Narrative spoken language skills in severely hearing impaired school-aged children with cochlear implants

Comparing Deaf/Hard-of-Hearing Children's Oral Narratives Using Movies and Static Books

Clinicians utilize various methods for narrative sampling, including oral assessments like story generation and retelling, often aided by visual aids. Assessing language skills in deaf/hard of hearing (DHH) children requires careful narrative technique selection. This comparative observational study investigates the narrative outcomes of story generation and retelling tasks in 21 DHH children, using both book and movie contexts. Most microstructural elements (except for the mean length of utterance) were similar across the book and movie conditions. Differences in word choice, such as the use of action verbs, were evident. Macrostructural differences between book and movie conditions were insignificant regarding story grammar elements. However, movies, being visually engaging, potentially enhance the inclusion of characters, settings, plot, and actions. This research illuminates narrative assessment considerations, emphasizing technology's role in enhancing options for assessment for DHH 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.

Comparative analysis of microstructures of narrative abilities in language-age-matched Tamil-speaking children with cochlear implants and typical hearing

In a unique exploration of narrative development among Tamil-speaking children, this study delves into the intricacies of linguistic expression, explicitly comparing the microstructure of narratives in two distinct groups: those with hearing differences (HD) and those with normal hearing. A total of 30 children were included in the study, with 15 children in each group, matched for language age between 3-5 years on standard language tests. The children were asked to retell a story they had listened to, and the obtained samples were transcribed verbatim and analyzed for various microstructural elements, including the mean length of utterances, total number of words, number of utterances, and number of different word types. The results revealed that children with hearing loss used fewer words and simpler sentences during retelling despite having the same language age as their peers. This highlights the importance of incorporating narrative assessment in standard language evaluations. Furthermore, the findings emphasise integrating narrative intervention into language intervention programs to enhance language productivity. Overall, this study provides valuable insights into the narrative abilities of Tamil-speaking children with cochlear implants and underscores the significance of addressing narrative skills in language intervention approaches.

Early cochlear implantation supports narrative skills of children with prelingual single-sided deafness

Prelingual single-sided deafness (SSD) not only affects children's hearing skills, but can also lead to speech-language delays and academic underachievement. Early cochlear implantation leads to improved spatial hearing, but the impact on language development is less studied. In our longitudinal study, we assessed the language skills of young children with SSD and a cochlear implant (CI). In particular, we investigated their narrative skills in comparison to two control groups: children with SSD without a CI, and children with bilateral normal hearing. We found that children with SSD and a CI performed in line with their normal-hearing peers with regard to narrative and verbal short-term memory skills. Children with SSD without a CI had worse narrative (group difference = - 0.67, p = 0.02) and verbal short-term memory (group difference = - 0.68, p = 0.03) scores than the implanted group. Verbal short-term memory scores and grammar scores each correlated positively with narrative scores across all groups. Early grammar scores (at 2-3 years of age) could partially predict later narrative scores (at 4-6 years of age). These results show that young children with prelingual SSD can benefit from early cochlear implantation to achieve age-appropriate language skills. They support the provision of a CI to children with prelingual SSD.

Story Generation and Narrative Retells in Children Who Are Hard of Hearing and Hearing Children

PURPOSE

The primary goal for this study was to compare story generation and narrative retell performance in children who are hard of hearing (CHH) and hearing children. A secondary goal was to determine factors that influence narrative performance. Research on this topic is important because narrative language competency is an essential communication function.

METHOD

Participants included 86 CHH and 53 seven-year-old hearing children who had completed a test battery composed of vocabulary, grammar, phonological processing, story generation, and narrative retell tasks. Coders who were blind to hearing status used a scoring rubric to judge the quality of narrative macrostructure in story generation and narrative retells. Data were analyzed using analysis of variance to determine group differences and correlational models to examine individual differences.

RESULTS

At 7 years of age, CHH demonstrated significant deficits in narrative macrostructure compared to hearing children, with larger delays in narrative retell than story generation. Vocabulary, grammar, and phonological memory acted as mediators in the relationship between hearing status and story generation; grammar acted as a mediator between hearing status and narrative retell. Auditory access variables accounted for a significant proportion of shared variance in story generation skills for CHH.

CONCLUSIONS

School-age CHH are at risk for delays in narrative production, particularly with retelling stories. The results of this study highlight a narrative coding approach and task procedures that are sensitive to differences in language levels and may be clinically useful for professionals working with early school-age children.

