Expressive vocabulary word categories of children who are deaf and hard-of-hearing.

This study investigated the acquisition of early expressive vocabulary among young children who are deaf and hard-of-hearing (DHH; n = 68) using auditory technology (hearing aids and cochlear implants). Parents completed a standardized vocabulary checklist, which allowed analyses of (i) the size of their child's spoken vocabulary; (ii) composition of the expressive lexicon (e.g., parts of speech such as nouns and verbs; semantic categories such as routines and body parts); and (iii) demographic and audiologic factors (e.g., chronologic age, degree of hearing access) potentially associated with these metrics. Young children who are DHH and use auditory technology acquired fewer spoken words than peers with typical hearing (TH) matched for chronologic age but more spoken words than peers with TH matched for listening experience. Action verbs-not nouns-significantly increased the odds of a child who is DHH achieving a vocabulary quotient within the normative range. These findings support the exploration of early expressive vocabulary size and composition-especially the number of active verbs-to guide clinical management and decision-making for young children who are DHH.

Speaking Rate, Immediate Memory, and Grammatical Processing in Prelingual Cochlear Implant Recipients.

PURPOSE: This study examined the extent to which prelingual cochlear implant (CI) users show a slowed speaking rate compared with typical-hearing (TH) talkers when repeating various speech stimuli and whether the slowed speech of CI users relates to their immediate verbal memory. METHOD: Participants included 10 prelingually deaf teenagers who received CIs before the age of 5 years and 10 age-matched TH teenagers. Participants repeated nonword syllable strings, word strings, and center-embedded sentences, with conditions balanced for syllable length and metrical structure. Participants' digit span forward and backward scores were collected to measure immediate verbal memory. Speaking rate data were analyzed using a mixed-design, repeated-measures analysis of variance, and the relationships between speaking rate and digit spans were evaluated by Pearson correlation. RESULTS: Participants with CIs spoke more slowly than their TH peers during the sentence repetition task but not in the nonword string and word string repetition tasks. For the CI group, significant correlations emerged between speaking rate and digit span scores (both forward and backward) for the sentence repetition task but not for the nonword string or word string repetition task. For the TH group, no significant correlations were found. CONCLUSIONS: The findings indicate a relation between slowed speech production, reduced immediate verbal memory, and diminished language capabilities of prelingual CI users, particularly for syntactic processing. These results support theories claiming that immediate memory, including components of a central executive, influences the speaking rate of these talkers. Implications for therapies designed to increase speech fluency in CI recipients are discussed. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21644795.

Parent-reported quality of life in children with cochlear implants differs across countries.

Pediatric cochlear implantation affects communication skills and quality of life, specifically how children interact with others and feel about themselves. Numerous studies worldwide examine well-being among pediatric cochlear implant users, but none to date compare condition-specific quality of life across countries. This retrospective study compares parent-reported cochlear implant-specific quality of life summary data across 14 published studies spanning 11 countries and 9 languages. Sample size ranged from 7 to 370 participants, and children across studies varied in mean chronologic age (3.1-12.2 years), implantation age (1.5-4.6 years), and cochlear implant experience (1.3-8.2 years). Parents completed the Children with Cochlear Implants: Parental Perspectives (CCIPP) questionnaire, an instrument assessing parent-reported cochlear implant-specific quality of life, in their home language. Analysis of variance tests were run for each CCIPP subscale across studies using summary data to determine significant differences between published manuscripts. Across countries, parents of children with cochlear implants appraise communication, social relations, and self-reliance most positively, and the effects of implantation and supporting the child least positively. Cross-country analyses revealed a significant effect of study (country) on quality of life ratings in each domain, with the largest differences in the communication domain. Limited access to implant-related accommodations, cultural awareness of hearing loss, and varying parent expectations may explain country differences in parental ratings of quality of life. Culturally sensitive psychoeducation for the entire family may foster improved life satisfaction for pediatric cochlear implant users and their families.

American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children.

This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child's skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

Quantitative and Qualitative Perspectives of Siblings of Children With Cochlear Implants.

