SLPs’ perceptions of language learning myths about children who are DHH

Jena McDaniel; Hannah Krimm; C Melanie Schuele

doi:10.1093/deafed/enad043

. 2023 Sep 23;29(2):245–257. doi: 10.1093/deafed/enad043

SLPs’ perceptions of language learning myths about children who are DHH

Jena McDaniel ^1,^✉, Hannah Krimm ², C Melanie Schuele ³

PMCID: PMC10950421 PMID: 37742092

Abstract

This article reports on speech-language pathologists’ (SLPs’) knowledge related to myths about spoken language learning of children who are deaf and hard of hearing (DHH). The broader study was designed as a step toward narrowing the research-practice gap and providing effective, evidence-based language services to children. In the broader study, SLPs (n = 106) reported their agreement/disagreement with myth statements and true statements (n = 52) about 7 clinical topics related to speech and language development. For the current report, participant responses to 7 statements within the DHH topic were analyzed. Participants exhibited a relative strength in bilingualism knowledge for spoken languages and a relative weakness in audiovisual integration knowledge. Much individual variation was observed. Participants’ responses were more likely to align with current evidence about bilingualism if the participants had less experience as an SLP. The findings provide guidance on prioritizing topics for speech-language pathology preservice and professional development.

Introduction

Speech-language pathologists (SLPs) are called to provide high-quality, evidence-based services to a wide variety of individuals with communication needs. SLPs need to access, interpret, and apply the extant and evolving evidence related to speech and language development as it becomes available. Doing so is necessary to provide effective, evidence-based interventions. Keeping current on the evidence, especially for low-incidence diagnoses, can be challenging for SLPs. Approximately 2–3 of every 1,000 children born in the United States are deaf and hard of hearing (DHH; Centers for Disease Control and Prevention, 2010; Vohr, 2003). Given this incidence level, an SLP may experience a period of time in which their caseload does not include any children who are DHH. However, that could change at any time, especially for school SLPs who typically serve all children receiving speech and language services within their assigned school(s).

Revealing SLPs’ current understanding related to language development in children who are DHH is essential to determining whether and what types of support SLPs need so that they can provide effective, evidence-based language services to children who are DHH. Many SLPs, including those who serve children who are DHH, express lower-than-desirable comfort levels with serving the DHH population (Blaiser & Mahshie, 2022; Harrison et al., 2016). Reported comfort levels were especially low for children who are DHH under age 3 and for certain practice areas (e.g., sign language development and troubleshooting hearing technology). Such perceived and true areas of need could place SLPs at risk for providing services that are not evidence-based.

The current report was a step toward narrowing the research–practice gap and providing effective, evidence-based services to children who are DHH. We aimed to determine the degree to which SLPs endorse or reject statements related to myths about spoken language learning of children who are DHH. We focus on myths because myths provide an opportunity to identify areas of SLPs’ thinking or practice that do not align with current evidence. Further, myths can be addressed or countered via supports or interventions for SLPs. In this report, we specifically focused on myths from three subtopics related to whether and how speech-language intervention services are provided to children who are DHH and learning to use spoken language. We focus on spoken language because of (a) the likelihood of SLPs interacting with DHH children who use spoken language outside of schools specific for children who are DHH and (b) the ability to compare results for children who are DHH with results for other populations for certain myths.

The first subtopic addresses whether children who are DHH can be bilingual for spoken languages. The myth that bilingualism has a negative impact on language development is pervasive, not only related to children who are DHH but also other populations. Addressing bilingualism specifically for spoken languages enables us to compare perspectives about this myth for children who are DHH relative to other populations who primarily use spoken languages. SLPs’ perspectives on bilingualism are expected to influence recommendations they provide to families for which language(s) to use and which language(s) are used in intervention.

The second subtopic addresses the use of hearing technology and how the use of hearing technology influences speech and language abilities and need of intervention services. SLPs need an accurate understanding of the potential benefits and limitations of hearing technology to provide needed educational supports and refer students to an audiologist to explore hearing technology adjustments.

