Introduction
Early interventions (EI) in special education for children with hearing impairments (CHI) are of crucial importance because they allow to compensate for the lack of proper linguistic environment, which is a result of the child’s hearing impairment (HI), and alleviate its adverse effect on the child’s language development and other aspects of the child’s development (Ansari, 2014). However, both the availability of EI and their effect may be negatively affected by several factors, one of which is the poor socio-economic status (SES) of the child’s parents or caregivers. Therefore, it is paramount to determine the concrete effects of low SES on post-EI outcomes for CHI to be able to address these effects in a proper, targeted manner. The purpose of the current research is to identify some of such concrete results of low SES in the population of Saudi Arabia.
Literature Review
To identify some of the effects of low SES on the outcomes of EI for CHI, a literature review has been carried out. Five scholarly articles related to the topic have been scrutinized.
Ansari (2014) attempted to identify the age of children at which their parents and relatives start suspecting HI in these children. The sample comprised parents of kids with confirmed severe to profound HI, aged 8-96 months (average age = 36.1 months), from Mumbai, India; 135 responses were obtained. A questionnaire was developed for the study. The data was collected through interview surveys and analyzed via the SPSS software.
The mean ages at which suspicion, diagnosing, fitting of amplification and starting EI took place were found to be 16.5, 24.3, 31.7, and 33.4 months, respectively. What is important for our study, the SES of the family did not affect the early detection of HI, but a better educational background of the parents and family members favorably influenced early detection. Also, the families of children enrolled in speech and language remedial programs had better SES than the rest of the sample.
Chang, Ko, Murray, Arnold, and Megerian (2010) investigated the question whether SES had an impact on the access to cochlear implants, and attempted to identify the influence of SES on outcomes of children after unilateral cochlear implantation had been carried out. In the retrospective cohort study, the records of 133 pediatric patients (aged 0-18 years) of two hospitals in Cleveland, Ohio, 64 out of whom had Medicaid insurance and 69 – private insurance, were reviewed; binary logistic regression was employed for analysis. It was found out that “there was no statistical difference in the odds of initial cochlear implantation, age at referral, or age at implantation between the 2 groups” (Chang et al., 2010, p. 648).
However, prelingual patients with Medicaid insurance received sequential bilateral cochlear implantation more rarely than privately-insured children (OR=0.43); besides, Medicaid-insured children more often had complications (OR=4.6), missed much more follow-up appointments (35% versus 23%) and consecutive visits than kids who had private insurance. Therefore, CHI with low SES (ones covered by Medicaid insurance) suffered from more frequent postoperative complications, had more adverse follow-up attendance, and achieved sequential bilateral implantation more seldom, which dictates the need to improve service for such CHI.
Morgan, Farkas, Hillemeier, and Maczuga (2012) conducted a study aimed at finding out if and to which extent children belonging to racial-ethnic minorities were disproportionately gaining EI and/or special education. The sample consisted of 7,950 children aged 48 months who were part of “Early Childhood Longitudinal Study-Birth Cohort… a nationally representative, longitudinal cohort study of U.S. children born in 2001” (Morgan et al., 2012, p. 341).
The children’s parents were interviewed. Multivariate logistic regression analysis was employed; SAS 9.2 software was utilized. It was found out that male children, kids who had very low weight at birth or congenital anomalies, and kids who had externalizing problem behaviors were more likely to participate in EI and/or special education programs. Simultaneously, children from households with low SES (odds ratio = 0.48), kids with better numeracy or receptive language knowledge, as well as children from families whose first language was not English were less probable to be represented in EI and/or special education programs. Black and Asian children were also disproportionately enrolled in EI and/or special education programs.
Sacks et al. (2014) studied the possibility of Project ASPIRE (a parent-directed intervention) to influence parents of CHI from commonly underserved populations, for instance, those whose first language is not English or who have low SES. The sample consisted of 11 parents (10 mothers, one father); seven families made less than 15,000 USD annually. The intervention comprised 1 educational intervention, 5 home linguistic environment recordings, and 4 linguistic feedback reviews.
The measurements assessed the linguistic behavior of parents, children, and the linguistic interactions between parents and their offspring. The analysis conducted with the Language Environment Analysis system (LENA) showed a significant increase of child-parent linguistic interactions count and child vocalization count. For the topic of this paper, the study is important because it addresses the needs of the families with low SES, and stresses that these families belong to the typically underserved population with regards to special education provision.
Suskind et al. (2016) conducted a quasi-experimental study to examine the influence of an intervention designed to enhance the language environment that is supplied for CHI by their caregivers with low SES in the U.S. Caregivers from 32 caregiver-child dyads with low SES (indicated by the low level of education and low income of caregivers), where children were aged <54 months, were provided with a behavioral educational intervention. This led to essential improvements in caregiver quiz scores but caused no substantial differences in LENA outcomes. As a conclusion, the statement that such interventions can improve the language environment of CHI is partially supported.
To sum up, problems faced by CHI from households with low SES may include later detection of HI, poor quality of hospital care, and lower representation in special education and EI programs. Also, certain interventions for caregivers of CHI might improve the language environment of CHI.
Rationale and Research Question
The literature review shows that CHI may face additional complications that may adversely affect the outcomes of EI. However, the studies that were reviewed are related to the population of the U.S. (4 articles) and India (1 article).
