Narrative spoken language skills in severely hearing impaired school-aged children with cochlear implants

Cochlear implants have a significant positive effect on spoken language development in severely hearing impaired children. Previous work in this population has focused mostly on the emergence of early-developing language skills, such as vocabulary. The current study aims at comparing narratives, which are more complex and later-developing spoken language skills, of a contemporary group of profoundly deaf school-aged children using cochlear implants (n = 66, median age = 8 years 3 months) with matched normal hearing peers. Results show that children with cochlear implants demonstrate good results on quantity and coherence of the utterances, but problematic outcomes on quality, content and efficiency of retold stories. However, for a subgroup (n = 20, median age = 8 years 1 month) of deaf children without additional disabilities who receive cochlear implantation before the age of 2 years, use two implants, and are raised with one spoken language, age-adequate spoken narrative skills at school-age are feasible. This is the first study to set the goals regarding spoken narrative skills for deaf children using cochlear implants.     

Expressive vocabulary,morphology, syntax and narrative skills in profoundly deaf children after early cochlear implantation

Practical experience and research reveal generic spoken language benefits after cochlear implantation. However, systematic research on specific language domains and error analyses are required to probe sub-skills. Moreover, the effect of predictive factors on distinct language domains is unknown. In this study, outcomes of 70 school-aged children with cochlear implants were compared with hearing peers. Approximately half of the children with cochlear implants achieved age-adequate language levels. Results did not reveal systematic strong or weak language domains. Error analyses showed difficulties with morphological and syntactic rules and inefficient narrative skills. Children without additional disabilities who received early intervention were raised with one spoken language, and used a second cochlear implant or contralateral hearing aid were more likely to present good language skills.     

Auditory and verbal memory predictors of spoken language skills in children with cochlear implants

BackgroundLarge variability in individual spoken language outcomes remains a persistent finding in the group of children with cochlear implants (CIs), particularly in their grammatical development.AimsIn the present study, we examined the extent of delay in lexical and morphosyntactic spoken language levels of children with CIs as compared to those of a normative sample of age-matched children with normal hearing. Furthermore, the predictive value of auditory and verbal memory factors in the spoken language performance of implanted children was analyzed.Methods & proceduresThirty-nine profoundly deaf children with CIs were assessed using a test battery including measures of lexical, grammatical, auditory and verbal memory tests. Furthermore, child-related demographic characteristics were taken into account.Outcomes & resultsThe majority of the children with CIs did not reach age-equivalent lexical and morphosyntactic language skills. Multiple linear regression analyses revealed that lexical spoken language performance in children with CIs was best predicted by age at testing, phoneme perception, and auditory word closure. The morphosyntactic language outcomes of the CI group were best predicted by lexicon, auditory word closure, and auditory memory for words.ConclusionsQualitatively good speech perception skills appear to be crucial for lexical and grammatical development in children with CIs. Furthermore, strongly developed vocabulary skills and verbal memory abilities predict morphosyntactic language skills.     

Neurophysiological evidence of impaired musical sound perception in cochlear-implant users

Objective

Music perception with a cochlear implant (CI) can be unsatisfactory because current-day implants are primarily designed to enable speech discrimination. The present study aimed at evaluating electrophysiological correlates of musical sound perception in CI users to help achieve the long-term goal of improved restoration of hearing in those individuals.

Methods

Auditory discrimination accuracy in adult CI users (n = 12) and matched normal-hearing controls (n = 12) was measured by behavioral discrimination tasks and mismatch negativity (MMN) recordings. Discrimination profiles were obtained by using a set of clarinet sounds (original/vocoded) varying along different acoustic dimensions (frequency/intensity/duration) and deviation magnitudes (four levels).

Results

Behavioral results and MMN recordings revealed reduced auditory discrimination accuracy in CI users. An inverse relationship was found between MMN amplitudes and duration of profound deafness.

Conclusions

CI users have difficulties in discriminating small changes in the acoustic properties of musical sounds. The recently developed multi-feature MMN paradigm (Pakarinen et al., 2007) can be used to objectively evaluate discrimination abilities of CI users for musical sounds.

Significance

Measuring auditory discrimination functions by means of a multi-feature MMN paradigm could be of substantial clinical value by providing a comprehensive profile of the extent of restored hearing in CI users.     

