Concept formation skills in long-term cochlear implant users

Neurocognitive outcomes in young adults with cochlear implants: The role of early language access and crossmodal plasticity

Many children with profound hearing loss have received cochlear implants (CI) to help restore some sense of hearing. There is, however, limited research on long-term neurocognitive outcomes in young adults who have grown up hearing through a CI. This study compared the cognitive outcomes of early-implanted (n = 20) and late-implanted (n = 21) young adult CI users, and typically hearing (TH) controls (n=56), all of whom were enrolled in college. Cognitive fluidity, nonverbal intelligence, and American Sign Language (ASL) comprehension were assessed, revealing no significant differences in cognition and nonverbal intelligence between the early and late-implanted groups. However, there was a difference in ASL comprehension, with the late-implanted group having significantly higher ASL comprehension. Although young adult CI users showed significantly lower scores in a working memory and processing speed task than TH age-matched controls, there were no significant differences in tasks involving executive function shifting, inhibitory control, and episodic memory between young adult CI and young adult TH participants. In an exploratory analysis of a subset of CI participants (n = 17) in whom we were able to examine crossmodal plasticity, we saw greater evidence of crossmodal recruitment from the visual system in late-implanted compared with early-implanted CI young adults. However, cortical visual evoked potential latency biomarkers of crossmodal plasticity were not correlated with cognitive measures or ASL comprehension. The results suggest that in the late-implanted CI users, early access to sign language may have served as a scaffold for appropriate cognitive development, while in the early-implanted group early access to oral language benefited cognitive development. Furthermore, our results suggest that the persistence of crossmodal neuroplasticity into adulthood does not necessarily impact cognitive development. In conclusion, early access to language - spoken or signed - may be important for cognitive development, with no observable effect of crossmodal plasticity on cognitive outcomes.

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

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

An approach designed to fail deaf children and their parents and how to change it

The matter of raising and educating deaf children has been caught up in percepts of development that are persistently inaccurate and at odds with scientific research. These percepts have negatively impacted the health and quality of life of deaf children and deaf people in general. The all too prevalent advice is to raise the child strictly orally and wait to see what happens. Only when the child is seriously behind is a completely accessible language - a sign language - introduced, and that is far too late for protecting cognitive health. The medical profession, along with others, needs to offer parents better advice and better supports so that neither the children nor their parents wait and watch as the oral-only method fails. All must take responsible action to assure an approach that succeeds.

How Hearing Loss and Cochlear Implantation Affect Verbal Working Memory: Evidence From Adolescents

PURPOSE

Verbal working memory is poorer for children with hearing loss than for peers with normal hearing (NH), even with cochlear implantation and early intervention. Poor verbal working memory can affect academic performance, especially in higher grades, making this deficit a significant problem. This study examined the stability of verbal working memory across middle childhood, tested working memory in adolescents with NH or cochlear implants (CIs), explored whether signal enhancement can improve verbal working memory, and tested two hypotheses proposed to explain the poor verbal working memory of children with hearing loss: (a) Diminished auditory experience directly affects executive functions, including working memory; (b) degraded auditory inputs inhibit children's abilities to recover the phonological structure needed for encoding verbal material into storage.

DESIGN

Fourteen-year-olds served as subjects: 55 with NH; 52 with CIs. Immediate serial recall tasks were used to assess working memory. Stimuli consisted of nonverbal, spatial stimuli and four kinds of verbal, acoustic stimuli: nonrhyming and rhyming words, and nonrhyming words with two kinds of signal enhancement: audiovisual and indexical. Analyses examined (a) stability of verbal working memory across middle childhood, (b) differences in verbal and nonverbal working memory, (c) effects of signal enhancement on recall, (d) phonological processing abilities, and (e) source of the diminished verbal working memory in adolescents with cochlear implants.

RESULTS

Verbal working memory remained stable across middle childhood. Adolescents across groups performed similarly for nonverbal stimuli, but those with CIs displayed poorer recall accuracy for verbal stimuli; signal enhancement did not improve recall. Poor phonological sensitivity largely accounted for the group effect.

CONCLUSIONS

The central executive for working memory is not affected by hearing loss or cochlear implantation. Instead, the phonological deficit faced by adolescents with CIs denigrates the representation in storage and augmenting the signal does not help.

