View in EDS HTML Full Text PDF Full Text

Parental Self-Efficacy and Early Language Development in Deaf and Hard-of-Hearing Children

Saved in:
Bibliographic Details
Title: Parental Self-Efficacy and Early Language Development in Deaf and Hard-of-Hearing Children
Language: English
Authors: Carrie A. Davenport (ORCID 0000-0002-2130-5757), Elaine Smolen, Irina Castellanos, Evelien Dirks, Derek M. Houston
Source: Journal of Deaf Studies and Deaf Education. 2025 30(1):31-40.
Availability: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://jdsde.oxfordjournals.org/
Peer Reviewed: Y
Page Count: 10
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Self Efficacy, Parent Child Relationship, Mother Attitudes, Parents, Students with Disabilities, Deafness, Hearing Impairments, Language Acquisition, Parent Participation, Listening Comprehension, Expressive Language, Total Communication, Language Skills, Parent Role, Parents as Teachers, Beliefs, Child Development
Assessment and Survey Identifiers: Preschool Language Scale
DOI: 10.1093/jdsade/enae036
ISSN: 1081-4159
1465-7325
Abstract: This study examined the relationship between parental self-efficacy in parents of young deaf and hard-of-hearing (DHH) children and children's spoken language skills. A retrospective within-subjects study design was used that included 24 mother-child dyads with DHH children. Parental self-efficacy was assessed using the Scale of Parental Involvement and Self-Efficacy--Revised. Children's language abilities were assessed using the Preschool Language Scale--5th edition. Our data revealed no significant associations between global measures of parental self-efficacy and children's auditory comprehension, expressive communication, and total language scores. However, positive correlations were found between child language skills and specific parents' beliefs about their ability to support their child's spoken language development, their ability to use strategies to help their child communicate, and their active involvement in intervention. Findings highlight the importance of examining discrete aspects of parental self-efficacy as it specifically relates to parents supporting their DHH child's spoken language development. Future directions and implications are provided.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1457175
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwElPa2-4CebdpN26-rkY0KKAAAA4TCB3gYJKoZIhvcNAQcGoIHQMIHNAgEAMIHHBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDFiuHMYe-06CEAB_AwIBEICBmShNroiZP8E7tBgud_eV0ogLqrUCTH9Hnp3ay073A52xKOKi16uSwxjXJvBahqkgzpISK_LcWAADqO4ztPfPJwM_02FH30kNKHYTpm9avr5yy80kSa_Xgix2Q2RTaby2DM6NV1BP_bx2V8Q6bcR7oFl1ZmUqTamAR8X_Mv8pXjJcJsRfZ_pZmqJUqEg7YUskI7PQyzP1So5YSg==
Text:
  Availability: 1
  Value: <anid>AN0181969923;big01jan.25;2025Jan02.04:09;v2.2.500</anid> <title id="AN0181969923-1">Parental self-efficacy and early language development in deaf and hard-of-hearing children </title> <p>This study examined the relationship between parental self-efficacy in parents of young deaf and hard-of-hearing (DHH) children and children's spoken language skills. A retrospective within-subjects study design was used that included 24 mother–child dyads with DHH children. Parental self-efficacy was assessed using the Scale of Parental Involvement and Self-Efficacy–Revised. Children's language abilities were assessed using the Preschool Language Scale–5th edition. Our data revealed no significant associations between global measures of parental self-efficacy and children's auditory comprehension, expressive communication, and total language scores. However, positive correlations were found between child language skills and specific parents' beliefs about their ability to support their child's spoken language development, their ability to use strategies to help their child communicate, and their active involvement in intervention. Findings highlight the importance of examining discrete aspects of parental self-efficacy as it specifically relates to parents supporting their DHH child's spoken language development. Future directions and implications are provided.</p> <p>A primary goal of family-centered early intervention (FCEI) for children who are deaf and hard-of-hearing (DHH) is for parents and caregivers to acquire a sense of self-efficacy in supporting their child's development in all domains, with an emphasis on fostering language growth ([<reflink idref="bib25" id="ref1">25</reflink>]). The majority of DHH children are born to typically hearing parents; therefore, a diagnosis of deafness is unexpected ([<reflink idref="bib24" id="ref2">24</reflink>]). Parents' lack of prior experience or knowledge of how to foster their child's language development after a diagnosis of hearing loss creates the need for parents (inclusive of other caregivers) to acquire new knowledge and skills. FCEI employs evidence-based practices offering parents the opportunity to observe, practice, and receive feedback ([<reflink idref="bib23" id="ref3">23</reflink>]) on strategies (e.g. asking open-ended questions, expansion) that facilitate language development ([<reflink idref="bib15" id="ref4">15</reflink>]). Importantly, parents are coached on how to implement those strategies within the context of their daily lives, thus developing a sense of competence and confidence (i.e. <emph>self-efficacy</emph>). The focus for most parents is on strategies that will promote expressive and receptive language development. The purpose of this study is to examine the direct relationship between parental self-efficacy and DHH children's spoken language skills.</p> <hd id="AN0181969923-2">Parental self-efficacy</hd> <p>Parental self-efficacy, an extension of <emph>self-efficacy</emph>, is a parents' estimation of their ability to engage in behaviors and tasks that will promote their child's development ([<reflink idref="bib5" id="ref5">5</reflink>]). Based on Bandura's Social Cognitive Theory, human development and adaptation occurs through the reciprocal interplay between individual, behavioral, and environmental factors (1997). Self-efficacy is one's perception of their ability to engage in behaviors and tasks that will result in achieving a particular goal. The malleability of self-efficacy, combined with the emergence of parental self-efficacy, as a key predictor of parenting behaviors (e.g. responsivity to children's communication attempts) is associated with positive child outcomes (e.g. better child language skills) ([<reflink idref="bib1" id="ref6">1</reflink>]).</p> <p>[<reflink idref="bib6" id="ref7">6</reflink>] posited that individuals gauge their sense of self-efficacy based on mastery experiences (i.e. engaging in a particular task and experiencing success), social modeling or vicarious experience, verbal or social persuasion, and emotional state (e.g. level of stress, anxiety). In the realm of self-efficacy related to parenting, several studies demonstrate the importance of social models, parents who share a social identity (e.g. parent of a child with a disability) in decreasing the effects of parental stress and postpartum depression (e.g. [<reflink idref="bib20" id="ref8">20</reflink>]; [<reflink idref="bib26" id="ref9">26</reflink>]). Observing others as they carry out parenting tasks creates opportunities in which parents can estimate their own ability to carry out that task. Bandura also asserted that parents' perceptions of their ability to successfully carry out their parenting role depends on their psychological or emotional state (e.g. anxiety and stress leading to inaction).</p> <p>Parental self-efficacy requires knowledge about appropriate childcare responses (e.g. soothing baby), confidence in their ability to engage in appropriate responses, and the belief that their child will respond contingently ([<reflink idref="bib9" id="ref10">9</reflink>]). It is parents' and caregivers' interpretation, or self-assessment, of their capacity and confidence to effectively parent their children that is the focus; thus, parental self-efficacy reflects a firsthand, subjective view of success, rather than an outsider's view. Previous studies with hearing children have shown that higher levels of parental self-efficacy are related to facilitative parenting behaviors (e.g. more instances of parental responsivity to child communication behaviors) and child outcomes (for a review see [<reflink idref="bib21" id="ref11">21</reflink>]).</p> <p>A parent might have a positive sense of self-efficacy in the general care of their child, while viewing themselves as less self-efficacious in managing tasks specific to new or unexpected circumstances, such as, for parents of children who are DHH, actively facilitating language development. Parental self-efficacy is also domain and task specific ([<reflink idref="bib31" id="ref12">31</reflink>]). In the case of DHH children, parents who receive early intervention services focusing on development more broadly rather than targeting the unique language needs of DHH children might convey a stronger sense of parental self-efficacy in supporting their child's general development compared to facilitating their child's language development.</p> <hd id="AN0181969923-3">Parental self-efficacy and language development</hd> <p>Research with typically hearing parent–child dyads demonstrate that parental self-efficacy functions as a predictor of positive parenting behaviors (i.e. responsiveness to infant communication). Subsequently, responsive parenting behaviors are strongly related to children's language growth ([<reflink idref="bib28" id="ref13">28</reflink>]). Mothers with a greater sense of parental self-efficacy demonstrate more responsivity and sensitivity in interactions with their children ([<reflink idref="bib30" id="ref14">30</reflink>]), and provide higher-quality linguistic input (e.g. longer utterances, more diverse vocabulary). In contrast, mothers who self-report lower parental self-efficacy demonstrate less positive parenting behaviors, such as fewer contingent responses to their children, use of more directives ([<reflink idref="bib10" id="ref15">10</reflink>]), and fewer types of words ([<reflink idref="bib28" id="ref16">28</reflink>]), that are not associated with positive language growth.</p> <p>A recent literature review reported mixed results in investigations of how parental self-efficacy relates to early language development ([<reflink idref="bib28" id="ref17">28</reflink>]). [<reflink idref="bib8" id="ref18">8</reflink>] demonstrate significant correlations between high levels of parental self-efficacy specific to language development (i.e. domain-specific parental self-efficacy) and language outcomes in hearing children. In a longitudinal study, [<reflink idref="bib2" id="ref19">2</reflink>] report significant correlations between parental self-efficacy of parents of infants (i.e. 2 months) and later expressive and receptive language (i.e. 18 months of age). However, a study with children diagnosed with disabilities associated with communication delays (e.g. general developmental delay, pervasive developmental disorder) indicated no significant association between parental self-efficacy and expressive and receptive language ([<reflink idref="bib19" id="ref20">19</reflink>]). [<reflink idref="bib17" id="ref21">17</reflink>] reported no associations between parental self-efficacy and vocabulary abilities in 3- to 5-year-old children.