Principles of Executive Functioning Interventions for Children With Cochlear Implants: Guidance From Research Findings and Clinical Experience.

: Children with cochlear implants (CIs) are at risk for experiencing deficits in the development of neurocognitive processes known as executive functions (EF). Such deficits likely arise as a consequence of early-onset deafness, the degraded auditory input provided by CIs, and delays in spoken language development. Interventions specifically designed for pediatric CI users are needed to address challenges and delays in EF because of the unique influences of hearing loss and language delay on EF development, which have deleterious, cascading effects on speech and language development and subsequent reading and academic achievement. Because patterns of EF weakness emerge even in the preschool years, interventions to improve EF should be implemented at early ages, while children are young and neuroplasticity is high. Drawing on previous research findings and clinical experience, this paper highlights 10 principles to guide the development of EF interventions for children with CIs.

Language outcomes after cochlear implantation.

This article presents a focused review of language, speech, and comprehension outcomes in children with cochlear implants. Language acquisition with early-age implants and later-age implants are discussed, along with literacy and comprehension skills. A wide range of language outcomes is possible for children with cochlear implants, but many can achieve listening and spoken language skills at the same rate as their hearing peers. Appropriate auditory rehabilitation and parental guidance is vital for the development of listening and spoken language skills.

Effect of age at cochlear implantation on auditory skill development in infants and toddlers.

OBJECTIVES: To investigate the effect of age at cochlear implantation on the auditory development of children younger than 3 years and to compare these children's auditory development with that of peers with normal hearing. DESIGN: Using a repeated-measures paradigm, auditory skill development was evaluated before and 3, 6, and 12 months after implantation. Data were compared with previously published data from cohorts with normal hearing. PARTICIPANTS: One hundred seven hearing-impaired children (age range, 12-36 months) who received a cochlear implant during clinical trials in North America. MAIN OUTCOME MEASURE: Auditory skill development was assessed using the Infant-Toddler Meaningful Auditory Integration Scale, a tool that provides a quantitative measure in children as young as newborns. RESULTS: Infants and toddlers who receive implants show rapid improvement in auditory skills during the first year of device use regardless of age at implantation, although younger children achieve higher scores. Children who undergo implantation at a younger age acquire auditory skills nearer to those of their peers with normal hearing at a younger age. The mean rate of acquisition of auditory skills is similar to that of infants and toddlers with normal hearing regardless of age at implantation. CONCLUSION: Performing implantation in children with profound hearing loss at the youngest age possible allows the best opportunity for them to acquire communication skills that approximate those of their peers with normal hearing.

Bilingual oral language proficiency in children with cochlear implants.

OBJECTIVE: To document oral language proficiency in a group of prelingually deaf bilingual children with a cochlear implant. DESIGN: Using a repeated-measures paradigm, oral language skills in the first and second language were evaluated at 2 yearly intervals after implantation. Language data were compared with normative data from children with normal hearing. SUBJECTS: Twelve deaf children between the ages of 20 months and 15 years who had received a cochlear implant before the age of 3 years. OUTCOME MEASURE: First-language skills were assessed using 1 of 2 standardized tests, either the Oral and Written Language Scales or the Reynell Developmental Language Scales, depending on the child's age. Second-language proficiency was assessed using the Student Oral Language Observation Matrix. RESULTS: Average standard scores in the first language fell solidly within the average range of normal-hearing peers. Second-language skills showed steady improvement from year 1 to year 2, along a continuum that reflected the amount and intensity of exposure of the child to the second language and the length of experience with the implant. CONCLUSION: A cochlear implant can make oral proficiency in more than 1 language possible for prelingually deaf children.