The third subtopic addresses audiovisual integration for speech perception. Consistent with the focus on spoken language, we address how auditory input and visual input from the speech articulators interact for understanding speech. SLPs’ perspectives on audiovisual input are expected to influence the use of certain spoken language intervention techniques and thereby the effectiveness of intervention.

Bilingualism for spoken languages

One widespread myth about bilingualism asserts that learning two languages can confuse a child. According to this myth, if a child who is learning two languages is slower than peers in learning to talk, the child should only be exposed to one language to alleviate the confusion, thereby improving the child’s language skills. This recommendation seemingly is made without regard to the languages used by the child’s family and community (Blanc et al., 2022; Guiberson, 2013a; Yu, 2013). Within the United States, the suggested language to use in such cases is almost always English even if the child’s family uses another language more, or solely, at home (Blanc et al., 2022; Yu, 2013). This myth has influenced services not only for children who are DHH but also for children with autism spectrum disorder, Down syndrome, and specific language impairment (Kay-Raining Bird et al., 2005; Paradis et al., 2003; Wharton et al., 2000; Yu, 2013). In this study, we were focused particularly on bilingualism in children who use two spoken (oral) languages. Questions regarding use of signed and spoken languages are also important (Steinberg et al., 2003) but were beyond the scope of this study.

This myth about bilingualism being confusing or slowing the pace of a child’s language development is not supported by current evidence. In fact, there is substantial evidence against this myth. Counter to this pervasive myth, bilingualism yields positive effects for language learning (Kay-Raining Bird et al., 2005, 2012; Perozzi & Sanchez, 1992; Seung et al., 2006; Thordardottir et al., 1997) as well as cultural awareness and identity (Yu, 2013; Zentella, 1997). Additionally, monolingual children with disabilities (e.g., autism spectrum disorder, DHH, Down syndrome, and specific language impairment) do not outperform their bilingual peers with the same diagnosis (Bird et al., 2005; Bunta & Douglas, 2013; Feltmate & Kay-Raining Bird, 2008; Guiberson, 2013a; Ohashi et al., 2012; Paradis et al., 2003; Petersen et al., 2012). If bilingualism is an added burden for learning language, one would expect weaker language skills across bilingual children as compared with monolingual children. The available empirical evidence does not yield such results. Further, children who use cochlear implants (CIs) have shown strong performance in a second spoken language (McConkey Robbins et al., 2004; Waltzman et al., 2003).

A few studies document the pervasiveness of this bilingualism myth specifically for children who are DHH. Guiberson (2013b) surveyed parents of children who are DHH in Spain to investigate the pervasiveness of the myth that children who are DHH will be confused by learning two languages and therefore cannot be bilingual. The 71 surveyed parents reported their beliefs and practices regarding bilingualism for themselves and their children. Among other questions, the survey included three questions about their beliefs of raising children who are DHH to use two spoken languages. An apparent discrepancy between the parents’ beliefs and practices was revealed. Although most parents (more than 80%) expressed that bilingualism is natural and beneficial and that children who are DHH can learn two spoken languages, only 38% were raising their children who are DHH to use two spoken languages.

In a related study, Benítez-Barrera et al. (2023) surveyed caregivers of children who are DHH who speak Spanish and live in the United States. Caregivers were asked about the recommendations professionals and nonprofessionals had provided to them about using two spoken languages with their children who are DHH. Caregivers reported whether they were only encouraged to use two spoken languages, were only discouraged from using two spoken languages, were given mixed advice, or received no recommendation. Only 23% of caregivers reported only being encouraged to use two spoken languages with their children by professionals (e.g., audiologists, deaf educators, otolaryngologists, physicians, SLPs, and teachers). In contrast, 45% of caregivers reported that nonprofessionals (e.g., family, friends, and community support) only encouraged them to do so. Remarkably, 6% of caregivers reported only being discouraged from using two spoken languages with their children from professionals. No caregivers reported being only discouraged by nonprofessionals. Some caregivers received mixed advice from professionals (12%) and nonprofessionals (10%). These findings highlight that professionals are not serving as experts in the provision of current evidence.

