-report measure of self-efficacy and involvement in
parents. Previous research has suggested that, for many social constructs,
self-report measures may not necessarily reflect what the parents actually do
in their homes (Akey et al., 2000). Although self- reports of how people
perceive their knowledge and competence may be reasonably valid, self-
reports of participatory behavior may show less consistency (e.g., parents'
involvement in the development of their children's IFSP). Nevertheless, the
SPISE offers researchers and practitioners valuable information in terms of
parents' perception of specific skills related to their children's sensory device
and speech-language development (see Desjardin, 2003, for further research
on and practical use of the SPISE).

Summary

Both the Individuals with Disabilities Education Improvement Act (IDEIA, 2004)
and the Division of Early Childhood (DEC) Recommended Practices in Early In-
tervention/Early Childhood Special Education state the importance of not only
family involvement, but also early intervention practices implemented in a
manner that strengthens parents' sense of competence in guiding their chil-
dren's early development. Findings from this study highlight the influence of
parental self-efficacy and involvement on children's spoken language devel-
opment. Families of children who are deaf or hard of hearing could benefit
from early intervention programs that capitalize on parents' sense of efficacy
and facilitative language techniques that are tailored to their children's lan-
guage level.

Acknowledgments

Tlie author wishes to express a very special thank you to the mothers and
children who participated in this study. Support for this research was pro-
vided by the National Institute on Deafness and Other Communication Dis-
orders (NIDCD) of the National Institutes of Health, grant #R01DC006238.
The author would like to thank Laurie Eisenberg, Ph.D. for her valuable
contributions throughout this project. Gratitude is also expressed to the
CARE Center's research language consultant. Donna Thai, Ph.D., who pro-
vided expertise and guidance in videotape analyses, and Kathleen Lehnert,
M.A., CCC-SLP, for transcription and videotape coding.

Empowering Families of Young Children Who Are Deaf 293

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