Picture naming and verbal fluency in children with cochlear implants

Association of domain-general speed of information processing with spoken language outcomes in prelingually-deaf children with cochlear implants

Spoken language development after pediatric cochlear implantation requires rapid and efficient processing of novel, degraded auditory signals and linguistic information. These demands for rapid adaptation tax the information processing speed ability of children who receive cochlear implants. This study investigated the association of speed of information processing ability with spoken language outcomes after cochlear implantation in prelingually deaf children aged 4-6 years. Two domain-general (visual, non-linguistic) speed of information processing measures were administered to 21 preschool-aged children with cochlear implants and 23 normal-hearing peers. Measures of speech recognition, language (vocabulary and comprehension), nonverbal intelligence, and executive functioning skills were also obtained from each participant. Speed of information processing was positively associated with speech recognition and language skills in preschool-aged children with cochlear implants but not in normal-hearing peers. This association remained significant after controlling for hearing group, age, nonverbal intelligence, and executive functioning skills. These findings are consistent with models suggesting that domain-general, fast-efficient information processing speed underlies adaptation to speech perception and language learning following implantation. Assessment and intervention strategies targeting speed of information processing may provide better understanding and development of speech-language skills after cochlear implantation.

Language, cognitive, and speech in noise perception abilities of children with cochlear ımplants: a comparative analysis by implantation period and bilateral versus unilateral cochlear implants

PURPOSE

The purpose of this study was to compare the language, cognitive, and speech in noise (SiN) perception abilities of children with cochlear implants (CIs) to those of their peers with NH by grouping them according to their implantation period (12-18 months/19-24 months) and unilateral/bilateral CI use.

METHODS

The sample comprised 50 children with cochlear implants (CIs) and 20 children with normal hearing (NH), ages 6-9 years. Children's language, cognitive, and speech in noise (SiN) perception skills were assessed.

RESULTS

Children with CIs between 12 and 18 months and 19 and 24 months performed more poorly than children with NH on language, verbal memory (VM), verbal-short-term memory (V-STM), verbal working memory (V-WM), rapid naming, and speech in noise (SiN) perception abilities measures (p < 0.001). In addition, children with CIs between 19 and 24 months performed worse on rapid naming and V-WM tasks than children with CIs between 12 and 18 months (p < 0.017). Children with unilateral and bilateral CI performed more poorly than children with NH on language, VM, V-STM, V-WM, rapid naming, and SiN perception abilities assessments (p < 0.001). Additionally children with unilateral CI users performed poorly than children with bilateral CI users on SiN perception (p < 0.017).

CONCLUSIONS

In children with congenital hearing loss (CHL), cochlear implantation between 12 and 18 months or sequential bilateral implantation is not sufficient for these children to perform like their NH peers in language, cognitive, and SiN perception abilities. In addition, intervention approaches should focus not only on increasing language skills, but also on cognitive abilities.

Production of nouns and adjectives of children with cochlear implants and of children with typical hearing

This analytical cross-sectional study aimed to investigate the production of nouns and adjectives in 62 children between the ages 5 and 7, with 31 children having Cochlear Implants (CIs) and 31 children having Typical Hearing (TH). The study compaired their performance in a picture naming test of nouns and adjectives. Poisson regression models were fitted to compare the responses of both groups of children, and intra-subject differences between responses to the noun and adjective naming tasks were also analyzed. The results showed that both groups of children produced the same number of non-responses of nouns and of adjectives and a higher number of correct productions of nouns than of adjectives. However, children with CIs produced more errors when naming adjectives than when naming nouns, while this difference is not observed in children with TH. The comparative analysis between both groups of children indicates that children with CIs produced a higher proportion of non-responses when naming nouns, but the same proportion as children with TH when naming adjectives. Children with CIs also produced fewer correct nouns and adjectives and more errors than children with TH. Vocabulary expansion and repair of production errors in children with CIs should be targeted by speech-language pathologists in intervention programs.

Lexical-Semantic Organization as Measured by Repeated Word Association in Children Who Are Deaf and Hard of Hearing Who Use Spoken Language

PURPOSE

This study compares responses of children who are deaf and hard of hearing (DHH) who use spoken language with responses of children who have typical hearing on a repeated word association task to evaluate lexical-semantic organization.

METHOD

This study included 109 participants in early kindergarten or who had completed first grade. The younger group included 30 children with typical hearing, 22 with hearing aids, and 21 with cochlear implants. The older group included 16 children with typical hearing, nine with hearing aids, and 11 with cochlear implants. Children were asked to give a word associated with 24 stimuli words. Responses were coded according to their relation to the target.

