Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl Enhancing language in children who are deaf/hard-of-hearing using augmentative and alternative communication technology strategies Jareen Meinzen-Derr a,* , Rose M. Sheldon b , Seth Henry a , Sandra M. Grether b , Laura E. Smith a , Lindsay Mays b , Ilka Riddle b , Mekibib Altaye a , Susan Wiley b a Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229-3039, United States b Division of Developmental and Behavioral, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229-3039, United States ARTICLE INFO Keywords: Deaf/hard of hearing Augmentative and alternative communication Language development Technology Therapy Intervention ABSTRACT Background: Despite early identification and intervention, many children who are deaf/hard of hearing (D/HH) demonstrate significant gaps in language development which can directly impact social interactions. Aims: The objective of this pilot study was to determine whether integrating augmentative and alternative communication (AAC) core word language strategies into a speech-language therapy program for young children who are D/HH improves spoken language outcomes. Methods: Eleven young children, median age 5 years 7 months (range 3y;11 m to 10y;8 m) with bilateral hearing loss were enrolled in a single-case experimental design and completed a 24-week intervention that incorporated high-tech AAC strategies into a traditional speech-language therapy model (technology-assisted language in- tervention or TALI). The goal of the TALI was to improve spoken language development in children who were D/ HH. Language samples were collected throughout the study and pragmatic language was assessed pre and post intervention. Results: At the end of 24 weeks, children demonstrated a significant increase in their mean length of utterance, number of words spoken, and mean turn length according to language samples. Children also made gains in their pragmatic skills pre to post intervention. Conclusions: Results of this study suggest that using AAC core word language strategies delivered via iPad technology may support continued and rapid spoken language skill growth among young school-age children who are D/HH. By leveraging AAC technology, we are pioneering a structured and dynamic approach to lan- guage learning, building an effective foundation for concepts and grammar for children who are D/HH. 1. Introduction Between 1 and 3 per 1000 infants are born with permanent hearing loss each year, making congenital hearing loss a commonly identified condition among infants born in the United States [1]. Early Hearing Detection and Intervention (EHDI) programs throughout the country have made advances in addressing early language development for infants and young children who are deaf or hard of hearing (D/HH) [2], which has helped ensure that children who are D/HH receive oppor- tunities for optimal development. Earlier diagnosis of hearing loss and subsequent advances in technologies, such as hearing aids and cochlear implants, have not fully mitigated the risk children who are D/HH face regarding delays in language outcomes [3–12]. Delays and deficits in language development continue to persist and ultimately impact other areas of development [7]. Specific language skills that are often chal- lenging for children who are D/HH, pertain to the areas of grammar, lexicon, phonology, and pragmatics [11,13]. Pragmatics are a compo- nent of language development that address the ability to use appro- priate language in a social context [14,15]. Examples of pragmatic skills include turn taking in conversation, maintaining conversations, making requests, and asking questions. Children who are D/HH acquire prag- matic skills more slowly than their hearing peers [14], particularly as the development of these skills are tied to receptive and expressive language development. Although multiple areas of language are chal- lenging for many children who are D/HH, few novel approaches have been tested to improve these areas of language development for https://doi.org/10.1016/j.ijporl.2019.06.015 Received 8 April 2019; Received in revised form 13 June 2019; Accepted 16 June 2019 * Corresponding author. Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5041, Cincinnati, OH, 45229-3039, United States. E-mail address: jareen.meinzen-derr@cchmc.org (J. Meinzen-Derr). International Journal of Pediatric Otorhinolaryngology 125 (2019) 23–31 Available online 20 June 2019 0165-5876/ © 2019 Published by Elsevier B.V. T