</p> <p>Several methodological considerations have been identified related to examining parental self-efficacy and early language development. Parental self-efficacy has been conceptualized in different ways in studies and has sometimes been conflated with parental confidence or self-esteem ([<reflink idref="bib31" id="ref22">31</reflink>]). [<reflink idref="bib28" id="ref23">28</reflink>] point to the need for "specific and aligned conceptual relations" in future research. They highlight the need for measuring aspects of early language development, specifically, recommending tools such as the MacArthur–Bates Communication Development Inventory ([<reflink idref="bib18" id="ref24">18</reflink>]) to assess areas of early social communicative behaviors. Selection of domain-specific measurement tools is essential. This is an important consideration as it relates to DHH children. For parents of DHH children, then, general parental self-efficacy tools may be too broad, as they pertain to parental self-efficacy in general child development, rather than language development.</p> <hd id="AN0181969923-4">Parental self-efficacy and language development in DHH children</hd> <p>Early parental self-efficacy studies with mothers of children who are DHH focused on two domains: mothers' belief in their capacity to care for their child's hearing devices (e.g. carrying out daily listening checks, adjusting device settings) and belief in their capacity to nurture their child's spoken language development (e.g. knowledge of how their child develops sounds, belief in the ability to positively affect their child's speech development) ([<reflink idref="bib12" id="ref25">12</reflink>], [<reflink idref="bib13" id="ref26">13</reflink>], [<reflink idref="bib14" id="ref27">14</reflink>]). Mothers have rated themselves relatively high in parental self-efficacy in both domains; however, differences emerged based on whether children used cochlear implants or hearing aids. Mothers of children with cochlear implants rate themselves higher in parental self-efficacy compared with mothers of children with hearing aids and consider themselves more involved in their child's early intervention ([<reflink idref="bib13" id="ref28">13</reflink>]), a difference DesJardin attributed to DHH children with cochlear implants receiving timelier audiological care and more intensive early intervention services compared to children with lesser degrees of hearing loss.</p> <p>Directionality between parental self-efficacy and linguistic input (i.e. quality and quantity) remains unspecified; however, studies indicate a positive relationship between parental self-efficacy and parental linguistic input in children who are DHH (e.g. [<reflink idref="bib14" id="ref29">14</reflink>]; [<reflink idref="bib15" id="ref30">15</reflink>]). Mothers who view themselves as more self-efficacious provide language that is higher in both quality (i.e. facilitative language techniques) and quantity (i.e. mean length of utterance, number of spoken word tokens and word types); in turn, better quality and quantity of linguistic input are positively related to stronger expressive and receptive spoken language skills ([<reflink idref="bib15" id="ref31">15</reflink>]). A study of mothers of DHH children aged 12–18 months found a positive correlation between perceived maternal self-efficacy and children's early developmental abilities, language skills, and adaptive behavior, and significant negative correlations with children's problem behaviors (i.e. externalizing, internalizing, dysregulation) ([<reflink idref="bib29" id="ref32">29</reflink>]). Furthermore, parental self-efficacy plays a mediating role, serving as "buffer" between the negative affect of parental stress on spoken language outcomes ([<reflink idref="bib7" id="ref33">7</reflink>]).</p> <p>More recently, [<reflink idref="bib4" id="ref34">4</reflink>] piloted a revised version of the Scale of Parental Involvement and Self-Efficacy (SPISE-R) with 61 parents of children with hearing aids and cochlear implants between the ages of 4 and 36 months. Results demonstrated that parents' knowledge and confidence scores were significantly associated with action scores and children's auditory access ([<reflink idref="bib4" id="ref35">4</reflink>]). The SPISE-R reflects multiple elements of parental self-efficacy (i.e. parents' beliefs, knowledge, confidence, and actions), providing an opportunity to delineate which aspects of parental self-efficacy relate to child outcomes (i.e. language development). Ambrose and colleagues examined the relationship between parents' beliefs, knowledge, confidence, and actions and language outcomes. Perceived confidence levels were associated with children's spoken language scores per the communication scale of the Developmental Profile-3 ([<reflink idref="bib3" id="ref36">3</reflink>]). Altogether, this body of work has informed our understanding of parental self-efficacy among parents with children who are DHH and highlights the importance of monitoring parental self-efficacy as a means of supporting early language development. Nonetheless, further research is needed to inform aspects of FCEI practices such as providing parents with knowledge and confidence to support their children's language development.</p> <p>The purpose of the current study is to provide an in-depth examination of specific aspects of parental self-efficacy (i.e. parents' beliefs, knowledge, confidence, and actions) using the newly revised SPISE-R ([<reflink idref="bib4" id="ref37">4</reflink>]). We also expand on the literature by using a more robust language measure to understand how parental self-efficacy relates to expressive and receptive spoken language skills.</p> <hd id="AN0181969923-5">Method</hd> <p></p> <hd id="AN0181969923-6">Participants</hd> <p>The present research study was approved by the Institutional Review Board at a major university in the Midwestern United States. Participants were primarily recruited from the clinical caseload at a nearby children's hospital and written consent was obtained prior to study initiation. Participants were evaluated as part of a larger longitudinal study investigating the social dynamics of parent–toddler play interactions (blinded citation). To be included in the present study, participants needed to provide parental self-efficacy and child language scores during the same testing visit. Additional inclusion criteria included (<reflink idref="bib1" id="ref38">1</reflink>) hearing aid (HA) fitting or cochlear implant (CI) activation by age 24 months; (<reflink idref="bib2" id="ref39">2</reflink>) English as the primary language in the home, defined as >70% in the home; and (<reflink idref="bib3" id="ref40">3</reflink>) no comorbid diagnoses. The final sample consisted of 24 dyads. This sample happened to include all mothers (fathers were not intentionally excluded), all of whom identified as White non-Hispanic. At the time of testing, toddlers averaged 33.74 months of age (<emph>SD</emph> = 5.90) and included 12 hearing aid users and 12 cochlear implant users. Etiology of hearing loss was unknown or not reported for most participants. Etiology reported included Pendred syndrome, enlarged vestibular aqueduct syndrome, Connexin, and cytomegalovirus. One child was exposed to Spanish in the home and five children were exposed to American Sign Language (data related to the extent American Sign Language was used in the home were not collected). See Tables 1 and 2 for demographic characteristics.</p> <p>Table 1 Parent demographic characteristics.</p> <p> <ephtml> <table><thead><tr><th>Characteristics. </th><th>Parents (<italic>n</italic> = 24). </th></tr></thead><tbody><tr><td>Maternal education</td><td /></tr><tr><td> High school graduate</td><td>6 (25%)</td></tr><tr><td> Associate degree</td><td>1 (4.2%)</td></tr><tr><td> Bachelor's degree</td><td>14 (58.3%)</td></tr><tr><td> Master's/PhD/professional degree</td><td>3 (12.5%)</td></tr><tr><td>Annual household income</td><td /></tr><tr><td> <$5,500–$24,999</td><td>1 (4.2%)</td></tr><tr><td> $25,000–$49,999</td><td>6 (25%)</td></tr><tr><td> $50,000–$99,999</td><td>6 (25%)</td></tr><tr><td> ≥$100,000</td><td>10 (41.6%)</td></tr><tr><td> No response</td><td>1 (4.2%)</td></tr></tbody></table> </ephtml> </p> <p>Table 1 Parent demographic characteristics.</p> <p> <ephtml> <table><thead><tr><th>Characteristics. </th><th>Parents (<italic>n</italic> = 24). </th></tr></thead><tbody><tr><td>Maternal education</td><td /></tr><tr><td> High school graduate</td><td>6 (25%)</td></tr><tr><td> Associate degree</td><td>1 (4.2%)</td></tr><tr><td> Bachelor's degree</td><td>14 (58.3%)</td></tr><tr><td> Master's/PhD/professional degree</td><td>3 (12.5%)</td></tr><tr><td>Annual household income</td><td /></tr><tr><td> <$5,500–$24,999</td><td>1 (4.2%)</td></tr><tr><td> $25,000–$49,999</td><td>6 (25%)</td></tr><tr><td> $50,000–$99,999</td><td>6 (25%)</td></tr><tr><td> ≥$100,000</td><td>10 (41.6%)</td></tr><tr><td> No response</td><td>1 (4.2%)</td></tr></tbody></table> </ephtml> </p> <p>Table 2 Child demographic characteristics.</p> <p> <ephtml> <table><thead><tr><th>Characteristic. </th><th><italic>M</italic> (<italic>SD</italic>; range). </th></tr></thead><tbody><tr><td>Age at test (months)</td><td>33.74 (5.9; 27–52)</td></tr><tr><td>Hearing device</td><td /></tr><tr><td> Hearing aids<xref ref-type="fn" rid="tfn1" /></td><td>12 (50%)</td></tr><tr><td> Cochlear implants<xref ref-type="fn" rid="tfn2" /></td><td>12 (50%)</td></tr><tr><td>Age at first CI activation</td><td /></tr><tr><td> ≤12 months</td><td>9</td></tr><tr><td> ≥12 months</td><td>1</td></tr><tr><td>Age at first HA fitting</td><td /></tr><tr><td> ≤3 months</td><td>2</td></tr><tr><td> ≥3 months</td><td>4</td></tr><tr><td>Sex</td><td /></tr><tr><td> Female</td><td>13</td></tr><tr><td> Male</td><td>11</td></tr><tr><td>Race/ethnicity</td><td /></tr><tr><td> White/non-Hispanic</td><td>24 (100%)</td></tr></tbody></table> </ephtml> </p> <p>Table 2 Child demographic characteristics.</p> <p> <ephtml> <table><thead><tr><th>Characteristic. </th><th><italic>M</italic> (<italic>SD</italic>; range). </th></tr></thead><tbody><tr><td>Age at test (months)</td><td>33.74 (5.9; 27–52)</td></tr><tr><td>Hearing device</td><td /></tr><tr><td> Hearing aids<xref ref-type="fn" rid="tfn1" /></td><td>12 (50%)</td></tr><tr><td> Cochlear implants<xref ref-type="fn" rid="tfn2" /></td><td>12 (50%)</td></tr><tr><td>Age at first CI activation</td><td /></tr><tr><td> ≤12 months</td><td>9</td></tr><tr><td> ≥12 months</td><td>1</td></tr><tr><td>Age at first HA fitting</td><td /></tr><tr><td> ≤3 months</td><td>2</td></tr><tr><td> ≥3 months</td><td>4</td></tr><tr><td>Sex</td><td /></tr><tr><td> Female</td><td>13</td></tr><tr><td> Male</td><td>11</td></tr><tr><td>Race/ethnicity</td><td /></tr><tr><td> White/non-Hispanic</td><td>24 (100%)</td></tr></tbody></table> </ephtml> </p> <p>1 aAge at first hearing aid fitting is missing for five children.</p> <p>2 bAge at first cochlear implant activation is missing for one child.</p> <hd id="AN0181969923-7">Measures</hd> <p>Parental self-efficacy</p> <p>The Scale of Parental Involvement and Self-Efficacy-Revised (SPISE-R) is a self-report questionnaire for parents of children who are DHH ([<reflink idref="bib4" id="ref41">4</reflink>]). The SPISE-R measures parents' perceptions of their beliefs, knowledge, confidence, and actions when supporting their child's auditory development/auditory access and spoken language development. Items relating to parental beliefs, knowledge, confidence, and actions are rated on a 1 ("not at all") to 7 ("a great deal") Likert scale, such that higher scores indicate higher self-efficacy within a domain. The SPISE-R has strong internal consistency (Cronbach's α values range from.89 to.92), though work is still needed to establish test–retest reliability and construct validity ([<reflink idref="bib4" id="ref42">4</reflink>]). Parents completed the SPISE-R through REDCap, a secure web application for building and managing online surveys and collecting data.