There are around one in 1000 babies born with permanent hearing loss, which means it is one of the most common chronic conditions in children. Around 95% of these children are born to hearing parents who have little to no experience of deafness, and these parents usually choose for their child to use spoken language (even those that choose to use sign language). Being able to hear speech sounds is critical to this goal. Any level of hearing loss can make a baby's language learning journey harder because access to sound is effected to some degree, meaning they are at significant risk of delays in language development. These delays can have long-term effects on school readiness, later academic achievement, social and emotional development, employment, and mental health. For deaf children (label used here to describe children with any degree of hearing loss), hearing aids are a key part of the support they receive. This is because they help babies access speech sounds, which are critical for spoken language development and to develop the auditory parts of the brain, especially in the first year of life. By getting hearing aids from an early age and using them consistently, babies are more likely to have better language outcomes. However, research has shown that: 1) hearing aid use in the early years is inconsistent; 2) babies are not wearing their hearing aids as often as they need to for optimal benefits; and 3) caregivers face a number of things that can get in the way of achieving consistent hearing aid use. Any reduction in hearing aid use - even if it's only partial - limits experience with sound and access to spoken language, which can lead to poorer spoken language outcomes. Even though there is a clear need, there are very few programmes of support that could help parents increase hearing aid use with their child, and those that exist do not use the most up to date evidence on how to increase hearing aid use. This means that these programmes of support might not be as effective as they could be. We therefore aim to develop a programme of support that targets the barriers to consistent hearing aid use with babies faced by families. We will do this within the scientific theory known as 'behaviour change theory', which is about understanding the things that influence what we do (our behaviours), and then providing support to help adapt behaviours to meet goals; in this case, the goal of consistent hearing aid use. The programme of support will be co-developed with parents, Audiologists, Teachers of the Deaf, and Educational Audiologists, building on work already being done with families across the UK.

Low levels of reading create educational disadvantage, barriers for employment, and have substantial socio-economic, health and mental health implications. Despite large-scale public health interventions for deaf children, including cochlear implants and universal newborn hearing screening, many deaf children experience severe reading delays, which increase with age. To advance educational opportunities and social well-being of deaf children, we need a better understanding of what enables some deaf children to become good readers, and where the reading process breaks down for other deaf children. The overarching aim of this timely project is to determine how deaf children's reading skills develop in middle childhood and identify the language and cognitive factors that predict progress in reading. We will conduct two complementary longitudinal studies. Study 1 will be a large two-year longitudinal study with 100 deaf and 200 hearing children in middle childhood. Study 2 will be a smaller but longer-term longitudinal study building on existing data collected from deaf and hearing children in preschool, and following them up as they reach middle childhood. Together, these two studies provide a unique opportunity to map deaf children's reading and language trajectories, determine factors predictive of reading growth in middle childhood, and establish the role of preschool language skills in predicting long-term reading outcomes for deaf children. This project is timely because we have an existing cohort who are the requisite age to be included in study 1, and we can build upon their existing preschool data in study 2. Previous studies have mainly included beginning readers and focused on the role of phonology (understanding the sounds of spoken language) in deaf children's reading with inconsistent findings. We will focus on older children and go beyond phonology by investigating a range of skills including vocabulary, morphological skills (knowledge of word structure), language comprehension (English and/or BSL), speechreading (lipreading), and executive functions (mental processes including working memory, inhibition and cognitive flexibility). We are particularly interested in the role of morphological skills, which can be derived through exposure to visual print, and might act as a compensatory route into successful reading for deaf children. This project will be transformative for current knowledge and our understanding of how deaf children read and which language and cognitive factors are predictive of good reading progress. This information will inform current reading instruction and pave the way for developing appropriate reading interventions for deaf children. It is ambitious yet realistic in its scope because we have already recruited 92 out of the required 300 children. Datasets will be shared on the Open Science Framework to facilitate reproducibility and create a robust, unprecedented resource for future research studies. We will ensure significant academic impact by sharing our ground-breaking dataset with researchers across different fields including psychology, audiology, deafness, language and communication science, education, and linguistics. We will engage throughout with key stakeholders and project partners to translate research findings into practice and ensure that the relevant findings and implications are disseminated across clinical and educational practitioners and professionals working with deaf children and their families, and organisations and associations who influence policy on the education of deaf children.

Five percent of children have disabling hearing loss. These children often experience delayed speech and language development. Although the majority of these children attend mainstream schools in the UK, only 34% achieve two A-levels (or the equivalent), compared to 55% of their hearing peers. Mild-to-moderate hearing loss (MMHL) is the most common hearing impairment in children. However, despite the effect of their hearing impairment on development it is the least understood form of hearing loss in children. This means there is an urgent need for research on this group in order to meet the goal set by the National Deaf Children's Society (the UK's biggest children's hearing charity and a partner on this project) of making sure that "by 2030, no deaf child will be left behind". Children with MMHL are prescribed auditory technology (AT) to assist them. Hearing aids are more advanced and accessible than ever, and assisted listening devices - where a talker's speech is streamed directly to the hearing aid to reduce the effects of a noisy background - are now common in classrooms. However, AT is designed based on how adults communicate: adults generally look at the person they are talking with and ask for information to be repeated when they do not hear clearly. On the other hand, children with normal hearing do not look. It is unknown if children with MMHL look at the talker while they listen. This has an impact on the effectiveness of the AT algorithms. PI Stewart has shown that children with MMHL do not have the same improvements in attention, memory and learning as adults do when using AT. This could be due to 1) the children are not wearing their AT; 2) the ATs are "too much of a good thing" and have short- or long-term effects on key hearing and listening skills (e.g. children have found that they can hear without turning to look at the talker); or 3) the ATs are not appropriate for children. To test these hypotheses, we will first systematically review children's AT usage across the UK. Second, we will gather data on the developmental impact of ATs over an 18-month period. Key hearing and listening skills including working out where a sound came from and combining audio with visual information will be assessed. Third, we will assess how children with MMHL communicate with adults and children. We will do this in a research lab in the form of a classroom where eye and head movements and brain activity can be measured. This will allow iCAT to evaluate if AT algorithms (e.g. designed for the listener to look at the talker) are appropriate for children. iCAT will work with industry, audiologists and teachers of the deaf throughout the project to ensure change towards providing child-appropriate ATs for the benefit of children with MMHL. Through the publication of white papers, iCAT will work with UK-based charities and professional bodies to create evidence-based recommendations for policy regarding the use and fitting of the AT in children with MMHL.