Deaf adults without attention deficit hyperactivity disorder display reduced perceptual sensitivity and elevated impulsivity on the Test of Variables of Attention (T.O.V.A.)

Research of visual attention networks in deaf individuals: a systematic review

The impact of deafness on visual attention has been widely discussed in previous research. It has been noted that deficiencies and strengths of previous research can be attributed to temporal or spatial aspects of attention, as well as variations in development and clinical characteristics. Visual attention is categorized into three networks: orienting (exogenous and endogenous), alerting (phasic and tonic), and executive control. This study aims to contribute new neuroscientific evidence supporting this hypothesis. This paper presents a systematic review of the international literature from the past 15 years focused on visual attention in the deaf population. The final review included 24 articles. The function of the orienting network is found to be enhanced in deaf adults and children, primarily observed in native signers without cochlear implants, while endogenous orienting is observed only in the context of gaze cues in children, with no differences found in adults. Results regarding alerting and executive function vary depending on clinical characteristics and paradigms used. Implications for future research on visual attention in the deaf population are discussed.

Development of visual sustained selective attention and response inhibition in deaf children

Studies of deaf and hard-of-hearing (henceforth, deaf) children tend to make comparisons with typically hearing children for the purpose of either identifying deficits to be remediated or understanding the impact of auditory deprivation on visual or domain general processing. Here, we eschew these clinical and theoretical aims, seeking instead to understand factors that explain variability in cognitive function within deaf children. A total of 108 bilingual deaf children ages 7-13 years who use both English and American Sign Language (ASL) participated in a longitudinal study of executive function (EF) development. We report longitudinal data from a visual continuous performance task that measured sustained selective attention and response inhibition. Results show that the impact of deafness on these processes is negligible, but that language skills have a positive relationship with both: better English abilities were associated with better selective sustained attention, and better ASL abilities with better response inhibition. The relationship between sustained selective attention and English abilities may reflect the cognitive demands of spoken language acquisition for deaf children, whereas better ASL abilities may promote an "inner voice," associated with improved response inhibition. The current study cannot conclusively demonstrate causality or directionality of effects. However, these data highlight the importance of studies that focus on atypical individuals, for whom the relationships between language and cognition may be different from those observed in typically developing populations.

Inattention, Impulsivity, and Hyperactivity in Deaf Children Are Not Due to Deficits in Inhibitory Control, but May Reflect an Adaptive Strategy

The present study had two main aims: (1) to determine whether deaf children show higher rates of key behaviors of ADHD (inattentive, hyperactive, and impulsive behaviors) and of Conduct Disorder—CD—(disruptive, aggressive, or antisocial behaviors) than hearing children, also examining whether the frequency of these behaviors in deaf children varied based on cochlear implant (CI) use, type of school (regular vs. specific for deaf) and level of receptive vocabulary; and (2) to determine whether any behavioral differences between deaf and hearing children could be explained by deficits in inhibitory control. We measured behaviors associated with ADHD and CD in 34 deaf and hearing children aged 9–10 years old, using the revised Spanish version of the Conners scale. We then assessed inhibitory control ability using a computerized Stroop task and a short version of the Attention Network Test for children. To obtain a measure of the level of receptive vocabulary of the deaf children we used a Spanish version of the Carolina Picture Vocabulary Test for Deaf and hearing-impaired children. Deaf children showed significantly higher rates of behaviors associated with ADHD and CD, and over 85% of cases detected with high risk of ADHD-inattentive type in the entire present sample were deaf children. Further, in the group of deaf children a negative correlation was found between receptive vocabulary and frequency of disruptive, aggressive, or antisocial behaviors associated with CD. However, inhibitory control scores did not differ between deaf and hearing children. Our results suggested that the ADHD-related behaviors seen in deaf children were not associated with a deficit in inhibitory control, at least in the interference suppression subcomponent. An alternative explanation could be that these behaviors are reflecting an adaptive strategy that permits deaf children to access information from their environment which is not available to them via audition.

Concussion Epidemiology in Athletes Who Are Deaf or Hard-of-Hearing Compared With Athletes Who Are Hearing

OBJECTIVE

To compare the epidemiology of concussion between athletes who are deaf or hard-of-hearing (D/HoH) and athletes who are hearing.

DESIGN

Descriptive epidemiology study.

SETTING

Data were collected from 2 Division III athletic programs. One institution is the world's only university designed to be barrier-free for students who are D/HoH.

