Optimizing language development in hearing-impaired children - the impact of family-centered interventions: a systematic review

Gomes, Larissa Fernandes; Taveira, Karinna Veríssimo Meira; Brazorotto, Joseli Soares

doi:10.1590/2317-6431-2024-2964pt

Figures (3)
Tables (10)

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Figure 1 Flowchart demonstrating the search and selection criteria of studies

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Figure 2 Summary risk of bias evaluation according to Cochrane’s tool to assessed risk of bias in randomized controlled trials (RevMan 5.3, The Nordic Cochrane Centre, Copenhagen, Denmark) – randomized.

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Figure 3 Summary risk of bias evaluation according to Cochrane’s tool to assessed risk of bias in randomized controlled trials (RevMan 5.3, The Nordic Cochrane Centre, Copenhagen, Denmark) –not randomized.

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Banco de dados Pesquisa realizada em 30 de julho de 2019 e atualizada em 06 de junho de 2024 Cochrane baby OR babies OR infant* OR toddler* OR child* OR pre-school* OR preschool* in Title Abstract Keyword AND “Parent education” OR “Family-centered” OR “Family-centered intervention” OR “Family-centered interventions” OR “Video Interaction Guidance” OR “Parent Child Interaction Therapy” OR “parental language input” OR “early intervention” OR “Auditory Verbal Intervention” in Title Abstract Keyword AND “hearing loss” OR “hypoacusis” OR “hypoacuses” OR “Hearing Impairment” OR “cochlear implants” OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses” in Title Abstract Keyword - (Word variations have been searched) LILACS ((tw:(child OR niño OR criança OR crianças)) AND (tw:(“early intervention” OR “intervenciónprecoz“ OR “intervençãoprecoce”)) AND (tw:(“hearing loss” OR “pérdidaauditiva” OR “perdaauditiva”))) PsycINFO Any Field: baby OR Any Field: Any Field: babies OR Any Field: Any Field: infant* OR Any Field: Any Field: toddler* OR Any Field: Any Field: child* OR Any Field: Any Field: pre-school* OR Any Field: Any Field: preschool* AND Any Field: “hearing loss” OR “hypoacusis” OR “hypoacuses” OR “Hearing Impairment” OR “cochlear implants” OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses” AND Any Field:: “Parent education” OR Any Field: Any Field: “Family-centered approach” OR Any Field: Any Field: “Family-centered intervention” OR Any Field: Any Field: “Family-centered interventions” OR Any Field: Any Field: “Video Interaction Guidance” OR Any Field: Any Field: “Parent Child Interaction Therapy” OR Any Field: Any Field: “parental language input” OR Any Field: Any Field: “early intervention” OR Any Field: Any Field: “Auditory Verbal PubMed ((((baby OR babies OR infant* OR toddler* OR child* OR pre-school* OR preschool*))) AND ((“Parent education” OR “Family-centered approach” OR “Family-centered intervention” OR “Family-centered interventions” OR “Video Interaction Guidance” OR “VIG” OR “Parent Child Interaction Therapy” OR “PCIT” OR “parental language input” OR “early intervention” OR “Auditory Verbal Intervention”))) AND ((“hearing loss”[MeSH Terms] OR “hypoacusis” OR “hypoacuses” OR “Hearing Impairment” OR “cochlear implants”[MeSH Terms] OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses”)) Scopus TITLE-ABS-KEY (baby OR babies OR infant* OR toddler* OR child* OR pre-school* OR preschool* AND “hearing loss” OR hypoacusis OR hypoacuses OR “Hearing Impairment” OR “cochlear implants” OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses” AND “Parent education” OR “Family- centered approach” OR “Family-centered intervention” OR “Family-centered interventions” OR “Video Interaction Guidance” OR “Parent Child Interaction Therapy” OR “parental language input” OR “early intervention” OR “Auditory Verbal Intervention”) Web of Science ((ALL=(baby OR babies OR infant OR toddler* OR child* OR pre-school* OR preschool*)) AND ALL=(“hearing loss” OR “hypoacusia” OR “hypoacusia” OR “Hearing Impairment” OR “cochlear implants” OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses”)) AND ALL=(“Parent education” OR “Family-centered approach” OR “Family-centered intervention” OR “Family-centered interventions” OR “Video Interaction Guidance” OR “VIG” OR “Parent Child Interaction Therapy” OR “pcet” OR “parental language input” OR “early intervention” OR “Auditory Verbal Intervention”) EMBASE #1 'baby'/exp OR baby OR babies OR infant* OR toddler* OR child* OR 'pre school*' OR preschool* #2 'hearing loss' OR hypoacusis OR hypoacuses OR 'hearing impairment' OR 'cochlear implants' OR 'cochlear implant' OR 'cochlear prosthesis' OR 'cochlear prostheses' OR 'auditory prosthesis' OR 'auditory prostheses' #3 'parent education' OR 'family- centered approach' OR 'family-centered intervention' OR 'family-centered interventions' OR 'video interaction guidance' OR 'parent child interaction therapy' OR 'parental language input' OR 'early intervention' OR 'auditory verbal intervention' #4 #1 AND #2 AND #3 #5 #4 AND [embase]/lim NOT ([embase]/lim AND [medline]/lim) Literatura Cinzenta Google Acadêmico Infant AND “Parent education” OR “Family-centered approach” OR “Family-centered intervention” OR “Family-centered interventions” AND “hearing loss” filetype:pdf

