A Longitudinal Investigation of the Home Literacy Environment and Shared Book Reading in Young Children With Hearing Loss.

OBJECTIVES: The principle goal of this longitudinal study was to examine parent perceptions of home literacy environment (e.g., frequency of book reading, ease of book reading with child) and observed behaviors during shared book reading (SBR) interactions between parents and their children with hearing loss (HL) as compared with parents and their children with normal hearing (NH) across 3 time points (12, 24, and 36 months old). Relationships were also explored among home literacy environment factors and SBR behaviors and later language outcomes, across all three time points for parents of children with and without HL. DESIGN: Participants were a group of parents and their children with HL (N = 17) and typically developing children with NH (N = 34). Parent perceptions about the home literacy environment were captured through a questionnaire. Observed parent behaviors and their use of facilitative language techniques were coded during videotaped SBR interactions. Children's oral language skills were assessed using a standardized language measure at each time point. RESULTS: No significant differences emerged between groups of parents (HL and NH) in terms of perceived home literacy environment at 12 and 36 months. However, significant group differences were evident for parent perceived ease of reading to their child at 24 months. Group differences also emerged for parental SBR behaviors for literacy strategies and interactive reading at 12 months and for engagement and interactive reading at 36 months, with parents of children with HL scoring lower in all factors. No significant relationships emerged between early home literacy factors and SBR behaviors at 12 months and oral language skills at 36 months for parents of children with NH. However, significant positive relationships were evident between early home literacy environment factors at 12 months and oral language skills at 36 months for parents and their children with HL. CONCLUSIONS: Although both groups of parents increased their frequency of SBR behaviors over time, parents of children with HL may need additional support to optimize SBR experiences to better guide their toddlers' and preschoolers' language skills. Early intervention efforts that focus on SBR interactions that are mutually enjoyed and incorporate specific ways to encourage parent-child conversations will be essential as children with HL acquire language.

Concept formation skills in long-term cochlear implant users.

This study investigated if a period of auditory sensory deprivation followed by degraded auditory input and related language delays affects visual concept formation skills in long-term prelingually deaf cochlear implant (CI) users. We also examined if concept formation skills are mediated or moderated by other neurocognitive domains (i.e., language, working memory, and executive control). Relative to normally hearing (NH) peers, CI users displayed significantly poorer performance in several specific areas of concept formation, especially when multiple comparisons and relational concepts were components of the task. Differences in concept formation between CI users and NH peers were fully explained by differences in language and inhibition-concentration skills. Language skills were also found to be more strongly related to concept formation in CI users than in NH peers. The present findings suggest that complex relational concepts may be adversely affected by a period of early prelingual deafness followed by access to underspecified and degraded sound patterns and spoken language transmitted by a CI. Investigating a unique clinical population such as early-implanted prelingually deaf children with CIs can provide new insights into foundational brain-behavior relations and developmental processes.

Developmental outcomes of early-identified children who are hard of hearing at 12 to 18 months of age.

AIMS: To examine the developmental outcomes of early-identified children who are hard of hearing, at 12 to 18 months of age, compared to those for children of similar age with normal hearing; and to investigate parent and child factors that are associated with these developmental outcomes. METHODS: As part of a prospective study, 28 children with mild to severe hearing loss between the ages of 12 and 18 months and 42 children with normal hearing of similar age completed a comprehensive assessment battery. All children with hearing loss were identified by newborn hearing screening and amplified, on average, by 5 months of age. Outcome measures included: Mullen Scales of Early Learning; Preschool Language Scale-4th Ed; MacArthur-Bates Communicative Development Inventory; Infant-Toddler Social and Emotional Assessment; Vineland Adaptive Behavior Scales, Second Edition; Parenting Stress Index-Short Form; and Maternal Self-Efficacy Scale. RESULTS: Children with hearing loss scored comparably to children with normal hearing on select outcome measures, with mean scores for both groups falling within normal limits. Greater maternal self-efficacy was associated with children's better language skills, adaptive behavior, social-emotional competence, and fewer problem behaviors. CONCLUSION: Very young children with mild to severe hearing loss, who are identified early and provided prompt intervention that includes amplification, can demonstrate age appropriate development in multiple domains. Results also underscore the significance of parenting factors, especially perceived maternal self-efficacy, in relation to positive developmental outcomes for these children early in life.