PARTICIPANTS

Six hundred ninety-three athletes who are D/HoH and 1284 athletes who are hearing were included in this study. Athletes participated in collegiate athletics during the 2012 to 2013 through the 2016 to 2017 academic years.

INTERVENTIONS

Concussion data were provided by the athletic training staff at each institution.

MAIN OUTCOME MEASURES

Concussion counts, concussion rate, and injury rate ratios (IRRs) with 95% confidence intervals (95% CIs).

RESULTS

Thirty athletes who are D/HoH and 104 athletes who are hearing suffered concussions. Athletes who are hearing had an increased injury rate compared with athletes who are D/HoH for all sports combined (IRR = 1.87, 95% CI, 1.26-2.78). Football athletes who are hearing also had an increased injury rate compared with football athletes who are D/HoH (IRR = 3.30, 95% CI, 1.71-6.37). Concussion rate was higher for male athletes who are hearing than male athletes who are D/HoH (IRR = 2.84, 95% CI, 1.62-4.97). No other significant differences regarding concussion risk were identified.

CONCLUSIONS

Athletes who are D/HoH in sex-comparable sports may not have a higher rate of concussion than athletes who are hearing. Rate of concussion in football may be greater among athletes who are hearing compared with athletes who are D/HoH.

Sign language experience redistributes attentional resources to the inferior visual field

While a substantial body of work has suggested that deafness brings about an increased allocation of visual attention to the periphery there has been much less work on how using a signed language may also influence this attentional allocation. Signed languages are visual-gestural and produced using the body and perceived via the human visual system. Signers fixate upon the face of interlocutors and do not directly look at the hands moving in the inferior visual field. It is therefore reasonable to predict that signed languages require a redistribution of covert visual attention to the inferior visual field. Here we report a prospective and statistically powered assessment of the spatial distribution of attention to inferior and superior visual fields in signers - both deaf and hearing - in a visual search task. Using a Bayesian Hierarchical Drift Diffusion Model, we estimated decision making parameters for the superior and inferior visual field in deaf signers, hearing signers and hearing non-signers. Results indicated a greater attentional redistribution toward the inferior visual field in adult signers (both deaf and hearing) than in hearing sign-naïve adults. The effect was smaller for hearing signers than for deaf signers, suggestive of either a role for extent of exposure or greater plasticity of the visual system in the deaf. The data provide support for a process by which the demands of linguistic processing can influence the human attentional system.

Applicability of the Test of Variables of Attention - T.O.V.A in Brazilian adults

The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity.

Executive Function in Deaf Children: Auditory Access and Language Access

Purpose

Deaf children are frequently reported to be at risk for difficulties in executive function (EF); however, the literature is divided over whether these difficulties are the result of deafness itself or of delays/deficits in language that often co-occur with deafness. The purpose of this study is to discriminate these hypotheses by assessing EF in populations where the 2 accounts make contrasting predictions.

Method

We use a between-groups design involving 116 children, ages 5-12 years, across 3 groups: (a) participants with normal hearing (n = 45), (b) deaf native signers who had access to American Sign Language from birth (n = 45), and (c) oral cochlear implant users who did not have full access to language prior to cochlear implantation (n = 26). Measures include both parent report and performance-based assessments of EF.

Results

Parent report results suggest that early access to language has a stronger impact on EF than early access to sound. Performance-based results trended in a similar direction, but no between-group differences were significant.

Conclusions

These results indicate that healthy EF skills do not require audition and therefore that difficulties in this domain do not result primarily from a lack of auditory experience. Instead, results are consistent with the hypothesis that language proficiency, whether in sign or speech, is crucial for the development of healthy EF. Further research is needed to test whether sign language proficiency also confers benefits to deaf children from hearing families.

Visual Temporal Acuity Is Related to Auditory Speech Perception Abilities in Cochlear Implant Users

OBJECTIVES

Despite significant improvements in speech perception abilities following cochlear implantation, many prelingually deafened cochlear implant (CI) recipients continue to rely heavily on visual information to develop speech and language. Increased reliance on visual cues for understanding spoken language could lead to the development of unique audiovisual integration and visual-only processing abilities in these individuals. Brain imaging studies have demonstrated that good CI performers, as indexed by auditory-only speech perception abilities, have different patterns of visual cortex activation in response to visual and auditory stimuli as compared with poor CI performers. However, no studies have examined whether speech perception performance is related to any type of visual processing abilities following cochlear implantation. The purpose of the present study was to provide a preliminary examination of the relationship between clinical, auditory-only speech perception tests, and visual temporal acuity in prelingually deafened adult CI users. It was hypothesized that prelingually deafened CI users, who exhibit better (i.e., more acute) visual temporal processing abilities would demonstrate better auditory-only speech perception performance than those with poorer visual temporal acuity.

