Early listening and speaking skills predict later reading proficiency in pediatric cochlear implant users

Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment

OBJECTIVES

To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years.

METHODS

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

RESULTS

The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children.

CONCLUSIONS

In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.

Effects of Segmental and Suprasegmental Speech Perception on Reading in Pediatric Cochlear Implant Recipients

PURPOSE

The aim of this study was to determine whether suprasegmental speech perception contributes unique variance in predictions of reading decoding and comprehension for prelingually deaf children using two devices, at least one of which is a cochlear implant (CI).

METHOD

A total of 104, 5- to 9-year-old CI recipients completed tests of segmental perception (e.g., word recognition in quiet and noise, recognition of vowels and consonants in quiet), suprasegmental perception (e.g., talker and stress discrimination, nonword stress repetition, and emotion identification), and nonverbal intelligence. Two years later, participants completed standardized tests of reading decoding and comprehension. Using regression analyses, the unique contribution of suprasegmental perception to reading skills was determined after controlling for demographic characteristics and segmental perception performance.

RESULTS

Standardized reading scores of the CI recipients increased with nonverbal intelligence for both decoding and comprehension. Female gender was associated with higher comprehension scores. After controlling for gender and nonverbal intelligence, segmental perception accounted for approximately 4% and 2% of the variance in decoding and comprehension, respectively. After controlling for nonverbal intelligence, gender, and segmental perception, suprasegmental perception accounted for an extra 4% and 7% unique variance in reading decoding and reading comprehension, respectively.

CONCLUSIONS

Suprasegmental perception operates independently from segmental perception to facilitate good reading outcomes for these children with CIs. Clinicians and educators should be mindful that early perceptual skills may have long-term benefits for literacy. Research on how to optimize suprasegmental perception, perhaps through hearing-device programming and/or training strategies, is needed.

Long-Term Device Satisfaction and Safety after Cochlear Implantation in Children

(1) Objectives: For full benefit in children implanted with a cochlear implant (CI), wearing the device all waking hours is necessary. This study focuses on the relationship between daily use and audiological outcomes, with the hypothesis that frequent daily device use coincides with high device satisfaction resulting in better functional gain (FG). Confounding factors such as implantation age, device experience and type of device were considered. (2) Results: Thirty-eight CI children (65 ears) were investigated. In total, 76.92% of the children were using their device for >12 h per day (h/d), 18.46% for 9−12 h/d, the remaining for 6−9 h/d and one subject reported 3 h/d. The revision rate up to the 90-month follow-up (F/U) was 4.6%. The mean FG was 59.00 ± 7.67 dB. The Audio Processor Satisfaction Questionnaire (APSQ) separated for single unit (SU) versus behind the ear (BTE) devices showed significantly better results for the latter in terms of wearing comfort (WC) (p = 0.00062). A correlation between device use and FG was found with a device experience of <2 years (n = 29; r2 = 0.398), whereas no correlation was seen with ≥2 years of device experience (n = 36; r2 = 0.0038). (3) Conclusion: This study found significant relationships between daily device use and FG, wearing comfort and long-term safety (90 months).

Predictors of Word and Text Reading Fluency of Deaf Children in Bilingual Deaf Education Programmes

Reading continues to be a challenging task for most deaf children. Bimodal bilingual education creates a supportive environment that stimulates deaf children’s learning through the use of sign language. However, it is still unclear how exposure to sign language might contribute to improving reading ability. Here, we investigate the relative contribution of several cognitive and linguistic variables to the development of word and text reading fluency in deaf children in bimodal bilingual education programmes. The participants of this study were 62 school-aged (8 to 10 years old at the start of the 3-year study) deaf children who took part in bilingual education (using Dutch and Sign Language of The Netherlands) and 40 age-matched hearing children. We assessed vocabulary knowledge in speech and sign, phonological awareness in speech and sign, receptive fingerspelling ability, and short-term memory at time 1 (T1). At times 2 (T2) and 3 (T3), we assessed word and text reading fluency. We found that (1) speech-based vocabulary strongly predicted word and text reading at T2 and T3, (2) fingerspelling ability was a strong predictor of word and text reading fluency at T2 and T3, (3) speech-based phonological awareness predicted word reading accuracy at T2 and T3 but did not predict text reading fluency, and (4) fingerspelling and STM predicted word reading latency at T2 while sign-based phonological awareness predicted this outcome measure at T3. These results suggest that fingerspelling may have an important function in facilitating the construction of orthographical/phonological representations of printed words for deaf children and strengthening word decoding and recognition abilities.

