Expressive Vocabulary Predicts Nonverbal Executive Function: A 2-year Longitudinal Study of Deaf and Hearing Children

Language and executive function in Mandarin-speaking deaf and hard-of-hearing children aged 3-5

The study aimed to explore spoken language and executive function (EF) characteristics in 3-5-year-old prelingually deaf and hard-of-hearing (DHH) children, and evaluate the impact of demographic variables and EF on spoken language skills. 48 DHH children and 48 typically developing children who use auditory-oral communication were recruited. All participants underwent EF tests, including auditory working memory (WM), inhibitory control, cognitive flexibility, and the EF performance reported by parents. Using Mandarin Clinical Evaluation of Language for Preschoolers (MCELP), vocabulary comprehension, sentence comprehension, vocabulary naming, sentence structure imitation, and story narration were evaluated only in the DHH group, and their results were compared with the typical developmental level provided by MCELP. Results showed that DHH children exhibit deficiencies in different spoken language domains and EF components. While the spoken language skills of DHH children tend to improve as they age, a growing proportion of individuals fail to reach the typical developmental level. The spoken language ability in DHH children was positively correlated with age and EFs, and negatively correlated with aided hearing threshold, while auditory WM could positively predict their spoken language performance.

A Virtual Reality Platform for Evaluating Deficits in Executive Functions in Deaf and Hard of Hearing Children-Relation to Daily Function and to Quality of Life

Background: Childhood hearing loss is a common chronic condition that may have a broad impact on children's communication and motor and cognitive development, resulting in functional challenges and decreased quality of life (QoL). Objectives: This pilot study aimed to compare executive functions (EFs) as expressed in daily life and QoL between deaf and hard-of-hearing (D/HH) children and children with typical hearing. Furthermore, we examined the relationship between EFs and QoL in D/HH children. Methods: The participants were 76 children aged 7-11 yr: 38 D/HH and 38 with typical hearing. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and Pediatric Quality of Life Inventory (PedsQL), while the child performed a shopping task in the virtual action planning supermarket (VAP-S) to reflect the use of EFs in daily activity. Results: D/HH children showed significantly poorer EFs (as measured by BRIEF and VAP-S) and reduced QoL. Difficulties in EFs were correlated with lower QoL. BRIEF scores were significant predictors of QoL domains. Conclusions: Difficulties in EFs may characterize children with D/HH and reduce their QoL. Therefore, EFs should be screened and treated. VAP-S and BRIEF are feasible tools for evaluating EFs that reflect children's challenges due to EF difficulties in real-life contexts.

The roles of language and executive function in Mandarin-speaking children's theory of mind development

Introduction

Research has indicated that language and executive function relate closely to first-order false belief reasoning, yet their roles in second-order false belief reasoning are under-explored, and their interplay in theory of mind development remains obscure.

Methods

This study assessed 160 Mandarin-speaking preschoolers' and early primary schoolers' language, executive function, and theory of mind abilities to examine the unique roles and interplay of language and executive function in first-order and second-order false belief reasoning.

Results

Results showed that language significantly uniquely predicted the children's first-order as well as second-order false belief reasoning when controlling for the effects of age and executive function. Although executive function significantly predicted first-order FB reasoning when controlling for age, it was no longer a significant predictor of first-order FB reasoning when language was included in the model. However, executive function played a significant unique role in second-order FB reasoning when controlling for the effects of age and language.

Discussion

The current findings suggest that language plays a greater role than executive function in Mandarin-speaking children's theory of mind development and the contributors to theory of mind development vary in different levels of false belief reasoning.

How word meaning structure relates to executive functioning and theory of mind in children with developmental language disorder: A multiple case study

Background and aims

Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD.

Methods

Participants were five children with DLD aged 9-12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories.

Results

For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions.

Conclusions

By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD.

Implications

The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.

