PEARLS: A Parenting Intervention for Pediatric CI Recipients & Their Families
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PEARLS: A Parenting
Intervention for Pediatric CI
Recipients & Their Families
Ivette Cejas, PhD1, Michael Hoffman, MS2, Domitille Lochet, MS1, & Alexandra L Quittner, PhD3
1Department of Otolaryngology, University of Miami; 2Department of Psychology, University of
Miami; 3Miami Children’s Research Institute
1
Conflict of Interest
§ AG Bell Board of Directors
§ MED-EL Pediatric Advisory Board
§ Research agreement - Advanced Bionics
§ Research is funded by:
§ NIDCD RO1 DC04797
§ NIDCD R03 DC014760
§ CTSI – UM Internal Grant
2
Background Information
§ Maternal Sensitivity
§ Significant predictor of children’s behavior, social competence, cognition, academic
achievement
§ NICHD Early Childcare Study: 1500 nationally representative children followed
from birth to 18 year (Ipsa et al., 2004; Belsy et al., 2007; Leerkes et al., 2009)
§ CDaCI study: 188 CI children & 96 controls (Quittner et al., 2013)
§ Predicted expressive and receptive language over 4 years post-implantation
§ As predictive as age as implantation
§ Facilitative Language Techniques
§ Higher-level techniques are positively associated with language, phonological
awareness, and reading (DesJardin et al., 2009; DesJardin & Eisennbery, 2007)
§ Higher-level FLTs predicted faster language growth post-CI (Cruz/Cejas et al., 2013)
3
PEARLS
§ 10 session intervention
§ Focus on coaching parents on
improving
§ Maternal Sensitivity
§ Facilitative Language Techniques
§ Incorporated in weekly auditory-
verbal therapy
§ Tailored to each family and
incorporates practice at home
4
Higher-Level Strategies
Open-ended
• Question or phrase child can answer using more than one word
question
• Parent fills in the missing parts of the child’s utterances while retaining the
Expansion child’s meaning
• Parent repeats the child’s utterance and adds new information
Expatiation
• A form of expansion, involving a change in mood or voice; parent changes
Recast child’s utterance into a question
• Provides linguistic labels that describe the parent and/or child’s activities or
Parallel Talk aspects of the environment to which the mother and/or child is attending
Measures
§ Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS;
Zimmerman-Phillips et al., 2001)
§ Measure spontaneous responses to a child’s everyday environment.
§ Performance is measured in terms of vocalization behavior, alerting to
sounds, and deriving meaning from a sound.
§ Scores: 0-40
§ Scale of Parental Involvement and Self-Efficacy for Children with
Hearing Loss (SPISE; DesJardin, 2003).
§ The SPISE is a well-validated measure of parental involvement and self-
efficacy for children with hearing loss.
9
Coding Maternal Sensitivity
§ Parent-child interactions were measured during 2 video-taped tasks
§ Free Play (10 minutes)
§ Art Gallery (5 minutes)
§ Interactions were coding using the Mother-Child Structured Interaction
Qualitative Rating Scales developed for the NICHD Early Child Care Study
§ Maternal Sensitivity Composite: Sensitivity, Respect for Autonomy,
Positive Regard, Hostility
§ Rated on a 7-point Likert Scale (1=Low, 7 =High)
10Maternal Sensitivity
Low Rating High Rating
§Parent ignores the child §Parent acknowledges the child’s
§Parent responds with developmentally affect
inappropriate comments or behaviors §Responds to the child’s talk and/or
§Parent is over-stimulating and intrusive activity
§Parent acknowledges the child’s affect §Facilitates play
§Responds to the child’s talk and/or activity §Appropriately times activities to
reflect the child’s interest
§Facilitates play
§Appropriately times the activities to reflect
the child’s interest
11Demographics
Mean
Age (Months) 28.8
Parental Education (n)
Less than High School 1
High School 0
College 3
Graduate Degree 2
Leiter Nonverbal IQ Composite 108
Batelle
Motor Developmental Quotient 114.25
Cognitive Developmental Quotient 118.74
12PEARLS Intervention
Pre-PEARLS Post-PEARLS
SPISE
Self-efficacy 6.20 6.60
Parental Involvement 6.35 6.63
IT-MAIS 27.2 32.6
Maternal Sensitivity
Free Play 5.55 6.19
Art Gallery 5.30 6.30
13Maternal Sensitivity Results
Free Play
7.00
6.00
5.00
MS Ratings
4.00 Pre-PEARLS
Post-PEARLS
3.00
2.00
1.00
Maternal Cognitive Linguistic Enthusiam Persistence Child Affection Dyadic
Sensitivity Stimulation Stimulation Mutuality
14Maternal Sensitivity Results
Art Gallery
7.00
6.00
5.00
MS Ratings
4.00 Pre- PEARLS
Post- PEARLS
3.00
2.00
1.00
Maternal Cognitive Linguistic Enthusiam Persistence Child Affection Dyadic
Sensitivity Stimulation Stimulation Mutuality
15Parent & Therapist Satisfaction
§ Parent Satisfaction
§ 49 out of 50
§ Feedback:
§ “I hope to have more exposure during therapy ongoing”
§ “I love the program”
§ “I like the concept of integrating both the clinical aspect and the parent
sensitivity. Feel it is more balanced and realistic approach.”
§ “The best part about the PEARLS program was the flexibility of the setup of
AVT sessions. Also, different components. Helped with home involvement.”
§ “Possible additional info on each skill, maybe video clip to refer back to if
needed)”
§ Therapist Satisfaction
§ 49 out of 50
16Future Directions
§ R21 NIDCD award for a small RCT on PEARLS intervention
§ Spanish translation of the intervention/manual
§ Addition of video clips to model parental behaviors
§ If successful, a multicenter study will be completed
§ Dissemination and implementation of PEARLS
17July 11 – 13
S ave T he D ate 2019
The world famous Diplomat Beach Resort will be the host site for CI2019 which
features Ft Lauderdale and Miami Beach.
See you in South Florida in 2019.You can also read
