Lexical and semantic development in children with cochlear implants

Introduction: Two important events have changed the prerequisites for children with severe-profound hearing impairment (HI). The first is the universal newborn hearing screening (UNHS) that enables early detection and identification of congenital or early- acquired HI. The second factor is the possibility of cochlear implant (CI) intervention at younger ages. There has been little previous interest in studying lexical-semantic ability in the new generation of children with CI who are implanted at a fairly young age, often bilaterally, in relation to the cognitive capacities that influence on use and knowledge of words. Aim: The general aim was to explore lexical-semantic ability and development in a group of school-aged children with CI and in comparison with age-matched normal hearing (NH) children. Method: The four studies examined different aspects of lexical-semantic ability in children aged 6-9 years. The cohort consisted of 34 children with CI and 39 age- matched children with NH (Study I-IV). In addition, two other clinical groups: children with language impairment (LI) (n=12) and children with autism spectrum disorder (ASD) (n=12) participated in Study II. A broad test battery was used, especially examining lexical-semantic ability but also non-verbal cognitive ability as well as phonological and learning ability. An error response analysis was conducted on a picture-naming test and a linguistic cluster analysis was performed on two different word fluency tasks with the purpose of examining strategies that the participants used when they retrieved words from their long-term-memory (LTM). Study IV had a partly longitudinal approach where a subgroup of children with CI (n=18) were examined more closely over time and in comparison with other age-matched groups at the age of 8-9 years. Statistical analyses were made primarily to examine group differences. Results: Many children with CI reached age-equivalent lexical-semantic ability at the age of 8-9 years. Semantic knowledge and non-verbal cognitive ability predicted grammatical sentence understanding (GSU) in both groups (CI and NH). Children with CI used age-appropriate learning strategies and had similar cognitive capacities necessary for managing use and knowledge of words as NH controls. In addition, children with CI showed better outcome than children with LI or ASD. However, an atypical developmental pattern was found in Study II where children with CI had better expressive than receptive vocabulary compared to typically developed children with NH. Also, the variation of the outcome was overall greater in children with CI (Study I- IV). An age-related CI subgroup-pattern was found in Study I that lead to the planning of a follow-up study, also examining retrospective, early spoken language development (Study IV). Children in the subgroup with higher group mean age at 1st CI had significantly poorer results on receptive vocabulary, phonemically based letter word fluency and GSU than NH controls. Despite of these results, the whole sample of children with CI had an age-appropriate level of expressive vocabulary and semantic feature knowledge. Semantic knowledge was demonstrated as an adequate ability to recognize semantic features and to use semantically relevant responses when lacking the lexical term while naming pictures (Study III). Children with an younger group mean age at 1 CI had better early expressive language use, two years after CI-operation, than the other subgroup, and they were also able to catch up after school entry on receptive vocabulary and phonemically based letter word fluency ability (Study IV). Conclusions: Children with CI and typical non-verbal cognitive ability did not have specific deficiencies in cognitive processing of lexical-semantic items, but some children had deficiencies with phonological and lexical-semantic knowledge. The results indicate that age at 1st CI is important as a starter engine of spoken language development through listening, but that other more linguistic-related factors and strategies also are important for development of lexical-semantic ability. There was a greater variation of the spoken language outcome in children with CI, and some atypical developmental patterns were found in the sample. Future studies of lexical-semantic ability in children with CI should therefore have a longitudinal approach and also explore the influence of environmental factors

Correlates of Orthographic Learning in Swedish Children With Cochlear Implants

This study set out to explore the cognitive and linguistic correlates of orthographic learning in a group of 32 deaf and hard of hearing children with cochlear implants, to better understand the factors that affect the development of fluent reading in these children. To date, the research about the mechanisms of reading fluency and orthographic learning in this population is scarce. The children were between 6:0 and 10:11 years of age and used oral language as their primary mode of communication. They were assessed on orthographic learning, reading fluency and a range of cognitive and linguistic skills including working memory measures, word retrieval and paired associate learning. The results were analyzed in a set of correlation analyses. In line with previous findings from children with typical hearing, orthographic learning was strongly correlated with phonological decoding, receptive vocabulary, phonological skills, verbal-verbal paired-associate learning and word retrieval. The results of this study suggest that orthographic learning in children with CI is strongly dependent on similar cognitive and linguistic skills as in typically hearing peers. Efforts should thus be made to support phonological decoding skill, vocabulary, and phonological skills in this population

Comparing the semantic networks of children with cochlear implants and children with typical hearing: Effects of length of language access.

