Computer-assisted training of phoneme-grapheme correspondence for children who are deaf and hard of hearing: effects on phonological processing skills

Effectiveness of Computerized Auditory Training on Speech Perception in Children With Hearing Loss: A Systematic Review

PURPOSE

The purpose of this study was to investigate the effectiveness of using computerized auditory training in the auditory perception of speech in children who use electronic devices through a systematic review of the literature.

METHOD

This is a systematic review based on the elaboration of the following guiding question: In hearing-impaired children who use electronic devices, how effective is the use of computerized auditory training in the auditory perception of speech? The Cochrane Library, Embase, LILACS, PubMed, Web of Science, and Scopus databases and gray literature (Google Scholar and ProQuest) were consulted.

RESULTS

Nine hundred and eighteen records were identified, with additional two studies in the citation search, totaling 920 studies. After excluding the 184 duplicate references, using the Rayyan platform, the titles and abstracts were screened (n = 736), with 20 studies selected and considered for full reading. Six of the 20 studies were included in the systematic review of the literature.

CONCLUSIONS

Positive and beneficial results regarding computerized auditory training are evidenced, which describe and discuss the proof of the effectiveness of the positive effects on the auditory perception of speech in children using hearing aids and cochlear implants with regard to auditory detection skills, discrimination, recognition, and auditory memory. The positive results are inspiring for the continuity and expansion of studies that further investigate the use of computerized auditory training with contemporary technologies and have an impact on the improvement of access to specialized intervention.

Semantic processing in children with Cochlear Implants: A review of current N400 studies and recommendations for future research

Deaf and hard of hearing children with cochlear implants (CI) often display impaired spoken language skills. While a large number of studies investigated brain responses to sounds in this population, relatively few focused on semantic processing. Here we summarize and discuss findings in four studies of the N400, a cortical response that reflects semantic processing, in children with CI. A study with auditory target stimuli found N400 effects at delayed latencies at 12 months after implantation, but at 18 and 24 months after implantation effects had typical latencies. In studies with visual target stimuli N400 effects were larger than or similar to controls in children with CI, despite lower semantic abilities. We propose that in children with CI, the observed large N400 effect reflects a stronger reliance on top-down predictions, relative to bottom-up language processing. Recent behavioral studies of children and adults with CI suggest that top-down processing is a common compensatory strategy, but with distinct limitations such as being effortful. A majority of the studies have small sample sizes (N < 20), and only responses to image targets were studied repeatedly in similar paradigms. This precludes strong conclusions. We give suggestions for future research and ways to overcome the scarcity of participants, including extending research to children with conventional hearing aids, an understudied group.

Predicting Early Literacy: Auditory and Visual Speech Decoding in Deaf and Hard-of-Hearing Children

The current study investigated the relative contributions of auditory speech decoding (i.e., auditory discrimination) and visual speech decoding (i.e., speechreading) on phonological awareness and letter knowledge in deaf and hard-of-hearing (DHH) kindergartners (Mage = 6;4, n = 27) and hearing kindergartners (Mage = 5;10, n = 42). Hearing children scored higher on auditory discrimination and phonological awareness, with the DHH children scoring at chance level for auditory discrimination, while no differences were found on speechreading and letter knowledge. For DHH children, speechreading correlated with phonological awareness and letter knowledge, for the hearing children, auditory discrimination correlated with phonological awareness. Two regression analyses showed that speechreading predicted phonological awareness and letter knowledge in DHH children only. Speechreading may thus be a compensatory factor in early literacy for DHH children, at least for those who are exposed to spoken language in monolingual or in bilingual or bimodal-bilingual contexts, and could be important to focus on during early literacy instruction.

