MATERNAL AND CHILD CHARACTERISTICS DURING MOTHER-CHILD PLAY SESSIONS: ASSOCIATIONS WITH CHILD LANGUAGE OUTCOMES AT M FOR CHILDREN WITH

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1 MATERNAL AND CHILD CHARACTERISTICS DURING MOTHER-CHILD PLAY SESSIONS: ASSOCIATIONS WITH CHILD LANGUAGE OUTCOMES AT M FOR CHILDREN WITH CONGENITAL HEARING LOSS April 2, 2009 Presented by AUCD and supported by Cooperative Agreement from the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at Center for Disease Control and Prevention (CDC)

2 Webinar Agenda 2 I. Welcome & Introduction Karla Kmetz, Project Specialist, AUCD-NCBDDD Cooperative Agreement II. Presentation: Child Language Outcomes at m for Children with Congenital Hearing Loss Betty Vohr, MD, Lucille St Pierre BS, Julie Jodoin-Krauzyk, MEd, MA, Deborah Topol, BA, Richard Tucker, BA Organization: Warren Alpert Medical School of Brown University Women & Infants Hospital, affiliated with Paul V. Sherlock Center on Disabilities (RI UCEDD) III. Question and Answer

3 Overview: AUCD-NCBDDD Cooperative Agreement Strengthen the nation's capacity to carry out public health and disability activities Foster collaborations among AUCD, its network (UCEDD, LEND, DDRC) members, and NCBDDD Provide technical assistance to State Disability and Health Grantees Eh Enhance the capacity of states t and creating collaborative systems change in the early identification, assessment, service coordination for children with autism spectrum disorder and related disabilities through Act Early Regional Summits Strengthen expertise in the fields of birth defects and developmental disabilities through training of professionals in public health and related fields. Facilitate a wide range of research, education, and dissemination activities.

4 Research Topics of Interests (RTOI) 4 RTOI are specific research area of significance identified by scientists at NCBDDD, CDC. Past RTOI projects have focused on the following areas: Health Communication and Education Prevention of Secondary Conditions i Healthcare Cost Analysis Quality of Life Studies Developmental l Factors and Outcomes Health Promotion Interventions Co-Morbidity Prevalence Studies Specific disabilities areas include: autism spectrum disorder, Down syndrome, Duchenne muscular dystrophy, epilepsy, Fragile X syndrome, hearing loss, fetal alcohol syndrome, spina bifida, and Tourette syndrome.

5 Webinar Guidelines 5 All participants p lines will be MUTED during the presentation Operator will facilitate the Q&A session Participants i may submit questions online during presentation through Go To Webinar text box at any time Sample webinar screen

6 Maternal and Child Characteristics during Mother-Child Play Sessions: Associations with Child Language Outcomes at m for Children with Congenital Hearing Loss Betty Vohr, MD Lucille St Pierre BS, Julie Jodoin-Krauzyk, MEd, MA, Deborah Topol, Richard Tucker, BA Women & Infants Hospital Warren Alpert Medical School of Brown University Providence, RI Funded by cooperative agreements between the Rhode Island Department of Health and the Early Hearing Detection and Intervention Program at the Centers for Disease Control & Prevention and the Association of University Centers on Disabilities Grant UR3/CCU AUCD-RTOI

7 Family Perspectives Study Prospective study of a cohort of children born and screened for HL in RI Home visits conducted at 6-10, & 18-24m Initially funded d by a Cooperative Agreement between CDC and RI DOH Funding received from AUCD for 36 and 48m assessments 7

8 Study Design for Child Outcomes Study Groups Hearing Loss Typical Hearing Predictors Maternal Stress PCIS Scores Hearing loss NICU Stay Outcome Words Produced at months Objective: To assess the effects of maternal stress and maternal communicative effectiveness and hearing loss on words produced at 18 months for children with and without congenital hearing loss and to assess the effects of stay in the NICU. 8

9 Hypotheses successful mother-infant t interactions ti will foster improved language outcomes for children with HL and hearing children. verbal involvement, Improved affective atmosphere, positive regard and global measures of interaction (atmosphere, availability, and enjoyment), will a be associated with language skills. Controlling behaviors, such as control/directiveness and intrusiveness, will be associated with language skills. maternal stress will be associated with language skills. 9

10 Study Sample Study subjects were children with permanent hearing loss born in Rhode Island from 10/15/02 to 1/31/05 (n=31) Children identified d with permanent congenital hearing loss were matched to control children ( n=40)with no hearing loss. 10

11 Methods Enroll families of infants with HL Identify control matches Informed consent: Schedule home visits Matching Criteria (Gender, NICU versus Well-Baby Nursery, Date of Birth (+/- 30 to 90 days), Hospital of Birth, Maternal Education, Race/Ethnicity, Health Insurance) Assessments at home visits Demographics and Hollingshead SES Parenting Stress Index Parent Caregiver Interaction Scale MacArthur Bates CDI 11

12 Parent Caregiver Involvement Scale (PCIS) 10 minute play session coded by trained coders Farran D, 1986 Six areas were coded for amount and quality of behaviors displayed by the parent Verbal Involvement Responsiveness Play Involvement Control/Directives Positive Regard Negative Regard 12

13 Parent Caregiver Involvement Scale (PCIS) Four items were scored on amount as overall indicators Availability, Acceptance, Atmosphere, Enjoyment Five items are rated as independent d scores Sensitivity, Scaffolding, Intrusiveness, Structuring/Intrusiveness, Hostility 13