DESIGN

Ten prelingually deafened adult CI users were recruited for this study. Participants completed a visual temporal order judgment task to quantify visual temporal acuity. To assess auditory-only speech perception abilities, participants completed the consonant-nucleus-consonant word recognition test and the AzBio sentence recognition test. Results were analyzed using two-tailed partial Pearson correlations, Spearman's rho correlations, and independent samples t tests.

RESULTS

Visual temporal acuity was significantly correlated with auditory-only word and sentence recognition abilities. In addition, proficient CI users, as assessed via auditory-only speech perception performance, demonstrated significantly better visual temporal acuity than nonproficient CI users.

CONCLUSIONS

These findings provide the first behavioral evidence that visual temporal acuity is related to post implantation CI proficiency as indexed by auditory-only speech perception performance. These preliminary data bring to light the possible future role of visual temporal acuity in predicting CI outcomes before implantation, as well as the possible utility of visual training methods in improving CI outcomes.

Neural Correlates of Sensory Abnormalities Across Developmental Disabilities

Abnormalities in sensory processing are a common feature of many developmental disabilities (DDs). Sensory dysfunction can contribute to deficits in brain maturation, as well as many vital functions. Unfortunately, while some patients with DD benefit from the currently available treatments for sensory dysfunction, many do not. Deficiencies in clinical practice surrounding sensory dysfunction may be related to lack of understanding of the neural mechanisms that underlie sensory abnormalities. Evidence of overlap in sensory symptoms between diagnoses suggests that there may be common neural mechanisms that mediate many aspects of sensory dysfunction. Thus, the current manuscript aims to review the extant literature regarding the neural correlates of sensory dysfunction across DD in order to identify patterns of abnormality that span diagnostic categories. Such anomalies in brain structure, function, and connectivity may eventually serve as targets for treatment.

The Effect of Methylphenidate on the Hearing of Children with Attention Deficit Hyperactivity Disorder

Introduction  There has been a sudden idiopathic hearing loss case presented after methylphenidate treatment in a child with attention deficit hyperactivity disorder (ADHD).

Objective  This study was performed to reveal the probable ototoxic side effects of methylphenidate use in patients with ADHD.

Methods  Thirty pediatric patients with ADHD were included in the study. Pure tone audiometry, speech discrimination scores, waves I, III, V absolute latencies and waves I-III, I-V, III-V interpeak latencies at the 80 dB nHL intensity after click stimulus auditory brainstem response (ABR) results were compared before and 3 months after methylphenidate treatment.

Results  There were no statistically significant difference between pretreatment and posttreatment pure tone and speech audiometry findings and ABR results (p > 0.05 for all parameters).

Conclusion  Methylphenidate can be regarded as a safe drug regarding ototoxic side effects. Additional studies with a larger sample size and longer follow-up may be needed.

Does a Flatter General Gradient of Visual Attention Explain Peripheral Advantages and Central Deficits in Deaf Adults?

Individuals deaf from early age often outperform hearing individuals in the visual periphery on attention-dependent dorsal stream tasks (e.g., spatial localization or movement detection), but sometimes show central visual attention deficits, usually on ventral stream object identification tasks. It has been proposed that early deafness adaptively redirects attentional resources from central to peripheral vision to monitor extrapersonal space in the absence of auditory cues, producing a more evenly distributed attention gradient across visual space. However, little direct evidence exists that peripheral advantages are functionally tied to central deficits, rather than determined by independent mechanisms, and previous studies using several attention tasks typically report peripheral advantages or central deficits, not both. To test the general altered attentional gradient proposal, we employed a novel divided attention paradigm that measured target localization performance along a gradient from parafoveal to peripheral locations, independent of concurrent central object identification performance in prelingually deaf and hearing groups who differed in access to auditory input. Deaf participants without cochlear implants (No-CI), with cochlear implants (CI), and hearing participants identified vehicles presented centrally, and concurrently reported the location of parafoveal (1.4°) and peripheral (13.3°) targets among distractors. No-CI participants but not CI participants showed a central identification accuracy deficit. However, all groups displayed equivalent target localization accuracy at peripheral and parafoveal locations and nearly parallel parafoveal-peripheral gradients. Furthermore, the No-CI group's central identification deficit remained after statistically controlling peripheral performance; conversely, the parafoveal and peripheral group performance equivalencies remained after controlling central identification accuracy. These results suggest that, in the absence of auditory input, reduced central attentional capacity is not necessarily associated with enhanced peripheral attentional capacity or with flattening of a general attention gradient. Our findings converge with earlier studies suggesting that a general graded trade-off of attentional resources across the visual field does not adequately explain the complex task-dependent spatial distribution of deaf-hearing performance differences reported in the literature. Rather, growing evidence suggests that the spatial distribution of attention-mediated performance in deaf people is determined by sophisticated cross-modal plasticity mechanisms that recruit specific sensory and polymodal cortex to achieve specific compensatory processing goals.

