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Parent Infant Programs (PIP) & Preschool Education of Children with Hearing Impairment

Parent Infant Programs (PIP) & Preschool Education of Children with Hearing Impairment
Ananya Chatterjee, Srikantakr Mishra
November 1, 2004
District Center for Rehabilitation for the Persons with Disabilities
Jalpaiguri, West Bengal, India


The purpose of this study was to evaluate the impact of a parent infant program (PIP) on academic performance and cooperativeness of children with hearing impairment attending preschool. Scores in academic performance and cooperativeness of 73 hearing impaired children attending preschool were obtained using two sets of questionnaires. Statistical analysis revealed hearing impaired children who attended a formal PIP showed better pre-school performance in academics and cooperativeness, as compared to their counterparts who did not attend.


Advances in hearing screening technology make it possible to identify hearing-impaired infants at birth, enhancing the opportunity for early intervention. To provide services for families of hearing-impaired infants, the Parent Infant Program (PIP) was established. Enthusiasm for PIP emerged from the concept that children advance to the best of their abilities when their emerging speech, language and auditory skills are reinforced in a context of acceptance and respect, and importantly, the most important learning environment for a child during the early years, is the home.

During these early formative years, the child's most important relationships are with their parents and other primary care-givers, such as siblings, grandparents and other family members.

Consequently, the emphasis of PIP is a home-based, family-centered, parent-guided, child-specific, natural approach to learning. The parent infant program brings together children from infancy through pre-school age, their parents, family and a variety of early intervention professionals to work as a team and offer services to assist families in communicating and bonding with their children in the child's natural environment. Parents are encouraged to network with other parents. PIP helps hearing impaired children and their parents develop potential in primary areas and strives to nurture the child's development of language, literacy skills, growth in world awareness, positive self-esteem, personal responsibility and cultural pride.

Although there are improved and widespread special schools for hearing impaired children available across India, the value of an integrated educational program remains significant. The Indian government's educational legislation emphasizes integration of the disabled child into ''normal' schools through mainstreaming of children with various disabilities, including hearing impairment. Consequently, to achieve successful integration, pre-school education for hearing impaired children plays a key role in establishing the foundation upon which further learning occurs.

Research suggests that, hearing impaired children who have attended pre-school showed better academic performance and social integration in normal schools when compared to their counterparts who did not attend pre-school (Mahendru, 2001). However, pre-school programs for hearing impaired children may not be a success without active participation by parents.

The PIP was established to assist parents in developing strategies needed to nurture their child's language, speech, auditory, intellectual abilities, social and emotional growth throughout their education.

However, there is lack of research which emphasizes the role of PIP in pre-schools for the hearing impaired children. Therefore, the present study aimed to evaluate the impact of PIP on academic performance and cooperativeness of hearing impaired children in preschool.

In the present context, academic performance refers to the basic preschool tasks as specified in Mukul, 1999 and cooperativeness refers to the child's overall willingness and participation in a formal pre-school. Validity information was obtained by conducting a study of 73 children, scores in academic performance and cooperativeness were compared between two groups (PIP attending and not attending).



The sample consisted of 73 pre-school attending hearing impaired children (53 male and 20 female) ranging in age from 2.5 to 6.0 years with a mean age of 4.7 years. 29 hearing impaired children (22 male and 7 female) were attending a formal PIP while 44 (31 male and 13 female) were not. The sample was selected randomly from children referred by the special education departments, local special schools and speech and hearing centers. 31 children (22 male and 9 female) had bilateral severe sensorineural hearing loss and 42 (31 female and 11 female) had bilateral profound sensorineural hearing loss. The selection criteria for the study specified that each child be available during all procedures, that every subject should be using their hearing aid(s) routinely, and that both parents of each participant needed to have a minimum educational level equivalent to the 10th grade.


