What is TAAC? Total Language that is Accessible, Attended, and Coordinated

Join me in a conversation with Derek Houston, Ph.D. as we discuss how language impacts children with cochlear implants.  Dr. Houston brings a wealth of information to this topic.  Dr. Houston currently is in the Department of Otolaryngology-Head and Neck Surgery at The Ohio State University College of Medicine where he directs the Buckeye Center for Hearing and Development. His work has focused on the effects of early auditory deprivation and subsequent cochlear implantation on speech discrimination, attention to speech, sensitivity to language-specific properties of speech, word learning, and general cognitive skills in deaf infants and toddlers. In this episode, Dr. Houston discusses a proposed conceptual framework to explain the relationship between language input and language outcomes. TAAC is the idea that total language input directed to children with cochlear implants  is moderated by what is accessible, attended, and coordinated with the child. Take a listen as we take a deeper dive into each of the TAAC components.

For more information about the Buckeye Center for Hearing and Development and also to connect with Dr. Derek Houston, visit the website: 

https://medicine.osu.edu/departments/otolaryngology/research/buckeye-center

https://medicine.osu.edu/find-faculty/clinical/otolaryngology/derek-houston-phd

For more information about Dr. Carrie Spangler- check out her LinkedIn at https://www.linkedin.com/in/carrie-spangler/

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

[00:00:00] Announcer: Welcome to episode 34 of empowEAR Audiology with Dr. Carrie Spangler.
[00:00:17] Carrie: Welcome to the empowEAR Audiology podcast, which is part of the 3C Digital Media Network. My name is Dr. Carrie Spangler. And I am your host. I am a passionate audiologist with a lifelong journey of living with hearing challenges in this vibrant hearing world. This podcast is for professionals, parents, individuals, with your own challenges and those who want to be inspired.
[00:00:45] Thank you for listening, and I hope you will subscribe, invite others to listen and leave me a positive review. I also wanted to invite all of you to visit and engage in the conversation on the empowEAR Audiology Facebook group. Transcripts for each episode can be found at www dot three, the number three, C digital media network.com under the empowEAR podcast tab.
[00:01:19] Now let's get started with today's episode. Again, welcome to the empowerEAR podcast. I am so excited to have a friend and colleague with me today, Dr. Derek Houston. And I'm just going to share a little bit about Dr. Derek Houston. He joined the department of otolaryngology, had a neck surgery at the.
[00:01:41] Ohio State university college of medicine in July, 2013. He received his doctorate in psychology from John Hopkins university in 2000. his graduate training research focused on how normal hearing, typically developing infant segment words in fluent speech and recognize words across different talkers. After graduating, he moved to Indiana university school of medicine and constructed the world's first laboratory to investigate the speech perception and language skills of deaf infants who received cochlear implants.
[00:02:19] Since then his work has investigated the effects of early auditory, deprivation and subsequent cochlear implantation on speech discrimination, attention to speech, sensitivity, to language, specific properties of speech, word learning, and general cognitive skills in deaf infants and toddlers. His research in Columbus, Ohio represents a collaborative effort between OSU and nationwide children's hospital.
[00:02:51] His work is currently funded by the national Institute on deafness and other communication disorders. Dr. Houston is currently director of the Buckeye center for hearing and development, whose mission is to make discoveries that will empower care givers of children who are deaf. And hard of hearing with knowledge that will help them foster.
[00:03:15] The children's development in alignment with the goals and culture. Welcome Dr. Houston to the empowEAR podcast. I'm so excited to have you today.
[00:03:28] Derek: Well, I am very excited to be here, Dr. Spangler. It's I really love your podcast. You know, this format for, you know, having people come on and talk about their personal journeys.
[00:03:46] With hearing loss, I think is so important. I mean, each person is different. Each person has different experience. So I think that we just learned so much from, you know, I've learned so much from you and I think, you know, each of each of your guests and their own journeys we just learned so much from, so I'm really happy that, you know, you're not, I, I will probably be like one of your less interesting guests, cause I don't have that personal jouirney hearing loss, but I nonetheless very much appreciate you.
[00:04:17] You know, inviting me on here.
[00:04:19] Carrie: Well, thank you for being here. And I know this is going to be a great conversation cause you have a lot to offer and I love being able to have guests who have personal journeys, but also have a lot of professional and research background to help empower those who on.