Purpose: Kenett et al. (2013) report that the sematic networks, measured by using an oral semantic fluency task, of children with cochlear implants (CI) are less structured compared to the sematic networks of children with typical hearing (TH). This study aims to evaluate if such differences are only evident if children with CI are compared to children with TH matched on chronological age, or also if they are compared to children with TH matched on hearing age. Method: The performance of a group of children with CI on a verbal fluency task was compared to the performance of a group of chronological-age matched children with TH. Subsequently, computational network analysis was used to compare the semantic network structure of the groups. The same procedure was applied to compare a group of children with CI to a group of hearing-age matched children with TH. Results: The children with CI perform on the same level on an oral semantic verbal fluency task as the children with TH matched on hearing age. There are significant differences in terms of the structure of the semantic network between the groups. The magnitude of these differences is very small and they are non-significant for a proportion of nodes included in the bootstrap analysis. This indicates that there is no true difference between the networks. Hearing age, but not age at implantation was found to be significantly positively correlated with semantic verbal fluency performance for the children with CI. Conclusions: The results from the current study indicate that length of exposure to the tested language is an important factor for the structure of the semantic network and the performance on a semantic verbal fluency task for children with CI. Further studies are needed to explore the role of the accessibility of the language input for the development of semantic networks of children with CI

Phonological and grammatical production in children with developmental language disorder and children with hearing impairment

Children with hearing impairment (HI) are at an increased risk of developing speech and language problems similar to those of children with developmental language disorder (DLD), including difficulties with phonology and grammar. This study investigated similarities and differences in phonological and grammatical production between children with bilateral sensorineural HI (n = 14) and children with DLD (n = 30) between 4-6 years of age and age-matched controls with typical language development and normal hearing (TLD) (n = 29), all with Swedish as their first language. Production of consonants, vowels, stress patterns and tonal word accents was assessed in a picture naming task, and in a word and nonword repetition task. Grammatical production was assessed for verb and noun morphology, and syntax. While performance for both children with HI and DLD were generally significantly below that of the controls with TLD, production of accents and syntax emerged as relative strengths. There were few differences between the between the children with HI and DLD, but noun–adjective agreement in predicative was more challenging for the children with HI. The results have implications for language assessment and planning of intervention

Prosodic and segmental aspects of nonword repetition in 4- to 6-year-old children who are deaf and hard of hearing compared to controls with normal hearing

Children who are deaf or hard of hearing (DHH) are at an increased risk of speech and language deficits. Nonword repetition (NWR) is a potential predictor of problems with phonology, grammar and lexicon in DHH children. The aim of the present study was to examine repetition of prosodic features and segments in nonwords by DHH children compared to children with normal hearing (NH) and to relate NWR performance to measures of language ability and background variables. In this cross-sectional study, 14 Swedish-speaking children with mild–profound sensorineural hearing loss, aged 4–6 years, and 29 age-matched controls with NH and typical language development participated. The DHH children used cochlear implants (CI), hearing aids or a combination of both. The assessment materials included a prosodically controlled NWR task, as well as tests of phonological production, expressive grammar and receptive vocabulary. The DHH children performed below the children with NH on the repetition of tonal word accents, stress patterns, vowels and consonants, with consonants being hardest, and tonal word accents easiest, to repeat. NWR performance was also correlated with language ability, and to hearing level, in the DHH children. Both prosodic and segmental features of nonwords are problematic for Swedish-speaking DHH children compared to children with NH, but performance on tonal word accent repetition is comparably high. NWR may have potential as a clinically useful tool for identification of children who are in need of speech and language intervention

The impact of Permanent Early-Onset unilareal hearing Impairment in children - A Systematic Review