RESULTS

An analysis of variance revealed that older children, regardless of hearing status, produced more semantically related responses to prompts than younger children. Children in the younger DHH group differed from children with typical hearing in their production of non-semantically related responses: They produced errored responses at higher rates.

CONCLUSION

This preliminary data may indicate an early deficit in recognition of semantic relations between words for children who are DHH and provides a basis for continued longitudinal study of changes in lexical-semantic organization.

Verbal, Figural, and Arithmetic Fluency of Children with Cochlear Implants

Cochlear implantation gives children with prelingual severe hearing loss and deafness the opportunity to develop their hearing abilities, speech, language, cognitive abilities and academic skills with adequate rehabilitation. The aim of the research was to analyze verbal, figural and arithmetic fluency and their interrelationship in children with a cochlear implant (CI) and children with normal hearing (NH). A total of 46 children with CI and 110 children with NH, aged 9 to 16, participated in the research. Verbal fluency was assessed using phonemic and semantic fluency, and non-verbal fluency using figural fluency. Arithmetic fluency was assessed using simple arithmetic tasks within the number range up to 100. The results showed that children with CI achieved poorer results in phonemic fluency (z = -4.92; p < 0.001), semantic fluency (z = -3.89; p < 0.001), figural fluency (z = -3.07; p = 0.002), and arithmetic fluency (z = -4.27; p < 0.001). In both groups, a positive correlation was obtained between the measured modalities and types of fluency. In the group of children with CI, a sex difference was obtained on the phonemic fluency test, in favor of girls. The age of children with CI was correlated with arithmetic fluency. Verbal, figural and arithmetic fluency of children with CI speak in favor of the importance of early auditory and language experiences.

Effectiveness of rhythmic training on linguistics skill development in deaf children and adolescents with cochlear implants: A systematic review

OBJECTIVE

This review compiles the scientific evidence to date on the effectiveness of musical/rhythmic training for improving and/or enhancing the development of language skills in deaf children aged 6-16 years with cochlear implants.

METHODS

PubMed, ScienceDirect, and Web of Science were used for the research following the PRISMA protocol.

RESULTS

The reviewed studies indicate that rhythmic training can improve language skills (perception, production, and comprehension) in this population, as well as in other cognitive skills.

CONCLUSION

Although further research is still needed, the current evidence can help identify new and more effective early intervention methods for deaf children.

Verbal Fluency in Prelingually Deaf, Early Implanted Children and Adolescents With Cochlear Implants

PURPOSE

Verbal fluency tasks assess the ability to quickly and efficiently retrieve words from the mental lexicon by requiring subjects to rapidly generate words within a phonological or semantic category. This study investigated differences between cochlear implant users and normal-hearing peers in the clustering and time course of word retrieval during phonological and semantic verbal fluency tasks.

METHOD

Twenty-eight children and adolescents (aged 9-17 years) with cochlear implants and 33 normal-hearing peers completed measures of verbal fluency, nonverbal intelligence, speech perception, and verbal short-term/working memory. Phonological and semantic verbal fluency tests were scored for total words generated, words generated in each 10-s interval of the 1-min task, latency to first word generated, number of word clusters, average cluster size, and number of word/cluster switches.

RESULTS

Children and adolescents with cochlear implants generated fewer words than normal-hearing peers throughout the entire 60-s time interval of the phonological and semantic fluency tasks. Cochlear implant users also had slower start latency times and produced fewer clusters and switches than normal-hearing peers during the phonological fluency task. Speech perception and verbal working memory scores were more strongly associated with verbal fluency scores in children and adolescents with cochlear implants than in normal-hearing peers.

CONCLUSIONS

Cochlear implant users show poorer phonological and semantic verbal fluency than normal-hearing peers, and their verbal fluency is significantly associated with speech perception and verbal working memory. These findings suggest deficits in fluent retrieval of phonological and semantic information from long-term lexical memory in cochlear implant users.

Delayed Lexical Access and Cascading Effects on Spreading Semantic Activation During Spoken Word Recognition in Children With Hearing Aids and Cochlear Implants: Evidence From Eye-Tracking

OBJECTIVE

The objective of this study was to characterize the dynamics of real-time lexical access, including lexical competition among phonologically similar words, and spreading semantic activation in school-age children with hearing aids (HAs) and children with cochlear implants (CIs). We hypothesized that developing spoken language via degraded auditory input would lead children with HAs or CIs to adapt their approach to spoken word recognition, especially by slowing down lexical access.