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Autor Razões para exclusão * Brown e Remine1 4 Glanemann et al.2 2 Holzinger e Fellinger3 5 Kishida e Kemp4 3 Moeller et al.5 3 Reichmuth et al.6 2

*

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Domínios 1 Khoshakhlagh et al. 2 Roberts 3 1. Viés de desempenho A A 2. Ocultação de alocação (viés de seleção) A A 3. Geração de sequência aleatória (viés de seleção) A A 4. Viés de detecção A A 5. Desfechos incompletos (viés de atrito) B B 6. Relato seletivo (viés de relato) B B 7.Outro viés B B % Risco de viés 42,8% 42,8% Alto Alto Cochrane’s tool to assessed risk of bias in randomized controlled trials Legenda: B=Baixo risco, U=Risco incerto, A=Alto risco, NI=Não Informado.

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Domínios 1 Costa et al. 2 Glanemann et al. 3 Lam-Cassettari et al. 4 Nicastri et al. 5 1. Viés de confusão A A A A 2. Viés na seleção de participantes para o estudo B B B B 3. Viés na classificação de intervenções B B B B 4. Viés devido a desvios das intervenções pretendidas I I I I 5. Viés devido a dados ausentes B B B B 6. Viés na medição de resultados B B B B 7. Viés na seleção do resultado relatado B B B B 8. Outro viés B B B B % Risco de viés 75% 75% 75% 75% Baixo Baixo Baixo Baixo Legenda: B = Baixo risco, U = Risco incerto, A =Alto risco, NI =Não Informado.

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Table 1 Descriptive summary of the characteristics of the included studies (n =6)

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Table 2 Evidence Profile and Quality Assessment(³⁰)