Purpose The sibling relationship teaches children to navigate social interactions with their peers. However, the presence of an exceptionality, such as hearing loss, in one child can affect the dynamic of this relationship. This article examines quantitative and qualitative effects of having a brother or sister with a cochlear implant (CI) on siblings with typical hearing (TH) to determine how children with TH perceive their sibling with a CI and how having a CI user in the family affects the sibling's activities, emotions, and parental attention. Method Participants include 36 siblings with TH (M age = 11.6 years) of CI users (M age = 11.9 years) who completed quantitative measures of their perspectives of their brother/sister with CIs and the effect of hearing loss on themselves. Siblings with TH also could express their opinions via open-ended prompts. Results Overall, siblings with TH express positive perspectives of their brother/sister with CIs and report having a CI user in the family does not affect them much, particularly if the CI user has adequate communication skills. Responses to both quantitative and qualitative items converge on the close relationship between siblings but diverge relative to differential attention from parents (i.e., open-ended responses suggest parents spend more time with the CI user than the sibling with TH). Additionally, siblings acknowledge the presence of social communication deficits of the CI user in real-world situations. Conclusion This nuanced look at relationships among the parent, CI user, and sibling with TH highlights the importance of understanding the family system when working with children with hearing loss.

Relationships Between Daily Device Use and Early Communication Outcomes in Young Children With Cochlear Implants.

OBJECTIVES: Children with significant hearing loss can gain access to sound via a cochlear implant (CI), but they must wear the device to reap the communication benefits of the device. That is, poor daily device use may result in underdeveloped perceptual and language skills in children and adolescents using CIs. This retrospective study focuses on the relationship between daily CI use and communication performance (auditory skills, speech recognition, expressive and receptive language) in young children, with the hypothesis that greater daily device use coincides with better communication outcomes. DESIGN: The authors conducted a clinical chart review of patients with CIs younger than 5 years old who used at least 1 CI speech processor with datalogging technology. Participants (n = 65) had a mean chronologic age of 3.5 years, mean implantation age of 1.9 years, and mean device experience of 1.6 years. Approximately one quarter of participants had additional disabilities. Daily device use (i.e., datalogging information), child characteristics (e.g., age at CI), and assessments of communication skills (i.e., parent questionnaires, speech recognition tests, standardized language assessments) were obtained from each child's records. The investigators performed correlational analyses to examine relationships between communication outcomes and daily device use, and they employed group comparisons and correlations to identify child characteristics that were significantly associated with daily device use (p < 0.05, corrections for family-wise error). RESULTS: Young children with CIs used their device, on average, 6.7 hr/d, with 63% below full-time use (<8 hr/d). Children without additional disabilities who wore their CI more hours per day had significantly better auditory, speech recognition, and language skills. A significant correlation also emerged between daily device use and early auditory skills in young CI users with additional disabilities, though relationships were more complicated for this subsample. Longer daily device use significantly correlated with younger age at CI and longer device experience. Differences in device use occurred in regards to absence versus presence of additional disabilities, bilateral versus unilateral device configuration, sign versus spoken language, and private versus government-assisted insurance. CONCLUSIONS: The strong relationship between daily device use and early communication suggests clinicians and parents should focus on increasing the number of hours per day young children wear their CIs to enhance auditory and language outcomes. However, intervention strategies must consider barriers to consistent device use and goals of the family to efficiently and effectively support families of young children with CIs who struggle with inconsistent device use.

Music Perception and Speech-in-Noise Skills of Typical Hearing and Cochlear Implant Listeners.