</p> <p>Scores on the Beliefs domain are reported item by item (rather than resulting in a total section score), allowing for between-item comparisons. Three items are positively keyed indicating higher scores are desirable: (a) if children are given the right supports, they can overcome the effects of hearing loss, (b) how my family talks to and interacts with my child will have a big impact on how my child develops, and (c) my child's hearing devices help him/her communicate. Four items are negatively keyed, indicating that disagreement is more desirable: (d) no matter what we do as a family, my child's development will be delayed compared to children with normal hearing; (e) if people see my child wearing his/her hearing devices, they will judge my child or family; (f) if I keep my home too quiet, my child won't learn to listen in noise; and (g) if children wear their hearing devices all the time, they will become overly dependent on them. The negatively keyed items are reversed scored upon completion of the section.</p> <p>The Knowledge, Confidence, and Actions sections include items specific to auditory development/auditory access or facilitating spoken language development. Example items from the Knowledge section include (a) how to manage my child's hearing devices, (b) how to share a book with my child in a way that helps him/her learn to communicate, and (c) strategies the interventionist recommends using to help my child learn to communicate. The Confidence section includes items such as (a) put and keep my child's hearing devices on him/her, (b) help my child hear by making changes in his/her environment, and (c) help my child learn to say new sounds, words, or sentences. The Actions section includes items such as (a) make sure other people caring for my child know how to help my child learn to communicate, and (b) advocate for my child's needs in intervention sessions and IFSP/IEP (Individualized Family Service Plan/Individualized Education Program) meetings. The Actions section also includes items related to parental involvement in intervention. A final section queries parents on their child's sensory auditory access (e.g. number of hours used during waking hours).</p> <p>Language skills</p> <p>The Preschool Language Scales-Fifth Edition (PLS-5) is a play-based assessment which measures receptive and expressive language skills in children from birth to age 7 years ([<reflink idref="bib35" id="ref43">35</reflink>]). It is a well-validated norm-referenced assessment, with strong psychometric properties (internal consistency <emph>r</emph> =.93–.98, test–retest stability <emph>r</emph> =.96–.98; [<reflink idref="bib35" id="ref44">35</reflink>]). The PLS-5 provides standard scores for auditory comprehension, expressive communication, and a composite total language score (<emph>M</emph> = 100, <emph>SD</emph> = 15). In the present study, the PLS-5 was administered in spoken English by a research speech-language pathologist with experience assessing children who are DHH.</p> <hd id="AN0181969923-8">Data analyses</hd> <p>Descriptive statistics were carried out for each domain (parental beliefs, knowledge, confidence, and actions) of the SPISE-R. Correlations between SPISE-R and PLS-5 scores were carried out to examine the relationship with parental self-efficacy and child language skills. Consistent with previous findings, we predicted that higher parental self-efficacy scores would be associated with higher child language scores.</p> <hd id="AN0181969923-9">Results</hd> <p></p> <hd id="AN0181969923-10">Parental self-efficacy</hd> <p>Beliefs</p> <p>The Beliefs domain queries parents on how much they share beliefs concerning auditory development/auditory access and supporting spoken language development in their children. The average scores for all seven items were above the midpoint of 4 on the scale (range = 4.46–6.67), indicating that mothers tended to endorse items above "Somewhat." The range for individual item endorsement varied, such that two items revealed a range of scores from 2 to 7, two items revealed a range of scores from 3 to 7, while the remaining three items revealed a range of scores from 4 to 7. See Table 3 for item-by-item data on parents' beliefs.</p> <p>Table 3 SPISE-R Beliefs descriptive data.</p> <p> <ephtml> <table><thead><tr><th>Code. </th><th>Items. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>B1</td><td>"If children are given the right supports, they can overcome the effects of hearing loss"</td><td>6.29</td><td>1.23</td><td>2–7</td></tr><tr><td>B2</td><td>"How my family talks to and interacts with my child will have a big impact on how he/she develops"</td><td>6.67</td><td>0.48</td><td>6–7</td></tr><tr><td>B3</td><td>"No matter what we do as a family, my child's development will be delayed compared to children with normal hearing"</td><td>6.00</td><td>1.18</td><td>3–7</td></tr><tr><td>B4</td><td>"My child's hearing device(s) help him/her learn to communicate"</td><td>6.63</td><td>0.71</td><td>4–7</td></tr><tr><td>B5</td><td>"If people see my child wearing his/her hearing device(s), they will judge my child or my family"</td><td>5.38</td><td>1.21</td><td>3–7</td></tr><tr><td>B6</td><td>"If I keep my home too quiet, my child won't learn to listen in noise"</td><td>4.46</td><td>1.64</td><td>2–7</td></tr><tr><td>B7</td><td>"If children wear their hearing device(s) all the time, they will become overly dependent on them"</td><td>6.29</td><td>0.91</td><td>4–7</td></tr></tbody></table> </ephtml> </p> <p>Table 3 SPISE-R Beliefs descriptive data.</p> <p> <ephtml> <table><thead><tr><th>Code. </th><th>Items. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>B1</td><td>"If children are given the right supports, they can overcome the effects of hearing loss"</td><td>6.29</td><td>1.23</td><td>2–7</td></tr><tr><td>B2</td><td>"How my family talks to and interacts with my child will have a big impact on how he/she develops"</td><td>6.67</td><td>0.48</td><td>6–7</td></tr><tr><td>B3</td><td>"No matter what we do as a family, my child's development will be delayed compared to children with normal hearing"</td><td>6.00</td><td>1.18</td><td>3–7</td></tr><tr><td>B4</td><td>"My child's hearing device(s) help him/her learn to communicate"</td><td>6.63</td><td>0.71</td><td>4–7</td></tr><tr><td>B5</td><td>"If people see my child wearing his/her hearing device(s), they will judge my child or my family"</td><td>5.38</td><td>1.21</td><td>3–7</td></tr><tr><td>B6</td><td>"If I keep my home too quiet, my child won't learn to listen in noise"</td><td>4.46</td><td>1.64</td><td>2–7</td></tr><tr><td>B7</td><td>"If children wear their hearing device(s) all the time, they will become overly dependent on them"</td><td>6.29</td><td>0.91</td><td>4–7</td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph>. Items were scored on a 7-point Likert scale; 1 = not at all, 7 = a great deal.</p> <p>Knowledge, confidence, and actions</p> <p>Average scores for knowledge, confidence, and actions were relatively high (<emph>M</emph> = 6.1, <emph>SD</emph> = 0.68, <emph>M</emph> = 6.17, <emph>SD</emph> = 0.73, and <emph>M</emph> = 6, <emph>SD</emph> = 0.61, respectively). Scores for auditory access and spoken language development subsections contribute some variability to total section scores. See Table 4 for descriptive data for parents' knowledge, confidence, and actions.</p> <p>Table 4 SPISE-R Knowledge, Confidence, and Actions descriptive data</p> <p> <ephtml> <table><thead><tr><th>. </th><th colspan="3">Knowledge. </th><th colspan="3">Confidence. </th><th colspan="3">Actions. </th></tr><tr><th>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Auditory access subsection</td><td>6.17</td><td>0.73</td><td>5–7</td><td>6.23</td><td>0.66</td><td>4.6–7</td><td>5.72</td><td>0.87</td><td>4.14–7</td></tr><tr><td>Language development subsection</td><td>6.06</td><td>0.93</td><td>3.4–7</td><td>6.10</td><td>0.80</td><td>4.8–7</td><td>6.23</td><td>0.74</td><td>4.8–7</td></tr><tr><td>Involvement in intervention</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>6.71</td><td>0.4</td><td>6–7</td></tr><tr><td>Total section</td><td>6.1</td><td>0.68</td><td>4.6–7</td><td>6.17</td><td>0.73</td><td>4.9–7</td><td>6</td><td>0.61</td><td>5–7</td></tr></tbody></table> </ephtml> </p> <p>Table 4 SPISE-R Knowledge, Confidence, and Actions descriptive data</p> <p> <ephtml> <table><thead><tr><th>. </th><th colspan="3">Knowledge. </th><th colspan="3">Confidence. </th><th colspan="3">Actions. </th></tr><tr><th>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Auditory access subsection</td><td>6.17</td><td>0.73</td><td>5–7</td><td>6.23</td><td>0.66</td><td>4.6–7</td><td>5.72</td><td>0.87</td><td>4.14–7</td></tr><tr><td>Language development subsection</td><td>6.06</td><td>0.93</td><td>3.4–7</td><td>6.10</td><td>0.80</td><td>4.8–7</td><td>6.23</td><td>0.74</td><td>4.8–7</td></tr><tr><td>Involvement in intervention</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>6.71</td><td>0.4</td><td>6–7</td></tr><tr><td>Total section</td><td>6.1</td><td>0.68</td><td>4.6–7</td><td>6.17</td><td>0.73</td><td>4.9–7</td><td>6</td><td>0.61</td><td>5–7</td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph>. Items were scored on a 7-point Likert scale; 1 = not at all, 7 = a great deal/very/always for Knowledge, Confidence, and Actions, respectively.</p> <p>An item-by-item analysis of the Knowledge, Confidence, and Actions sections indicate variability (range 0.62–2.25, respectively) in parents' perception of their knowledge, confidence, and ability to act related to auditory access and spoken language development. Mean scores on the Knowledge section indicate little variability in parents' knowledge about auditory access and spoken language development (range 6.33–5.71).</p> <p>The Actions section mean scores indicate the highest variability ranging from 4.21 (<emph>SD</emph> = 1.89) for "Daily check of my child's listening with the Ling 6-Sound test (ah, ee, oo, m, sh, s)" on the low end and 6.46 (0.88) for <bold>"</bold>Mak[ing] sure other people caring for my child know how to manage my child's hearing device(s)." Parents rated items for their involvement in intervention very high, within 0.6 of the highest score with little variability (range 6.4–6.79). See Tables 5–7 for item-by-item descriptive data.</p> <p>Table 5 SPISE-R Knowledge item-by-item descriptive data</p> <p> <ephtml> <table><thead><tr><th>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Auditory items</td><td /><td /><td /></tr><tr><td> How to manage my child's hearing device(s)</td><td>6.29</td><td>0.91</td><td>4–7</td></tr><tr><td> Strategies to use to keep my child's hearing device(s) on him/her</td><td>6.17</td><td>1.05</td><td>3–7</td></tr><tr><td> What my child can and cannot hear WITHOUT his/her hearing device(s)</td><td>5.71</td><td>1.6</td><td>1–7</td></tr><tr><td> What my child can and cannot hear WITH his/her hearing device(s)</td><td>6.04</td><td>1.08</td><td>3–7</td></tr><tr><td> How to do the Ling 6-Sound test (ah, ee, oo, m, sh, s)</td><td>6.5</td><td>0.78</td><td>5–7</td></tr><tr><td>Language development items</td><td /><td /><td /></tr><tr><td> The sounds, words, or sentence types my child should be learning to say</td><td>6.04</td><td>1.12</td><td>3–7</td></tr><tr><td> How to help my child learn to communicate</td><td>6.12</td><td>1.19</td><td>2–7</td></tr><tr><td> How my child's learning is affected by his/her hearing loss</td><td>5.71</td><td>1.37</td><td>2–7</td></tr><tr><td> How to share a book with my child in a way that helps him/her learn to communicate</td><td>6.08</td><td>1.02</td><td>4–7</td></tr><tr><td> Strategies the interventionist recommends using to help my child learn to communicate</td><td>6.33</td><td>0.7</td><td>5–7</td></tr></tbody></table> </ephtml> </p> <p>Table 5 SPISE-R Knowledge item-by-item descriptive data</p> <p> <ephtml> <table><thead><tr><th>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Auditory items</td><td /><td /><td /></tr><tr><td> How to manage my child's hearing device(s)</td><td>6.29</td><td>0.91</td><td>4–7</td></tr><tr><td> Strategies to use to keep my child's hearing device(s) on him/her</td><td>6.17</td><td>1.05</td><td>3–7</td></tr><tr><td> What my child can and cannot hear WITHOUT his/her hearing device(s)</td><td>5.71</td><td>1.6</td><td>1–7</td></tr><tr><td> What my child can and cannot hear WITH his/her hearing device(s)</td><td>6.04</td><td>1.08</td><td>3–7</td></tr><tr><td> How to do the Ling 6-Sound test (ah, ee, oo, m, sh, s)</td><td>6.5</td><td>0.78</td><td>5–7</td></tr><tr><td>Language development items</td><td /><td /><td /></tr><tr><td> The sounds, words, or sentence types my child should be learning to say</td><td>6.04</td><td>1.12</td><td>3–7</td></tr><tr><td> How to help my child learn to communicate</td><td>6.12</td><td>1.19</td><td>2–7</td></tr><tr><td> How my child's learning is affected by his/her hearing loss</td><td>5.71</td><td>1.37</td><td>2–7</td></tr><tr><td> How to share a book with my child in a way that helps him/her learn to communicate</td><td>6.08</td><td>1.02</td><td>4–7</td></tr><tr><td> Strategies the interventionist recommends using to help my child learn to communicate</td><td>6.33</td><td>0.7</td><td>5–7</td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph>. Items were scored on a 7-point Likert scale; 1 = not at all, 7 = a great deal.