Preschool Children with Hearing Loss: Social Communication and Parenting Stress

Studies on parenting stress (PS) in parents of children with hearing loss (HL) have found relationships between child behavior, language skills and parenting stress. The role of early social communication skills has not been researched before. The aim of this cross-sectional study was to investigate the relationship between child behavior, social communication and PS. The study was performed in a subgroup of a total population sample from the AChild (Austrian Children with Hearing Impairment-Longitudinal Databank) study. Preschool children (n = 81) with all degrees of HL and average cognitive functioning and their families were included, and the Parenting Stress Index (PSI) was used. Through factor component analysis, compound scores for externalizing/internalizing problem behavior and hyperactivity were analyzed. Although mean PS was not elevated, the proportion of those with elevated scores was higher compared with the norm population. There was a strong correlation between child behavior problems and PS (strongest correlation: externalizing problem behavior r = 0.643; p < 0.001). All three problem behaviors accounted for 49.7% of the variance in PS. An indirect effect of social communication on PS was almost completely mediated by problem behavior (especially hyperactivity). The importance of social communication development with respect to problem behavior and PS is highlighted.

Early access to language supports number mapping skills in deaf children

The ability to associate different types of number representations referring to the same quantity (symbolic Arabic numerals, signed/spoken number words, and nonsymbolic quantities), is an important predictor of overall mathematical success. This foundational skill-mapping-has not been examined in deaf and hard-of-hearing (DHH) children. To address this gap, we studied 188 4 1/2 to 9-year-old DHH and hearing children and systematically examined the relationship between their language experiences and mapping skills. We asked whether the timing of children's language exposure (early vs. later), the modality of their language (signed vs. spoken), and their rote counting abilities related to mapping performance. We found that language modality did not significantly relate to mapping performance, but timing of language exposure and counting skills did. These findings suggest that early access to language, whether spoken or signed, supports the development of age-typical mapping skills and that knowledge of number words is critical for this development.

How executive functioning, sentence processing, and vocabulary are related at 3 years of age

There is a wealth of evidence demonstrating that executive function (EF) abilities are positively associated with language development during the preschool years, such that children with good executive functions also have larger vocabularies. However, why this is the case remains to be discovered. In this study, we focused on the hypothesis that sentence processing abilities mediate the association between EF skills and receptive vocabulary knowledge, in that the speed of language acquisition is at least partially dependent on a child's processing ability, which is itself dependent on executive control. We tested this hypothesis in longitudinal data from a cohort of 3- and 4-year-old children at three age points (37, 43, and 49 months). We found evidence, consistent with previous research, for a significant association between three EF skills (cognitive flexibility, working memory [as measured by the Backward Digit Span], and inhibition) and receptive vocabulary knowledge across this age range. However, only one of the tested sentence processing abilities (the ability to maintain multiple possible referents in mind) significantly mediated this relationship and only for one of the tested EFs (inhibition). The results suggest that children who are better able to inhibit incorrect responses are also better able to maintain multiple possible referents in mind while a sentence unfolds, a sophisticated sentence processing ability that may facilitate vocabulary learning from complex input.

Cochlear Implants or Hearing Aids: Speech Perception, Language, and Executive Function Outcomes

OBJECTIVES

We aimed to determine whether children with severe hearing loss (HL) who use hearing aids (HAs) may experience added value in the perception of speech, language development, and executive function (EF) compared to children who are hard of hearing (HH) or children who are deaf and who use cochlear implants (CIs) and would benefit from CIs over HAs. The results contribute to the ongoing debate concerning CI criteria. We addressed the following research question to achieve this aim: Do children who are HH or deaf with CIs perform better than children with severe HL with HAs with respect to auditory speech perception, and receptive vocabulary and/or EF?

DESIGN

We compared two groups of children with severe HL, profound HL or deafness, with CIs or HAs, matched for gender, test age (range, 8 to 15 years), socioeconomic status, and nonverbal intelligence quotient. Forty-three children had CIs (pure-tone average at 2000 and 4000 Hz >85 dB HL), and 27 children had HAs (mean pure-tone average: 69 dB HL). We measured speech perception at the conversational level (65 dB SPL) and the soft speech perception level (45 dB SPL). We established receptive vocabulary using the Peabody Picture Vocabulary Test-III-NL. We tested EF using the Delis Kaplan Executive Function System battery and the Dutch Rey Auditory Verbal Learning Test. We employed the Mann-Whitney U test to compare data between the CI and HA groups. We used Chi-square goodness of fit tests to contrast the CI and HA group distributions with the norm data of children who are typically developing (TD). We harnessed Kendall's Tau-b to investigate relationships between the study variables.

