The Production of Question Intonation by Young Adult Cochlear Implant Users: Does Age at Implantation Matter?

Purpose The purpose of this observational study was to investigate the properties of sentence-final prosody in yes/no questions produced by cochlear implant (CI) users in order to determine whether and how the age at CI implantation impacts CI users' production of question intonation later in life. Method We acoustically analyzed recordings from 46 young adult CI users and 10 young adults with normal hearing who read yes/no questions. Of the 46 CI users, 20 had received their CI before the age of 4.0 years (early implantation group), 15 between ages 4.0 and 8.11 years (midimplantation group), and 11 at the age of 9.0 years or later (late implantation group). We assessed the prosodic properties of the produced questions for each implantation group and the normal hearing comparison group (a) by measuring the sentence-final rise in fundamental frequency, (b) by labeling the question-final intonation contour using the Tones and Breaks Index ( Beckman & Ayers, 1994 ; Silverman, Beckman, et al., 1992 ; Veilleux, Shattuck-Hufnagel, & Brugos, 2006 ), and (c) by assessing phrase-final lengthening. Results The fundamental frequency rises produced by all CI users exhibited a smaller magnitude than those produced by the normal hearing comparison group, although the difference between early implanted CI users and the normal hearing group did not reach statistical significance. Early implanted CI users were more comparable in their use of question-final intonation contours to the individuals with typical hearing than to those users with CI implanted later in life. All CI users exhibited significantly less phrase-final lengthening than the normal hearing comparison group, regardless of age at CI implantation. Conclusion The results of this investigation of question intonation produced by CI users suggest that those CI users who were implanted with CI earlier in life produce yes/no question intonation in a manner that is more similar to, albeit not the same as, individuals with normal hearing when compared to the productions of those users with CI implanted after 4.0 years of age.

Communication skills of deaf and hard-of-hearing college students: Objective measures and self-assessment.

Objectively measured speech reception, speech production and expressive and receptive sign skills were compared with the self-assessment ratings of those skills in 96 college students with hearing loss. Participants with no aidable hearing used cochlear implants (CIs) or nothing. Participants with aidable hearing used either hearing aids (HAs) or nothing. Results revealed that individuals using CIs had speech reception and production skills that were as good as or better than students with more hearing who used HAs. Students using CIs or HAs had better speech reception and production skills than those without sensory aids. There was no difference in measured receptive sign skills across groups, despite differences in age of sign acquisition. Students typically provided accurate self-assessments of their communication skills with two notable exceptions: CI users overestimated their speech skills and nonusers overestimated their receptive sign skills. This study extends our knowledge regarding speech reception, production, sign skills and the ability to self-assess those skills in college students with hearing loss. Students who do not use sensory aids may be at academic risk with regard to receiving input via speech or sign.

Language and Psychosocial Functioning among Deaf Learners with and without Cochlear Implants.

Various studies have examined psychosocial functioning and language abilities among deaf children with and without cochlear implants (CIs). Few, however, have explored how relations among those abilities might change with age and setting. Most relevant studies also have failed to consider that psychosocial functioning among both CI users and nonusers might be influenced by having language abilities in both signed and spoken language. The present investigation explored how these variables might influence each other, including the possibility that deaf individuals' psychosocial functioning might be influenced differentially by perceived and actual signed and spoken language abilities. Changes in acculturation and quality of life were examined over their first year in college, together with changes in perceived and assessed language abilities. Students with and without CIs differed significantly in some aspects of psychosocial functioning and language ability, but not entirely in the directions expected based on studies involving school-aged deaf students. Participants' cultural affiliations were related as much or more to perceived language abilities as to the reality of those abilities as indicated by formal assessments. These results emphasize the need to consider the heterogeneity of deaf learners if they are to receive the support services needed for personal and academic growth.

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

Purpose: We sought to evaluate the development of grammatical accuracy in English-speaking children with cochlear implants (CIs) over a 3-year span. Method: Ten children who received CIs before age 30 months participated in this study at 3, 4, and 5 years postimplantation. For the purpose of comparison, 10 children each at ages 3, 4, and 5 years with typical hearing were included as well. All children participated in a story-retell task. We computed percent grammatical communication units (PGCU) in the task. Results: Children with CIs showed significant improvement in PGCU over the 3-year span. However, they produced lower PGCU than children with typical hearing who had matched hearing age at 4 and 5 years postimplantation. At the individual level, some children with CIs were able to produce PGCU comparable to children with typical hearing as early as 3 years after implantation. Better speech-perception skills at earlier time points were associated with higher PGCU at later time points. Moreover, children with and without CIs showed similar rankings in the types of grammatical errors. Conclusion: Despite having auditory-perceptual and information-processing constraints, children who received CIs before age 30 months were able to produce grammatical sentences, albeit with a delayed pattern.