DESIGN

Participants were children ages 9- to 12-years old with normal hearing (NH), HAs, or CIs. Participants completed a Visual World Paradigm task in which they heard a spoken word and selected the matching picture from four options. Competitor items were either phonologically similar, semantically similar, or unrelated to the target word. As the target word unfolded, children's fixations to the target word, cohort competitor, rhyme competitor, semantically related item, and unrelated item were recorded as indices of ongoing lexical access and spreading semantic activation.

RESULTS

Children with HAs and children with CIs showed slower fixations to the target, reduced fixations to the cohort competitor, and increased fixations to the rhyme competitor, relative to children with NH. This wait-and-see profile was more pronounced in the children with CIs than the children with HAs. Children with HAs and children with CIs also showed delayed fixations to the semantically related item, although this delay was attributable to their delay in activating words in general, not to a distinct semantic source.

CONCLUSIONS

Children with HAs and children with CIs showed qualitatively similar patterns of real-time spoken word recognition. Findings suggest that developing spoken language via degraded auditory input causes long-term cognitive adaptations to how listeners recognize spoken words, regardless of the type of hearing device used. Delayed lexical access directly led to delays in spreading semantic activation in children with HAs and CIs. This delay in semantic processing may impact these children's ability to understand connected speech in everyday life.

Lexical Access in Preschool Mandarin-Speaking Children With Cochlear Implants

PURPOSE

Children with cochlear implants (CIs) have less experience accessing spoken language. Mandarin Chinese uses pitch information to contrast word meaning, and the signal that the CI devices provide is degraded. Thus, Mandarin-speaking children with CIs may face more challenges in the development of language skills. This study examines preschool Mandarin-speaking children's performance in lexical access. We hypothesized that children with CIs and their peers with normal hearing (NH) have comparable naming ability, but they process phonological or semantic information differently.

METHOD

Twenty children with CIs and 20 age-matched children with NH were tested. The cross-modal visual-auditory picture-word interference paradigm was applied. The distractor was either phonologically related (mao⁵⁵ cat -mao⁵¹ hat), semantically related (mao⁵⁵ cat -shu²¹⁴ mouse) or unrelated (mao⁵⁵ cat -zhi²¹⁴ paper) to the target, and it was aurally presented at four different points in time relative to the picture. Accuracy was compared between the two groups to tap into the children's naming abilities, and reaction time was analyzed to examine the effects of phonological and semantic information.

RESULTS

No group difference in accuracy was found. The phonologically related distractors led to significantly higher accuracy scores and shorter reaction times, whereas the semantically related distractors did not. Unlike the NH group, the CI group did not respond significantly faster or slower in phonologically related condition when the distractor and picture occurred simultaneously. Finally, the CI group made overall quicker responses than the NH group.

CONCLUSIONS

Children with CIs are as successful as children with NH in word retrieval and production, and the two groups both show phonological priming effect and lack semantic effect. However, children with CIs do not process phonological information as early as their NH peers, and they may be more tasks directed and hence make quicker responses.

Comparing the semantic networks of children with cochlear implants and children with typical hearing: Effects of length of language access

PURPOSE

Kenett et al. (2013) report that the sematic networks, measured by using an oral semantic fluency task, of children with cochlear implants (CI) are less structured compared to the sematic networks of children with typical hearing (TH). This study aims to evaluate if such differences are only evident if children with CI are compared to children with TH matched on chronological age, or also if they are compared to children with TH matched on hearing age.

METHOD

The performance of a group of children with CI on a verbal fluency task was compared to the performance of a group of chronological-age matched children with TH. Subsequently, computational network analysis was used to compare the semantic network structure of the groups. The same procedure was applied to compare a group of children with CI to a group of hearing-age matched children with TH.

RESULTS

The children with CI perform on the same level on an oral semantic verbal fluency task as the children with TH matched on hearing age. There are significant differences in terms of the structure of the semantic network between the groups. The magnitude of these differences is very small and they are non-significant for a proportion of nodes included in the bootstrap analysis. This indicates that there is no true difference between the networks. Hearing age, but not age at implantation was found to be significantly positively correlated with semantic verbal fluency performance for the children with CI.

CONCLUSIONS

The results from the current study indicate that length of exposure to the tested language is an important factor for the structure of the semantic network and the performance on a semantic verbal fluency task for children with CI. Further studies are needed to explore the role of the accessibility of the language input for the development of semantic networks of children with CI.

Phonological Priming as a Lens for Phonological Organization in Children With Cochlear Implants

OBJECTIVES

To evaluate the subconscious knowledge of between-word phonological similarities in children with cochlear implants as compared with children with typical hearing.

