Some measures of verbal and spatial working memory in eight- and nine-year-old hearing-impaired children with cochlear implants.

OBJECTIVE: The purpose of this study was to examine working memory for sequences of auditory and visual stimuli in prelingually deafened pediatric cochlear implant users with at least 4 yr of device experience. DESIGN: Two groups of 8- and 9-yr-old children, 45 normal-hearing and 45 hearing-impaired users of cochlear implants, completed a novel working memory task requiring memory for sequences of either visual-spatial cues or visual-spatial cues paired with auditory signals. In each sequence, colored response buttons were illuminated either with or without simultaneous auditory presentation of verbal labels (color-names or digit-names). The child was required to reproduce each sequence by pressing the appropriate buttons on the response box. Sequence length was varied and a measure of memory span corresponding to the longest list length correctly reproduced under each set of presentation conditions was recorded. Additional children completed a modified task that eliminated the visual-spatial light cues but that still required reproduction of auditory color-name sequences using the same response box. Data from 37 pediatric cochlear implant users were collected using this modified task. RESULTS: The cochlear implant group obtained shorter span scores on average than the normal-hearing group, regardless of presentation format. The normal-hearing children also demonstrated a larger "redundancy gain" than children in the cochlear implant group-that is, the normal-hearing group displayed better memory for auditory-plus-lights sequences than for the lights-only sequences. Although the children with cochlear implants did not use the auditory signals as effectively as normal-hearing children when visual-spatial cues were also available, their performance on the modified memory task using only auditory cues showed that some of the children were capable of encoding auditory-only sequences at a level comparable with normal-hearing children. CONCLUSIONS: The finding of smaller redundancy gains from the addition of auditory cues to visual-spatial sequences in the cochlear implant group as compared with the normal-hearing group demonstrates differences in encoding or rehearsal strategies between these two groups of children. Differences in memory span between the two groups even on a visual-spatial memory task suggests that atypical working memory development irrespective of input modality may be present in this clinical population.

Speech and language acquisition in young children after cochlear implantation.

Auditory and speech intelligibility scores of 22 prelingually profoundly deaf children who had used cochlear implants for between 1 and 7 years in an intensive auditory/oral educational program greatly exceeded those previously obtained from similar samples of deaf children using hearing aids. Half of the children obtained language quotient scores within the average range for normal-hearing children and the majority obtained reading quotients within 80% of normal levels. Normal levels of language and reading development were associated with early implantation and open set speech perception.

Inter-rater reliability as a reflection of ambiguity in the communication of deaf and normally-hearing children.

This study involves (a) procedures for coding intentionality and communicative function from the behavior of young children, (b) determining inter-rater reliability on those decisions, and (c) making judgments about which data to use for presentation and analysis. Communication data from videotaped interactions of 48 deaf and 96 normally-hearing children (12-54 months of age) and their mothers were obtained from two independent coders. As predicted, the percent-agreement between coders was higher for older children and for hearing children compared to deaf children. It is argued that the ambiguity reflected in poor coder agreement for less skilled communicators may represent the extent to which these children are understood. It is suggested that for such children data analysis should be restricted to those behaviors on which two independent coders agree.

Comparing implants with hearing aids in profoundly deaf children.

Speech perception, speech production, and spoken language skills of 13 age-matched groups of prelingually deaf children, all enrolled in the same educational setting, were compared. Each group consisted of three children, two with hearing aids but different degrees of hearing loss (pure-tone average > 100 dB HL and pure-tone average between 90 and 100 dB HL) and one who had used a Nucleus multichannel implant (Cochlear Corp., Englewood, Colo.) for 3 years. The implanted group exhibited significantly better performance in all areas than aided children with greater than 100 dB losses. However, children with hearing losses in the 90 to 100 dB range who received hearing aids and auditory oral instruction at an early age performed just as well as children who had used implants for 3 years.

Communication of oral deaf and normally hearing children at 36 months of age.

