Developmental Social Cognitive Neuroscience: Insights From Deafness

Cross-modal plasticity in children with cochlear implant: converging evidence from EEG and functional near-infrared spectroscopy

Over the first years of life, the brain undergoes substantial organization in response to environmental stimulation. In a silent world, it may promote vision by (i) recruiting resources from the auditory cortex and (ii) making the visual cortex more efficient. It is unclear when such changes occur and how adaptive they are, questions that children with cochlear implants can help address. Here, we examined 7-18 years old children: 50 had cochlear implants, with delayed or age-appropriate language abilities, and 25 had typical hearing and language. High-density electroencephalography and functional near-infrared spectroscopy were used to evaluate cortical responses to a low-level visual task. Evidence for a 'weaker visual cortex response' and 'less synchronized or less inhibitory activity of auditory association areas' in the implanted children with language delays suggests that cross-modal reorganization can be maladaptive and does not necessarily strengthen the dominant visual sense.

Social perception in deaf individuals: A meta-analysis of neuroimaging studies

Deaf individuals may report difficulties in social interactions. However, whether these difficulties depend on deafness affecting social brain circuits is controversial. Here, we report the first meta-analysis comparing brain activations of hearing and (prelingually) deaf individuals during social perception. Our findings showed that deafness does not impact on the functional mechanisms supporting social perception. Indeed, both deaf and hearing control participants recruited regions of the action observation network during performance of different social tasks employing visual stimuli, and including biological motion perception, face identification, action observation, viewing, identification and memory for signs and lip reading. Moreover, we found increased recruitment of the superior-middle temporal cortex in deaf individuals compared with hearing participants, suggesting a preserved and augmented function during social communication based on signs and lip movements. Overall, our meta-analysis suggests that social difficulties experienced by deaf individuals are unlikely to be associated with brain alterations but may rather depend on non-supportive environments.

Cognition Assessment Technologies on Deaf People

In recent years there has been a growing interest in research about the different ways of processing and consolidating cognition in deaf people. It is known that hearing loss can lead to differences in some executive functions like control inhibitory or working memory. This literature review describes executive functions in deaf people and how they could be evaluated through technological devices complementing traditional assessments, like neuropsychological batteries. We identified biometric devices, digital and physical interfaces, and software from the literature, whose goal is to design or adapt technology to assess some cognition domains in several ways. The results of the review suggest the need to understand the cognitive phenomenon that significantly impacts the context of deaf people; moreover, it becomes relevant as a line of research in the Cognitive Science of Hearing. Using technologies to measure them and gain a better understanding of cognition in deaf people may provide possibilities for designing or adapting targeted educational or therapeutic strategies.

The socialization of modality capital in sign language ecologies: A classroom example

Gaze behavior is an important component of children’s language, cognitive, and sociocultural development. This is especially true for young deaf children acquiring a signed language—if they are not looking at the language model, they are not getting linguistic input. Deaf caregivers engage their deaf infants and toddlers using visual and tactile strategies to draw in, support, and promote their child’s visual attention; we argue that these caregiver actions create a developmental niche that establishes the visual modality capital their child needs for successful sign language learning. But most deaf children do not have deaf signing parents (reportedly over 90%) and they will need to rely on adult signing teachers if they are to acquire a signed language at an early age. This study examines classroom interactions between a Deaf teacher, her teacher’s aide, and six deaf preschoolers to document the teachers’ “everyday practices” as they socialize the gaze behavior of these children. Utilizing a detailed behavioral and linguistic analysis of two video-recorded book-sharing contexts, we present data summarizing the teacher’s attention-getting actions directed toward the children and the discourse-embedded cues that signal the teacher’s expectations for student participation in the signed conversation. We observed that the teacher’s behaviors differed according to the parent status of the deaf preschooler (Deaf parents vs. hearing parents) suggesting that Deaf children of Deaf parents arrive to the preschool classroom with well-developed self-regulation of their attention or gaze. The teachers also used more physical and explicit cueing with the deaf children of hearing parents—possibly to promote their ability to leverage the visual modality for sign language acquisition. We situate these socialization patterns within a framework that integrates notions of intuitive or indigenous practices, developmental niche, and modality capital. Implications for early childhood deaf education are also discussed.