DESIGN

Participants included 30 children with cochlear implants between the ages of five and seven who used primarily spoken English to communicate, 30 children matched for chronological age, and 30 children matched for vocabulary size. Participants completed an animacy judgment task in either a (a) neutral condition, (b) a phonological prime condition where the consonant and vowel onset of the pictured word was presented prior to the visual target's appearance, (c) an inhibition prime condition where a consonant and vowel onset not matching the pictured word was presented prior to the target's appearance. Reaction times were recorded.

RESULTS

Children with cochlear implants reacted differently and more slowly than children with typical hearing in both groups to the primes: children with typical hearing experienced a phonological facilitation effect in the phonological prime condition, whereas children with cochlear implants did not. Children with cochlear implants also had reaction times that, overall, were slower than children matched for chronological age but similar to children matched for vocabulary size.

CONCLUSIONS

The different experience of children with cochlear implants with phonological facilitation and inhibition effects may indicate children with cochlear implants have phonological organization strategies that are different from those of children with typical hearing.

Differences in picture naming between children with cochlear implants and children with typical hearing

Increase in the auditory abilities of children with cochlear implants (CIs) has led to an improvement in naming tasks, although divergent results are still being reported; this strongly suggests that further studies are needed. The study aims to compare the responses in a picture-naming activity between the complete population of children aged 5 to 7 with cochlear implants in Catalonia -Spain- (N = 31), without developmental problems, and a matched sample of 31 children with typical hearing. A picture-naming task was used to assess their lexical naming abilities. The results show that children with CIs provide more non-responses, they produce fewer words correctly, they require a longer reaction time and they commit more picture-naming errors than children with typical hearing. The auditory age does significantly affect the results, but not the type of implant. In spite of the hearing gain achieved with the cochlear implant and the listening experience progressively achieved in distinct contexts, further explicit work on lexical naming in speech-therapy intervention is clearly required.

Vocabulary Development and the Shape Bias in Children With Hearing Loss

Purpose Although children with hearing loss (HL) can benefit from cochlear implants (CIs) and hearing aids (HAs), they often show language delays. Moreover, little is known about the mechanisms by which children with HL learn words. One mechanism by which typically hearing (TH) children learn words is by acquiring word learning biases such as the "shape bias," that is, generalizing the names of novel solid objects by similarity in shape. In TH children, the shape bias emerges out of regularities in the early vocabulary and, once acquired, has consequences for subsequent vocabulary development. Method Here, we ask whether children with HL exhibit similar word learning biases as TH children. In the current study, nineteen 2- to 3.5-year-old children with HL generalized the names of novel objects by similarity in shape or material. We compared their performance to that of 20 TH children matched on age and 20 TH children matched on vocabulary size. Results Children with HL were significantly less likely than age-matched TH children and vocabulary-matched TH children to generalize novel names to objects of the same shape. However, there was also an interaction such that vocabulary has a stronger effect on novel noun generalization for those with HL than for those who are TH. Exploratory analyses of children with HL reveal similar novel noun generalization and vocabulary sizes in children who use CIs and those who use HAs, regardless of hearing age or degree of HL. Conclusion Together, the results suggest that, although vocabulary knowledge drives development of the shape bias in general for all children, it may be especially important for children with HL, who are at risk for language delays.

Links of Prosodic Stress Perception and Musical Activities to Language Skills of Children With Cochlear Implants and Normal Hearing

OBJECTIVES

A major issue in the rehabilitation of children with cochlear implants (CIs) is unexplained variance in their language skills, where many of them lag behind children with normal hearing (NH). Here, we assess links between generative language skills and the perception of prosodic stress, and with musical and parental activities in children with CIs and NH. Understanding these links is expected to guide future research and toward supporting language development in children with a CI.

DESIGN

Twenty-one unilaterally and early-implanted children and 31 children with NH, aged 5 to 13, were classified as musically active or nonactive by a questionnaire recording regularity of musical activities, in particular singing, and reading and other activities shared with parents. Perception of word and sentence stress, performance in word finding, verbal intelligence (Wechsler Intelligence Scale for Children (WISC) vocabulary), and phonological awareness (production of rhymes) were measured in all children. Comparisons between children with a CI and NH were made against a subset of 21 of the children with NH who were matched to children with CIs by age, gender, socioeconomic background, and musical activity. Regression analyses, run separately for children with CIs and NH, assessed how much variance in each language task was shared with each of prosodic perception, the child's own music activity, and activities with parents, including singing and reading. All statistical analyses were conducted both with and without control for age and maternal education.