RESULTS

Both groups of children, with CIs and Has, obtained ceiling scores for perception of speech on a conversational level. However, the HA group exhibited significantly lower perception on a soft speech level scores (68 %) than the CI group (87%). No difference was present between the receptive vocabulary distributions of the CI and HA groups. The median receptive vocabulary standard scores for both groups were well within the normal range (CI group: 93; HA group: 96). In addition, we did not find any difference in EF between the CI and HA groups. For planning and verbal memory, the distributions of observed scores for children with CIs were different from the expected distributions of children who are TD. In both groups, a large proportion of children obtained below-average scores for planning (CI: 44%; HA: 33%) and for long-term verbal memory (CI: 44%; HA: 35%). In the HA group, perception at a soft speech level was associated with receptive vocabulary and planning. In the CI group, we did not find any associations.

CONCLUSIONS

Both groups of children with severe and profound HL with HAs exhibit less favorable auditory perception on the soft speech level, but not at a conversational level, compared to children who are HH or deaf with CIs. Both groups, children with CIs and HAs, only exhibit more problems in planning and verbal memory than the norm groups of children who are TD. The results indicate that to obtain age-appropriate levels of receptive vocabulary and EF, the perception at the soft speech level is a necessary but not sufficient prerequisite.

Deafness and early language deprivation influence arithmetic performances

It has been consistently reported that deaf individuals experience mathematical difficulties compared to their hearing peers. However, the idea that deafness and early language deprivation might differently affect verbal (i.e., multiplication) vs. visuospatial (i.e., subtraction) arithmetic performances is still under debate. In the present paper, three groups of 21 adults (i.e., deaf signers, hearing signers, and hearing controls) were therefore asked to perform, as fast and as accurately as possible, subtraction and multiplication operations. No significant group effect was found for accuracy performances. However, reaction time results demonstrated that the deaf group performed both arithmetic operations slower than the hearing groups. This group difference was even more pronounced for multiplication problems than for subtraction problems. Weaker language-based phonological representations for retrieving multiplication facts, and sensitivity to interference are two hypotheses discussed to explain the observed dissociation.

Executive functioning and spoken language skills in young children with hearing aids and cochlear implants: Longitudinal findings

Deaf or hard-of-hearing (DHH) children who use auditory-oral communication display considerable variability in spoken language and executive functioning outcomes. Furthermore, language and executive functioning skills are strongly associated with each other in DHH children, which may be relevant for explaining this variability in outcomes. However, longitudinal investigations of language and executive functioning during the important preschool period of development in DHH children are rare. This study examined the predictive, reciprocal associations between executive functioning and spoken language over a 1-year period in samples of 53 DHH and 59 typically hearing (TH) children between ages 3-8 years at baseline. Participants were assessed on measures of receptive spoken language (vocabulary, sentence comprehension, and following spoken directions) and caregiver-completed executive functioning child behavior checklists during two in-person home visits separated by 1 year. In the sample of DHH children, better executive functioning at baseline (Time 1) was associated with better performance on the higher-order language measures (sentence comprehension and following spoken directions) 1 year later (Time 2). In contrast, none of the Time 1 language measures were associated with better executive functioning in Time 2 in the DHH sample. TH children showed no significant language-executive functioning correlations over the 1-year study period. In regression analyses controlling for Time 1 language scores, Time 1 executive functioning predicted Time 2 language outcomes in the combined DHH and TH samples, and for vocabulary, that association was stronger in the DHH than in the TH sample. In contrast, after controlling for Time 1 executive functioning, none of the regression analyses predicting Time 2 executive functioning from Time 1 language were statistically significant. These results are the first findings to demonstrate that everyday parent-rated executive functioning behaviors predict basic (vocabulary) and higher-order (comprehension, following directions) spoken language development 1 year later in young (3-8 year old) DHH children, even after accounting for initial baseline language skills.