Purpose Adult cochlear implant (CI) users rate music as one of the most important auditory stimuli, second to speech perception. However, few studies simultaneously examine music perception and speech-in-noise perception in adult CI recipients. This study explores the effect of auditory status on music perception and speech-in-noise perception recognition in noise as well as the relationship among music engagement, music perception, and speech-in-noise perception. Method Participants include 10 adults with typical hearing (TH) and 10 adults with long-term CI use. All participants completed the Music-Related Quality of Life Questionnaire, which assesses subjective music experiences and their importance; the Pitch Direction Discrimination, Familiar Melody Recognition, and Timbre Recognition subtests of the Clinical Assessment of Music Perception for Cochlear Implants; the Unfamiliar Melody Recognition subtest of the Profile of Music Perception Skills; and the Bamford-Kowal-Bench Speech-in-Noise Test. Results The TH group significantly outperformed the CI group for speech-in-noise perception and on all four music perception tasks. The CI group exhibited not only significantly poorer mean scores but also greater variability in performance compared to the TH group. Only Familiar Melody Recognition and Unfamiliar Melody Recognition subtests significantly correlated with speech-in-noise scores. Conclusions Patients and professionals should not assume speech perception and music perception in adult CI users derive from the same auditory or cognitive foundations. The lack of significant relationships among music engagement, music perception, and speech-in-noise perception scores in adult CI users suggests this population enjoys music despite poor and variable performance in discrete music tasks.

Stress in Parents of School-Age Children and Adolescents With Cochlear Implants.

Parents of children with cochlear implants (CIs) face unique challenges in caring for their child, potentially fostering parental stress. Most studies of stress in parents of CI users do not examine stress specific to having a deaf and hard-of-hearing (DHH) child. This study compares general and condition-specific stress (via the Family Stress Scale) in 31 parents of CI users (8-16 years) to previously published samples of DHH children, and it examines child- and CI-related factors associated with parental stress. Parents of modern-day CI users reported significantly lower stress than parents of children using older-generation CI technology and similar levels of overall stress to parents of young children preimplantation. However, significant item-level differences emerged (e.g., communication, device management) pre- versus postimplant. Child temperament significantly predicted parental stress after controlling for other variables. Intervention strategies for children with CIs should engage a family systems approach to reduce parental stress and better support the child.

Early Vocabulary Profiles of Young Deaf Children Who Use Cochlear Implants.

Purpose This study examined vocabulary profiles in young cochlear implant (CI) recipients and in children with normal hearing (NH) matched on receptive vocabulary size to improve our understanding of young CI recipients' acquisition of word categories (e.g., common nouns or closed-class words). Method We compared receptive and expressive vocabulary profiles between young CI recipients (n = 48; mean age at activation = 15.61 months, SD = 4.20) and children with NH (n = 48). The two groups were matched on receptive vocabulary size as measured by the MacArthur-Bates Communicative Development Inventories (Fenson et al., 2006): Words and Gestures form. The CI group had, on average, 8.98 months of hearing experience. The mean chronological age at completing the MacArthur-Bates Communicative Development Inventories was 23.99 months (SD = 5.14) for the CI group and 13.72 months (SD = 1.50) for the NH group. Results The CI group had a larger expressive vocabulary size than the receptive vocabulary size-matched NH group. The larger expressive vocabulary size was associated with the group difference in social words but not with common nouns. The analyses for predicate words and closed-class words included only children who produced the target categories. The CI group had a larger proportion of predicate words than the NH group, but no difference was found in closed-class words in expressive vocabulary. Conclusions Differences found in expressive vocabulary profiles may be affected by spoken vocabulary size and their age. A further examination is warranted using language samples to understand the effect of language input on children's vocabulary profiles.

Effect of auditory status on visual emotion recognition in adolescents.