Intensive computer-based phonics training in the educational setting of children with Down syndrome: An explorative study

Children with Down syndrome (DS) using intensive computer-based phonics (GraphoGame, GG) were studied. The children's independence and improvement in phonological processing, letter knowledge, word decoding, and reading strategies were investigated. Seventeen children (5-16 years) with DS participated in a crossover design through 8 weeks (one period), with three test sessions separated by 4 weeks. Children were randomly assigned to GG intervention or regular schooling (RS). All children completed one period and eight children completed two periods. A majority gradually became independent in managing GG. At the group level, very little benefit was found from working with GG. At the individual level, several children with mild to severe intellectual disabilities showed increased decoding of trained words. After one period of GG and RS, an increase in alphabetically decoded words was found. The finding suggests that when individual challenges are considered, computer-based phonics may be beneficial for children with DS in their educational setting.

Meta-Analytic Findings on Reading in Children With Cochlear Implants

This meta-analysis study aims to quantify the group differences in reading skills between children with cochlear implants and their hearing peers and between children with cochlear implants and children with hearing aids (aged between 3 and 18 years old). Of the 5,642 articles screened, 47 articles met predetermined inclusion criteria (published between 2002 and 2019). The robust variance estimation based meta-analysis models were used to synthesize all the effect sizes. Children with cochlear implants scored significantly lower than their hearing peers in phonological awareness (g = -1.62, p < 0.001), vocabulary (g = -1.50, p < 0.001), decoding (g = -1.24, p < 0.001), and reading comprehension (g = -1.39, p < 0.001), but not for fluency (g = -0.67, p = 0.054). Compared to children with hearing aids, children with cochlear implants scored significantly lower in phonological awareness (g = -0.30, p = 0.028). The percentage of unilateral cochlear implant negatively impacts the group difference between children with cochlear implants and their hearing peers. Findings from this study confirm a positive shift in reading outcomes for profoundly deaf children due to cochlear implantation. Some children with cochlear implants may need additional supports in educational settings.

Auditory event-related potentials and mismatch negativity in children with hearing loss using hearing aids or cochlear implants - A three-year follow-up study

OBJECTIVES

The primary aim was to examine how event-related potentials (ERPs) and mismatch negativity (MMN) change and develop over time among children with hearing loss (HL) using hearing aids (HAs) or cochlear implants (CIs). Children with normal hearing (NH) were tested as a reference group.

METHODS

This three-year follow-up study included 13 children with sensorineural HL (SNHL); 7 children using bilateral HAs and 6 children using CIs; and 10 children with NH as a reference group. ERPs were recorded at baseline and after three years. At time for the original study the children were approximately 5-8 years old and at the follow-up study 8-11 years old. ERP recordings and data processing were identical in both sessions. A standard stimulus alternated with five different deviants (gap, intensity, pitch, location and duration), presented in a pseudorandom sequence, thus following the multi-feature paradigm, Optimum-1. MMN was calculated from the average ERP of each deviant minus the standard stimuli. Repeated measures ANOVA was used for the statistical analyses and the results were based on samples within a specific time interval; 80-224 ms.

RESULTS

There was a statistically significant difference in the obligatory responses between the NH and HA groups at baseline, but this difference disappeared after three years in our follow-up study. The children with HA also showed a significant difference in mean ERP at baseline compared to follow-up, and significant differences between the deviants at follow-up but not at baseline. This suggests an improvement over time among the children with HAs. On the other hand, the children with CIs did not differ from the NH children at baseline, but after three years their mean ERP was significantly lower compared to both the children with HA and NH, indicating a reduced development of the central auditory system in this age span among the children with CIs. Regarding MMN, there was an interaction between the duration deviant and time for the children with HA, also indicating a possible improvement over time among the HA children.

CONCLUSIONS

This three-year follow-up study shows neurophysiological differences between children with HL and children with NH. The results suggest a delay in the central auditory processing among the HA children compared to children with NH, but a possible catch-up, over time, and this potential may be worth to be utilized. Regarding the CI children, similar improvement in this age span is missing, meaning there are differences between the subgroups of children with HL, i.e. the children with HAs vs. CIs. The results highlight the importance of distinguishing between subgroups of children with HL in further research.