Language Intervention Instead of Speech Intervention for Children With Cochlear Implants

Cochlear implants are a standard rehabilitation option for children with severe hearing loss or deafness, allowing access to speech sounds necessary for the development of spoken language. However, the speech-language outcomes of pediatric cochlear implant users vary widely and are not directly or exclusively linked to technology but to combinations of individual audiological, personal, technical, and habilitational factors. These combinations may not favor spoken language development, which may further be linked to the issue of prior insistence on spoken language learning and associated with a high risk of language deprivation. Here, we discuss the outcomes of cochlear implantation from a habilitative perspective and lay down the efforts and resources necessary for the development of communication competence after cochlear implantation rather than the achievement of specific hearing, language, or speech skills that have limited socioemotional and educational contributions and do not guarantee an independent or productive life.

Does auditory deprivation impairs statistical learning in the auditory modality?

Early sensory deprivation allows assessing the extent of reorganisation of cognitive functions, well beyond sensory processing. As such, it is a good model to explore the links between sensory experience and cognitive functions. One of these functions, statistical learning - the ability to extract and use regularities present in the environment - is suspected to be impaired in prelingually deaf children with a cochlear implant. However, empirical evidence supporting this claim is very scarce and studies have reported contradictory results. This might be because previous studies have tested statistical learning only in the visual modality and did not make clear distinctions between multiple types of statistical regularities. To overcome these problems, we designed a modified serial reaction time task where cochlear implanted children and normal hearing children had to react to auditory sequences that embed multiple statistical regularities, namely transition probabilities of 0^th, 1^st or 2^nd order. We compared the reaction times of the children with the output of a simple computational model that learns transition probabilities. First, 6-12 years old children were able to learn 0^th and 1^st order transition probabilities but not 2^nd order ones. Second, there were no differences between cochlear implanted children and their normal hearing peers. These results indicate that auditory statistical learning is preserved in congenitally deaf children with cochlear implants. This suggests in turn that early auditory deprivation might not be crucially detrimental for the normal development of statistical learning.

Functional Consequences of Poor Binaural Hearing in Development: Evidence From Children With Unilateral Hearing Loss and Children Receiving Bilateral Cochlear Implants

Poor binaural hearing in children was hypothesized to contribute to related cognitive and academic deficits. Children with unilateral hearing have normal hearing in one ear but no access to binaural cues. Their cognitive and academic deficits could be unique from children receiving bilateral cochlear implants (CIs) at young ages who have poor access to spectral cues and impaired binaural sensitivity. Both groups are at risk for vestibular/balance deficits which could further contribute to memory and learning challenges. Eighty-eight children (43 male:45 female, aged 9.89  ±  3.40 years), grouped by unilateral hearing loss (n = 20), bilateral CI (n = 32), and typically developing (n = 36), completed a battery of sensory, cognitive, and academic tests. Analyses revealed that children in both hearing loss groups had significantly poorer skills (accounting for age) on most tests than their normal hearing peers. Children with unilateral hearing loss had more asymmetric speech perception than children with bilateral CIs (p < .0001) but balance and language deficits (p = .0004, p < .0001, respectively) were similar in the two hearing loss groups (p > .05). Visuospatial memory deficits occurred in both hearing loss groups (p = .02) but more consistently across tests in children with unilateral hearing loss. Verbal memory was not significantly different than normal (p > .05). Principal component analyses revealed deficits in a main cluster of visuospatial memory, oral language, mathematics, and reading measures (explaining 46.8% data variability). The remaining components revealed clusters of self-reported hearing, balance and vestibular function, and speech perception deficits. The findings indicate significant developmental impacts of poor binaural hearing in children.

Can a Self-report Measure Be Used to Assess Cognitive Skills in Adults With Hearing Loss?

HYPOTHESES

Adult cochlear implant candidates would self-report their executive functioning abilities as poorer than normal-hearing peers. These executive function abilities would correlate with laboratory-based cognitive tests. Lastly, executive functioning (EF) abilities would be associated with hearing-related quality of life.

BACKGROUND

Executive function refers to cognitive abilities involved in behavioral regulation during goal-directed activity. Pediatric and adult users have demonstrated delays and deficits in executive function skills compared with normal-hearing peers. This study aimed to compare self-report executive function in adult cochlear implant candidates and normal-hearing peers and to relate executive function skills to laboratory-based cognitive testing and hearing-related quality of life.

