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

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