Deaf Children Need Rich Language Input from the Start: Support in Advising Parents

Bilingual bimodalism is a great benefit to deaf children at home and in schooling. Deaf signing children perform better overall than non-signing deaf children, regardless of whether they use a cochlear implant. Raising a deaf child in a speech-only environment can carry cognitive and psycho-social risks that may have lifelong adverse effects. For children born deaf, or who become deaf in early childhood, we recommend comprehensible multimodal language exposure and engagement in joint activity with parents and friends to assure age-appropriate first-language acquisition. Accessible visual language input should begin as close to birth as possible. Hearing parents will need timely and extensive support; thus, we propose that, upon the birth of a deaf child and through the preschool years, among other things, the family needs an adult deaf presence in the home for several hours every day to be a linguistic model, to guide the family in taking sign language lessons, to show the family how to make spoken language accessible to their deaf child, and to be an encouraging liaison to deaf communities. While such a support program will be complicated and challenging to implement, it is far less costly than the harm of linguistic deprivation.

Just listen to your mind: Consequences of theory of mind development for deaf or hard-of-hearing children

BACKGROUND

Previous research reveals relations between theory of mind (ToM) and cognitive outcomes, but mostly among typically developing children.

AIM

To study these relations in children with developmental difficulties, this longitudinal study investigated the cognitive consequences of ToM in deaf or hard-of-hearing (DHH) children.

METHODS AND PROCEDURES

One hundred and thirty-four (X = 9.2 years) participants were assessed in three waves, i.e., one wave every ten months. The participants completed the ToM scale, language and literacy skills (LLS) tests, the academic self-concept in language (ASC-L) questionnaire, and the sensitivity to criticism measure.

OUTCOMES AND RESULTS

The results revealed that high levels of children's ToM ability predicted higher levels of LLS 20 months later. Mediators of this association were sensitivity to criticism and ASC-L. Controlling for LLS at T1, ASC-L at T2 mediated the relations between ToM and LLS at T3. Moreover, sensitivity to criticism predicted ASC-L, and sensitivity to criticism and ASC-L mediated the relation between ToM and LLS at T3. That is, children who were sensitive to criticism and held positive views of their academic self were also better skilled in ToM and in LLS.

CONCLUSIONS AND IMPLICATIONS

Our results can help improve the education of DHH students.

Predicting Quality of Life and Behavior and Emotion from Functional Auditory and Pragmatic Language Abilities in 9-Year-Old Deaf and Hard-of-Hearing Children

Children who are deaf or hard of hearing (DHH) are likely to exhibit difficulties in development of psychosocial skills, pragmatic language skills, and use of hearing for social communication in real-world environments. Some evidence suggests that pragmatic language use affects peer-relationships and school engagement in these children. However, no studies have investigated the influence of functional auditory performance and use of language and speech in real-world environments on children's behavior and emotion, and on their health-related quality of life. This study explored the relationship in DHH children at 9 years of age. Data from 144 participants of the Longitudinal Outcomes of Children with Hearing Impairment study were analyzed. Parent reports were obtained on quality of life, behavior and emotion, pragmatic language skills, and auditory functional performance of children in real life. Children's spoken language abilities and speech intelligibility were assessed by research speech pathologists. On average, performance of children in all domains was within the range of typically developing peers. There were significant associations among functional auditory performance, use of speech and language skills, psychosocial skills, and quality of life. Multiple linear regression analyses revealed that better auditory functional performance and pragmatic language skills, rather than structural language abilities, were associated with better psychosocial abilities and quality of life. The novel findings highlight the importance of targeted intervention for improving functional hearing skills and social communication abilities in DHH children, and emphasize the importance of collaborative approaches among medical, audiology, allied health, and educational professionals to identify those at risk so that timely referral and intervention can be implemented for improving psychosocial health and well-being in DHH children.