Maternal functional speech to children: a comparison of autism spectrum disorder, Down syndrome, and typical development

Children with developmental disabilities benefit from their language environment as much as, or even more than, typically developing (TD) children, but maternal language directed to developmentally delayed children is an underinvestigated topic. The purposes of the present study were to compare maternal functional language directed to children with two developmental disabilities - autism spectrum disorder (ASD) and Down syndrome (DS) - with TD children and to investigate relations of maternal functional language with child language skills. Participants were 60 mothers and their children with TD (n = 20), DS (n = 20), or ASD (n = 20). Children's mean developmental age was 24.77 months (SD = 8.47) and did not differ across the groups. Mother and child speech were studied during naturalistic play. We found (a) similarities in maternal functional language directed to the two groups of children with developmental disabilities compared to that directed to TD children and (b) a positive association between subcategories of information-salient speech and child mean length of utterance in TD dyads only. The clinical and developmental implications of these findings are discussed.     

Deficit of long-term memory traces for words in children with cochlear implants

ObjectiveLanguage experience can develop long-term memory traces for speech units in the brain, to ensure efficient processing of speech sounds. However, prelingually deafened children lack sufficient auditory input before cochlear implantation. Whether the experience-dependent long-term memory traces exist in prelingually deafened children with cochlear implants (CIs) remains unclear.MethodsWe presented CI and normal hearing (NH) children with Mandarin Chinese spoken disyllables in an oddball paradigm and recorded event-related potentials. Each disyllable was defined as a meaningful word or a meaningless pseudoword by the tonal information in the second syllable.ResultsThe amplitude of mismatch negativity (MMN) elicited by words was larger than that elicited by pseudowords in NH children. However, this enhancement of the MMN amplitude was not found in CI children. Behavioral results showed later recognition points for words and lower accuracies for speech comprehension in CI children than in NH children. Furthermore, increased theta power for words compared with pseudowords was only found in NH children.ConclusionsOur findings indicate a deficit of long-term memory traces for words in prelingually deafened children with cochlear implants.SignificanceEarly speech input may be crucial to the formation of long-term memory traces for speech units.     

Children's development of intonation during the first year of cochlear implant experience

This article describes the longitudinal development of intonation in 18 deaf children who received cochlear implants (CIs) before the age of 3 years and 12 infants with typical development (TD) who served as controls. At the time their implants were activated, the children with CIs ranged in age from 9 to 36 months. Cross-group comparisons were made when the children had equivalent amounts of robust hearing experience but different chronological ages. This article reports the results for the 6-month period ending 9 months after activation of the child's device for children with CIs, and the 6-month period ending at 12 months of age for TD infants. The findings were compared with a model of early intonation development in children with normal hearing. The results indicated that all groups progressed through one or more of the stages predicted by the normative model. At the end of the study period, however, children who had received a CI later than 24 months reached a more mature stage of intonation development than younger CI recipients. Moreover, the older CI group reached the same stage of development as the TD infants who had 3 additional months of language listening experience. The findings suggest that the developmental advantage which older children had previously demonstrated shortly after activation of their CIs is maintained throughout most or all of the first year of CI use.     

Cerebral lateralisation during signed and spoken language production in children born deaf

The effect of sensory experience on hemispheric specialisation for language production is not well understood. Children born deaf, including those who have cochlear implants, have drastically different perceptual experiences of language than their hearing peers. Using functional transcranial Doppler sonography (fTCD), we measured lateralisation during language production in a heterogeneous group of 19 deaf children and in 19 hearing children, matched on language ability. In children born deaf, we observed significant left lateralisation during language production (British Sign Language, spoken English, or a combination of languages). There was no difference in the strength of lateralisation between deaf and hearing groups. Comparable proportions of children were categorised as left-, right-, or not significantly-lateralised in each group. Moreover, an exploratory subgroup analysis showed no significant difference in lateralisation between deaf children with cochlear implants and those without. These data suggest that the processes underpinning language production remain robustly left lateralised regardless of sensory language experience.     