Impact of Meeting Early Hearing Detection and Intervention Benchmarks on Spoken Language

This study compared preschool spoken language outcomes for children with hearing loss who met Early Hearing Detection and Intervention (EHDI) guidelines to those who did not, as well as to compare outcomes for those who met current EHDI guidelines to those who met earlier benchmarks. Finally, the predictive role of meeting each component of the guidelines was evaluated relative to language outcomes. Children who met the EHDI guidelines had higher language scores than those who did not; however, there was no difference between children who met the current guidelines and those who met the earlier benchmarks. Entering early intervention by six months of age was the only unique predictor of spoken language outcomes. The findings suggest that EHDI programs should target increasing the number of children with hearing loss who meet the current 1-3-6 benchmarks with a particular focus on enrollment in early intervention by six months.

PROTOCOL: School-based language, math, and reading interventions for executive functions in children and adolescents: A systematic review

This is the protocol for a Campbell systematic review. Our primary objective for this systematic review is to examine if preschool and school-based interventions aimed at improving language, literacy, and/or mathematical skills increase children's and adolescents' executive functions. As a secondary objective, we will examine how the effects of language, literacy, and mathematics interventions on executive functions are moderated by the subject of the intervention, child age or grade, the type of EF measured, and the at-risk status of participants. We will also explore how the effects are moderated by other study characteristics, and estimate the effects of the included interventions on language, literacy, and mathematical skills.

Language development as a mechanism linking socioeconomic status to executive functioning development in preschool

Childhood socioeconomic status (SES) is related to disparities in the development of both language and executive functioning (EF) skills. Emerging evidence suggests that language development may precede and provide necessary scaffolding for EF development in early childhood. The present preregistered study investigates how these skills co-develop longitudinally in early childhood and whether language development explains the relationship between SES and EF development. A socioeconomically diverse sample of 305 children completed repeated assessments of language (sentence comprehension) and EF (cognitive flexibility, behavioral inhibition, and cognitive inhibition) at four waves spaced 9 months apart from ages 3 to 5 years. Bivariate latent curve models with structured residuals were estimated to disaggregate between-person and within-person components of stability and change. Results revealed bidirectional relationships between language and EF across all waves. However, at 3 years, language comprehension more strongly predicted EF than the reverse; yet by 5 years, the bidirectional effects across domains did not significantly differ. Children from higher-SES backgrounds exhibited higher initial language and EF skills than children from lower-SES families, though SES was not associated with either rate of growth. Finally, early language-mediated the association between SES and early EF skills, and this model outperformed a reverse direction mediation. Together, results suggest that EF development is driven by early language development, and that SES disparities in EF are explained, at least in part, by early differences in language comprehension. These findings have implications for early interventions to support children's language skills as a potential pathway to improving early EF development.

Children's knowledge of superordinate words predicts subsequent inductive reasoning

Children's early language knowledge-typically assessed using standardized word comprehension tests or through parental reports-has been positively linked to a variety of later outcomes, from reasoning tests to academic performance to income and health. To better understand the mechanisms behind these links, we examined whether knowledge of certain "seed words"-words with high inductive potential-is positively associated with inductive reasoning. This hypothesis stems from prior work on the effects of language on categorization suggesting that certain words may be important for helping people to deploy categorical hypotheses. Using a longitudinal design, we assessed 36 2- to 4-year-old children's knowledge of 333 words of varying levels of generality (e.g., toy vs. pinwheel, number vs. five). We predicted that adjusting for overall vocabulary, knowledge of more general words (e.g., toy, number) would predict children's performance on inductive reasoning tasks administered 6 months later (i.e., a subset of the Stanford-Binet Intelligence Scales for Early Childhood-Fifth Edition [SB-5] and Woodcock-Johnson Tests of Cognitive Abilities [WJ] concept formation tasks). This prediction was confirmed for one of the measures of inductive reasoning (i.e., the SB-5 but not the WJ) and notably for the task considered to be less reliant on language. Although our experimental design demonstrates only a correlational relationship between seed word knowledge and inductive reasoning ability, our results are consistent with the possibility that early knowledge of certain seed words facilitates performance on putatively nonverbal reasoning tasks.