[00:04:37] This journey, regardless of where they're at, but before we get started, I thought I would just kind of take a step back and figure out when did we actually meet? I feel like we met at
[00:04:51] Derek: yeah, yeah, yeah. That's that's it at the, yeah. So when I joined shortly after moving to Columbus and joining Ohio State I was invited to serve on.
[00:05:03] That committee for the state's committee advisory committee for universal newborn hearing screening. Yeah, and I, the first meeting I, you know, came early. I didn't, you know, because I didn't know where to go, so I want to make sure I was there on time and I came early. And you were there, you were there with somebody else?
[00:05:20] I don't, I don't remember who, but anyway, I just remember, you know, that. You know, you being you and the friendly person and welcoming person, you, you are, you were like, Hey, who are you? It's like, oh, I'm new here. I'm Derek.
[00:05:35] Carrie: Nice to meet you. I probably said it just like that.
[00:05:39] Derek: Yeah. Yeah. And then, and then and then, you know, shortly after that, or maybe within the next year, we had some changes to, to some of the. Administration of the EHDI system in Ohio that led to, you know, a group of people, you know, getting together and just, you know, kind of discussing the implications.
[00:06:03] And then that led to like, You know, projects that has been one of the favorite projects of mine that I've ever been involved with with, you know, with you and Todd Houston and no relation Maria Sentelik and Wendy Steurwald and then, and Jessa Reed. My post-doc at the time got funding through the Oberkotter foundation to do kind of a survey of the state on families on families' journeys with hearing loss in the, in the state of Ohio and, and kind of like what, what kinds of you know, challenges they face, you know, it was, you know, it was a broad look at what their experiences were.
[00:06:45] It wasn't focused just on like, you know, the state EHDI system per se. Like, you know, what, what are some things that are challenges where some things that, you know, they really enjoy enjoy. And, you know, I think we learned a lot from that. And that's, you know, kind of, you know, kept you know, several.
[00:07:05] Or I guess it's led to several collaborations of of different kinds, but that was, that was a really fun project that we, you know, you and I were both on this steering committee together and, and then remembered Cheryl. Cheryl Johnson was our facilitator that we were able to, to bring on and and and then a ton of people of different.
[00:07:27] You know, perspectives throughout the state different viewpoints from different areas of the state, you know, came together to, you know, develop focus groups, questions, and surveys. You know, we had of course audiologists, speech, language pathologists, but also teachers the deaf parents people in the state agencies early intervention providers.
[00:07:50] And indeed even, even a grandparent, right. Who were, who were all involved in this project. So that, that was a lot of fun. And that was, yeah.
[00:07:59] Carrie: Yeah, it was. And I think what we gleaned from that we can still use moving forward as we work on other collaborative projects to help our state and hopefully others too, who are on this journey.
[00:08:15] Derek: Yeah. Yeah, absolutely. I think the key lesson for me was really, you know, listening to families and, and other professionals. And really, we have a lot that We can learn from each other as in terms of like what's really important for families on, on their journey and how we can, you know how we can best support them.
[00:08:39] Carrie: Yes. So kind of taking another step back. I always like to ask my guests how they actually got into the field of working with children who are deaf and hard of hearing. So how did you get into this?
[00:08:56] Derek: All right. So I knew you're going to ask this cause you, you always do. All right. So I, so go back to 1999.
[00:09:04] All right. Early in 1999, I'm a graduate student in psychology studying infant speech perception. So just. Perception with typically developing, typically hearing infants in, in Peter Jusics lab in Baltimore. And I'm, I'm sitting there in the lab. I'm analyzing data for my dissertation project, which was about infants ability to recognize words across different talkers.
[00:09:32] Okay. and Peter comes in to the room I was in. And you know, it doesn't say hello or anything. He just says, wants to know why you haven't. To be a postdoc with him yet. Okay. And so he's referring to, to David Pisoni and David , you know, is, and, and, and was, you know, even, you know, 20 plus years ago, a huge, a world renowned figure and in speech perception.
[00:10:01] So I'm just like, Thoughts are racing through my head. Right. I'm thinking, okay, how does David Pisoni even know who I am? Okay. Yeah, we've met once because he happens to be, you know, a friend of, of my advisors. You know, but like he has lots of colleagues and friends and they all have lots of students.