A visual processing advantage for young-adolescent deaf observers: Evidence from face and object matching tasks

It is unresolved whether the permanent auditory deprivation that deaf people experience leads to the enhanced visual processing of faces. The current study explored this question with a matching task in which observers searched for a target face among a concurrent lineup of ten faces. This was compared with a control task in which the same stimuli were presented upside down, to disrupt typical face processing, and an object matching task. A sample of young-adolescent deaf observers performed with higher accuracy than hearing controls across all of these tasks. These results clarify previous findings and provide evidence for a general visual processing advantage in deaf observers rather than a face-specific effect.

Grey matter connectivity within and between auditory, language and visual systems in prelingually deaf adolescents

PURPOSE

Previous studies have shown brain reorganizations after early deprivation of auditory sensory. However, changes of grey matter connectivity have not been investigated in prelingually deaf adolescents yet. In the present study, we aimed to investigate changes of grey matter connectivity within and between auditory, language and visual systems in prelingually deaf adolescents.

METHODS

We recruited 16 prelingually deaf adolescents and 16 age-and gender-matched normal controls, and extracted the grey matter volume as the structural characteristic from 14 regions of interest involved in auditory, language or visual processing to investigate the changes of grey matter connectivity within and between auditory, language and visual systems. Sparse inverse covariance estimation (SICE) was utilized to construct grey matter connectivity between these brain regions.

RESULTS

The results show that prelingually deaf adolescents present weaker grey matter connectivity within auditory and visual systems, and connectivity between language and visual systems declined. Notably, significantly increased brain connectivity was found between auditory and visual systems in prelingually deaf adolescents.

CONCLUSIONS

Our results indicate "cross-modal" plasticity after deprivation of the auditory input in prelingually deaf adolescents, especially between auditory and visual systems. Besides, auditory deprivation and visual deficits might affect the connectivity pattern within language and visual systems in prelingually deaf adolescents.

Color-Shape Associations in Deaf and Hearing People

Studies have contended that neurotypical Japanese individuals exhibit consistent color-shape associations (red-circle, yellow-triangle, and blue-square) and those color-shape associations could be constructed by common semantic information between colors and shapes through learning and/or language experiences. Here, we conducted two experiments using a direct questionnaire survey and an indirect behavioral test (Implicit Association Test), to examine whether the construction of color-shape associations entailed phonological information by comparing color-shape associations in deaf and hearing participants. The results of the direct questionnaire showed that deaf and hearing participants had similar patterns of color-shape associations (red-circle, yellow-triangle, and blue-square). However, deaf participants failed to show any facilitated processing of congruent pairs in the IAT tasks as hearing participants did. The present results suggest that color-shape associations in deaf participants may not be strong enough to be proved by the indirect behavior tasks and relatively weaker in comparison to hearing participants. Thus, phonological information likely plays a role in the construction of color-shape associations.

Functional Reorganizations of Brain Network in Prelingually Deaf Adolescents

Previous neuroimaging studies suggested structural or functional brain reorganizations occurred in prelingually deaf subjects. However, little is known about the reorganizations of brain network architectures in prelingually deaf adolescents. The present study aims to investigate alterations of whole-brain functional network using resting-state fMRI and graph theory analysis. We recruited 16 prelingually deaf adolescents (10~18 years) and 16 normal controls matched in age and gender. Brain networks were constructed from mean time courses of 90 regions. Widely distributed network was observed in deaf subjects, with increased connectivity between the limbic system and regions involved in visual and language processing, suggesting reinforcement of the processing for the visual and verbal information in deaf adolescents. Decreased connectivity was detected between the visual regions and language regions possibly due to inferior reading or speaking skills in deaf subjects. Using graph theory analysis, we demonstrated small-worldness property did not change in prelingually deaf adolescents relative to normal controls. However, compared with healthy adolescents, eight regions involved in visual, language, and auditory processing were identified as hubs only present in prelingually deaf adolescents. These findings revealed reorganization of brain functional networks occurred in prelingually deaf adolescents to adapt to deficient auditory input.