RESULTS

Musically active children with CIs performed similarly to NH controls in all language tasks, while those who were not musically active performed more poorly. Only musically nonactive children with CIs made more phonological and semantic errors in word finding than NH controls, and word finding correlated with other language skills. Regression analysis results for word finding and VIQ were similar for children with CIs and NH. These language skills shared considerable variance with the perception of prosodic stress and musical activities. When age and maternal education were controlled for, strong links remained between perception of prosodic stress and VIQ (shared variance: CI, 32%/NH, 16%) and between musical activities and word finding (shared variance: CI, 53%/NH, 20%). Links were always stronger for children with CIs, for whom better phonological awareness was also linked to improved stress perception and more musical activity, and parental activities altogether shared significantly variance with word finding and VIQ.

CONCLUSIONS

For children with CIs and NH, better perception of prosodic stress and musical activities with singing are associated with improved generative language skills. In addition, for children with CIs, parental singing has a stronger positive association to word finding and VIQ than parental reading. These results cannot address causality, but they suggest that good perception of prosodic stress, musical activities involving singing, and parental singing and reading may all be beneficial for word finding and other generative language skills in implanted children.

Recognizing spoken words in semantically-anomalous sentences: Effects of executive control in early-implanted deaf children with cochlear implants

OBJECTIVES

To investigate differences in speech, language, and neurocognitive functioning in normal hearing (NH) children and deaf children with cochlear implants (CIs) using anomalous sentences. Anomalous sentences block the use of downstream predictive coding during speech recognition, allowing for investigation of rapid phonological coding and executive functioning.Methods: Extreme groups were extracted from samples of children with CIs and NH peers (ages 9 to 17) based on the 7 highest and 7 lowest scores on the Harvard-Anomalous sentence test (Harvard-A). The four groups were compared on measures of speech, language, and neurocognitive functioning.Results: The 7 highest-scoring CI users and the 7 lowest-scoring NH peers did not differ in Harvard-A scores but did differ significantly on measures of neurocognitive functioning. Compared to low-performing NH peers, highperforming children with CIs had significantly lower nonword repetition scores but higher nonverbal IQ scores, greater verbal WM capacity, and excellent EF skills related to inhibition, shifting attention/mental flexibility and working memory updating.Discussion: High performing deaf children with CIs are able to compensate for their sensory deficits and weaknesses in automatic phonological coding of speech by engaging in a slow effortful mode of information processing involving inhibition, working memory and executive functioning.

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.

The relationship between reasoning and language ability: comparing children with cochlear implants and children with typical hearing

PURPOSE

Language has been suggested to play a facilitating role for analogical reasoning tasks, especially for those with high complexity. This study aims to evaluate if differences in analogical reasoning ability between children with cochlear implants (CI) and children with typical hearing (TH) might be explained by differences in language ability.

METHODS

The analogical reasoning ability (verbal; non-verbal; complex non-verbal: high relational integration demand) of children with CI (N = 15, mean age = 6;7) was compared to two groups of children with TH: age and language matched (TH-A+L, N = 23, mean age = 6;5), and age matched (TH-A, N = 23, mean age = 6;5).

RESULTS

Children with CI were found to perform comparable to Group TH-A+L on non-verbal reasoning tasks but significantly more poorly on a verbal analogical reasoning task. Children with CI were found to perform significantly more poorly on both the non-verbal analogical reasoning task with high relational integration demand and on the verbal analogical reasoning task compared to Group TH-A. For the non-verbal analogical reasoning task with lower relational integration demand only a tendency for a difference between group CI and Group TH-A was found.

CONCLUSIONS

The results suggest that verbal strategies are influencing the performance on the non-verbal analogical reasoning tasks with a higher relational integration demand. The possible reasons for this are discussed. The verbal analogical reasoning task used in the current study partly measured lexical access. Differences between the children with CI and both groups of children with TH might therefore be explained by differences in expressive vocabulary skills.

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.

The Relation Between Vocabulary Knowledge and Phonological Awareness in Children With Cochlear Implants

Purpose The purpose of this study was to evaluate the relation between lexical knowledge and phonological awareness performance of children with cochlear implants. Method Thirty children with cochlear implants (aged 5-7 years), 30 children with normal hearing matched for age, and 30 children with normal hearing matched for vocabulary size participated in the study. Children completed a vocabulary knowledge measure and three phonological awareness tasks with words that had high and low neighborhood density. Results Children with cochlear implants performed more poorly than their age-matched peers and similarly to their vocabulary-matched peers on phonological awareness tasks. When performance was analyzed according to the neighborhood density of the target word, children with cochlear implants and age-matched children performed better with high-density words. Across all groups, vocabulary size correlated significantly with phonological awareness performance. Conclusion Children with cochlear implants demonstrate delays in both vocabulary knowledge and phonological awareness performance, but children with cochlear implants appear to take advantage of lexical information similarly to their age-matched peers.

