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Wiseman KB, McCreery RW, Walker EA. Hearing Thresholds, Speech Recognition, and Audibility as Indicators for Modifying Intervention in Children With Hearing Aids. Ear Hear 2023; 44:787-802. [PMID: 36627755 PMCID: PMC10271969 DOI: 10.1097/aud.0000000000001328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The purpose of this study was to determine if traditional audiologic measures (e.g., pure-tone average, speech recognition) and audibility-based measures predict risk for spoken language delay in children who are hard of hearing (CHH) who use hearing aids (HAs). Audibility-based measures included the Speech Intelligibility Index (SII), HA use, and auditory dosage, a measure of auditory access that weighs each child's unaided and aided audibility by the average hours of HA use per day. The authors also sought to estimate values of these measures at which CHH would be at greater risk for delayed outcomes compared with a group of children with typical hearing (CTH) matched for age and socioeconomic status, potentially signaling a need to make changes to a child's hearing technology or intervention plan. DESIGN The authors compared spoken language outcomes of 182 CHH and 78 CTH and evaluated relationships between language and audiologic measures (e.g., aided SII) in CHH using generalized additive models. They used these models to identify values associated with falling below CTH (by > 1.5 SDs from the mean) on language assessments, putting CHH at risk for language delay. RESULTS Risk for language delay was associated with aided speech recognition in noise performance (<59% phonemes correct, 95% confidence interval [55%, 62%]), aided Speech Intelligibility Index (SII < 0.61, 95% confidence internal [.53,.68]), and auditory dosage (dosage < 6.0, 95% confidence internal [5.3, 6.7]) in CHH. The level of speech recognition in quiet, unaided pure-tone average, and unaided SII that placed children at risk for language delay could not be determined due to imprecise estimates with broad confidence intervals. CONCLUSIONS Results support using aided SII, aided speech recognition in noise measures, and auditory dosage as tools to facilitate clinical decision-making, such as deciding whether changes to a child's hearing technology are warranted. Values identified in this article can complement other metrics (e.g., unaided hearing thresholds, aided speech recognition testing, language assessment) when considering changes to intervention, such as adding language supports, making HA adjustments, or referring for cochlear implant candidacy evaluation.
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Affiliation(s)
| | | | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA
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Walker EA. The Importance of High-Frequency Bandwidth on Speech and Language Development in Children: A Review of Patricia Stelmachowicz's Contributions to Pediatric Audiology. Semin Hear 2023; 44:S3-S16. [PMID: 36970651 PMCID: PMC10033203 DOI: 10.1055/s-0043-1764138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
We review the literature related to Patricia Stelmachowicz's research in pediatric audiology, specifically focusing on the influence of audibility in language development and acquisition of linguistic rules. Pat Stelmachowicz spent her career increasing our awareness and understanding of children with mild to severe hearing loss who use hearing aids. Using a variety of novel experiments and stimuli, Pat and her colleagues produced a robust body of evidence to support the hypothesis that development moderates the role of frequency bandwidth on speech perception, particularly for fricative sounds. The prolific research that came out of Pat's lab had several important implications for clinical practice. First, her work highlighted that children require access to more high-frequency speech information than adults in the detection and identification of fricatives such as /s/ and /z/. These high-frequency speech sounds are important for morphological and phonological development. Consequently, the limited bandwidth of conventional hearing aids may delay the formation of linguistic rules in these two domains for children with hearing loss. Second, it emphasized the importance of not merely applying adult findings to the clinical decision-making process in pediatric amplification. Clinicians should use evidence-based practices to verify and provide maximum audibility for children who use hearing aids to acquire spoken language.
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Affiliation(s)
- Elizabeth A. Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa
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Wiseman KB, McCreery RW. Quantifying Access to Speech in Children with Hearing Loss: The Influence of the Work of Pat Stelmachowicz on Measures of Audibility. Semin Hear 2023; 44:S17-S28. [PMID: 36970647 PMCID: PMC10033202 DOI: 10.1055/s-0043-1764136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
This article reviews the research of Pat Stelmachowicz on traditional and novel measures for quantifying speech audibility (i.e., pure-tone average [PTA], the articulation/audibility index [AI], the speech intelligibility index, and auditory dosage) as predictors of speech perception and language outcomes in children. We discuss the limitations of using audiometric PTA as a predictor of perceptual outcomes in children and how Pat's research shed light on the importance of measures that characterize high-frequency audibility. We also discuss the AI, Pat's work on the calculation of the AI as a hearing aid outcome measure, and how this work led to the application of the speech intelligibility index as a clinically utilized measure of unaided and aided audibility. Finally, we describe a novel measure of audibility-auditory dosage-that was developed based on Pat's work on audibility and hearing aid use for children who are hard of hearing.
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Affiliation(s)
- Kathryn B. Wiseman
- Audibility, Perception and Cognition Lab, Boys Town National Research Hospital, Omaha, Nebraska
| | - Ryan W. McCreery
- Audibility, Perception and Cognition Lab, Boys Town National Research Hospital, Omaha, Nebraska
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Ross CA, Moore MW. Spectral degradation influences phonological memory in typically hearing adults. CLINICAL LINGUISTICS & PHONETICS 2022; 36:968-987. [PMID: 34505813 DOI: 10.1080/02699206.2021.1974563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
Phonological processing is a fundamental component of language, can be impaired in people with hearing loss, and involves several confounded subprocesses. The purpose of this study was to systematically examine several phonological subprocesses - i.e., the spectral quality of auditory input and phonological short-term and long-term memory - in order to better understand how they interact with one another in basic linguistic tasks. Using an experimental, within-subjects design, 30 typically-hearing adults completed nonword repetition (NWR) and auditory lexical decision (ALD) tasks varying in spectral quality (normal versus spectrally-degraded), consonant age of acquisition (CAoA; i.e. early-acquired versus late-acquired consonants), syllable length (NWR task), and lexical status (ALD task). In NWR, spectral degradation muted the word length effect, though performance differed depending on how familiar participants were with the degraded stimuli. ALD findings showed that the magnitude of the degradation effect varied between stimuli comprising early-acquired versus late-acquired consonants. The robust effect of spectral degradation on phonological short-term and long-term memory provides a model of the interactive nature of these subprocesses in typical adults. Future work with populations with hearing loss can provide a comparison to help understand how the typical and clinical phonological systems differ.
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Affiliation(s)
- Caitlin A Ross
- Division of Communication Sciences & Disorders, Department of Human Performance, West Virginia University, Morgantown, West Virginia, USA
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut, USA
| | - Michelle W Moore
- Division of Communication Sciences & Disorders, Department of Human Performance, West Virginia University, Morgantown, West Virginia, USA
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5
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Edquist G, Flynn T, Jennische M. Expressive vocabulary of school-age children with mild to moderately severe hearing loss. Int J Pediatr Otorhinolaryngol 2022; 162:111281. [PMID: 36001910 DOI: 10.1016/j.ijporl.2022.111281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The main goal of this study was to describe the expressive vocabulary of school-age children with mild to moderately severe hearing loss (CHL group) and to compare their performance with children with normal hearing (CNH group) of the same age. Another aim was to examine the interaction between nonword repetition and expressive vocabulary size. Furthermore, the interaction between results on vocabulary tests and background factors, such as the age of diagnosis, age of hearing aid fitting, and amount of hearing aid use, was explored. METHOD School-aged children with mild to moderately severe, permanent bilateral hearing loss and children with normal hearing were included in this cross-sectional study. The children participated in assessments of naming pictures, defining words, and repetition of nonwords and sentences. Results of the CHL group and the CNH group were compared. The analysis also included the degree of hearing loss, the age of diagnosis, amount of hearing aid use, and level of parental education. RESULTS The CHL group performed significantly below the CNH group on all measures: picture naming, defining words, nonword repetition, and repetition of sentences. The proportion of words pronounced with correct phonological structure when picture naming was more limited in the CHL group than in the CNH group. There was a significant positive correlation between the amount of hearing aid use and nonword repetition ability in the CHL group. Age of diagnosis and age of hearing aid fitting was not significantly correlated with the outcomes of the vocabulary assessments in this study. CONCLUSION Despite the technological advancement of hearing aids, the expressive vocabulary in school-aged children with mild to moderately severe, permanent bilateral, hearing impairment does not reach the same level as for children with normal hearing, although there is a variation in performance within the group. The variation in the CHL group was not uniquely impacted by either age, degree of hearing loss, or the age of diagnosis. The amount of hearing aid use seems to impact the perception of new words. More studies of expressive vocabulary are needed, because they capture a dimension of word learning that seems particularly sensitive to hearing loss and hearing aid use.
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Affiliation(s)
- Gertrud Edquist
- Department of Public Health and Caring Sciences, Uppsala University, Sweden.
| | - Traci Flynn
- Hearing Australia, University of Newcastle, College of Human and Social Futures, School of Humanities, Creative Industries and Social Sciences, Sydney, Australia
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Pinkl J, Cash EK, Evans TC, Neijman T, Hamilton JW, Ferguson SD, Martinez JL, Rumley J, Hunter LL, Moore DR, Stewart HJ. Short-Term Pediatric Acclimatization to Adaptive Hearing Aid Technology. Am J Audiol 2021; 30:76-92. [PMID: 33351648 DOI: 10.1044/2020_aja-20-00073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose This exploratory study assessed the perceptual, cognitive, and academic learning effects of an adaptive, integrated, directionality, and noise reduction hearing aid program in pediatric users. Method Fifteen pediatric hearing aid users (6-12 years old) received new bilateral, individually fitted Oticon Opn hearing aids programmed with OpenSound Navigator (OSN) processing. Word recognition in noise, sentence repetition in quiet, nonword repetition, vocabulary learning, selective attention, executive function, memory, and reading and mathematical abilities were measured within 1 week of the initial hearing aid fitting and 2 months post fit. Caregivers completed questionnaires assessing their child's listening and communication abilities prior to study enrollment and after 2 months of using the study hearing aids. Results Caregiver reporting indicated significant improvements in speech and sound perception, spatial sound awareness, and the ability to participate in conversations. However, there was no positive change in performance in any of the measured skills. Mathematical scores significantly declined after 2 months. Conclusions OSN provided a perceived improvement in functional benefit, compared to their previous hearing aids, as reported by caregivers. However, there was no positive change in listening skills, cognition, and academic success after 2 months of using OSN. Findings may have been impacted by reporter bias, limited sample size, and a relatively short trial period. This study took place during the summer when participants were out of school, which may have influenced the decline in mathematical scores. The results support further exploration with age- and audiogram-matched controls, larger sample sizes, and longer test-retest intervals that correspond to the academic school year.