Receptive Vocabulary of Children With Bilateral Cochlear Implants From 3 to 16 Years of Age

OBJECTIVES

The vocabulary of children with cochlear implants is often smaller than that of their peers with typical hearing, but there is uncertainty regarding the extent of the differences and potential risks and protective factors. Some studies indicate that their receptive vocabulary develops well at first, but that they fail to keep up with their typical hearing peers, causing many CI users to enter school with a receptive vocabulary that is not age-appropriate. To better understand the receptive vocabulary abilities of children with cochlear implants this study explored age-related differences to matched children with typical hearing and associations between vocabulary skills and child-level characteristics.

DESIGN

A retrospective cross-sectional study with matched controls was conducted at the Norwegian national cochlear implant center at Oslo University Hospital. Eighty-eight children (mean age 8.7 years; range 3.2 to 15.9; 43 girls, 45 boys) who had received bilateral cochlear implants before 3 years of age were compared with two groups of children with typical hearing. One group was matched for maternal education, sex, and chronological age, the other group was matched for maternal education, sex, and hearing age. Receptive vocabulary performance was measured with the British Picture Vocabulary Scale.

RESULTS

Cochlear implant users' receptive vocabulary was poorer than that of age-matched children with typical hearing ( M = 84.6 standard points, SD = 21.1; children with typical hearing: M = 102.1 standard points, SD = 15.8; mean difference -17.5 standard points, 95% CI [-23.0 to -12.0], p < 0.001; Hedges's g = -0.94, 95% CI [-1.24 to -0.62]), and children with cochlear implants were significantly more likely to perform below the normative range (risk ratio = 2.2, 95% CI [1.42 to 3.83]). However, there was a significant nonlinear U-shaped effect of age on the scores of cochlear implant users, with the difference to the matched typical hearing children being largest (23.9 standard points, on average) around 8.7 years of age and smaller toward the beginning and end of the age range. There was no significant difference compared with children with typical hearing when differences in auditory experience were accounted for. Variability was not significantly different between the groups. Further analysis with a random forest revealed that, in addition to chronological age and hearing age, simultaneous versus sequential implantation, communication mode at school, and social integration were predictors of cochlear implant users' receptive vocabulary.

CONCLUSIONS

On average, the receptive vocabulary of children with cochlear implants was smaller than that of their typical hearing peers. The magnitude of the difference was changing with age and was the largest for children in early primary school. The nonlinear effect of age might explain some of the ambiguity in previous research findings and could indicate that better intervention is required around school entry. The results emphasize that continuous monitoring and support are crucial to avoid far-reaching negative effects on the children's development and well-being.

Disparate Oral and Written Language Abilities in Adolescents With Cochlear Implants: Evidence From Narrative Samples

PURPOSE

In spite of improvements in language outcomes for children with hearing loss (HL) arising from cochlear implants (CIs), these children can falter when it comes to academic achievement, especially in higher grades. Given that writing becomes increasingly relevant to educational pursuits as children progress through school, this study explored the hypothesis that one challenge facing students with CIs may be written language.

METHOD

Participants were 98 eighth graders: 52 with normal hearing (NH) and 46 with severe-to-profound HL who used CIs. Oral and written narratives were elicited and analyzed for morphosyntactic complexity and global narrative features. Five additional measures were collected and analyzed as possible predictors of morphosyntactic complexity: Sentence Comprehension of Syntax, Grammaticality Judgment, Expressive Vocabulary, Forward Digit Span, and Phonological Awareness.

RESULTS

For oral narratives, groups performed similarly on both morphosyntactic complexity and global narrative features; for written narratives, critical differences were observed. Compared with adolescents with NH, adolescents with CIs used fewer markers of morphosyntactic complexity and scored lower on several global narrative features in their written narratives. Adolescents with NH outperformed those with CIs on all potential predictor measures, except for Sentence Comprehension of Syntax. Moderately strong relationships were found between predictor variables and individual measures of morphosyntactic complexity, but no comprehensive pattern explained the results. Measures of morphosyntactic complexity and global narrative features were not well correlated, suggesting these measures are assessing separate underlying constructs.

CONCLUSIONS

Adolescents with CIs fail to show writing proficiency at high school entry equivalent to that of their peers with NH, which could constrain their academic achievement. Interventions for children with CIs need to target writing skills, and writing assessments should be incorporated into diagnostic assessments.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17139059.