Parental Support for Language Development During Joint Book Reading for Young Children With Hearing Loss.

Parent and child joint book reading (JBR) characteristics and parent facilitative language techniques (FLTs) were investigated in two groups of parents and their young children; children with normal hearing (NH; n = 60) and children with hearing loss (HL; n = 45). Parent-child dyads were videotaped during JBR interactions, and parent and child behaviors were coded for specific JBR behaviors using a scale developed for this study. Children's oral language skills were assessed using the Preschool Language Scale-4 (PLS-4). Parents of children with HL scored higher on two of the four subscales of JBR: Literacy Strategies and Teacher Techniques. Parents of children with NH utilized higher level FLTs with their children who had higher language skills. Higher level FLTs were positively related to children's oral language abilities. Implications are discussed for professionals who work with families of very young children with HL.

Executive functioning and speech-language skills following long-term use of cochlear implants.

Neurocognitive processes such as executive functioning (EF) may influence the development of speech-language skills in deaf children after cochlear implantation in ways that differ from normal-hearing, typically developing children. Conversely, spoken language abilities and experiences may also exert reciprocal effects on the development of EF. The purpose of this study was to identify EF domains that are related to speech-language skills in cochlear implant (CI) users, compared to normal-hearing peers. Sixty-four prelingually deaf, early-implanted, long-term users of CIs and 74 normal-hearing peers equivalent in age and nonverbal intelligence completed measures of speech-language skills and three domains of EF: working memory, fluency-speed, and inhibition-concentration. Verbal working memory and fluency-speed were more strongly associated with speech-language outcomes in the CI users than in the normal-hearing peers. Spatial working memory and inhibition-concentration correlated positively with language skills in normal-hearing peers but not in CI users. The core domains of EF that are associated with spoken language development are different in long-term CI users compared to normal-hearing peers, suggesting important dissociations in neurocognitive development.

Executive functioning skills in preschool-age children with cochlear implants.

PURPOSE: The purpose of this study was to determine whether deficits in executive functioning (EF) in children with cochlear implants (CIs) emerge as early as the preschool years. METHOD: Two groups of children ages 3 to 6 years participated in this cross-sectional study: 24 preschoolers who had CIs prior to 36 months of age and 21 preschoolers with normal hearing (NH). All were tested on normed measures of working memory, inhibition-concentration, and organization-integration. Parents completed a normed rating scale of problem behaviors related to EF. Comparisons of EF skills of children with CIs were made to peers with NH and to published nationally representative norms. RESULTS: Preschoolers with CIs showed significantly poorer performance on inhibition-concentration and working memory compared with peers with NH and with national norms. No group differences were found in visual memory or organization-integration. When data were controlled for language, differences in performance measures of EF remained, whereas differences in parent-reported problems with EF were no longer significant. Hearing history was generally unrelated to EF. CONCLUSIONS: This is the first study to demonstrate that EF deficits found in older children with CIs begin to emerge as early as preschool years. The ability to detect these deficits early has important implications for early intervention and habilitation after cochlear implantation.

Preschool speech intelligibility and vocabulary skills predict long-term speech and language outcomes following cochlear implantation in early childhood.