Differences and Similarities in the Contributions of Phonological Awareness, Orthographic Knowledge and Semantic Competence to Reading Fluency in Chinese School-Age Children With and Without Hearing Loss

Compared with the large number of studies on reading of children with hearing loss (HL) in alphabetic languages, there are only a very limited number of studies on reading of Chinese-speaking children with HL. It remains unclear how phonological, orthographic, and semantic skills contribute to reading fluency of Chinese school-age children with HL. The present study explored this issue by examining the performances of children with HL on reading fluency and three linguistic skills compared with matched controls with normal hearing (NH). Specifically, twenty-eight children with HL and 28 chronological-age-matched children with NH were tested on word/sentence reading fluency (WRF/SRF), phonological awareness (PA) which was composed of onset/vowel/lexical tone awareness, orthographic knowledge (OK), and semantic competence (SC) which comprised animal word identification, pseudo-homophone detection, and word segmentation. Results showed that children with HL lagged behind their peers with NH in WRF/SRF and most of the phonological, orthographic, and semantic subskills except onset awareness and pseudo-homophone detection. Furthermore, the significant contributors to WRF differed between the two groups with PA being the significant contributor in the children with NH while OK being the significant contributor in the children with HL. However, the significant contributor to SRF did not differ between the two groups with SC being the only significant contributor. These results revealed not only between-group differences but also similarities in the relative contributions of PA, OK, and SC to reading fluency at both word and sentence levels, which has practical implications for developing better training programs to improve reading for children with HL.

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.

Phonological Awareness Skills in Children With Early and Late Cochlear Implantation: Effects of Task and Phonological Unit

Purpose Phonological awareness (PA) skills are critical for spoken language acquisition and literacy. PA manifests in various skills that can be identified based on task performance and speech sound unit size. This study compared the PA skills of children with early cochlear implantation (E-CI), children with late cochlear implantation (L-CI), and children with typical hearing (TH) in relation to task and phonological unit. It also attempted to identify the significant predictors of PA skills in each CI and TH group. Method Twenty children with E-CI, 20 children with L-CI, and 20 children with TH participated in this study. PA skills were assessed using elision, blending, and segmenting tasks at both the syllabic and phonemic levels. Results The E-CI and L-CI groups performed significantly less well than the TH group on the elision and blending tasks at the syllabic level. However, the E-CI group performed at a similar level as the TH group in the segmenting tasks at both the syllabic and phonemic levels. The regression analysis identified age at implantation and receptive vocabulary scores as significant predictors of PA skills in children with CIs. Conclusions Although all the children with CIs had age-appropriate receptive vocabulary skills, the PA skills of both the E-CI and L-CI groups tended to lag behind those of the TH group in the elision and blending tasks at the syllabic level. Age at implantation and receptive vocabulary skills affected the development of PA skills in children with CIs.

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.

Home Literacy Environment and Emergent Skills in Preschool Children With Hearing Loss

Home literacy practices reported by parents of preschool children with hearing loss were compared to those reported by parents of their peers with typical hearing. Parents completed a questionnaire from Boudreau, D. (2005. Use of a parent questionnaire in emergent and early literacy assessment of preschool children. Language, Speech, and Hearing Services in Schools, 36, 33-47. doi:10.1044/0161-1461(2005/004)) assessing home literacy practices across areas such as parent facilitation of literacy and time spent reading per week. As part of a larger study, children completed language and emergent literacy assessments. Parents of both groups reported similar amounts of time spent reading to their children and scored similarly on report of parent facilitation of literacy, even though children with hearing loss scored lower on measures of emergent literacy. However, parents of children with typical hearing reported that their children had higher engagement and interest in books than children with hearing loss. Additionally, only child engagement with books was correlated with emergent literacy skills and only for children with hearing loss. The results suggest that parent facilitation of literacy alone is not correlated with emergent literacy scores; children must take an active role in their reading development. Children with hearing loss must be active participants during shared book reading. It is therefore essential to develop ways to actively engage children with hearing loss during reading activities.

Improving oral sentence production in children with cochlear implants: effects of equivalence-based instruction and matrix training

ᅟ: Children who use cochlear implants (CI) and who are readers usually produce more accurate speech in response to text than to pictures. Equivalence-based instruction (EBI) can be a route to establish functional interdependence between these verbal operants. The present study investigated whether children with CI who read would improve speech accuracy when tacting pictures of scenes after EBI that included dictated sentences, pictures of scenes, and printed sentences. This study evaluated whether teaching verbal relations to diagonal sentences from a matrix with subject-verb-object combinations promoted recombinative generalization to untrained sentences. Participants were three children with CI with a more accurate speech when reading print than when tacting pictures of scenes. They were taught to select pictures of scenes in response to dictated sentences (AB) by matching-to-sample (MTS) and to construct printed sentences in response to dictated sentences (AE) by constructed-response-matching-to-sample (CRMTS). Speech production in response to print (CD) and in response to pictures of scenes (BD) were probed for both trained and untrained sentences, using a multiple baseline design across participants. All participants learned the trained relations, showed emergence of derived relations, and improved speech accuracy when tacting pictures of scenes. They were able to recombine sentence components and tact novel pictures using untrained sentences from the matrix. These results indicate that speech accuracy and generative sentence production can be improved in children with CI from interventions that incorporate EBI and matrix training. TRIAL REGISTRATION: CAAE#01454412.0.0000.5441 registered 01/29/2013.