Adolescents with severe to profound hearing loss who wear cochlear implants (CIs) experience significantly more peer problems compared to peers with typical hearing (TH). Differences in peer social dynamics may relate to perception not only of message content, but also message intent based on a speaker's emotion from visual (e.g. facial expressions) and auditory (e.g. prosody) cues. Pediatric CI users may experience greater difficulty with auditory emotion recognition due to an impoverished signal representation provided by the device, but the effect of auditory status on visual emotion recognition yields conflicting results. OBJECTIVES: The current study examined accuracy and speed of visual emotion recognition in adolescents with CIs and peers with TH. METHODS: Participants included 58 adolescents (10-18 years) stratified by auditory status: 34 CI users and 24 TH peers. Participants identified the intended emotion (i.e. happiness, sadness, anger, fear, disgust, and surprise) of static images of faces displayed on a computer screen. RESULTS: No significant differences by auditory status emerged for response accuracy, response time to all trials, or response time to correct trials. Type of emotion significantly affected both accuracy and response time. CONCLUSION: Adolescents with CIs show similar accuracy and response time in recognizing static facial expressions compared to TH peers. Future studies should explore the association between visual emotion recognition and social well-being to determine the relationship between emotion recognition and overall quality of life in adolescents with CIs.

Inconsistent device use in pediatric cochlear implant users: Prevalence and risk factors.

OBJECTIVES: Cochlear implants (CIs) afford an opportunity for children with a significant hearing loss to access spoken language through auditory input, but challenges post-implantation could impede success. Inconsistent device use occurs when a child wears their device less than full-time (<8 hours per day). Previous studies may underestimate the prevalence of inconsistent device use in pediatric CI users due to methodological issues (subjective parent report vs. objective measures). METHODS: This retrospective chart review identifies risk factors (demographic, audiologic, and device) associated with poorer daily device use in children with CI using objective datalogging. Non-parametric correlations, Mann-Whitney U, and Kruskal-Wallis H tests were used to evaluate effects of demographic, audiologic, and device factors on daily device use via datalogging. RESULTS: Participants included 71 children (age M = 7.0 years) with mean implantation age of 4.0 years and mean device experience of 3.0 years. Children with CIs used their device, on average, 7.6 hours/day (range: 0.1-15.5 hours). Half of the participants wore their device less than full-time. Fewer hours of device use coincided with younger chronologic age, presence of additional disabilities, lower maternal education, younger age at CI, use of Medicaid, and smaller dynamic range. DISCUSSION: The prevalence of inconsistent device use may exceed previous estimations based on parent report. CONCLUSION: Professionals working with pediatric CI users should consider incorporating datalogging into clinical practice to counsel families at risk for poorer device use. Future studies should compare objective device use with communication outcomes in pediatric CI users.

Early Sign Language Exposure and Cochlear Implantation Benefits.

BACKGROUND: Most children with hearing loss who receive cochlear implants (CI) learn spoken language, and parents must choose early on whether to use sign language to accompany speech at home. We address whether parents' use of sign language before and after CI positively influences auditory-only speech recognition, speech intelligibility, spoken language, and reading outcomes. METHODS: Three groups of children with CIs from a nationwide database who differed in the duration of early sign language exposure provided in their homes were compared in their progress through elementary grades. The groups did not differ in demographic, auditory, or linguistic characteristics before implantation. RESULTS: Children without early sign language exposure achieved better speech recognition skills over the first 3 years postimplant and exhibited a statistically significant advantage in spoken language and reading near the end of elementary grades over children exposed to sign language. Over 70% of children without sign language exposure achieved age-appropriate spoken language compared with only 39% of those exposed for 3 or more years. Early speech perception predicted speech intelligibility in middle elementary grades. Children without sign language exposure produced speech that was more intelligible (mean = 70%) than those exposed to sign language (mean = 51%). CONCLUSIONS: This study provides the most compelling support yet available in CI literature for the benefits of spoken language input for promoting verbal development in children implanted by 3 years of age. Contrary to earlier published assertions, there was no advantage to parents' use of sign language either before or after CI.

Pediatric Minimum Speech Test Battery.