We aim to extend these findings on the pervasiveness of the myth that children who are DHH cannot learn two spoken languages to SLPs specifically. SLPs are often involved in counseling parents on the possible language options for children who are DHH (Blanc et al., 2022). Therefore, SLPs are in a position to potentially combat this myth, if they have the necessary knowledge and skills to do so.

Hearing technology

To best serve children who are DHH, SLPs must be knowledgeable about the benefits and limitations of hearing technology as well as the educational impact of reduced auditory access. If an SLP assumes that hearing technology is all that is needed to achieve educational success, that SLP misses opportunities to provide needed educational supports. Alternatively, failing to recognize the myriad benefits of hearing technology for children who are DHH and use spoken language may lead SLPs to disregard signs that a child needs to be referred to an audiologist for new hearing technology or modifications to their existing hearing technology.

Appropriately-fit hearing technology can provide substantial benefits for children who are DHH with varied hearing levels (Geers et al., 2003; McCreery et al., 2015; Svirsky et al., 2000; Tomblin et al., 2015; Walker et al., 2015). Unfortunately, simply wearing hearing aids or CIs does not ensure that a child has full auditory access to language and the general education curriculum. Many children who are DHH, including children who use hearing technology, continue to exhibit difficulty achieving age-expected language skills (Antia et al., 2020; Boons et al., 2013; Dettman et al., 2013; Geers et al., 2017; Geers & Sedey, 2011; Harris & Terlektsi, 2011; Kyle & Harris, 2011; Lund, 2016; Nittrouer et al., 2020; Ruben, 2018). Audibility, “the proportion of the speech signal that is audible,” is one influential factor on spoken language outcomes (McCreery et al., 2014, p. 440). Well-fit hearing technology supports audibility and, in turn, supports spoken language outcomes, but it is far from the only factor that matters (McCreery et al., 2019; Tomblin et al., 2015).

An influential factor on language outcomes for children who receive CIs is age of implantation. Children who are eligible for cochlear implantation benefit from being implanted at younger ages relative to older ages (Colletti et al., 2011; Dettman et al., 2007; Nicholas & Geers, 2013). Observed benefits include higher language skills before entering school for children implanted relatively young (i.e., 6–11 months vs. 12–18 months of age; Nicholas & Geers, 2013) and earlier attainment of age-expected expressive language growth rates (Tomblin et al., 2005). Thus, replicated findings support higher language skills for children who receive CIs at younger ages compared with older ages.

Audiovisual integration for speech perception

Knowledge of audiovisual integration, especially for children who are DHH, has implications for how SLPs structure intervention. Spoken word recognition often is treated as a unisensory auditory process, even though it is a multisensory process under natural conditions (Holt et al., 2011). A listener receives not only auditory input from conversational partners but also visual input from the movement of the partners’ articulators¹. Auditory input is especially influential for perceiving the manner of articulation and voicing, whereas visual input is especially influential for perceiving the place of articulation (Eisenberg, 1985; Grant & Seitz, 1998; Rouger et al., 2008; Rudner et al., 2016). Speech processing, including word recognition, is enhanced with multisensory input compared with unisensory input for individuals with typical hearing (Erber, 1969, 1972; Kim & Davis, 2003; Reisberg et al., 1987; Sumby & Pollack, 1954) and individuals who are DHH (Bergeson et al., 2005; Grant & Seitz, 1998; Kaiser et al., 2003; Kirk et al., 2002, 2007; Lachs et al., 2001). Individuals with typical hearing repeatedly have shown benefit from access to speechreading cues under relatively more difficult listening conditions such as low signal-to-noise ratios (Erber, 1969, 1972; Sumby & Pollack, 1954) or an unfamiliar language or accent (Kim & Davis, 2003; Reisberg et al., 1987). Even infants show a preference for congruent rather than incongruent auditory and visual input (Dodd, 1979; Patterson & Werker, 2003). Individuals who are DHH also demonstrate greater word recognition when provided with multisensory input as compared to auditory or visual input alone (Bergeson et al., 2005; Grant & Seitz, 1998; Kaiser et al., 2003; Kirk et al., 2002, 2007; Lachs et al., 2001). Variation in audiovisual integration for speech perception has been observed among children with CIs; age of implantation, language skills, and speech intelligibility have been identified as factors that relate to this variation (Bergeson et al., 2003; Gilley et al., 2010; Kirk et al., 2002; Schorr et al., 2005).