Two closed-set questionnaires were prepared per MUKUL. One set for evaluating the academic performance and the other for assessing cooperativeness. Each questionnaire consisted of 10 queries (2 points each) with a maximum possible score of 20. Scores for academic performance were evaluated by the special educator while scores in cooperativeness were jointly marked by the special educator and the parents. The average score of three trials from three different occasions for a given participant in each set of questionnaires was considered for analysis. While evaluating the scores for each child, many attempts were enforced to eliminate measurement errors and subject- related biases. For instance, to avoid influence on a participant's performance and to reduce order effects, the scoring orders were randomized. Some children were scored for cooperativeness first followed by academic performance scoring. Another child may have begun with scoring for academic performance followed by scoring for cooperativeness.

Data Anaylsis

Statistical analysis at 95 % confidence level was applied for the obtained raw data separately for the scores in academic performance and cooperativeness. Despite some data that appeared to be contaminated due to measurement- errors, no data outliers were removed for the analysis because these errors are considered to be typical of those seen in clinical settings.


A summary of the descriptive results of the statistical analysis for academic performance is given in Table I.

This suggests that, children who were attending a formal PIP showed better academic performance in the preschool when compared with those who were not. Analysis of the cooperativeness scores are presented in Table II. As the analysis indicates that children who were attending a formal PIP were more cooperative than who did not.
Table II.


The high level of significance indicated by the analysis of academic performance and cooperativeness cannot be examined within context of historic data, due to non- availability of similar literature. Nonetheless, possible explanations for better preschool performance (academics and cooperativeness) of PIP attending children may be due to:

  • Better acceptance and orientation of the hearing impaired child in the family,

  • Facilitation of communication between the child and parents or other primary care givers,

  • Providing the child optimum speech, language and auditory stimulation at home,

  • Maximum utilization of the critical age period,
  • Giving parents necessary information for their child's overall development.

Interestingly, when all data are considered, the highest score in academic performance and cooperativeness was obtained by a male child (3.0 years) with bilaterally severe sensorineural hearing loss who was attending a formal PIP. In contrast, a female child (4.0 years) with bilaterally profound sensorineural hearing loss not attending PIP scored lowest in both academic performance and cooperativeness. It was also observed that, among those children with bilaterally profound sensorineural hearing loss, the highest score in both academic performance and cooperativeness was obtained by a female child (5.8 years) who was attending a formal PIP. Furthermore, the child who scored highest in academic performance usually also scored highest in cooperativeness and the child who scored lowest in academic performance also scored lowest in cooperativeness.

From these observations, it can be speculated that degree of hearing loss plays a role in academic performance and cooperativeness of hearing impaired children in the preschool. This is consistent with the fact that degree of hearing loss has a significant impact on academic performance. For a given degree of hearing loss PIP helps enhance preschool performance (academics and cooperativeness) of hearing impaired children. The data from this study further reinforce that there could be a relation between academic performance and cooperativeness of the hearing impaired children in preschool.


There is no one ''right'' course of action for a family with a hearing impaired child. Parent-infant program specialists can help parents learn about hearing loss, guide them in learning their child's strengths and needs, and the educational options available. Once parents have this information, they will be able to make the best decision for their family.

The data from the present study supports PIP as a routine early intervention program, however, additional empirical research needs to be conducted.

Finally, in developing countries like India, if preschool education for the children with hearing impairment is to be a reality, sufficient emphasis needs to be placed on implementation of parent infant programs.

Author's Note

This study was conducted during the second author's clinical posting for Internship (BASR) at DCRPD. The second author is currently pursuing his postgraduate studies at AIISH, Mysore, India.


1. Mahendru A. Impact of pre-school education on integrated education of the hearing impaired children at primary level. Hearing Aid Journal, 15 (2), 2001, 68 - 73.

2. Mukul: Pre-school for the hearing handicapped children, 1999. A publication (in Bangla) of AYJNIHH, ERC, Kolkata, India.

3. Persons with Disabilities Act (1995), Govt. of India.

4., for comprehensive information on PIP.
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Ananya Chatterjee

Srikantakr Mishra

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