[00:10:20] Second, I didn't know that he had a postdoc position available. Why does, like, he think I should apply for it? Why, why is he wondering why. I haven’t already applied for it. So as I'm just like, you know, thinking all these thoughts, just kind of staring at Peter, you know, with a blank stare he goes, well, just go ahead and apply.
[00:10:41] It'll be a good experience for you. And you know, it'll appease PIsoni and, you know and, and anyone who knows David Pisoni will laugh at. Hearing that, you know, it'll a piece presented, cause they'll they'll know exactly what that means. And, and, and, and it's actually a very positive thing. It's just that the, you know, he's, he's very intense person.
[00:11:01] And, and, and if he has, if he has an idea of like that, something should happen, you kind of won't let up on it until it happens. So, so yeah, so I, I go, he, so he was at Indiana university and he was you know, he's in the psychology department, he's also a psychologist. And but collaborating with the cochlear implant program up in Indianapolis.
[00:11:23] And so I go out to Indianapolis to, to interview you know, and I, and ahead of time, I, I, you know, I think, well, I had heard that. David Pisoni, had started collaborating in this new area of cochlear implants. I didn't know what a cochlear implant even was, you know, at, at that time. And you know, You know, he, he sends me, so I get the mail, like this pile, like it's like, it's like, like four inches thick of, of papers right ahead of my interview to read.
[00:12:01] And so I started reading them. Oh, actually, this topic's really interesting. So, you know, maybe, maybe this could be really interesting and then, and then I go there and I just, you know, I just fall in love with the people, like, you know, immediately just with the work that they're doing and the, and the environment you know, there was Karen Kirk was there Maria Skriski of course, Richard Miyamoto.
[00:12:24] You know, the, the, the chair of the department and cochlear implant surgeon, Steve Chen. Marsha Hey McCutchen was there at the time. And the, we had our cochlear implant, audiologists, Wendy Myers and Kelly Laura Moore and speech language pathologists, Liz yang, Kara Kaiser, and Shelley Goldar and you know, a bunch of, a bunch of other people.
[00:12:45] It was just, you know, as and then all the people who can. You know, through there during the 15 years I was there just like incredible you know, a group of people. So, you know, this was yeah, I just thought, wow, this is like a really interesting opportunity to work in an area that you know, where.
[00:13:08] You know, it's an opportunity to understand neuro-plasticity sensitive periods of language development to understand, you know, add up how infants might adapt to this new signal. So it was really, you know, kind of just like in an intellectual interest to begin with really, to, you know, be honest and and, and then.
[00:13:32] You know, but I did, you know, actually my first interest in this is, you know, a whole other story was, was in aphasia actually. And then and so it was like, okay, well, you know, now I'm finishing my PhD in this, you know, sort of basic science area. It would be, you know, really interesting. And, and, you know, I think that it be fulfilling to work in an area that, you know, might have more direct you know, impact in the lives of people who, you know, have challenges.
[00:13:59] With communication. So that was, that was really you know, appealing to, so yeah, so that's, that's where it started and, you know, and, and since then, You know, it really just has, has been inspiring, you know, how much I've, I've learned from and, and, you know, really made it, you know, it's something I'm, I'm, I, I'm really more and more focused on, you know, wanting to understand what will, you know, help families on their journey with with hearing loss.
[00:14:31] Carrie: Yeah. I love hearing how people get into this little niche of a profession. And I love how you bring that psychology perspective to our field be out too. Cause we don't always, there's not enough of you to bring that kind of lens to our field. But kind of taking a step back as far as language and. You know, your whole focus is really been on that early editorial experience and language development from that whole child perspective.
[00:15:05] Can you just take a step back and kind of look at it from a more global perspective of how language as a system, how we communicate with each other, whether it's, you know, through a spoken language or a sign language. How does having a direct or indirect exposure facilitate growth? For communication?
[00:15:29] Derek: Yeah, a director or indirect exposure to, to language. Well, really language needs to be direct. I mean, you know, we. Yeah, I don't know how big picture I want to go, but but I mean, let's just, you know, go back and, and, you know, think of us, you know, in terms of like being human beings. Right. And why do we even have language?
[00:15:56] And we have language because we are highly social animals. I mean, it, it, we probably evolved language. Because of a need for a social interaction and understanding each other's intentions so that we could cooperate better for survival. Right? So So language didn't evolve to be, you know, an intellectual exercise to learn it, it, it evolved in order to help us interact better with the, with each other and more effectively with each other.