Literacy Outcomes in Deaf Students with Cochlear Implants: Current State of the Knowledge

The purpose of this paper is to examine the available peer-reviewed research regarding literacy achievement in deaf children with cochlear implants. A related goal is to identify gaps in the empirical literature and suggest directions for future research. Included in this review are studies that exclusively report reading and writing outcomes for groups of students. A total of 21 studies were identified, representing those published over approximately a 20-year time period (1997-2016) and collectively reporting the literacy outcomes for over 1,000 cochlear implant users. Overall findings of the studies of reading comprehension suggest that the majority of participants achieved scores in the average range, although a wide-range of variability was reported. Only 3 studies of writing were available for review, with 2 reporting lower achievement in this area as compared to reading. Factors impacting outcomes achieved such as age at implantation, presence of additional disabilities, consistency of device use, and communication modality are explored and summarized.

Altering Practices to Include Bimodal-bilingual (ASL-Spoken English) Programming at a Small School for the Deaf in Canada

Bimodal-bilingual programs are emerging as one way to meet broader needs and provide expanded language, educational and social-emotional opportunities for students who are deaf and hard of hearing (Marschark, M., Tang, G. & Knoors, H. (Eds). (2014). Bilingualism and bilingual Deaf education. New York, NY: Oxford University Press; Paludneviciene & Harris, R. (2011). Impact of cochlear implants on the deaf community. In Paludneviciene, R. & Leigh, I. (Eds.), Cochlear implants evolving perspectives (pp. 3-19). Washington, DC: Gallaudet University Press). However, there is limited research on students' spoken language development, signed language growth, academic outcomes or the social-emotional factors associated with these programs (Marschark, M., Tang, G. & Knoors, H. (Eds). (2014). Bilingualism and bilingual Deaf education. New York, NY: Oxford University Press; Nussbaum, D & Scott, S. (2011). The cochlear implant education center: Perspectives on effective educational practices. In Paludneviciene, R. & Leigh, I. (Eds.) Cochlear implants evolving perspectives (pp. 175-205). Washington, DC: Gallaudet University Press. The cochlear implant education center: Perspectives on effective educational practices. In Paludnevicience & Leigh (Eds). Cochlear implants evolving perspectives (pp. 175-205). Washington, DC: Gallaudet University Press; Spencer, P. & Marschark, M. (Eds.) (2010). Evidence-based practice in educating deaf and hard-of-hearing students. New York, NY: Oxford University Press). The purpose of this case study was to look at formal and informal student outcomes as well as staff and parent perceptions during the first 3 years of implementing a bimodal-bilingual (ASL and spoken English) program within an ASL milieu at a small school for the deaf. Speech and language assessment results for five students were analyzed over a 3-year period and indicated that the students made significant positive gains in all areas, although results were variable. Staff and parent survey responses indicated primarily positive perceptions of the program. Some staff identified ongoing challenges with balancing signed and spoken language use. Many parents responded with strong emotions, some stating that the program was "life-changing" for their children/families.

Development of Grammatical Accuracy in English-Speaking Children With Cochlear Implants: A Longitudinal Study

PURPOSE

We sought to evaluate the development of grammatical accuracy in English-speaking children with cochlear implants (CIs) over a 3-year span.

METHOD

Ten children who received CIs before age 30 months participated in this study at 3, 4, and 5 years postimplantation. For the purpose of comparison, 10 children each at ages 3, 4, and 5 years with typical hearing were included as well. All children participated in a story-retell task. We computed percent grammatical communication units (PGCU) in the task.

RESULTS

Children with CIs showed significant improvement in PGCU over the 3-year span. However, they produced lower PGCU than children with typical hearing who had matched hearing age at 4 and 5 years postimplantation. At the individual level, some children with CIs were able to produce PGCU comparable to children with typical hearing as early as 3 years after implantation. Better speech-perception skills at earlier time points were associated with higher PGCU at later time points. Moreover, children with and without CIs showed similar rankings in the types of grammatical errors.

CONCLUSION

Despite having auditory-perceptual and information-processing constraints, children who received CIs before age 30 months were able to produce grammatical sentences, albeit with a delayed pattern.