False Belief Understanding in Deaf Children With Cochlear Implants

Theory of mind (ToM) is crucial for social interactions. Previous research has indicated that deaf and hard-of-hearing children born into hearing families (DoH) are at risk of delayed ToM development. However, it is unclear whether this is the case for DoH children who receive cochlear implants (CIs) before and around the second year of life. The present study aimed to investigate false belief understanding (FBU) in DoH children with CIs. The relationships between false belief task (FBT) performance, sentence comprehension, age at implantation, duration of CI use, and Speech Recognition Threshold were explored. A total of 94 children with typical levels of hearing (TH) and 45 DoH children (age range: 3-8), who received their first CI between 6 and 27 months of age, were tested on the FBT and a sentence comprehension test. Results showed that 4- and 5-year-old children with CIs performed significantly worse than their peers with TH on the FBT; 6- to 8-year-old children with CIs performed similarly to age-matched children with TH. Age at implantation and duration of CI use were correlated with sentence comprehension but not with the FBT. The results indicated that FBU was delayed until the age of 6 years in most of children with CIs.

Rhythmic Abilities of Children With Hearing Loss

OBJECTIVES

Children with hearing loss (HL), in spite of early cochlear implantation, often struggle considerably with language acquisition. Previous research has shown a benefit of rhythmic training on linguistic skills in children with HL, suggesting that improving rhythmic capacities could help attenuating language difficulties. However, little is known about general rhythmic skills of children with HL and how they relate to speech perception. The aim of this study is twofold: (1) to assess the abilities of children with HL in different rhythmic sensorimotor synchronization tasks compared to a normal-hearing control group and (2) to investigate a possible relation between sensorimotor synchronization abilities and speech perception abilities in children with HL.

DESIGN

A battery of sensorimotor synchronization tests with stimuli of varying acoustic and temporal complexity was used: a metronome, different musical excerpts, and complex rhythmic patterns. Synchronization abilities were assessed in 32 children (aged from 5 to 10 years) with a severe to profound HL mainly fitted with one or two cochlear implants (n = 28) or with hearing aids (n = 4). Working memory and sentence repetition abilities were also assessed. Performance was compared to an age-matched control group of 24 children with normal hearing. The comparison took into account variability in working memory capacities. For children with HL only, we computed linear regressions on speech, sensorimotor synchronization, and working memory abilities, including device-related variables such as onset of device use, type of device, and duration of use.

RESULTS

Compared to the normal-hearing group, children with HL performed poorly in all sensorimotor synchronization tasks, but the effect size was greater for complex as compared to simple stimuli. Group differences in working memory did not explain this result. Linear regression analysis revealed that working memory, synchronization to complex rhythms performances, age, and duration of device use predicted the number of correct syllables produced in a sentence repetition task.

CONCLUSION

Despite early cochlear implantation or hearing aid use, hearing impairment affects the quality of temporal processing of acoustic stimuli in congenitally deaf children. This deficit seems to be more severe with stimuli of increasing rhythmic complexity highlighting a difficulty in structuring sounds according to a temporal hierarchy.

Comparison of Expressive Spoken Language Skills in Children With Cochlear Implants and Children With Typical Hearing

When children start formal education, they are expected to be able to express complex thoughts. However, in order to do so, they need to be able to use both complex grammatical structures and a variety of words. One group that is at risk of having a delay in terms of their expressive language ability is children with cochlear implants (CI). In this study, we evaluated whether children with CI perform comparably to children with typical hearing (TH) on a standard expressive spoken grammar and a standard expressive spoken vocabulary task when the groups were matched on non-verbal intelligence and working memory capacity. It was found that the children with CI in this study performed more poorly on a standard expressive spoken vocabulary task but not on a standard expressive spoken grammar task when compared to the children with TH. Differences in terms of expressive spoken vocabulary do not seem to be explained by differences in cognitive ability. In addition, the variation in terms of expressive spoken language ability was larger in the children with CI compared to the children with TH. This might be explained by additional confounding factors, like the time of language deprivation or by a greater influence of cognitive differences for the acquisition of spoken language for children with CI.

Capability of deaf children with a cochlear implant

INTRODUCTION

The main idea underlying this paper is that impairments such as deafness are particularly relevant to the extent that they lead to deprivation of capability. Likewise, the impact of healthcare services such as cochlear implants and subsequent rehabilitation can best be inferred from the extent that they protect or restore capability of those affected.