The multisensory processing of speech appears to contraindicate unisensory approaches for training auditory skills in children who are DHH. Unisensory approaches focus on isolating auditory input and limiting visual cues to prevent vision, which is unimpaired, from being “victorious” over audition, which is limited in acuity (Pollack, 1970, p. 18). Unisensory approaches emerged in the United States in the 1930s to 1970s prior to the availability of modern hearing aids and CIs. In subsequent decades, strategies for isolating auditory input for speech processing have evolved. Use of the hand cue (i.e., speaker covering mouth with flat hand; Estabrooks, 2001) has been reduced. However, use of speech hoops, strategic sitting (e.g., sitting behind or beside the child), and visual distractors (e.g., speaking when a child is looking at an object rather than the speaker’s face) to minimize access to visual speechreading cues remain as recommendations within auditory-only approaches (Estabrooks, 2001; Rhoades et al., 2016; Robbins, 2016). A lack of awareness of the more recent multisensory processing findings may result in SLPs restricting access to visual input during intervention in a manner that hampers progress.

Purpose of current study report

This report explored the extent to which SLPs agree or disagree with myths about spoken language learning of children who are DHH. We specifically focused on myths about bilingualism for spoken languages, the use of hearing technology, and audiovisual integration of children who are DHH. This early-stage study is intended to inform future work that addresses identified gaps in SLPs’ knowledge so that SLPs provide effective, evidence-based intervention services to children who are DHH and learning to use spoken language.

Research questions

We addressed two research questions. We first asked the following: (a) To what extent do SLPs endorse or reject true statements and false (i.e., myth) statements related to children who are DHH? To explore differences in knowledge across SLPs, we then asked: (b) Do years of speech-language pathology experience correlate with the degree to which SLPs’ responses align with current evidence? Due to limited evidence, we did not generate specific hypotheses.

Methods

The Vanderbilt University Institutional Review Board approved all study procedures.

Participants

Participants were recruited electronically in July and August 2020 from 338 registered attendees (primarily SLPs and SLP graduate students) of an online 2-day statewide professional development conference focused on the educational needs of school SLPs and a large lab database of SLPs. The conference attracts a relatively large number of SLPs from varied urban and rural counties. The database included SLPs who attended speech, language, and literacy professional development sponsored by Vanderbilt University Medical Center. In response to invitations sent via conference emails and verbal announcements, 155 individuals expressed interest in participating. They received access to the consent form and study survey. Of those 155 individuals, 106 SLPs (103 females, 3 males) completed the consent and study survey; 3 SLPs completed the consent but abandoned the survey; and 31 SLPs did not access the consent or study survey. Fifteen graduate students also completed the survey. However, their responses are not included in this report due to space limitations for thorough analysis of their responses relative to the SLPs’ responses.

At the beginning of the survey, participants reported demographic information. Only 1 of the 106 SLPs was not currently employed as an SLP. The participants had a mean age of 38 years (SD = 11 years; range: 23–68 years) with a mean years of speech-language pathology experience of 12 (SD = 10 years; range: 0–43 years; n = 103). Three participants did not report their years of experience. One participant reported a value exceeding their chronological age; this value was excluded. Seventy-four participants (70%) reported working currently in a school setting, which is expected given that the conference from which participants were recruited focuses on the needs of school SLPs. Three participants did not report whether they worked in a school. The other 29 participants reported not working in school currently. The participants had a mean of 9.00 years (SD = 8.43 years; range: 0–38 years) of experience as a school SLP. Most participants (n = 85) worked in Tennessee; 20 were from 14 other states, and 1 participant lived outside of the United States. For highest degree earned, 101 participants reported a master’s degree and 5 reported a doctorate. Twelve participants reported being bilingual or multilingual. French (n = 4) and Spanish (n = 4) were the most common non-English languages used, followed by American Sign Language (n = 3). Other reported languages were German (n = 1), Portuguese (n = 1), and Vietnamese (n = 1).