Don't Assume Deaf Students are Visual Learners.

In the education of deaf learners, from primary school to postsecondary settings, it frequently is suggested that deaf students are visual learners. That assumption appears to be based on the visual nature of signed languages-used by some but not all deaf individuals-and the fact that with greater hearing losses, deaf students will rely relatively more on vision than audition. However, the questions of whether individuals with hearing loss are more likely to be visual learners than verbal learners or more likely than hearing peers to be visual learners have not been empirically explored. Several recent studies, in fact, have indicated that hearing learners typically perform as well or better than deaf learners on a variety of visual-spatial tasks. The present study used two standardized instruments to examine learning styles among college deaf students who primarily rely on sign language or spoken language and their hearing peers. The visual-verbal dimension was of particular interest. Consistent with recent indirect findings, results indicated that deaf students are no more likely than hearing students to be visual learners and are no stronger in their visual skills and habits than their verbal skills and habits, nor are deaf students' visual orientations associated with sign language skills. The results clearly have specific implications for the educating of deaf learners.

Understanding Language, Hearing Status, and Visual-Spatial Skills.

It is frequently assumed that deaf individuals have superior visual-spatial abilities relative to hearing peers and thus, in educational settings, they are often considered visual learners. There is some empirical evidence to support the former assumption, although it is inconsistent, and apparently none to support the latter. Three experiments examined visual-spatial and related cognitive abilities among deaf individuals who varied in their preferred language modality and use of cochlear implants (CIs) and hearing individuals who varied in their sign language skills. Sign language and spoken language assessments accompanied tasks involving visual-spatial processing, working memory, nonverbal logical reasoning, and executive function. Results were consistent with other recent studies indicating no generalized visual-spatial advantage for deaf individuals and suggested that their performance in that domain may be linked to the strength of their preferred language skills regardless of modality. Hearing individuals performed more strongly than deaf individuals on several visual-spatial and self-reported executive functioning measures, regardless of sign language skills or use of CIs. Findings are inconsistent with assumptions that deaf individuals are visual learners or are superior to hearing individuals across a broad range of visual-spatial tasks. Further, performance of deaf and hearing individuals on the same visual-spatial tasks was associated with differing cognitive abilities, suggesting that different cognitive processes may be involved in visual-spatial processing in these groups.

Are Young Children With Cochlear Implants Sensitive to the Statistics of Words in the Ambient Spoken Language?

PURPOSE: The purpose of this study was to determine whether children with cochlear implants (CIs) are sensitive to statistical characteristics of words in the ambient spoken language, whether that sensitivity changes in expected ways as their spoken lexicon grows, and whether that sensitivity varies with unilateral or bilateral implantation. METHOD: We analyzed archival data collected from the parents of 36 children who received cochlear implantation (20 unilateral, 16 bilateral) before 24 months of age. The parents reported their children's word productions 12 months after implantation using the MacArthur Communicative Development Inventories: Words and Sentences (Fenson et al., 1993). We computed the number of words, out of 292 possible monosyllabic nouns, verbs, and adjectives, that each child was reported to say and calculated the average phonotactic probability, neighborhood density, and word frequency of the reported words. RESULTS: Spoken vocabulary size positively correlated with average phonotactic probability and negatively correlated with average neighborhood density, but only in children with bilateral CIs. CONCLUSION: At 12 months postimplantation, children with bilateral CIs demonstrate sensitivity to statistical characteristics of words in the ambient spoken language akin to that reported for children with normal hearing during the early stages of lexical development. Children with unilateral CIs do not.

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

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

Consonant development in pediatric cochlear implant users who were implanted before 30 months of age.

This study provided a yearly record of consonant development for the initial 4 years of cochlear implant (CI) use and established a precedent for using a standardized articulation test, the Goldman-Fristoe Test of Articulation-2 (Goldman, R., & Fristoe, M. [2000]. Goldman-Fristoe Test of Articulation-2. Circle Pines, MN: American Guidance Services). The study used CI age as a referent for 32 children who received their CI before 30 months of age. Consonants produced by 70% of the children were listed, as were the most common error types, which were consonant omissions and substitutions. Using consonant repertoire lists and standard scores, the study revealed that children with CIs had acquisition patterns that were similar to their peers when the duration of CI experience was similar to the chronological age norms of typically developing children. The results revealed that CI users need time to coordinate their articulatory organizing principles with the input they receive from their CI. It is appropriate to use length of CI use as a proxy for chronological age during the first 4 years when comparing articulation development with hearing peers.