Eighteen orally educated deaf and 18 normally hearing 36-month-old children were observed in a play session with their mother. Communicative behavior of the child was coded for modality and communicative function. Although the oral deaf children used a normal range of functions, both the quantity and proportions differed from normally hearing children. Whereas the normally hearing 3-year-olds used speech almost exclusively, the deaf children exhibited about equal use of speech, vocalizations, and gestures. Spoken language scores of the deaf children at 5 years of age were best predicted by (a) more frequent use of speech at age 36 months, (b) more frequent use of the Statement function, and (c) relatively infrequent use of the Directive function. It is suggested that some communicative functions are more informative or heuristic than others, and that the early use of these functions is most likely to predict later language competence.

Speech perception and production skills of students with impaired hearing from oral and total communication education settings.

This study examined the degree to which students with profoundly impaired hearing who had been educated in oral and total communication (TC) environments developed auditory and speech skills. The sample consisted of 227 16- and 17-year-old students with profoundly impaired hearing: 127 from TC programs (63 with normal-hearing parents and 64 with deaf parents) and 100 from oral programs. Subject groups were matched in terms of age, unaided residual hearing, and IQ. On average, students from oral programs acquired more intelligible speech and made significantly better use of their limited residual hearing than did the TC students. This finding held for all TC students--those with deaf parents as well as those with normal-hearing parents. Although results of this study indicate that auditory and speech production skills are comparatively well developed in students who have consistently used spoken language throughout the day as the primary means of communicating, other factors associated with this oral sample, such as early amplification, consistent hearing aid use, early education, and parental support, may also be necessary for the development of good spoken language skills.

Educational management of children with cochlear implants.

During the last decade, the technology of assistive hearing devices for hearing-impaired children has improved significantly. Improvements in hearing aids and the introduction of cochlear implants and wearable tactile aids for children have made spoken language available to more deaf children and have changed the techniques for teaching listening and speaking skills. In June 1990, the Food and Drug Administration approved the Nucleus 22 channel cochlear implant for use with children. As a result, it is expected that more children will be implanted and, consequently, that the teachers and audiologist in the schools in which they are enrolled will need to learn to manage the devices. Since the Nucleus 22 cochlear implant does not restore normal hearing, children will continue to need instruction in listening and speaking. Furthermore, school personnel, who will be responsible for caring for and monitoring the implants, will have to learn how to maintain the devices. This article outlines some procedures for maximizing the benefits that profoundly deaf children can achieve with the cochlear implant.

Evaluating the benefits of cochlear implants in an education setting.

The material presented here summarizes the first year of a study to determine whether cochlear implants, tactile aids, acoustic hearing aids, or some combination of these are best for developing spoken language in prelingual profoundly deaf children. The effects of each device over and above the gains normally achieved as a result of oral instruction are examined. Each group contains three matched children, one fitted with each device, who are enrolled in the Central Institute for the Deaf (CID) school for 3 years of evaluation and training. This report describes results obtained from four groups of matched subjects during their first year in the study. These subjects improved in all areas evaluated, regardless of the device used. However, the implanted subjects exhibited a greater rate of progress in acquiring auditory speech perception skills. They exhibited no advantage in acquiring speech production skills and spoken language skills during their first year with the device. The subtle advantages provided by the implant may become apparent in spoken language development when 2- and 3-year post-test results are examined.

Acquisition of spoken and signed English by hearing-impaired children of hearing-impaired or hearing parents.

This study examines the degree to which hearing-impaired children of hearing-impaired parents (HIP) demonstrate an advantage in their acquisition of signed and spoken English over hearing-impaired children of hearing parents (HP). A subset from the normative sample of the Grammatical Analysis of Elicited Language, 50 HIP children and 50 HP children, were matched in terms of their educational program, hearing level, and age. Results indicate that both groups had comparably poor expressive English language ability at 5 and 6 years of age. However, at age 7 and 8 HIP children demonstrated a significant linguistic advantage in both their spoken and signed English over HP children. Because the production of English by HIP children closely resembled that of orally educated hearing-impaired children of hearing parents, consistent language stimulation throughout the child's early years may be a critical factor in the development of English, regardless of the language or mode of expression.