Improvement in speech-reading ability by auditory training: Evidence from gender differences in normally hearing, deaf and cochlear implanted subjects

Several neuropsychological and neuroimaging studies on gender differences in speech processing lead to the suggestion that women use the neural network of predictive and integrative analysis of speech to a larger extent than men. During speech-reading there is indeed a lack of reliable clues for word recognition which should emphasize predictive and integrative strategies of the brain. Our study aimed to explore gender differences in deaf and cochlear implanted (CI) patients at different levels during speech-reading, for words or phonemes, that we consider, correspond to increased involvement of predictive and integrative analysis. We collected speech-reading scores in a control group of normally hearing subjects (n = 42) and in a group of deaf patients - who are good speech-readers - tested before, early after and late after cochlear implantation (n = 97). Patient groups were almost equally distributed between follow-up and new patients. In normally hearing controls, women speech-read words better than men. This difference was also observed in all patients but not in experienced cochlear implant users. We did not observe a gender difference during speech-reading of isolated phonemes neither for controls nor for patients. We conclude that the better speech-reading ability of women for words but not for phonemes is in line with their greater use of predictive and integrative strategies for speech processing. Furthermore, we observed a progressive cross-modal compensation in male CI users after cochlear implantation which suggests a synergetic perceptual facilitation involving the visual and the recovering auditory modalities. This could lead to an improved performance in both auditory and visual modalities, the latter being constantly recruited to complement the crude information provided by the implant. Altogether, our data provide insights into cross-modal compensation in the adult brain following sensory privation.     

An investigation of weak syllable processing in deaf children with cochlear implants

In this study the influence of prosodic foot structure on the processing of weak syllables in children with cochlear implants (CI) was investigated. A battery of tests investigating processing of weak syllables in single and multi-word utterances was carried out on four groups of children: 15 children with CI developing spoken language as expected (Main CI); five children with CI reported to have additional speech and language problems; 15 age matched; and 15 language matched (LM) children with normal hearing (NH). Children in the main CI and, to a lesser extent, the LM groups processed footed weak syllables preferably over unfooted weak syllables (particularly as memory load increased). Thus, these children with CI appear to possess a similar Prosodic Hierarchy (PH) to their LM peers with NH, and possibly due to the impact of delayed and constrained exposure to audition on the development of linguistic processing and short-term memory, are influenced by its foot structure in the processing of weak syllables.     

Word-learning performance of children with and without cochlear implants given synchronous and asynchronous cues

This study sought to evaluate the effects of synchronous and asynchronous auditory–visual cues on the word-learning performance of children with cochlear implants and children with normal hearing matched for chronological age. Children with cochlear implants (n = 9) who had worn the implant for less than one year and children matched for chronological age (n = 9) participated in rapid word-learning trials. Children with cochlear implants did not learn words in either the synchronous or asynchronous condition (U = 49.5, p = .99; d = 0.05). Children with normal hearing learned more words in the synchronous rather than asynchronous condition (U = 78.5, p = .04; d = 0.95). These findings represent a first step toward determining how task-level factors influence the lexical outcomes of children with cochlear implants.     

Impact of cognitive impairment on coping strategies in multiple sclerosis

Objectives: To assess the impact of cognitive impairment (CI) on coping strategies in multiple sclerosis (MS). Materials and methods: Sixty-three patients (40 women, 55 relapsing-remitting and 8 secondary progressive, age 42.6 ± 10.1 years, Expanded Disability Status Scale 2.2 ± 1.7) were assessed using the Coping Orientation for Problem Experiences-New Italian version Inventory, the Beck Depression Inventory and the Rao's Brief Repeatable Battery. Results: MS patients were less likely to use positive and problem-focused strategies, whereas avoiding strategies were adopted more frequently. Twenty-three (36.5%) cases were CI. We found no differences in the type of coping between CI and cognitively preserved patients. Scores on the Stroop test (beta = −0.91, p = 0.04) and on the Word List Generation (beta = 1.15, p = 0.04) were associated with poorer coping strategies. Conclusions: Our study suggests that cognitive functioning (in particular on sustained attention and aspects of executive function) must be considered in a comprehensive account of the factors contributing to successful coping in MS patients.     