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Affiliation(s)
- Joseph Pinkl
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, OH
| | - Erin K. Cash
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Department of Neuroscience, College of Arts and Sciences, University of Cincinnati, OH
| | - Tommy C. Evans
- Division of Audiology, Cincinnati Children's Hospital Medical Center, OH
| | - Timothy Neijman
- Division of Audiology, Cincinnati Children's Hospital Medical Center, OH
| | - Jean W. Hamilton
- Division of Audiology, Cincinnati Children's Hospital Medical Center, OH
| | - Sarah D. Ferguson
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, OH
| | - Jasmin L. Martinez
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, OH
| | - Johanne Rumley
- Oticon A/S, Kongebakken, Denmark
- Department of Nordic Studies and Linguistics, Faculty of Humanities, University of Copenhagen, Denmark
| | - Lisa L. Hunter
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, OH
| | - David R. Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Department of Otolaryngology, College of Medicine, University of Cincinnati, OH
- Manchester Centre for Audiology and Deafness, The University of Manchester, United Kingdom
| | - Hannah J. Stewart
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Division of Psychology and Language Sciences, University College London, United Kingdom
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Cabrera L, Halliday LF. Relationship between sensitivity to temporal fine structure and spoken language abilities in children with mild-to-moderate sensorineural hearing loss. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 148:3334. [PMID: 33261401 PMCID: PMC7613189 DOI: 10.1121/10.0002669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Children with sensorineural hearing loss show considerable variability in spoken language outcomes. The present study tested whether specific deficits in supra-threshold auditory perception might contribute to this variability. In a previous study by Halliday, Rosen, Tuomainen, and Calcus [(2019). J. Acoust. Soc. Am. 146, 4299], children with mild-to-moderate sensorineural hearing loss (MMHL) were shown to perform more poorly than those with normal hearing (NH) on measures designed to assess sensitivity to the temporal fine structure (TFS; the rapid oscillations in the amplitude of narrowband signals over short time intervals). However, they performed within normal limits on measures assessing sensitivity to the envelope (E; the slow fluctuations in the overall amplitude). Here, individual differences in unaided sensitivity to the TFS accounted for significant variance in the spoken language abilities of children with MMHL after controlling for nonverbal intelligence quotient, family history of language difficulties, and hearing loss severity. Aided sensitivity to the TFS and E cues was equally important for children with MMHL, whereas for children with NH, E cues were more important. These findings suggest that deficits in TFS perception may contribute to the variability in spoken language outcomes in children with sensorineural hearing loss.
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Affiliation(s)
- Laurianne Cabrera
- Integrative Neuroscience and Cognition Center, CNRS-Université de Paris, Paris, 75006, France
| | - Lorna F. Halliday
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
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Davies B, Xu Rattanasone N, Davis A, Demuth K. The Acquisition of Productive Plural Morphology by Children With Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:552-568. [PMID: 32004109 DOI: 10.1044/2019_jslhr-19-00208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Normal-hearing (NH) children acquire plural morphemes at different rates, with the segmental allomorphs /-s, -z/ (e.g., cat-s) being acquired before the syllabic allomorph /-əz/ (e.g., bus-es). Children with hearing loss (HL) have been reported to show delays in the production of plural morphology, raising the possibility that this might be due to challenges acquiring different types of lexical/morphological representations. This study therefore examined the comprehension of plural morphology by 3- to 7-year-olds with HL and compared this with performance by their NH peers. We also investigated comprehension as a function of wearing hearing aids (HAs) versus cochlear implants (CIs). Method Participants included 129 NH children aged 3-5 years and 25 children with HL aged 3-7 years (13 with HAs, 12 with CIs). All participated in a novel word two-alternative forced-choice task presented on an iPad. The task tested comprehension of the segmental (e.g., teps, mubz) and syllabic (e.g., kosses) plural, as well as their singular counterparts (e.g., tep, mub, koss). Results While the children with NH were above chance for all conditions, those with HL performed at chance. As a group, the performance of the children with HL did not improve with age. However, results suggest possible differences between children with HAs and those with CIs, where those with HAs appeared to be in the process of developing representations of consonant-vowel-consonant singulars. Conclusions Results suggest that preschoolers with HL do not yet have a robust representation of plural morphology for words they have not heard before. However, those with HAs are beginning to access the singular/plural system as they get older.
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Affiliation(s)
- Benjamin Davies
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Cognition and Its Disorders, Macquarie University, Sydney, New South Wales, Australia
- The HEARing Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Nan Xu Rattanasone
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Cognition and Its Disorders, Macquarie University, Sydney, New South Wales, Australia
- The HEARing Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Aleisha Davis
- The HEARing Cooperative Research Centre, Melbourne, Victoria, Australia
- The Shepherd Centre, Sydney, New South Wales, Australia
| | - Katherine Demuth
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Cognition and Its Disorders, Macquarie University, Sydney, New South Wales, Australia
- The HEARing Cooperative Research Centre, Melbourne, Victoria, Australia
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Al-Salim S, Moeller MP, McGregor KK. Performance of Children With Hearing Loss on an Audiovisual Version of a Nonword Repetition Task. Lang Speech Hear Serv Sch 2020; 51:42-54. [PMID: 31913807 DOI: 10.1044/2019_lshss-ochl-19-0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The aims of this study were to (a) determine if a high-quality adaptation of an audiovisual nonword repetition task can be completed by children with wide-ranging hearing abilities and to (b) examine whether performance on that task is sensitive to child demographics, hearing status, language, working memory, and executive function abilities. Method An audiovisual version of a nonword repetition task was adapted and administered to 100 school-aged children grouped by hearing status: 35 with normal hearing, 22 with mild bilateral hearing loss, 17 with unilateral hearing loss, and 26 cochlear implant users. Participants also completed measures of vocabulary, working memory, and executive function. A generalized linear mixed-effects model was used to analyze performance on the nonword repetition task. Results All children were able to complete the nonword repetition task. Children with unilateral hearing loss and children with cochlear implants repeated nonwords with less accuracy than normal-hearing peers. After adjusting for the influence of vocabulary and working memory, main effects were found for syllable length and hearing status, but no interaction effect was observed. Conclusions The audiovisual nonword repetition task captured individual differences in the performance of children with wide-ranging hearing abilities. The task could act as a useful tool to aid in identifying children with unilateral or mild bilateral hearing loss who have language impairments beyond those imposed by the hearing loss.
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Affiliation(s)
- Sarah Al-Salim
- Center for Childhood Deafness, Language & Learning, Boys Town National Research Hospital, Omaha, NE
| | - Mary Pat Moeller
- Center for Childhood Deafness, Language & Learning, Boys Town National Research Hospital, Omaha, NE
| | - Karla K McGregor
- Center for Childhood Deafness, Language & Learning, Boys Town National Research Hospital, Omaha, NE
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Abstract
Radical advancements in hearing technology in the last 30 years have offered some deaf and hard-of-hearing (DHH) children the adequate auditory access necessary to acquire spoken language with high-quality early intervention. However, meaningful achievement gaps in reading and spoken language persist despite the engineering marvel of modern hearing aids and cochlear implants. Moreover, there is enormous unexplained variability in spoken language and literacy outcomes. Aspects of signal processing in both hearing aids and cochlear implants are discussed as they relate to spoken language outcomes in preschool and school-age children. In suggesting areas for future research, a case is made for not only expanding the search for mechanisms of influence on outcomes outside of traditional device- and child-related factors, but also for framing the search within Biopsychosocial systems theories. This theoretical approach incorporates systems of risk factors across many levels, as well as the bidirectional and complex ways in which factors influence each other. The combination of sophisticated hearing technology and a fuller understanding of the complex environmental and biological factors that shape development will help maximize spoken language outcomes in DHH children and contribute to laying the groundwork for successful literacy and academic development.