METHODS

To explore children's post-implant capabilities, we tested two newly developed digital, adaptive child self-report and parent-report questionnaires in 19 deaf children (aged 8-12 years) and their parents during rehabilitation, as well as in 23 age peers with normal hearing.

RESULTS

Despite the impressive speech-language results that were recorded with cochlear implants, the post-implant capabilities of the deaf children we evaluated differed from those of their hearing peers, with the cochlear implant group appearing particularly disadvantaged in areas such as accessing information, communication, social participation, and participation in school.

CONCLUSION

Deaf children with cochlear implants who are performing well on linguistic and auditory tests can still experience serious limitations in desired functioning. Our findings suggest that a capability approach may reveal aspects of what is being achieved through rehabilitation that might otherwise remain unnoticed, and that could help to further improve the well-being of our patients.IMPLICATIONS FOR REHABILITATIONOverall, children with cochlear implants appeared disadvantaged in certain capability areas, like accessing information, communication, social participation, and participation in school.It may be worthwhile to also ascertain capabilities in these children, representing a domain not covered by clinical measures, tapping directly into areas that are valuable to the patient.

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.

Personality Traits of Profoundly Hearing Impaired Adolescents with Cochlear Implants - A Comparison with Normal Hearing Peers

The aim of this study was to compare the personality traits of adolescents with cochlear implants (CIs) to a reference group (normal-hearing peers). In the past, the personality development of hearing impaired adolescents was severely compromised. Improved speech perception with CI significantly increased their perspectives. In addition, differences between the reference group and CI users were investigated on personality traits according to level of speech perception skills (high/low) and level of language comprehension (adequate/poor). A cohort of 59 adolescents was assessed 10 years after CI implantation. Personality traits were measured using the standardized Dutch Personality Questionnaire, which consists of 5 scales: Inadequacy, Social Inadequacy, Recalcitrance (RE), Perseverance, and Dominance. Speech perception and language comprehension were tested with standardized tests. The distributions of personality scores, in the clinical or non-clinical range, for the CI group were compared to the reference group using the Chi-Square test for Goodness of Fit. Adolescents with CI showed normal or favorable distributions on all personality scales except for the RE scale. There was a significant influence of speech perception and language comprehension on this scale. Consequently, adolescents with CI who demonstrated high speech perception and adequate language comprehension scores showed similar distribution patterns as the reference group on all personality scales. In conclusion; personality traits that reflect social relations, self-conscience, and school- and task orientation in adolescents with CI are similar to those in normal-hearing peers. This holds, despite variations in speech perception ability and language comprehension levels, for the CI group. On the RE scale, the adolescents with CI with low speech perception and poor language comprehension scores are more likely to score in the clinical deviant range and are at risk.

Assessment of narrative writing by Persian-speaking students with hearing impairments

OBJECTIVE

Previous studies have highlighted that narrative skill is critical to the development of the literacy skills by children. Children with cochlear implants (CI) and hearing aids (HA) may have problems in narrative development compared to peers with healthy hearing (HH). There is no exact data about the narrative writing ability of Persian-speaking students who are hearing-impaired. This study was undertaken to compare the microstructure and macrostructure scores for narrative writing of Persian-speaking students who are hearing-impaired and peers with HH.

DESIGN

This was a cross-sectional descriptive-analytical study.

SETTING

The subjects were recruited from elementary schools in the city of Tehran.

PARTICIPANTS

A total of 144 elementary school students were participated.

OUTCOME MEASURES

The written narratives were elicited using a wordless pictorial storybook story. Three-way ANOVA with post hoc adjusted Bonferroni test was applied to determine the main effects and interactions of grounded variables on the microstructure and macrostructure components of narrative writing.

RESULTS

No significant differences were observed in the macrostructure components of narrative writing between hearing-impaired and HH students. Factors analysis showed that the 4th grade HH students had significantly the highest scores, and the 3rd grade HA students had significantly the lowest scores in microstructure components of narrative writing.

CONCLUSION

The findings revealed that hearing-impaired students similarly to their HH peers can transmit the main idea (macrostructure) of narrative writing, but show critical difficulties when using complete grammatical elements (microstructures) to form sentences to convey the idea in the narrative.

