Functional hearing quality in prelingually deaf school-age children and adolescents with cochlear implants

Development of the Children's English and Spanish Speech Recognition Test: Psychometric Properties, Feasibility, Reliability, and Normative Data

OBJECTIVES

The Children's English and Spanish Speech Recognition (ChEgSS) test is a computer-based tool for assessing closed-set word recognition in English and in Spanish, with a masker that is either speech-shaped noise or competing speech. The present study was conducted to (1) characterize the psychometric properties of the ChEgSS test, (2) evaluate feasibility and reliability for a large cohort of Spanish/English bilingual children with normal hearing, and (3) establish normative data.

DESIGN

Three experiments were conducted to evaluate speech perception in children (4-17 years) and adults (19-40 years) with normal hearing using the ChEgSS test. In Experiment 1, data were collected from Spanish/English bilingual and English monolingual adults at multiple, fixed signal-to-noise ratios. Psychometric functions were fitted to the word-level data to characterize variability across target words in each language and in each masker condition. In Experiment 2, Spanish/English bilingual adults were tested using an adaptive tracking procedure to evaluate the influence of different target-word normalization approaches on the reliability of estimates of masked-speech recognition thresholds corresponding to 70.7% correct word recognition and to determine the optimal number of reversals needed to obtain reliable estimates. In Experiment 3, Spanish/English bilingual and English monolingual children completed speech perception testing using the ChEgSS test to (1) characterize feasibility across age and language group, (2) evaluate test-retest reliability, and (3) establish normative data.

RESULTS

Experiments 1 and 2 yielded data that are essential for stimulus normalization, optimizing threshold estimation procedures, and interpreting threshold data across test language and masker type. Findings obtained from Spanish/English bilingual and English monolingual children with normal hearing in Experiment 3 support feasibility and demonstrate reliability for use with children as young as 4 years of age. Equivalent results for testing in English and Spanish were observed for Spanish/English bilingual children, contingent on adequate proficiency in the target language. Regression-based threshold norms were established for Spanish/English bilingual and English monolingual children between 4 and 17 years of age.

CONCLUSIONS

The present findings indicate the ChEgSS test is appropriate for testing a wide age range of children with normal hearing in either Spanish, English, or both languages. The ChEgSS test is currently being evaluated in a large cohort of patients with hearing loss at pediatric audiology clinics across the United States. Results will be compared with normative data established in the present study and with established clinical measures used to evaluate English- and Spanish-speaking children. Questionnaire data from parents and clinician feedback will be used to further improve test procedures.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Estimating Early Language Input in Deaf and Hard of Hearing Children With the Language Access Profile Tool

PURPOSE

The purpose of this study was to describe the Language Access Profile Tool (LAPT) and its psychometric properties with the aim of evaluating its suitability as an alternative to the deaf or hard of hearing (DHH) Language Exposure Assessment Tool (D-LEAT) in clinical practice with DHH children age 12 years and younger.

METHOD

We administered both the LAPT and D-LEAT to the caregivers of 105 DHH children 12 years old and younger from across the United States, 40% of whom were interviewed again after a delay of at least 1 month. Each interview resulted in a child-specific estimate of their cumulative experience with language input, expressed as a proportion divided across eight categories.

RESULTS

Participants in the sample reported experience with all eight input categories, but four categories were common and four were rare. Estimates for all input categories were consistent at both initial and follow-up interviews. Estimates for each input category were also strongly correlated with the corresponding estimates from the D-LEAT, although correlations for the rare categories should be interpreted cautiously.

CONCLUSIONS

The LAPT demonstrates sufficient test-retest reliability and convergent validity to be a useful and more user-friendly alternative to the D-LEAT. We provide recommendations for how the LAPT and the D-LEAT can be best used in their current form.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20669001.

Verbal Working Memory Error Patterns and Speech-Language Outcomes in Youth With Cochlear Implants

PURPOSE

Verbal working memory (VWM) delays are commonly found in prelingually deaf youth with cochlear implants (CIs), albeit with considerable interindividual variability. However, little is known about the neurocognitive information-processing mechanisms underlying these delays and how these mechanisms relate to spoken language outcomes. The goal of this study was to use error analysis of the letter-number sequencing (LNS) task to test the hypothesis that VWM delays in CI users are due, in part, to fragile, underspecified phonological representations in short-term memory.

METHOD

Fifty-one CI users aged 7-22 years and 53 normal hearing (NH) peers completed a battery of speech, language, and neurocognitive tests. LNS raw scores and error profiles were compared between samples, and a hierarchical regression model was used to test for associations with measures of speech, language, and hearing.

RESULTS

Youth with CIs scored lower on the LNS test than NH peers and committed a significantly higher number of errors involving phonological confusions (recalling an incorrect letter/digit in place of a phonologically similar one). More phonological errors were associated with poorer performance on measures of nonword repetition and following spoken directions but not with hearing quality.

CONCLUSIONS

Study findings support the hypothesis that poorer VWM in deaf children with CIs is due, in part, to fragile, underspecified phonological representations in short-term/working memory, which underlie spoken language delays. Programs aimed at strengthening phonological representations may improve VWM and spoken language outcomes in CI users.