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Database Research carried out July 30, 2019, and updated on June 06, 2024 Cochrane baby OR babies OR infant* OR toddler* OR child* OR pre-school* OR preschool* in Title Abstract Keyword AND “Parent education” OR “Family-centered” OR “Family-centered intervention” OR “Family-centered interventions” OR “Video Interaction Guidance” OR “Parent Child Interaction Therapy” OR “parental language input” OR “early intervention” OR “Auditory Verbal Intervention” in Title Abstract Keyword AND “hearing loss” OR “hypoacusis” OR “hypoacuses” OR “Hearing Impairment” OR “cochlear implants” OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses” in Title Abstract Keyword - (Word variations have been searched) LILACS ((tw:(child OR niño OR criança OR crianças)) AND (tw:(“early intervention” OR “intervenciónprecoz“ OR “intervençãoprecoce”)) AND (tw:(“hearing loss” OR “pérdidaauditiva” OR “perdaauditiva”))) PsycINFO Any Field: baby OR Any Field: Any Field: babies OR Any Field: Any Field: infant* OR Any Field: Any Field: toddler* OR Any Field: Any Field: child* OR Any Field: Any Field: pre-school* OR Any Field: Any Field: preschool* AND Any Field: “hearing loss” OR “hypoacusis” OR “hypoacuses” OR “Hearing Impairment” OR “cochlear implants” OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses” AND Any Field:: “Parent education” OR Any Field: Any Field: “Family-centered approach” OR Any Field: Any Field: “Family-centered intervention” OR Any Field: Any Field: “Family-centered interventions” OR Any Field: Any Field: “Video Interaction Guidance” OR Any Field: Any Field: “Parent Child Interaction Therapy” OR Any Field: Any Field: “parental language input” OR Any Field: Any Field: “early intervention” OR Any Field: Any Field: “Auditory Verbal PubMed ((((baby OR babies OR infant* OR toddler* OR child* OR pre-school* OR preschool*))) AND ((“Parent education” OR “Family-centered approach” OR “Family-centered intervention” OR “Family-centered interventions” OR “Video Interaction Guidance” OR “VIG” OR “Parent Child Interaction Therapy” OR “PCIT” OR “parental language input” OR “early intervention” OR “Auditory Verbal Intervention”))) AND ((“hearing loss”[MeSH Terms] OR “hypoacusis” OR “hypoacuses” OR “Hearing Impairment” OR “cochlear implants”[MeSH Terms] OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses”)) Scopus TITLE-ABS-KEY (baby OR babies OR infant* OR toddler* OR child* OR pre-school* OR preschool* AND “hearing loss” OR hypoacusis OR hypoacuses OR “Hearing Impairment” OR “cochlear implants” OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses” AND “Parent education” OR “Family- centered approach” OR “Family-centered intervention” OR “Family-centered interventions” OR “Video Interaction Guidance” OR “Parent Child Interaction Therapy” OR “parental language input” OR “early intervention” OR “Auditory Verbal Intervention”) Web of Science ((ALL=(baby OR babies OR infant OR toddler* OR child* OR pre-school* OR preschool*)) AND ALL=(“hearing loss” OR “hypoacusia” OR “hypoacusia” OR “Hearing Impairment” OR “cochlear implants” OR “Cochlear Implant” OR “Cochlear Prosthesis” OR “Cochlear Prostheses” OR “Auditory Prosthesis” OR “Auditory Prostheses”)) AND ALL=(“Parent education” OR “Family-centered approach” OR “Family-centered intervention” OR “Family-centered interventions” OR “Video Interaction Guidance” OR “VIG” OR “Parent Child Interaction Therapy” OR “pcet” OR “parental language input” OR “early intervention” OR “Auditory Verbal Intervention”) EMBASE #1 'baby'/exp OR baby OR babies OR infant* OR toddler* OR child* OR 'pre school*' OR preschool* #2 'hearing loss' OR hypoacusis OR hypoacuses OR 'hearing impairment' OR 'cochlear implants' OR 'cochlear implant' OR 'cochlear prosthesis' OR 'cochlear prostheses' OR 'auditory prosthesis' OR 'auditory prostheses' #3 'parent education' OR 'family- centered approach' OR 'family-centered intervention' OR 'family-centered interventions' OR 'video interaction guidance' OR 'parent child interaction therapy' OR 'parental language input' OR 'early intervention' OR 'auditory verbal intervention' #4 #1 AND #2 AND #3 #5 #4 AND [embase]/lim NOT ([embase]/lim AND [medline]/lim) Gray literature Google Scholar Infant AND “Parent education” OR “Family-centered approach” OR “Family-centered intervention” OR “Family-centered interventions” AND “hearing loss” filetype:pdf

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Author Reasons for exclusion * Brown and Remine1 4 Glanemann et al.2 2 Holzinger and Fellinger3 5 Kishida and Kemp4 3 Moeller et al.5 3 Reichmuth et al.6 2

*

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Domains 1 Khoshakhlagh et al. 2 Roberts 3 1. Performance bias S S 2. Allocation concealment (selection bias) S S 3. Random sequence generation (selection bias) S S 4. Detection bias S S 5. Attrition bias L L 6. Reporting bias L L 7.Other bias L L % Risk of bias 42,8% 42,8% High High Cochrane’s tool to assessed risk of bias in randomized controlled trials Subtitle: L = Low risk, U = Unclear Risk, S = Serious risk, NI = No info

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Domains 1 Costa et al. 2 Glanemann et al. 3 Lam-Cassettari et al. 4 Nicastri et al. 5 1. Bias due to confounding S S S S 2. Bias in selection of participants into the study L L L L 3. Bias in classification of interventions L L L L 4. Bias due to deviations from intended interventions U U U U 5. Bias due to missing data L L L L 6. Bias in measurement of outcomes L L L L 7. Bias in selection of the reported result L L L L 8. Other bias L L L L % Risk of bias 75% 75% 75% 75% Low Low Low Low Subtitle: L = Low risk, U = Unclear Risk, S = Serious risk, NI = No info