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Walker EA, Redfern A, Oleson JJ. Linear Mixed-Model Analysis to Examine Longitudinal Trajectories in Vocabulary Depth and Breadth in Children Who Are Hard of Hearing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:525-542. [PMID: 30950738 PMCID: PMC6802902 DOI: 10.1044/2018_jslhr-l-astm-18-0250] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/20/2018] [Accepted: 09/25/2018] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Elizabeth A. Walker
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Alexandra Redfern
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | - Jacob J. Oleson
- Department of Biostatistics, The University of Iowa, Iowa City
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Ackroyd V, Wright B. Working with British Sign Language (BSL) interpreters: lessons from child and adolescent mental health services in the U.K. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/17538068.2018.1492218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Robertson VS, von Hapsburg D, Hay JS. The Effect of Hearing Loss on Novel Word Learning in Infant- and Adult-Directed Speech. Ear Hear 2018; 38:701-713. [PMID: 28650353 PMCID: PMC5659891 DOI: 10.1097/aud.0000000000000455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Relatively little is known about how young children with hearing impairment (HI) learn novel words in infant- and adult-directed speech (ADS). Infant-directed speech (IDS) supports word learning in typically developing infants relative to ADS. This study examined how children with normal hearing (NH) and children with HI learn novel words in IDS and ADS. It was predicted that IDS would support novel word learning in both groups of children. In addition, children with HI were expected to be less proficient word learners as compared with their NH peers. DESIGN A looking-while-listening paradigm was used to measure novel word learning in 16 children with sensorineural HI (age range 23.2 to 42.1 months) who wore either bilateral hearing aids (n = 10) or bilateral cochlear implants (n = 6) and 16 children with NH (age range 23.1 to 42.1 months) who were matched for gender, chronological age, and maternal education level. Two measures of word learning were assessed (accuracy and reaction time). Each child participated in two experiments approximately 1 week apart, one in IDS and one in ADS. RESULTS Both groups successfully learned the novel words in both speech type conditions, as evidenced by children looking at the correct picture significantly above chance. As a group, children with NH outperformed children with HI in the novel word learning task; however, there were no significant differences between performance on IDS versus ADS. More fine-grained time course analyses revealed that children with HI, and particularly children who use hearing aids, had more difficulty learning novel words in ADS, compared with children with NH. CONCLUSIONS The pattern of results observed in the children with HI suggests that they may need extended support from clinicians and caregivers, through the use of IDS, during novel word learning. Future research should continue to focus on understanding the factors (e.g., device type and use, age of intervention, audibility, acoustic characteristics of input, etc.) that may influence word learning in children with HI in both IDS and ADS.
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Affiliation(s)
- V. Susie Robertson
- Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN, USA
| | | | - Jessica S. Hay
- Department of Psychology, University of Tennessee, Knoxville, TN, USA
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Sundström S, Löfkvist U, Lyxell B, Samuelsson C. Prosodic and segmental aspects of nonword repetition in 4- to 6-year-old children who are deaf and hard of hearing compared to controls with normal hearing. CLINICAL LINGUISTICS & PHONETICS 2018; 32:950-971. [PMID: 29723069 DOI: 10.1080/02699206.2018.1469671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Children who are deaf or hard of hearing (DHH) are at an increased risk of speech and language deficits. Nonword repetition (NWR) is a potential predictor of problems with phonology, grammar and lexicon in DHH children. The aim of the present study was to examine repetition of prosodic features and segments in nonwords by DHH children compared to children with normal hearing (NH) and to relate NWR performance to measures of language ability and background variables. In this cross-sectional study, 14 Swedish-speaking children with mild-profound sensorineural hearing loss, aged 4-6 years, and 29 age-matched controls with NH and typical language development participated. The DHH children used cochlear implants (CI), hearing aids or a combination of both. The assessment materials included a prosodically controlled NWR task, as well as tests of phonological production, expressive grammar and receptive vocabulary. The DHH children performed below the children with NH on the repetition of tonal word accents, stress patterns, vowels and consonants, with consonants being hardest, and tonal word accents easiest, to repeat. NWR performance was also correlated with language ability, and to hearing level, in the DHH children. Both prosodic and segmental features of nonwords are problematic for Swedish-speaking DHH children compared to children with NH, but performance on tonal word accent repetition is comparably high. NWR may have potential as a clinically useful tool for identification of children who are in need of speech and language intervention.
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Affiliation(s)
- Simon Sundström
- a Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Ulrika Löfkvist
- b Department of Special Needs Education , University of Oslo , Oslo , Norway
- c Department of Clinical Science, Intervention and Technology , Karolinska Institute , Stockholm , Sweden
| | - Björn Lyxell
- d Department of Behavioural Sciences and Learning and the Swedish Institute for Disability Research , Linköping University , Linköping , Sweden
| | - Christina Samuelsson
- a Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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Walker E, McCreery R, Spratford M, Roush P. Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes. J Am Acad Audiol 2018; 27:204-218. [PMID: 26967362 DOI: 10.3766/jaaa.15050] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Up to 15% of children with permanent hearing loss (HL) have auditory neuropathy spectrum disorder (ANSD), which involves normal outer hair cell function and disordered afferent neural activity in the auditory nerve or brainstem. Given the varying presentations of ANSD in children, there is a need for more evidence-based research on appropriate clinical interventions for this population. PURPOSE This study compared the speech production, speech perception, and language outcomes of children with ANSD, who are hard of hearing, to children with similar degrees of mild-to-moderately severe sensorineural hearing loss (SNHL), all of whom were fitted with bilateral hearing aids (HAs) based on the American Academy of Audiology pediatric amplification guidelines. RESEARCH DESIGN Speech perception and communication outcomes data were gathered in a prospective accelerated longitudinal design, with entry into the study between six mo and seven yr of age. Three sites were involved in participant recruitment: Boys Town National Research Hospital, the University of North Carolina at Chapel Hill, and the University of Iowa. STUDY SAMPLE The sample consisted of 12 children with ANSD and 22 children with SNHL. The groups were matched based on better-ear pure-tone average, better-ear aided speech intelligibility index, gender, maternal education level, and newborn hearing screening result (i.e., pass or refer). DATA COLLECTION AND ANALYSIS Children and their families participated in an initial baseline visit, followed by visits twice a year for children <2 yr of age and once a yr for children >2 yr of age. Paired-sample t-tests were used to compare children with ANSD to children with SNHL. RESULTS Paired t-tests indicated no significant differences between the ANSD and SNHL groups on language and articulation measures. Children with ANSD displayed functional speech perception skills in quiet. Although the number of participants was too small to conduct statistical analyses for speech perception testing, there appeared to be a trend in which the ANSD group performed more poorly in background noise with HAs, compared to the SNHL group. CONCLUSIONS The American Academy of Audiology Pediatric Amplification Guidelines recommend that children with ANSD receive an HA trial if their behavioral thresholds are sufficiently high enough to impede speech perception at conversational levels. For children with ANSD in the mild-to-severe HL range, the current results support this recommendation, as children with ANSD can achieve functional outcomes similar to peers with SNHL.
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Luft P, Amiruzzaman S. Examining States’ Responses to the IDEA Special Factors Requirements for DHH Students. JOURNAL OF DISABILITY POLICY STUDIES 2018. [DOI: 10.1177/1044207317751675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deaf and hard-of-hearing (DHH) students have exhibited deficient language competencies and low academic achievement for over four decades. As a result, Individuals With Disabilities Education Act (IDEA) 2004 requires schools to address special language and communication factors through each student’s Individualized Education Program (IEP). States have responded in a variety of ways with several that supplement their IEPs using a communication plan. This article examined states’ IEP or communication plan templates to identify the format and specificity with which they addressed these requirements. The IDEA language was parsed into distinct items to allow ratings using a Likert-type scale. The analyses performed descriptive, t test, and ANOVA comparisons on the forms posted on states’ website. Those states using a communication plan had significantly higher ratings overall. Kentucky’s form was the most highly rated IEP and identified each required item. Most state IEP forms identified these factors more generally with a majority rated as only minimally specified. Use of a communication plan or IEP form that incorporates IDEA language similar was the most effective strategy. Overt specificity ensures that DHH students’ language and communication needs are being met in the educational environment and facilitates states’ oversight in meeting their educational responsibilities.
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van de Weijer J, Åkerlund V, Johansson V, Sahlén B. Writing intervention in university students with normal hearing and in those with hearing impairment: can observational learning improve argumentative text writing? LOGOP PHONIATR VOCO 2018; 44:115-123. [PMID: 29303017 DOI: 10.1080/14015439.2017.1418427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Observational learning has shown to be a successful intervention for writing. Until now, however, studies have only been performed with normal-hearing participants, usually high school or university students. Additionally, there have been conflicting results in whether subjective text quality correlates with one or more objectively measured text characteristics. In this study, we measured the effect of observational learning in a group of four university students with hearing impairment, and compared the results with those of a group of 10 students with normal hearing who did the same intervention, and those of a control group consisting of 10 students with normal hearing who did not do the intervention. Subjective text quality ratings and nine objectively measured text characteristics were collected for three argumentative texts written by each of the participants. In between writing these three texts, the participants in the experimental groups watched a video of a model writer who read out loud and corrected a similar kind of text. The statistical analysis showed significant correlations between the subjective ratings and four out of the nine objective measures, but no significant intervention effect. These findings suggest that observation-learning intervention is most effective when the model writer is a peer learner, and when the intervention is stretched out over time. Additionally, the method may be better suited for learners younger than the ones who were included in the present study.
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Affiliation(s)
| | | | - Victoria Johansson
- a Center for Languages and Literature, General Linguistics , Lund , Sweden
| | - Birgitta Sahlén
- b Lund University , Logopedics and Phoniatrics , Lund , Sweden
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White LJ, Alexander A, Greenfield DB. The relationship between executive functioning and language: Examining vocabulary, syntax, and language learning in preschoolers attending Head Start. J Exp Child Psychol 2017; 164:16-31. [DOI: 10.1016/j.jecp.2017.06.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
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Penke M, Wimmer E. Deficits in comprehending wh-questions in children with hearing loss - the contribution of phonological short-term memory and syntactic complexity. CLINICAL LINGUISTICS & PHONETICS 2017; 32:267-284. [PMID: 28846461 DOI: 10.1080/02699206.2017.1350883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/01/2017] [Indexed: 06/07/2023]
Abstract
The aim of the study is to investigate if German children with hearing loss (HL) display persisting problems in comprehending complex sentences and to find out whether these problems can be linked to limitations in phonological short-term memory (PSTM). A who-question comprehension test (picture pointing) and a nonword repetition (NWR) task were conducted with 21 German children with bilateral sensorineural HL (ages 3-4) and with age-matched 19 normal hearing (NH) children. Follow-up data (ages 6-8) are reported for 10 of the children with HL. The data reveal that the comprehension of who-questions as well as PSTM was significantly more impaired in children with HL than in children with NH. For both groups of participants, there were no correlations between question comprehension scores and performance in the NWR test. Syntactic complexity (subject vs. object question) affected question comprehension in children with HL, however, these problems were overcome at school age. In conclusion, the data indicate that a hearing loss affects the comprehension of complex sentences. The observed problems did, however, not persist and were, therefore, unlikely to be caused by a genuine syntactic deficit. For the tested wh-questions, there is no indication that syntactic comprehension problems of children with HL are due to limitations in PSTM.