The Directionality of the Relationship Between Executive Functions and Language Skills: A Literature Review

It has been demonstrated that executive functions play a significant role in different aspects of the development of children. Development of language is also one of the most important accomplishments of the preschool years, and it has been linked to many outcomes in life. Despite substantial research demonstrating the association between executive function and language development in childhood, only a handful of studies have examined the direction of the developmental pathways between EF skills and language skills, therefore little is known about how these two constructs are connected. In this review paper, we discuss three possible directional relationships between EFs and language development throughout childhood. First, we discuss how EF might affect language functioning. Next, we discuss how language functioning might affect EF. Lastly, we consider other possible relationships between EF and language. Given that children with better EF and language skills are more likely to succeed in educational settings and demonstrate greater social–emotional competencies, investigating the relationship between EF and language in the preschool period provides insight into mechanisms that have not been extensively studied. Furthermore, it could create new opportunities for designing effective and efficient interventions aimed at addressing EF and language deficits during the preschool period which could in turn influence later development.

Amount of Hearing Aid Use Impacts Neural Oscillatory Dynamics Underlying Verbal Working Memory Processing for Children With Hearing Loss

OBJECTIVES

Children with hearing loss (CHL) may exhibit spoken language delays and may also experience deficits in other cognitive domains including working memory. Consistent hearing aid use (i.e., more than 10 hours per day) ameliorates these language delays; however, the impact of hearing aid intervention on the neural dynamics serving working memory remains unknown. The objective of this study was to examine the association between the amount of hearing aid use and neural oscillatory activity during verbal working memory processing in children with mild-to-severe hearing loss.

DESIGN

Twenty-three CHL between 8 and 15 years-old performed a letter-based Sternberg working memory task during magnetoencephalography (MEG). Guardians also completed a questionnaire describing the participants' daily hearing aid use. Each participant's MEG data was coregistered to their structural MRI, epoched, and transformed into the time-frequency domain using complex demodulation. Significant oscillatory responses corresponding to working memory encoding and maintenance were independently imaged using beamforming. Finally, these whole-brain source images were correlated with the total number of hours of weekly hearing aid use, controlling for degree of hearing loss.

RESULTS

During the encoding period, hearing aid use negatively correlated with alpha-beta oscillatory activity in the bilateral occipital cortices and right precentral gyrus. In the occipital cortices, this relationship suggested that with greater hearing aid use, there was a larger suppression of occipital activity (i.e., more negative relative to baseline). In the precentral gyrus, greater hearing aid use was related to less synchronous activity (i.e., less positive relative to baseline). During the maintenance period, hearing aid use significantly correlated with alpha activity in the right prefrontal cortex, such that with greater hearing aid use, there was less right prefrontal maintenance-related activity (i.e., less positive relative to baseline).

CONCLUSIONS

This study is the first to investigate the impact of hearing aid use on the neural dynamics that underlie working memory function. These data show robust relationships between the amount of hearing aid use and phase-specific neural patterns during working memory encoding and maintenance after controlling for degree of hearing loss. Furthermore, our data demonstrate that wearing hearing aids for more than ~8.5 hours/day may serve to normalize these neural patterns. This study also demonstrates the potential for neuroimaging to help determine the locus of variability in outcomes in CHL.

Inhibitory Control of Emotional Interference in Deaf Children: Evidence From Event-Related Potentials and Event-Related Spectral Perturbation Analysis

BACKGROUND

Impairment of interference control ability may reflect a more general deficit in executive functioning, and lead to an increase in internal-externalized problems such as impulsivity, which has been reported in deaf children. However, few researches have examined the neural mechanism of this impairment.

METHODS

This study applied the electroencephalogram (EEG) technique to investigate the interference control ability in 31 deaf children and 28 hearing controls with emotional face-word stroop task.

RESULTS

Results from behavioral task showed that deaf children exhibited lower accuracy compared to hearing controls. As for EEG analysis, reduced activation of ERP components in N1 and enhanced activation of ERP components in N450 have been found in deaf children. Besides, incongruent condition elicited larger N450 than congruent condition. Furthermore, for brain oscillation, alpha band (600-800 ms) revealed a reduced desynchronization in deaf children, while theta band (200-400 ms) revealed an enhanced synchronization in deaf children and incongruent condition, which were in line with ERP components.