The current sample’s racial profile is similar to that of national demographic data from American Speech-Language-Hearing Association (ASHA) members, nonmember certificate holders, international affiliates, and associates certified in speech-language pathology. It should be noted that, for this report, we calculated categorical percentages based on the total number of participants who provided race information (three did not provide information). We did not use the full sample because 14% of the national sample did not provide race information and were not included in ASHA’s categorical percentages. Ninety-eight participants (94%) identified as white, three (2.9%) as Black or African American, two (1.9%) as Asian, and one (1.0%) as more than one race. For the national sample, 91.3% identified as White, 3.6% as Black or African American, 3.1% as Asian, and 1.5% as more than one race (ASHA, 2022). The participant sample included a similar percentage of females as the national sample (i.e., 98% vs. 96%; ASHA, 2022). Regarding ethnicity of the participant sample, 101 participants reported to be non-Hispanic, 3 participants preferred not to answer, and 2 did not provide a response. For the national sample, 6% reported being Hispanic (ASHA, 2022). We cannot compare the study participants’ ethnicity and race proportions to those of the total conference attendees because we do not collect ethnicity and race information from conference registrants.

Survey development and format

The authors and several research assistants developed an initial survey draft based on the relevant literature, including results from published studies (e.g., Guiberson, 2013b) to utilize prior validation processes, improve validity, and provide an opportunity for replication (Rickards et al., 2012). We followed survey development practices of minimizing negative statements and avoiding double-barreled items (Dillman et al., 2009; Tourangeau et al., 2000). We included both true and false statements related to myths to minimize the likelihood that respondents would simply disagree (or agree) with every statement. We sought to avoid participants guessing that disagreeing was the “right” answer based on a few statements and then marking disagree for all statements regardless of their true perspectives. Through an iterative piloting process, practicing SLPs and SLP graduate students (master’s and PhD) provided feedback. We identified and edited confusing phrasings and estimated the time required to complete the survey (15 min; Sullivan & Artino Jr., 2017). Phrases were deemed as confusing for a variety of reasons including use of unfamiliar or unknown terms, possible alternative interpretation provided, or multiple interpretations reported.

The final study survey included 3–15 statements for each of seven topics presented in alphabetical order: bilingualism, autism spectrum disorder, DHH, dyslexia, language development, speech–language impairment, and vocal development/babbling. These seven topics were selected because (a) they relate to speech, language, and literacy; (b) they are expected to be familiar to and important for SLPs serving children, including but not limited to school SLPs; and (c) we have encountered these myths in clinical and educational settings (e.g., caregivers sharing experiences about information they received, students asking questions from conversations or clinical practicum experiences). The survey concluded by asking participants to report professional development resources that they use in a typical school year. See McDaniel et al. (2023) and Krimm et al. (2023) for additional findings.

We chose to use a visual analogue scale to increase the variance across participants and to increase sensitivity to change compared with discrete Likert-style and verbal rating scales (Briggs & Closs, 1999; Hasson & Arnetz, 2005; Pfennings et al., 1995). Participants were presented with written statements and asked to move the slider to mark the extent to which they agree or disagree with each statement. See Figure 1 for two example statements. Consistent with best practices for electronic administration of visual analogue scales, all scales were displayed horizontally and appeared with the statement on the same screen (Byrom et al., 2022). Participants could select a location on the scale by tapping the line in a specific location or by sliding the slider. The first statement in Figure 1 illustrates a participant’s answer, having moved the slider to the right to indicate general but not total agreement with the statement; the second statement illustrates how a statement appears before the participant marks their response. As displayed in Figure 1, the anchor of “strongly disagree” appears at the far left side of the scale and the “strongly agree” appears at the far right. No additional anchors were provided.

Example visual analogue scale questions from the survey.