Concurrent and Longitudinal Predictors of Reading for Deaf and Hearing Children in Primary School

Forty-one children with severe-profound prelingual hearing loss were assessed on single word reading, reading comprehension, English vocabulary, phonological awareness and speechreading at three time points, 1 year apart (T1-T3). Their progress was compared with that of a group of hearing children of similar nonverbal IQ, initially reading at the same level. Single word reading improved at each assessment point for the deaf children but there was no growth in reading comprehension from T2 to T3. There were no differences between children with cochlear implants and those with hearing aids on either reading measure but orally educated children had higher scores than children who signed in the classroom. English vocabulary and speechreading were the most consistent longitudinal predictors of reading for the deaf children. Phonological awareness was the most consistent longitudinal predictor for the hearing group and also a concurrent predictor of reading at T3 for both groups. There were many more significant correlations among the various measures for the deaf children than the hearing at both T1 and T3, suggesting that skills underpinning reading, including phonological awareness and vocabulary, are more closely related for deaf children. Implications of these findings for of deaf children's literacy are explored.

Literacy Outcomes for Primary School Children Who Are Deaf and Hard of Hearing: A Cohort Comparison Study

PURPOSE

In this study, we compared the language and literacy of two cohorts of children with severe-profound hearing loss, recruited 10 years apart, to determine if outcomes had improved in line with the introduction of newborn hearing screening and access to improved hearing aid technology.

METHOD

Forty-two children with deafness, aged 5-7 years with a mean unaided loss of 102 DB, were assessed on language, reading, and phonological skills. Their performance was compared with that of a similar group of 32 children with deafness assessed 10 years earlier and also a group of 40 children with normal hearing of similar single word reading ability.

RESULTS

English vocabulary was significantly higher in the new cohort although it was still below chronological age. Phonological awareness and reading ability had not significantly changed over time. In both cohorts, English vocabulary predicted reading, but phonological awareness was only a significant predictor for the new cohort.

CONCLUSIONS

The current results show that vocabulary knowledge of children with severe-profound hearing loss has improved over time, but there has not been a commensurate improvement in phonological skills or reading. They suggest that children with severe-profound hearing loss will require continued support to develop robust phonological coding skills to underpin reading.

Comprehension of texts by deaf elementary school students: The role of grammatical understanding

BACKGROUND

The aim of this study was to analyze how the reading process of deaf Spanish elementary school students is affected both by those components that explain reading comprehension according to the Simple View of Reading model: decoding and linguistic comprehension (both lexical and grammatical) and by other variables that are external to the reading process: the type of assistive technology used, the age at which it is implanted or fitted, the participant's socioeconomic status and school stage.

DESIGN

Forty-seven students aged between 6 and 13 years participated in the study; all presented with profound or severe prelingual bilateral deafness, and all used digital hearing aids or cochlear implants. Students' text comprehension skills, decoding skills and oral comprehension skills (both lexical and grammatical) were evaluated.

RESULTS

Logistic regression analysis indicated that neither the type of assistive technology, age at time of fitting or activation, socioeconomic status, nor school stage could predict the presence or absence of difficulties in text comprehension. Furthermore, logistic regression analysis indicated that neither decoding skills, nor lexical age could predict competency in text comprehension; however, grammatical age could explain 41% of the variance. Probing deeper into the effect of grammatical understanding, logistic regression analysis indicated that a participant's understanding of reversible passive object-verb-subject sentences and reversible predicative subject-verb-object sentences accounted for 38% of the variance in text comprehension.

CONCLUSIONS

Based on these results, we suggest that it might be beneficial to devise and evaluate interventions that focus specifically on grammatical comprehension.

Reading skills in Persian deaf children with cochlear implants and hearing aids

OBJECTIVES

Reading skills are necessary for educational development in children. Many studies have shown that children with hearing loss often experience delays in reading. This study aimed to examine reading skills of Persian deaf children with cochlear implant and hearing aid and compare them with normal hearing counterparts.

METHOD

The sample consisted of 72 s and third grade Persian-speaking children aged 8-12 years. They were divided into three equal groups including 24 children with cochlear implant (CI), 24 children with hearing aid (HA), and 24 children with normal hearing (NH). Reading performance of participants was evaluated by the "Nama" reading test. "Nama" provides normative data for hearing and deaf children and consists of 10 subtests and the sum of the scores is regarded as reading performance score.

RESULTS

Results of ANOVA on reading test showed that NH children had significantly better reading performance than deaf children with CI and HA in both grades (P < 0.001). Post-hoc analysis, using Tukey test, indicated that there was no significant difference between HA and CI groups in terms of non-word reading, word reading, and word comprehension skills (respectively, P = 0.976, P = 0.988, P = 0.998).

CONCLUSION

Considering the findings, cochlear implantation is not significantly more effective than hearing aid for improvement of reading abilities. It is clear that even with considerable advances in hearing aid technology, many deaf children continue to find literacy a challenging struggle.