METHODS

Twenty-four postlingually deaf adult cochlear implant candidates were enrolled, along with 42 normal-hearing age-matched peers. Participants completed self-reports of executive function using the Behavior Rating Inventory of Executive Function- Adult (BRIEF-A). Participants were also tested using laboratory-based cognitive measures, as well as assessment of hearing-related quality of life on the Nijmegen Cochlear Implant Questionnaire. Groups were compared on BRIEF-A scores, and relations between BRIEF-A and lab-based cognitive measures as well as Nijmegen Cochlear Implant Questionnaire scores were examined.

RESULTS

Self-report executive function on the BRIEF-A was not significantly different between groups. Consistent relations of self-report executive function and nonverbal reasoning were identified. Strong relations were not found between self-report executive function and hearing-related quality of life.

CONCLUSIONS

Executive function as measured by BRIEF-A demonstrates some relation with a laboratory-based metric of nonverbal reasoning, but not other cognitive measures. Hearing-impaired individuals did not report poorer EF than normal-hearing controls. EF additionally did not correlate with quality of life. Our findings provide preliminary, partial validation of the BRIEF-A instrument in the preoperative evaluation of adult cochlear implant candidates.

Widespread plasticity of cognition-related brain networks in single-sided deafness revealed by randomized window-based dynamic functional connectivity

As an extreme type of partial auditory deprivation, single-sided deafness (SSD) has been demonstrated to lead to extensive neural plasticity according to multimodal neuroimaging studies. Among them, resting-state functional magnetic resonance imaging (rs-fMRI) offers valuable information on functional connectivities (FCs). However, most previous SSD rs-fMRI studies assumed that the extracted FC remains stationary during the entire fMRI scan and neglected dynamic functional activities. Existing fixed window-based dynamic FC analysis also ignores dynamic functional activities under different temporal terms. Additionally, due to the cost constraints of using MRI machines, using data-driven methods for unbiased hypothesis investigations may require more effective sample data augmentation techniques. To tackle these challenges and problems together, in this study, we proposed a dynamic window with a random length and position to extract participants' dynamic characteristics under different temporal terms and to extract more information from the dataset. Then, we proposed a nodal efficiency-based correlation matrix to describe the relationships of synergism between regions as features and applied a linear support vector machine (SVM) model to learn the importance of the features, which helped to identify SSD patients and healthy controls. A total of 68 participants (including 23 with left SSD, 20 with right SSD and 25 healthy controls) were enrolled. Our proposed approach with a random window showed clear improvement compared with traditional static and fixed window-based dynamic FC by using the linear SVM model. FCs related to the frontoparietal, somatomotor, dorsal attention, limbic and default mode networks played significant roles in differentiating SSD patients from healthy controls. Additionally, FCs between the somatomotor and frontoparietal networks made the greatest contribution to the classification model. Regarding brain regions, FCs related to the superior frontal gyrus, superior parietal lobule, superior temporal gyrus, amygdala, and orbital gyrus played significant roles. These findings suggest that networks and regions related to higher-order cognitive functions showed the most significant FC alterations in SSD, which may represent a compensatory collaboration of cognitive resources in SSD.

Principles of Executive Functioning Interventions for Children With Cochlear Implants: Guidance From Research Findings and Clinical Experience

: Children with cochlear implants (CIs) are at risk for experiencing deficits in the development of neurocognitive processes known as executive functions (EF). Such deficits likely arise as a consequence of early-onset deafness, the degraded auditory input provided by CIs, and delays in spoken language development. Interventions specifically designed for pediatric CI users are needed to address challenges and delays in EF because of the unique influences of hearing loss and language delay on EF development, which have deleterious, cascading effects on speech and language development and subsequent reading and academic achievement. Because patterns of EF weakness emerge even in the preschool years, interventions to improve EF should be implemented at early ages, while children are young and neuroplasticity is high. Drawing on previous research findings and clinical experience, this paper highlights 10 principles to guide the development of EF interventions for children with CIs.

Cognitive improvement after cochlear implantation in deaf children with associated disabilities

AIM

To monitor functional auditory and non-verbal cognitive skills in children with cochlear implants who had associated disabilities over a 24-month period and define how cochlear implantation may impact on non-verbal cognition by restoring functional auditory skills.

