Morpho-syntactic reading comprehension in children with early and late cochlear implants

Executive functions in preschool and school-age cochlear implant users: do they differ from their hearing peers? A systematic review and meta-analysis

PURPOSE

Executive functions (EF) play a fundamental role in planning and executing goal-driven behaviours. The purpose of this systematic review and meta-analysis was to investigate EF skills mastered by preschool/school-age cochlear implanted children (CIC) without morpho-functional abnormalities and to compare their outcomes with typically hearing children (THC).

METHODS

Bibliographic search for observational studies of any language/date up to 16 December 2022 was performed with the following electronic databases: PubMed, Scopus, and Web of Science. After removal of duplicates, 2442 records were subjected to a three-stage screening process and 83 potentially eligible articles were identified. A total of 15 studies was included in the final analysis: 9 articles directly meeting the eligibility criteria plus 6 more studies thanks to the authors sharing their data set, specifically for participants who met present inclusion criteria.

RESULTS

Meta-analysis showed a statistically significant difference only for verbal short-term memory, whereas group differences for visuospatial short-term memory and verbal/visuospatial working memory were not significant. For fluency skills, meta-analysis revealed statistical significance for the semantic fluency task but not for the rapid naming test. Qualitative analysis reflected group similarities in flexibility but CIC's difficulties in auditory attention/planning skills. Controversial findings for inhibitory control skills were observed.

CONCLUSIONS

EF performance comparisons between CIC and THC show inter-skill and inter-test variances. Due to the paucity of existing studies, present findings should be interpreted with caution. Future research in this domain is strongly recommended.

Morphological Awareness and DHH Students' Reading-Related Abilities: A Meta-Analysis of Correlations

This article presents the first meta-analysis on correlations of morphological awareness (MA) with reading-related abilities in deaf and hard-of-hearing (DHH) students (k = 14, N = 556). The results showed high mean correlations of MA with all three reading-related abilities: rs = 0.610, 0.712, and 0.669 (all ps < 0.001), respectively, for word reading, vocabulary knowledge, and reading comprehension. A set of moderator analysis was conducted of language, DHH students' age/reading stage and degree of hearing loss, and task type. The correlation of MA with word reading was significantly stronger in alphabetic than in non-alphabetic languages, and for fluency than accuracy; for vocabulary knowledge, the correlation was significantly stronger for production MA tasks than for judgment tasks; for reading comprehension, derivational MA tasks showed a stronger correlation than those having a mixed focus on inflection and derivation. While no other moderator effects were significant, the correlations for subsets of effect sizes were largely high for a moderator. These findings reaffirmed the importance of morphology in DHH students' reading development. The present synthesis, while evidencing major development of research on the metalinguistic underpinnings of reading in DHH students, also showed that the literature on MA is still very limited.

The Importance of Morphological Knowledge in the Reading Comprehension Difficulties in a Highly Agglutinative Language: Evidence from Poor Comprehenders

This study examined the importance of morphological knowledge in the reading comprehension difficulties of poor comprehenders reading in a highly agglutinative language, Turkish. Participants were 56 students recruited from the second and third grades. In the assessment process, we applied three experimental paradigms addressing the participants' morphological and morpho-syntactical knowledge at the lexical and the supralexical levels. Data were collected in individual sessions and analyzed by running a series of GLM ANOVAs and calculating the Spearman-Brown correlation coefficient. Findings suggest morphological knowledge is an important indicator of reading comprehension difficulties in Turkish, a highly agglutinative language. The acquisition of adequate reading comprehension seems to be modified by particularities of the morphological knowledge.

Did the three little pigs frighten the wolf? How deaf readers use lexical and syntactic cues to comprehend sentences

BACKGROUND

The ways in which students with deafness process syntactic and semantic cues while reading sentences are unclear. While some studies have supported the preference for semantic cues, others have not.

AIM

To examine differences in the processing of syntactic versus semantic cues during sentence reading among students who are deaf or hard of hearing (DHH).