An evaluation of systematized phonics on reading proficiency in Swedish second grade poor readers: Effects on pseudoword and sight word reading skills

The aim of the present study was to evaluate the effect of systematized phonics on word reading in Swedish second grade poor readers. Forty-nine children who performed at or below the 25th percentile on pseudoword reading and/or sight word reading at the beginning of second grade participated in the study. The study had a cross-over design exploring within-and between-group effects of two different conditions: systematized phonics and classroom instruction. Overall, systematized phonics proved more effective than classroom instruction. At pre-intervention, no child performed above the 30th percentile in pseudoword reading or sight word reading. At post-intervention, corresponding numbers were 69% for pseudoword reading and 35% for sight word reading. Implications for a policy change in Sweden towards mandatory systematized phonics in primary school are discussed.

Computer-assisted reading intervention for children with hearing impairment using cochlear implants: Effects on auditory event-related potentials and mismatch negativity

OBJECTIVES

The primary aim was to find out whether a computer-assisted reading intervention program with a phonic approach can affect event-related (ERPs) and mismatch negativity (MMN) in hearing impaired (HI) children using cochlear implants (CIs).

METHODS

This study involved a test group of 15 HI children with CIs and a control group of 14 normal hearing (NH) children. The children were 4 years and 10 months to 8 years and 1 month old. ERPs were recorded immediately before and after 4 weeks of training with a computer-assisted reading intervention, GraphoGame. A multi-feature paradigm, Optimum-1, was used, i.e. a standard stimulus alternated with five different deviants: gap intensity, pitch, location and duration. MMN was calculated from the mean amplitude ERP of each deviant minus the standard stimulus response in a specific time interval, 80 - 224 ms. Repeated measures ANOVA was used for the statistical analysis.

RESULTS

The results did not show any significant changes with the computerassisted training in the ERPs and MMNs among the HI children with CIs. The presence of both MMN and a positive mismatch response (pMMR), which might reflect an immaturity, complicates interpreting the results in this age group. Individually, there was a mix of MMNs and pMMRs among all participants, pre and post training, and the change of each deviant after intervention was not predictable.

CONCLUSIONS

There are no significant changes in ERP or MMN after intervention, however lack of significances must be interpreted with caution. Besides the presence of both MMNs and pMMRs, only modest changes are to be expected on an individual basis and small samples hinder making statistical conclusions regarding the training's effects. The study contributes to some more descriptive pieces of ERPs and MMNs among the HI children with CIs. The issues of MMN and pMMR are highlighted.

Evidence-Based Interventions for Learners Who Are Deaf and/or Multilingual: A Systematic Quality Review

Purpose Many educators and speech-language pathologists have difficulty providing effective interventions to the growing population of d/Deaf and hard-of-hearing (DHH) learners who use more than 1 language. The purpose of this review article was to identify evidence-based interventions for speech, language, and literacy used with DHH multilingual learners (DMLs), monolingual DHH learners, and hearing bilingual learners without hearing loss. Interventions used with these groups can inform the practice of professionals providing services to DMLs. Method This review article considered speech, language, and literacy interventions used with DHH and hearing bilingual learners from birth to 21 years of age. The following electronic databases were searched: Academic Search Complete/EBSCO (CINAHL, Education, ERIC), Linguistics & Language Behavior Abstracts, PsycINFO, and PubMed. Data describing article, participant, methodological, and intervention variables were extracted from studies. The methodological quality of studies was examined using the Council for Exceptional Children's (2014) standards for evidence-based practice in special education. Results A total of 144 studies were reviewed, describing over 9,370 learners aged 1.8-22.0 years. Two studies investigated DMLs, 76 investigated DHH learners, and 67 investigated hearing bilingual learners. A total of 146 different interventions were examined. Most studies reported positive effects. Only 17 studies met all quality indicators specified by the Council for Exceptional Children (2014): 7 examined DHH learners, and 10 examined hearing bilingual learners. There was insufficient evidence for any intervention to be considered an evidence-based intervention, although 6 could potentially contribute to evidence-based practice. Conclusions No evidence-based interventions for DMLs were identified. A small number of interventions examined in high-quality studies of DHH and hearing bilingual learners were identified, which may be appropriate for use with DMLs following further investigation. Supplemental Material https://doi.org/10.23641/asha.9108386.