</p> <p>Table 6 SPISE-R Confidence item-by-item descriptive data</p> <p> <ephtml> <table><thead><tr><th>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Auditory access items</td><td /><td /><td /></tr><tr><td> Determine if my child's hearing device(s) are working okay</td><td>6.50</td><td>0.66</td><td>5–7</td></tr><tr><td> Put and keep my child's hearing device(s) on him/her</td><td>6.54</td><td>0.78</td><td>4–7</td></tr><tr><td> Help my child hear by making change in his/her environment</td><td>6.00</td><td>1.5</td><td>2–7</td></tr><tr><td> Help my child hear and understand new speech sounds or sounds in his/her environment</td><td>6.00</td><td>1.2</td><td>2–7</td></tr><tr><td> Find out if my child is hearing okay by using the Ling 6-Sound test (ah, ee, oo, m, sh, s)</td><td>6.17</td><td>1.13</td><td>3–7</td></tr><tr><td>Language development items</td><td /><td /><td /></tr><tr><td> Help my child learn to say new sounds, words, or sentences</td><td>6.17</td><td>0.87</td><td>4–7</td></tr><tr><td> Help my child communicate what he/she wants and needs</td><td>5.83</td><td>1.05</td><td>3–7</td></tr><tr><td> Communicate with my child in a way that is appropriate to address his/her hearing needs</td><td>6.04</td><td>1.04</td><td>3–7</td></tr><tr><td> Share books with my child in a way that helps him/her learn to communicate</td><td>6.12</td><td>1.04</td><td>4–7</td></tr><tr><td> Do the things I learned during intervention sessions when the professional is not there to help me</td><td>6.33</td><td>0.76</td><td>5–7</td></tr></tbody></table> </ephtml> </p> <p>Table 6 SPISE-R Confidence item-by-item descriptive data</p> <p> <ephtml> <table><thead><tr><th>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Auditory access items</td><td /><td /><td /></tr><tr><td> Determine if my child's hearing device(s) are working okay</td><td>6.50</td><td>0.66</td><td>5–7</td></tr><tr><td> Put and keep my child's hearing device(s) on him/her</td><td>6.54</td><td>0.78</td><td>4–7</td></tr><tr><td> Help my child hear by making change in his/her environment</td><td>6.00</td><td>1.5</td><td>2–7</td></tr><tr><td> Help my child hear and understand new speech sounds or sounds in his/her environment</td><td>6.00</td><td>1.2</td><td>2–7</td></tr><tr><td> Find out if my child is hearing okay by using the Ling 6-Sound test (ah, ee, oo, m, sh, s)</td><td>6.17</td><td>1.13</td><td>3–7</td></tr><tr><td>Language development items</td><td /><td /><td /></tr><tr><td> Help my child learn to say new sounds, words, or sentences</td><td>6.17</td><td>0.87</td><td>4–7</td></tr><tr><td> Help my child communicate what he/she wants and needs</td><td>5.83</td><td>1.05</td><td>3–7</td></tr><tr><td> Communicate with my child in a way that is appropriate to address his/her hearing needs</td><td>6.04</td><td>1.04</td><td>3–7</td></tr><tr><td> Share books with my child in a way that helps him/her learn to communicate</td><td>6.12</td><td>1.04</td><td>4–7</td></tr><tr><td> Do the things I learned during intervention sessions when the professional is not there to help me</td><td>6.33</td><td>0.76</td><td>5–7</td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph>. Items were scored on a 7-point Likert scale; 1 = not at all, 7 = very.</p> <p>Table 7 SPISE-R Actions item-by-item descriptive data.</p> <p> <ephtml> <table><thead><tr><th>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Auditory access items</td><td /><td /><td /></tr><tr><td> Daily listening checks on my child's hearing device(s)</td><td>4.92</td><td>1.98</td><td>1–7</td></tr><tr><td> Make sure other people caring for my child know how to manage my child's hearing device(s)</td><td>6.46</td><td>0.88</td><td>4–7</td></tr><tr><td> Make sure I, or someone else, puts my child's hearing device(s) on immediately AFTER HE/SHE WAKES UP</td><td>6.33</td><td>0.76</td><td>4–7</td></tr><tr><td> Make sure I, or someone else, puts my child's hearing device(s) on immediately IF THEY FALL OFF OR my child TAKES THEM OFF</td><td>6.21</td><td>0.98</td><td>4–7</td></tr><tr><td> Make sure my child's environment makes it as easy as possible for him/her to hear</td><td>6.04</td><td>0.81</td><td>4–7</td></tr><tr><td> Draw my child's attention to sounds in speech or the environment that he/she is still learning or might not have heard</td><td>5.88</td><td>1.19</td><td>3–7</td></tr><tr><td> Daily check of my child's listening with the Ling 6-Sound test (ah, ee, oo, m, sh, s)</td><td>4.21</td><td>1.89</td><td>1–7</td></tr><tr><td>Language development items</td><td /><td /><td /></tr><tr><td> Use strategies during our daily activities to help my child learn to say new sounds words, or sentences</td><td>6.21</td><td>0.88</td><td>4–7</td></tr><tr><td> Use strategies to help my child communicate his/her wants and needs</td><td>6.33</td><td>0.82</td><td>4–7</td></tr><tr><td> Make sure other people caring for my child know how to help my child learn to communicate</td><td>6.17</td><td>0.82</td><td>4–7</td></tr><tr><td> Share books with my child at least one time a day</td><td>6.25</td><td>0.94</td><td>4–7</td></tr><tr><td> Use the strategies I learned during intervention sessions to help my child learn to communicate</td><td>6.17</td><td>0.87</td><td>5–7</td></tr><tr><td>Involvement in intervention items</td><td /><td /><td /></tr><tr><td> Advocate for my child's needs in intervention sessions and IFSP/IEP</td><td>6.54</td><td>0.78</td><td>4–7</td></tr><tr><td> Get my child to the audiologist as soon as a visit is needed</td><td>6.79</td><td>.42</td><td>6–7</td></tr><tr><td> Attend and be involved in my child's intervention sessions (instead of having to do other things during that time, such as prepare meals or take care of siblings)</td><td>6.79</td><td>0.42</td><td>6–7</td></tr></tbody></table> </ephtml> </p> <p>Table 7 SPISE-R Actions item-by-item descriptive data.</p> <p> <ephtml> <table><thead><tr><th>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Auditory access items</td><td /><td /><td /></tr><tr><td> Daily listening checks on my child's hearing device(s)</td><td>4.92</td><td>1.98</td><td>1–7</td></tr><tr><td> Make sure other people caring for my child know how to manage my child's hearing device(s)</td><td>6.46</td><td>0.88</td><td>4–7</td></tr><tr><td> Make sure I, or someone else, puts my child's hearing device(s) on immediately AFTER HE/SHE WAKES UP</td><td>6.33</td><td>0.76</td><td>4–7</td></tr><tr><td> Make sure I, or someone else, puts my child's hearing device(s) on immediately IF THEY FALL OFF OR my child TAKES THEM OFF</td><td>6.21</td><td>0.98</td><td>4–7</td></tr><tr><td> Make sure my child's environment makes it as easy as possible for him/her to hear</td><td>6.04</td><td>0.81</td><td>4–7</td></tr><tr><td> Draw my child's attention to sounds in speech or the environment that he/she is still learning or might not have heard</td><td>5.88</td><td>1.19</td><td>3–7</td></tr><tr><td> Daily check of my child's listening with the Ling 6-Sound test (ah, ee, oo, m, sh, s)</td><td>4.21</td><td>1.89</td><td>1–7</td></tr><tr><td>Language development items</td><td /><td /><td /></tr><tr><td> Use strategies during our daily activities to help my child learn to say new sounds words, or sentences</td><td>6.21</td><td>0.88</td><td>4–7</td></tr><tr><td> Use strategies to help my child communicate his/her wants and needs</td><td>6.33</td><td>0.82</td><td>4–7</td></tr><tr><td> Make sure other people caring for my child know how to help my child learn to communicate</td><td>6.17</td><td>0.82</td><td>4–7</td></tr><tr><td> Share books with my child at least one time a day</td><td>6.25</td><td>0.94</td><td>4–7</td></tr><tr><td> Use the strategies I learned during intervention sessions to help my child learn to communicate</td><td>6.17</td><td>0.87</td><td>5–7</td></tr><tr><td>Involvement in intervention items</td><td /><td /><td /></tr><tr><td> Advocate for my child's needs in intervention sessions and IFSP/IEP</td><td>6.54</td><td>0.78</td><td>4–7</td></tr><tr><td> Get my child to the audiologist as soon as a visit is needed</td><td>6.79</td><td>.42</td><td>6–7</td></tr><tr><td> Attend and be involved in my child's intervention sessions (instead of having to do other things during that time, such as prepare meals or take care of siblings)</td><td>6.79</td><td>0.42</td><td>6–7</td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph>. Items were scored on a 7-point Likert scale; 1 = not at all, 7 = always. IFSP = Individualized Family Service Plan; IEP = Individualized Education Program.</p> <hd id="AN0181969923-11">Language skills</hd> <p>On average, children's total language scores fell within 1 <emph>SD</emph> of the normative mean of 100 (<emph>M</emph> = 97.54, <emph>SD</emph> = 15.37). Children's total language scores varied, and as expected, their standard scores exhibited wide variability (range 63–127). Auditory comprehension and expressive communication were also within 1 <emph>SD</emph> of the mean and widely variable (<emph>M</emph> = 98.46, <emph>SD</emph> = 14.40, range 60–127 and <emph>M</emph> = 97.38, <emph>SD</emph> = 12.58, range 69–123, respectively).</p> <hd id="AN0181969923-12">Correlations between parental self-efficacy and child language skills</hd> <p>A series of Pearson bivariate correlation calculations were carried out to examine the relationship between parental self-efficacy and child language outcomes. Generally, parents' sense of self-efficacy did not correlate with language outcomes. Statistically significant correlations were not found between the Knowledge, Confidence, and Actions sections of the SPISE-R and auditory comprehension, expressive communication, and total language scores on the PLS-5 (<emph>p</emph> >.05).</p> <p>However, several individual items among the Beliefs and Actions sections were positively correlated with auditory comprehension, expressive communication, and/or total language scores. The SPISE-R belief item "No matter what we do as a family, my child's development will be delayed compared to children with normal hearing" was weakly to moderately positively correlated with children's auditory comprehension (<emph>r</emph> =.45, <emph>p</emph> =.03) and moderately positively correlated with expressive communication (<emph>r</emph> =.64, <emph>p</emph> <.001) and total language (<emph>r</emph> =.55, <emph>p</emph> =.01).