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

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

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

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

Long-term trajectories of the development of speech sound production in pediatric cochlear implant recipients.

PURPOSE: This study characterized the development of speech sound production in prelingually deaf children with a minimum of 8 years of cochlear implant (CI) experience. METHOD: Twenty-seven pediatric CI recipients' spontaneous speech samples from annual evaluation sessions were phonemically transcribed. Accuracy for these speech samples was evaluated in piecewise regression models. RESULTS: As a group, pediatric CI recipients showed steady improvement in speech sound production following implantation, but the improvement rate declined after 6 years of device experience. Piecewise regression models indicated that the slope estimating the participants' improvement rate was statistically greater than 0 during the first 6 years postimplantation, but not after 6 years. The group of pediatric CI recipients' accuracy of speech sound production after 4 years of device experience reasonably predicts their speech sound production after 5-10 years of device experience. CONCLUSIONS: The development of speech sound production in prelingually deaf children stabilizes after 6 years of device experience, and typically approaches a plateau by 8 years of device use. Early growth in speech before 4 years of device experience did not predict later rates of growth or levels of achievement. However, good predictions could be made after 4 years of device use.

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

OBJECTIVES: Previous studies have reported that children who use cochlear implants (CIs) tend to achieve higher reading levels than their peers with profound hearing loss who use hearing aids. The purpose of this study was to investigate the influences of auditory information provided by the CI on the later reading skills of children born with profound deafness. The hypothesis was that there would be a positive and predictive relationship between earlier speech perception, production, and subsequent reading comprehension. DESIGN: The speech perception and production skills at the vowel, consonant, phoneme, and word level of 72 children with prelingual, profound hearing loss were assessed after 48 mos of CI use. The children's reading skills were subsequently assessed using word and passage comprehension measures after an average of 89.5 mos of CI use. A regression analysis determined the amount of variance in reading that could be explained by the variables of perception, production, and socioeconomic status. RESULTS: Regression analysis revealed that it was possible to explain 59% of the variance of later reading skills by assessing the early speech perception and production performance. The results indicated that early speech perception and production skills of children with profound hearing loss who receive CIs predict future reading achievement skills. Furthermore, the study implies that better early speech perception and production skills result in higher reading achievement. It is speculated that the early access to sound helps to build better phonological processing skills, which is one of the likely contributors to eventual reading success.

Imitative production of rising speech intonation in pediatric cochlear implant recipients.

PURPOSE: This study investigated the acoustic characteristics of pediatric cochlear implant (CI) recipients' imitative production of rising speech intonation, in relation to the perceptual judgments by listeners with normal hearing (NH). METHOD: Recordings of a yes-no interrogative utterance imitated by 24 prelingually deafened children with a CI were extracted from annual evaluation sessions. These utterances were perceptually judged by adult NH listeners in regard with intonation contour type (non-rise, partial-rise, or full-rise) and contour appropriateness (on a 5-point scale). Fundamental frequency, intensity, and duration properties of each utterance were also acoustically analyzed. RESULTS: Adult NH listeners' judgments of intonation contour type and contour appropriateness for each CI participant's utterances were highly positively correlated. The pediatric CI recipients did not consistently use appropriate intonation contours when imitating a yes-no question. Acoustic properties of speech intonation produced by these individuals were discernible among utterances of different intonation contour types according to NH listeners' perceptual judgments. CONCLUSIONS: These findings delineated the perceptual and acoustic characteristics of speech intonation imitated by prelingually deafened children and young adults with a CI. Future studies should address whether the degraded signals these individuals perceive via a CI contribute to their difficulties with speech intonation production.

The effect of age at cochlear implant initial stimulation on expressive language growth in infants and toddlers.

This study examined the growth of expressive language skills in children who received cochlear implants (CIs) in infancy. Repeated language measures were gathered from 29 children who received CIs between 10 and 40 months of age. Both cross-sectional and growth curve analyses were used to assess the relationship between expressive language outcomes and CI experience. A beneficial effect of earlier implantation on expressive language growth was found. Growth curve analysis showed that growth was more rapid in children implanted as infants than those implanted as toddlers. Age at initial stimulation accounted for 14.6% of the variance of the individual differences in expressive language growth rates.

Outcomes and achievement of students who grew up with access to cochlear implants.