Schooling Relates to Mental Health Problems in Adolescents with Cochlear Implants-Mediation by Hearing and Family Variables

Aim of this multicenter study was to investigate whether schooling relates to mental health problems of adolescents with cochlear implants (CI) and how this relationship is mediated by hearing and family variables. One hundred and forty secondary school students with CI (mean age = 14.7 years, SD = 1.5), their hearing parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ). Additional audiological tests (speech comprehension tests in quiet and noise) were performed. Students of special schools for hearing impaired persons (SSHIs) showed significantly more conduct problems (p < 0.05) and a significantly higher total difficulty score (TDS) (p < 0.05) compared to students of mainstream schools. Mental health problems did not differ between SSHI students with sign language education and SSHI students with oral education. Late implanted students and those with indication for additional handicaps were equally distributed among mainstream schools and SSHIs. However, students in SSHIs were more restricted to understand speech in noise, had a lower social background and were more likely to come from single-parent families. These factors were found to be partial mediators of the differences in mental health problems between the two school types. However, no variable could explain comprehensively, why students of SSHIs have more mental health problems than mainstream pupils.

Academic Outcomes for School-Aged Children With Severe-Profound Hearing Loss and Early Unilateral and Bilateral Cochlear Implants

PURPOSE

This study sought to (a) determine whether academic outcomes for children who received early cochlear implants (CIs) are age appropriate, (b) determine whether bilateral CI use significantly improves academic outcomes, and (c) identify other factors that are predictive of these outcomes.

METHOD

Forty-four 8-year-old children with severe-profound hearing loss participated in this study. Their academic development in mathematics, oral language, reading, and written language was assessed using a standardized test of academic achievement.

RESULTS

(a) Across all academic areas, the proportion of children in the average or above-average ranges was lower than expected for children with normal hearing. The strongest area of performance was written language, and the weakest was mathematics. (b) Children using bilateral CIs achieved significantly higher scores for oral language, math, and written language, after controlling for predictive factors, than did children using unilateral CIs. Younger ages at second CI predicted the largest improvements. (c) High levels of parental involvement and greater time spent by children reading significantly predicted academic success, although other factors were identified.

CONCLUSIONS

Average academic outcomes for these children were below those of children with normal hearing. Having bilateral CIs at younger ages predicted the best outcomes. Family environment was also important to children's academic performance.

Oral communicating children using a cochlear implant: good reading outcomes are linked to better language and phonological processing abilities

INTRODUCTION/OBJECTIVE

Cochlear implantation provides children with a significant hearing loss the potential to engage in phonological processing via audition; however these children can still have poor or inadequately detailed mental (phonological) representations of speech and as such phonological awareness and reading difficulties. Heterogeneous participant profiles, particularly varying modes of communication have clouded the research regarding reading outcomes of children using a cochlear implant. The objective of this study was to explore the relationships between word reading and reading comprehension outcomes, and a range of variables of a relatively homogenous group of children using cochlear implants.

METHOD

Forty-seven oral communicating children using a cochlear implant and who had attended auditory-verbal therapy served as participants. They were administered a comprehensive battery of 10 different assessments covering 22 different tasks across the domains of speech perception, speech production, language, phonological processing and reading. Correlation and principal component analyses were used to examine the relationships between outcome areas.

RESULTS

Audiologic and demographic variables were not significantly related to reading outcomes, with the exception of family size. Language and word reading were most strongly related to reading comprehension, while phonological awareness and language were most strongly related to word reading. It is proposed that the development of well-specified phonological representations might underlie these relationships.

CONCLUSION

For oral communicating children using a cochlear implant, good reading outcomes are linked to better language and phonological processing abilities.

Measuring phonological awareness in deaf and hard-of-hearing children

PURPOSE

This study evaluated psychometric properties of 2 phonological awareness (PA) tests normed for hearing children when used with deaf and hard-of-hearing (DHH) children with functional hearing. It also provides an in-depth description of these children's PA.

METHOD

One hundred and eight DHH children (mean age = 63.3 months) with cochlear implants or hearing aids were assessed in the fall and spring of the school year. Sixty-three percent communicated only with spoken language; 37% communicated with both sign and speech. Examiners administered PA subtests from the Phonological Awareness Test-2 and the Test of Preschool Early Literacy, along with assessments of speech perception and early literacy.

RESULTS

Item analyses indicated that both tests showed good psychometric properties (e.g., high item discriminations and internal consistencies). DHH children scored higher on subtests and items that measured words, rhymes, and syllables than those that assessed phonemes. Although subtest difficulty influenced the factor structure in the fall, spring PA was best characterized as a single factor. PA correlated concurrently and predictively with early literacy.

CONCLUSIONS

This study suggests that these 2 standardized tests are valid for use with DHH children with functional hearing. Although delayed, these children's PA was structurally similar to that of hearing children.

Comparison of reading skills between children with cochlear implants and children with typical hearing in Iran

OBJECTIVE

Cochlear implantation has significant effects on language abilities and reading skills. The current study compared the reading performance of children with cochlear implants with that of typically developing children in second and third grades.