[00:16:34] So and, and now we have a lot of research, a lot of evidence showing that that infants and children really don't learn much from indirect Exposure to language. They don't learn much from, from watching people talk on TV and or from, from overheard speech. They, they really, they really need that social interaction to to connect with language and to makes sense of it.
[00:17:03] And you know, it doesn't matter if it's, if it's spoken or sign language other, you know, any more than it matters. If it's, if it's English or Spanish humans have evolved to be very good at decoding linguistic systems when they are motivated to do so by, by social interaction.
[00:17:25] Carrie: And basically the key is having that direct language
[00:17:30] Like immersive language, no matter what it is.
[00:17:33] Derek: Yes. Having an immersive and having it connected to social interaction. Right. So like there's a lot of You know, there's a lot of emphasis on, on language input. And you know, and most people do also emphasize the interaction part of it, but that, you know, I think we could do more to, you know, continue to emphasize that too.
[00:17:57] So, you know it's, it's not just about like how much. You know, you talk to your child, it's about turn-taking with your child, engaging them in, in social interaction and, and, and having them integrate language as part of that social interaction. And of course, social interaction can be just like, you know, smiling at each other.
[00:18:19] That's that social interaction. But then, you know, incorporating language into that is, is really what is going to hook language into the child's brain.
[00:18:31] Carrie: So knowing what we know about language as a whole, when your new research, you focus a lot on children who are deaf and hard of hearing, and in particular, those who receive cochlear implants.
[00:18:44] So how does that part of it impact language.
[00:18:52] Derek: Yeah, well, the you know, a child with a cochlear implant, you know, so we're talking about children with, you know, typically severe to profound hearing loss. So they've had very little to no access to sound before they get a cochlear implant. Right. And you know, during that time, You know, the, the brain doesn't wait for, you know, all these experiences to happen, to develop it's, it's going the brain develops based on the input, that and experiences that it is getting no, no matter what it's getting and, and you know what it's not getting.
[00:19:29] So, you know, the brain is highly adaptive and, you know, we, we, you know, and this is a good thing, or this is like, you know, this gives us neurodiversity, you know, No two brains are, are alike. And, and, and then a, you know, then when a child gets a cochlear implant, then there, you know, is you know, then adaptation to a new signal is is needed.
[00:19:53] And, you know, I think that, you know, what we're seeing is that what you know, so, so I guess what's different for these infants and children is that, you know, maybe attention to sound and to speech isn't as automatic. Right. It's maybe more effortful. And that's because they've, they've been.
[00:20:17] You know, plugging along, you know, fine, you know what, you know, without sound or, you know, or that that's the experience that they know. So now they have this new signal that, you know, they, they, you know, have to learn to make sense of for, to, for it, to be meaningful for them. So, you know, so then, so then that's where, you know, language development.
[00:20:42] Is more of a challenge. I think you know, the, the signal itself is always going to be, you know, not as you know rich or detailed as it is for typically hearing children, but there, there's also this aspect that what's, what's new. Is, you know, integrating the sounds with what they're experiencing in the world.
[00:21:06] So that's been that, that for me has been a real learning journey because, you know, I came into this field, as I just said, as an, as an infant. Speech Perception person. So I just was really, you know, one of the things that my colleagues and I say is, you know, the ears connected to the brain. We, you know, remind ourselves of that.
[00:21:25] And so developing language for a child with cochlear implant You know, giving them optimal access to fine grained, acoustic phonetic information is important, but that's not the only challenge. The it's also another challenge is integrating what they hear with, with their other experiences in the world because they've developed.
[00:21:49] Up until getting a cochlear implant there, their brain has developed without the auditory input. So it's really something new that they have to learn to, to integrate in with everything else.
[00:22:00] Carrie: And I think your research you've been able to really propose a Conceptual framework to dig deeper into this topic, like using your knowledge of, children of a typical hearing, as well as those who are deaf and hard of hearing to a, an idea called TAAC.
[00:22:19] And I'm going to let you explain and dig deeper into this idea, but taking a total language input directed to children is moderated by what is accessible, attended, and coordinated with the child. So I guess maybe picking this apart a little. What would you describe as accessible and how does that impact children with cochlear implants?