</p> <p>Two items in the Actions section revealed weak to moderate positive correlations with language outcomes. Higher self-ratings on "Use strategies to help my child communicate his/her wants and needs" were weakly to moderately positively related to children's expressive communication (<emph>r =</emph>.45, <emph>p</emph> =.03) and total language scores (<emph>r</emph> =.43, <emph>p</emph> =.04). Higher self-ratings on "Attend and be involved in my child's intervention sessions (instead of having to do other things during that time, such as prepare meals or take care of siblings)" was weakly positively related to children's expressive communication (<emph>r</emph> =.47, <emph>p</emph> =.02). No significant correlations were found between SPISE-R Confidence items and PLS-5 scores. See Tables 8 and 9 for correlations.</p> <p>Table 8 Correlations between SPISE-R Beliefs items and PLS-5 standard scores.</p> <p> <ephtml> <table><thead><tr><th colspan="2">. </th><th>Auditory comprehension. </th><th>Expressive communication. </th><th>Total language. </th></tr></thead><tbody><tr><td>B1</td><td>Pearson correlation</td><td>.345</td><td>.279</td><td>.324</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.098</td><td>.188</td><td>.122</td></tr><tr><td>B2</td><td>Pearson correlation</td><td>.209</td><td>.359</td><td>.278</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.327</td><td>.085</td><td>.188</td></tr><tr><td>B3</td><td>Pearson correlation</td><td>.454</td><td>.636</td><td>.547</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.026<sup>*</sup></td><td><.001<sup>**</sup></td><td>.006<sup>**</sup></td></tr><tr><td>B4</td><td>Pearson correlation</td><td>−.257</td><td>−.261</td><td>−.275</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.226</td><td>.219</td><td>.193</td></tr><tr><td>B5</td><td>Pearson correlation</td><td>−.135</td><td>−.058</td><td>−.110</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.531</td><td>.787</td><td>.610</td></tr><tr><td>B6</td><td>Pearson correlation</td><td>−.026</td><td>−.051</td><td>−.046</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.903</td><td>.814</td><td>.829</td></tr><tr><td>B7</td><td>Pearson correlation</td><td>−0.10</td><td>−0.17</td><td>−0.14</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.64</td><td>.43</td><td>.51</td></tr></tbody></table> </ephtml> </p> <p>Table 8 Correlations between SPISE-R Beliefs items and PLS-5 standard scores.</p> <p> <ephtml> <table><thead><tr><th colspan="2">. </th><th>Auditory comprehension. </th><th>Expressive communication. </th><th>Total language. </th></tr></thead><tbody><tr><td>B1</td><td>Pearson correlation</td><td>.345</td><td>.279</td><td>.324</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.098</td><td>.188</td><td>.122</td></tr><tr><td>B2</td><td>Pearson correlation</td><td>.209</td><td>.359</td><td>.278</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.327</td><td>.085</td><td>.188</td></tr><tr><td>B3</td><td>Pearson correlation</td><td>.454</td><td>.636</td><td>.547</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.026<sup>*</sup></td><td><.001<sup>**</sup></td><td>.006<sup>**</sup></td></tr><tr><td>B4</td><td>Pearson correlation</td><td>−.257</td><td>−.261</td><td>−.275</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.226</td><td>.219</td><td>.193</td></tr><tr><td>B5</td><td>Pearson correlation</td><td>−.135</td><td>−.058</td><td>−.110</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.531</td><td>.787</td><td>.610</td></tr><tr><td>B6</td><td>Pearson correlation</td><td>−.026</td><td>−.051</td><td>−.046</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.903</td><td>.814</td><td>.829</td></tr><tr><td>B7</td><td>Pearson correlation</td><td>−0.10</td><td>−0.17</td><td>−0.14</td></tr><tr><td /><td>Sig. (2-tailed)</td><td>.64</td><td>.43</td><td>.51</td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph>. See Table 3 for beliefs items according to codes.</p> <p>*<emph>p</emph> <.05, two-tailed. **<emph>p</emph> <.01, two-tailed.</p> <p>Table 9 Correlations between SPISE-R Actions items and PLS-5 standard scores.</p> <p> <ephtml> <table><thead><tr><th colspan="2">. </th><th>Auditory comprehension. </th><th>Expressive communication. </th><th>Total language. </th></tr></thead><tbody><tr><td rowspan="2">Act_aud_1</td><td>Pearson correlation</td><td>.024</td><td>−.065</td><td>−.020</td></tr><tr><td>Sig. (2-tailed)</td><td>.910</td><td>.762</td><td>.926</td></tr><tr><td rowspan="2">Act_aud_2</td><td>Pearson correlation</td><td>.123</td><td>.125</td><td>.131</td></tr><tr><td>Sig. (2-tailed)</td><td>.566</td><td>.562</td><td>.540</td></tr><tr><td rowspan="2">Act_aud_3</td><td>Pearson correlation</td><td>.181</td><td>.377</td><td>.266</td></tr><tr><td>Sig. (2-tailed)</td><td>.397</td><td>.070</td><td>.208</td></tr><tr><td rowspan="2">Act_aud_4</td><td>Pearson correlation</td><td>.046</td><td>.170</td><td>.094</td></tr><tr><td>Sig. (2-tailed)</td><td>.831</td><td>.427</td><td>.664</td></tr><tr><td rowspan="2">Act_aud_5</td><td>Pearson correlation</td><td>.288</td><td>.324</td><td>.307</td></tr><tr><td>Sig. (2-tailed)</td><td>.172</td><td>.122</td><td>.145</td></tr><tr><td rowspan="2">Act_aud_6</td><td>Pearson correlation</td><td>.122</td><td>.122</td><td>.127</td></tr><tr><td>Sig. (2-tailed)</td><td>.569</td><td>.569</td><td>.553</td></tr><tr><td rowspan="2">Act_aud_7</td><td>Pearson correlation</td><td>−.284</td><td>−.293</td><td>−.293</td></tr><tr><td>Sig. (2-tailed)</td><td>.179</td><td>.165</td><td>.164</td></tr><tr><td rowspan="2">Act_lang_1</td><td>Pearson correlation</td><td>.100</td><td>.259</td><td>.177</td></tr><tr><td>Sig. (2-tailed)</td><td>.643</td><td>.222</td><td>.408</td></tr><tr><td rowspan="2">Act_lang_2</td><td>Pearson correlation</td><td>.380</td><td>.453<xref ref-type="fn" rid="tfn3" /></td><td>.425<xref ref-type="fn" rid="tfn3" /></td></tr><tr><td>Sig. (2-tailed)</td><td>.067</td><td>.026</td><td>.038</td></tr><tr><td rowspan="2">Act_lang_3</td><td>Pearson correlation</td><td>.038</td><td>.171</td><td>.093</td></tr><tr><td>Sig. (2-tailed)</td><td>.861</td><td>.423</td><td>.666</td></tr><tr><td rowspan="2">Act_lang_4</td><td>Pearson correlation</td><td>.089</td><td>.233</td><td>.158</td></tr><tr><td>Sig. (2-tailed)</td><td>.678</td><td>.273</td><td>.461</td></tr><tr><td rowspan="2">Act_lang_5</td><td>Pearson correlation</td><td>.307</td><td>.356</td><td>.342</td></tr><tr><td>Sig. (2-tailed)</td><td>.144</td><td>.088</td><td>.102</td></tr><tr><td rowspan="2">Act_inv_1</td><td>Pearson correlation</td><td>−.111</td><td>−.141</td><td>−.127</td></tr><tr><td>Sig. (2-tailed)</td><td>.607</td><td>.510</td><td>.553</td></tr><tr><td rowspan="2">Act_inv_2</td><td>Pearson correlation</td><td>−.023</td><td>.149</td><td>.053</td></tr><tr><td>Sig. (2-tailed)</td><td>.916</td><td>.487</td><td>.807</td></tr><tr><td rowspan="2">Act_inv_3</td><td>Pearson correlation</td><td>.326</td><td>.465<xref ref-type="fn" rid="tfn3" /></td><td>.400</td></tr><tr><td>Sig. (2-tailed)</td><td>.120</td><td>.022</td><td>.052</td></tr></tbody></table> </ephtml> </p> <p>Table 9 Correlations between SPISE-R Actions items and PLS-5 standard scores.</p> <p> <ephtml> <table><thead><tr><th colspan="2">. </th><th>Auditory comprehension. </th><th>Expressive communication. </th><th>Total language. </th></tr></thead><tbody><tr><td rowspan="2">Act_aud_1</td><td>Pearson correlation</td><td>.024</td><td>−.065</td><td>−.020</td></tr><tr><td>Sig. (2-tailed)</td><td>.910</td><td>.762</td><td>.926</td></tr><tr><td rowspan="2">Act_aud_2</td><td>Pearson correlation</td><td>.123</td><td>.125</td><td>.131</td></tr><tr><td>Sig. (2-tailed)</td><td>.566</td><td>.562</td><td>.540</td></tr><tr><td rowspan="2">Act_aud_3</td><td>Pearson correlation</td><td>.181</td><td>.377</td><td>.266</td></tr><tr><td>Sig. (2-tailed)</td><td>.397</td><td>.070</td><td>.208</td></tr><tr><td rowspan="2">Act_aud_4</td><td>Pearson correlation</td><td>.046</td><td>.170</td><td>.094</td></tr><tr><td>Sig. (2-tailed)</td><td>.831</td><td>.427</td><td>.664</td></tr><tr><td rowspan="2">Act_aud_5</td><td>Pearson correlation</td><td>.288</td><td>.324</td><td>.307</td></tr><tr><td>Sig. (2-tailed)</td><td>.172</td><td>.122</td><td>.145</td></tr><tr><td rowspan="2">Act_aud_6</td><td>Pearson correlation</td><td>.122</td><td>.122</td><td>.127</td></tr><tr><td>Sig. (2-tailed)</td><td>.569</td><td>.569</td><td>.553</td></tr><tr><td rowspan="2">Act_aud_7</td><td>Pearson correlation</td><td>−.284</td><td>−.293</td><td>−.293</td></tr><tr><td>Sig. (2-tailed)</td><td>.179</td><td>.165</td><td>.164</td></tr><tr><td rowspan="2">Act_lang_1</td><td>Pearson correlation</td><td>.100</td><td>.259</td><td>.177</td></tr><tr><td>Sig. (2-tailed)</td><td>.643</td><td>.222</td><td>.408</td></tr><tr><td rowspan="2">Act_lang_2</td><td>Pearson correlation</td><td>.380</td><td>.453<xref ref-type="fn" rid="tfn3" /></td><td>.425<xref ref-type="fn" rid="tfn3" /></td></tr><tr><td>Sig. (2-tailed)</td><td>.067</td><td>.026</td><td>.038</td></tr><tr><td rowspan="2">Act_lang_3</td><td>Pearson correlation</td><td>.038</td><td>.171</td><td>.093</td></tr><tr><td>Sig. (2-tailed)</td><td>.861</td><td>.423</td><td>.666</td></tr><tr><td rowspan="2">Act_lang_4</td><td>Pearson correlation</td><td>.089</td><td>.233</td><td>.158</td></tr><tr><td>Sig. (2-tailed)</td><td>.678</td><td>.273</td><td>.461</td></tr><tr><td rowspan="2">Act_lang_5</td><td>Pearson correlation</td><td>.307</td><td>.356</td><td>.342</td></tr><tr><td>Sig. (2-tailed)</td><td>.144</td><td>.088</td><td>.102</td></tr><tr><td rowspan="2">Act_inv_1</td><td>Pearson correlation</td><td>−.111</td><td>−.141</td><td>−.127</td></tr><tr><td>Sig. (2-tailed)</td><td>.607</td><td>.510</td><td>.553</td></tr><tr><td rowspan="2">Act_inv_2</td><td>Pearson correlation</td><td>−.023</td><td>.149</td><td>.053</td></tr><tr><td>Sig. (2-tailed)</td><td>.916</td><td>.487</td><td>.807</td></tr><tr><td rowspan="2">Act_inv_3</td><td>Pearson correlation</td><td>.326</td><td>.465<xref ref-type="fn" rid="tfn3" /></td><td>.400</td></tr><tr><td>Sig. (2-tailed)</td><td>.120</td><td>.022</td><td>.052</td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph>. Act = actions; aud = auditory access items; lang = spoken language items; inv = involvement in intervention.</p> <p>3 *p <.05, two-tailed. **p<.001, two-tailed.</p> <hd id="AN0181969923-13">Discussion</hd> <p>The purpose of this study was twofold: first, to examine the relationship between parental self-efficacy specific to auditory access and spoken language development and children's spoken language outcomes; then, to examine the relationship between aspects of parental self-efficacy (beliefs, knowledge, confidence, actions) related to those domains. Our findings indicate no statistically significant correlations between parental self-efficacy and auditory comprehension, expressive communication, and overall language abilities. However, positive correlations were found between child language skills and parents' <emph>perceptions of their ability</emph> to support their child's spoken language development, to <emph>use strategies</emph> to help their child communicate, and be <emph>actively involved</emph> in intervention.</p> <hd id="AN0181969923-14">Parental self-efficacy beliefs</hd> <p>Parents' self-ratings on belief items reflected trends demonstrated in the initial SPISE-R study conducted by [<reflink idref="bib4" id="ref45">4</reflink>]. In both studies, parents expressed strong agreement with the belief that how the family talks to and interacts with their DHH child can have a "big impact" on how their child develops. Of note, parents in the [<reflink idref="bib4" id="ref46">4</reflink>] sample whose children did not have an immediate DHH family member were more likely to strongly express this belief compared to parents of children without an immediate DHH family member.