Story retelling skills in Persian speaking hearing-impaired children

OBJECTIVES

Since the pragmatic skills of hearing-impaired Persian-speaking children have not yet been investigated particularly through story retelling, this study aimed to evaluate some pragmatic abilities of normal-hearing and hearing-impaired children using a story retelling test.

METHODS

15 normal-hearing and 15 profound hearing-impaired 7-year-old children were evaluated using the story retelling test with the content validity of 89%, construct validity of 85%, and reliability of 83%. Three macro structure criteria including topic maintenance, event sequencing, explicitness, and four macro structure criteria including referencing, conjunctive cohesion, syntax complexity, and utterance length were assessed. The test was performed with live voice in a quiet room where children were then asked to retell the story. The tasks of the children were recorded on a tape, transcribed, scored and analyzed.

RESULTS

In the macro structure criteria, utterances of hearing-impaired students were less consistent, enough information was not given to listeners to have a full understanding of the subject, and the story events were less frequently expressed in a rational order than those of normal-hearing group (P < 0.0001). Regarding the macro structure criteria of the test, unlike the normal-hearing students who obtained high scores, hearing-impaired students failed to gain any scores on the items of this section.

CONCLUSIONS

These results suggest that Hearing-impaired children were not able to use language as effectively as their hearing peers, and they utilized quite different pragmatic functions.

Narrative skills in deaf children who use spoken English: Dissociations between macro and microstructural devices

Previous research has highlighted that deaf children acquiring spoken English have difficulties in narrative development relative to their hearing peers both in terms of macro-structure and with micro-structural devices. The majority of previous research focused on narrative tasks designed for hearing children that depend on good receptive language skills. The current study compared narratives of 6 to 11-year-old deaf children who use spoken English (N=59) with matched for age and non-verbal intelligence hearing peers. To examine the role of general language abilities, single word vocabulary was also assessed. Narratives were elicited by the retelling of a story presented non-verbally in video format. Results showed that deaf and hearing children had equivalent macro-structure skills, but the deaf group showed poorer performance on micro-structural components. Furthermore, the deaf group gave less detailed responses to inferencing probe questions indicating poorer understanding of the story's underlying message. For deaf children, micro-level devices most strongly correlated with the vocabulary measure. These findings suggest that deaf children, despite spoken language delays, are able to convey the main elements of content and structure in narrative but have greater difficulty in using grammatical devices more dependent on finer linguistic and pragmatic skills.

Benefits of simultaneous bilateral cochlear implantation on verbal reasoning skills in prelingually deaf children

BACKGROUND

Impaired auditory speech perception abilities in deaf children with hearing aids compromised their verbal intelligence enormously. The availability of unilateral cochlear implantation (CI) auditory speech perception and spoken vocabulary enabled them to reach near ageappropriate levels. This holds especially for children in spoken language environments. However, speech perception in complex listening situations and the acquisition of complex verbal skills remains difficult. Bilateral CI was expected to enhance the acquisition of verbal intelligence by improved understanding of speech in noise.

METHODS

This study examined the effect of bilateral CI on verbal intelligence of 49 deaf children (3;5-8;0 years). Relations between speech perception in noise, auditory short-term memory and verbal intelligence were analysed with multiple linear regressions. In addition, the interaction of educational setting, mainstream or special, on these relations was analysed.

RESULTS

Children with bilateral CI obtained higher scores on verbal intelligence. Significant associations were present between speech perception in noise, auditory short-term memory and verbal intelligence.

CONCLUSION

Children with simultaneous bilateral CIs showed better speech perception in noise than children with unilateral CIs, which mediated by the auditory short-term memory capacity, enhanced the ability to acquire more complex verbal skills for BICI children in mainstream education.

Reliability, validity and normative data of the Italian version of the Bus Story test

OBJECTIVES

Evaluation of the reliability and the validity of the Italian version of the Bus Story Test (I-BST), providing normative data in Italian children.

METHODS

A total of 552 normally developing children (278 males and 274 females) aged 3; 6 to 9; 0 years, were enrolled. Test-retest, intra- and inter-rater reliability were analysed on a sample of respectively 145, 178 and 178 children. Normative data were gathered from all the enrolled children and estimate centiles according to the CG-LMS method provided. The children were divided into 11 age classes of six months each; percentile scores and standard error measurement were analysed in children from age class 4; 0-4; 5 years to age class 8; 6-811 years. Age effects on I-BST were analysed.