Atypical Resting-State Functional Connectivity of Intra/Inter-Sensory Networks Is Related to Symptom Severity in Young Boys With Autism Spectrum Disorder

Autism spectrum disorder (ASD) has been reported to have altered brain connectivity patterns in sensory networks, assessed using resting-state functional magnetic imaging (rs-fMRI). However, the results have been inconsistent. Herein, we aimed to systematically explore the interaction between brain sensory networks in 3–7-year-old boys with ASD (N = 29) using independent component analysis (ICA). Participants were matched for age, head motion, and handedness in the MRI scanner. We estimated the between-group differences in spatial patterns of the sensory resting-state networks (RSNs). Subsequently, the time series of each RSN were extracted from each participant’s preprocessed data and associated estimates of interaction strength between intra- and internetwork functional connectivity (FC) and symptom severity in children with ASD. The auditory network (AN), higher visual network (HVN), primary visual network (PVN), and sensorimotor network (SMN) were identified. Relative to TDs, individuals with ASD showed increased FC in the AN and SMN, respectively. Higher positive connectivity between the PVN and HVN in the ASD group was shown. The strength of such connections was associated with symptom severity. The current study might suggest that the abnormal connectivity patterns of the sensory network regions may underlie impaired higher-order multisensory integration in ASD children, and be associated with social impairments.

Rapid development of perceptual gaze control in hearing native signing Infants and children

Children's gaze behavior reflects emergent linguistic knowledge and real-time language processing of speech, but little is known about naturalistic gaze behaviors while watching signed narratives. Measuring gaze patterns in signing children could uncover how they master perceptual gaze control during a time of active language learning. Gaze patterns were recorded using a Tobii X120 eye tracker, in 31 non-signing and 30 signing hearing infants (5-14 months) and children (2-8 years) as they watched signed narratives on video. Intelligibility of the signed narratives was manipulated by presenting them naturally and in video-reversed ("low intelligibility") conditions. This video manipulation was used because it distorts semantic content, while preserving most surface phonological features. We examined where participants looked, using linear mixed models with Language Group (non-signing vs. signing) and Video Condition (Forward vs. Reversed), controlling for trial order. Non-signing infants and children showed a preference to look at the face as well as areas below the face, possibly because their gaze was drawn to the moving articulators in signing space. Native signing infants and children demonstrated resilient, face-focused gaze behavior. Moreover, their gaze behavior was unchanged for video-reversed signed narratives, similar to what was seen for adult native signers, possibly because they already have efficient highly focused gaze behavior. The present study demonstrates that human perceptual gaze control is sensitive to visual language experience over the first year of life and emerges early, by 6 months of age. Results have implications for the critical importance of early visual language exposure for deaf infants. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=2ahWUluFAAg.

Coordinating attention requires coordinated senses

From playing basketball to ordering at a food counter, we frequently and effortlessly coordinate our attention with others towards a common focus: we look at the ball, or point at a piece of cake. This non-verbal coordination of attention plays a fundamental role in our social lives: it ensures that we refer to the same object, develop a shared language, understand each other's mental states, and coordinate our actions. Models of joint attention generally attribute this accomplishment to gaze coordination. But are visual attentional mechanisms sufficient to achieve joint attention, in all cases? Besides cases where visual information is missing, we show how combining it with other senses can be helpful, and even necessary to certain uses of joint attention. We explain the two ways in which non-visual cues contribute to joint attention: either as enhancers, when they complement gaze and pointing gestures in order to coordinate joint attention on visible objects, or as modality pointers, when joint attention needs to be shifted away from the whole object to one of its properties, say weight or texture. This multisensory approach to joint attention has important implications for social robotics, clinical diagnostics, pedagogy and theoretical debates on the construction of a shared world.