Attending at a Low Intensity Increases Impulsivity in an Auditory Sustained Attention to Response Task

Why attention lapses during prolonged tasks is debated, specifically whether errors are a consequence of under-arousal or exerted effort. To explore this, we investigated whether increased impulsivity is associated with effortful processing by modifying the demand of a task by presenting it at a quiet intensity. Here, we consider whether attending at low but detectable levels affects impulsivity in a population with intact hearing. A modification of the Sustained Attention to Response Task was used with auditory stimuli at two levels: the participants’ personal “lowest detectable” level and a “normal speaking” level. At the quiet intensity, we found that more impulsive responses were made compared with listening at a normal speaking level. These errors were not due to a failure in discrimination. The findings suggest an increase in processing time for auditory stimuli at low levels that exceeds the time needed to interrupt a planned habitual motor response. This leads to a more impulsive and erroneous response style. These findings have important implications for understanding the nature of impulsivity in relation to effortful processing. They may explain why a high proportion of individuals with hearing loss are also diagnosed with Attention Deficit Hyperactivity Disorder.

Improving behavior using child-directed interaction skills: A case study determining cochlear implant candidacy

OBJECTIVE AND IMPORTANCE

Children with hearing loss (HL) are at increased risk of developing externalizing behavior problems (e.g., hyperactivity, attention problems). These problems can lead to cascading effects on children's overall development. However, few studies have identified evidence-based interventions for this population.

CLINICAL PRESENTATION

A 6-year-old boy with bilateral HL presented to the clinic with significant behavioral challenges. These challenges (e.g., fatigued quickly, poor attention, and hyperactivity) were affecting the reliability of audiological testing to determine cochlear implant candidacy. Thus, the child was referred for Parent-Child Interaction Therapy (PCIT) to address these behavioral challenges.

INTERVENTION AND TECHNIQUE

PCIT is an evidence-based intervention that has been shown to significantly improve externalizing behavior problems. This study describes how the Child-Directed Interaction phase of PCIT was tailored for a child with bilateral HL. The goal of the intervention was to reduce externalizing behaviors in order to reliably complete a cochlear implant evaluation. Post-intervention, significant improvements were noted in behavior, including a decrease in disruptive behavior to normal levels. This led to completion of previously unsuccessful audiological testing and determination of cochlear implant candidacy.

CONCLUSION

This study illustrates how PCIT was successfully tailored to one child with an HL. This is critical as children with HL are at risk for behavior problems, and effective interventions for disruptive behaviors in children with HL may lead to significant improvements in medical and psychosocial outcomes for children with HL and their families.

Altered regional and circuit resting-state activity associated with unilateral hearing loss

The deprivation of sensory input after hearing damage results in functional reorganization of the brain including cross-modal plasticity in the sensory cortex and changes in cognitive processing. However, it remains unclear whether partial deprivation from unilateral auditory loss (UHL) would similarly affect the neural circuitry of cognitive processes in addition to the functional organization of sensory cortex. Here, we used resting-state functional magnetic resonance imaging to investigate intrinsic activity in 34 participants with UHL from acoustic neuroma in comparison with 22 matched normal controls. In sensory regions, we found decreased regional homogeneity (ReHo) in the bilateral calcarine cortices in UHL. However, there was an increase of ReHo in the right anterior insular cortex (rAI), the key node of cognitive control network (CCN) and multimodal sensory integration, as well as in the left parahippocampal cortex (lPHC), a key node in the default mode network (DMN). Moreover, seed-based resting-state functional connectivity analysis showed an enhanced relationship between rAI and several key regions of the DMN. Meanwhile, lPHC showed more negative relationship with components in the CCN and greater positive relationship in the DMN. Such reorganizations of functional connectivity within the DMN and between the DMN and CCN were confirmed by a graph theory analysis. These results suggest that unilateral sensory input damage not only alters the activity of the sensory areas but also reshapes the regional and circuit functional organization of the cognitive control network.

