Assessing expressive spoken language in children with permanent childhood hearing impairment in mid-childhood

Language tests standardised on hearing children are regularly used with children with permanent childhood hearing impairment (PCHI). The validity of this practice is examined in this thesis. The research examined whether there are measurable differences in expressive spoken language skills of school age children whose PCHI is confirmed early and late. It also examined whether standardised tests underestimate expressive spoken language abilities of children in mid-childhood with PCHI relative to their everyday performance, and whether an alternative approach using ‘naturalistic’ conversation samples would provide a better indicator of performance.In the first study, audio-taped spoken narrative was assessed for syntax, phonology, morphology, and narrative in transcripts from 89 primary school age children with bilateral PCHI and 63 children with normal hearing. Forty one children had had their hearing impairment confirmed by age nine months. Compared to those with late confirmed PCHI, children with early confirmed PCHI used significantly more sentences and high-pitched morphological markers, and had significantly increased odds for better narrative structure and content. Numbers of sentences with multiple clauses, low-pitched morphological markers and phonological simplifications did not differ between groups.In the second study, three testing settings (traditional standardised language test (CELF-4(UK), narrative test (Peter and the Cat), and ‘naturalistic’ conversation) were compared with respect to their capability to measure everyday expressive spoken language in school age children with PCHI. Videoed expressive spoken language samples were collected at home from 11 children with PCHI and 6 children with normal hearing. The traditional language test placed the expressive language ability of the PCHI group much lower than did the measures of everyday conversation. Use in conversation of future tense and gesture by children with PCHI was not reflected by the tests. Results indicate potential benefits of using non-standard approaches to assessment in this population in mid-childhood