The Impact of Pragmatic Delays for Deaf and Hard of Hearing Students in Mainstream Classrooms

Increasingly, across the globe, deaf and hard of hearing (DHH) students are educated in mainstream schools using spoken language for communication. Classroom interactions require the use of sophisticated pragmatic language skills. Pragmatic skills can be delayed in DHH students and create challenges for the social and emotional adjustment of DHH students at school. School-aged DHH children may present to pediatric health care providers with concerns about communicating effectively and forming friendships with hearing school peers. This review of pragmatic research between school-aged DHH students and their typically hearing peers reveals that this group of students displays some well-developed pragmatic skills such as turn taking, questioning, seeking general clarifications, and using a range of turn types. In it, we identify key areas in which DHH students experience significant challenges in both the social use of language and expository interactions (involving descriptions or explanations) that characterize classroom communication. DHH students tend to dominate interactions and have challenges with being contingent on their partners' contributions. In addition, many DHH students display some difficulty with sequencing instructions and may use referents poorly, making it difficult for peers to follow their instructions and fully grasp their meaning. The conversation model is presented in this article as a guide for pediatric health care providers, clinicians, educators, and parents and/or caregivers to understand these pragmatic challenges. The model guides medical and education practitioners with the development of targeted intervention that will support these students' ability to interact with others, learn more effectively, and develop friendships.

Enhanced gaze-following behavior in Deaf infants of Deaf parents

Gaze following plays a role in parent-infant communication and is a key mechanism by which infants acquire information about the world from social input. Gaze following in Deaf infants has been understudied. Twelve Deaf infants of Deaf parents (DoD) who had native exposure to American Sign Language (ASL) were gender-matched and age-matched (±7 days) to 60 spoken-language hearing control infants. Results showed that the DoD infants had significantly higher gaze-following scores than the hearing infants. We hypothesize that in the absence of auditory input, and with support from ASL-fluent Deaf parents, infants become attuned to visual-communicative signals from other people, which engenders increased gaze following. These findings underscore the need to revise the 'deficit model' of deafness. Deaf infants immersed in natural sign language from birth are better at understanding the signals and identifying the referential meaning of adults' gaze behavior compared to hearing infants not exposed to sign language. Broader implications for theories of social-cognitive development are discussed. A video abstract of this article can be viewed at https://youtu.be/QXCDK_CUmAI.

Environmental Learning of Social Cues: Evidence From Enhanced Gaze Cueing in Deaf Children

The susceptibility to gaze cueing in deaf children aged 7-14 years old (N = 16) was tested using a nonlinguistic task. Participants performed a peripheral shape-discrimination task, whereas uninformative central gaze cues validly or invalidly cued the location of the target. To assess the role of sign language experience and bilingualism in deaf participants, three groups of age-matched hearing children were recruited: bimodal bilinguals (vocal and sign-language, N = 19), unimodal bilinguals (two vocal languages, N = 17), and monolinguals (N = 14). Although all groups showed a gaze-cueing effect and were faster to respond to validly than invalidly cued targets, this effect was twice as large in deaf participants. This result shows that atypical sensory experience can tune the saliency of a fundamental social cue.

Exploring in Silence: Hearing and Deaf Infants Explore Objects Differently before Cochlear Implantation

Infant development has rarely been informed by the behavior of infants with sensory differences despite increasing recognition that infant behavior itself creates sensory learning opportunities. The purpose of this study of object exploration was to compare the behavior of hearing and deaf infants, with and without cochlear implants, in order to identify the effects of profound sensorineural hearing loss on infant exploration before cochlear implantation, the behavioral effects of access to auditory feedback after cochlear implantation, and the sensory motivation for exploration behaviors performed by hearing infants as well. The results showed that 9-month-old deaf infants explored objects as often as hearing infants but they used systematically different approaches and less variation before compared to after cochlear implantation. Potential associations between these early experiences and later learning are discussed in the context of embodied developmental theory, comparative studies, and research with adults. The data call for increased recognition of the active sensorimotor nature of infant learning and future research that investigates differences in sensorimotor experience as potential mechanisms in later learning and sequential memory development.

