JCPSLP Vol 21 No 2 2019 DIGITAL Edition

facing the child) that optimise opportunities for eye contact and joint attention (Brown et al., under review). Limitations The results from this study provide preliminary information on ESR with young children with HL; however, due to the small sample size, it is limited in terms of generalisability. The present study also reflected the variability of the HL population at large, as the participants had different types and severity of HL and used different auditory intervention. This diversity can also be viewed as a strength, as it provided a more holistic view of children with a HL, rather than one specific cohort. Questionnaires have been used in previous research to examine parent–child book reading (Boudreau, 2005; Brown et al., 2017; DesJardin et al., 2014; DesJardin et al., 2017; Sénéchal et al., 1996; Sénéchal et al., 1998) and while measures such as booklists aim to minimise social desirability (Sénéchal et al., 1998) it is possible that parents may shape their responses to what is considered best practice. More specific data could have been obtained from the questionnaire used for the present study, through open-ended responses rather than tick-a-box responses (such as asking parents when they considered it important to commence ESR, but not providing age range responses for the parent to select). Further examination of parents’ enjoyment of ESR and their perceptions on their child’s enjoyment of ESR through open-ended responses may have strengthened this questionnaire as 4 of the 12 participants did not respond to the Likert scale questions regarding parent and child enjoyment of ESR. Using a mixed method design (quantitative and qualitative) may also be viewed as a limitation due to the difficulties with integrating the results and reporting the findings (Tariq & Woodman, 2013). Future directions The present study identified barriers towards ESR for some parents with children with a HL, such as maintaining children’s interest and attention, and offered potential solutions for these barriers such as further education on book selection (using board books with bright, colourful pictures and interactive components) and implementing a seating environment (sitting at eye-level facing the child) that increases opportunities for parent–child interactions (such as eye contact and joint attention). Future research is now needed to investigate whether parent education on ESR does translate to increased occasions of parent–child interaction and stronger language and social communication skills. Implications and conclusion This study provided initial insights into the perceptions towards ESR of parents with children with a HL and their home reading practices. The initial evidence provided in this study indicates that parents with young children with a HL may value ESR, read frequently, and provide access to children’s books within the family home, although may require further education on the importance of ESR, book selection, and seating environment. This education should encourage parents to use board books with big, colourful pictures, and interactive components to facilitate children’s participation and maintain children’s attention (Brookshire et al., 2002; Dickinson et al., 2012; Fletcher & Reese, 2005). Additionally, education on how to promote parent–child interactions through a seating environment that creates

While parents provided access to children’s books within the family home, few parents engaged in literacy activities such as visiting libraries/bookstores. Further investigation is needed to understand why many of the parents with children with a HL seldom or never visited libraries/ bookstores. As time restraints were identified as a difficulty with ESR by the parents in the present study, it is possible that time constraints were also the reason for the limited visits to libraries/bookstores. The parents in the present study reported that they had read few of the age-appropriate and recommended books for children on the booklist, even though many of the books are well established and would have been accessible to the parents in the present study, such as Dear Zoo (Campbell, 1982). It is possible that the parents from the present study are reading other age-appropriate books/texts that were not included in the booklist. It is also possible that the parents in the present study may benefit from further education on book selection, given that four parents reported reading thin-paged books and one parent reported reading newspapers and magazines. The books parents provide while reading with children are important as not all books support parent–child interactions to the same extent (Brookshire et al., 2002). Given that children’s interest and attention is supported through big, bright, and colourful pictures that are relevant to children, reading newspapers and magazines may reduce children’s interest and attention while reading. Difficulties with maintaining attention was also reported as a barrier towards ESR for parents from the present study. Reading thin-paged books may be problematic for very young children as they may tear the pages, also identified as a barrier for parents from the present study. Providing parents with education on the benefits of using board books with bright, colourful pictures and interactive components, may provide a simple solution to reduce the occurrences of children tearing pages as well as increase child attention and interest. Education on book selection could encourage parents to select books with interactive components that support non-verbal turns (such as lifting the flap) to increase parent–child interactions (Brown et al., 2018). Recent research with babies with a HL has provided preliminary evidence to suggest that the seating environment, specifically when parents sit at eye-level, facing their children while reading, can facilitate parent–child interactions (Brown, Trembath, Westerveld, & Gillon, under review). This is important, as Zaidman-Zait and Dromi (2007) have found that children with a HL demonstrate significantly fewer parent–child interactions (triadic interaction) than TH children while reading storybooks. The results from the present study indicated that few parents implemented a seating environment that is thought to support parent–child interactions while reading, with half of the parents reporting that their child sat with their back to the parent, thus reducing opportunities for eye contact and joint attention. Given that children with a HL are reported to have significantly fewer parent–child interactions (triadic interaction) than TH children during ESR (Zaidman-Zait & Dromi, 2007) and are known to have social communication difficulties (Netten et al., 2015), providing parents with children with a HL with education on how to promote parent–child interactions through their seating environment may be beneficial. This is especially important given that recent research with children with a HL, suggests that parent–child interactions during ESR can be increased through seating environments (such as sitting at eye-level,

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JCPSLP Volume 21, Number 2 2019

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