Narrative abilities in early implanted children

Narrative skills and language comprehension in preschool children with cochlear implants: A comparison with children with Developmental Language Disorder or typical development

INTRODUCTION

The narrative skills of children with cochlear implants (CIs) are fragile, but the factors at play and whether these difficulties could be similar to those detected in language impairment are not clear. The present study aims to assess, at the microstructural level, narrative skills, comparing children with CIs with children with Developmental Language Disorder (DLD) or Typical Development (TD). Furthermore, the relationship between verbal (lexical and morphosyntactic) comprehension and narrative skills across groups is investigated.

METHODS

The narratives of 19 children with CIs (Mage = 62.42 months, SD = 6.83), 13 children with DLD (Mage = 65.38 months, SD = 4.27), and 18 preschool children with TD (Mage = 63.67 months, SD = 4.31) were assessed in a standardized task. Articles, prepositions, pronouns, gender and number agreement, accuracy in the use of verbs, and number of arguments in each sentence were analysed. Lexical and morphosyntactic comprehension were also assessed. Performance was compared across groups using ANOVAs or Kruskal-Wallis tests. The role of lexical and morphosyntactic comprehension in predicting each morphological and syntactic element in the narrative task was examined using linear regressions.

RESULTS

Data analysis showed that both children with CIs and DLD had fragilities in narration, both in the morphological and syntactic components. Although some differences between children with CIs and those with DLD emerged in descriptive analyses, these were not statistically significant. Regressions showed that morphosyntactic comprehension predicted the number of pronouns produced only in the TD group.

CONCLUSIONS

The scarce differences between CI and DLD groups and the absence of an effect of morphosyntactic comprehension on pronoun production may be due to their low production of these elements in the narrative task and/or to a difficulty in managing pronouns in an expressive task regardless of their ability to comprehend them. Potential implications of these results are discussed.

Complex Language Use in Children With Hearing Loss: A Scoping Review

PURPOSE

Understanding what is known about the language profiles of children with hearing loss (CHL) is vital so that researchers and teachers can identify the specific complex syntactic structures that CHL may struggle to master. An understanding of which aspects of complex syntax pose difficulties for CHL is necessary to inform the kind of intervention that will facilitate learning complex syntax for this cohort of children. This scoping review aims to identify what is currently known about the complex syntax use of CHL who communicate through spoken language, and uncover gaps in the literature to guide further research.

METHOD

Ascoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The Covidence software was utilized to manage the initial and full-text screening process for the search.

RESULTS

From a total of 304 studies, 42 studies were identified that met the eligibility criteria. The review highlights the use of broad-based language assessments and limited use of specific descriptions of the types of complex syntactic structures and skills.

CONCLUSIONS

Findings highlight the need for assessment protocols and analysis methods that better support the description of complex syntax profiles for CHL. School-age CHL continue to display challenges with complex syntax development. The review highlighted the need for further research to improve understanding of the complex syntax strengths and vulnerabilities of CHL. Further investigation is needed to better understand their ability to combine ideas and build complexity in their language use, which in turn can inform teaching in schools and interventions for children who require support.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21980177.

Determination of language performance by discriminant function analysis in Mandarin-speaking preschoolers with auditory neuropathy spectrum disorder

OBJECTIVE

Characteristics of the audiological performance of children with auditory neuropathy spectrum disorder (ANSD) have been identified; however, studies regarding factors influencing their language development, especially those related to aural-oral rehabilitation, are relatively few. This study aimed to investigate classification functions among the factors regarding audiological, interventional (rehabilitation) and demographic variables that can help determine group membership in language performance for Mandarin-speaking preschoolers with ANSD.

METHODS

Children with ANSD aged 3-6 years (n = 27) enrolled in an auditory-verbal therapy were recruited. The combination of factors that could be used to predict memberships of children regarding whether they achieved age-appropriate language performance or were at risk of language delay were explored using discriminant function analysis.

RESULTS

Maternal education level, age at initial hearing aid fitting, and duration of rehabilitation were all significant factors in predicting the membership of children with ANSD and whether they could achieve an age-appropriate language level or were at risk for language delay. The correct rate for predicting the memberships ranged from 70.4% to 83.3%. Duration of rehabilitation accounted for the greatest effect on discriminant membership regarding achieving age-appropriate language performance and being at risk of language delay. Effect of maternal education level tended to centralize on language comprehension.

CONCLUSIONS

Differences were observed in the quantifiable effects of predictors in discriminant functions for language ability domains. Except for using suitable hearing devices, adequate duration of enrollment in aural and oral rehabilitation would also be important for children with ANSD to develop better language abilities.