[00:22:44] When it comes to spoken language acquisition?
[00:22:48] Derek: Yeah. So actually, can I, can I say something about like this conceptual model? Cause like, like I feel almost uncomfortable, like, like saying that it proposed a conceptual model. So I feel like I almost have to like justify this. And so this came about by, I was, I was invited to submit a manuscript.
[00:23:11] To a journal. I won't name the journal because it's, it's only like kind of sort sorta provisionally accepted right now. So maybe these last revisions, they'll say, nevermind. And this'll be the last you ever hear of this conceptual framework. But you know, they want me to be kind of summarize, you know, some of, some of the work that my colleagues and I do.
[00:23:31] And and so I did that and then, you know, the reviewers, like, ah, you know, this. Nice summary, but can you kind of put it together in like a little bit more of like a conceptual framework? So they, they said, you know, can you put together a conceptual framework? So, so I did. So I said, okay, you know, I'll, I'll, I'll, you know, try to try to do then actually it's been helpful for me.
[00:23:52] In terms of just like, I don't think, you know, it's nothing. You know, earth shattering or anything. But kind of just like helping me and maybe it'll help others, you know, just to sort of think about things. And part of what motivated it also is that, you know, there are. With typically developing children.
[00:24:17] There's a lot of evidence that, that there's a pretty strong relationship between amount of language input the children receive in their language development with deaf and hard of hearing children, including children with cochlear implants, the findings are pretty mixed. There's actually like not very good evidence for that relationship.
[00:24:37] And, and, you know, that's like really puzzling, right? Cause you, you. You know, in some ways like it should be even more important. Because you know, that, that, you know, they're, you know, being children at risk for difficulties with language development, you know, having, you know, a lot of input is, is is going to be important.
[00:24:57] So this is kind of an attempt, you know, for me too, You know, try to kind of unpack and think about, you know, why so far we're not seeing a lot of evidence for this relationship. And, and so that's, that's where, so, you know, each of these things accessible, attended and coordinated, these are, these are all things that I think are more variable for children with cochlear implants and therefore you know, kind of complicate
[00:25:29] The relationship between language input and language, language outcomes. So I just, I just wanted to sort of give a little bit of a framework for talking about this conceptual framework. If we're going to go dig into it. So we're on the first part, right? The accessible. What does that mean for language development?
[00:25:53] Yeah. So for kids who Cochlear implants. So of course, you know language input, isn't going to do a child any good. If, if they can't hear it, if it's not accessible. So this is, this is really this first level. And, you know, for a child with cochlear implant, it's, it's, it's not accessible if they're, if their cochlear implants not on, right.
[00:26:18] If they're not wearing it. Right. And we know that children who receive cochlear implants are not always wearing their cochlear implant. Right. So that that's, that's one factor. And you know, for children are typically hearing, you know, their ears are always on. So, so that particular variable is, is or.
[00:26:42] Factors less variable for typically hearing children than it is for children with cochlear implants. Also audibility is more variable for kids who have cochlear implants and also sensitivity to environmental noise, or I guess say, you know how the degree to which environmental noise will will, will sort of block access to sound is, you know, all these things are more variable for, for kids with cochlear implants and than they are for kids with a normal hearing.
[00:27:14] So. That is the first step at which the relationship between language input and language outcomes, you know becomes kind of complicated to look at for kids with cochlear implants,
[00:27:29] Carrie: but taking an unpacking it that way helps families or, you know, other professionals, working with the children to really think about like amount of time and a good mapping.
[00:27:42] And you know, is the TV on, in the background inthe house and, and all of those variables that maybe you don't think about with typical hearing children because they can filter out that background noise or they don't, you know, it doesn't impact them as much, but having that accessibility for children with cochlear implants and paying attention to it is going to be important.
[00:28:07] Derek: Yeah. Yeah, absolutely. Yeah. And I think that this is what, you know, people who work with these families, you know, emphasize a lot. Right. You know, clinicians emphasize this stuff. So,
[00:28:19] Carrie: so then the next part is that concept of attended language input. So what does that mean?
[00:28:26] Derek: So that, that means that, you know, we have to remember that just because a child can hear something doesn't mean they're, they're attending to it.
[00:28:37] And attention is, is, is fundamental for learning. And we know that. Attention to speech is different for children with cochlear implants than it, than it is for children with normal hearing. So, so the, this is, you know, so we have several studies showing this that it's not as, it's not as automatic.