No articles containing original research about the topic of provision of EI for CHI and touching upon the SES of caregivers in Saudi Arabia were found. Simultaneously, it is known that early identification of HI in children in Saudi Arabia is not regulated by laws and not addressed by government policies (Aldabas, 2015, p. 1162). Therefore, the proposed study will compare the age of identification of HI and the amount of special education received by CHI from households of low SES to those of CHI from households of high SES. The research question of this study will be as follows: What is the correlation between SES of CHI’s caregivers, the age of HI identification, and the total time of EI received by CHI of age lower than 5 in Saudi Arabia?
Methods
Research Design
The study will be adapted from Ansari (2014). The research design of the proposed study will be correlational; the study will be quantitative. The independent variable of the research is the SES of parents of CHI as determined by their educational level and their yearly income during the assessed period. The dependent variables are the age of CHI at which HI was diagnosed, the age at which the first EI took place, and the total number of hours of EI that the CHI received. This type of research design is appropriate for the proposed research question because the question asks about the correlation of the named variables of the study.
Sample
To gather the sample for the study, parents or caregivers of first- or second-grade students with HI of several special education schools located in the city of Riyadh, Saudi Arabia, will be asked to complete a questionnaire.
The sampling technique, therefore, will be opportunity sampling, but the researchers will try to include a significant number of participants at each of the levels of SES. The gender of CHI may influence the education they obtain in Saudi Arabia; therefore, only parents of male children will be included in the sample. The choice of first- or second-graders is determined by the fact that these children will have the age greater than 60 months, which will allow the parents to summarize their experience with HI and special education during the period when their children were aged 0-60 months, while they will have a sufficient likelihood of remembering details about the services they were provided with.
The opportunity sampling is appropriate for the study because the main aim is to find the correlation between the SES, on the one hand, and the age of identification of HI and the total number of EI hours, on the other. Each group that has a particular SES is independent of the rest, at least for the study, and the proportion of the parts of the sample is not crucial. It is only important to gather enough representatives of each SES for the results of the study to be statistically significant.
Instruments
The main tool of the research will be a questionnaire designed for the parents or caregivers of CHI. The questionnaire will include questions about
- education levels of caregivers during the period when their CHI was aged 0-60 months;
- the level of their household’s yearly income during the same period;
- the age of the child at which the HI was diagnosed;
- the age at which the first EI was implemented;
- the estimated number of hours during which the child was receiving EI when they were aged 0-60 months.
The last item will include some subquestions that will allow for finding an approximate number of hours of receiving EI services, such as the frequency and the length of interventions.
The reliability will be obtained via the test-retest procedure for the same caregivers with an interval of three months to measure the error with which the interviewees completed the survey. The validity will be achieved since SES can be assessed via the level of income and education status (Suskind et al., 2016), whereas the age of diagnosing the HI, the age at which the first EI is implemented, and the total amount of received EI all influence the outcomes of EI (Ansari, 2014; Morgan et al., 2012).
Procedure
The parents of CHI studying in first or second grades of special schools will be contacted and asked to complete the survey; their informed consent will be obtained, and their anonymity and confidentiality will be preserved by only recording the first name of the parent and a specially assigned number; the surnames will not be recorded. After three months have passed, when the participants do not remember the numbers they put in the questionnaire, they will be contacted and asked to complete the same survey once again.
Analysis Plan
The participants will be grouped according to their SES. Then, the mean and the standard deviation of each of the dependent variables (the age of CHI at which HI was diagnosed, the age at which the first EI took place, and the total number of hours of EI that the CHI received) will be calculated for each of the groups. After the retest, the same procedure will be carried out. This will allow for determining whether there exist differences in the dependent variables for each of the SES groups, and how significant these differences are, which will provide a direct answer to the research question.
Limitations
The limitations of the study are determined by the fact that the sample will only be gathered in the schools of Riyadh, while the access to EI may be additionally influenced by living in remote locations (for instance, caregivers living outside cities or towns where there are special education services provided may need additional resources to gain the services of EI due to the logistics issues, which is important for caregivers with low SES). This poses a problem for the external validity of the study.
References
Aldabas, R. (2015) Special education in Saudi Arabia: History and areas for reform. Creative Education, 6, 1158-1167. Web.
Ansari, M. S. (2014). Assessing parental role as resource persons in achieving goals of early detection and intervention for children with hearing impairment. Disability, CBR and Inclusive Development, 25(4), 84-98. Web.
Chang, D. T., Ko, A. B., Murray, G. S., Arnold, J. E., & Megerian, C. A. (2010). Lack of financial barriers to pediatric cochlear implantation: Impact of socioeconomic status on access and outcomes. Archives of Otolaryngology: Head and Neck Surgery, 136(7), 648-657. Web.
Morgan, P. L., Farkas, G., Hillemeier, M. M., & Maczuga, S. (2012). Are minority children disproportionately represented in early intervention and early childhood special education? Educational Researcher, 41(9), 339-351. Web.
Sacks, C., Shay, S., Repplinger, L., Leffel, K. R., Sapolich, S. G., Suskind, E.,…Suskind, D. (2014). Pilot testing of a parent-directed intervention (project ASPIRE) for underserved children who are deaf or hard of hearing. Child Language Teaching and Therapy, 30(1), 91-102. Web.
Suskind, D. L., Graf, E., Leffel, K. R., Hernandez, M. W., Suskind, E., Webber, R.,…Nevins, M. E. (2016). Project ASPIRE: Spoken language intervention curriculum for parents of low-socioeconomic status and their deaf and hard-of-hearing children. Otology & Neurotology, 37(2), e110-e117. Web.