Sustained attention, selective attention and cognitive control in deaf and hearing children

Deaf children have been characterized as being impulsive, distractible, and unable to sustain attention. However, past research has tested deaf children born to hearing parents who are likely to have experienced language delays. The purpose of this study was to determine whether an absence of auditory input modulates attentional problems in deaf children with no delayed exposure to language. Two versions of a continuous performance test were administered to 37 deaf children born to Deaf parents and 60 hearing children, all aged 6-13 years. A vigilance task was used to measure sustained attention over the course of several minutes, and a distractibility test provided a measure of the ability to ignore task irrelevant information - selective attention. Both tasks provided assessments of cognitive control through analysis of commission errors. The deaf and hearing children did not differ on measures of sustained attention. However, younger deaf children were more distracted by task-irrelevant information in their peripheral visual field, and deaf children produced a higher number of commission errors in the selective attention task. It is argued that this is not likely to be an effect of audition on cognitive processing, but may rather reflect difficulty in endogenous control of reallocated visual attention resources stemming from early profound deafness.

Visual advantage in deaf adults linked to retinal changes

The altered sensory experience of profound early onset deafness provokes sometimes large scale neural reorganisations. In particular, auditory-visual cross-modal plasticity occurs, wherein redundant auditory cortex becomes recruited to vision. However, the effect of human deafness on neural structures involved in visual processing prior to the visual cortex has never been investigated, either in humans or animals. We investigated neural changes at the retina and optic nerve head in profoundly deaf (N = 14) and hearing (N = 15) adults using Optical Coherence Tomography (OCT), an in-vivo light interference method of quantifying retinal micro-structure. We compared retinal changes with behavioural results from the same deaf and hearing adults, measuring sensitivity in the peripheral visual field using Goldmann perimetry. Deaf adults had significantly larger neural rim areas, within the optic nerve head in comparison to hearing controls suggesting greater retinal ganglion cell number. Deaf adults also demonstrated significantly larger visual field areas (indicating greater peripheral sensitivity) than controls. Furthermore, neural rim area was significantly correlated with visual field area in both deaf and hearing adults. Deaf adults also showed a significantly different pattern of retinal nerve fibre layer (RNFL) distribution compared to controls. Significant correlations between the depth of the RNFL at the inferior-nasal peripapillary retina and the corresponding far temporal and superior temporal visual field areas (sensitivity) were found. Our results show that cross-modal plasticity after early onset deafness may not be limited to the sensory cortices, noting specific retinal adaptations in early onset deaf adults which are significantly correlated with peripheral vision sensitivity.

The effect of early confirmation of hearing loss on the behaviour in middle childhood of children with bilateral hearing impairment

AIM

To determine if the benefit of early confirmation of permanent childhood hearing impairment (PCHI) on children's receptive language development is associated with fewer behavioural problems.

METHOD

Follow-up of a total population cohort of 120 children with PCHI of moderate or greater severity (≥ 40 decibels relative to hearing threshold level) (67 males, 53 females; mean age 7 y 11 mo, range 5 y 5 mo-11 y 8 mo) and 63 hearing children (37 males, 26 females; mean age 8 y 1 mo, range 6 y 4 mo-9 y 10 mo). The main outcome measures were the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents and the Vineland Adaptive Behaviour Scales (VABS) which are completed on the basis of a parental interview.

RESULTS

Children with PCHI had lower standard scores than hearing children on the Daily Living Skills (p=0.001) and the Socialisation (p=0.001) scales of the VABS. They had significantly higher Total Behaviour Problem scores on the parent-rated (p=0.002) and teacher-rated SDQ (p=0.03). Children for whom PCHI was confirmed by 9 months did not have significantly fewer problems on the behavioural measures than those confirmed after that age (p=0.635 and p=0.196).

INTERPRETATION

Early confirmation has a beneficial effect on receptive language development but no significant impact in reducing behavioural problems in children with PCHI.

The relationship between language development and behaviour problems in children with hearing loss

BACKGROUND

There are well-replicated findings that link poor development on a range of communication skills with increased behavioural problems. This paper examines this relationship in children with hearing loss.

METHOD

One hundred and twenty children with hearing loss (67 boys, 53 girls) and 63 hearing children (37 boys, 26 girls) with a mean age of 8 years from eight districts in Southern England were assessed for receptive and expressive language skills. The relationships between these measures and an aggregate of parent- and teacher-reported behaviour problems in the children were investigated.

RESULTS

Children with hearing loss had higher levels of behaviour problems compared to hearing children. Once the language abilities of children with hearing loss are taken into account, the negative effects of hearing loss on behaviour disappear.

CONCLUSIONS

Behaviour problems are found more commonly in children with hearing loss and the level of behaviour problems is highest amongst those children with hearing loss with the least developed language capabilities.

The effect of implantation age on visual attention skills

OBJECTIVE

The aim of this study is to evaluate the visual attention skills of deaf children with cochlear implants and to determine whether age at implantation had any impact on visual attention skills.