</p> <p>Both studies found that parents expressed the least agreement with the beliefs that "If I keep my home too quiet, my child 'won't learn to listen in noise'" and "If people see my child wearing his/her hearing device(s), they will judge my child or my family." For families who are committed to their child using sensory devices consistently, these findings suggest the need for early intervention providers to address parents' worry about their child or family being judged (e.g. provide social support by introducing the family and child to DHH adults and other families) and guide them in attending to noise levels in the home and making adjustments. In sum, the findings about parents' beliefs indicate the positive impact that interacting with DHH adults who also use sensory devices can have on parents' understanding and acceptance of their child.</p> <hd id="AN0181969923-15">Parental self-efficacy related to auditory access</hd> <p>Knowledge</p> <p>Our results demonstrate that parents view themselves as most knowledgeable about auditory access compared to facilitating spoken language development. Parents rated themselves as most knowledgeable about what their child can hear with their devices and how to carry out a Ling 6-Sound test, and least knowledgeable about what their child can and cannot hear without their devices. Average knowledge scores were higher in the current sample compared to [<reflink idref="bib4" id="ref47">4</reflink>] and within a narrower range. [<reflink idref="bib4" id="ref48">4</reflink>] did not include an item-by-item analysis for the Knowledge, Confidence, and Actions sections; therefore, a direct comparison cannot be made. However, this finding may be attributed to families not receiving early intervention services from providers who specialize in early language development in DHH children. DHH children benefit from FCEI interventions that emphasize language development and involves coaching families in implementing strategies in their daily lives.</p> <p>Confidence</p> <p>Parents reported slightly higher levels of confidence about promoting auditory access compared to facilitating spoken language development. Average scores were higher than scores in [<reflink idref="bib4" id="ref49">4</reflink>] and within a narrower range. The highest levels of confidence were related to determining if their child's hearing device(s) are working okay and putting and keeping child's hearing device(s) on. The lowest levels of confidence were about "helping my child hear by making change in his/her environment" and "helping them hear and understand new speech sounds or sounds in their environment." Comparable with [<reflink idref="bib4" id="ref50">4</reflink>], which found that knowledge and confidence were strongly correlated, parents' confidence was higher (albeit slightly) in managing their child's devices compared to supporting their language development. This is understandable as developing confidence in a task requires observation, practice, and feedback (i.e. coaching).</p> <p>Actions</p> <p>Out of the three subsections of the Actions section, parents reported the highest average scores related to their involvement in intervention. Parents reported higher average scores for taking actions related to facilitating spoken language development compared to auditory access. Parents perceived themselves as actively able to "get my child to the audiologist as soon as a visit is needed" and "attend and be involved" in intervention sessions. Parents most strongly agreed about their ability to act in using strategies to help their child communicate their wants and needs and sharing books at least once a day. Parents' ability and confidence to carry out strategies that promote language development is key to FCEI practices.</p> <hd id="AN0181969923-16">Parental self-efficacy related to supporting language development</hd> <p>Knowledge</p> <p>Knowledge about supporting spoken language development in this study was highest related to "strategies the interventionist recommends using to help my child learn to communicate" and "how to help my child learn to communicate." Parents reported the least agreement about their knowledge of "the sounds, words, or sentence types that my child should be learning to say" and "communicat[ing] with my child in a way that is appropriate to address his/her hearing needs." FCEI using listening and spoken language focuses on collaborating with families to set and target clear language goals, often using parent-friendly criterion-referenced milestones such as those provided in the <emph>Cottage Acquisition Scales for Listening, Language, & Speech.</emph> Parents receiving such intervention might thus report being more knowledgeable in articulation, vocabulary, and syntax milestones, as well as the ways they can use facilitative language strategies to support their child's communication needs. At the same time, these milestones and strategies should be reviewed with parents throughout their time in early intervention.</p> <p>Confidence</p> <p>The strongest agreement among parents in terms of confidence in supporting their child's spoken language development was related to "doing the things learned during intervention sessions when the professional is not there to help" and in helping their child learn to say new sounds, words, or sentences. Confidence was lowest related to helping their child communicate their wants and needs and communicating with their child in a way that is "appropriate to address their hearing needs," indicating a need for increasing parents' confidence in facilitating their child's language growth. As [<reflink idref="bib15" id="ref51">15</reflink>] suggest, two primary goals of FCEI programs should be to strengthen parental confidence and provide parents with knowledge about facilitative language techniques. Additionally, monitoring and evaluating language are important for identifying language goals, as well as discussing the effectiveness of the child's current modality; exploring other communication opportunities could be helpful in facilitating the child's capacity to communicate their wants and needs.</p> <hd id="AN0181969923-17">Parental self-efficacy and involvement in early intervention</hd> <p>Parents expressed a strong sense of self-efficacy related to their involvement in early intervention. They reported the strongest agreement about "attending and being involved in their child's intervention sessions (instead of having to do other things during that time, such as prepare meals or take care of siblings)" and "getting their child to the audiologist as soon as a visit is needed." This finding is encouraging; however, the sample comprised all mothers. Several studies have found that fathers are not as involved in early intervention as mothers and report lower levels of parental self-efficacy ([<reflink idref="bib16" id="ref52">16</reflink>]; [<reflink idref="bib33" id="ref53">33</reflink>], [<reflink idref="bib32" id="ref54">32</reflink>]). Providers should actively encourage all caregivers to participate in intervention and seek ways to individualize engagement.</p> <p>The lowest agreement was related to being able to advocate for their child's needs in intervention sessions and Individualized Education Programs/Individualized Family Service Plans. This finding is consistent with results from previous studies ([<reflink idref="bib22" id="ref55">22</reflink>]) that have examined parent perspectives of early intervention. Parents of children who are DHH oftentimes desire to better advocate for their child's needs and struggle to find the tools to do so ([<reflink idref="bib22" id="ref56">22</reflink>]). Connecting parents to family-based organizations and supporting the development of advocacy programs can provide them with the knowledge and support to effectively advocate for their children.</p> <hd id="AN0181969923-18">Relationship between parental self-efficacy and language development</hd> <p>The primary aim of the current study was to examine the relationship between parental self-efficacy specific to facilitating auditory access and spoken language development and language outcomes. Interestingly, we did not find statistically significant correlations between aspects of parental self-efficacy (i.e. knowledge, confidence, and actions) and children's language scores (i.e. auditory comprehension, expressive communication, and total language). These findings diverge somewhat from [<reflink idref="bib4" id="ref57">4</reflink>], which reported a positive correlation between the SPISE-R Confidence section and child language outcomes. This divergence might be attributed to the more general nature of the communication scale in the DP-3 used in [<reflink idref="bib4" id="ref58">4</reflink>] compared to the PLS-5, leading to less distinct language scores compared to PLS-5 scores. The current study expands on the work of Ambrose and colleagues by using a more robust measure of language (i.e. PLS-5); the PLS-5 includes distinct measures of receptive and expressive language skills and relies on direct observation rather than parent report as is the case with the DP-3.</p> <p>Our item-by-item analysis revealed that the strength of one parent belief was positively correlated with better receptive and expressive language skills; the belief that families can positively affect their child's development (delays are not inevitable). This finding is consistent with [<reflink idref="bib4" id="ref59">4</reflink>], highlighting the importance of providers and others (i.e. diagnosing audiologists, speech-language pathologists, teachers of the deaf, other families, and DHH adults) emphasizing with families the positive impact they can have on their child's development. Two action items also positively correlated with expressive language. Children whose parents perceive themselves as able to implement strategies that will help their child communicate their wants and needs performed better expressively compared to children whose parents reported lower self-efficacy in this area.</p> <p>The second action item positively correlated with better expressive language skills was related to involvement in intervention. Attending and being involved in intervention sessions (instead of having to do other things during that time, such as prepare meals or take care of siblings) was related to better expressive language skills, a result that aligns with findings from over two decades of research on parental involvement in FCEI (e.g. [<reflink idref="bib25" id="ref60">25</reflink>]; [<reflink idref="bib34" id="ref61">34</reflink>]). While more research is needed to clarify how components of parent involvement in FCEI (e.g. deciding IFSP goals and services) ([<reflink idref="bib11" id="ref62">11</reflink>]), our findings suggest that facilitating parents' sense of confidence in supporting their child's language needs is essential for them to be able to put strategies into action.</p> <hd id="AN0181969923-19">Limitations and future directions</hd> <p>Several limitations should be considered when interpreting the current findings. First, generalizability is limited due to the homogeneity of the sample (i.e. White, middle- to upper-income, college educated). As in previous parental self-efficacy studies with parents of DHH children, our sample does not reflect the families served by providers and clinicians (racially, culturally, and linguistically diverse, widely variable household income levels). Although the literature indicates that certain cultural and contextual factors (e.g. social support, family functioning) explain differences in parental self-efficacy among parents of typically hearing children, findings on similarities and differences based on race and ethnicity are divergent ([<reflink idref="bib27" id="ref63">27</reflink>]). It is possible that the race and socioeconomic characteristics of our sample predisposed the parents toward higher general self-efficacy in parenting, which may then have skewed findings of parental self-efficacy related specifically to parenting a DHH child. Further research is needed to understand the relationship between parental self-efficacy in parents of children who are from diverse cultures and contexts.