[00:29:03] So even if something is presented above threshold children with cochlear implants, we have found do not attend to all types of speech as much as, as normal hearing children. And more specifically you know, you have this like type of speech that's referred to as infant directed speech right or motherese is like, how, how we talk to how we talk to infants.
[00:29:28] In, in one of our studies, we found that at. Older ages then. Okay. So let me back up. So for typically developing children they show an attentional preference for infant directed speech over adult directed speech, but it's, it starts to fade away. You know, at older ages say, you know, 18 months, two years what we found was that fortunately a cochlear implants, even at older ages, they show that preference.
[00:30:02] And actually they, they, in our experiment, they showed no preference for adult directed speech compared to hearing nothing. And, and so it, it really suggests. You know, there are that it's really important. Kind of like what the speech sounds. I, two children and cochlear implants. Now I'm saying that in a way that's being, you know, maybe I'm generalizing too much, like really what our findings show is that there's more variability in, in attention.
[00:30:38] To speech and in children and cochlear implants. So some kids, cochlear implants are attending to speech just like chills as normal hearing. But that others aren't. And so again, this is this like increased variability on this factor is, you know, complicating the relationship between amount of language input and, and language development.
[00:30:59] 'cause, you know, two parents might be providing, you know, two families might be providing their child with just as much, you know, the same amount of accessible speech, but for one child, just the way their attentional system has developed, they might be attending to more of it than, than another child. And that, and that will probably lead to you know, different language outcomes.
[00:31:25] So I think like really paying attention to what the child is actually attending to is important
[00:31:34] Carrie: because if they're interested in it, then they're going to be more likely to gain that language input Then, if you're talking about something that they aren't interested in attending to. Yeah. So, and then going back to the motheresewhat you talked about and, you know, typical developing a typical hearing children, you said about 18 to 20 months, that kind of.
[00:31:58] Don't attend to it as much. Do you might
[00:32:01] Derek: be misremembering the exact ages. So
[00:32:07] it's some something around that. Yeah.
[00:32:09] Carrie: Do you think that because children who are severe to profound and typically don't get their cochlear implant till about a year of age? Need to have that motherese for a longer period of time, because they've missed both in utero hearing. If they were born with a hearing last and that possibly first year of hearing until they're a candidate to get a cochlear implant, they need to almost their brain needs to hear that .
[00:32:42] In order to have that stepping stone for good language
[00:32:47] Derek: access. I think that's an excellent hypothesis, Dr. Spangler. And we, we are right now analyzing data for a study that is looking at novel word learning. I mean in children with cochlear implants under conditions of infant directed and adult directed speech.
[00:33:06] And so this is, I think, getting this will address your hypothesis, I think to some degree, because what we will find out is if, because we, in, in a previous study with typically hearing children, we found that not only do infants prefer infant directed speech over adult directed speech, but actually helps them learn words better.
[00:33:29] But this, this benefit of infant directed speech of motherese goes away for this at, at, you know, around again around two years of age So we, what we'll find out in this study is if the benefit of infant directed speech, actually, if there is any benefit at all of infant directed speech for kids who have cochlear implants, and then if there is, does this, does this benefit persist, you know, later into development than, than what we found with typically hearing children?
[00:34:05] Carrie: Well, you have to let me know what the outcome is
[00:34:09] Derek: I will. I definitely
[00:34:11] Carrie: will. And then you also mentioned coordinated language in print. Can you share more about what that means? Yeah,
[00:34:19] Derek: that's about joint attention, right? So, so we, there's a huge literature on joint attention and, and typically developing children and, and, and other populations and particularly for developing a vocabulary for learning words it's important that, you know, parents and children are, you know, sort of potentially on the same page, right.
[00:34:40] That the child knows what the parent is attending to. The parent knows that the child is attending to it's even better if they both know, you know, that the other knows what, what they're attending to. And, and then that helps children connect what the parent is saying to what they're experiencing. So like, you know, if, if, if.
[00:35:04] You know, if a child is playing with a toy and they hear, you know, a. The parents say Blick. Okay. They, they may or may not attach that word to that toy. And part of what will determine that is if the child is attending to it, but also if the parents is attending to it and if the child knows they're attending to it if, if the child is playing with that toy, you know, say called a Blick.