METHOD

Twenty DHH students (mean age = 12.48 years) and 20 chronologically age-matched students with typical hearing (TH) were asked to read sentences written in Spanish with different grammatical structures and to choose the picture that best matched the sentences' meaning while their eye movements were being registered. The picture options were manipulated so that, in addition to the correct ones, there were lexical distractors and syntactic distractors.

RESULTS

The TH participants outperformed the DHH participants in reading complex sentences but not simple sentences in the active voice. In the correctly answered trials, both groups fixated longer and made more fixations on the target than on the syntactic distractor than on the lexical distractor. DHH participants made significantly longer fixations on the lexical distractions.

CONCLUSIONS

Our results did not support a strict preference for either lexical or semantic cues in the DHH participants.

Cochlear Implantation

BACKGROUND

Hearing impairment that is too severe to be adequately treated with conventional hearing aids can lead, in children, to severe developmental disturbances of hearing and language, and, in adults, to communicative and social deprivation. Recent advances in medical device technology and in microsurgical techniques have led to an expansion of the indications for cochlear implantation (CI) for adults with progressive hearing loss in older age, and to a restructuring of the process of care for these patients in Germany.

METHODS

This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on the CI guidelines and CI "white book" of the German Society of Otolaryngology and Head and Neck Surgery.

RESULTS

Early and accurate diagnosis is crucial for the successful auditory rehabilitation of high-grade hearing impairment. In children, a key role is played by newborn auditory screening, which is mandatory in Germany and enables the provision of a CI in the first year of life when necessary. 86% of the children receiving a CI achieve linguistic comprehension of fluently spoken sentences. For adults, positive prognostic factors for hearing after the provision of a CI include a highly motivated patient, "postlingual" onset of the hearing impairment (i.e., after the acquisition of language), and a brief duration of deafness. Auditory rehabilitation is associated with significant improvement, not just of hearing and of the comprehension of spoken language, but also of quality of life, particularly in elderly patients. For patients of any age with bilateral hearing loss, CIs should be provided on both sides, if possible. The more common complications of the procedure, with a probability of 2-4% each, are technical implant defects, dizziness, and wound-healing disturbances.

CONCLUSION

Cochlear implantation, performed in specialized centers, is a safe and reliable technique and regularly enables the successful rehabilitation of hearing in both children and adults.

The Effect of Syntactic Impairment on Errors in Reading Aloud: Text Reading and Comprehension of Deaf and Hard of Hearing Children

Deaf and Hard of Hearing (DHH) children show difficulties in reading aloud and comprehension of texts. Here, we examined the hypothesis that these reading difficulties are tightly related to the syntactic deficit displayed by DHH children. We first assessed the syntactic abilities of 32 DHH children communicating in spoken language (Hebrew) aged 9;1-12;2. We classified them into two groups of DHH children-with and without a syntactic deficit according to their performance in six syntactic tests assessing their comprehension and production of sentences with syntactic movement. We also assessed their reading at the single word level using a reading aloud test of words, nonwords, and word pairs, designed to detect the various types of dyslexia, and established, for each participant, whether they had dyslexia and of what type. Following this procedure, 14 of the children were identified with a syntactic deficit, and 15 with typical syntax (3 marginally impaired); 22 of the children had typical reading at the word level, and 4 had dyslexia (3 demonstrated sublexical reading). The main experiment examined reading aloud and comprehension of 6 texts with syntactic movement (which contained, e.g., relative clauses and topicalized sentences), in comparison to 6 parallel texts without movement. The results indicated a close connection between syntactic difficulties and errors in reading aloud and in comprehension of texts. The DHH children with syntactic deficit made significantly more errors in reading aloud and more comprehension errors than the DHH children with intact syntax (and than the hearing controls), even though most of them did not have dyslexia at the word level. The DHH children with syntactic deficit made significantly more reading errors when they read texts with syntactic movement than on matched texts without movement. These results indicate that difficulties in text reading, manifesting both in errors in reading aloud and in impaired comprehension, may stem from a syntactic deficit and may occur even when reading at the word level is completely intact.