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Affiliation(s)
- Martina Penke
- a Department of Therapeutic and Rehabilitation, University of Cologne , Cologne , Germany
| | - Eva Wimmer
- a Department of Therapeutic and Rehabilitation, University of Cologne , Cologne , Germany
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Halliday LF, Tuomainen O, Rosen S. Language Development and Impairment in Children With Mild to Moderate Sensorineural Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1551-1567. [PMID: 28547010 DOI: 10.1044/2016_jslhr-l-16-0297] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/03/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE The goal of this study was to examine language development and factors related to language impairments in children with mild to moderate sensorineural hearing loss (MMHL). METHOD Ninety children, aged 8-16 years (46 children with MMHL; 44 aged-matched controls), were administered a battery of standardized language assessments, including measures of phonological processing, receptive and expressive vocabulary and grammar, word and nonword reading, and parental report of communication skills. Group differences were examined after controlling for nonverbal ability. RESULTS Children with MMHL performed as well as controls on receptive vocabulary and word and nonword reading. They also performed within normal limits, albeit significantly worse than controls, on expressive vocabulary, and on receptive and expressive grammar, and worse than both controls and standardized norms on phonological processing and parental report of communication skills. However, there was considerable variation in performance, with 26% showing evidence of clinically significant oral or written language impairments. Poor performance was not linked to severity of hearing loss nor age of diagnosis. Rather, outcomes were related to nonverbal ability, maternal education, and presence/absence of family history of language problems. CONCLUSIONS Clinically significant language impairments are not an inevitable consequence of MMHL. Risk factors appear to include lower maternal education and family history of language problems, whereas nonverbal ability may constitute a protective factor.
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Affiliation(s)
- Lorna F Halliday
- Division of Psychology and Language Sciences, University College London (UCL), United Kingdom
| | - Outi Tuomainen
- Division of Psychology and Language Sciences, University College London (UCL), United Kingdom
| | - Stuart Rosen
- Division of Psychology and Language Sciences, University College London (UCL), United Kingdom
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Phonological Priming in Children with Hearing Loss: Effect of Speech Mode, Fidelity, and Lexical Status. Ear Hear 2016; 37:623-633. [PMID: 27438867 DOI: 10.1097/aud.0000000000000334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This research determined (1) how phonological priming of picture naming was affected by the mode (auditory-visual [AV] versus auditory), fidelity (intact versus nonintact auditory onsets), and lexical status (words versus nonwords) of speech stimuli in children with prelingual sensorineural hearing impairment (CHI) versus children with normal hearing (CNH) and (2) how the degree of HI, auditory word recognition, and age influenced results in CHI. Note that the AV stimuli were not the traditional bimodal input but instead they consisted of an intact consonant/rhyme in the visual track coupled to a nonintact onset/rhyme in the auditory track. Example stimuli for the word bag are (1) AV: intact visual (b/ag) coupled to nonintact auditory (-b/ag) and 2) auditory: static face coupled to the same nonintact auditory (-b/ag). The question was whether the intact visual speech would "restore or fill-in" the nonintact auditory speech in which case performance for the same auditory stimulus would differ depending on the presence/absence of visual speech. DESIGN Participants were 62 CHI and 62 CNH whose ages had a group mean and group distribution akin to that in the CHI group. Ages ranged from 4 to 14 years. All participants met the following criteria: (1) spoke English as a native language, (2) communicated successfully aurally/orally, and (3) had no diagnosed or suspected disabilities other than HI and its accompanying verbal problems. The phonological priming of picture naming was assessed with the multimodal picture word task. RESULTS Both CHI and CNH showed greater phonological priming from high than low-fidelity stimuli and from AV than auditory speech. These overall fidelity and mode effects did not differ in the CHI versus CNH-thus these CHI appeared to have sufficiently well-specified phonological onset representations to support priming, and visual speech did not appear to be a disproportionately important source of the CHI's phonological knowledge. Two exceptions occurred, however. First-with regard to lexical status-both the CHI and CNH showed significantly greater phonological priming from the nonwords than words, a pattern consistent with the prediction that children are more aware of phonetics-phonology content for nonwords. This overall pattern of similarity between the groups was qualified by the finding that CHI showed more nearly equal priming by the high- versus low-fidelity nonwords than the CNH; in other words, the CHI were less affected by the fidelity of the auditory input for nonwords. Second, auditory word recognition-but not degree of HI or age-uniquely influenced phonological priming by the AV nonwords. CONCLUSIONS With minor exceptions, phonological priming in CHI and CNH showed more similarities than differences. Importantly, this research documented that the addition of visual speech significantly increased phonological priming in both groups. Clinically these data support intervention programs that view visual speech as a powerful asset for developing spoken language in CHI.
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Tomblin JB, Harrison M, Ambrose SE, Walker EA, Oleson JJ, Moeller MP. Language Outcomes in Young Children with Mild to Severe Hearing Loss. Ear Hear 2016; 36 Suppl 1:76S-91S. [PMID: 26731161 DOI: 10.1097/aud.0000000000000219] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study examined the language outcomes of children with mild to severe hearing loss during the preschool years. The longitudinal design was leveraged to test whether language growth trajectories were associated with degree of hearing loss and whether aided hearing influenced language growth in a systematic manner. The study also explored the influence of the timing of hearing aid fitting and extent of use on children's language growth. Finally, the study tested the hypothesis that morphosyntax may be at particular risk due to the demands it places on the processing of fine details in the linguistic input. DESIGN The full cohort of children in this study comprised 290 children who were hard of hearing (CHH) and 112 children with normal hearing who participated in the Outcomes of Children with Hearing Loss (OCHL) study between the ages of 2 and 6 years. CHH had a mean better-ear pure-tone average of 47.66 dB HL (SD = 13.35). All children received a comprehensive battery of language measures at annual intervals, including standardized tests, parent-report measures, and spontaneous and elicited language samples. Principal components analysis supported the use of a single composite language score for each of the age levels (2, 3, 4, 5, and 6 years). Measures of unaided (better-ear pure-tone average, speech intelligibility index) and aided (residualized speech intelligibility index) hearing were collected, along with parent-report measures of daily hearing aid use time. Mixed modeling procedures were applied to examine the rate of change (227 CHH; 94 children with normal hearing) in language ability over time in relation to (1) degree of hearing loss, (2) aided hearing, (3) age of hearing aid fit and duration of use, and (4) daily hearing aid use. Principal components analysis was also employed to examine factor loadings from spontaneous language samples and to test their correspondence with standardized measures. Multiple regression analysis was used to test for differential effects of hearing loss on morphosyntax and lexical development. RESULTS Children with mild to severe hearing loss, on average, showed depressed language levels compared with peers with normal hearing who were matched on age and socioeconomic status. The degree to which CHH fell behind increased with greater severity of hearing loss. The amount of improved audibility with hearing aids was associated with differential rates of language growth; better audibility was associated with faster rates of language growth in the preschool years. Children fit early with hearing aids had better early language achievement than children fit later. However, children who were fit after 18 months of age improved in their language abilities as a function of the duration of hearing aid use. These results suggest that the language learning system remains open to experience provided by improved access to linguistic input. Performance in the domain of morphosyntax was found to be more delayed in CHH than their semantic abilities. CONCLUSION The data obtained in this study largely support the predictions, suggesting that mild to severe hearing loss places children at risk for delays in language development. Risks are moderated by the provision of early and consistent access to well-fit hearing aids that provide optimized audibility.
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Affiliation(s)
- J Bruce Tomblin
- 1Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA; 2Department of Speech and Hearing Sciences, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; 3Center for Childhood Deafness, Boys Town National Research Hospital, Omaha, Nebraska, USA; and 4Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
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Winiger AM, Alexander JM, Diefendorf AO. Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice. Am J Audiol 2016; 25:232-45. [PMID: 27367972 DOI: 10.1044/2016_aja-15-0060] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/17/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention. METHOD Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed. RESULTS In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood. CONCLUSIONS Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.
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Symbolic Play and Novel Noun Learning in Deaf and Hearing Children: Longitudinal Effects of Access to Sound on Early Precursors of Language. PLoS One 2016; 11:e0155964. [PMID: 27228032 PMCID: PMC4882020 DOI: 10.1371/journal.pone.0155964] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/07/2016] [Indexed: 11/19/2022] Open
Abstract
In the largest, longitudinal study of young, deaf children before and three years after cochlear implantation, we compared symbolic play and novel noun learning to age-matched hearing peers. Participants were 180 children from six cochlear implant centers and 96 hearing children. Symbolic play was measured during five minutes of videotaped, structured solitary play. Play was coded as "symbolic" if the child used substitution (e.g., a wooden block as a bed). Novel noun learning was measured in 10 trials using a novel object and a distractor. Cochlear implant vs. normal hearing children were delayed in their use of symbolic play, however, those implanted before vs. after age two performed significantly better. Children with cochlear implants were also delayed in novel noun learning (median delay 1.54 years), with minimal evidence of catch-up growth. Quality of parent-child interactions was positively related to performance on the novel noun learning, but not symbolic play task. Early implantation was beneficial for both achievement of symbolic play and novel noun learning. Further, maternal sensitivity and linguistic stimulation by parents positively affected noun learning skills, although children with cochlear implants still lagged in comparison to hearing peers.
