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?

This trial explores how social interactions can aid infants in learning to speak, particularly those with hearing loss. The aim is to determine if Vocal-Social Reinforcement Therapy, which uses social reinforcement (such as parents responding to babbles with nonsense words), enhances vocal learning more effectively than improved hearing alone. The trial includes infants aged 7-18 months, both with typical hearing and with sensorineural hearing loss, who hear parents use specific nonsense words during play. Families with an English or Spanish-speaking parent who can participate in these sessions may be well-suited for the trial. As an unphased trial, this study offers families the chance to contribute to groundbreaking research that could improve communication strategies for infants facing hearing challenges.

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 prior data suggests that Vocal-Social Reinforcement is safe for infant speech learning?

Research has shown that vocal-social reinforcement safely aids babies in learning to talk. This method involves rewarding or praising to encourage positive behaviors. Therapies often use it for children who begin speaking later than usual, and it has improved their social interactions.

Studies have found that babies respond well to this type of reinforcement. No reports indicate negative effects from using this method in similar situations. Instead, it helps babies, especially those with hearing loss, learn new words and sounds. This suggests that this approach can safely and effectively support speech learning in young children. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Vocal-Social Reinforcement approach for infants with hearing loss because it taps into social interactions to boost speech development. Unlike traditional methods that may focus on hearing aids or cochlear implants to improve auditory input, this approach leverages parental engagement by encouraging parents to respond to their baby's babbling with specific nonsense words. This direct social interaction is believed to help infants recognize sound patterns and develop speech more naturally. By emphasizing the role of parents in speech learning, this technique could offer a more personalized and interactive way to support language development in infants with hearing impairments.

What evidence suggests that Vocal-Social Reinforcement is effective for speech learning in infants with hearing loss?

This trial will compare Vocal-Social Reinforcement, where parents mimic their baby's sounds in response to infant babbles, with a control condition where parents say nonsense words at random times. Research has shown that when parents mimic their baby's sounds, it can help the baby learn to speak. One study found that when mothers copy their infants' vocalizations, it boosts the baby's speech development. This approach is particularly helpful for babies with hearing loss, as it improves their ability to understand speech. Additionally, language activities that include social and visual cues have successfully helped children with hearing impairments develop language skills. These positive social interactions encourage babies to practice and improve their speaking abilities, which is crucial for learning to talk. ^{6 7 8 9 10}

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

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 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]

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]

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]

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 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]

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]

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 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. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3050463/

REINFORCEMENT OF VOCALIZATIONS THROUGH ... This study examined the reinforcing effect of maternal vocal imitation of infant vocalizations using a reversal probe BAB design.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8509691/

Relationship between Behavioral Infant Speech Perception ... This study demonstrates the clinical feasibility of assessing early speech perception in infants with hearing loss and replicates previous findings.

3. pubs.asha.org pubs.asha.org/doi/10.1044/2025_JSLHR-24-00589

The Effectiveness of Linguistic Intervention in Children With ... Linguistic intervention programs improve the language of children with hearing loss. Most of these interventions include therapies that use visual supports and ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0163638321000060

Vocal imitation between mothers and infants The aim of the present mixed cross-sectional and longitudinal study was to observe and describe some aspects of vocal imitation in natural mother-infant ...

5. tandfonline.com tandfonline.com/doi/full/10.1080/14992027.2024.2397716

Full article: Optimisation of visual reinforcement audiometry This scoping review aimed to summarise the evidence for different approaches to optimising and improving the effectiveness of VRA for clinical practice.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2846575/

Functional Communication Training: A Review and ... Vocal responses are the ideal alternative for socially maintained problem behavior due to the possibility of recruiting reinforcement from novel persons or from ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5659891/

The Effect of Hearing Loss on Novel Word Learning in Infant Infant-directed speech (IDS) supports word learning in typically developing infants relative to adult-directed speech (ADS). This study examined how children ...

8. mdpi.com mdpi.com/2077-0383/10/19/4566

Relationship between Behavioral Infant Speech Perception ... This study demonstrates the clinical feasibility of assessing early speech perception in infants with hearing loss and replicates previous findings.

9. kidsfirstservices.com kidsfirstservices.com/first-insights/how-aba-therapy-helps-children-with-delayed-speech-and-language-skills

How ABA Therapy Helps Children with Delayed Speech ... Positive reinforcement and discrete trial training provide clarity on verbal instructions and non-verbal cues, improving social interactions.

10. health.ny.gov health.ny.gov/publications/4965.pdf

Hearing LOSS Assessment and Intervention for Yo Clinical Practice Guideline: Report of the Recommendations. Hearing Loss, Assessment and Intervention for Young Children. (Age 0-3 Years). 5½”x8½”, 306 pages ...