CONCLUSION

The present findings seem to indicate that the deficit during emotional interference control ability among deaf children might be due to the impaired attention allocation ability and emotional cognitive monitoring function during emotional conflict detection process. Consequently, reduced N1 and enhanced N450 might be due to early attention impairment causing more effort of deaf children later in emotional cognitive monitoring.

Variation in Auditory Experience Affects Language and Executive Function Skills in Children Who Are Hard of Hearing

OBJECTIVE

Children who are hard of hearing (CHH) experience delays in spoken language and executive function, but the mechanisms for these deficits remain unresolved. Differences in auditory experience and language skills have been examined as contributing factors to deficits in executive function, primarily with children who are deaf and children with cochlear implants. The theoretical model of cumulative auditory experience quantifies auditory dosage as how much speech is audible and how often children wear their hearing aids. CHH with higher auditory dosage have better language outcomes than peers with less auditory dosage. However, the effects of auditory experience on executive function have not been studied in CHH. The goal of this study was to examine the influences of auditory experience and language skills on the development of executive function in CHH.

DESIGN

We collected measures of aided speech audibility, hearing aid use, executive function, and receptive vocabulary in 177 CHH and 86 children with typical hearing who were 5- to 10 years old and matched for socioeconomic status and nonverbal intelligence. Auditory dosage was calculated by combining each child's average hours of hearing aid use with their audibility for speech to create a variable that quantifies individual differences in auditory access.

RESULTS

CHH had lower receptive vocabulary and deficits in executive function related to working memory and selective attention compared to peers with typical hearing. CHH with greater auditory dosage had higher receptive vocabulary than CHH with lower auditory dosage. Better receptive vocabulary was associated with better scores on executive function measures related to working memory and attention. Auditory dosage was also directly associated with measures of verbal working memory.

CONCLUSIONS

CHH have deficits in language and some, but not all, areas of executive function related to working memory and attention. Auditory dosage was associated with language abilities and verbal working memory. Language was associated with individual differences in executive function skills related to attention and working memory. These results provide support for systems theories regarding the development of executive function in CHH. Interventions that improve auditory access and language may be effective for improving executive function related to working memory and attention in CHH.

Executive Functions and Deafness: Results in a Group of Cochlear Implanted Children

Objects: This study aimed to evaluate the Executive Function (EF) domains in a group of profoundly deaf children treated with cochlear implant (CI) in comparison to normal hearing (NH) children. The secondary aim was to evaluate the influence exerted by the age at cochlear implant activation on EFs. Materials and Methods: 32 children were enrolled into two groups: group A of 17 CI users with a mean age of 8.78 years and group B of 15 NH subjects with a mean age of 7.99 years (SD + 2.3). All subjects were tested using the following tests: the subtests for working memory of the neuropsychological evaluation battery for the developmental age (Batteria di valutazione neuropsicologica per l’età evolutive), inhibition and control of the impulsive response—CAF, and the tower of London test. Results: No children with CIs scored within the normal range in the tests administered for the evaluation of EF domains. The same scores were significantly lower when compared with scores obtained by NH children. Children with younger age at CI activation showed better executive performances in planning, working memory (backward digit span), and cognitive flexibility (categorical fluency). Conclusion: The results of this study highlight that cochlear implantation plays a role in improving hearing and consequently influences the development of EFs in deaf children.

Executive Function Training for Deaf Children: Impact of a Music Intervention

Several studies have reported poor executive function (EF) development in deaf children with subsequent impacts on their social and academic attainment. This paper describes the results of a music-based EF intervention designed for deaf children and carried out in two sets of primary schools. This is the first classroom-based EF training study with deaf children, and it also incorporates a replication phase. The intervention was a within-subject crossover design, with 29 deaf children aged 7-11 years who participated in both an EF and an art class control activity, each lasting 10 hours over 5 weeks. Non-verbal EF skills were assessed at pre-test, the crossover point, and post-test. Findings indicated that the EF intervention led to an improvement in participants' working memory and inhibitory skills in comparison with their performance on the same tasks after the control activity. The findings were not uniform for all EFs targeted nor for all cognitive ability levels in the sample. We discuss the implications of our findings for deaf children with different ability levels and for how EF interventions can be further improved.