METHOD

Sixty-four children with cochlear implants (36 females, 28 males; mean age 4y 3mo, SD 3y 5mo, 9mo-14y 5mo) were recruited and divided into three groups: children with typical development group (TDG); children with associated disabilities not linked to non-verbal cognitive disorders group (ADG1); and children with associated disabilities linked to non-verbal cognitive disorders group (ADG2). Tests of functional auditory, communicative, and non-verbal cognitive skills were performed before cochlear implantation and at 12 and 24 months after cochlear implantation.

RESULTS

Functional auditory and communicative skills improved similarly in the three groups at 12 and 24 months after implantation. An increase in non-verbal cognitive scores was present in children in the ADG2 from baseline to 12 and 24 months (p<0.01), whereas scores remained stable in children in the TDG and ADG1. The increased functional auditory skills scores after cochlear implantation corresponded to an increase in non-verbal cognitive scores (p=0.032) in children in the ADG2.

INTERPRETATION

Children with associated disabilities, especially if linked to non-verbal cognitive disorders, benefitted from cochlear implantation. They improved their comprehension of acoustic information inferred from the environment, improving not only functional auditory skills but also non-verbal cognition.

Academic Performance, Communication, and Psychosocial Development of Prelingual Deaf Children with Cochlear Implants in Mainstream Schools

BACKGROUND AND OBJECTIVES

To assess the academic performance, communication skills, and psychosocial development of prelingual deaf children with cochlear implants (CIs) attending mainstream schools, and to evaluate the impact of auditory speech perception on their classroom performance. Subjects and.

METHODS

As participant, 67 children with CI attending mainstream schools were included. A survey was conducted using a structured questionnaire on academic performance in the native language, second language, mathematics, social studies, science, art, communication skills, self-esteem, and social relations. Additionally, auditory and speech performances on the last follow-up were reviewed retrospectively.

RESULTS

Most implanted children attending mainstream school appeared to have positive self-esteem and confidence, and had little difficulty in conversing in a quiet classroom. Also, half of the implanted children (38/67) scored above average in general academic achievement. However, academic achievement in the second language (English), social studies, and science were usually poorer than general academic achievement. Furthermore, half of the implanted children had difficulty in understanding the class content (30/67) or conversing with peers in a noisy classroom (32/67). These difficulties were significantly associated with poor speech perception.

CONCLUSIONS

Improving the listening environment for implanted children attending mainstream schools is necessary.

Effects of Early Auditory Deprivation on Working Memory and Reasoning Abilities in Verbal and Visuospatial Domains for Pediatric Cochlear Implant Recipients

OBJECTIVES

The overall goal of this study was to compare verbal and visuospatial working memory in children with normal hearing (NH) and with cochlear implants (CI). The main questions addressed by this study were (1) Does auditory deprivation result in global or domain-specific deficits in working memory in children with CIs compared with their NH age mates? (2) Does the potential for verbal recoding affect performance on measures of reasoning ability in children with CIs relative to their NH age mates? and (3) Is performance on verbal and visuospatial working memory tasks related to spoken receptive language level achieved by children with CIs?

DESIGN

A total of 54 children ranging in age from 5 to 9 years participated; 25 children with CIs and 29 children with NH. Participants were tested on both simple and complex measures of verbal and visuospatial working memory. Vocabulary was assessed with the Peabody Picture Vocabulary Test (PPVT) and reasoning abilities with two subtests of the WISC-IV (Wechsler Intelligence Scale for Children, 4th edition): Picture Concepts (verbally mediated) and Matrix Reasoning (visuospatial task). Groups were compared on all measures using analysis of variance after controlling for age and maternal education.

RESULTS

Children with CIs scored significantly lower than children with NH on measures of working memory, after accounting for age and maternal education. Differences between the groups were more apparent for verbal working memory compared with visuospatial working memory. For reasoning and vocabulary, the CI group scored significantly lower than the NH group for PPVT and WISC Picture Concepts but similar to NH age mates on WISC Matrix Reasoning.

CONCLUSIONS

Results from this study suggest that children with CIs have deficits in working memory related to storing and processing verbal information in working memory. These deficits extend to receptive vocabulary and verbal reasoning and remain even after controlling for the higher maternal education level of the NH group. Their ability to store and process visuospatial information in working memory and complete reasoning tasks that minimize verbal labeling of stimuli more closely approaches performance of NH age mates.

