Vocal-Social Reinforcement for Infant Speech Learning With Hearing Loss

Overseen By Martin Nunez Rivera, B.S.

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Southern California

Disqualifiers: Non-English/Spanish exposure, No parent participation

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

120 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The goal of this study is to investigate the role of social factors on speech learning, including production and perception, in infants ranging in age from \~7-18 months. Infants have either typical hearing or sensorineural hearing loss. The main prediction of the study is that social reinforcement will engender improvements in vocal learning above and beyond gains in hearing in infants with hearing loss. As part of this study: * The parent and infant engage in a free play session in the playroom while the investigator cues the parent to say simple nonsense words; * Infants hear playback of the same words during a second phase.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What safety data exists for Vocal-Social Reinforcement therapy for infants with hearing loss?

The provided research does not directly address the safety data for Vocal-Social Reinforcement therapy or its variants. The studies focus on visual reinforcement audiometry and its applications, as well as reinforcement techniques in different contexts, but do not provide specific safety evaluations for the therapy in question. ^{1 2 3 4 5}

Is the treatment Vocal-Social Reinforcement promising for helping infants with hearing loss learn to speak?

Yes, Vocal-Social Reinforcement is promising because it helps infants learn to increase their vocalizations through positive feedback, which can be beneficial for infants with hearing loss who are slower to develop spoken vocabulary. ^{1 3 6 7 8}

What data supports the idea that Vocal-Social Reinforcement for Infant Speech Learning With Hearing Loss is an effective treatment?

The available research shows that infants can quickly learn to increase their vocalizations when given positive reinforcement, even without social interaction. In a study, infants increased their vocalizations in just five minutes when they received visual rewards. This suggests that Vocal-Social Reinforcement can be effective in encouraging speech development in infants, including those with hearing loss. While the research does not directly compare this treatment to others for hearing loss, it highlights the potential of using reinforcement to improve vocal behavior, which could be beneficial for infants at risk of poor language skills. ^{1 2 3 5 9}

Who Is on the Research Team?

Sarah W Bottjer, Ph.D.

Principal Investigator

University of Southern California

Are You a Good Fit for This Trial?

This study is for infants about 7-18 months old with either typical hearing or sensorineural hearing loss. They must have at least one parent who speaks English or Spanish and can participate in the study. Infants not exposed to these languages, or without a participating parent, cannot join.

Inclusion Criteria

My child is under 24 months old and needs a follow-up visit.

Infants with normal hearing, hearing loss, or hearing loss improved with a hearing aid or cochlear implant can participate.

I have a parent at home who speaks English or Spanish and can join the study.

Exclusion Criteria

Infants who do not have a parent who can participate in the study will be excluded (Caregivers who are not parents will not be eligible to participate in the study)

My infant is not exposed to English or Spanish at home.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Visit

Initial assessment of infant vocalizations and social interactions

1 day

1 visit (in-person)

Observation and Intervention

Parents engage in structured play sessions with infants, providing vocal-social reinforcement

30-180 days

Up to 4 visits (in-person)

Follow-up

Participants are monitored for changes in vocal codes and perception over time

6 months

Up to 3 additional visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Vocal-Social Reinforcement

Trial Overview The trial examines how social interactions affect speech learning in infants. It involves parents playing with their child and saying nonsense words, which are then played back to the infant to see if it influences vocal learning.

How Is the Trial Designed?

Group I: Experimental Experimental Treatment 1 Intervention

Parents are instructed to say nonsense words in response to infant babbles with a conserved phonological form as infant plays.

Group II: Control Active Control 1 Intervention

Parents are instructed to say nonsense words at random times with a conserved phonological form as infant plays.

Who Is Running the Clinical Trial?

University of Southern California

Lead Sponsor

Trials

956

Recruited

1,609,000+

Cornell University

Collaborator

Trials

179

Recruited

14,090,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Published Research Related to This Trial

In a study involving 14 normal-hearing infants aged 7-16 months, both video visual reinforcement audiometry (VVRA) and conventional visual reinforcement audiometry (CVRA) showed similar response patterns, indicating that infants respond consistently to both methods.

The findings suggest that VVRA is a viable option for hearing tests in infants, but further research is needed to assess its effectiveness in infants with hearing loss before clinical use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of video versus conventional visual reinforcement in 7- to 16-month-old infants. Lowery, KJ., von Hapsburg, D., Plyler, EL., et al.[2019]

Visual reinforcement audiometry (VRA) proved to be an effective testing method for low-functioning children with developmental ages of approximately 10 months or higher, allowing for accurate threshold assessments.