DHH survey items

In this report, we focus on the seven statements (two true and five myth statements) related to spoken language learning of children who are DHH. These statements address the subtopics of bilingualism, hearing technology, and audiovisual integration for children who are DHH. Two or three statements related to each subtopic.

Survey administration

Participants completed the survey electronically via Research Electronic Data Capture (REDCap; Harris et al., 2009, 2019), which is a web application developed by Vanderbilt University. REDCap is used to build and manage online surveys and databases. Prior to answering study questions, participants reviewed the consent form within REDCap. If they electronically agreed to participate, they sequentially completed the nine survey sections: demographic information (one section), ratings for true and myth statements arranged by seven topics (seven sections), and description of professional development resources that they access in a typical year (one section). Participants were permitted to return to prior sections before submitting the survey.

Data processing and analysis plan

Some participants did not respond for all statements, resulting in 103–105 responses per statement. For each statement, each participant earned an endorsement score from 0 (“strongly disagree”) to 100 (“strongly agree”) based on where the participant placed the slider on the line. Scores between 51 and 100 indicate movement of the slider to the right (i.e., toward “strongly agree”). Scores in this range align with the current evidence for a true statement but do not align with the current evidence for a myth statement. Scores between 0 and 49 indicate movement to the left (i.e., toward “strongly disagree”). Scores in this range align with the current evidence for a myth statement but do not align with the current evidence for a true statement. The participants never saw these numbers. The numbers only exist in an underlying metric.

We display the distribution of responses on a histogram for each statement. Using a one-sample t-test, we tested whether the mean endorsement score differed from the neutral midpoint (i.e., score of 50). We calculated an effect size, d, for each statement (Francis & Jakicic, 2022). Visual analogue scale results permit these parametric analyses (Maxwell, 1978; Myles et al., 1999). We identify relative strengths and weaknesses across the statements based on the distributions, t-test results, and effect sizes.

We also tested for significant correlations between endorsement scores and years of speech-language pathology experience. The current evidence aligns with high endorsement scores for true statements and low scores for myth statements. Therefore, interpretation for the direction of correlation differs for true versus myth statements. For true statements, positive correlations align with SLPs’ knowledge about evidence-based practices increasing as they work as SLPs. Negative correlations for true statements align with SLPs not staying current on evidence-based practices and with implementing outdated ideas or practices. In contrast, for myth statements, positive correlations align with SLPs not staying current on evidence-based practices and with implementing outdated ideas or practices. Negative correlations for myth statements align with SLPs’ knowledge about evidence-based practices increasing as they work as SLPs.

Results

Endorsement scores across statements

The survey included two true statements and five myth statements related to spoken language learning of children who are DHH. Table 1 displays descriptive statistics, a one-sample t-test result, and an effect size (Francis & Jakicic, 2022) for the endorsement scores for each statement across participants. Given the seven dependent variables, p-values < .007 are statistically significant with the Bonferroni correction to address family-wise error (Nicholson et al., 2022). For the effect size (d), .2 is considered small, .5 is considered medium, and .8 is considered large (Cohen, 1988).

Table 1.

Descriptive statistics, one-sample t-test (vs. 50) results, and correlations with SLP experience for SLPs’ endorsement scores.

					One sample t-test			Correlation with SLP experience
Statement	True or myth	Mean (SD)	Range	n	t	p	d	r	p
Bilingualism
Children who are deaf and hard of hearing have the capacity to develop skills in two oral languages.	True	75 (20)	19–100	105	13.09*	<.001	1.28	−.23	.02
Children who are deaf and hard of hearing will be confused by being exposed to two oral languages.	Myth	25 (20)	0–81	105	−12.84*	<.001	1.25	.29	.003
Learning two oral languages is too great of a challenge for children who are deaf and hard of hearing.	Myth	24 (19)	0–83	104	−14.03*	<.001	1.38	.45*	<.001
Hearing technology
Pediatric cochlear implant candidates who undergo cochlear implantation at relatively young ages are expected to achieve higher speech and language outcomes than candidates who undergo implantation at relatively older ages.	True	73 (19)	0–100	105	12.50*	<.001	1.22	−.13	.20
School-age children who are deaf and hard of hearing who use spoken language and are fit appropriately with hearing technology likely do not need additional education services.	Myth	24 (18)	0–100	104	−14.22*	<.001	1.39	−.05	.59
Audiovisual integration
Children who are deaf and hard of hearing develop their auditory skills more during language intervention sessions if they cannot see the person talking than if they can.	Myth	45 (26)	0–100	103	−1.85	.07	0.18	−.12	.25
Children who are deaf and hard of hearing will become overly reliant on visual cues if they are not taught to listen.	Myth	46 (22)	0–100	105	−1.97	.05	0.19	−.004	.97