Visual Rhyme Judgment in Adults With Mild-to-Severe Hearing Loss

Adults with poorer peripheral hearing have slower phonological processing speed measured using visual rhyme tasks, and it has been suggested that this is due to fading of phonological representations stored in long-term memory. Representations of both vowels and consonants are likely to be important for determining whether or not two printed words rhyme. However, it is not known whether the relation between phonological processing speed and hearing loss is specific to the lower frequency ranges which characterize vowels or higher frequency ranges that characterize consonants. We tested the visual rhyme ability of 212 adults with hearing loss. As in previous studies, we found that rhyme judgments were slower and less accurate when there was a mismatch between phonological and orthographic information. A substantial portion of the variance in the speed of making correct rhyme judgment decisions was explained by lexical access speed. Reading span, a measure of working memory, explained further variance in match but not mismatch conditions, but no additional variance was explained by auditory variables. This pattern of findings suggests possible reliance on a lexico-semantic word-matching strategy for solving the rhyme judgment task. Future work should investigate the relation between adoption of a lexico-semantic strategy during phonological processing tasks and hearing aid outcome.

Computer-assisted reading intervention for children with sensorineural hearing loss using hearing aids: Effects on auditory event-related potentials and mismatch negativity

OBJECTIVES

The primary aim was to investigate whether computer-assisted reading intervention somehow can affect event-related potentials (ERP) and mismatch negativity (MMN) in hearing impaired (HI) children with hearing aids (HAs) and normal hearing (NH) children.

METHODS

The study included 15 HI children with sensorineural hearing loss (SNHL) using bilateral HAs and 14 NH children as a reference group; all children between the ages of 5 and 8. A multi-feature MMN-paradigm, Optimum-1, with a standard stimulus alternating with 5 different deviants was used. ERPs were recorded pre and post intervention, i.e. one month of repeatedly computer-assisted training (GraphoGame). MMN was calculated from the average ERP of each deviant minus standard. Data were based on samples within a specific time interval, 80-224 ms, and repeated measures ANOVA was used to analyze possible interactions.

RESULTS

There was a significant difference between groups before training, though, the mean obligatory responses or MMN was not statistically significantly different before versus after training, neither among the NH nor the HI children. Further, the HI children did generally achieve lower levels in GraphoGame compared to the NH children. Altogether, our findings indicate differences between the groups and that training may affect the neurophysiological processing in the brain, gaining the HI children. Both MMN and positive mismatch response (pMMR) were seen among both the HA and NH children, irrespective to deviant type. Individually, changes of the MMN and pMMR after training seem unpredictable.

CONCLUSION

There are statistically significant differences in both the obligatory responses in ERP and the MMNs between the NH and HI groups before the computer-assisted training. Though, these differences disappear after the intervention. This suggests possible training effects regarding the central auditory processing among the HI children.

Literacy Outcomes for Primary School Children Who Are Deaf and Hard of Hearing: A Cohort Comparison Study

PURPOSE

In this study, we compared the language and literacy of two cohorts of children with severe-profound hearing loss, recruited 10 years apart, to determine if outcomes had improved in line with the introduction of newborn hearing screening and access to improved hearing aid technology.

METHOD

Forty-two children with deafness, aged 5-7 years with a mean unaided loss of 102 DB, were assessed on language, reading, and phonological skills. Their performance was compared with that of a similar group of 32 children with deafness assessed 10 years earlier and also a group of 40 children with normal hearing of similar single word reading ability.