Early predictors of phonological and morphosyntactic skills in second graders with cochlear implants

PurposeNewborn hearing screening has made it possible to provide early treatment of hearing loss to more children than ever before, raising expectations these children will be able to attend regular schools. But continuing deficits in spoken language skills have led to challenges in meeting those expectations. This study was conducted to (1) examine two kinds of language skills (phonological and morphosyntactic) at school age (second grade) for children with cochlear implants (CIs); (2) see which measures from earlier in life best predicted performance at second grade; (3) explore how well these skills supported other cognitive and language functions; and (4) examine how treatment factors affected measured outcomes.MethodsData were analyzed from 100 second-grade, monolingual English-speaking children: 51 with CIs and 49 with normal hearing (NH). Ten measures of spoken language and related functions were collected: three each of phonological and morphosyntactic skills; and four of other cognitive and language functions. Six measures from preschool and seven from kindergarten served as predictor variables. The effects of treatment variables were examined.ResultsChildren with CIs were more delayed acquiring phonological than morphosyntactic skills. Mean length of utterance at earlier ages was the most consistent predictor of both phonological and morphosyntactic skills at second grade. Early bimodal stimulation had a weak, but positive effect on phonological skills at second grade; sign language experience during preschool had a negative effect on morphosyntactic structures in spoken language.ConclusionsChildren with CIs are delayed in language acquisition, and especially so in phonological skills. Appropriate testing and treatments can help ameliorate these delays.     

Assessment of white matter integrity of autistic preschool children with diffusion weighted MR imaging

The purpose was to assess white matter integrity of autistic preschool children with diffusion weighted MR imaging. Prospective study was carried on 19 autistic children (mean age 55.2 ms, IQ of 86.5) and 10 sex, age and IQ matched control (mean age 53.2 ms, IQ 84.5). The childhood Autism Rating Scale (CARS), social age and language age were calculated. Patients and controls underwent diffusion weighted MR imaging of the brain with b factor of 0, 500 and 1000 s/mm². The apparent diffusion coefficient (ADC) value at different regions of the white matter were calculated and correlated with CARS, social age and language age. There were significant differences at the ADC value of the white matter between autistic and control children at genu (P = 0.043), splenium (P = 0.003) of the corpus callosum, frontal white matter (P = 0.015) and temporal white matter (P = 0.020). There was positive correlation of CARS score with ADC value of the genu (r = 0.63, P = 0.001), splenium (r = 0.59, P = 0.005), frontal white matter (r = 0.81, P = 0.001) and temporal white matter (r = 0.74, P = 0.001). The social age well correlated with ADC value of the frontal white matter (r = 0.81, P = 0.001) and language age well correlated with ADC value of the temporal white matter (r = 0.78, P = 0.001). We concluded that ADC value can be helpful in assessment of integrity of the white matter in autistic preschool children and well correlated with CARS score, social age and language age.     

Long-term outcomes on spatial hearing,speech recognition and receptive vocabulary after sequential bilateral cochlear implantation in children

Sequential bilateral cochlear implantation in profoundly deaf children often leads to primary advantages in spatial hearing and speech recognition. It is not yet known how these children develop in the long-term and if these primary advantages will also lead to secondary advantages, e.g. in better language skills. The aim of the present longitudinal cohort study was to assess the long-term effects of sequential bilateral cochlear implantation in children on spatial hearing, speech recognition in quiet and in noise and receptive vocabulary. Twenty-four children with bilateral cochlear implants (BiCIs) were tested 5–6 years after sequential bilateral cochlear implantation. These children received their second implant between 2.4 and 8.5 years of age. Speech and language data were also gathered in a matched reference group of 26 children with a unilateral cochlear implant (UCI). Spatial hearing was assessed with a minimum audible angle (MAA) task with different stimulus types to gain global insight into the effective use of interaural level difference (ILD) and interaural timing difference (ITD) cues. In the long-term, children still showed improvements in spatial acuity. Spatial acuity was highest for ILD cues compared to ITD cues. For speech recognition in quiet and noise, and receptive vocabulary, children with BiCIs had significant higher scores than children with a UCI. Results also indicate that attending a mainstream school has a significant positive effect on speech recognition and receptive vocabulary compared to attending a school for the deaf. Despite of a period of unilateral deafness, children with BiCIs, participating in mainstream education obtained age-appropriate language scores.     