Pragmatic Language Skills: A Comparison of Children With Cochlear Implants and Children Without Hearing Loss

Pragmatic language ability refers to the ability to use language in a social context. It has been found to be correlated with success in general education for deaf and hard of hearing children. It is therefore of great importance to study why deaf and hard of hearing children often perform more poorly than their hearing peers on tests measuring pragmatic language ability. In the current study the Pragmatics Profile questionnaire from the CELF-IV battery was used to measure pragmatic language ability in children using cochlear implants (N = 14) and children without a hearing loss (N = 34). No significant difference was found between the children with cochlear implants (CI) and the children without hearing loss (HL) for the sum score of the pragmatics language measure. However, 35.71% of the children with CI performed below age norm, while only 5.89% of the children without HL performed below age norm. In addition, when dividing the sum score into three sub-measures: Rituals and Conversational skills (RCS), Asking for, Giving, and Responding to Information (AGRI), and Nonverbal Communication skills (NCS), significant differences between the groups were found for the NCS measure and a tendency for a difference was found for the RCS measure. In addition, all three sub-measures (NCS, AGRI, RCS) were correlated to verbal fluency in the children with CI, but not the children without HL.

Linear Mixed-Model Analysis to Examine Longitudinal Trajectories in Vocabulary Depth and Breadth in Children Who Are Hard of Hearing

Purpose Children who are hard of hearing (CHH) tend to have reduced vocabularies compared to children with normal hearing (CNH). Prior research on vocabulary skills in children with hearing loss has focused primarily on their breadth of knowledge (how many words are known). Depth of vocabulary knowledge (how well words are known) is not well documented for CHH. The current study used linear mixed models (LMMs) to investigate growth trajectories of vocabulary depth and breadth in CHH relative to age-matched CNH. Method Participants for this study included 155 children (93 CHH, 62 CNH) enrolled in a longitudinal study. Examiners administered a standardized measure of vocabulary knowledge at ages 7, 8, and 9 years. We constructed multiple LMMs with fixed effects for group and age. The models included various combinations of random intercepts for subject and item and random slope for age. Results For depth, CHH showed significant and stable deficits compared to CNH over time. For breadth, CNH showed greater vocabulary breadth, but the group differences diminished with age. For CHH, higher aided audibility, age, and maternal educational level were associated with greater vocabulary breadth and depth. Age at hearing aid fitting was not. Conclusions A major advantage of using LMM is that it allowed us to cope with missing data points while still accounting for variability within and across participants. Assessment of both vocabulary breadth and depth may be useful in identifying school-age CHH who are at risk of delays in language outcomes.

Comparing Auditory-Only and Audiovisual Word Learning for Children With Hearing Loss

Although reducing visual input to emphasize auditory cues is a common practice in pediatric auditory (re)habilitation, the extant literature offers minimal empirical evidence for whether unisensory auditory-only (AO) or multisensory audiovisual (AV) input is more beneficial to children with hearing loss for developing spoken language skills. Using an adapted alternating treatments single case research design, we evaluated the effectiveness and efficiency of a receptive word learning intervention with and without access to visual speechreading cues. Four preschool children with prelingual hearing loss participated. Based on probes without visual cues, three participants demonstrated strong evidence for learning in the AO and AV conditions relative to a control (no-teaching) condition. No participants demonstrated a differential rate of learning between AO and AV conditions. Neither an inhibitory effect predicted by a unisensory theory nor a beneficial effect predicted by a multisensory theory for providing visual cues was identified. Clinical implications are discussed.

Pairing New Words With Unfamiliar Objects: Comparing Children With and Without Cochlear Implants

PURPOSE

This study investigates differences between preschool children with cochlear implants and age-matched children with normal hearing during an initial stage in word learning to evaluate whether they (a) match novel words to unfamiliar objects and (b) solicit information about unfamiliar objects during play.

METHOD

Twelve preschool children with cochlear implants and 12 children with normal hearing matched for age completed 2 experimental tasks. In the 1st task, children were asked to point to a picture that matched either a known word or a novel word. In the 2nd task, children were presented with unfamiliar objects during play and were given the opportunity to ask questions about those objects.