Do Acoustic Environment Characteristics Affect the Lexical Development of Children With Cochlear Implants? A Longitudinal Study Before and After Cochlear Implant Activation

Purpose This study investigates the acoustic environment of children with cochlear implants (CIs) and the relationship between exposure to speech, in noise and in quiet, and the children's lexical production up to 1 year after CI activation, while controlling for the effect of early individual differences in receptive vocabulary growth. Method Eighteen children with CIs were observed at 3, 6, and 12 months after CI activation. Children's spontaneous word production during interaction with their mothers (types and tokens) and their expressive and receptive vocabulary size were considered. The characteristics of the acoustic environments in terms of acoustic scenes (speech in noise or in quiet, quiet, noise, music, and other) and of loudness ranges were assessed using data logging of the children's devices. Results Data analysis showed that both the number of tokens and the number of types produced 1 year after CI activation were affected by the children's exposure to speech in quiet with a loudness range between 40 and 69 dB. Expressive vocabulary size and types were affected by the receptive vocabulary knowledge that the children achieved over the first 3 months after CI activation. Conclusions Our data support the role of speech environment and individual differences in early comprehension on lexical production. The importance of exposure to speech with particular characteristics for the lexical development of children with CIs and the implications for clinical practice are discussed.

Production of third-person direct object clitics in children with cochlear implants speaking Italian

Previous research has shown that the production of third-person singular accusative object clitics (3DO clitics) might be taxing in Italian-speaking pre-school children with cochlear implants (CIs). We investigated this topic by assessing 3DO clitic production in 14 children with an average age of 8 years, who had received CI between age 1 and 4. The first goal of the study was to analyze whether school-aged children with CIs exhibit atypical behavior in 3DO clitic production. The second goal was to analyze whether children with CIs are prone to agreement errors in case of gender mismatch between the subject and the 3DO clitic, as has been shown for normal-hearing, typically developing children. To achieve this, we used two tasks in which subject and object clitic grammatical genders were manipulated so that they would or would not match. As for the first goal, the majority of children with CIs had good performance on the clitic tasks. However, some participants' performance was poor. The pattern of deviant responses differed among the poor performers. We believe that children with CIs showing impairments in 3DO clitic production need careful individual analysis in order to plan effective speech therapy. As for the second goal, children with CIs were more prone to agreement errors in the mismatch condition compared to the match condition; this dimension needs to be considered when assessing and eventually rehabilitating clitic production.

Comparison of Social Interaction between Cochlear-Implanted Children with Normal Intelligence Undergoing Auditory Verbal Therapy and Normal-Hearing Children: A Pilot Study

OBJECTIVE

A cochlear implant is a device that helps hearing-impaired children by transmitting sound signals to the brain and helping them improve their speech, language, and social interaction. Although various studies have investigated the different aspects of speech perception and language acquisition in cochlear-implanted children, little is known about their social skills, particularly Persian-speaking cochlear-implanted children. Considering the growing number of cochlear implants being performed in Iran and the increasing importance of developing near-normal social skills as one of the ultimate goals of cochlear implantation, this study was performed to compare the social interaction between Iranian cochlear-implanted children who have undergone rehabilitation (auditory verbal therapy) after surgery and normal-hearing children.

MATERIALS AND METHODS

This descriptive-analytical study compared the social interaction level of 30 children with normal hearing and 30 with cochlear implants who were conveniently selected. The Raven test was administered to the both groups to ensure normal intelligence quotient. The social interaction status of both groups was evaluated using the Vineland Adaptive Behavior Scale, and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.

RESULTS

After controlling age as a covariate variable, no significant difference was observed between the social interaction scores of both the groups (p > 0.05). In addition, social interaction had no correlation with sex in either group.

CONCLUSION

Cochlear implantation followed by auditory verbal rehabilitation helps children with sensorineural hearing loss to have normal social interactions, regardless of their sex.

Glendonald Auditory Screening Procedure (GASP): clinical markers of the development of auditory recognition and comprehension abilities in children using cochlear implants

PURPOSE

To verify the influence of the age of implantation in the development of closed-set auditory recognition and auditory comprehension abilities in children using unilateral cochlear implants (CI), comparing distinct groups and determining clinical markers.

METHODS

Participants were 180 children operated and activated until 36 months of age and who used a CI for at least 60 months. Abilities of auditory recognition in closed-set and auditory comprehension were analyzed through the GASP Tests 5 and 6. The influence of age of implantation was investigated with three groups of children: implanted before 18 months (G1), between 19 and 24 months (G2) and between 25 and 36 months of age (G3).

RESULTS

There was no statistically significant difference when comparing the three groups. Children progressively developed auditory abilities, presenting auditory recognition ability together at approximately 41±4 months of CI use and auditory comprehension at 53±4 months.