Neural Correlates of Sensory Abnormalities Across Developmental Disabilities

Abnormalities in sensory processing are a common feature of many developmental disabilities (DDs). Sensory dysfunction can contribute to deficits in brain maturation, as well as many vital functions. Unfortunately, while some patients with DD benefit from the currently available treatments for sensory dysfunction, many do not. Deficiencies in clinical practice surrounding sensory dysfunction may be related to lack of understanding of the neural mechanisms that underlie sensory abnormalities. Evidence of overlap in sensory symptoms between diagnoses suggests that there may be common neural mechanisms that mediate many aspects of sensory dysfunction. Thus, the current manuscript aims to review the extant literature regarding the neural correlates of sensory dysfunction across DD in order to identify patterns of abnormality that span diagnostic categories. Such anomalies in brain structure, function, and connectivity may eventually serve as targets for treatment.

American Sign Language Syntax and Analogical Reasoning Skills Are Influenced by Early Acquisition and Age of Entry to Signing Schools for the Deaf

Failing to acquire language in early childhood because of language deprivation is a rare and exceptional event, except in one population. Deaf children who grow up without access to indirect language through listening, speech-reading, or sign language experience language deprivation. Studies of Deaf adults have revealed that late acquisition of sign language is associated with lasting deficits. However, much remains unknown about language deprivation in Deaf children, allowing myths and misunderstandings regarding sign language to flourish. To fill this gap, we examined signing ability in a large naturalistic sample of Deaf children attending schools for the Deaf where American Sign Language (ASL) is used by peers and teachers. Ability in ASL was measured using a syntactic judgment test and language-based analogical reasoning test, which are two sub-tests of the ASL Assessment Inventory. The influence of two age-related variables were examined: whether or not ASL was acquired from birth in the home from one or more Deaf parents, and the age of entry to the school for the Deaf. Note that for non-native signers, this latter variable is often the age of first systematic exposure to ASL. Both of these types of age-dependent language experiences influenced subsequent signing ability. Scores on the two tasks declined with increasing age of school entry. The influence of age of starting school was not linear. Test scores were generally lower for Deaf children who entered the school of assessment after the age of 12. The positive influence of signing from birth was found for students at all ages tested (7;6–18;5 years old) and for children of all age-of-entry groupings. Our results reflect a continuum of outcomes which show that experience with language is a continuous variable that is sensitive to maturational age.

Sensitivity to verb bias in American sign language-English bilinguals

Native speakers of English are sensitive to the likelihood that a verb will appear in a specific subcategorization frame, known as verb bias. Readers rely on verb bias to help them resolve temporary ambiguity in sentence comprehension. We investigate whether deaf sign-print bilinguals who have acquired English syntactic knowledge primarily through print exposure show sensitivity to English verb biases in both production and comprehension. We first elicited sentence continuations for 100 English verbs as an offline production measure of sensitivity to verb bias. We then collected eye movement records to examine whether deaf bilinguals' online parsing decisions are influenced by English verb bias. The results indicate that exposure to a second language primarily via print is sufficient to influence use of implicit frequency-based characteristics of a language in production and also to inform parsing decisions in comprehension for some, but not all, verbs.

Emotional and behavioural difficulties in children and adolescents with hearing impairment: a systematic review and meta-analysis

The aim of this study is to estimate the extent to which children and adolescents with hearing impairment (HI) show higher rates of emotional and behavioural difficulties compared to normally hearing children. Studies of emotional and behavioural difficulties in children and adolescents were traced from computerized systematic searches supplemented, where appropriate, by studies referenced in previous narrative reviews. Effect sizes (Hedges' g) were calculated for all studies. Meta-analyses were conducted on the weighted effect sizes obtained for studies adopting the Strength and Difficulties Questionnaire (SDQ) and on the unweighted effect sizes for non-SDQ studies. 33 non-SDQ studies were identified in which emotional and behavioural difficulties in children with HI could be compared to normally hearing children. The unweighted average g for these studies was 0.36. The meta-analysis of the 12 SDQ studies gave estimated effect sizes of 0.23 (95% CI 0.07, 0.40), 0.34 (95% CI 0.19, 0.49) and -0.01 (95% CI -0.32, 0.13) for Parent, Teacher and Self-ratings of Total Difficulties, respectively. The SDQ sub-scale showing consistent differences across raters between groups with HI and those with normal hearing was Peer Problems. Children and adolescents with HI have scores on emotional and behavioural difficulties measures about a quarter to a third of a standard deviation higher than hearing children. Children and adolescents with HI are in need of support to help their social relationships particularly with their peers.