[00:35:32] But then like, you know the, the parent talks about the Modi. You know, a different toy, then, you know, that's labeling something else that the child is not attending to. And you know, that, that as you can imagine, that might not encourage or facilitate learning of that particular item. So.
[00:35:56] You know, so it's, so basically what we mean by coordinated is the degree to which the parents language is coordinated with what the child is attending to. That's one sort of meaning of, of coordinated. A second. One is the degree to which the language is coordinated with the child's development.
[00:36:19] Because. You know, if, if if a you know, if a child is at a very early stage of language development and they're, you know, processing of language is maybe you know, not, not as efficient than. You know, they, they might need like this motherese or infant directed speech. Whereas like, if, if the parent isn't, you know, it's just talking, you know, maybe like really quickly, like they would with an adult, then that would be sort of like, That's what I mean by sort of not being coordinated with the child's development.
[00:36:58] Right. And I think that this is, you know, this is a, can be a challenge for parents w for children, the cochlear implants, because you, the, the way parents speak with their children changes. With the child's development but a child that gets a cochlear implant, you know, their, their sort of cognitive age, their developmental age is, is different from their, their hearing age.
[00:37:29] You know, we sort of have no idea, like at this point you know, like what would, you know, should, should a parent talk with a kid who is two years old, but had a cochlear implant for six months? Like the child is a six month old or should, should the parent be talking to the child and, you know, Yeah, I hope nobody is like looking for answers to that question.
[00:37:57] Cause we, we don't have answers to that question. We do have evidence that, that some parents do sort of use at least intonational patterns that are. More aligned with the child's hearing age when they have a cochlear implant than that, than it is with their, with their chronological age that that's worked by my colleague, Tonya Bergeson.
[00:38:21] But I, I guess we, we don't really know at this point, if that's like beneficial or not, or detrimental or, or whatever, or anything
[00:38:29] Carrie: beyond, well, I know we have like a lot of unanswered questions. Yeah, it's just the nature of the field and not knowing. And like you said, there's so many variables too. For children who are deaf and hard of hearing and get cochlear implants.
[00:38:50] However, I think you, like you said, you've done so much research and we do know, we do know a lot too at the same time. And I think this framework and just kind of putting it into these. This way with accessible and attended and coordinated language input is a, you can grab onto it, like if something that you could apply, but taking that framework that you kind of put together or piece together.
[00:39:21] What can we share with parents or professionals who are working with these children to positively facilitate spoken language acquisition for children who are deaf and hard of hearing and who have cochlear implants? Do you have like a top five or something to get our listeners started with?
[00:39:43] Derek: Well I, I think really I can.
[00:39:47] Really just emphasize probably. You know, some of the things that probably they're there, you know, speech-language pathologists or audiologists are probably already telling them. But let me just emphasize you know, the importance of, of interactions of, of back and forth communication. Again, it's not just about like how much.
[00:40:10 parent is talking with their child, but the back and forth I think, and, and this involves in terms of coordinating of attention, this, this might be you know, thinking, you know, probably doing more following of attention. And what is your child interested in and talking about that rather than doing, you know, more, more directing of the child's attention, I think has, has been found to be beneficial.
[00:40:40] I think Okay. Now we all, I am guilty as guilty of this as anybody else, but I think we all should be paying attention to how much time we're spending on our smartphones on when we have children. There, there are actually studies out now showing that this is like we're w we all, all of us I'm, I'm included you know, we're, we are When we're on our smartphones, we're not engaging with our children.
[00:41:06] And, and, and we're, you know, we're losing opportunities to, to communicate with them. So, you know, we all, we all, you know, nowadays need to be on our smartphone some sometimes, but, you know, I think just like we should be cognizant of how much time we're spending on it. Also, you know, environmental noise.
[00:41:27] I mean, I think that. You know those of us with typical hearing, you know, I think that it's hard for us to appreciate the challenges of dealing with noise. So, you know, I think it like really, you know, we have. You know, sort of exert some mental effort to like keep, you know, remember that this is like an important thing to be paying attention to so that you know, so that our children with hearing loss can you know access and, and attend to what is being said more, more easily by, you know, trying to reduce the amount of Of environmental noise.
[00:42:08] I think, and this is something I've, I've, I've kind of learned or, you know, thought about thanks to some talks that I've, I've heard recently. But I do think is a really important thing to keep in mind is, is. This idea of fostering joy in, in communicating with your child you know, having joy in it is very motivating.