14 Definitions for PCIS General Impressions of Caregiver Involvement with Child Availability Parent response based on child s expressed needs or cues Acceptance Approval and acceptance of child Atmosphere Synchrony between adult and child Enjoyment Amount of time that adult and child seem to be delighted with each 14

15 Definitions for PCIS: Areas Coded d for Amount and Quality Verbal Involvement Amount and quality of caregiver s verbal communications Responsiveness- Caregiver s reaction to child initiations Play involvement Amount and quality of caregiverchild play during session Control/Directives Amount and quality of structure and directives by caregiver Positive regard Caregiver displays positive attitude toward child. Negative regard Negative emotions and statements directed toward child 15

16 Emotional Availability Scales Sensitivity- genuine interest and pleasure with child. Play creative and joyful for both Scaffolding-Maintain appropriate level of structure to allow success for child Intrusiveness-parenting behavior that prevents child autonomy. Parent does not let child lead in play. Structuring/Intrusiveness-degree to which caregiver e structures child s play taking care to follow child s lead. (Optimal score midpoint) Hostility-threatening or frightening interaction 16

17 Parenting Stress Index* Short form 36 questions Likert Scale 1 to 5: Strongly Agree to Strongly Disagree Total Stress Score (36-180) Factor Scores (12-60) Parental Distress Parent-Child Dysfunctional Interaction Difficult Child *Abidin RR. Parenting Stress Index (PSI) Third Edition. Lutz, FL: Psychological Assessment Resources, Inc;

18 CDI at 18m: Words & Sentences* Part I: Words Children Use includes 680 item vocabulary checklist for words produced and questions s on how children use words. Part II: Sentences & Grammar includes questions on word endings, word forms, word combinations, and sentence complexity. Percentile scores are available for: words produced and sentence complexity. *Fenson L Dale PS Reznick JS Thal D Bates E Hartung JP et al The Fenson L, Dale PS, Reznick JS, Thal D, Bates E, Hartung JP, et al. The McArthur Communicative Development Inventories: User's Guide and Technical Manual. San Diego: Singular Thomson Learning; 1993.

19 Analysis Data Analysis Hearing Loss vs. Hearing Controls T tests to analyze differences between groups Ҳ 2 to analyze differences among proportions Correlations Regression Models to show relationships of predictors with outcomes for the total cohort. 19

20 Maternal Characteristics* HL Controls P (28) (30) Age 32±6 35± Married 23(83%) 27(90%).3859 high school 2(7%) 1(3%).5127 Primary English 24(86%) 30(100%).0319 Medicaid / No 4(13%) 6(21%).4147 Ins. SES 39±14 48±10.01 Total Stress 67±10 70± *Mothers with multiples are counted once and assigned to most severe group

21 Infant Characteristics HL (31) H Controls (40) Female 12(39%) 16(40%).9121 White 28(90%) 39(98%).1917 NICU 19(61%) 26(65%).7476 <37 wks 20(65%) 21(53%).3093 Visit Age 22.5±2 21.8±2 NS EI 30(97%) 13(33%)

22 PCIS Scores for Moderate or High Response hearing loss Control Verb. Inv. Play Inv. Cont. Direct. + Regard Respons. Enjoyment 22

23 Effects of Impact and Resources on Stress Total Cohort Impact and Parenting Stress Resources and Parenting Stress n g Stress ean) Parentin ( m r= or less Impact ting Stress s mean) Paren ( or less R= Resources Increasing impact was associated with stress Increasing resources were associated with stress 23

24 Parenting Stress and PCIS Scores Total Cohort Parenting Stress and Availability Parenting Stress and Positive Regard Availability (me ean) r= or less Parenting Stress Positive Rega ard (mean) r= or less Parenting Stress Parenting Stress and Enjoyment Parenting Stress and Verbal Involvement Enjoyment (m ean) r= or less r=.19 R=-.41 r= or less Parenting Stress Parenting Stress 24

25 Words m Total Sample P Sample Excluding P including NICU Infants NICU Infants N HL Control HL Control Words 71 ± ± ± ± WP % 17 ± ± ±32 40± <10th % 20 (69%) 13 (33%) (45%) 2(14%)

26 PCIS Scores and Words Produced Total Cohort PCIS Availability and Words Produced PCIS Control and Directives and Words Produced Wo ords Produced (mean) r= Availability Wo ords Produced (mean) r= Control and Directives Words Produced (mean) PCIS Sensitivity and Words Produced r= Sensitivity Words Produc ced (mean) PCIS Atmosphere and Words Produced r= Atmosphere 26

27 Parenting Stress and Words Produced W o r d s or less r = Parenting Stress rds Wo PCIS Verbal Involvement and Words Produced r= Verbal Involvement 27

28 Factors Associated with Fewer Words Produced: Correlation o Coefficients e Resources Support Stress HL Availability Verbal Involvement Atmosphere Control/Directiveness Q Sensitivity ;.19;.30;.33;.21 Words Produced NICU

29 Regressions to Predict Words Produced Availability Control Dir Control Dir Q b p b p b p NICU Hearing Loss Total Stress PCIS Total R

30 Regressions to Predict Words Produced Atmosphere Sensitivity Verbal Invol b p b p b p NICU Hearing Loss Total Stress PCIS Total R

31 Conclusions at 18-24m Child HL, NICU stay and maternal stress were assoc. with words produced at 18-24m. maternal control & directiveness during a play session was assoc. with 36 words whereas Control/directiveness Quality was assoc with 45 more words produced maternal atmosphere during a play session was associated with 36 more words produced. Both maternal and child factors contribute to number of words produced d at months for 31 children.

32 EI Providers should take all maternal and child factors into consideration when developing an Individualized Family Service Plan. 32