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Geers AE, Nicholas J, Tobey E, Davidson L. Persistent Language Delay Versus Late Language Emergence in Children With Early Cochlear Implantation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:155-70. [PMID: 26501740 PMCID: PMC4867929 DOI: 10.1044/2015_jslhr-h-14-0173] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 03/02/2015] [Indexed: 05/05/2023]
Abstract
PURPOSE The purpose of the present investigation is to differentiate children using cochlear implants (CIs) who did or did not achieve age-appropriate language scores by midelementary grades and to identify risk factors for persistent language delay following early cochlear implantation. MATERIALS AND METHOD Children receiving unilateral CIs at young ages (12-38 months) were tested longitudinally and classified with normal language emergence (n = 19), late language emergence (n = 22), or persistent language delay (n = 19) on the basis of their test scores at 4.5 and 10.5 years of age. Relative effects of demographic, audiological, linguistic, and academic characteristics on language emergence were determined. RESULTS Age at CI was associated with normal language emergence but did not differentiate late emergence from persistent delay. Children with persistent delay were more likely to use left-ear implants and older speech processor technology. They experienced higher aided thresholds and lower speech perception scores. Persistent delay was foreshadowed by low morphosyntactic and phonological diversity in preschool. Logistic regression analysis predicted normal language emergence with 84% accuracy and persistent language delay with 74% accuracy. CONCLUSION CI characteristics had a strong effect on persistent versus resolving language delay, suggesting that right-ear (or bilateral) devices, technology upgrades, and improved audibility may positively influence long-term language outcomes.
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Affiliation(s)
- Ann E. Geers
- Callier Center for Advanced Hearing Research and the Southwestern Medical Center, The University of Texas at Dallas
| | | | - Emily Tobey
- Callier Center for Advanced Hearing Research and the Southwestern Medical Center, The University of Texas at Dallas
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Abstract
The landscape of service provision for young children with hearing loss has shifted in recent years as a result of newborn hearing screening and the early provision of interventions, including hearing technologies. It is expected that early service provision will minimize or prevent linguistic delays that typically accompany untreated permanent childhood hearing loss. The post-newborn hearing screening era has seen a resurgence of interest in empirically examining the outcomes of children with hearing loss to determine if service innovations have resulted in expected improvements in children's functioning. The Outcomes of Children with Hearing Loss (OCHL) project was among these recent research efforts, and this introductory article provides background in the form of literature review and theoretical discussion to support the goals of the study. The Outcomes of Children with Hearing Loss project was designed to examine the language and auditory outcomes of infants and preschool-age children with permanent, bilateral, mild-to-severe hearing loss, and to identify factors that moderate the relationship between hearing loss and longitudinal outcomes. The authors propose that children who are hard of hearing experience limitations in access to linguistic input, which lead to a decrease in uptake of language exposure and an overall reduction in linguistic experience. The authors explore this hypothesis in relation to three primary factors that are proposed to influence children's access to linguistic input: aided audibility, duration and consistency of hearing aid use, and characteristics of caregiver input.
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Affiliation(s)
- Mary Pat Moeller
- Boys Town National Research Hospital, Center for Childhood Deafness
| | - J. Bruce Tomblin
- University of Iowa, Department of Communication Sciences and Disorders
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Nittrouer S, Tarr E, Wucinich T, Moberly AC, Lowenstein JH. Measuring the effects of spectral smearing and enhancement on speech recognition in noise for adults and children. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2015; 137:2004-14. [PMID: 25920851 PMCID: PMC4417020 DOI: 10.1121/1.4916203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 05/24/2023]
Abstract
Broadened auditory filters associated with sensorineural hearing loss have clearly been shown to diminish speech recognition in noise for adults, but far less is known about potential effects for children. This study examined speech recognition in noise for adults and children using simulated auditory filters of different widths. Specifically, 5 groups (20 listeners each) of adults or children (5 and 7 yrs), were asked to recognize sentences in speech-shaped noise. Seven-year-olds listened at 0 dB signal-to-noise ratio (SNR) only; 5-yr-olds listened at +3 or 0 dB SNR; and adults listened at 0 or -3 dB SNR. Sentence materials were processed both to smear the speech spectrum (i.e., simulate broadened filters), and to enhance the spectrum (i.e., simulate narrowed filters). Results showed: (1) Spectral smearing diminished recognition for listeners of all ages; (2) spectral enhancement did not improve recognition, and in fact diminished it somewhat; and (3) interactions were observed between smearing and SNR, but only for adults. That interaction made age effects difficult to gauge. Nonetheless, it was concluded that efforts to diagnose the extent of broadening of auditory filters and to develop techniques to correct this condition could benefit patients with hearing loss, especially children.
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Affiliation(s)
- Susan Nittrouer
- Department of Otolaryngology, The Ohio State University, 915 Olentangy River Road, Suite 4000, Columbus, Ohio 43212
| | - Eric Tarr
- Department of Otolaryngology, The Ohio State University, 915 Olentangy River Road, Suite 4000, Columbus, Ohio 43212
| | - Taylor Wucinich
- Department of Otolaryngology, The Ohio State University, 915 Olentangy River Road, Suite 4000, Columbus, Ohio 43212
| | - Aaron C Moberly
- Department of Otolaryngology, The Ohio State University, 915 Olentangy River Road, Suite 4000, Columbus, Ohio 43212
| | - Joanna H Lowenstein
- Department of Otolaryngology, The Ohio State University, 915 Olentangy River Road, Suite 4000, Columbus, Ohio 43212
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Sandgren O, Hansson K, Sahlén B. Working memory and referential communication-multimodal aspects of interaction between children with sensorineural hearing impairment and normal hearing peers. Front Psychol 2015; 6:242. [PMID: 25806012 PMCID: PMC4353181 DOI: 10.3389/fpsyg.2015.00242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
Abstract
Whereas the language development of children with sensorineural hearing impairment (SNHI) has repeatedly been shown to differ from that of peers with normal hearing (NH), few studies have used an experimental approach to investigate the consequences on everyday communicative interaction. This mini review gives an overview of a range of studies on children with SNHI and NH exploring intra- and inter-individual cognitive and linguistic systems during communication. Over the last decade, our research group has studied the conversational strategies of Swedish speaking children and adolescents with SNHI and NH using referential communication, an experimental analog to problem-solving in the classroom. We have established verbal and non-verbal control and validation mechanisms, related to working memory capacity and phonological short term memory. We present main findings and future directions relevant for the field of cognitive hearing science and for the clinical and school-based management of children and adolescents with SNHI.
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Affiliation(s)
- Olof Sandgren
- Department of Logopedics, Phoniatrics, and Audiology, Clinical Sciences, Lund University , Lund, Sweden
| | - Kristina Hansson
- Department of Logopedics, Phoniatrics, and Audiology, Clinical Sciences, Lund University , Lund, Sweden
| | - Birgitta Sahlén
- Department of Logopedics, Phoniatrics, and Audiology, Clinical Sciences, Lund University , Lund, Sweden
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Doković S, Gligorović M, Ostojić S, Dimić N, Radić-Šestić M, Slavnić S. Can mild bilateral sensorineural hearing loss affect developmental abilities in younger school-age children? JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2014; 19:484-95. [PMID: 25063005 DOI: 10.1093/deafed/enu018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The research study was conducted for the purpose of examining the influence of mild bilateral sensorineural hearing loss (MBSNHL) on developmental abilities of younger school-age children. The sample encompassed 144 children with MBSNHL, aged 7.5-11 (M = 8.85). MBSNHL (20-40 dB HL) was identified by pure tone audiometry. The control group encompassed 160 children with normal hearing. The Acadia test of developmental abilities was used for assessment of developmental abilities. Although statistically significant differences between participants with MBSNHL and those with normal hearing were established in the majority of estimated developmental abilities domains, those differences do not indicate any significant delay in development of assessed abilities, except in the domain of auditory discrimination. The obtained results call for a systematic approach to children with MBSNHL in elementary schools.
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Tomblin JB, Oleson JJ, Ambrose SE, Walker E, Moeller MP. The influence of hearing aids on the speech and language development of children with hearing loss. JAMA Otolaryngol Head Neck Surg 2014; 140:403-9. [PMID: 24700303 DOI: 10.1001/jamaoto.2014.267] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Hearing loss (HL) in children can be deleterious to their speech and language development. The standard of practice has been early provision of hearing aids (HAs) to moderate these effects; however, there have been few empirical studies evaluating the effectiveness of this practice on speech and language development among children with mild-to-severe HL. OBJECTIVE To investigate the contributions of aided hearing and duration of HA use to speech and language outcomes in children with mild-to-severe HL. DESIGN, SETTING, AND PARTICIPANTS An observational cross-sectional design was used to examine the association of aided hearing levels and length of HA use with levels of speech and language outcomes. One hundred eighty 3- and 5-year-old children with HL were recruited through records of Universal Newborn Hearing Screening and referrals from clinical service providers in the general community in 6 US states. INTERVENTIONS All but 4 children had been fitted with HAs, and measures of aided hearing and the duration of HA use were obtained. MAIN OUTCOMES AND MEASURES Standardized measures of speech and language ability were obtained. RESULTS Measures of the gain in hearing ability for speech provided by the HA were significantly correlated with levels of speech (ρ179 = 0.20; P = .008) and language: ρ155 = 0.21; P = .01) ability. These correlations were indicative of modest levels of association between aided hearing and speech and language outcomes. These benefits were found for children with mild and moderate-to-severe HL. In addition, the amount of benefit from aided hearing interacted with the duration of HA experience (Speech: F4,161 = 4.98; P < .001; Language: F4,138 = 2.91; P < .02). Longer duration of HA experience was most beneficial for children who had the best aided hearing. CONCLUSIONS AND RELEVANCE The degree of improved hearing provided by HAs was associated with better speech and language development in children. In addition, the duration of HA experience interacted with the aided hearing to influence outcomes. These results provide support for the provision of well-fitted HAs to children with HL. In particular, the findings support early HA fitting and HA provision to children with mild HL.