[00:42:34] And you know, so, so it's important. Like it's, it's really actually important not to think of this as always just, just. Right. That, that it is, is going to, to, to, to let yourself just, you know, feel the joy of the journey of interacting, you know, with your child is, is not you know, is, is. It is not you know, sort of being lax in your, in what you might think is your duties as a parent, you know, to, you know, help with language development.
[00:43:10] It is actually helping language development by, by enjoying it because. Infants and children are very sensitive. I mean, we have evolved to be very sensitive to, to each other's emotions and social interactions. So to, to feel joy yourself in the interactions we'll, we'll help children. Enjoy the interactions, you know, if I enjoy the interactions also in that and that, that, okay.
[00:43:39] I don't have any research really to, to, to point, to, to, to prove that. But I feel strongly that that's, that's the case. And, and there is some research that, that, you know, In, in general, fostering joy is, is helpful for motivation and in providing language input. So so to me that that's, that's, that's enough evidence to suggest that it, it is going to be important.
[00:44:04] And we do know that infants are very sensitive to, to our emotions.
[00:44:09] Carrie: No, I love that. That's a great way to sum everything up because there is a lot of work that goes behind the scenes and families have to know about and learn about in this whole journey, but to think about it as fostering joy throughout the journey can make that interaction more meaningful along the way.
[00:44:32] Derek: Yeah.
[00:44:34] Carrie: So just to kind of sum up today, where do you see this research headed? What, what needs to still be done?
[00:44:45] Derek: Well there there's a ton that needs to still be done. But I think the future, you know, for me, the future of research is, is, is that research, you know, shouldn't be, you know, done just by. You know, people with PhDs or, you know, other letters behind their names that that research should be science should be a community, you know, activity I've, I've learned so much from, from providers and parents that, you know, I really think it's important to to, you know, involve.
[00:45:22] You know, the people that we, that we want to help, you know, I think really need to be a part of like developing the research questions because you know, if we want the research to, you know, impact people we need to understand from them, like what, what are their challenges and what are their perspectives?
[00:45:46] What are their experiences? So I'm, I'm really excited about that. Carrie Davenport, who's a postdoc working with me is leading an effort to form, but she's calling a family research council to the, the idea of the project. And we're hoping to get some funding for it. Some support for it as is to.
[00:46:08] Is to make efforts toward bringing parents and, and and, and some providers like more into a little bit more into the research world. So that then, you know, we, as researchers have a little more common ground. With families to talk about research and to develop research questions. And, and that's, that's what I'm excited to do.
[00:46:35] I'm, I'm excited to do, you know, research that will lead to discoveries that will, you know, provide knowledge to to families so that they can foster a healthy language environment for their children.
[00:46:52] Carrie: Yeah, that's a great idea. Cause like you said, those are in the trenches. I understand the challenges of everyday life.
[00:47:00] And, but then to coordinate that with research can really solve some problems, you know, more discoveries along the way.
[00:47:12] Derek: I hope so. I hope so. Yeah.
[00:47:15] Carrie: So if, is there anything that I didn't ask you that you wish I would have.
[00:47:21] Derek: I can't think of anything. That's okay. We've covered. We've covered. We've covered a lot.
[00:47:26] Yeah.
[00:47:29] Carrie: If people wanted to get a hold of you, how should they do that?
[00:47:34] Derek: So I'm in the department of otolaryngology at Ohio State University. We have something that we call the Buckeye center for hearing and development that I'm a part of. And you know, so they could find that through the department's website, Okay.
[00:47:50] I mean, I could, I could read off the URL. Yeah.
[00:47:54] Carrie: I’ll link it in the show notes. And if people wanted to visit the webpage, they can do that. Okay. Sound good. Well, I want to thank you for being a guest today on the empowEAR audiology podcast. I think it was a great conversation and thank you for being a part of it.
[00:48:12] Derek: Thank you so much for having me, Carrie. It's been a real pleasure.
[00:48:16] Carrie: Yes. So listeners, I just want to thank you for engaging in the conversation and be sure to follow and empowEAR audilogy and our Facebook page. And if you liked this podcast, please share it with others so that they can listen in as well. And post a positive review.
[00:48:35] Thank you for listening.