</p> <p>Second, while the PLS-5 is a more robust measure of receptive and expressive language than the parent-reported measure of communication used in [<reflink idref="bib4" id="ref64">4</reflink>] original SPISE-R study, it may not have been sensitive enough to identify individual differences in specific areas of spoken language and vocabulary development (e.g. syntax, morphology, phonological awareness). At a mean chronological age of 33.74, most of our participants were not yet eligible for most standardized language assessments for preschoolers. Future research might incorporate more specific measures, particularly for participants who are older than those in this study.</p> <p>Third, the directionality between parental self-efficacy and children's language abilities is unclear. Do better language skills in DHH children positively affect parents' perceptions of self-efficacy, or does higher parental self-efficacy positively affect children's language abilities? [<reflink idref="bib15" id="ref65">15</reflink>] posit that mothers might adjust the language they use with their child based on the child's language abilities. Mothers whose children demonstrate more advanced language skills may use longer utterances and employ higher-level facilitative language strategies. The mode(s) of communication used by parents and children may also influence this relationship. The present study included families who had chosen listening and spoken language in English as their primary modality, though five children were reported to be exposed to American Sign Language to some degree. The quantity and quality of this signed input was not measured in this study, though future research might consider the effect of sign language usage on parental self-efficacy and language development (both spoken and signed). The current study analyzed data from one point in time using correlational methods. Without longitudinal data or experimental manipulation of variables, we cannot make claims about causation. Future studies should include longitudinal analysis of parental self-efficacy to determine if and how parental self-efficacy levels change over time, and whether parental self-efficacy functions as a mediator between children's language skills and potential predictors of parental self-efficacy (e.g. social support, parent knowledge of child development).</p> <hd id="AN0181969923-20">Implications for practice</hd> <p>For parents of DHH children to acquire a sense of self-efficacy, providers must communicate the value of their involvement in early intervention and the positive impact they can have on their child's language development. In our study, parents who more strongly agreed that they could attend and be involved in their child's intervention sessions, instead of having to attend to other responsibilities, were more likely to have children with higher expressive communication skills. This points to the need for intervention to be truly family centered beyond simply taking place in the family's home or requiring a parent to be present. Such intervention might address the cognitive load shouldered by parents, particularly mothers, by including creative strategies for childcare for siblings, wraparound supports for food and housing, and other ways to facilitate parents' full participation in FCEI sessions.</p> <p>Parents' sense of self-efficacy in using strategies to help their child communicate their wants and needs was related to children's expressive communication and total language scores. Considering the likely bidirectional nature of this relationship, providers should consider two forms of focused feedback: one focused on parent actions and one focused on children's expressive communicative attempts. To demonstrate parental self-efficacy, parents need both knowledge of facilitative language strategies—which are already covered in many DHH-specific FCEI programs—<emph>and</emph>, critically, the belief that they can implement those strategies effectively. They, thus, require specific, personalized feedback on the ways that providers observe them expanding their child's utterances, using acoustic highlighting to draw attention to target words and sounds, and employing other strategies in everyday conversation. Parents may use strategies, such as auditory bombardment (i.e. intentional repetition of a target word or sound) and auditory sandwich (i.e. providing a visual support between two auditory-only presentations of a word or phrase) nearly unconsciously without being able to name them. Providers who carefully observe parent–child interactions and specifically highlight instances in which parents used strategies effectively may facilitate parents' development of self-efficacy. PSE also relies on parents' perception that their efforts are leading to improvements in their child's communication skills. For children who are DHH, these improvements may be incremental and may take subtler forms than formal spoken language. Parents whose providers specifically point out the ways in which children respond, whether with words, vocal approximations, signs, gestures, or facial expressions, may develop greater sensitivity to their child's communication and higher estimations of their child's abilities. These may lead to great confidence in their ability to support communication, higher expectations, greater parental self-efficacy, and, ultimately, improvements in children's spoken language abilities.</p> <p>Funding</p> <p>This research was supported in part through a grant from the National Institutes of Health (NIDCD R01DC017925).</p> <p> <emph>Conflicts of interest</emph>: None declared.</p> <ref id="AN0181969923-21"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref6" type="bt">1</bibl> <bibtext> Albanese, A. M., Russo, G. R., & Geller, P. A. (2019). The role of parental self-efficacy in parent and child well-being: A systematic review of associated outcomes. Child: Care, Health and Development, 45 (3), 333 – 363. 10.1111/cch.12661 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibl id="bib2" idref="ref19" type="bt">2</bibl> <bibtext> Albarran, A. S., & Reich, S. M. (2014). Using baby books to increase new mothers' self-efficacy and improve toddler language development. Infant and Child Development, 23 (4), 374 – 387. 10.1002/icd.1832 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibl id="bib3" idref="ref36" type="bt">3</bibl> <bibtext> Alpern, G. D. (2007). Developmental Profile 3 (DP-3) ((3rd ed.) Ed.). Los Angeles, CA: Western Psychological Services. Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC</bibtext> </blist> <blist> <bibl id="bib4" idref="ref34" type="bt">4</bibl> <bibtext> Ambrose, S. E., Appenzeller, M., Mai, A., & DesJardin, J. L. (2020). Beliefs and self-efficacy of parents of young children with hearing loss. Journal of Early Hearing Detection and Intervention, 5 (1), 73 – 85. 10.26077/kkkh-vj55 Google Scholar PubMed OpenURL Placeholder Text WorldCat</bibtext> </blist> <blist> <bibl id="bib5" idref="ref5" type="bt">5</bibl> <bibtext> Ardelt, M., & Eccles, J. S. (2001). Effects of mothers' parental efficacy beliefs and promotive parenting strategies on inner-city youth. Journal of Family Issues, 22 (8), 944 – 972. 10.1177/019251301022008001 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibl id="bib6" idref="ref7" type="bt">6</bibl> <bibtext> Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84 (2), 191 – 215. 10.1037/0033-295X.84.2.191 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibl id="bib7" idref="ref33" type="bt">7</bibl> <bibtext> Cejas, I., Mitchell, C. M., Barker, D. H., Sarangoulis, C., Eisenberg, L. S., & Quittner, A. L. (2021). Parenting stress, self-efficacy, and involvement: Effects on spoken language ability three years after cochlear implantation. Otology & Neurotology, 42 (10), S11 – S18. 10.1097/mao.0000000000003374 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibl id="bib8" idref="ref18" type="bt">8</bibl> <bibtext> Coleman, P. K., & Karraker, K. H. (2003). Maternal self-efficacy beliefs, competence in parenting, and toddlers' behavior and developmental status. Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health, 24 (2), 126 – 148. 10.1002/imhj.10048 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibl id="bib9" idref="ref10" type="bt">9</bibl> <bibtext> Coleman, P. K., & Karraker, K. H. (1998). Self-efficacy and parenting quality: Findings and future applications. Developmental review, 18 (1), 47 – 85. Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Conway, L. J., Levickis, P. A., Smith, J., Mensah, F., Wake, M., & Reilly, S. (2018). Maternal communicative behaviours and interaction quality as predictors of language development: Findings from a community-based study of slow-to-talk toddlers. International Journal of Language & Communication Disorders, 53 (2), 339 – 354. 10.1111/1460-6984.12352 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Davenport, C. A., Houston, D. M., Bowdrie, K., & Frush Holt, R. (2021). The role of early intervention in parental self-efficacy for families of deaf/hard of hearing children. Journal of Early Hearing Detection and Intervention., 6 (1), 38 – 47. 10.26077/cf34_9189 Google Scholar OpenURL Placeholder Text WorldCat Crossref</bibtext> </blist> <blist> <bibtext> DesJardin, J. L. (2003). Assessing parental perceptions of self-efficacy and involvement in families of young children with hearing loss. The Volta Review, 103 (4), 391 – 409. Google Scholar OpenURL Placeholder Text WorldCat</bibtext> </blist> <blist> <bibtext> DesJardin, J. L. (2005). Maternal perceptions of self-efficacy and involvement in the auditory development of young children with prelingual deafness. Journal of Early Intervention, 27 (3), 193 – 209. 10.1177/105381510502700306 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> DesJardin, J. L. (2006). Family empowerment: Supporting language development in young children who are deaf or hard of hearing. The Volta Review, 106 (3), 275 – 298. 10.17955/tvr.106.3.m.574 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> DesJardin, J. L., & Eisenberg, L. S. (2007). Maternal contributions: Supporting language development in young children with cochlear implants. Ear and Hearing, 28 (4), 456 – 469. 10.1097/aud.0b013e31806dc1ab Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Dirks, E., & Szarkowski, A. (2022). Family-centered early intervention (FCEI) involving fathers and mothers of children who are deaf or hard of hearing: Parental involvement and self-efficacy. Journal of clinical medicine, 11 (3), 492. 10.3390/jcm11030492 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Dulay, K. M., Cheung, S. K., & McBride, C. (2018). Environmental correlates of early language and literacy in low- to middle-income Filipino families. Contemporary Educational Psychology, 53, 45 – 56. 10.1016/j.cedpsych.2018.02.002 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Fenson, L. (2007). MacArthur-Bates communicative development inventories. OpenURL Placeholder Text WorldCat</bibtext> </blist> <blist> <bibtext> Harty, M., Alant, E., & Uys, C. J. E. (2007). Maternal self-efficacy and maternal perception of child language competence in pre-school children with a communication disability. Child: Care, Health and Development, 33 (2), 144 – 154. 10.1111/j.1365-2214.2006.00661.x Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Izzo, C., Weiss, L., Shanahan, T., & Rodriguez-Brown, F. (2000). Parental self-efficacy and social support as predictors of parenting practices and children's socioemotional adjustment in Mexican immigrant families. Journal of Prevention & Intervention in the Community, 20 (1–2), 197 – 213. 10.4324/9781315809403-17 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Jones, T. L., & Prinz, R. J. (2005). Potential roles of parental self-efficacy in parent and child adjustment: A review. Clinical Psychology Review, 25 (3), 341 – 363. 