Open in a new tab

Note. A score of 0 corresponds to the anchor of “strongly disagree” and 100 corresponds to the anchor of “strongly agree” on the visual analogue scale. d = effect size (Francis & Jakicic, 2022). SLP = speech-language pathologist.

*Statistically significant with the Bonferroni correction to address family-wise error (i.e., p < .007; Nicholson et al., 2022).

Bilingualism

The survey included one true statement and two myth statements about children who are DHH using two spoken languages. The participants’ responses to questions on this subtopic were areas of relative strength; see Figure 2 and Table 1. The scaling across all histograms (Figures 2–4) is the same to aid comparison across statements.

Histogram of endorsement scores for statements about audiovisual integration. An endorsement score of 0 aligns with the “strongly disagree” anchor on the left, and a score of 100 aligns with the “strongly agree” anchor on the right. The vertical dashed line identifies the midpoint (i.e., 50).

Children who are DHH have the capacity to develop skills in two oral languages [true]. With a mean endorsement score of 75 (SD = 20; range: 19–100), the participants endorsed this true statement with a large effect size (d = 1.28). Most (87%) of the participants agreed with the statement albeit to varying degrees, as can be seen by the relatively flat distribution between 61 and 95. Twenty-six participants marked at or very close to “strongly disagree.” Nine participants marked the midpoint (i.e., 50), and six participants selected a response between the midpoint and “strongly disagree” (i.e., score of 19–49). In contrast to the other true DHH statements, no participants marked between 0 and 15. Thus, the minimum value of 19 is relatively high for the study.

Children who are DHH will be confused by being exposed to two oral languages [myth]. The participants exhibited a nearly mirror image distribution for this myth statement relative to the prior statement. This inverse relation between these two statements is expected because the statements were designed to counter one another. With a mean endorsement score of 25 (SD = 20; range: 0–81), the participants rejected this myth with a large effect size (d = 1.25). Analogous to the prior statement, most participants (81%) rejected this myth, again to varying degrees. The distribution is relatively flat for the left half of the histogram (i.e., disagree section). Nine participants marked the midpoint (i.e., 50). Eleven participants (10%) agreed with the statement. Nonetheless, none of the participants marked the maximum value (i.e., 100) for “strongly agree.” Instead, the maximum value marked by any participant was 81, which is consistent with the minimum value of 19 for the prior true statement (i.e., children who are DHH have the capacity to develop skills in two oral languages).

Learning two oral languages is too great of a challenge for children who are DHH [myth]. Participants responded very similarly to this myth as to the prior bilingual myth. With a mean endorsement score of 24 (SD = 19; range: 0–83), they rejected this myth with a large effect size (d = 1.38). Only four participants agreed to some degree with the statement. Similar to the other myth about bilingualism, but unlike myths on other subtopics, the maximum value marked for any participant was less than 100 (i.e., 83). Twelve participants marked the midpoint (i.e., 50).

Hearing technology

The survey included one true statement and one myth statement about the effects of hearing technology and the educational needs of children who are DHH. See Figure 3 and Table 1.

Pediatric CI candidates who undergo cochlear implantation at relatively young ages are expected to achieve higher speech and language outcomes than candidates who undergo implantation at relatively older ages [true]. With a mean endorsement score of 73 (SD = 19; range: 0–100), the participants strongly endorsed this true statement with a large effect size (d = 1.22). Responses spanned the full range of possible scores. Sixteen participants marked at or very close to “strongly agree,” and most (65%) other scores fell between 60 and 85. This pattern shows moderate agreement with the statement. Although participants selected the full range of scores, only six participants (6%) disagreed with the statement to some degree (i.e., score < 50). Four participants marked the midpoint (i.e., 50).