CONCLUSION

There was no correlation between hearing performance and age of implantation for children implanted before 36 months of age. For the abilities of auditory recognition and comprehension, the clinical marker was 41±4 and 53±4 months of auditory age, respectively. Therefore, it is expected that, around 60 months of CI use, children implanted during the sensitive period can understand speech without the aid of orofacial reading, reaching the most complex hearing abilities.

The effects of narrative-based language intervention (NBLI) on spoken narrative structures in Persian-speaking cochlear implanted children: A prospective randomized control trial

BACKGROUND

Previous research has shown that narrative-based language intervention (NBLI) is a feasible approach increasing the narrative skills of hearing-impaired children.

OBJECTIVE

In the present study, the efficacy of NBLI on the macrostructure and microstructure components of the spoken narrative of children with cochlear implants (CI) was evaluated in an experimental study.

MATERIALS AND METHODS

Thirty-six CI children between the ages of 5.5 and 7 years were randomly divided in three groups of equal size. Group 1 attended 24 1-h sessions of NBLI group therapy. Group 2 participants each attended 24 1-h private sessions of NBLI instruction. Group 3 attended 24 1-h conventional speech therapy (CST) sessions. The subjects' storytelling skills were prompted using pictures from the Persian version of the Language Sample Analysis test. The results were assessed before treatment (T0), after treatment (T1) and two months after treatment (T2) as follow-up.

RESULTS

Groups 1 and 2 showed significantly better results over Group 3 on all microstructure components of spoken narrative at the T1 (p ≤ 0.04) and T2 (p ≤ 0.04) levels in comparison with T0, but no differences were observed between the NBLI approaches (p > 0.05). All three intervention programs significantly improved the macrostructure of the spoken narrative in CI children.

CONCLUSION

Improvements in spoken narrative structures were observed in CI children that support the efficacy of NBLI over CST for the hearing-impaired population.

Language development in the pediatric cochlear implant patient

Objective

To access the long-term outcomes of children implanted during most sensitive period for language development.

Study design

Literature review.

Method

An initial PubMed search was carried out using the search terms language development and cochlear implant resulted in 1149 citations. A second search was carried out on the initial citations using the criterion of implantation in the period of birth to 24 months, which identified 386 articles. These were analyzed to determine those studies in which linguistic outcome was measured at least three or more years following implantation.

Results

Twenty-one reports published from 2004 to 2017 that met the criteria. The range of follow-up was from 3 years to an excess of 10 years. Four => 10-year follow-up reports were consistent in showing that the earlier the subject is implanted the better the outcome. Many, but not all, of these children did obtain age-appropriate language. There were 17 reports with follow-up from 3 to less than 10 years. In 7 of the 11 studies, the children's expressive language was reported to have reached an age level of less than 80%. The results for receptive language showed that 4 of the 11 studies found that the children achieved a receptive language age level of less than 80%. There were 8 studies which documented the effect of implantation before 12 months of age and between 12 and 24 months of age and they all found that the earlier the implantation, the better the outcome for language.

Conclusion

The cochlear implant is efficacious in the amelioration of receptive and expressive language deficits in most congenitally deafened children implanted before the age of one. The language outcomes for those implanted after the age of one decline as the age of implantation increases.

Level of Evidence

N/A.

Speech processor data logging helps in predicting early linguistic outcomes in implanted children

OBJECTIVE

To analyse the value of listening-data logged in the speech processor on the prediction of the early auditory and linguistic skills in children who received a cochlear implant in their first 2 years of life.

STUDY DESIGN

Prospective observational non-randomized study.

METHODS

Ten children with profound congenital sensorineural hearing loss were included in the study. The mean age at CI activation was 16.9 months (SD ± 7.2; range 10-24). The auditory skills were evaluated with the Infant Toddler Meaningful Inventory Scale and the Category of Auditory Performance. Lexical level was assessed with the MacArthur-Bates Communicative Development Inventory. The overall data of average daily use and acoustic scene-analyses were extracted from Data Logging system. The effect of the one-year cumulative listening time to speech (in quiet) and speech-in-noise on the auditory and lexical scores was analysed.

RESULTS

A significant positive correlation was found between speech in quiet exposure time at low loudness level (<70 dB) and lexical quotient after one year of CI use. Infant Toddler Meaningful Inventory Scale was negatively correlated with the highest speech-in-noise loudness levels (>80 dB). The Category of Auditory Performance was not related to the logged data.

CONCLUSION

The listening environment can influence the early functional outcomes in younger implanted children. In this perspective, the data logging system is a promising tool in predicting early linguistic and auditory outcomes.