SUBJECTS AND METHODS

This descriptive-analytic study was performed including 24 children with cochlear implants and 24 typically developing peers. The grade range of the participants was second and third grades. All of students were selected from Tehran city elementary schools. The reading performance of children was assessed by the "Nama" reading test.

RESULTS

The results showed that the means of reading scores of typically developed children were significantly greater than the children with cochlear implants (P < 0.01) and there was a significant relationship between reading skills and age of surgery (P < 0.05). Also, there was a significant relationship between reading skills and the period of cochlear implantation (P < 0.05).

CONCLUSIONS

Children with cochlear implants showed a weak performance in reading skills in comparison to typically developing children due to lower accessibility to phonological information. However, this limitation can be compensated for partly by early surgery. Parents should refer their deaf children for cochlear implantation before the age of language learning.

Acquisition of tense marking in English-speaking children with cochlear implants: a longitudinal study

This study investigated the development of tense markers (e.g., past tense -ed) in children with cochlear implants (CIs) over a 3-year span. Nine children who received CIs before 30 months of age participated in this study at three, four, and five years postimplantation. Nine typical 3-, 4-, and 5-year- olds served as control groups. All children participated in a story-retell task. Percent correct of tense marking in the task was computed. Within the groups, percent correct of tense marking changed significantly in children with CIs and in typical children who had more hearing experience. Across the groups, children with CIs were significantly less accurate in tense marking than typical children at four and five years postimplantation. In addition, the performance of tense marking in children with CIs was correlated with their speech perception skills at earlier time points. Errors of tense marking tended to be omission rather than commission errors in typical children as well as in children with CIs. The findings suggested that despite the perceptual and processing constraints, children who received CIs may learn tense marking albeit with a delayed pattern.

Influence of implantation age on school-age language performance in pediatric cochlear implant users

OBJECTIVE

This study examined specific spoken language abilities of 160 children with severe-to-profound sensorineural hearing loss followed prospectively 4, 5, or 6 years after cochlear implantation.

STUDY SAMPLE

Ninety-eight children received implants before 2.5 years, and 62 children received implants between 2.5 and 5 years of age.

DESIGN

Language was assessed using four subtests of the Comprehensive Assessment of Spoken Language (CASL). Standard scores were evaluated by contrasting age of implantation and follow-up test time.

RESULTS

Children implanted under 2.5 years of age achieved higher standard scores than children with older ages of implantation for expressive vocabulary, expressive syntax, and pragmatic judgments. However, in both groups, some children performed more than two standard deviations below the standardization group mean, while some scored at or well above the mean.

CONCLUSIONS

Younger ages of implantation are associated with higher levels of performance, while later ages of implantation are associated with higher probabilities of continued language delays, particularly within subdomains of grammar and pragmatics. Longitudinal data from this cohort study demonstrate that after 6 years of implant experience, there is large variability in language outcomes associated with modifiers of rates of language learning that differ as children with implants age.

Growing up with a cochlear implant: education, vocation, and affiliation

The long-term educational/vocational, affiliation, and quality-of-life outcomes of the first and second cohorts of children with bilateral, profound hearing loss who received cochlear implants under a large National Institutes of Health-funded study was investigated in 41 of 61 eligible participants. Educational and vocational outcomes were collected from user survey data. Affiliation and quality-of-life data were collected from the Satisfaction-with-Life scale and the Deaf Identity Scale. Qualitative results indicated that compared with their hearing, adult-age peers, this group obtained high educational achievement, and they reported a very high satisfaction of life. With respect to forming an identity in these first 2 cohorts of cochlear implant users, we found that most of the individuals endorsed a dual identity, which indicates they feel just as comfortable with Deaf individuals as they do with hearing individuals. Quantitative results revealed a significant relationship between ability to hear and ability to speak, in addition to consistency of device use. Additional relationships were found between mother's and the individual's educational statuses, hearing scores, and communication system used. Younger individuals scored higher on satisfaction-with-life measures, and they also tended to endorse a dual identity more often. Taken together, these findings diminish concerns that profoundly deaf individuals growing up with cochlear implants will become culturally bereft and unable to function in the hearing world.

Phonological awareness and print knowledge of preschool children with cochlear implants

PURPOSE

To determine whether preschool-age children with cochlear implants have age-appropriate phonological awareness and print knowledge and to examine the relationships of these skills with related speech and language abilities.

METHOD

The sample comprised 24 children with cochlear implants (CIs) and 23 peers with normal hearing (NH), ages 36 to 60 months. Children's print knowledge, phonological awareness, language, speech production, and speech perception abilities were assessed.

RESULTS

For phonological awareness, the CI group's mean score fell within one standard deviation of the Test of Preschool Early Literacy's (Lonigan, Wagner, Torgesen, & Rashotte, 2007) normative sample mean but was more than one standard deviation below the NH group mean. The CI group's performance did not differ significantly from that of the NH group for print knowledge. For the CI group, phonological awareness and print knowledge were significantly correlated with language, speech production, and speech perception. Together these predictor variables accounted for 34% of variance in the CI group's phonological awareness but no significant variance in their print knowledge.