Speech and language measures during grade school predict adolescent speech-language outcomes in children who receive cochlear implants (CIs), but no research has examined whether speech and language functioning at even younger ages is predictive of long-term outcomes in this population. The purpose of this study was to examine whether early preschool measures of speech and language performance predict speech-language functioning in long-term users of CIs. Early measures of speech intelligibility and receptive vocabulary (obtained during preschool ages of 3-6 years) in a sample of 35 prelingually deaf, early-implanted children predicted speech perception, language, and verbal working memory skills up to 18 years later. Age of onset of deafness and age at implantation added additional variance to preschool speech intelligibility in predicting some long-term outcome scores, but the relationship between preschool speech-language skills and later speech-language outcomes was not significantly attenuated by the addition of these hearing history variables. These findings suggest that speech and language development during the preschool years is predictive of long-term speech and language functioning in early-implanted, prelingually deaf children. As a result, measures of speech-language functioning at preschool ages can be used to identify and adjust interventions for very young CI users who may be at long-term risk for suboptimal speech and language outcomes.

Long-term speech and language outcomes in prelingually deaf children, adolescents and young adults who received cochlear implants in childhood.

This study investigated long-term speech and language outcomes in 51 prelingually deaf children, adolescents and young adults who received cochlear implants (CIs) prior to 7 years of age and had used their implants for at least 7 years. Average speech perception scores were similar to those found in prior research with other samples of experienced CI users. Mean language test scores were lower than norm-referenced scores from nationally representative normal-hearing, typically developing samples, although a majority of the CI users scored within 1 standard deviation of the normative mean or higher on the Peabody Picture Vocabulary Test, Fourth Edition (63%), and the Clinical Evaluation of Language Fundamentals, Fourth Edition (69%). Speech perception scores were negatively associated with a meningitic etiology of hearing loss, older age at implantation, poorer preimplant unaided pure-tone average thresholds, lower family income and the use of 'total communication'. Subjects who had used CIs for 15 years or more were more likely to have these characteristics and were more likely to score lower on measures of speech perception compared to those who had used CIs for 14 years or less. The aggregation of these risk factors in the >15 years of CI use subgroup accounts for their lower speech perception scores and may stem from more conservative CI candidacy criteria in use at the beginning of pediatric cochlear implantation.

Executive functioning skills in long-term users of cochlear implants: a case control study.

OBJECTIVE: To investigate differences in executive functioning between deaf children with cochlear implants (CIs) and normal-hearing (NH) peers. The cognitive effects of auditory deprivation in childhood may extend beyond speech-language skills to more domain-general areas including executive functioning. METHODS: Executive functioning skills in a sample of 53 prelingually deaf children, adolescents, and young adults who received CIs prior to age 7 years and who had used their CIs for ≥7 years were compared with age- and nonverbal IQ-matched NH peers and with scale norms. RESULTS: Despite having above average nonverbal IQ, the CI sample scored lower than the NH sample and test norms on several measures of short-term/working memory, fluency-speed, and inhibition-concentration. Executive functioning was unrelated to most demographic and hearing history characteristics. CONCLUSIONS: Prelingual deafness and long-term use of CIs was associated with increased risk of weaknesses in executive functioning.

Working memory training for children with cochlear implants: a pilot study.

PURPOSE: This study investigated the feasibility and efficacy of a working memory training program for improving memory and language skills in a sample of 9 children who are deaf (age 7-15 years) with cochlear implants (CIs). METHOD: All children completed the Cogmed Working Memory Training program on a home computer over a 5-week period. Feasibility and acceptability of the program were evaluated using parent report and measures of children's performance on the training exercises. Efficacy measures of working memory and sentence repetition were obtained prior to training, immediately after training, and 1 month and 6 months after training. RESULTS: Children's performance improved on most training exercises, and parents reported no problems with children's hearing or understanding of the exercises. After completion of working memory training, children demonstrated significant improvement on measures of verbal and nonverbal working memory, parent-reported working memory behavior, and sentence-repetition skills. The magnitude of improvement in working memory decreased slightly at the 1-month follow-up and more substantially at 6-month follow-up. However, sentence repetition continued to show marked improvement at 6-month follow-up. CONCLUSIONS: Working memory training may produce benefit for some memory and language skills for children with CIs, supporting the importance of conducting a large-scale, randomized clinical trial with this population.