RESULTS

English vocabulary was significantly higher in the new cohort although it was still below chronological age. Phonological awareness and reading ability had not significantly changed over time. In both cohorts, English vocabulary predicted reading, but phonological awareness was only a significant predictor for the new cohort.

CONCLUSIONS

The current results show that vocabulary knowledge of children with severe-profound hearing loss has improved over time, but there has not been a commensurate improvement in phonological skills or reading. They suggest that children with severe-profound hearing loss will require continued support to develop robust phonological coding skills to underpin reading.

Semantic Processing in Deaf and Hard-of-Hearing Children: Large N400 Mismatch Effects in Brain Responses, Despite Poor Semantic Ability

Difficulties in auditory and phonological processing affect semantic processing in speech comprehension for deaf and hard-of-hearing (DHH) children. However, little is known about brain responses related to semantic processing in this group. We investigated event-related potentials (ERPs) in DHH children with cochlear implants (CIs) and/or hearing aids (HAs), and in normally hearing controls (NH). We used a semantic priming task with spoken word primes followed by picture targets. In both DHH children and controls, cortical response differences between matching and mismatching targets revealed a typical N400 effect associated with semantic processing. Children with CI had the largest mismatch response despite poor semantic abilities overall; Children with CI also had the largest ERP differentiation between mismatch types, with small effects in within-category mismatch trials (target from same category as prime) and large effects in between-category mismatch trials (where target is from a different category than prime), compared to matching trials. Children with NH and HA had similar responses to both mismatch types. While the large and differentiated ERP responses in the CI group were unexpected and should be interpreted with caution, the results could reflect less precision in semantic processing among children with CI, or a stronger reliance on predictive processing.

Developing Sound Skills for Reading: Teaching Phonological Awareness to Preschoolers With Hearing Loss

This study evaluated the effectiveness of intervention for developing deaf and hard-of-hearing (DHH) preschoolers' phonological awareness (PA) skills. Thirty children (mean age 57 months) with aided, bilateral hearing loss (and who primarily communicated using spoken English) were recruited in the year prior to commencing formal schooling. The study used an experimental design with participants assigned to one of two intervention conditions-vocabulary instruction, or explicit PA instruction. Both intervention programs were based around items drawn from a common word set and presented over six short weekly sessions by a researcher using a computer tablet. Overall, participants showed greater knowledge of word items used in interventions and improved performance on rhyme-based PA skills following intervention. However, the PA group showed significantly greater improvement than the vocabulary group for both overall PA performance and for consonant-vowel-consonant blending. DHH children's order of PA skill development was also examined, with comparison to that shown for children without hearing loss. The results provide early encouraging evidence about the potential benefit of explicit PA instruction for this population.

Cognitive skills and reading in adults with Usher syndrome type 2

OBJECTIVE

To investigate working memory (WM), phonological skills, lexical skills, and reading comprehension in adults with Usher syndrome type 2 (USH2).

DESIGN

The participants performed tests of phonological processing, lexical access, WM, and reading comprehension. The design of the test situation and tests was specifically considered for use with persons with low vision in combination with hearing impairment. The performance of the group with USH2 on the different cognitive measures was compared to that of a matched control group with normal hearing and vision (NVH).

STUDY SAMPLE

Thirteen participants with USH2 aged 21-60 years and a control group of 10 individuals with NVH, matched on age and level of education.

RESULTS

The group with USH2 displayed significantly lower performance on tests of phonological processing, and on measures requiring both fast visual judgment and phonological processing. There was a larger variation in performance among the individuals with USH2 than in the matched control group.

CONCLUSION

The performance of the group with USH2 indicated similar problems with phonological processing skills and phonological WM as in individuals with long-term hearing loss. The group with USH2 also had significantly longer reaction times, indicating that processing of visual stimuli is difficult due to the visual impairment. These findings point toward the difficulties in accessing information that persons with USH2 experience, and could be part of the explanation of why individuals with USH2 report high levels of fatigue and feelings of stress (Wahlqvist et al., 2013).