CONCLUSIONS

Children with CIs have the potential to develop age-appropriate early literacy skills by preschool age but are likely to lag behind their NH peers in phonological awareness. Intervention programs serving these children should target these skills with instruction and by facilitating speech and language development.

Rehabilitation and educational considerations for children with cochlear implants

A growing number of children with severe-to-profound hearing loss are receiving cochlear implants. This article provides information about the various educational and rehabilitation options for these children, emphasizing the need for a collaborative approach to rehabilitation planning and implementation. Decisions about such options should be individualized and are informed by several factors including age at implantation and family expectations and desires. A review of legislation affecting the education of children with hearing loss is also provided.

Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria

Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.

Reading, writing, and phonological processing skills of adolescents with 10 or more years of cochlear implant experience

OBJECTIVES

This study had three goals: (1) to document the literacy skills of deaf adolescents who received cochlear implants (CIs) as preschoolers; (2) to examine reading growth from elementary grades to high school; (3) to assess the contribution of early literacy levels and phonological processing skills, among other factors, to literacy levels in high school.

DESIGN

A battery of reading, spelling, expository writing, and phonological processing assessments were administered to 112 high school (CI-HS) students, ages 15.5 to 18.5 yrs, who had participated in a reading assessment battery in early elementary grades (CI-E), ages 8.0 to 9.9 yrs. The CI-HS students' performance was compared with either a control group of hearing peers (N = 46) or hearing norms provided by the assessment developer.

RESULTS

Many of the CI-HS students (47 to 66%) performed within or above the average range for hearing peers on reading tests. When compared with their CI-E performance, good early readers were also good readers in high school. Importantly, the majority of CI-HS students maintained their reading levels over time compared with hearing peers, indicating that the gap in performance was, at the very least, not widening for most students. Written expression and phonological processing tasks posed a great deal of difficulty for the CI-HS students. They were poorer spellers, poorer expository writers, and displayed poorer phonological knowledge than hearing age-mates. Phonological processing skills were a critical predictor of high school literacy skills (reading, spelling, and expository writing), accounting for 39% of variance remaining after controlling for child, family, and implant characteristics.

CONCLUSIONS

Many children who receive CIs as preschoolers achieve age-appropriate literacy levels as adolescents. However, significant delays in spelling and written expression are evident compared with hearing peers. For children with CIs, the development of phonological processing skills is not just important for early reading skills, such as decoding, but is critical for later literacy success as well.

Longitudinal patterns of emerging literacy in beginning deaf and hearing readers

The emerging reading and spelling abilities of 24 deaf and 23 hearing beginning readers were followed over 2 years. The deaf children varied in their language backgrounds and preferred mode of communication. All children were given a range of literacy, cognitive and language-based tasks every 12 months. Deaf and hearing children made similar progress in literacy in the beginning stages of reading development and then their trajectories began to diverge. The longitudinal correlates of beginning reading in the deaf children were earlier vocabulary, letter-sound knowledge, and speechreading. Earlier phonological awareness was not a longitudinal correlate of reading ability once earlier reading levels were controlled. Only letter name knowledge was longitudinally related to spelling ability. Speechreading was also a strong longitudinal correlate of reading and spelling in the hearing children. The findings suggested that deaf and hearing children utilize slightly different reading strategies over the first 2 years of schooling.

Long-term language levels and reading skills in mandarin-speaking prelingually deaf children with cochlear implants

The aim of this study was to document receptive and expressive language levels and reading skills achieved by Mandarin-speaking children who had received cochlear implants (CIs) and used them for 4.75-7.42 years. The effects of possible associated factors were also analyzed. Standardized Mandarin language and reading tests were administered to 39 prelingually deaf children with Nucleus 24 devices. The Mandarin Chinese version of the Peabody Picture Vocabulary Test was used to assess their receptive vocabulary knowledge and the Revised Primary School Language Assessment Test for their receptive and expressive language skills. The Graded Chinese Character Recognition Test was used to test their written word recognition ability and the Reading Comprehension Test for their reading comprehension ability. Raw scores from both language and reading measurements were compared to normative data of nor- mal-hearing children to obtain standard scores. The results showed that the mean standard score for receptive vocabulary measurement and the mean T scores for the receptive language, expressive language and total language measurement were all in the low-average range in comparison to the normative sample. In contrast, the mean T scores for word and text reading comprehension were almost the same as for their age-matched hearing counterparts. Among all children with CIs, 75.7% scored within or above the normal range of their age-matched hearing peers on receptive vocabulary measurement. For total language, Chinese word recognition and reading scores, 71.8, 77 and 82% of children with CIs were age appropriate, respectively. A strong correlation was found between language and reading skills. Age at implantation and sentence perception scores account for 37% of variance for total language outcome. Sentence perception scores and preimplantation residual hearing were revealed to be associated with the outcome of reading comprehension. We concluded that by using standard tests, the language development and reading skill of Mandarin-speaking children who use CIs from a young age appear to fall within the normal range of their hearing age mates, at least after 4.8-7.4 years of experience. However, to fully evaluate the fine linguistic skills of these subjects, a more detailed study and longer follow-up period are needed.