Author	Study design	Experimental group	Control group	Age Group	Aims	Intervention model	Outcomes
Costa et al.(³⁴)	Not randomized .	Children with hearing impairment (n = 6)	Children with hearing impairment (n = 6)	2 years and 5 months to 5 years and 11 months	To evaluate the effectiveness of Parent-Child Interaction Therapy (PCIT) in behavioral intervention and language development in children with hearing impairment.	Parent-Child Interaction Therapy (PCIT).	Parents were involved in language stimulation. There was an improvement in the interactions between parent and child. The child's behavior and oral language skills, such as expressive vocabulary, were improved.
Glanemann et al.(³⁵)	Not randomized	15 parents of hearing impaired children	14 parents of hearing impaired children	3 months to 18 months	Evaluate the Muenster Parental Program (MPP).	Muenster Parental Program (MPP). Two individual counseling sessions, six group sessions and two individual training sessions with video feedback.	Trained parents improved their ability to respond to the child's vocal and pre-verbal cues and to respond to no-signs. In addition, parents reduced their inappropriate behavior and improved communication skills with their children.
Khoshakhlagh et al.(³⁷)	Randomized	15 hearing impaired children	15 hearing impaired children	Age group below 5 years	To analyze the impact of early family-centered psychological and educational interventions on expressive and receptive language in children with hearing loss.	Group and individual counseling sessions with varied materials and focusing on teaching families about language development.	Early family-centered interventions would positively influence expressive and receptive language in children with hearing impairment, under the age of five.
Lam-Cassettari et al.(³²)	Not randomized	7 families of children with hearing impairment who received the intervention.	7 families of hearing impaired children who participated in the waiting list before receiving the intervention	The children in Those who received the intervention had a mean age of 3 years and 4 months (SD: 2.6; range: 6 months - 6 years, 2 months) and those who did not receive the intervention had an average age of 1 year, 4 months (SD: 1.10; range: 9 months - 3 years, 2 months)	To examine the effect of videofeedback on parent-child communication in the context of childhood deafness.	Family-focused video intervention program.	Videofeedback, as an early intervention strategy, improves communication in families with prelingually hearing impaired children and encourages greater parent-child interaction.
Nicastri et al.(³⁶)	Not randomized	22 parents (14 mothers and 8 fathers) of 14 children with profound hearing loss who received a Cochlear Implant at the Cochlear Implant Center of the Policlinico Umberto I-University Sapienza in Rome, Italy	22 parents (14 mothers and 8 fathers) of 14 children with profound hearing loss who received a Cochlear Implant at the Cochlear Implant Center of the Policlinico Umberto I-University Sapienza in Rome, Italy	Children's chronological age: ± 2 months; hearing age: ± 2 months; pre-implant pure tone average from 250 to 4000 Hz and language level. Mean chronological age of mothers was 35.4 years (SD = 5.4) and of fathers 40.4 years (SD = 4.3).	To evaluate the effects of parental training in improving the communication development of children with profound hearing loss, users of Cochlear Implants.	Applied specific Parent Training (PT) programs, based on It Takes Two to Talk (ITTT), a program designed for children with language delays with the aim of empowering family-child interactions and making parents language facilitators for their children. sons. The ITTT was adapted to families of children with hearing impairment, being used to improve the parents' ability to respond to their children's communicative signals. For this, parents learned to apply specific strategies, such as observing, waiting and listening to the child's attempts to communicate before responding. Being considered as communicative acts, vocal and non-vocal signals, such as movements and actions, for the elaboration of joint attention with an emphasis on spoken language during interactions, in order to increase their linguistic skills.	The quality of family interaction and children's language increased significantly more in the Experimental group than in the control. This difference in communication between the study groups was present after 3 years. Parents seemed to benefit from the intervention (PT), which focused on strategies to enable and promote communicative skills in infants with Cochlear Implants.
Roberts(³³)	Randomized	9 children with hearing impairment	10 hearing impaired children	Between 6 and 24 months	To test the effects of a communication treatment implemented in parents, targeting prelinguistic communication skills in infants and children with hearing loss.	Communication treatment implemented in parents, targeting prelinguistic communication skills in infants and children with hearing loss	Parents increased their use of supportive communication strategies. Children developed pre-linguistic and speech skills.

Certainty assessment
Participants(studies)follow-up	Risk of bias	Inconsistency	Indirect evidence	Imprecision	Publication bias	Overall certainty of evidence
Participants(studies)follow-up	Risk of bias	Inconsistency	Indirect evidence	Imprecision	Publication bias	Overall certainty of evidence	0	serious a	serious b	not serious	serious c	none	⨁◯◯◯
(2 Randomized Clinical Trials)	VERY LOW
Child's language	VERY LOW
0 (2 Randomized Clinical Trials)	serious d	serious	not serious	serious c	none	⨁◯◯◯
Communication skills of parents or family	serious d	serious	not serious	serious c	none	VERY LOW
0 (4 Not randomized)	serious e	serious b	not serious	serious c	none	⨁◯◯◯
Child's language	serious e	serious b	not serious	serious c	none	VERY LOW
0 (4 Not randomized)	serious e	serious f	not serious	serious c	none	⨁◯◯◯
Communication skills of parents or family	serious e	serious f	not serious	serious c	none	VERY LOW

[1] Between 6 and 24 months

[2] To test the effects of a communication treatment implemented in parents, targeting prelinguistic communication skills in infants and children with hearing loss

[3] Communication treatment implemented in parents, targeting prelinguistic communication skills in infants and children with hearing loss

[4] Parents increased their use of supportive communication strategies. Children developed pre-linguistic and speech skills

Optimizing language development in hearing-impaired children - the impact of family-centered interventions: a systematic review

ABSTRACT