SUBJECT AND METHODS

Thirty children with cochlear implants aged 6 and 11 years were evaluated and were compared with age matched 36 normal hearing children. The children with cochlear implants were analyzed in to two groups according to their age at implantation; under and at/over 4 years old. The Gordon Diagnostic System (GDS) was used in order to evaluate visual attention skills of cochlear implanted (Group 1 and Group 2) and children with normal hearing. The number of correct responses, extraneous button presses (commission errors) and the number of omission errors or the failure to respond to target stimuli which were recorded by GDS was used to evaluate the visual attention skills of the subjects. Also six different types of commission errors (19X, XX9, XX1, X1X, X9X, XXX) were analyzed and compared both for normal and cochlear implant user children.

RESULTS

Concerning the total number of correct response, omission and commission errors no statistical difference was found between two implanted groups. Besides, both groups with cochlear implantation differed from normal hearing peers on the total number of correct responses, omission errors (p<0.017). According to these findings cochlear implanted children had less correct responses and had more omission errors compared with control group. These findings clearly show that children with cochlear implants performed poorly on visual attention task which requires constant attention together with the ability to exert impulse control despite they hear enhanced sensory information by cochlear implants. Concerning the types of commission errors Group 1 and 2 performed similarly in all types of errors (p>0.017). Besides, Group 1 and 2 made more errors in types 19X, XX9 and XXX, XX9 compared with the control group (p<0.017). Group 2 who had their implants after age of 4 years old had more commission errors than the control group (p<0.017) and positive correlation was found between the total commission errors and XX9 error type with age at implantation. These findings show that children who had their implants at older ages made more commission errors and XX9 type of commission error. The children who were implanted after 4 years old were less mature; unsuccessful in controlling their impulsive behaviors and more careless where they can not get enough benefit from social and environmental motives compared with their normal hearing peers.

CONCLUSION

This present research points out the positive effect of early implantation on visual attention and the possible adversities such as impulsivity, over-impatience and attention deficits which have been previously suggested as preventive or slowing down factors for the pace of auditory-verbal therapy for cochlear implantees. Assuming that the results of this study support the theory of insufficiency which suggested that the deprivation in auditory system would also adversely affect cognitive structures involved in intermodal processing the importance of early implantation is underlined. If early cochlear implantation will be carried out especially at the very critical period of language development (before age of four), this will help the child, in his/her future life, not only with his/her hearing skills and communication but for his/her attention skills and behavior.

Comparison of Cognitive Function in Deaf Children Between Before and After Cochlear Implant

OBJECTIVES

This study was conducted to examine improvements of cognitive abilities after cochlear implantation in deaf children. We also examined the psychosocial factors that predict good outcomes of cochlear implantation.

DESIGN

A neuropsychological test battery was administered to 17 deaf children (mean age, 7 yr 2 mo) before receiving the cochlear implant, and they were reassessed with the same test at 6-mo follow-up. Their parents completed questionnaires concerning their medical and educational history, parenting style, and parental emotional problems.

RESULTS

Deaf children showed marked improvement in speedy and delicate motor coordination and visual organization abilities. Their cognitive functions of comprehension, concentration, and sequential processing, as measured by nonverbal tests, were found to have improved from the levels of borderline to mild mental retardation to that of near-normal range. However, their performances on Information, Comprehension and Similarity, and Mathematics subtests requiring verbal abilities did not show significant changes. Deaf children's working memory improved significantly after cochlear implantation. However, they showed more omission errors in the visual attention test at follow-up than before cochlear implantation. Such inattentiveness for visual stimuli in children post-implantation could be attributed to distractibility of these children toward external noise. Mothers' depression was negatively correlated with scores of acquired knowledge of deaf children.

CONCLUSION

At the 6-mo follow-up after cochlear implant, deaf children showed marked improvement in nonverbal cognitive functions and working memory. Conversely, their verbal abilities did not significantly change. Maternal factors were found to be important for predicting the prognosis of cochlear implantation. The absence of a control group precludes the possibility of drawing any firm conclusions because the effect of the implant cannot be teased apart from the effects of maturation and training. Future studies should address this question with the use of appropriate control groups.

Do deaf individuals see better?

The possibility that, following early auditory deprivation, the remaining senses such as vision are enhanced has been met with much excitement. However, deaf individuals exhibit both better and worse visual skills than hearing controls. We show that, when deafness is considered to the exclusion of other confounds, enhancements in visual cognition are noted. The changes are not, however, widespread but are selective, limited, as we propose, to those aspects of vision that are attentionally demanding and would normally benefit from auditory-visual convergence. The behavioral changes are accompanied by a reorganization of multisensory areas, ranging from higher-order cortex to early cortical areas, highlighting cross-modal interactions as a fundamental feature of brain organization and cognitive processing.

