The relationship between reading comprehension, working memory and language in children with cochlear implants

Working memory, language, and reading comprehension are strongly associated in children with severe and profound hearing impairment treated by cochlear implants (CI). In this study we explore this relationship in sixteen Swedish children with CI. We found that over 60% of the children with CI performed at the level of their hearing peers in a reading comprehension test. Demographic factors were not predictive of reading comprehension, but a complex working memory task was. Reading percentile was significantly correlated to the working memory test, but no other correlations between reading and cognitive/linguistic factors remained significant after age was factored out. Individual results from a comparison of the two best and the two poorest readers corroborate group results, confirming the important role of working memory for reading as measured by comprehension of words andmsentences in this group of children

Spoken and written narratives in Swedish children and adolescents with hearing impairment

Twenty 10- to 18-year-old children and adolescents with varying degrees of hearing impairment (HI) and hearing aids (HA), ranging from mild-moderate to severe, produced picture-elicited narratives in a spoken and written version. Their performance was compared to that of 63 normally hearing (NH) peers within the same age span. The participants with HI and NH showed similar patterns regarding intragroup correlations between corresponding measures of spoken and written narratives. However, the participants with HI had significantly less diverse language than the NH group. The participants with poorer hearing (higher best ear hearing level [BEHL]) produced spoken and written narratives comprising more content words and they also produced written narratives that were less lexically diverse than the participants with better hearing (lower BEHL). The difference as to lexical skills emphasizes the importance of focusing on these skills in the group of children with HI. However, the results give support for a quite optimistic view on the development of narration in children with HI with HA, at least for picture-elicited narratives

Narration and reading comprehension in Swedish children and adolescents with hearing impairment

The aim of the present thesis was to explore reading comprehension and narration in children and adolescents with different degrees of hearing impairment (HI). In Study I, reading comprehension was investigated in 16 children with cochlear implants (CI), aged 7-13 years. Over 60% of the investigated children performed at the level of their hearing peers. Reading comprehension was better than expected taking the participants poor phonological skills into consideration. The association between reading comprehension and working memory capacity was robust. Study II was a methodological study, where narrative writing (picture-elicited) was studied using keystroke-logging, which was found to be a valid method for children with typical language developing and NH of 10 years of age and above. The analyses of narratives from 27 children aged 8-12 years, showed several relations between the writing process and the writing product. In Study III, the process and the product in written narration was explored in 18 participants with CI, aged 11-19. When comparing their performance to that of participants with NH, the most prominent difference was that the children and adolescents with CI were less linguistically mature. This was illustrated by a much higher proportion of content words (less function words). Regarding older participants, although they wrote as fast, they used significantly more pause time than participants with NH. In study IV, spoken, as well as written narration was investigated in 20 participants with HI and HA, 10-18 years old. The main finding was that they were less lexically varied than participants with NH. Narration and reading comprehension are important skills for academic success and social inclusion. This thesis clearly indicates that many individuals with HI who are over the age of 10 years clearly lag behind their age peers in complex language activities

Process and product in writing-a methodological contribution to the assessment of written narratives in 8-12-year-old Swedish children using ScriptLog.

Twenty-seven children, with typical language development (TLD), 8-10 years old and 10-12 years old, were assessed with keystroke-logging in order to investigate their narrative writing. Measures of the writing process and the written product were used. One purpose was to explore how children produce written narratives in on-line production, and to relate the writing process to the written product. The results showed that those children who produced the final text faster, also wrote stories that comprised of more words. In the group of older children, children with better narrative ability used less pause time than those with worse ability, and the girls were faster writers than the boys. We believe that keystroke-logging gives valuable information for the assessment of young children's writing and that it is a potentially valid assessment tool for children from about 10 years of age

Phonological processing, grammar and sentence comprehension in older and younger generations of Swedish children with cochlear implants

Background and aims Phonological processing skills measured by nonword repetition, are consistently found to be hampered in children with severe/profound hearing impairment and cochlear implants, compared to children with normal hearing. Many studies also find that grammar is affected. There are no studies exploring grammar in the Swedish population of children with cochlear implants. Documentation is also sparse regarding if and how language development in children with cochlear implants at the group level has changed over time with for example earlier implantation. The aim of the present study is to explore nonword repetition, grammatical production and sentence comprehension in an older generation of Swedish children with cochlear implants implanted during the 1990s and in a younger generation implanted after 2004. We also wanted to find out if and how nonword repetition is associated with grammatical production and comprehension in the two generations, taking the role of speech perception into consideration. Methods Thirteen adolescents with severe/profound hearing impairment and unilateral cochlear implants, aged 11;9 to 19;1 at the time of testing (age at implant 2;5 to 11;11) and 16 children with severe/profound hearing impairment and cochlear implants, aged 5;3 to 8;0 (age at implant 0;7 to 5;6, ten bilateral) participated. All participants used oral communication. They were tested with nonword repetition and sentence comprehension tasks. Language samples for grammatical analysis were collected during a referential communication task. Transcriptions were analysed with respect to mean length of utterance and grammatical accuracy. Results The two groups performed similar to each other and to reference data from much younger children with normal hearing and language development on nonword repetition. Both groups showed problems in grammatical accuracy. The majority of grammatical errors involved grammatical morphemes. All participants in the older group had significant problems with sentence comprehension, whereas variation was large in the younger group, some children performing at age level. In both groups, nonword repetition was associated with grammatical accuracy and in the younger group also with sentence comprehension. Conclusions Phonological processing skills are significantly hampered in children with cochlear implants, with consequences for language processing and development. Their grammatical problems involve the use of grammatical morphemes, similar to what is found for hearing children with specific language impairment. In spite of early implantation, the results from the younger group indicate that this is still a group at risk for problems with language learning. Implications Careful follow-up and support of language development in children with cochlear implants is crucial to identify children, whose problems are persistent. It is important for speech-language pathologists to take the interdependency of speech perception, phonological processing skills and other language skills into account