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Affiliation(s)
- J Bruce Tomblin
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Jacob J Oleson
- Department of Biostatistics, The University of Iowa, Iowa City
| | - Sophie E Ambrose
- Center for Childhood Deafness, Boys Town National Research Hospital, Omaha, Nebraska
| | - Elizabeth Walker
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Mary Pat Moeller
- Center for Childhood Deafness, Boys Town National Research Hospital, Omaha, Nebraska
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Bishop DVM. Ten questions about terminology for children with unexplained language problems. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2014; 49:381-415. [PMID: 25142090 PMCID: PMC4314704 DOI: 10.1111/1460-6984.12101] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/01/2013] [Indexed: 05/06/2023]
Abstract
BACKGROUND In domains other than language, there is fairly consistent diagnostic terminology to refer to children's developmental difficulties. For instance, the terms 'dyslexia', 'attention deficit hyperactivity disorder' and 'autistic spectrum disorder' are used for difficulties with reading, attention or social cognition, respectively. There is no agreed label, however, for children with unexplained language problems. AIMS To consider whether we need labels for unexplained language problems in children, and if so, what terminology is appropriate. MAIN CONTRIBUTION There are both advantages and disadvantages to labels, but they are important to ensure children receive services, and to increase our knowledge of the nature and causes of such problems. A survey of labels in current use found 132 different terms, 33 of which had 600 or more returns on Google Scholar between 1994 and 2013. Many of these labels were too general to be useful. Of the remainder, the term 'specific language impairment' was the most commonly used. CONCLUSIONS The current mayhem in diagnostic labels is unsustainable; it causes confusion and impedes research progress and access to appropriate services. We need to achieve consensus on diagnostic criteria and terminology. The DSM-5 term 'language disorder' is problematic because it identifies too wide a range of conditions on an internet search. One solution is to retain specific language impairment, with the understanding that 'specific' means idiopathic (i.e., of unknown origin) rather than implying there are no other problems beyond language. Other options are the terms 'primary language impairment', 'developmental language disorder' or 'language learning impairment'.
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Affiliation(s)
- D V M Bishop
- Department of Experimental Psychology, University of OxfordOxford, UK
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Sandgren O, Andersson R, van de Weijer J, Hansson K, Sahlén B. Coordination of gaze and speech in communication between children with hearing impairment and normal-hearing peers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2014; 57:942-951. [PMID: 24167237 DOI: 10.1044/2013_jslhr-l-12-0333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To investigate gaze behavior during communication between children with hearing impairment (HI) and normal-hearing (NH) peers. METHOD Ten HI-NH and 10 NH-NH dyads performed a referential communication task requiring description of faces. During task performance, eye movements and speech were tracked. Using verbal event (questions, statements, back channeling, and silence) as the predictor variable, group characteristics in gaze behavior were expressed with Kaplan-Meier survival functions (estimating time to gaze-to-partner) and odds ratios (comparing number of verbal events with and without gaze-to-partner). Analyses compared the listeners in each dyad (HI: n = 10, mean age = 12;6 years, mean better ear pure-tone average = 33.0 dB HL; NH: n = 10, mean age = 13;7 years). RESULTS Log-rank tests revealed significant group differences in survival distributions for all verbal events, reflecting a higher probability of gaze to the partner's face for participants with HI. Expressed as odds ratios (OR), participants with HI displayed greater odds for gaze-to-partner (ORs ranging between 1.2 and 2.1) during all verbal events. CONCLUSIONS The results show an increased probability for listeners with HI to gaze at the speaker's face in association with verbal events. Several explanations for the finding are possible, and implications for further research are discussed.
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Davidson LS, Geers AE, Nicholas JG. The effects of audibility and novel word learning ability on vocabulary level in children with cochlear implants. Cochlear Implants Int 2013; 15:211-21. [PMID: 23998324 DOI: 10.1179/1754762813y.0000000051] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES A novel word learning (NWL) paradigm was used to explore underlying phonological and cognitive mechanisms responsible for delayed vocabulary level in children with cochlear implants (CIs). METHODS One hundred and one children using CIs, 6-12 years old, were tested along with 47 children with normal hearing (NH). Tests of NWL, receptive vocabulary, and speech perception at 2 loudness levels were administered to children with CIs. Those with NH completed the NWL task and a receptive vocabulary test. CI participants with good audibility (GA) versus poor audibility (PA) were compared on all measures. Analysis of variance was used to compare performance across the children with NH and the two groups of children with CIs. Multiple regression analysis was employed to identify independent predictors of vocabulary outcomes. RESULTS Children with CIs in the GA group scored higher in receptive vocabulary and NWL than children in the PA group, although they did not reach NH levels. CI-aided pure tone threshold and performance on the NWL task predicted independent variance in vocabulary after accounting for other known predictors. DISCUSSION Acquiring spoken vocabulary is facilitated by GA with a CI and phonological learning and memory skills. Children with CIs did not learn novel words at the same rate or achieve the same receptive vocabulary levels as their NH peers. Maximizing audibility for the perception of speech and direct instruction of new vocabulary may be necessary for children with CIs to reach levels seen in peers with NH.
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Abstract
OBJECTIVES This research studied whether the mode of input (auditory versus audiovisual) influenced semantic access by speech in children with sensorineural hearing impairment (HI). DESIGN Participants, 31 children with HI and 62 children with normal hearing (NH), were tested with the authors' new multimodal picture word task. Children were instructed to name pictures displayed on a monitor and ignore auditory or audiovisual speech distractors. The semantic content of the distractors was varied to be related versus unrelated to the pictures (e.g., picture distractor of dog-bear versus dog-cheese, respectively). In children with NH, picture-naming times were slower in the presence of semantically related distractors. This slowing, called semantic interference, is attributed to the meaning-related picture-distractor entries competing for selection and control of the response (the lexical selection by competition hypothesis). Recently, a modification of the lexical selection by competition hypothesis, called the competition threshold (CT) hypothesis, proposed that (1) the competition between the picture-distractor entries is determined by a threshold, and (2) distractors with experimentally reduced fidelity cannot reach the CT. Thus, semantically related distractors with reduced fidelity do not produce the normal interference effect, but instead no effect or semantic facilitation (faster picture naming times for semantically related versus unrelated distractors). Facilitation occurs because the activation level of the semantically related distractor with reduced fidelity (1) is not sufficient to exceed the CT and produce interference but (2) is sufficient to activate its concept, which then strengthens the activation of the picture and facilitates naming. This research investigated whether the proposals of the CT hypothesis generalize to the auditory domain, to the natural degradation of speech due to HI, and to participants who are children. Our multimodal picture word task allowed us to (1) quantify picture naming results in the presence of auditory speech distractors and (2) probe whether the addition of visual speech enriched the fidelity of the auditory input sufficiently to influence results. RESULTS In the HI group, the auditory distractors produced no effect or a facilitative effect, in agreement with proposals of the CT hypothesis. In contrast, the audiovisual distractors produced the normal semantic interference effect. Results in the HI versus NH groups differed significantly for the auditory mode, but not for the audiovisual mode. CONCLUSIONS This research indicates that the lower fidelity auditory speech associated with HI affects the normalcy of semantic access by children. Further, adding visual speech enriches the lower fidelity auditory input sufficiently to produce the semantic interference effect typical of children with NH.
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Stiles DJ, McGregor KK, Bentler RA. Wordlikeness and word learning in children with hearing loss. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2013; 48:200-206. [PMID: 23472959 DOI: 10.1111/j.1460-6984.2012.00199.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The more a novel word conforms to the phonotactics of the language, the more wordlike it is and the easier it is to learn. It is unknown to what extent children with hearing loss (CHL) take advantage of phonotactic cues to support word learning. AIMS This study investigated whether CHL had similar sensitivities to wordlikeness during a word-learning task as children with normal hearing (CNH). METHODS & PROCEDURES Sixteen CHL and 24 CNH participated in a novel word-learning task. Novel words varied by English wordlikeness. Recall was tested using a forced-choice identification task wherein foils for each trial related semantically, lexically or not at all. Receptive vocabulary and working memory were also assessed. OUTCOMES & RESULTS All children were able to identify high wordlike novel words more accurately than low wordlike novel words. The number of errors on identification of words that were moderate in wordlikeness was inversely correlated to vocabulary size (not working memory) and CHL had smaller vocabularies than CNH. When in error, CHL were more likely than CNH to select a semantically related foil. CONCLUSIONS & IMPLICATIONS Although they are sensitive to extremes in wordlikeness, compared with their peers with normal hearing, CHL present with subtle differences in word learning. Clinical implications for exploiting wordlikeness in service of word learning assessment and intervention are presented.
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Affiliation(s)
- Derek J Stiles
- Department of Communication Disorders and Sciences, Rush University, Chicago, IL 60612, USA.