Development of visual attention skills in prelingually deaf children who use cochlear implants

OBJECTIVE

To determine the effects of length of cochlear implant use and other demographic factors on the development of sustained visual attention in prelingually deaf children and to examine the relations between performance on a test of sustained visual attention and audiological outcome measures in this population.

DESIGN

A retrospective analysis of data collected before cochlear implantation and over several years after implantation. Two groups of prelingually deaf children, one >6 years old (N = 41) and one <6 years old (N = 47) at testing, were given an age-appropriate Continuous Performance Task (CPT). In both groups, children monitored visually presented numbers for several minutes and responded whenever a designated number appeared. Hit rate, false alarm rate, and signal detection parameters were dependent measures of sustained visual attention. We tested for effects of a number of patient variables on CPT performance. Multiple regression analyses were conducted to determine if CPT scores were related to performance on several audiological outcome measures.

RESULTS

In both groups of children, mean CPT performance was low compared with published norms for normal-hearing children, and performance improved as a function of length of cochlear implant use and chronological age. The improvement in performance was manifested as an increase in hit rate and perceptual sensitivity over time. In the younger age group, a greater number of active electrodes predicted better CPT performance. Results from regression analyses indicated a relationship between CPT response criterion and receptive language in the younger age group. However, we failed to uncover any other relations between CPT performance and speech and language outcome measures.

CONCLUSIONS

Our findings suggest that cochlear implantation in prelingually deaf children leads to improved performance on a test of sustained visual processing of numbers over 2 or more years of cochlear implant use. In preschool-age children who use cochlear implants, individuals who are more conservative responders on the CPT show higher receptive language scores than do individuals with more impulsive response patterns. Theoretical accounts of these findings are discussed, including cross-modal reorganization of visual attention and enhanced phonological encoding of visually presented numbers.

Sensory temporal processing in adults with early hearing loss

This study examined tactile and visual temporal processing in adults with early loss of hearing. The tactile task consisted of punctate stimulations that were delivered to one or both hands by a mechanical tactile stimulator. Pairs of light emitting diodes were presented on a display for visual stimulation. Responses consisted of YES or NO judgments as to whether the onset of the pairs of stimuli was perceived simultaneously or non-simultaneously. Tactile and visual temporal thresholds were significantly higher for the deaf group when compared to controls. In contrast to controls, tactile and visual temporal thresholds for the deaf group did not differ when presentation locations were examined. Overall findings of this study support the notion that temporal processing is compromised following early deafness regardless of the spatial location in which the stimuli are presented.

Attentional blink in adolescents with varying levels of impulsivity

We explore the temporal attention function in a non-clinical sample of adolescents varying in impulsivity, as assessed with the Barratt Impulsiveness Scale. In a Rapid Serial Visual Presentation task, in which two targets (T(1) and T(2)) were presented in close temporal proximity among distractors, participants tried to identify T(1) and detect T(2) in one (dual-task) experiment and only to detect T(2) in a second, control (single-task) experiment. The sensitivity of T(2) detection was analyzed using signal detection theory. The attentional blink -- the impairment in T(2) detection following the identification of T(1) -- was increased in magnitude and protracted in adolescents with high impulsivity, compared with those with low impulsivity. Moreover, a few more participants with high impulsivity appeared to have a blink temporally weighing toward a later time, an observation also made in children with attention deficit hyperactivity disorder (ADHD) in an earlier study. Taken together, these findings suggest impairment in temporal attention in adolescents with high impulsivity. As in ADHD children, a gating deficit may play a central role in this attention impairment.

Visual attention, behavioral inhibition and speech/language outcomes in deaf children with cochlear implants

We investigated relations between sustained visual attention, behavioral inhibition skills, and speech-language outcomes in prelingually deaf children who use cochlear implants (CIs) using two computerized continuous performance tasks (CPTs). One test measured their ability to sustain visual attention to a string of numbers and another test measured their ability to delay a behavioral response. Performance on latter task was related to postimplant scores on tests of vocabulary knowledge, language skills, and speech intelligibility. We conclude that behavioral inhibition skills of prelingually deaf children are related to several audiological outcome measures in deaf children with CIs. Our findings suggest that further investigation is warranted into executive functions and subvocal rehearsal skills of deaf children with CIs.