Background Decision-making on treatment and (re)habilitation needs to be based on clinical expertise and scientific evidence. Research evidence for the impact of permanent unilateral hearing impairment (UHI) on children's development has been mixed and, in some of the reports, based on fairly small, heterogeneous samples. Additionally, treatment provided has been highly variable, ranging from no action taken or watchful waiting up to single-sided cochlear implantation. Published information about the effects of treatment has also been heterogeneous. Moreover, earlier reviews and meta-analyses published on the impact of UHI on children's development have generally focused on select areas of development. Objectives This systematic review aimed to summarize the impact of children's congenital or early onset unilateral hearing impairment on listening and auditory skills, communication, speech and language development, cognitive development, educational achievements, psycho-social development, and quality of life. Methods Literature searches were performed to identify reports published from inception to February 16th, 2018 with the main electronic bibliographic databases in medicine, psychology, education, and speech and hearing sciences as the data sources. PubMed, CINALH, ERIC, LLBA, PsychINFO, and ISI Web of Science were searched for unilateral hearing impairment with its synonyms and consequences of congenital or early onset unilateral hearing impairment. Eligible were articles written in English, German, or Swedish on permanent unilateral hearing impairments that are congenital or with onset before three years of age. Hearing impairment had to be of at least a moderate degree with PTA ≥40 dB averaged over frequencies 0.5 to 2 or 0.5–4 kHz, hearing in the contralateral ear had to have PTA0.5–2 kHz or PTA0.5–4 kHz ≤ 20 dB, and consequences of unilateral hearing impairment needed to be reported in an unanimously defined population in at least one of the areas the review focused on. Four researchers independently screened 1618 abstracts and 566 full-text articles for evaluation of study eligibility. Eligible full-text articles were then reviewed to summarize the results and assess the quality of evidence. Additionally, data from 13 eligible case and multi-case studies, each having less than 10 participants, were extracted to summarize their results. Quality assessment of evidence was made adapting the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) process, and reporting of the results adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results Three articles with the quality of evidence graded as very-low to low, fulfilled the eligibility criteria set. Due to the heterogeneity of the articles, only a descriptive summary could be generated from the results. Unilateral hearing impairment was reported to have a negative impact on preverbal vocalization of infants and on sound localization and speech perception both in quiet and in noise. Conclusions No high-quality studies of consequences of early-onset UHI in children were found. Inconsistency in assessing and reporting outcomes, the relatively small number of participants, low directness of evidence, and the potential risk of confounding factors in the reviewed studies prevented any definite conclusions. Further well-designed prospective research using larger samples is warranted on this topic

Female caregivers talk more to 18-56-months-old children with and without hearing impairment than male caregivers measured with LENA- a cross-sectional pilot study

The objective of the current study was to investigate possible differences in word count use per day (number of adult words) by caregivers of different gender, in a sample of Norwegian children (N = 17) with hearing impairment (HI) (n = 8) and normal hearing (NH) (n = 9), aged 18–56 months. The current study had a cross-sectional, descriptive study design. One all-day recording with the LENA technology was conducted to measure adult word use in the home environment (Md length: 12.46 h, 9.13–16 h). Female caregivers used a significantly higher amount of words than male caregivers close to the children, regardless of their hearing status, HI: p = .01, NH: p = .01. All children were exposed to a higher number of adult words from female caregivers. There is a need to conduct more and further research about possible caregiver differences, and investigate not only the quantity of word use, but also the qualitative interaction patterns between caregivers of different gender and young children with HI, and in relation to early intervention actions

Home language environment in relation to language outcome in Brazilian toddlers who are hard of hearing and controls with typical hearing : A pilot study including reliability analyses of the LENA recording system

Purpose: The purpose of this pilot study was to explore the home language environment and language outcome of Brazilian toddlers who were hard of hearing, (HH) and controls with typical hearing (TH), and investigate the reliability of using the LENA recording system within a Brazilian Portuguese context. Metkods: Fourteen families participated in the study (seven children who were HH and seven controls with TH. Each family contributed with one all-day recording. A smaller portion of the recordings of the typically hearing toddlers were manually transcribed by two transcribers. An interrater agreement was conducted, and then the human transcript results were compared against the LENA-generated data for three measures: Adult Words (AW), Child Vocalizations (CV) and Conversational Turns (CT). Results: Data analyses revealed a moderate to strong interrater agreement for CV and AW. Weak to moderate agreement was found between the LENA estimates and the means of the human counts for CV and AW. Seemingly, LENA overestimated human counts for AW and underestimated numbers of CV. Comparative analysis suggested similarities in the language and listening environment of the two groups (TH vs. HoH). Children's language development was supported by higher numbers of parent-child interactions (CT). Conclusion: The findings imply that LENA may contribute as an ecologically valid tool in preventive family-centered intervention programs for Brazilian toddlers who are hard of hearing and their families, although further validation studies are needed