10.1016/j.cpr.2004.12.004 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Reed, J., Findlen, U. M., Davenport, C., Deconde Johnson, C., Sentelik, M., Spangler, C.,... & Houston, D. (2023). Parent and provider perspectives on early intervention in ohio: a community collaborative approach. Journal of Early Hearing Detection and Intervention, 8 (1), 22 – 34. 10.26077/ee04-915b Google Scholar OpenURL Placeholder Text WorldCat Crossref</bibtext> </blist> <blist> <bibtext> Meadan, H., Douglas, S. N., Kammes, R., & Schraml-Block, K. (2018). "I'm a different coach with every family": Early interventionists' beliefs and practices. Infants & Young Children, 31 (3), 200 – 214. 10.1097/iyc.0000000000000118 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Mitchell, R. E., & Karchmer, M. A. (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign language studies, 4 (2), 138 – 163. Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Moeller, M. P., Carr, G., Seaver, L., Stredler-Brown, A., & Holzinger, D. (2013). Best practices in family-centered early intervention for children who are deaf or hard of hearing: An international consensus statement. The Journal of Deaf Studies and Deaf Education, 18 (4), 429 – 445. 10.1093/deafed/ent034 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Shorey, S., Chan, S. W. C., Chong, Y. S., & He, H. G. (2015). Predictors of maternal parental self-efficacy among primiparas in the early postnatal period. Western Journal of Nursing Research, 37 (12), 1604 – 1622. 10.1177/0193945914537724 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Shumow, L., & Lomax, R. (2002). Parental efficacy: Predictor of parenting behavior and adolescent outcomes. Parenting: Science and Practice, 2 (2), 127 – 150. Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Stiévenart, M., & Martinez Perez, T. (2021). How can parental self-efficacy support children's early language development? Review of preliminary research and future perspectives. European Journal of Developmental Psychology, 18 (2), 199 – 213. 10.1080/17405629.2020.1776102 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Stika, C. J., Eisenberg, L. S., Johnson, K. C., Henning, S. C., Colson, B. G., Ganguly, D. H., & DesJardin, J. L. (2015). Developmental outcomes of early-identified children who are hard of hearing at 12 to 18 months of age. Early Human Development, 91 (1), 47 – 55. 10.1016/j.earlhumdev.2014.11.005 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Teti, D. M., O'Connell, M. A., & Reiner, C. D. (1996). Parenting sensitivity, parental depression and child health: The mediational role of parental self-efficacy. Early Development and Parenting: An International Journal of Research and Practice, 5 (4), 237 – 250. 10.1002/(sici)1099-0917(199612)5:4237::aid-edp1363.0.co;2-5 Google Scholar Crossref Search ADS WorldCat</bibtext> </blist> <blist> <bibtext> Wittkowski, A., Garrett, C., Calam, R., & Weisberg, D. (2017). Self-report measures of parental self-efficacy: A systematic review of the current literature. Journal of Child and Family Studies, 26, 2960 – 2978. 10.1007/s10826-017-0830-5 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Zaidman-Zait, A., Most, T., Tarrasch, R., & Haddad, E. (2018). Mothers' and fathers' involvement in intervention programs for deaf and hard of hearing children. Disability and Rehabilitation, 40 (11), 1301 – 1309. 10.1080/09638288.2017.1297491 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Zaidman-Zait, A., Most, T., Tarrasch, R., Haddad-eid, E., & Brand, D. (2016). The impact of childhood hearing loss on the family: Mothers' and fathers' stress and coping resources. Journal of Deaf Studies and Deaf Education, 21 (1), 23 – 33. 10.1093/deafed/env038 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> van der Zee, R. B., & Dirks, E. (2022). Diversity of child and family characteristics of children with hearing loss in family-centered early intervention in the Netherlands. Journal of Clinical Medicine, 11 (8), 2074. 10.3390/jcm11082074 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibtext> Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (2011). Preschool Language Scale, Fifth Edition (PLS-5) [Database record]. APA PsycTests. 10.1037/t15141-000 Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC Crossref</bibtext> </blist> </ref> <aug> <p>By Carrie A Davenport; Elaine Smolen; Irina Castellanos; Evelien Dirks and Derek M Houston</p> <p>Reported by Author; Author; Author; Author; Author</p> <p></p> <p>The Ohio State University, Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212</p> </aug> <nolink nlid="nl1" bibid="bib25" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib24" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib23" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib15" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib20" firstref="ref8"></nolink> <nolink nlid="nl6" bibid="bib26" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib21" firstref="ref11"></nolink> <nolink nlid="nl8" bibid="bib31" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib28" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib30" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib10" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib19" firstref="ref20"></nolink> <nolink nlid="nl13" bibid="bib17" firstref="ref21"></nolink> <nolink nlid="nl14" bibid="bib18" firstref="ref24"></nolink> <nolink nlid="nl15" bibid="bib12" firstref="ref25"></nolink> <nolink nlid="nl16" bibid="bib13" firstref="ref26"></nolink> <nolink nlid="nl17" bibid="bib14" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib29" firstref="ref32"></nolink> <nolink nlid="nl19" bibid="bib35" firstref="ref43"></nolink> <nolink nlid="nl20" bibid="bib16" firstref="ref52"></nolink> <nolink nlid="nl21" bibid="bib33" firstref="ref53"></nolink> <nolink nlid="nl22" bibid="bib32" firstref="ref54"></nolink> <nolink nlid="nl23" bibid="bib22" firstref="ref55"></nolink> <nolink nlid="nl24" bibid="bib34" firstref="ref61"></nolink> <nolink nlid="nl25" bibid="bib11" firstref="ref62"></nolink> <nolink nlid="nl26" bibid="bib27" firstref="ref63"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1457175
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Parental Self-Efficacy and Early Language Development in Deaf and Hard-of-Hearing Children
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Carrie+A%2E+Davenport%22">Carrie A. Davenport</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-2130-5757">0000-0002-2130-5757</externalLink>)<br /><searchLink fieldCode="AR" term="%22Elaine+Smolen%22">Elaine Smolen</searchLink><br /><searchLink fieldCode="AR" term="%22Irina+Castellanos%22">Irina Castellanos</searchLink><br /><searchLink fieldCode="AR" term="%22Evelien+Dirks%22">Evelien Dirks</searchLink><br /><searchLink fieldCode="AR" term="%22Derek+M%2E+Houston%22">Derek M. Houston</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Deaf+Studies+and+Deaf+Education%22"><i>Journal of Deaf Studies and Deaf Education</i></searchLink>. 2025 30(1):31-40.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://jdsde.oxfordjournals.org/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 10
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Mother+Attitudes%22">Mother Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Deafness%22">Deafness</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Acquisition%22">Language Acquisition</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Participation%22">Parent Participation</searchLink><br /><searchLink fieldCode="DE" term="%22Listening+Comprehension%22">Listening Comprehension</searchLink><br /><searchLink fieldCode="DE" term="%22Expressive+Language%22">Expressive Language</searchLink><br /><searchLink fieldCode="DE" term="%22Total+Communication%22">Total Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Skills%22">Language Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Role%22">Parent Role</searchLink><br /><searchLink fieldCode="DE" term="%22Parents+as+Teachers%22">Parents as Teachers</searchLink><br /><searchLink fieldCode="DE" term="%22Beliefs%22">Beliefs</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Development%22">Child Development</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Preschool+Language+Scale%22">Preschool Language Scale</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1093/jdsade/enae036
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1081-4159<br />1465-7325
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study examined the relationship between parental self-efficacy in parents of young deaf and hard-of-hearing (DHH) children and children's spoken language skills. A retrospective within-subjects study design was used that included 24 mother-child dyads with DHH children. Parental self-efficacy was assessed using the Scale of Parental Involvement and Self-Efficacy--Revised. Children's language abilities were assessed using the Preschool Language Scale--5th edition. Our data revealed no significant associations between global measures of parental self-efficacy and children's auditory comprehension, expressive communication, and total language scores. However, positive correlations were found between child language skills and specific parents' beliefs about their ability to support their child's spoken language development, their ability to use strategies to help their child communicate, and their active involvement in intervention. Findings highlight the importance of examining discrete aspects of parental self-efficacy as it specifically relates to parents supporting their DHH child's spoken language development. Future directions and implications are provided.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1457175
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1457175
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1093/jdsade/enae036
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 31
    Subjects:
      – SubjectFull: Self Efficacy
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Mother Attitudes
        Type: general
      – SubjectFull: Parents
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Deafness
        Type: general
      – SubjectFull: Hearing Impairments
        Type: general
      – SubjectFull: Language Acquisition
        Type: general
      – SubjectFull: Parent Participation
        Type: general
      – SubjectFull: Listening Comprehension
        Type: general
      – SubjectFull: Expressive Language
        Type: general
      – SubjectFull: Total Communication
        Type: general
      – SubjectFull: Language Skills
        Type: general
      – SubjectFull: Parent Role
        Type: general
      – SubjectFull: Parents as Teachers
        Type: general
      – SubjectFull: Beliefs
        Type: general
      – SubjectFull: Child Development
        Type: general
      – SubjectFull: Preschool Language Scale
        Type: general
    Titles:
      – TitleFull: Parental Self-Efficacy and Early Language Development in Deaf and Hard-of-Hearing Children
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Carrie A. Davenport
      – PersonEntity:
          Name:
            NameFull: Elaine Smolen
      – PersonEntity:
          Name:
            NameFull: Irina Castellanos
      – PersonEntity:
          Name:
            NameFull: Evelien Dirks
      – PersonEntity:
          Name:
            NameFull: Derek M. Houston
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1081-4159
            – Type: issn-electronic
              Value: 1465-7325
          Numbering:
            – Type: volume
              Value: 30
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of Deaf Studies and Deaf Education
              Type: main
ResultId 1