Reading and Theory of Mind in Adolescents with Cochlear Implant

Previous research has shown a possible link between reading comprehension and theory of mind (ToM), but these findings are unclear in adolescents with cochlear implants (CI). In the present study, reading comprehension and ToM were assessed in adolescents with CI and the relation between both skills was also studied. Two sessions were performed on two groups of adolescents aged between 12 and 16 years of age (36 adolescents with CI and 54 participants with typical hearing, TH). They were evaluated by means of a standardized reading battery, a false belief task, and Faux Pas stories. The results indicated that reading and cognitive ToM were more developed in the TH group than in adolescents with CI. However, early-CI and binaural group performance were close to the TH group in narrative and expository comprehension and cognitive ToM. The results also indicated that cognitive ToM and reading comprehension appear to be related in deaf adolescents.

A sensitive period in the neural phenotype of language in blind individuals

Congenital blindness modifies the neural basis of language: "visual" cortices respond to linguistic information, and fronto-temporal language networks are less left-lateralized. We tested the hypothesis that this plasticity follows a sensitive period by comparing the neural basis of sentence processing between adult-onset blind (AB, n = 16), congenitally blind (CB, n = 22) and blindfolded sighted adults (n = 18). In Experiment 1, participants made semantic judgments for spoken sentences and, in a control condition, solved math equations. In Experiment 2, participants answered "who did what to whom" yes/no questions for grammatically complex (with syntactic movement) and simpler sentences. In a control condition, participants performed a memory task with non-words. In both experiments, visual cortices of CB and AB but not sighted participants responded more to sentences than control conditions, but the effect was much larger in the CB group. Only the "visual" cortex of CB participants responded to grammatical complexity. Unlike the CB group, the AB group showed no reduction in left-lateralization of fronto-temporal language network, relative to the sighted. These results suggest that congenital blindness modifies the neural basis of language differently from adult-onset blindness, consistent with a developmental sensitive period hypothesis.

Effects of Age at Cochlear Implantation on Learning and Cognition: A Critical Assessment

Purpose Age at cochlear implantation frequently is assumed to be a key predictor of pediatric implantation benefits, but outcomes related to learning and cognition appear inconsistent. This critical assessment examines relevant literature in an effort to evaluate the impact of age at implantation in those domains for individuals who received their devices as children. Method We examined 44 peer-reviewed articles from 2003 to 2018 considering age at implantation and conducted statistical analyses regarding its impact on several domains, including literacy, academic achievement, memory, and theory of mind. Results Across 167 assessments in various experiments and conditions, only 21% of the analyses related to age at implantation yielded evidence in favor of earlier implantation, providing greater benefits to academic achievement, learning, or cognition compared to implantation later in childhood. Among studies that considered cognitive processing (e.g., executive function, memory, visual-spatial functioning), over twice as many analyses indicated significant benefits of earlier implantation when it was considered as a discrete rather than a continuous variable. Conclusion Findings raise methodological, practical, and theoretical questions concerning how "early" is defined in studies concerning early cochlear implantation, the impact of confounding factors, and the use of nonstandard outcome measures. The present results and convergent findings from other studies are discussed in terms of the larger range of variables that need to be considered in evaluating the benefits of cochlear implantation and question the utility of considering age at implantation as a "gold standard" with regard to evaluating long-term outcomes of the procedure as a medical treatment/intervention for hearing loss. Supplemental Material https://doi.org/10.23641/asha.8323625.