RESULTS

Results showed high test-retest, intra- and inter-rater reliability scores. A significant age effect on I-BST scores emerged from the ANOVA test analysis; in particular, as age increases, so do I-BST scores.

CONCLUSION

The I-BST is a reliable and valid tool. The availability of normative data for Italian speaking children may help clinicians during clinical assessment.

Semantic and syntactic reading comprehension strategies used by deaf children with early and late cochlear implantation

Deaf students have traditionally exhibited reading comprehension difficulties. In recent years, these comprehension problems have been partially offset through cochlear implantation (CI), and the subsequent improvement in spoken language skills. However, the use of cochlear implants has not managed to fully bridge the gap in language and reading between normally hearing (NH) and deaf children, as its efficacy depends on variables such as the age at implant. This study compared the reading comprehension of sentences in 19 children who received a cochlear implant before 24 months of age (early-CI) and 19 who received it after 24 months (late-CI) with a control group of 19 NH children. The task involved completing sentences in which the last word had been omitted. To complete each sentence children had to choose a word from among several alternatives that included one syntactic and two semantic foils in addition to the target word. The results showed that deaf children with late-CI performed this task significantly worse than NH children, while those with early-CI exhibited no significant differences with NH children, except under more demanding processing conditions (long sentences with infrequent target words). Further, the error analysis revealed a preference of deaf students with early-CI for selecting the syntactic foil over a semantic one, which suggests that they draw upon syntactic cues during sentence processing in the same way as NH children do. In contrast, deaf children with late-CI do not appear to use a syntactic strategy, but neither a semantic strategy based on the use of key words, as the literature suggests. Rather, the numerous errors of both kinds that the late-CI group made seem to indicate an inconsistent and erratic response when faced with a lack of comprehension. These findings are discussed in relation to differences in receptive vocabulary and short-term memory and their implications for sentence reading comprehension.

Role of bimodal stimulation for auditory-perceptual skills development in children with a unilateral cochlear implant

This is a prospective randomised study that evaluated the differences arising from a bimodal stimulation compared to a monaural electrical stimulation in deaf children, particularly in terms of auditory-perceptual skills development. We enrolled 39 children aged 12 to 36 months, suffering from severe-to-profound bilateral sensorineural hearing loss with residual hearing on at least one side. All were unilaterally implanted: 21 wore only the cochlear implant (CI) (unilateral CI group), while the other 18 used the CI and a contralateral hearing aid at the same time (bimodal group). They were assessed with a test battery designed to appraise preverbal and verbal auditory-perceptual skills immediately before and 6 and 12 months after implantation. No statistically significant differences were observed between groups at time 0, while at 6 and 12 months children in the bimodal group had better scores in each test than peers in the unilateral CI group. Therefore, although unilateral deafness/hearing does not undermine hearing acuity in normal listening, the simultaneous use of a CI and a contralateral hearing aid (binaural hearing through a bimodal stimulation) provides an advantage in terms of acquisition of auditory-perceptual skills, allowing children to achieve the basic milestones of auditory perception faster and in greater number than children with only one CI. Thus, "keeping awake" the contralateral auditory pathway, albeit not crucial in determining auditory acuity, guarantees benefits compared with the use of the implant alone. These findings provide initial evidence to establish shared guidelines for better rehabilitation of patients undergoing unilateral cochlear implantation, and add more evidence regarding the correct indications for bilateral cochlear implantation.

The Contribution of Verbal Working Memory to Deaf Children's Oral and Written Production

This study investigated the contribution of verbal working memory to the oral and written story production of deaf children. Participants were 29 severely to profoundly deaf children aged 8-13 years and 29 hearing controls, matched for grade level. The children narrated a picture story orally and in writing and performed a reading comprehension test, the Wechsler Intelligence Scale for Children-Fourth Edition forward digit span task, and a reading span task. Oral and written stories were analyzed at the microstructural (i.e., clause) and macrostructural (discourse) levels. Hearing children's stories scored higher than deaf children's at both levels. Verbal working memory skills contributed to deaf children's oral and written production over and above age and reading comprehension skills. Verbal rehearsal skills (forward digit span) contributed significantly to deaf children's ability to organize oral and written stories at the microstructural level; they also accounted for unique variance at the macrostructural level in writing. Written story production appeared to involve greater verbal working memory resources than oral story production.

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>.