OBJECTIVES/HYPOTHESIS: To provide long-term speech perception and production, educational, vocational, and achievement outcome data for pediatric cochlear implant recipients. STUDY DESIGN: This is a retrospective study using consecutive referrals of prelingually, profoundly deaf children at the University of Iowa Hospitals and Clinics. METHODS: Twenty-seven prelingually deaf young adults who received a cochlear implant between the ages of 2 and 12 years participated. Outcome measures included device-use information, perceptual information, reading results for all participants and educational achievement results for 17 of 27 participants, educational placement information/vocational information for all students, as well as a comparison of the child's educational/vocational outcome with that of the parent's educational/vocational outcome. RESULTS: Speech perception and production scores were highly correlated. Achievement test results indicated that scores were within 1 SD from normative data based on hearing individuals. Over 50% of the college-age eligible students enrolled in college. This initial group of implant users had a nonuse rate of 11% in the first 3 years. Eighty-nine percent of the users maintained full-time use for 7 years, and 71% of this group have maintained full-time use to date. CONCLUSIONS: This cohort of cochlear implant users compared favorably with their hearing peers on academic achievement measures. Although there was a wide distribution of educational and vocational outcomes, the children tended to follow the educational/vocational patterns of their parents. As age of implantation decreases, it will be important to compare achievement outcomes of this first generation with those of subsequent generations of cochlear implant users.

An Evolution of Communication Modalities: Very Young Cochlear Implant Users who Transitioned from Sign to Speech During the First Years of Use.

The communication modalities used, and the articulation and aural-only receptive vocabulary skills were investigated in 19 prelingually profoundly deaf infants who initially utilized Total Communication and who were implanted between the ages of 12 and 29m. Results revealed the children overwhelmingly tended to use voice only modality for an expressive task. Additionally articulation and receptive vocabulary skills approached those of normal hearing peers. Implications of these findings and suggestions for future studies are provided.

Speech intelligibility of pediatric cochlear implant recipients with 7 years of device experience.

Speech intelligibility of 24 prelingually deaf pediatric cochlear implant (CI) recipients with 84 months of device experience was investigated. Each CI participant's speech samples were judged by a panel of 3 listeners. Intelligibility scores were calculated as the average of the 3 listeners' responses. The average write-down intelligibility score was 71.54% (SD = 29.89), and the average rating-scale intelligibility score was 3.03 points (SD = 1.01). Write-down and rating-scale intelligibility scores were highly correlated (r = .91, p < .001). Linear regression analyses revealed that both age at implantation and different speech-coding strategies contribute to the variability of CI participants' speech intelligibility. Implantation at a younger age and the use of the spectral-peak speech-coding strategy yielded higher intelligibility scores than implantation at an older age and the use of the multipeak speech-coding strategy. These results serve as indices for clinical applications when long-term advancements in spoken-language development are considered for pediatric CI recipients.

Exploring the language and literacy outcomes of pediatric cochlear implant users.

OBJECTIVE: The principal goal of this study was to investigate the relationship between language and literacy (i.e., reading and writing) skills in pediatric cochlear implant users. A peripheral objective was to identify the children's skills that were in need of remediation and subsequently to provide suggestions for remedial programming. It was predicted that the robust language skills often associated with children who have cochlear implant experience would facilitate the development of literacy skills. It was further proposed that the language and literacy skills of pediatric cochlear implant users would approximate the language and literacy skills of children with normal hearing. DESIGN: Sixteen pediatric cochlear implant users' language and literacy skills were evaluated and then compared with a reference group of 16 age-matched, normal-hearing children. All 32 participants were educated in mainstream classes within the public school system in the Midwest. The "Sentence Formulation" and "Concepts and Directions" subtests of the Clinical Evaluation of Language Fundamentals-3 test were used to evaluate receptive and expressive language skills. Reading comprehension was evaluated with the "Paragraph Comprehension" subtest of the Woodcock Reading Mastery Test. Performance measures for the writing analyses included productivity, complexity and grammaticality measures. RESULTS: Children with cochlear implants performed within 1 SD of the normal-hearing, age-matched children on measures of language comprehension, reading comprehension and writing accuracy. However, the children with cochlear implants performed significantly poorer than the children with normal hearing on the expressive "Sentence Formulation" subtest. The cochlear implant users also produced fewer words on the written narrative task than did the normal-hearing children, although there was not a significant difference between groups with respect to total words per clause. Furthermore there was a strong correlation between language performance and reading performance, as well as language performance and total words produced on the written performance measure for the children using cochlear implants. CONCLUSIONS: The results of this study suggest that the language skills of pediatric cochlear implant users are related to and correlated with the development of literacy skills within these children. Consequently, the performance of the cochlear implant users, on various language and literacy measures, compared favorably to an age-matched group of children with normal hearing. There were significant differences in the ability of the cochlear implant users to correctly utilize grammatical structures such as conjunctions and correct verb forms when they were required to formulate written and oral sentences. Given this information, it would be appropriate for their educational or remedial language programs to emphasize the use and development of these structures.