The relationship between gross motor skills and academic achievement in children with learning disabilities

The present study compared the gross motor skills of 7- to 12-year-old children with learning disabilities (n = 104) with those of age-matched typically developing children (n = 104) using the Test of Gross Motor Development-2. Additionally, the specific relationships between subsets of gross motor skills and academic performance in reading, spelling, and mathematics were examined in children with learning disabilities. As expected, the children with learning disabilities scored poorer on both the locomotor and object-control subtests than their typically developing peers. Furthermore, in children with learning disabilities a specific relationship was observed between reading and locomotor skills and a trend was found for a relationship between mathematics and object-control skills: the larger children's learning lag, the poorer their motor skill scores. This study stresses the importance of specific interventions facilitating both motor and academic abilities.     

Facial expression recognition: can preschoolers with cochlear implants and hearing aids catch it?

Tager-Flusberg and Sullivan (2000) presented a cognitive model of theory of mind (ToM), in which they thought ToM included two components--a social-perceptual component and a social-cognitive component. Facial expression recognition (FER) is an ability tapping the social-perceptual component. Previous findings suggested that normal hearing children did not demonstrate any advantage over those with cochlear implants (CI) or hearing aids (HA) in FER with age and gender matched. In these studies, the ages of the participants with CI or HA were over 7 years old. However, normal hearing preschoolers can accurately recognize basic facial expressions. Children's early FER skills are essential to later successful social interactions. It is not clear whether preschoolers with CI or HA have problems in FER. Two experiments were conducted to compare the FER of preschoolers with CI or HA with normal hearing children (with age matched). The results of both experiments consistently showed that normal hearing children performed significantly better than those with CI or HA, suggesting to some extent that there was a delay in preschoolers with CI or HA on FER. No significant correlations (with age and type of participants controlled) were found between language ability (measured by PPVT) and FER in Experiment 2, to some extent validating a cognitive model of ToM in another view. The findings suggested that earlier rehabilitation for children with CI or HA should include not only language treatment but also emotional intervention, which would help them catch up with normal hearings as soon as possible.     

Lexical access in children with hearing loss or specific language impairment,using the cross-modal picture–word interference paradigm

In this study we compared lexical access to spoken words in 25 deaf children with cochlear implants (CIs), 13 hard-of-hearing (HoH) children and 20 children with specific language impairment (SLI). Twenty-one age-matched typically developing children served as controls. The children with CIs and the HoH children in the present study had good speech perception abilities. We used a cross-modal picture–word interference paradigm to examine lexical access. Results showed that children with SLI revealed overall slower reaction times and produced more errors than the children with CIs, the HoH children, and the control children. Reaction times of children with CIs and the HoH children did not differ from those of the control children. Thus, problems with spoken language processing, as is the case in children with SLI, seem to affect lexical access more than limitations in auditory perception, as is the fundamental problem in children with hearing loss. We recommend that improvement of lexical access in children with SLI deserves specific attention in therapy and education.     

Latent factor structure of the Das-Naglieri Cognitive Assessment System: a confirmatory factor analysis in a Chinese setting

This study aims to measure the psychometric properties of the Das-Naglieri Cognitive Assessment System (D-N CAS) and to determine its clinical utility in a Chinese context. Confirmatory factor analysis (CFA) was conducted to examine the construct validity of the Chinese version of the D-N CAS among a group of 567, normally developed children. Test-retest reliability was examined in a random subsample of 30 children at a five-week interval. The clinical discrimination of the D-N CAS was also examined by comparing children with and without ADHD (18 children in each group) and by comparing children with and without Chinese reading disabilities (18 children in each group). The current Chinese sample demonstrated a four-factor solution for cognitive performance among children with normal development: Planning, Attention, Simultaneous processing and Successive processing (χ²(48) = 91.90, p = .000; χ²/df = 1.92, RMSEA = .050, GFI = .966, CFI = .954). Moreover, all subtests of the battery demonstrated acceptable test-retest reliability (r = .72-.90, p < .01) at a five-week interval among the subjects of the small subsample. Children with ADHD performed significantly worse than normal children on the Attention factor (p < .001) and the Planning factor (p < .05) of the D-N CAS, and children with Chinese reading disabilities performed significantly worse than normal children on the Simultaneous processing factor (p < .01), the Successive processing factor (p < .001) and the Planning factor (p < .05) of the D-N CAS. These findings suggested that the current four-factor structure of the D-N CAS was similar to the original factor structure of the test. The latent factor of the D-N CAS was fairly stable across the cultures. Moreover, the D-N CAS can distinguish between children with ADHD or Chinese reading disabilities and normally developed children.