BACKGROUND: Assessment of patient outcomes and documentation of treatment efficacy serves as an essential component of (re)habilitative audiology; however, no standardized protocol exists for the assessment of speech perception abilities for children with hearing loss. This presents a significant challenge in tracking performance of children who utilize various hearing technologies for within-subjects assessment, between-subjects assessment, and even across different facilities. PURPOSE: The adoption and adherence to a standardized assessment protocol could help facilitate continuity of care, assist in clinical decision making, allow clinicians and researchers to define benchmarks for an aggregate clinical population, and in time, aid with patient counseling regarding expectations and predictions regarding longitudinal outcomes. DESIGN: The Pediatric Minimum Speech Test Battery (PMSTB) working group-comprised of clinicians, scientists, and industry representatives-commenced in 2012 and has worked collaboratively to construct the first PMSTB, which is described here. CONCLUSIONS: Implementation of the PMSTB in clinical practice and dissemination of associated data are both critical for achieving the next level of success for children with hearing loss and for elevating pediatric hearing health care ensuring evidence-based practice for (re)habilitative audiology.

Age and gender differences in children and adolescents' attitudes toward noise.

OBJECTIVE: Most school-aged children experience exposure to hazardous sound levels via high-risk noise activities (e.g. loud music/concerts, firearms). Little information exists regarding factors influencing pediatric engagement in these activities and use of hearing protection devices. This study explores effects of age, gender, and attitudes toward noise on participation in acoustic risk-taking behaviors and hearing conservation practices in children and adolescents. DESIGN: Cross-sectional. STUDY SAMPLE: Children and adolescents (10-19 years) with normal hearing. RESULTS: Most children and adolescents (86.5%) participate in at least one potentially high-risk noise behavior. The most frequently cited activities include sporting events, concerts, and playing a musical instrument. Use of hearing protection devices varies by activity, with consistent wear while using firearms but inconsistent application during all other activities. Gender, but not age, influences acoustic risk-taking behaviors: Boys engage in significantly more high-risk noise activities than girls. Participants expressed a neutral attitude toward noise that persisted across age and gender, but a trend shifting toward a pro-noise attitude emerges in later adolescence. CONCLUSIONS: The proliferation of acoustic risk-taking behaviors and lack of hearing conservation practices in children and adolescents requires attention at an early age to prevent future noise-induced hearing loss and subsequent quality of life effects.

Self-esteem in children and adolescents with hearing loss.

Children with hearing loss are at risk for lower self-esteem due to differences from hearing peers relative to communication skills, physical appearance, and social maturity. This study examines the influence of generic factors unrelated to hearing loss (e.g., age, gender, temperament) and specific factors associated with hearing loss (e.g., age at identification, communication skills) on how children with hearing loss wearing cochlear implants or hearing aids appraise self-esteem. Fifty children with hearing loss wearing cochlear implants or hearing aids participated (Mean age: 12.88 years; mean duration of device use: 3.43 years). Participants independently completed online questionnaires to assess communication skills, social engagement, self-esteem, and temperament. Children with hearing loss rated global self-esteem significantly more positively than hearing peers, t = 2.38, p = .02. Self-esteem ratings attained significant positive correlations with affiliation (r = .42, p = .002) and attention (r = .45, p = .001) temperaments and a significant negative association with depressive mood (r = - .60, p < .0001). No significant correlations emerged between self-esteem and demographic factors, communication skills, or social engagement. Because successful communication abilities do not always co-occur with excellent quality of life, clinicians and professionals working with children with hearing loss need to understand components contributing to self-esteem to improve identification, counseling, and external referrals for children in this population.

American parent perspectives on quality of life in pediatric cochlear implant recipients.

