Gary Morgan

Narratives are part of children's everyday language interactions and an important precursor to broader competences such as literacy. This longitudinal study explores the development of spoken narrative skills in a large group of typically hearing and deaf and hard of hearing (DHH) children. Narrative skills, executive functions and vocabulary were assessed at two time points and relations between these factors analysed. Data were collected from 30 DHH children and 42 hearing age‐matched controls. Children were 6–11 years old at the first assessment point and retested two years later. Both groups improved their narrative scores over time. Despite a delay at T1, the DHH group narrowed the gap with their hearing peers two years later. EF predicted hearing but not DHH children's narrative development. In contrast, vocabulary predicted narrative for both groups. This study demonstrates that DHH children improve their narrative skills over time. There is a different association between EF and narrative in DHH children, which may be related to their wider spoken language development delays. This possibility is discussed along with clinical implications for future language interventions with DHH children.

In this editorial, we introduce the topic of the Special Issue: the effects of deafness on language and cognitive development

Children and young people living in care (aka looked-after children and young people) are at a high risk of language development delays. This scoping review aimed to identify and synthesise research published between 1989 and 2024 that examines the prevalence, nature and key areas of language difficulties among children and young people in care. It also aimed to report associated risk and protective factors and to identify existing intervention strategies relevant to supporting their language development. An iterative search strategy resulted in the inclusion of 38 studies, with the majority conducted in the United States ( n = 12). Studies varied widely in terms of methodological factors, and most were single research projects that had not been replicated. A range of language screening tools were used which included well-known and less-known measures that had different clinical thresholds. The results indicated that children and young people in care are at a greater risk of experiencing difficulties in all areas of language. This topic thus warrants more attention and further investigation. This research has the potential to significantly influence both policy and practice by highlighting the critical need for early identification and support for language difficulties among children in care, particularly those who have experienced maltreatment.

Theory of Mind (ToM) is a construct that includes a range of connected abilities linked to the understanding of others’ mental states. During the last three decades, ToM development has been studied extensively in deaf and hard of hearing (DHH) individuals and performances compared to the typically hearing (TH) population. Given the advances in the early diagnosis of deafness, interventions, and hearing devices over this period, variations in task performance among DHH participants might have been reduced. The current systematic review aims to synthesize all studies of ToM in DHH individuals and answer the following question: Do DHH individuals (Population), compared to a control sample of TH and/or among themselves (Comparator), in an assessment of ToM (Intervention), have differentiated results (Outcome)? After a search of the literature, 97 papers were included. We found that, in general, TH participants outperformed their DHH peers in ToM measures; however, there was a wide range of results. Explanations for this variability included the quality of early interactions and early exposure to both signed and spoken language. The review also indicates that the understanding of false belief was the most studied component within ToM, while other components, such as understanding intention and irony, require further research. Implications of these findings for clinical practice are discussed.

Executive function (EF) is a set of high-level cognitive processes required to obtain a desired goal, to solve a new problem or to react appropriately in a complex or ambiguous situation (Hughes an...

Executive functions (EFs) in both regulatory and meta-cognitive contexts are important for a wide variety of children’s daily activities, including play and learning. Despite the growing literature supporting the relationship between EF and language, few studies have focused on these links during everyday behaviours. Data were collected on 208 children from 6 to 12 years old of whom 89 were deaf children (55% female; M = 8;8; SD = 1;9) and 119 were typically hearing children (56% female, M = 8;9; SD = 1;5). Parents completed two inventories: to assess EFs and language proficiency. Parents of deaf children reported greater difficulties with EFs in daily activities than those of hearing children. Correlation analysis between EFs and language showed significant levels only in the deaf group, especially in relation to meta-cognitive EFs. The results are discussed in terms of the role of early parent–child interaction and the relevance of EFs for everyday conversational situations.

(1) Background: While spoken language learning delays are assumed for deaf and hard of hearing (DHH) children after cochlear implant (CI), many catch up with their hearing peers. Some DHH children with CIs, however, show persistent delays in language, despite protective factors being in place. This suggests a developmental language disorder (DLD). However, at present there is little consensus on how to diagnose DLD in DHH children. (2) Methods: Given the lack of consensus in this area, a set of case studies provides an appropriate first step. The goal of this paper is to show the plausibility of a DLD diagnosis, following careful analysis of protective and risk factors. A retrospective case study review was conducted for three children. Their long-term language outcomes up to four years after CI were considered in the context of access to sound, speech sound discrimination, social skills and non-verbal cognition. (3) Results: It was possible to posit DLD in one child who had experienced good access to sound, alongside good speech discrimination abilities and social development, and normal non-verbal cognition, but who presented with severe language learning difficulties. (4) Conclusions: Finding markers for DLD in DHH children is important for diagnosis and intervention. The implications for clinical practice are discussed.

