Identifying active ingredients of a parent-implemented communication intervention for deaf/hard of hearing toddlers: A randomized clinical trial

Objective: Deaf/hard of hearing toddlers benefit from support early in development to facilitate gains in communication outcomes. Outcomes of a recent randomized clinical trial indicate that parent-implemented communication interventions (PICTs) facilitate communication outcomes for DHH children. In the current study, we implemented a serial mediation analysis to isolate the active ingredients of a PICT for DHH children. Methods: This single-site parallel stratified clinical trial (2x2; hearing device, communication mode) enrolled 96 parent-child dyads. Child inclusion criteria were: (a) between 12-18 months, (b) diagnosed with bilateral hearing loss, (c) no additional diagnoses, (d) had one parent with normal hearing, and (e) exposed to some degree of spoken language by their parents. Dyads were randomized to the control group or the PICT group, which taught parents to use communication support strategies (i.e., engagement strategies, primary language strategies, and supplemental language strategies) weekly via telehealth for 6 months. Parents’ strategy use was measured before, during, and immediately after intervention. Child communication outcomes were measured before and immediately after intervention. Results: Results demonstrated a significant serial mediation of the effect of PICT on child communication outcomes through parents’ use of engagement strategies and primary language strategies.Conclusion: Parents in the PICT condition learned to use engagement strategies, which in turn, facilitated their implementation of primary language strategies, ultimately leading to an improvement in child communication outcomes. Understanding the active ingredients and causal pathway of the PICT is an important consideration for implementation of the PICT in clinical practice.