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Lee Y, Yim D, Sim H. Phonological processing skills and its relevance to receptive vocabulary development in children with early cochlear implantation. Int J Pediatr Otorhinolaryngol 2012; 76:1755-60. [PMID: 22963981 DOI: 10.1016/j.ijporl.2012.08.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/10/2012] [Accepted: 08/15/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purposes of this study were to investigate phonological processing skills for children with cochlear implants (CIs) in comparison with children with normal hearing (NH), and to assess whether phonological processing skills can explain variance in receptive vocabulary scores in children with CIs. METHODS Twenty-five deaf children who received a CI before 2 years of age were included in this study, and they ranged from 4 years to 6 years 11 months. Twenty-five children with NH as a control group were matched to children with CIs on the basis of chronological age with 3 months. Phonological processing skills were measured by the phonological awareness (PA), nonword repetition (NWR), and rapid automatized naming (RAN) tasks. Receptive vocabulary skills were also tested by the Peabody Picture Vocabulary Test - Korean version. RESULTS Children with CIs performed significantly lower than children with NH on PA (p<.05) and NWR (p<.001) tasks. Children with CIs showed slower naming speed than children with NH, which did not reach the significant level (p>.05). Among phonological processing skills, PA contributed significant amount to receptive vocabulary skills in children with CIs (p<.001). CONCLUSIONS Children with early implantation receive substantial benefits for developing lexical access skills. However, children with CIs showed delays in PA and NWR in comparison with age-matched children with NH. For children with CIs, PA among phonological processing skills plays an important role of developing receptive vocabulary skills.
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Affiliation(s)
- Youngmee Lee
- Department of Communication Disorders, Ewha Womans University, Seoul, Republic of Korea
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Vohr B, Topol D, Girard N, St Pierre L, Watson V, Tucker R. Language outcomes and service provision of preschool children with congenital hearing loss. Early Hum Dev 2012; 88:493-8. [PMID: 22264438 DOI: 10.1016/j.earlhumdev.2011.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 12/09/2011] [Accepted: 12/14/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Children with congenital hearing loss (HL) are at increased risk of speech and language delays and require increased resource needs. METHODS Assessments of language, adaptive behavior, and resource needs at mean age of 60±5 months. Effects of age of enrollment in Early Intervention (EI) and degree of HL were evaluated. RESULTS Children with HL had lower Reynell verbal comprehension scores (77.6±18 versus 94.8±15; p=0.0001) and expressive language scores (85.9±19 versus 97.4±15; p=0.0051) than hearing children. Children with HL enrolled in EI ≤3 months versus >3 months had higher verbal comprehension (86.6±21 versus 70.3±12; p=0.0143) and expressive language scores (92.1±12 versus 80.5±21; p=0.0601), respectively. Children with bilateral moderate to profound HL and children with unilateral or bilateral mild HL were more likely to have low verbal comprehension scores versus children with hearing (75.8±17 and 81.0±22 versus 94.8±15; p=0.001), and receive more special educational services (100% and 100% versus 42%) respectively. After adjusting for degree of HL and Vineland adaptive scores <70, entry to EI ≤3 months was associated with a 13.8 point higher verbal comprehension score (p=0.047) for children with HL. The model accounted for 26% of variance. CONCLUSIONS Persistent beneficial effects of early age of entry to EI on verbal comprehension scores are observed for children with congenital HL at preschool age. Children with HL continue to need comprehensive education services.
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Affiliation(s)
- Betty Vohr
- Department of Pediatrics, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA.
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Stiles DJ, Bentler RA, McGregor KK. The Speech Intelligibility Index and the pure-tone average as predictors of lexical ability in children fit with hearing AIDS. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2012; 55:764-778. [PMID: 22223888 DOI: 10.1044/1092-4388(2011/10-0264)] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To determine whether a clinically obtainable measure of audibility, the aided Speech Intelligibility Index (SII; American National Standards Institute, 2007), is more sensitive than the pure-tone average (PTA) at predicting the lexical abilities of children who wear hearing aids (CHA). METHOD School-age CHA and age-matched children with normal hearing (CNH) repeated words and nonwords, learned novel words, and completed a standardized receptive vocabulary test. Analyses of covariance allowed comparison of the 2 groups. For CHA, regression analyses determined whether SII held predictive value over and beyond PTA. RESULTS CHA demonstrated poorer performance than CNH on tests of word and nonword repetition and receptive vocabulary. Groups did not differ on word learning. Aided SII was a stronger predictor of word and nonword repetition and receptive vocabulary than PTA. After accounting for PTA, aided SII remained a significant predictor of nonword repetition and receptive vocabulary. CONCLUSIONS Despite wearing hearing aids, CHA performed more poorly on 3 of 4 lexical measures. Individual differences among CHA were predicted by aided SII. Unlike PTA, aided SII incorporates hearing aid amplification characteristics and speech-frequency weightings and may provide a more valid estimate of the child's access to and ability to learn from auditory input in real-world environments.
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Houston DM, Stewart J, Moberly A, Hollich G, Miyamoto RT. Word learning in deaf children with cochlear implants: effects of early auditory experience. Dev Sci 2012; 15:448-61. [PMID: 22490184 PMCID: PMC3573691 DOI: 10.1111/j.1467-7687.2012.01140.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Word-learning skills were tested in normal-hearing 12- to 40-month-olds and in deaf 22- to 40-month-olds 12 to 18 months after cochlear implantation. Using the Intermodal Preferential Looking Paradigm (IPLP), children were tested for their ability to learn two novel-word/novel-object pairings. Normal-hearing children demonstrated learning on this task at approximately 18 months of age and older. For deaf children, performance on this task was significantly correlated with early auditory experience: Children whose cochlear implants were switched on by 14 months of age or who had relatively more hearing before implantation demonstrated learning in this task, but later implanted profoundly deaf children did not. Performance on this task also correlated with later measures of vocabulary size. Taken together, these findings suggest that early auditory experience facilitates word learning and that the IPLP may be useful for identifying children who may be at high risk for poor vocabulary development.
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Affiliation(s)
- Derek M Houston
- Department of Otolaryngology – Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Fukushima K, Kasai N, Omori K, Sugaya A, Fujiyoshi A, Taguchi T, Konishi T, Sugishita S, Takei W, Fujino H, Ojima T, Nishizaki K. Assessment Package for Language Development in Japanese Hearing-Impaired Children (ALADJIN) as a Test Battery for the Development of Practical Communication. Ann Otol Rhinol Laryngol 2012; 202:3-15. [DOI: 10.1177/000348941212100401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The measurement of language development in hearing-impaired children is an important step in assessing the appropriateness of an intervention. We proposed a set of language tests (the Assessment Package for Language Development in Japanese Hearing-Impaired Children [ALADJIN]) to evaluate the development of practical communication skills. This package consisted of communication skills (TQAID), comprehensive (PVT-R and SCTAW) and productive vocabulary (WFT), comprehensive and productive syntax (STA), and the STRAW. Methods: A total of 638 children with greater than 70-dB hearing impairment were subjected to this set of language tests. Additional tests, including the PARS, the RCPM, and parental questionnaires, were administered to assess the backgrounds of the children. Results: A trimodal distribution was observed among hearing-impaired children by the histogram-based analysis of each test. Conclusions: The ALADJIN is a useful Japanese-language evaluation kit for hearing-impaired children.
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Stiles DJ, McGregor KK, Bentler RA. Vocabulary and working memory in children fit with hearing aids. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2012; 55:154-67. [PMID: 22199188 DOI: 10.1044/1092-4388(2011/11-0021)] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To determine whether children with mild-to-moderately severe sensorineural hearing loss (CHL) present with disturbances in working memory and whether these disturbances relate to the size of their receptive vocabularies. METHOD Children 6 to 9 years of age participated. Aspects of working memory were tapped by articulation rate, forward and backward digit span in the auditory and visual modalities, Corsi span, parent surveys, and a sequential encoding task. Articulation rate, digit spans, and Corsi spans were also administered in low-level broadband noise. RESULTS CHL and children with normal hearing (CNH) demonstrated auditory advantage in forward serial recall. CHL demonstrated slower articulation rates than CNH, but similar memory spans. CHL with poor executive function presented with poorer performance on the Corsi span task. The presence of background noise had no effect on performance in either group. CHL presented with significantly smaller receptive vocabularies than their CNH peers. Across groups, receptive vocabulary size was positively correlated with digit span in quiet, Corsi span in noise, and articulation rate. CONCLUSIONS In the presence of mild-to-moderately severe hearing loss, children demonstrated resilient working memory systems. For all children, working memory and vocabulary were related; that is, children with poorer working memory had smaller vocabulary sizes.
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Expressive vocabulary of children with hearing loss in the first 2 years of life: impact of early intervention. J Perinatol 2011; 31:274-80. [PMID: 20706190 DOI: 10.1038/jp.2010.110] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to determine the expressive vocabulary of children with hearing loss (HL) enrolled in early intervention (EI) ≤ 3 vs >3 months in the first 24 months and to compare with hearing controls. It was hypothesized that the number of words produced would be higher for children with HL enrolled in EI ≤ 3 vs >3 months. STUDY DESIGN This is a prospective longitudinal matched cohort study. RESULT The children with HL produced fewer words than the children with hearing. In addition, children with HL enrolled in EI ≤ 3 months had a larger expressive vocabulary percentile score compared with children with HL enrolled >3 months. Children with mild HL enrolled in EI ≤ 3 months had the greatest growth in vocabulary between 12 to 16 and 18 to 24 months. CONCLUSION Although multiple factors are associated with expressive vocabulary growth of children with HL, enrollment in EI ≤ 3 months has sustained beneficial effects on expressive vocabulary at 18 to 24 months.