Segmental and suprasegmental properties in nonword repetition--an explorative study of the associations with nonword decoding in children with normal hearing and children with bilateral cochlear implants

This study explored nonword repetition (NWR) and nonword decoding in normal-hearing (NH) children and in children with bilateral cochlear implants (CI). Participants were 11 children, with CI, 5:0-7:11 years (M = 6.5 years), and 11 NH children, individually age-matched to the children with CI. This study fills an important gap in research, since it thoroughly describes detailed aspects of NWR and nonword decoding and their possible associations. All children were assessed after having practiced with a computer-assisted reading intervention with a phonics approach during four weeks. Results showed that NH children outperformed children with CI on the majority of aspects of NWR. The analysis of syllable number in NWR revealed that children with CI made more syllable omissions than did the NH children, and predominantly in prestressed positions. In addition, the consonant cluster analysis in NWR showed significantly more consonant omissions and substitutions in children with CI suggesting that reaching fine-grained levels of phonological processing was particularly difficult for these children. No significant difference was found for nonword-decoding accuracy between the groups, as measured by whole words correct and phonemes correct, but differences were observed regarding error patterns. In children with CI phoneme, deletions occurred significantly more often than in children with NH. The correlation analysis revealed that the ability to repeat consonant clusters in NWR had the strongest associations to nonword decoding in both groups. The absence of as frequent significant associations between NWR and nonword decoding in children with CI compared to children with NH suggest that these children partly use other decoding strategies to compensate for less precise phonological knowledge, for example, lexicalizations in nonword decoding, specifically, making a real word of a nonword.

What can we expect of normally-developing children implanted at a young age with respect to their auditory, linguistic and cognitive skills?

As a result of neonatal hearing screening and subsequent early cochlear implantation (CI) profoundly deaf children have access to important information to process auditory signals and master spoken language skills at a young age. Nevertheless, auditory, linguistic and cognitive outcome measures still reveal great variability in individual achievements: some children with CI(s) perform within normal limits, while others lag behind. Understanding the causes of this variation would allow clinicians to offer better prognoses to CI candidates and efficient follow-up and rehabilitation. This paper summarizes what we can expect of normally developing children with CI(s) with regard to spoken language, bilateral and binaural auditory perception, speech perception and cognitive skills. Predictive factors of performance and factors influencing variability are presented, as well as some novel data on cognitive functioning and speech perception in quiet and in noise. Subsequently, we discuss technical and non-technical issues which should be considered in the future in order to optimally guide the child with profound hearing difficulties. This article is part of a Special Issue entitled <Lasker Award>.

Computer-assisted reading intervention with a phonics approach for children using cochlear implants or hearing aids

The present study examined computer-assisted reading intervention with a phonics approach for deaf and hard of hearing (DHH) children in Sweden using cochlear implants or hearing aids, or a combination of both. The study included 48 children, 5, 6 and 7 years of age. Sixteen children with normal hearing (NH) served as a reference group. The first purpose of the study was to compare NH and DHH children's reading ability at pre and post-intervention. The second purpose was to investigate effects of the intervention. Cognitive and demographic factors were analyzed in relation to reading improvement. Results showed no statistically significant difference for reading ability at the group level, although NH children showed overall higher reading scores at both test points. Age comparisons revealed a statistically significant higher reading ability in the NH 7-year-olds compared to the DHH 7-year-olds. The intervention proved successful for word decoding accuracy, passage comprehension and as a reduction of nonword decoding errors in both NH and DHH children. Reading improvement was associated with complex working memory and phonological processing skills in NH children. Correspondent associations were observed with visual working memory and letter knowledge in the DHH children. Age was the only demographic factor that was significantly correlated with reading improvement. The results suggest that DHH children's beginning reading may be influenced by visual strategies that might explain the reading delay in the older children.