RESULTS

In Task 1, children with cochlear implants paired novel words with unfamiliar pictures in fewer trials than children with normal hearing. In Task 2, children with cochlear implants were less likely to solicit information about new objects than children with normal hearing. Performance on the 1st task, but not the 2nd, significantly correlated with expressive vocabulary standard scores of children with cochlear implants.

CONCLUSION

This study provides preliminary evidence that children with cochlear implants approach mapping novel words to and soliciting information about unfamiliar objects differently than children with normal hearing.

Language processing fluency and verbal working memory in prelingually deaf long-term cochlear implant users: A pilot study

OBJECTIVE

Verbal working memory (WM) is more strongly correlated with spoken language skills in prelingually deaf, early-implanted cochlear implant (CI) users than in normal-hearing (NH) peers, suggesting that CI users access WM in order to support and compensate for their slower, more effortful spoken language processing. This pilot study tested the feasibility and validity of a dual-task method for establishing the causal role of WM in basic language processing (lexical access speed) in samples of 9 CI users (ages 8-26 years) and 9 NH peers.

METHODS

Participants completed tests of lexical access speed (rapid automatized picture naming test and lexical decision test) under two administration conditions: a standard condition and a dual-task WM condition requiring participants to hold numerals in WM during completion of the lexical access speed tests.

RESULTS

CI users showed more dual-task interference (decline in speed during the WM condition compared to the standard condition) than NH peers, indicating that their lexical access speed was more dependent on engagement of WM resources. Furthermore, dual-task interference scores were significantly correlated with several measures of speed-based executive functioning (EF), consistent with the hypothesis that the dual-task method reflects the involvement of EF in language processing.

CONCLUSION

These pilot study results support the feasibility and validity of the dual-task WM method for investigating the influence of WM in the basic language processing of CI users. Preliminary findings indicate that CI users are more dependent on the use of WM as a compensatory strategy during slow-effortful basic language processing than NH peers.

Semantic fluency in deaf children who use spoken and signed language in comparison with hearing peers

BACKGROUND

Deafness has an adverse impact on children's ability to acquire spoken languages. Signed languages offer a more accessible input for deaf children, but because the vast majority are born to hearing parents who do not sign, their early exposure to sign language is limited. Deaf children as a whole are therefore at high risk of language delays.

AIMS

We compared deaf and hearing children's performance on a semantic fluency task. Optimal performance on this task requires a systematic search of the mental lexicon, the retrieval of words within a subcategory and, when that subcategory is exhausted, switching to a new subcategory. We compared retrieval patterns between groups, and also compared the responses of deaf children who used British Sign Language (BSL) with those who used spoken English. We investigated how semantic fluency performance related to children's expressive vocabulary and executive function skills, and also retested semantic fluency in the majority of the children nearly 2 years later, in order to investigate how much progress they had made in that time.

METHODS & PROCEDURES

Participants were deaf children aged 6-11 years (N = 106, comprising 69 users of spoken English, 29 users of BSL and eight users of Sign Supported English-SSE) compared with hearing children (N = 120) of the same age who used spoken English. Semantic fluency was tested for the category 'animals'. We coded for errors, clusters (e.g., 'pets', 'farm animals') and switches. Participants also completed the Expressive One-Word Picture Vocabulary Test and a battery of six non-verbal executive function tasks. In addition, we collected follow-up semantic fluency data for 70 deaf and 74 hearing children, nearly 2 years after they were first tested.

OUTCOMES & RESULTS

Deaf children, whether using spoken or signed language, produced fewer items in the semantic fluency task than hearing children, but they showed similar patterns of responses for items most commonly produced, clustering of items into subcategories and switching between subcategories. Both vocabulary and executive function scores predicted the number of correct items produced. Follow-up data from deaf participants showed continuing delays relative to hearing children 2 years later.

CONCLUSIONS & IMPLICATIONS

We conclude that semantic fluency can be used experimentally to investigate lexical organization in deaf children, and that it potentially has clinical utility across the heterogeneous deaf population. We present normative data to aid clinicians who wish to use this task with deaf children.