The Importance of the Home Literacy Environment for Developing Literacy Skills in Young Children Who Are Deaf or Hard of Hearing

Four-year-old Olivia, who is deaf and has used a cochlear implant for 3 years, and her mother, Laura, enjoy looking at storybooks together at home. During storybook reading, Laura notices that Olivia tries to imitate some words that she reads to her yet does not seem to understand many words or story events. Laura is unsure whether to stop the storybook interaction and encourage Olivia’s attempts at word imitation and directly teach her the new vocabulary or continue reading the story for pleasure. Olivia’s preschool teacher, Ms. Lynn, also notices that Olivia displays a keen interest in storybook reading but is not able to answer or ask simple questions about the story. What can Laura and Ms. Lynn do collaboratively to support Olivia’s emerging language and literacy skills to better prepare Olivia for her upcoming transition into kindergarten?

Language development in children after receiving bilateral cochlear implants between 5 and 18 months

OBJECTIVE

The objective of this study was to examine receptive and expressive language development in children who received simultaneous bilateral cochlear implants (CIs) between 5 and 18 months of age and to compare the results with language development in chronologically age-matched children with normal hearing.

METHODS

The study used a prospective, longitudinal matched-group design. Data were collected in a clinical setting at postoperative cochlear implant check-ups after 3, 6, 9, 12, 18, 24, 36, and 48 months of implant use. The sample included 42 children: 21 cochlear implant users and 21 with normal hearing, matched pairwise according to gender and chronological age. Communication assessments included the LittlEARS questionnaire, the Mullen Scale of Early Learning, and the Minnesota Child Development Inventory.

RESULTS

The cochlear implant users' hearing function according to LittlEARS was comparable to that of normal-hearing children within 9 months post-implantation. The mean scores after 9 and 12 months were 31 and 33, respectively in the prelingually deaf versus 31 and 34 in the normal-hearing children. The children's receptive and expressive language scores showed that after 12-48 months with cochlear implants, 81% had receptive language skills within the normative range and 57% had expressive language skills within the normative range. The number of children who scored within the normal range increased with increasing CI experience.

CONCLUSIONS

The present study showed that prelingually deaf children's ability to develop complex expressive and receptive spoken language after early bilateral implantation appears promising. The majority of the children developed language skills at a faster pace than their hearing ages would suggest and over time achieved expressive and receptive language skills within the normative range.

Long-term outcomes of cochlear implantation in the preschool years: from elementary grades to high school

The objective of this study was to document the development of speech, language, and reading skills between primary and secondary school ages in children who received cochlear implants during preschool years. Subjects were a sample of 85 North American adolescents recruited from a larger sample of 181 participants from a previous investigation. Students were first tested in early elementary school (ages eight to nine years) and were re-evaluated in high school (ages 15-18 years) for this study. The methods used were: performance on a battery of speech perception, language, and reading tests. These were compared at both test ages and significant predictors of outcome level identified through multiple regression analysis. Speech perception scores improved significantly with long-term cochlear implant use. Average language scores improved at a faster than normal rate, but reading scores did not quite keep pace with normal development. Performance in high school was most highly correlated with scores obtained in elementary grades. In addition, better outcomes were associated with lower PTA cochlear implant threshold, younger age at implantation and higher nonverbal IQ. In conclusion, early cochlear implantation had a long-term positive impact on auditory and verbal development, but did not result in age-appropriate reading levels in high school for the majority of students.

Evaluating phonological processing skills in children with prelingual deafness who use cochlear implants

This study investigated the phonological processing skills of 29 children with prelingual, profound hearing loss with 4 years of cochlear implant experience. Results were group matched with regard to word-reading ability and mother's educational level with the performance of 29 hearing children. Results revealed that it is possible to obtain a valid measure of phonological processing (PP) skills in children using CIs. They could complete rhyming tasks and were able to complete sound-based tasks using standard test materials provided by a commercial test distributor. The CI children completed tasks measuring PP, but there were performance differences between the CI users and the hearing children. The process of learning phonological awareness (PA) for the children with CIs was characterized by a longer, more protracted learning phase than their counterparts with hearing. Tests of phonological memory skills indicated that when the tasks were controlled for presentation method and response modality, there were no differences between the performance of children with CIs and their counterparts with hearing. Tests of rapid naming revealed that there were no differences between rapid letter and number naming between the two groups. Results yielded a possible PP test battery for children with CI experience.