The deaf utilize phonological representations in visually presented verbal memory tasks

The phonological abilities of congenitally deaf individuals are inferior to those of people who can hear. However, deaf individuals can acquire spoken languages by utilizing orthography and lip-reading. The present study used functional magnetic resonance imaging (fMRI) to show that deaf individuals utilize phonological representations via a mnemonic process. We compared the brain activation of deaf and hearing participants while they memorized serially visually presented Japanese kana letters (Kana), finger alphabets (Finger), and Arabic letters (Arabic). Hearing participants did not know which finger alphabets corresponded to which language sounds, whereas deaf participants did. All of the participants understood the correspondence between Kana and their language sounds. None of the participants knew the correspondence between Arabic and their language sounds, so this condition was used as a baseline. We found that the left superior temporal gyrus (STG) was activated by phonological representations in the deaf group when memorizing both Kana and Finger. Additionally, the brain areas associated with phonological representations for Finger in the deaf group were the same as the areas for Kana in the hearing group. Overall, despite the fact that they are superior in visual information processing, deaf individuals utilize phonological rather than visual representations in visually presented verbal memory.

Which are the best predictors of theory of mind delay in children with specific language impairment?

BACKGROUND

The relationship between language and theory of mind (ToM) development in participants with specific language impairment (SLI) it is far from clear due to there were differences in study design and methodologies of previous studies.

AIMS

This research consisted of an in-depth investigation of ToM delay in children with SLI during the typical period of acquisition, and it studied whether linguistic or information-processing variables were the best predictors of this process. It also took into account whether there were differences in ToM competence due to the degree of pragmatic impairment within the SLI group.

METHODS & PROCEDURES

Thirty-one children with SLI (3;5-7;5 years old) and two control groups (age matched and language matched) were assessed with False Belief (FB) tasks, a wide battery of language measures and additional information-processing measures.

OUTCOMES & RESULTS

The members of the SLI group were less competent than their age-matched peers at solving FB tasks, but they performed similarly to the language-matched group. Regression analysis showed that overall linguistic skills of children with SLI were the best predictor of ToM performance, and especially grammar abilities. No differences between SLI subgroups were found according to their pragmatic level.

CONCLUSIONS & IMPLICATIONS

A delay in ToM development in children with SLI around the critical period of acquisition is confirmed more comprehensively, and it is shown to be more strongly related to their general linguistic level than to their age and other information-processing faculties. This finding stresses the importance of early educational and clinical programmes aimed at reducing deleterious effects in later development.

Gap detection measured with electrically evoked auditory event-related potentials and speech-perception abilities in children with auditory neuropathy spectrum disorder

OBJECTIVES

This study aimed (1) to investigate the feasibility of recording the electrically evoked auditory event-related potential (eERP), including the onset P1-N1-P2 complex and the electrically evoked auditory change complex (EACC) in response to temporal gaps, in children with auditory neuropathy spectrum disorder (ANSD); and (2) to evaluate the relationship between these measures and speech-perception abilities in these subjects.