Psychosocial Outcomes in Long-Term Cochlear Implant Users

OBJECTIVES

The objectives of this study were to investigate psychosocial outcomes in a sample of prelingually deaf, early-implanted children, adolescents, and young adults who are long-term cochlear implant (CI) users and to examine the extent to which language and executive functioning predict psychosocial outcomes.

DESIGN

Psychosocial outcomes were measured using two well-validated, parent-completed checklists: the Behavior Assessment System for Children and the Conduct Hyperactive Attention Problem Oppositional Symptom. Neurocognitive skills were measured using gold standard, performance-based assessments of language and executive functioning.

RESULTS

CI users were at greater risk for clinically significant deficits in areas related to attention, oppositional behavior, hyperactivity-impulsivity, and social-adaptive skills compared with their normal-hearing peers, although the majority of CI users scored within average ranges relative to Behavior Assessment System for Children norms. Regression analyses revealed that language, visual-spatial working memory, and inhibition-concentration skills predicted psychosocial outcomes.

CONCLUSIONS

Findings suggest that underlying delays and deficits in language and executive functioning may place some CI users at a risk for difficulties in psychosocial adjustment.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Relations Between Self-reported Executive Functioning and Speech Perception Skills in Adult Cochlear Implant Users

HYPOTHESIS

As a result of their hearing loss, adults with cochlear implants (CIs) would self-report poorer executive functioning (EF) skills than normal-hearing (NH) peers, and these EF skills would be associated with performance on speech recognition tasks.

BACKGROUND

EF refers to a group of high order neurocognitive skills responsible for behavioral and emotional regulation during goal-directed activity, and EF has been found to be poorer in children with CIs than their NH age-matched peers. Moreover, there is increasing evidence that neurocognitive skills, including some EF skills, contribute to the ability to recognize speech through a CI.

METHODS

Thirty postlingually deafened adults with CIs and 42 age-matched NH adults were enrolled. Participants and their spouses or significant others (informants) completed well-validated self-reports or informant-reports of EF, the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A). CI users' speech recognition skills were assessed in quiet using several measures of sentence recognition. NH peers were tested for recognition of noise-vocoded versions of the same speech stimuli.

RESULTS

CI users self-reported difficulty on EF tasks of shifting and task monitoring. In CI users, measures of speech recognition correlated with several self-reported EF skills.

CONCLUSION

The present findings provide further evidence that neurocognitive factors, including specific EF skills, may decline in association with hearing loss, and that some of these EF skills contribute to speech processing under degraded listening conditions.

Auditory access, language access, and implicit sequence learning in deaf children

Developmental psychology plays a central role in shaping evidence-based best practices for prelingually deaf children. The Auditory Scaffolding Hypothesis (Conway et al., 2009) asserts that a lack of auditory stimulation in deaf children leads to impoverished implicit sequence learning abilities, measured via an artificial grammar learning (AGL) task. However, prior research is confounded by a lack of both auditory and language input. The current study examines implicit learning in deaf children who were (Deaf native signers) or were not (oral cochlear implant users) exposed to language from birth, and in hearing children, using both AGL and Serial Reaction Time (SRT) tasks. Neither deaf nor hearing children across the three groups show evidence of implicit learning on the AGL task, but all three groups show robust implicit learning on the SRT task. These findings argue against the Auditory Scaffolding Hypothesis, and suggest that implicit sequence learning may be resilient to both auditory and language deprivation, within the tested limits. A video abstract of this article can be viewed at: https://youtu.be/EeqfQqlVHLI [Correction added on 07 August 2017, after first online publication: The video abstract link was added.].

Social Maturity and Executive Function Among Deaf Learners

Two experiments examined relations among social maturity, executive function, language, and cochlear implant (CI) use among deaf high school and college students. Experiment 1 revealed no differences between deaf CI users, deaf nonusers, and hearing college students in measures of social maturity. However, deaf students (both CI users and nonusers) reported significantly greater executive function (EF) difficulties in several domains, and EF was related to social maturity. Experiment 2 found that deaf CI users and nonusers in high school did not differ from each other in social maturity or EF, but individuals who relied on sign language reported significantly more immature behaviors than deaf peers who used spoken language. EF difficulties again were associated with social maturity. The present results indicate that EF and social maturity are interrelated, but those relations vary in different deaf subpopulations. As with academic achievement, CI use appears to have little long-term impact on EF or social maturity. Results are discussed in terms of their convergence with findings related to incidental learning and functioning in several domains.