Background: Between 90% and 95% of deaf children are born to hearing parents who often need support with how to adapt their communication. Parent–child interaction (PCI) is an important predictor of deaf children's future language development. It is therefore necessary for professionals to assess parents’ strengths and needs to identify areas for intervention. Qualified teachers of the deaf (QToDs), speech and language therapists (SLTs), psychologists, and national deaf child and adolescent mental health (NDCAMHS) professionals regularly support families with deaf children. With no current evidence‐based tool available to assist with the assessment of PCI in deafness, it is important to gather information on current professional practice as this may differ from known practices within research.Aims: To survey the practices of UK‐based professionals in the assessment of PCI where the deaf infant is aged 0–3 years. Professionals were QToDs, SLTs, psychologists or psychiatrists and professionals working at NDCAMHS services.Methods & Procedures: After a pilot phase, an 85‐item survey was distributed electronically through a range of professional and social media networks. Survey items were based on a systematic review of PCI with deaf infants. Survey questions were focused on parent behaviours that were assessed, methods of assessment, goal planning and service provision. Analysis was conducted using descriptive and inferential statistics.Outcomes & Results: A total of 190 professionals from across the UK completed part 1 of the survey; this decreased to 148 in part 4. Respondents were primarily female, hearing, used spoken English and had 16 years or more experience. Results indicate that PCI is routinely assessed by a large proportion of professionals and there is a substantial overlap in which parent behaviours are assessed. Some parent behaviours are assessed that do not feature in the research. Methods of assessment are informal and predominantly consist of observation and note making, with professionals using their own skills and experience to analyse interaction. Goal setting practices were largely similar between professionals, with many jointly deciding goals with parents.Conclusions & Implications: This survey highlights the range of parent behaviours assessed by UK professionals in PCI with deaf children aged 0–3. This survey provides valuable information about and for professionals who assess PCI and set intervention goals with parents. Information from research and professional practice is important to consider in the design of a future PCI assessment. Implications are included for future research in this area.What This Paper Adds: What is already known on this subject: Parental involvement is one of the greatest predictors of deaf children's language outcomes. With many deaf children born to hearing parents, parents often need guidance with how to facilitate effective communication. A recent systematic review identified the range of parent behaviours and methods used to analyse PCI in international research studies, but little evidence or guidance exists on how professionals assess this phenomenon in practice.What this study adds: This is the first survey to generate large, valuable practice‐based evidence for the assessment of parents’ communication behaviours as they interact with their deaf infants aged 0–3. The survey recruited a range of multidisciplinary professionals working on interaction within this field: SLTs, qualified teachers of the deaf, psychologists or psychiatrists, and professionals working within deaf child and adolescent mental health services. The study reports on which behaviours these professionals assess and how, and includes information on the goal setting behaviours of practitioners. Most respondents were highly experienced; the survey, therefore, reveals expert practice within the field.What are the potential or actual clinical implications of this work?: We recommend the following practice: (1) incorporate a range of parent‐based behaviours in PCI assessments, including establishing joint engagement and parental sensitivity, as well as communication‐focused behaviours; (2) video record PCI assessments where possible to enable professionals and parents to watch and reflect together; (3) following assessment, set parent‐focused goals in collaboration with families, ensuring parents’ skills, particularly their strengths, are considered. All primary caregivers should be included in the process where possible; and (4) reassess PCI regularly (at least termly) to monitor and encourage families’ progress. The timing of reviews should be discussed between parent and professional.

Infant–parent interaction forms the foundation for language learning. For the majority of deaf infants, hearing loss can impact access to, and the quality of communicative interactions, placing language development at risk. Support for families to meet the challenges faced during interaction is highly variable in the United Kingdom. In a step towards more standardized but tailorable family support, we co-produced an instructional, video-based intervention, testing for feasibility in terms of behavior change in seven communicative strategies and acceptability with 9 parents, forming study 1. Parents increased their use of the majority of behaviors and found content and delivery acceptable. However, further development was required to: (a) support use of semantically contingent talk and attention getting strategies to elicit infant attention, and (b) ensure the information was provided in a bite-size format that could be tailored to individual families. In study 2, the intervention was refined based on findings from study 1 and assessed for acceptability with 9 parents and 17 professionals, who reported similar high acceptability scores. Final refinements and modifications could be addressed in future interventions. The current studies provide a positive early step towards a standardized intervention to support communication that could be used in routine practice.