DESIGN

Fifteen ANSD children who are Cochlear Nucleus device users participated in this study. For each subject, the speech-processor microphone was bypassed and the eERPs were elicited by direct stimulation of one mid-array electrode (electrode 12). The stimulus was a train of biphasic current pulses 800 msec in duration. Two basic stimulation conditions were used to elicit the eERP. In the no-gap condition, the entire pulse train was delivered uninterrupted to electrode 12, and the onset P1-N1-P2 complex was measured relative to the stimulus onset. In the gapped condition, the stimulus consisted of two pulse train bursts, each being 400 msec in duration, presented sequentially on the same electrode and separated by one of five gaps (i.e., 5, 10, 20, 50, and 100 msec). Open-set speech-perception ability of these subjects with ANSD was assessed using the phonetically balanced kindergarten (PBK) word lists presented at 60 dB SPL, using monitored live voice in a sound booth.

RESULTS

The eERPs were recorded from all subjects with ANSD who participated in this study. There were no significant differences in test-retest reliability, root mean square amplitude or P1 latency for the onset P1-N1-P2 complex between subjects with good (>70% correct on PBK words) and poorer speech-perception performance. In general, the EACC showed less mature morphological characteristics than the onset P1-N1-P2 response recorded from the same subject. There was a robust correlation between the PBK word scores and the EACC thresholds for gap detection. Subjects with poorer speech-perception performance showed larger EACC thresholds in this study.

CONCLUSIONS

These results demonstrate the feasibility of recording eERPs from implanted children with ANSD, using direct electrical stimulation. Temporal-processing deficits, as demonstrated by large EACC thresholds for gap detection, might account in part for the poor speech-perception performances observed in a subgroup of implanted subjects with ANSD. This finding suggests that the EACC elicited by changes in temporal continuity (i.e., gap) holds promise as a predictor of speech-perception ability among implanted children with ANSD.

Visual context processing deficits in schizophrenia: effects of deafness and disorganization

Visual illusions allow for strong tests of perceptual functioning. Perceptual impairments can produce superior task performance on certain tasks (i.e., more veridical perception), thereby avoiding generalized deficit confounds while tapping mechanisms that are largely outside of conscious control. Using a task based on the Ebbinghaus illusion, a perceptual phenomenon where the perceived size of a central target object is affected by the size of surrounding inducers, we tested hypotheses related to visual integration in deaf (n = 31) and hearing (n = 34) patients with schizophrenia. In past studies, psychiatrically healthy samples displayed increased visual integration relative to schizophrenia samples and thus were less able to correctly judge target sizes. Deafness, and especially the use of sign language, leads to heightened sensitivity to peripheral visual cues and increased sensitivity to visual context. Therefore, relative to hearing subjects, deaf subjects were expected to display increased context sensitivity (ie, a more normal illusion effect as evidenced by a decreased ability to correctly judge central target sizes). Confirming the hypothesis, deaf signers were significantly more sensitive to the illusion than nonsigning hearing patients. Moreover, an earlier age of sign language acquisition, higher levels of linguistic ability, and shorter illness duration were significantly related to increased context sensitivity. As predicted, disorganization was associated with reduced context sensitivity for all subjects. The primary implications of these data are that perceptual organization impairment in schizophrenia is plastic and that it is related to a broader failure in coordinating cognitive activity.

Altered spatial distribution of visual attention in near and far space after early deafness

Early deafness results in a redistribution of more attentional resources to the visual periphery in near space, specifically under conditions of selective attention, probably to compensate for the loss of auditory alertness to potentially dangerous stimuli from outside the current attentional focus. It remains poorly understood, however, whether spatial distribution of attention in far space is altered by early deafness as well. In the present study, we investigated whether and how early deafness alters the distribution of visuospatial attention in far space, compared to hearing controls. We asked deaf individuals and hearing controls to perform a flanker task with either peripheral or central distractors, either in near or far space. Sizes of compatibility effect were used to assess the amount of attentional resources received by the peripheral and central distractors. In near space, peripheral distractors induced significantly larger compatibility effect in deaf individuals than in hearing controls while central distractors induced significantly larger compatibility effect in hearing controls than in deaf individuals. On the other hand in far space, although peripheral distractors induced equivalent sizes of compatibility effect in the deaf and hearing groups, central distractors caused significant compatibility effect only in deaf individuals, but not in hearing controls. Our results suggest that early deafness results in a redistribution of visuospatial attention not only in near space but also in far space, with enhanced peripheral attention in near space and enhanced central attention in far space.