Auditory Deprivation Does Not Impair Executive Function, But Language Deprivation Might: Evidence From a Parent-Report Measure in Deaf Native Signing Children

Deaf children are often described as having difficulty with executive function (EF), often manifesting in behavioral problems. Some researchers view these problems as a consequence of auditory deprivation; however, the behavioral problems observed in previous studies may not be due to deafness but to some other factor, such as lack of early language exposure. Here, we distinguish these accounts by using the BRIEF EF parent report questionnaire to test for behavioral problems in a group of Deaf children from Deaf families, who have a history of auditory but not language deprivation. For these children, the auditory deprivation hypothesis predicts behavioral impairments; the language deprivation hypothesis predicts no group differences in behavioral control. Results indicated that scores among the Deaf native signers (n = 42) were age-appropriate and similar to scores among the typically developing hearing sample (n = 45). These findings are most consistent with the language deprivation hypothesis, and provide a foundation for continued research on outcomes of children with early exposure to sign language.

Questionnaire-based assessment of executive functioning: Psychometrics

The psychometric properties of the Learning, Executive, and Attention Functioning (LEAF) scale were investigated in an outpatient clinical pediatric sample. As a part of clinical testing, the LEAF scale, which broadly measures neuropsychological abilities related to executive functioning and learning, was administered to parents of 118 children and adolescents referred for psychological testing at a pediatric psychology clinic; 85 teachers also completed LEAF scales to assess reliability across different raters and settings. Scores on neuropsychological tests of executive functioning and academic achievement were abstracted from charts. Psychometric analyses of the LEAF scale demonstrated satisfactory internal consistency, parent-teacher inter-rater reliability in the small to large effect size range, and test-retest reliability in the large effect size range, similar to values for other executive functioning checklists. Correlations between corresponding subscales on the LEAF and other behavior checklists were large, while most correlations with neuropsychological tests of executive functioning and achievement were significant but in the small to medium range. Results support the utility of the LEAF as a reliable and valid questionnaire-based assessment of delays and disturbances in executive functioning and learning. Applications and advantages of the LEAF and other questionnaire measures of executive functioning in clinical neuropsychology settings are discussed.

Understanding music with cochlear implants

Direct stimulation of the auditory nerve via a Cochlear Implant (CI) enables profoundly hearing-impaired people to perceive sounds. Many CI users find language comprehension satisfactory, but music perception is generally considered difficult. However, music contains different dimensions which might be accessible in different ways. We aimed to highlight three main dimensions of music processing in CI users which rely on different processing mechanisms: (1) musical discrimination abilities, (2) access to meaning in music, and (3) subjective music appreciation. All three dimensions were investigated in two CI user groups (post- and prelingually deafened CI users, all implanted as adults) and a matched normal hearing control group. The meaning of music was studied by using event-related potentials (with the N400 component as marker) during a music-word priming task while music appreciation was gathered by a questionnaire. The results reveal a double dissociation between the three dimensions of music processing. Despite impaired discrimination abilities of both CI user groups compared to the control group, appreciation was reduced only in postlingual CI users. While musical meaning processing was restorable in postlingual CI users, as shown by a N400 effect, data of prelingual CI users lack the N400 effect and indicate previous dysfunctional concept building.

Early Expressive Language Skills Predict Long-Term Neurocognitive Outcomes in Cochlear Implant Users: Evidence from the MacArthur-Bates Communicative Development Inventories

PURPOSE

The objective of the present article was to document the extent to which early expressive language skills (measured using the MacArthur-Bates Communicative Development Inventories [CDI; Fenson et al., 2006]) predict long-term neurocognitive outcomes in a sample of early-implanted prelingually deaf cochlear implant (CI) users.

METHOD

The CDI was used to index the early expressive language skills of 32 pediatric CI users after an average of 1.03 years (SD = 0.56, range = 0.39-2.17) of CI experience. Long-term neurocognitive outcomes were assessed after an average of 11.32 (SD = 2.54, range = 7.08-16.52) years of CI experience. Measures of long-term neurocognitive outcomes were derived from gold-standard performance-based and questionnaire-based assessments of language, executive functioning, and academic skills.

RESULT

Analyses revealed that early expressive language skills, collected on average 1.03 years post cochlear implantation, predicted long-term language, executive functioning, and academic skills up to 16 years later.