School-age children who are DHH who use spoken language and are fit appropriately with hearing technology likely do not need additional education services [myth]. With a mean endorsement score of 24 (SD = 18; range: 0–100), the participants overall rejected this myth statement with a large effect size (d = 1.39). Nonetheless, the range of scores still spanned from 0 to 100, and the distribution is relatively flat across the “disagree” portion of the histogram (i.e., left half). There is a small elevation at the far left of the histogram. Twenty-one participants marked at or very close to the “strongly disagree” endpoint. Five participants agreed with the statement (i.e., score > 50), and six participants marked the midpoint (i.e., 50).

Audiovisual integration

Participants exhibited an area of relative weakness in their knowledge of audiovisual integration and its implications for language intervention for children who are DHH. The participants failed to reject either myth on this subtopic. See Figure 4 and Table 1.

Children who are DHH develop their auditory skills more during language intervention sessions if they cannot see the person talking than if they can [myth]. With a mean endorsement score of 45 (SD = 26; range: 0–100), the participants failed to reject this myth statement. The effect size was small (d = 0.18). A peak at the midpoint is apparent on the histogram with 15 participants marking the midpoint (i.e., 50). The distribution is relatively flat on the disagree (i.e., left) side with 46 participants and slightly sloping downward on the agree (i.e., right) side with 42 participants. This pattern indicates an equivocal perspective for the participant group.

Children who are DHH will become overly reliant on visual cues if they are not taught to listen [myth]. With a mean endorsement score of 46 (SD = 22; range: 0–100), the participants also failed to reject this myth statement. The effect size was small (d = 0.19). The pattern of response was quite similar to the prior myth statement about audiovisual integration. There is a peak at the midpoint with 13 participants marking the midpoint (i.e., 50). The distribution slopes on either side with 51 participants on the disagree side and 41 on the agree side. As noted previously, this pattern indicates an overall equivocal perspective for the participant group.

Correlations between endorsement scores and SLP experience

To explore differences in knowledge across SLPs, we tested whether years of experience being an SLP correlates with the degree to which SLPs’ responses align with current evidence. See Table 1. The correlations between years of experience as an SLP and endorsement scores were significant for the three statements about bilingualism. The correlation was small to moderate and negative (r = −.23) for the true statement that “Children who are deaf and hard of hearing have the capacity to develop skills in two oral languages.” Correlations were positive for the myth statements, “Children who are deaf and hard of hearing will be confused by being exposed to two oral languages,” (r = .29; small to moderate) and “Learning two oral languages is too great of a challenge for children who are deaf and hard of hearing” (r = .45; moderate to large). These three correlations show that SLPs with more experience tended to be less aligned with the current evidence. In contrast, SLPs with less experience tended to be more aligned with the current evidence. Correlations for the statements related to hearing technology and audiovisual integration were not significant.

Discussion

This study was designed to evaluate (a) the extent to which SLPs endorse or reject statements related to children who are DHH and learning to use spoken language and (b) the correlations between knowledge about such statements and SLP experience. Overall, participants exhibited mean moderate agreement with true statements and mean moderate disagreement with myth statements. There were more participants who provided extreme responses in the correct direction for the statements about bilingualism than other subtopics. The pattern of responses indicates a relative strength in bilingual knowledge for the participants as a group. Nonetheless, the ample individual variation should be recognized. Responses ranged the full span (i.e., 0–100) for the hearing technology and audiovisual integration statements and approximately 80% of the range for the bilingualism statements. Variation in responses across statements for the various subtopics supports the need to view professional development related to children who are DHH as multifaceted rather than unitary. Professional development providers need to consider the myriad issues that potentially hinder application of evidence-based practices as well as the multiple means through which SLPs may uptake and apply knowledge about current best practices.