Variables influencing executive functioning in preschool hearing-impaired children implanted within 24 months of age: an observational cohort study

PURPOSE

Executive Functions (EFs) are fundamental to every aspect of life. The present study was implemented to evaluate factors influencing their development in a group of preschools orally educated profoundly deaf children of hearing parents, who received CI within 2 years of age.

METHODS

Twenty-five preschool CI children were tested using the Battery for Assessment of Executive Functions (BAFE) to assess their flexibility, inhibition, and non-verbal visuo-spatial working memory skills. The percentage of children performing in normal range was reported for each of the EF subtests. Mann-Whitney and Kruskal-Wallis were performed to assess differences between gender, listening mode, and degree of parents' education subgroups. The Spearman Rank Correlation Coefficient was calculated to investigate the relationship between EF scores of audiological and linguistic variables.

RESULTS

Percentages ranging from 76 to 92% of the children reached adequate EF scores at BAFE. Significant relations (p < 0.05) were found between EFs and early intervention, listening, and linguistic skills. Furthermore, CI children from families with higher education level performed better at the response shifting, inhibitory control, and attention flexibility tasks. Economic income correlated significantly with flexibility and inhibitory skills. Females performed better than males only in the attention flexibility task.

CONCLUSIONS

The present study is one of the first to focus attention on the development of EFs in preschool CI children, providing an initial understanding of the characteristics of EFs at the age when these skills emerge. Clinical practice must pay increasing attention to these aspects which are becoming the new emerging challenge of rehabilitation programs.

Visual Sequence Repetition Learning is Not Impaired in Signing DHH Children

The auditory scaffolding hypothesis states that early experience with sound underpins the development of domain-general sequence processing abilities, supported by studies observing impaired sequence processing in deaf or hard-of-hearing (DHH) children. To test this hypothesis, we administered a sequence processing task to 77 DHH children who use American Sign Language (ASL) and 23 hearing monolingual children aged 7-12 years and found no performance difference between them after controlling for age and nonverbal intelligence. Additionally, neither spoken language comprehension scores nor hearing loss levels predicted sequence processing scores in the DHH group, whereas ASL comprehension scores did. Our results do not indicate sequence processing deficits in DHH children and do not support the auditory scaffolding hypothesis; instead, these findings suggest that factors related to experience with and/or proficiency in an accessible language during development may be more important determinants of sequence processing abilities.

Deaf Children of Hearing Parents Have Age-Level Vocabulary Growth When Exposed to American Sign Language by 6 Months of Age

OBJECTIVE

To examine whether children who are deaf or hard of hearing who have hearing parents can develop age-level vocabulary skills when they have early exposure to a sign language.

STUDY DESIGN

This cross-sectional study of vocabulary size included 78 children who are deaf or hard of hearing between 8 and 68 months of age who were learning American Sign Language (ASL) and had hearing parents. Children who were exposed to ASL before 6 months of age or between 6 and 36 months of age were compared with a reference sample of 104 deaf and hard of hearing children who have parents who are deaf and sign.

RESULTS

Deaf and hard of hearing children with hearing parents who were exposed to ASL in the first 6 months of life had age-expected receptive and expressive vocabulary growth. Children who had a short delay in ASL exposure had relatively smaller expressive but not receptive vocabulary sizes, and made rapid gains.

CONCLUSIONS

Although hearing parents generally learn ASL alongside their children who are deaf, their children can develop age-expected vocabulary skills when exposed to ASL during infancy. Children who are deaf with hearing parents can predictably and consistently develop age-level vocabularies at rates similar to native signers; early vocabulary skills are robust predictors of development across domains.

The relationship between reasoning and language ability: comparing children with cochlear implants and children with typical hearing

PURPOSE

Language has been suggested to play a facilitating role for analogical reasoning tasks, especially for those with high complexity. This study aims to evaluate if differences in analogical reasoning ability between children with cochlear implants (CI) and children with typical hearing (TH) might be explained by differences in language ability.