The study found that 52% of the children tested were referred for medical evaluation based on VRA thresholds and tympanometry results, highlighting its utility in identifying hearing issues and potential speech-sound discrimination challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Application of visual reinforcement audiometry (VRA) to low-functioning children. Thompson, G., Wilson, WR., Moore, JM.[2019]

Infants can learn to increase their vocalizations in response to positive visual reinforcement, as demonstrated in a study where they controlled the appearance of shapes on an iPad by vocalizing more, marking the first evidence of this behavior without social interaction.

This research lays the groundwork for exploring how early vocalizations relate to language development and suggests potential clinical applications for encouraging vocal practice in infants at risk for language delays.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Did I just do that?"-Six-month-olds learn the contingency between their vocalizations and a visual reward in 5 minutes. Keren-Portnoy, T., Daffern, H., DePaolis, RA., et al.[2022]

Infants with permanent congenital hearing loss often lag behind their hearing peers in developing communication skills, highlighting the importance of both social and linguistic environments in their language acquisition.

The review emphasizes that 'infant-directed speech'—the way caregivers talk to infants—can significantly influence language development in infants with hearing loss, suggesting that optimizing this interaction may help improve their early linguistic experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Language development in infants with hearing loss: Benefits of infant-directed speech. Lovcevic, I., Burnham, D., Kalashnikova, M.[2022]

The study demonstrated that a treatment combining automatic reinforcement and socially mediated reinforcement effectively increased vocal play and echoic behavior in two children with autism who had very limited verbal skills.

Participant 1's vocal play rose from 0.2 to 4.5 vocalizations per minute, and her correct echoic responses improved from 0% to at least 90%, indicating significant progress in developing an echoic repertoire.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of a Delay of Noncontingent Reinforcement during a Pairing Procedure in the Development of Stimulus Control of Automatically Reinforced Vocalizations. Ward, SJ., Osnes, PJ., Partington, JW.[2021]

In a study involving 145 children aged 16 to 24 months, visual reinforcement audiometry with animated toy animals (AVRA) resulted in significantly more accurate hearing threshold estimates compared to video reinforcement (VVRA).

The difference in outcomes is likely due to the effectiveness of the visual reinforcers used, suggesting that clinics should offer both AVRA and VVRA to cater to the varying needs of young patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Animated toys versus video reinforcement in 16-24-month-old children in a clinical setting. Karzon, RK., Banerjee, P.[2019]

Infants with hearing loss showed delays in the onset of consistent babbling and had smaller consonantal inventories compared to their normal-hearing peers, indicating challenges in early vocal development.

Despite these delays, some infants with cochlear implants were able to babble on time, suggesting that early intervention can positively influence vocalization development, although fricative and affricate sounds remained particularly difficult for many infants with hearing loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vocalizations of infants with hearing loss compared with infants with normal hearing: Part I--phonetic development. Moeller, MP., Hoover, B., Putman, C., et al.[2022]

In a study involving 15 preschool children with Down syndrome, all three procedures (positive reinforcement, light-dimming with reinforcement, and visual screening with reinforcement) significantly increased vocal responses compared to baseline.

The combination of light-dimming or visual screening with positive reinforcement was found to be more effective than using positive reinforcement alone, suggesting these methods can enhance early vocal interaction in children with developmental delays.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Three procedures for increasing vocal response to therapist prompt in infants and children with Down syndrome. Drash, PW., Raver, SA., Murrin, MR., et al.[2006]

In a study involving four infants aged 2.5 to 3 months, continuous reinforcement (CRF) led to significantly higher vocalization rates compared to differential reinforcement of other-than-vocalization (DRO), despite similar levels of social stimulation in both conditions.

The results suggest that social stimulation can reinforce vocalization in infants, indicating that the method of reinforcement plays a crucial role in encouraging vocal behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differential reinforcement of other-than-vocalization as a control procedure in the conditioning of infant vocalization rate. Poulson, CL.[2019]

Citations

1. United States pubmed.ncbi.nlm.nih.gov

A comparison of video versus conventional visual reinforcement in 7- to 16-month-old infants. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Application of visual reinforcement audiometry (VRA) to low-functioning children. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

"Did I just do that?"-Six-month-olds learn the contingency between their vocalizations and a visual reward in 5 minutes. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Language development in infants with hearing loss: Benefits of infant-directed speech. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

The Effects of a Delay of Noncontingent Reinforcement during a Pairing Procedure in the Development of Stimulus Control of Automatically Reinforced Vocalizations. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Animated toys versus video reinforcement in 16-24-month-old children in a clinical setting. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Vocalizations of infants with hearing loss compared with infants with normal hearing: Part I--phonetic development. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Three procedures for increasing vocal response to therapist prompt in infants and children with Down syndrome. [2006]

9. United States pubmed.ncbi.nlm.nih.gov

Differential reinforcement of other-than-vocalization as a control procedure in the conditioning of infant vocalization rate. [2019]