CONCLUSION

These findings suggest that early expressive language skills, as indexed by the CDI, are clinically relevant for identifying CI users who may be at high risk for long-term neurocognitive delays and disturbances.

Questionnaire-based assessment of executive functioning: Case studies

Delays in the development of executive functioning skills are frequently observed in pediatric neuropsychology populations and can have a broad and significant impact on quality of life. As a result, assessment of executive functioning is often relevant for the development of formulations and recommendations in pediatric neuropsychology clinical work. Questionnaire-based measures of executive functioning behaviors in everyday life have unique advantages and complement traditional neuropsychological measures of executive functioning. Two case studies of children with spina bifida are presented to illustrate the clinical use of a new questionnaire measure of executive and learning-related functioning, the Learning, Executive, and Attention Functioning Scale (LEAF). The LEAF emphasizes clinical utility in assessment by incorporating four characteristics: brevity in administration, breadth of additional relevant content, efficiency of scoring and interpretation, and ease of availability for use. LEAF results were consistent with another executive functioning checklist in documenting everyday behavior problems related to working memory, planning, and organization while offering additional breadth of assessment of domains such as attention, processing speed, and novel problem-solving. These case study results demonstrate the clinical utility of questionnaire-based measurement of executive functioning in pediatric neuropsychology and provide a new measure for accomplishing this goal.

[Pathophysiology of hearing loss : Classification and treatment options]

From the therapeutic perspective, the etiology and pathophysiology of hearing loss can be classified based on the extent of the primary cause. Hearing loss can have very different consequences for cell preservation in the organ of Corti and the spiral ganglion. These not only have implications for prosthetic therapy outcome, but may also influence the potential for future causal molecular therapies. Etiologies leading to deficits that are limited to one or a few molecules without having an effect on cell survival have the greatest potential for future causal therapy using molecular and cellular approaches. Preliminary success for molecular therapy was recently reported in animal experiments. Unfortunately, the incidence of these types of hearing loss is very low and in the future the therapy of hearing loss will therefore also require several different approaches. In addition to peripheral pathophysiology, hearing loss has consequences on the functioning of the brain, which can vary greatly due to individual adaptation to the situation without hearing. The authors therefore argue for individualization of the diagnostics and therapy that focus not only the symptom of hearing loss, but also the individual pathophysiology and consequences. Only with individualized therapy can the success of treating hearing disorders be significantly improved.

Current trends in outcome studies for children with hearing loss and the need to establish a comprehensive framework of measuring outcomes in children with hearing loss in China

Since the 1970s, outcome studies for children with hearing loss expanded from focusing on assessing auditory awareness and speech perception skills to evaluating language and speech development. Since the early 2000s, the multi-center large scale research systematically studied outcomes in the areas of auditory awareness, speech-perception, language development, speech development, educational achievements, cognitive development, and psychosocial development. These studies advocated the establishment of baseline and regular follow-up evaluations with a comprehensive framework centered on language development. Recent research interests also include understanding the vast differences in outcomes for children with hearing loss, understanding the relationships between neurocognitive development and language acquisition in children with hearing loss, and using outcome studies to guide evidence-based clinical practice. After the establishment of standardized Mandarin language assessments, outcomes research in Mainland China has the potential to expand beyond auditory awareness and speech perception studies.

Neurocognitive factors in sensory restoration of early deafness: a connectome model

Progress in biomedical technology (cochlear, vestibular, and retinal implants) has led to remarkable success in neurosensory restoration, particularly in the auditory system. However, outcomes vary considerably, even after accounting for comorbidity-for example, after cochlear implantation, some deaf children develop spoken language skills approaching those of their hearing peers, whereas other children fail to do so. Here, we review evidence that auditory deprivation has widespread effects on brain development, affecting the capacity to process information beyond the auditory system. After sensory loss and deafness, the brain's effective connectivity is altered within the auditory system, between sensory systems, and between the auditory system and centres serving higher order neurocognitive functions. As a result, congenital sensory loss could be thought of as a connectome disease, with interindividual variability in the brain's adaptation to sensory loss underpinning much of the observed variation in outcome of cochlear implantation. Different executive functions, sequential processing, and concept formation are at particular risk in deaf children. A battery of clinical tests can allow early identification of neurocognitive risk factors. Intervention strategies that address these impairments with a personalised approach, taking interindividual variations into account, will further improve outcomes.