METHODS

The analogical reasoning ability (verbal; non-verbal; complex non-verbal: high relational integration demand) of children with CI (N = 15, mean age = 6;7) was compared to two groups of children with TH: age and language matched (TH-A+L, N = 23, mean age = 6;5), and age matched (TH-A, N = 23, mean age = 6;5).

RESULTS

Children with CI were found to perform comparable to Group TH-A+L on non-verbal reasoning tasks but significantly more poorly on a verbal analogical reasoning task. Children with CI were found to perform significantly more poorly on both the non-verbal analogical reasoning task with high relational integration demand and on the verbal analogical reasoning task compared to Group TH-A. For the non-verbal analogical reasoning task with lower relational integration demand only a tendency for a difference between group CI and Group TH-A was found.

CONCLUSIONS

The results suggest that verbal strategies are influencing the performance on the non-verbal analogical reasoning tasks with a higher relational integration demand. The possible reasons for this are discussed. The verbal analogical reasoning task used in the current study partly measured lexical access. Differences between the children with CI and both groups of children with TH might therefore be explained by differences in expressive vocabulary skills.

Do Children With Developmental Language Disorder (DLD) Have Difficulties With Interference Control, Visuospatial Working Memory, and Selective Attention? Developmental Patterns and the Role of Severity and Persistence of DLD

Purpose Many children with developmental language disorder (DLD) have weaknesses in executive functioning (EF), specifically in tasks testing interference control and working memory. It is unknown how EF develops in children with DLD, if EF abilities are related to DLD severity and persistence, and if EF weaknesses expand to selective attention. This study aimed to address these gaps. Method Data from 78 children with DLD and 39 typically developing (TD) children were collected at three times with 1-year intervals. At Time 1, the children were 5 or 6 years old. Flanker, Dot Matrix, and Sky Search tasks tested interference control, visuospatial working memory, and selective attention, respectively. DLD severity was based on children's language ability. DLD persistence was based on stability of the DLD diagnosis. Results Performance on all tasks improved in both groups. TD children outperformed children with DLD on interference control. No differences were found for visuospatial working memory and selective attention. An interference control gap between the DLD and TD groups emerged between Time 1 and Time 2. Severity and persistence of DLD were related to interference control and working memory; the impact on working memory was stronger. Selective attention was unrelated to DLD severity and persistence. Conclusions Age and DLD severity and persistence determine whether or not children with DLD show EF weaknesses. Interference control is most clearly impaired in children with DLD who are 6 years and older. Visuospatial working memory is impaired in children with severe and persistent DLD. Selective attention is spared.

Early Cognitive Predictors of 9-Year-Old Spoken Language in Children With Mild to Severe Hearing Loss Using Hearing Aids

This study examined the extent to which cognitive ability at 5 years of age predicted language development from 5 to 9 years of age in a population-based sample of children with hearing loss who participated in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. The developmental outcomes of 81 children with hearing loss were evaluated at 5 and 9 years of age. Hearing loss ranged from mild to severe degrees, and all participants used hearing aids. They all used spoken language as the primary mode of communication and education. Nine-year-old language was assessed using the Clinical Evaluation of Language Fundamentals – 4th edition (CELF-4), the Peabody Picture Vocabulary Test – 4th edition (PPVT-4), and the Expressive Vocabulary Test – 2nd edition (EVT-2). Multiple regression analyses were conducted to examine the extent to which children’s scores on these standardized assessments were predicted by their cognitive ability (non-verbal IQ and verbal working memory) measured at 5 years of age. The influence of early language scores at 5 years and a range of demographic characteristics on language scores at 9 years of age was evaluated. We found that 5-year-old digit span score was a significant predictor of receptive and expressive language, but not receptive or expressive vocabulary, at 9 years of age. Also, 5-year-old non-word repetition test score was a significant predictor of only expressive language and vocabulary, but not receptive language or vocabulary at 9 years of age. After allowing for the effects of non-verbal IQ and 5-year-old receptive vocabulary, early digit span score (but not non-word repetition score) was a significant predictor of expressive and receptive language scores at 9 years of age. The findings shed light on the unique role of early verbal working memory in predicting the development of receptive and expressive language skills and vocabulary skills in children who use hearing aids.