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Moeller MP, McCleary E, Putman C, Tyler-Krings A, Hoover B, Stelmachowicz P. Longitudinal development of phonology and morphology in children with late-identified mild-moderate sensorineural hearing loss. Ear Hear 2010; 31:625-35. [PMID: 20548239 PMCID: PMC2932864 DOI: 10.1097/aud.0b013e3181df5cc2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Studies of language development in children with mild-moderate hearing loss are relatively rare. Longitudinal studies of children with late-identified hearing loss are relevant for determining how a period of unaided mild-moderate hearing loss impacts development. In recent years, newborn hearing screening programs have effectively reduced the ages of identification for most children with permanent hearing loss. However, some children continue to be identified late, and research is needed to guide management decisions. Furthermore, studies of this group may help to discern whether language normalizes after intervention and/or whether certain aspects of language might be vulnerable to persistent delays. The current study examines the impact of late identification and reduced audibility on speech and language outcomes via a longitudinal study of four children with mild-moderate sensorineural hearing loss. DESIGN Longitudinal outcomes of four children with late-identified mild-moderate sensorineural hearing loss were studied using standardized measures and language sampling procedures from at or near the point of identification (28 to 41 mos) through 84 mos of age. The children with hearing loss were compared with 10 age-matched children with normal hearing on a majority of the measures through 60 mos of age. Spontaneous language samples were collected from mother-child interaction sessions recorded at consistent intervals in a laboratory-based play setting. Transcripts were analyzed using computer-based procedures (Systematic Analysis of Language Transcripts) and the Index of Productive Syntax. Possible influences of audibility were explored by examining the onset and productive use of a set of verb tense markers and by monitoring the children's accuracy in the use of morphological endings. Phonological samples at baseline were transcribed and analyzed using Computerized Profiling. RESULTS At entry to the study, the four children with hearing loss demonstrated language delays with pronounced delays in phonological development. Three of the four children demonstrated rapid progress with development and interventions and performed within the average range on standardized speech and language measures compared with age-matched children by 60 mos of age. However, persistent differences from children with normal hearing were observed in the areas of morphosyntax, speech intelligibility in conversation, and production of fricatives. Children with mild-moderate hearing loss demonstrated later than typical emergence of certain verb tense markers, which may be related to reduced or inconsistent audibility. CONCLUSIONS The results of this study suggest that early communication delays will resolve for children with late-identified, mild-moderate hearing loss, given appropriate amplification and intervention services. A positive result is that three of four children demonstrated normalization of broad language behaviors by 60 mos of age, despite significant delays at baseline. However, these children are at risk for persistent delays in phonology at the conversational level and for accuracy in use of morphological markers. The ways in which reduced auditory experiences and audibility may contribute to these delays are explored along with implications for evaluation of outcomes.
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Affiliation(s)
- Mary Pat Moeller
- Boys Town National Research Hospital, Omaha, Nebraska 68131, USA.
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Fagan MK, Pisoni DB. Hearing experience and receptive vocabulary development in deaf children with cochlear implants. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2010; 15:149-61. [PMID: 20130017 PMCID: PMC2836193 DOI: 10.1093/deafed/enq001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 12/22/2009] [Accepted: 12/22/2009] [Indexed: 05/24/2023]
Abstract
This study investigated receptive vocabulary delay in deaf children with cochlear implants. Participants were 23 children with profound hearing loss, ages 6-14 years, who received a cochlear implant between ages 1.4 and 6 years. Duration of cochlear implant use ranged from 3.7 to 11.8 years. Peabody Picture Vocabulary Test, Third Edition (PPVT-III) data were analyzed first by examining children's errors for evidence of difficulty in specific lexical content areas, and second by calculating standard scores with reference to hearing age (HA) (i.e., chronological age [CA]--age at implantation) rather than CA. Participants showed evidence of vocabulary understanding across all PPVT-III content categories with no strong evidence of disproportionate numbers of errors in any specific content area despite below-average mean standard scores. However, whereas mean standard scores were below the test mean established for hearing children when based on CA, they were within the average range for hearing children when calculated based on HA. Thus, children's vocabulary knowledge was commensurate with years of cochlear implant experience, providing support for the role of spoken language experience in vocabulary acquisition.
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Affiliation(s)
- Mary K Fagan
- Department of Communication Science and Disorders, University of Missouri, 303 Lewis Hall, Columbia, MO 65211, USA.
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Sahlén B, Hansson K. Novel word learning and its relation to working memory and language in children with mild-to-moderate hearing impairment and children with specific language impairment. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/14769670600929360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ibertsson T, Willstedt-Svensson U, Radeborg K, Sahlén B. A methodological contribution to the assessment of nonword repetition—a comparison between children with specific language impairment and hearing-impaired children with hearing aids or cochlear implants. LOGOP PHONIATR VOCO 2009; 33:168-78. [DOI: 10.1080/14015430801945299] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Willstedt-Svensson U, Löfqvist A, Almqvist B, Sahlén B. Is age at implant the only factor that counts? The influence of working memory on lexical and grammatical development in children with cochlear implants. Int J Audiol 2009; 43:506-15. [PMID: 15726841 DOI: 10.1080/14992020400050065] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this study, we explored the influence of time factors (age at implant, time with cochlear implant and age), complex working memory and phonological short-term memory on lexical and grammatical development in congenitally deaf children with cochlear implants. Fifteen children (aged 5 years 4 months to 11 years 5 months) were examined with the use of several linguistic and cognitive measures after a minimum of 18 months of implant use. Phonological short-term memory was assessed with non-word repetition, where the percentage of correctly repeated consonants and vowels was counted. For the assessment of lexical acquisition. a novel word learning task was administered. Receptive and expressive grammar was tested. Our results corroborate earlier findings on the influence of phonological short-term memory on novel word learning. The percentage of vowels correctly produced in non-word repetition was more important in this group than age at implant, not only for novel word learning. but also for receptive and expressive grammar.
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Vohr B, Jodoin-Krauzyk J, Tucker R, Johnson MJ, Topol D, Ahlgren M. Early language outcomes of early-identified infants with permanent hearing loss at 12 to 16 months of age. Pediatrics 2008; 122:535-44. [PMID: 18762523 DOI: 10.1542/peds.2007-2028] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this study were to determine the early language outcomes of children with mild to profound hearing loss, compared with hearing control children, at 12 to 16 months of age and to examine the effects of "very early" enrollment (</=3 months) in early intervention. METHODS This was a prospective longitudinal study of the outcomes of a cohort of 30 infants identified in the Rhode Island universal newborn hearing screening program and 96 hearing control subjects. Eligible families with children with all degrees of congenital hearing loss were invited to enroll. Child language skills were assessed by using the MacArthur-Bates Communicative Development Inventory, Words and Gestures, at 12 to 16 months. RESULTS Children with moderate/profound hearing loss had significantly lower numbers of phrases understood, words understood, and early, later, and total gestures, compared with children with mild/minimal hearing loss and hearing control subjects. Furthermore, children with hearing loss who were enrolled in early intervention at </=3 months had significantly higher percentile scores for number of words understood, words produced, and early, later, and total gestures, compared with those enrolled at >3 months. Regression analyses to test the independent effects on language skills of children with hearing loss identified enrollment in early intervention at </=3 months as an independent predictor of percentile scores for word and early gesture production. CONCLUSIONS Very early enrollment (</=3 months) in early intervention has beneficial effects on early language for children with hearing loss. Nevertheless, 12- to 16-month-old children with moderate/profound hearing loss exhibit delayed receptive and expressive language skills in oral and signed English modes, compared with peers with either mild/minimal hearing loss or typical hearing sensitivity.
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Affiliation(s)
- Betty Vohr
- Women and Infants Hospital, 101 Dudley St, Providence, RI 02905, USA.
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Pittman AL. Short-term word-learning rate in children with normal hearing and children with hearing loss in limited and extended high-frequency bandwidths. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2008; 51:785-97. [PMID: 18506051 PMCID: PMC2529180 DOI: 10.1044/1092-4388(2008/056)] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE This study examined children's word learning in limited and extended high-frequency bandwidth conditions. These conditions represent typical listening environments for children with hearing loss (HL) and children with normal hearing (NH), respectively. METHOD Thirty-six children with NH and 14 children with moderate-to-severe HL served as participants. All of the children were between 8 and 10 years of age and were assigned to either the limited or the extended bandwidth conditions. Five nonsense words were paired with 5 novel pictures. Word learning was assessed in a single session, multitrial, learning paradigm lasting approximately 15 min. Learning rate was defined as the number of exposures necessary to achieve 70% correct performance. RESULTS Analysis of variance revealed a significant main effect for bandwidth but not for group. A Bandwidth x Group interaction was also not observed. In this short-term learning paradigm, the children in both groups required 3 times as many exposures to learn each new word in the limited bandwidth condition compared with the extended bandwidth condition. CONCLUSION These results suggest that children with HL may benefit from extended high-frequency amplification when learning new words and for other long-term auditory processes.
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Affiliation(s)
- Andrea L Pittman
- Department of Speech and Hearing Science, Arizona State University, P.O. Box 870102, Tempe, AZ 85287-0102, USA.
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Lederberg AR, Spencer PE. Word-learning abilities in deaf and hard-of-hearing preschoolers: effect of lexicon size and language modality. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2008; 14:44-62. [PMID: 18495655 DOI: 10.1093/deafed/enn021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Deaf and hard-of-hearing (DHH) children's ability to rapidly learn novel words through direct reference and through novel mapping (i.e., inferring that a novel word refers to a novel object) was examined. Ninety-eight DHH children, ranging from 27 to 82 months old, drawn from 12 schools in five states participated. In two tasks that differed in how reference was established, word-learning abilities were measured by children's ability to learn novel words after only three exposures. Three levels of word-learning abilities were identified. Twelve children did not rapidly learn novel words. Thirty-six children learned novel words rapidly but only in the direct reference task. Forty-nine children learned novel words rapidly in both direct reference and novel mapping tasks. These levels of word-learning abilities were evident in children who were in oral-only and in signing environments, in children with cochlear implants, and in deaf children of deaf parents. Children's word-learning abilities were more strongly correlated to lexicon size than age, and this relation was similar for children in these different language-learning environments. Acquisition of these word-learning abilities seems based on linguistic mechanisms that are available to children in a wide range of linguistic environments. In addition, the word-learning tasks offer a promising dynamic assessment tool.
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Affiliation(s)
- Amy R Lederberg
- Department of Educational Psychology and Special Education, Georgia State University, Box 3999, Atlanta, GA 30303, USA.
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