Daniel Holzinger|Magdalena Dall|Susana Sanduvete?Chaves|David Saldaña|Salvador Chacón Moscoso|Johannes Fellinger
The Impact of Family Environment on Language Development of Children With Cochlear Implants: A Systematic Review and Meta-Analysis
Johannes Kepler University of Linz|Universidad de Sevilla|Universidad de Sevilla|Universidad de Sevilla|Universidad Autónoma de Chile|Johannes Kepler University of Linz|Medical University of Vienna
objectives authors conducted systematic review literature metaanalyses assess influence family environment language development children cochlear implants design pubmed excerpta medica database embase education research information center cumulative index nursing allied health literature cinahl healthcare literature information network pubpsych social scisearch databases searched search strategy included terms describing family environment child characteristics language development studies included assessed distal family variables parental income level parental education family size parental stress child language outcomes andor proximal correlates directly affect child family engagement participation intervention parenting style specifically quantity quality parental linguistic input child language b included children implanted age 5 years c measured child language age 21 years standardized instruments published 1995 february 2018 e published peerreviewed articles methodological quality assessed adaptation previously validated checklist metaanalyses conducted assuming randomeffects model results total 22 study populations reported 27 publications included methodological quality highly variable ten studies longitudinal design three metaanalyses correlations family variables child language development could performed strong effect quality quantity parental linguistic input first 4 years postimplantation childs language found r 0564 p 0001 95 confidence interval ci 0449 0660 accounting 317 variance child language outcomes results demonstrated high homogeneity q 3 1823 p 061 2 0 higherlevel facilitative language techniques parental expansions childs utterances use openended questions predicted child language skills risk publication bias detected results impact family involvementparticipation intervention child language development heterogeneous metaanalysis included mainly crosssectional studies identified low moderate benefits r 0380 p 0052 95 ci 0004 0667 almost attained significance level socioeconomic status mainly operationalized parental level education showed positive correlation child language development studies metaanalysis confirmed overall low nonsignificant average correlation coefficient r 0117 p 0262 95 ci 0087 0312 limitation study lack potentially relevant variables multilingualism family screen time conclusions data support hypothesis parental linguistic input first years cochlear implantation strongly predicts later child language outcomes effects parental involvement intervention parental education comparatively weaker heterogeneous findings underscore need earlyintervention programs children cochlear implants focusing providing support parents increase childrens exposure highquality conversation