OBJECTIVES: Cochlear implantation influences not only communication but also psychosocial outcomes in children with severe to profound hearing loss. Focusing on issues specific to cochlear implantation (e.g., self-reliance, social relations, education, effects of implantation, and supporting the child) may provide a more accurate and relative view of functional status of pediatric cochlear implant (CI) recipients. The present study analyzes parental perspectives of CI-specific health-related quality of life (HRQoL) in children with CIs to determine (a) if parents differentially rate their child's quality of life according to psychosocial domain (e.g., communication, self-reliance, education); (b) if associations exist between quality of life domains specific to cochlear implantation in pediatric implant recipients; and (c) if demographic variables (i.e., chronologic age, age at cochlear implantation, duration of device experience) mediate parent ratings of quality of life in pediatric CI recipients. DESIGN: Parents of 33 children with CIs (mean age, 9.85 years; mean age of CI activation, 2.47 years; mean device experience, 7.47 years) completed a validated condition-specific questionnaire, Children With Cochlear Implants: Parental Perspectives. RESULTS: Parents positively rated most HRQoL domains, although education and effects of implantation received significantly less positive ratings (p < 0.01). Three domains (communication, self-reliance, and well-being) significantly correlated with at least 5 other domains, suggesting that positivity in one domain co-occurs with positivity in other domains. Demographic variables (chronologic age, CI activation age, and duration of CI use) did not correlate significantly with psychosocial outcomes; rather, parents reported positive HRQoL and successful functional use of CI across demographic variables. CONCLUSIONS: Parents of children and adolescents with CIs rate overall HRQoL positively across psychosocial domains. Significantly less positive ratings of education and effects of implantation may result from limited access to CI-related accommodations and varying parent expectations, warranting further exploration to maximize psychosocial and performance outcomes in pediatric CI users.

Vowel discrimination by hearing infants as a function of number of spectral channels.

Reduced spectral resolution negatively impacts speech perception, particularly perception of vowels and consonant place. This study assessed impact of number of spectral channels on vowel discrimination by 6-month-old infants with normal hearing by comparing three listening conditions: Unprocessed speech, 32 channels, and 16 channels. Auditory stimuli (/ti/ and /ta/) were spectrally reduced using a noiseband vocoder and presented to infants with normal hearing via visual habituation. Results supported a significant effect of number of channels on vowel discrimination by 6-month-old infants. No differences emerged between unprocessed and 32-channel conditions in which infants looked longer during novel stimulus trials (i.e., discrimination). The 16-channel condition yielded a significantly different pattern: Infants demonstrated no significant difference in looking time to familiar vs novel stimulus trials, suggesting infants cannot discriminate /ti/ and /ta/ with only 16 channels. Results support effects of spectral resolution on vowel discrimination. Relative to published reports, young infants need more spectral detail than older children and adults to perceive spectrally degraded speech. Results have implications for development of perception by infants with hearing loss who receive auditory prostheses.

A comparative study of psychosocial development in children who receive cochlear implants.

OBJECTIVES: This study assessed self-reported quality of life of children with a cochlear implant (CI), comparing results with two published reports from the past decade. METHODS: Participants included 33 pediatric CI recipients with a mean age of 10.12 years (SD = 3.59), mean implantation age of 1.36 years (SD = 0.46), and mean CI experience of 6.23 years (SD = 1.75). Children in all three studies completed a self-report quality-of-life questionnaire that included seven benefit and six problem items, rated on a 5-point Likert scale. RESULTS: Outcomes revealed agreement across studies in overall benefit and problem ratings. Environmental awareness and frustration reduction were the most and least positively rated outcomes, respectively. Items contributing to overall ratings differed across studies. Current CI recipients rated speech production, making new friends, and understanding speech more positively and taking extra care of the device more negatively than previous generations of pediatric CI users. DISCUSSION: Overall, benefits outweigh problems of the device, according to children using CI. Differences in issues motivating self-report ratings reflect changes in CI candidacy, technology, and social participation over the past decade. These findings emphasize the need for clinicians to address not only communication needs, but also quality-of-life issues to optimize outcomes in children using CI.

Cochlear implantation updates: the Dallas Cochlear Implant Program.

This report provides an overview of many research projects conducted by the Dallas Cochlear Implant Program, a joint enterprise between the University of Texas at Dallas, the University of Texas Southwestern Medical Center, and Children's Medical Center. The studies extend our knowledge of factors influencing communication outcomes in users of cochlear implants. Multiple designs and statistical techniques are used in the studies described including both cross sectional and longitudinal analyses. Sample sizes vary across the studies, and many of the samples represent large populations of children from North America. Multiple statistical techniques are used by the team to analyze outcomes. The team has provided critical information regarding electrode placement, signal processing, and communication outcomes in users of cochlear implants.