Generation of Signs Within Semantic and Phonological Categories: Data from Deaf Adults and Children Who Use American Sign Language

Two key areas of language development include semantic and phonological knowledge. Semantic knowledge relates to word and concept knowledge. Phonological knowledge relates to how language parameters combine to create meaning. We investigated signing deaf adults' and children's semantic and phonological sign generation via one-minute tasks, including animals, foods, and specific handshapes. We investigated the effects of chronological age, age of sign language acquisition/years at school site, gender, presence of a disability, and geographical location (i.e., USA and Puerto Rico) on participants' performance and relations among tasks. In general, the phonological task appeared more difficult than the semantic tasks, students generated more animals than foods, age, and semantic performance correlated for the larger sample of U.S. students, and geographical variation included use of fingerspelling and specific signs. Compared to their peers, deaf students with disabilities generated fewer semantic items. These results provide an initial snapshot of students' semantic and phonological sign generation.

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.

Taxonomic Knowledge of Children With and Without Cochlear Implants

Purpose

The purpose of this study was to compare the taxonomic vocabulary knowledge and organization of children with cochlear implants to (a) children with normal hearing matched for age, and (b) children matched for vocabulary development.

Method

Ten children with cochlear implants, 10 age-matched children with normal hearing, and 10 vocabulary-matched children with normal hearing participated in this study. The children completed 2 experimental tasks: a forced-choice taxonomic sorting task, and a naming task requiring the children to use labels at multiple taxonomic levels.

Results

In the first task, the children in the cochlear implant group sorted pictures with accuracy consistent with the age-matched group. In the second task, the children with cochlear implants demonstrated delayed knowledge of superordinate relations as compared with the age-matched group, similar to the vocabulary-matched group. However, the children with cochlear implants did not demonstrate delayed knowledge of basic or subordinate relations.

Conclusion

The children with cochlear implants demonstrated a delay in use of superordinate taxonomic labels as compared with the children with normal hearing of the same age, which may lead to later difficulties with academic performance.

Structural correlates of spoken language abilities: A surface-based region-of interest morphometry study

Brain structure can predict many aspects of human behavior, though the extent of this relationship in healthy adults, particularly for language-related skills, remains largely unknown. The objective of the present study was to explore this relation using magnetic resonance imaging (MRI) on a group of 21 healthy young adults who completed two language tasks: (1) semantic fluency and (2) sentence generation. For each region of interest, cortical thickness, surface area, and volume were calculated. The results show that verbal fluency scores correlated mainly with measures of brain morphology in the left inferior frontal cortex and bilateral insula. Sentence generation scores correlated with structure of the left inferior parietal and right inferior frontal regions. These results reveal that the anatomy of several structures in frontal and parietal lobes is associated with spoken language performance. The presence of both negative and positive correlations highlights the complex relation between brain and language.

Syntagmatic and paradigmatic development of cochlear implanted children in comparison with normally hearing peers up to age 7

OBJECTIVE

Grammatical development is shown to be delayed in CI children. However, the literature has focussed mainly on one aspect of grammatical development, either morphology or syntax, and on standard tests instead of spontaneous speech. The aim of the present study was to compare grammatical development in the spontaneous speech of Dutch-speaking children with cochlear implants and normally hearing peers. Both syntagmatic and paradigmatic development will be assessed and compared with each other.

METHOD

Nine children with cochlear implants were followed yearly between ages 2 and 7. There was a cross-sectional control group of 10 normally hearing peers at each age. Syntactic development is measured by means of Mean Length of Utterance (MLU), morphological development by means of Mean Size of Paradigm (MSP). This last measure is relatively new in child language research.

RESULTS

MLU and MSP of children with cochlear implants lag behind that of their normally hearing peers up to age 4 and up to age 6 respectively. By age 5, CI children catch up on MSP and by age 7 they caught up on MLU.

CONCLUSION

Children with cochlear implants catch up with their normally hearing peers for both measures of syntax and morphology. However, it is shown that inflection is earlier age-appropriate than sentence length in CI children. Possible explanations for this difference in developmental pace are discussed.

Lexical access in children with hearing loss or specific language impairment, using the cross-modal picture-word interference paradigm

In this study we compared lexical access to spoken words in 25 deaf children with cochlear implants (CIs), 13 hard-of-hearing (HoH) children and 20 children with specific language impairment (SLI). Twenty-one age-matched typically developing children served as controls. The children with CIs and the HoH children in the present study had good speech perception abilities. We used a cross-modal picture-word interference paradigm to examine lexical access. Results showed that children with SLI revealed overall slower reaction times and produced more errors than the children with CIs, the HoH children, and the control children. Reaction times of children with CIs and the HoH children did not differ from those of the control children. Thus, problems with spoken language processing, as is the case in children with SLI, seem to affect lexical access more than limitations in auditory perception, as is the fundamental problem in children with hearing loss. We recommend that improvement of lexical access in children with SLI deserves specific attention in therapy and education.