Influencia de las habilidades lingüísticas en las estrategias lectoras de estudiantes sordos

El presente estudio examina, por un lado, la relación entre el uso de implantes cocleares (ICs) y los mecanismos implicados en la adquisición de la lectura en estudiantes sordos con y sin implante coclear, especialmente en aquellos que han recibido el implante de forma precoz, y por otro, los mecanismos que subyacen al aprendizaje de la lectura y las bases lingüísticas implicadas (sintaxis y vocabulario). Algunos estudios han puesto de manifiesto el uso continuo de la Estrategia de Palabras Clave en las personas sordas. Esta estrategia consiste en identificar las palabras con contenido semántico propio e ignorar las palabras funcionales. Fueron evaluados 172 estudiantes sordos y 797 estudiantes oyentes mediante una prueba que determina el nivel lector y tres pruebas, que evalúan el tipo de estrategia empleada en la lectura, y la competencia sintáctica y de vocabulario. Los resultados muestran que los estudiantes sordos, incluido el grupo de implantados precoces, usan la Estrategia de Palabras Clave. El uso de esta estrategia se debe a dificultades lingüísticas y una baja capacidad para manejar palabras funcionales. El grado de pérdida auditiva para alumnos con ICs, la edad de implantación y el nivel lector alcanzado (en todos los grupos de sordos) desempeña un papel importante en el uso de la Estrategia de Palabras Clave. En esta situación, se derivan algunas implicaciones educativas.

How Do Deaf Children With and Without Cochlear Implants Manage to Read Sentences: The Key Word Strategy

The aim of this study is to examine the mechanisms used by deaf children with and without cochlear implants (CIs) to read sentences and the linguistic bases (vocabulary and syntax) underlying those reading mechanisms. Previous studies have shown that deaf persons read sentences using the key word strategy (KWS), which consists of identifying some frequent content words and ignoring the function words. The present results show that deaf children, including those wearing CIs from an early age, do use the KWS. It is also shown that this tendency is related with a linguistic deficiency, especially with a poor ability to deal with function words. Furthermore, the age of implantation, and the degree of hearing loss for children without CIs, plays an important role in using the KWS. Some pedagogical consequences of this situation are considered.

Reading Function and Content Words in Subtitled Videos

In this study, we examined how function and content words are read in intra- and interlingual subtitles. We monitored eye movements of a group of 39 deaf, 27 hard of hearing, and 56 hearing Polish participants while they viewed English and Polish videos with Polish subtitles. We found that function words and short content words received less visual attention than longer content words, which was reflected in shorter dwell time, lower number of fixations, shorter first fixation duration, and lower subject hit count. Deaf participants dwelled significantly longer on function words than other participants, which may be an indication of their difficulty in processing this type of words. The findings are discussed in the context of classical reading research and applied research on subtitling.

Semantic and syntactic reading comprehension strategies used by deaf children with early and late cochlear implantation

Deaf students have traditionally exhibited reading comprehension difficulties. In recent years, these comprehension problems have been partially offset through cochlear implantation (CI), and the subsequent improvement in spoken language skills. However, the use of cochlear implants has not managed to fully bridge the gap in language and reading between normally hearing (NH) and deaf children, as its efficacy depends on variables such as the age at implant. This study compared the reading comprehension of sentences in 19 children who received a cochlear implant before 24 months of age (early-CI) and 19 who received it after 24 months (late-CI) with a control group of 19 NH children. The task involved completing sentences in which the last word had been omitted. To complete each sentence children had to choose a word from among several alternatives that included one syntactic and two semantic foils in addition to the target word. The results showed that deaf children with late-CI performed this task significantly worse than NH children, while those with early-CI exhibited no significant differences with NH children, except under more demanding processing conditions (long sentences with infrequent target words). Further, the error analysis revealed a preference of deaf students with early-CI for selecting the syntactic foil over a semantic one, which suggests that they draw upon syntactic cues during sentence processing in the same way as NH children do. In contrast, deaf children with late-CI do not appear to use a syntactic strategy, but neither a semantic strategy based on the use of key words, as the literature suggests. Rather, the numerous errors of both kinds that the late-CI group made seem to indicate an inconsistent and erratic response when faced with a lack of comprehension. These findings are discussed in relation to differences in receptive vocabulary and short-term memory and their implications for sentence reading comprehension.