Delayed recognition of profound hearing loss in a 7-year-old girl with a neurological condition

Kelly is a 7-year-old girl with a complex medical history including asthma, mild spastic diplegia, and seizure disorder that is controlled with carbamazepine. She had a significant receptive and expressive language impairment and milder delays in gross and fine motor skills. Kelly is currently repeating first grade in a self-contained classroom; she receives speech, occupational, and physical therapy. At the 7-year-old well child visit, her mother is worried about Kelly's poor progress in school, and she expresses concern about her daughter's hearing. Her pediatrician observes that Kelly is withdrawn, uses minimal language, and is fearful of the examination. Kelly was born full-term by Cesarean section because of placental abruption. She was in the neonatal intensive care nursery for 2 weeks with metabolic acidosis because of acute tubular necrosis. One day after arriving home, she had a cardiopulmonary arrest followed by emergency open-heart surgery for critical pulmonary hypertension. Her postoperative course was significant for renal failure, extracorporal membrane oxygenation, ventilator dependency, tracheostomy, and gastrostomy. By 3 years of age her medical condition stabilized, and the tracheostomy and gastrostomy tubes were removed. A review of Kelly's previous audiological tests revealed a failed otoacoustic emission test at 5 months. An auditory brain stem response test at 8 months recorded normal hearing in the right ear. At 4 years, behavioral audiometry was attempted but not completed because Kelly cried throughout the session. At 5 years, testing with ear inserts showed normal hearing bilaterally. Because of the concerns raised by Kelly's mother at the pediatric visit, she was referred to audiology for a reevaluation. Testing at this time revealed moderate to profound sensorineural hearing loss in both the ears, which was confirmed on subsequent examinations. Kelly was promptly fitted for hearing aids. Her individual education plan was changed to reflect the diagnosis of hearing impairment, and hearing services were implemented in the classroom. On a recent follow-up visit, Kelly was talkative, engaging, and cheerful.

Delayed recognition of profound hearing loss in a 7-year-old girl with a neurological condition

Kelly is a 7-year-old girl with a complex medical history including asthma, mild spastic diplegia, and seizure disorder that is controlled with carbamazepine. She had a significant receptive and expressive language impairment and milder delays in gross and fine motor skills. Kelly is currently repeating first grade in a self-contained classroom; she receives speech, occupational, and physical therapy. At the 7-year-old well child visit, her mother is worried about Kelly's poor progress in school, and she expresses concern about her daughter's hearing. Her pediatrician observes that Kelly is withdrawn, uses minimal language, and is fearful of the examination.Kelly was born full-term by Cesarean section because of placental abruption. She was in the neonatal intensive care nursery for 2 weeks with metabolic acidosis because of acute tubular necrosis. One day after arriving home, she had a cardiopulmonary arrest followed by emergency open-heart surgery for critical pulmonary hypertension. Her postoperative course was significant for renal failure, extracorporal membrane oxygenation, ventilator dependency, tracheostomy, and gastrostomy. By 3 years of age her medical condition stabilized, and the tracheostomy and gastrostomy tubes were removed.A review of Kelly's previous audiological tests revealed a failed otoacoustic emission test at 5 months. An auditory brain stem response test at 8 months recorded normal hearing in the right ear. At 4 years, behavioral audiometry was attempted but not completed because Kelly cried throughout the session. At 5 years, testing with ear inserts showed normal hearing bilaterally.Because of the concerns raised by Kelly's mother at the pediatric visit, she was referred to audiology for a reevaluation. Testing at this time revealed moderate to profound sensorineural hearing loss in both the ears, which was confirmed on subsequent examinations. Kelly was promptly fitted for hearing aids. Her individual education plan was changed to reflect the diagnosis of hearing impairment, and hearing services were implemented in the classroom. On a recent follow-up visit, Kelly was talkative, engaging, and cheerful.