Language Development and Impairment in Children With Mild to Moderate Sensorineural Hearing Loss.

PURPOSE: The goal of this study was to examine language development and factors related to language impairments in children with mild to moderate sensorineural hearing loss (MMHL). METHOD: Ninety children, aged 8-16 years (46 children with MMHL; 44 aged-matched controls), were administered a battery of standardized language assessments, including measures of phonological processing, receptive and expressive vocabulary and grammar, word and nonword reading, and parental report of communication skills. Group differences were examined after controlling for nonverbal ability. RESULTS: Children with MMHL performed as well as controls on receptive vocabulary and word and nonword reading. They also performed within normal limits, albeit significantly worse than controls, on expressive vocabulary, and on receptive and expressive grammar, and worse than both controls and standardized norms on phonological processing and parental report of communication skills. However, there was considerable variation in performance, with 26% showing evidence of clinically significant oral or written language impairments. Poor performance was not linked to severity of hearing loss nor age of diagnosis. Rather, outcomes were related to nonverbal ability, maternal education, and presence/absence of family history of language problems. CONCLUSIONS: Clinically significant language impairments are not an inevitable consequence of MMHL. Risk factors appear to include lower maternal education and family history of language problems, whereas nonverbal ability may constitute a protective factor

A tale of two studies on auditory training in children: A response to the claim that 'discrimination training of phonemic contrasts enhances phonological processing in mainstream school children' by Moore, Rosenberg and Coleman (2005).

In a previous article, Moore, Rosenberg and Coleman (Brain and Language, 2005, 94, 72-85) reported evidence for significant improvements in phonological awareness in mainstream children following 6 h of exposure to a commercially available phoneme discrimination training programme, but not in a control group. In a follow-up study, we failed to replicate this finding, despite using an almost identical training programme (Halliday, Taylor, Millward, & Moore, Journal of Speech, Language, and Hearing Research, 2012, 55, 168-181). This paper directly compares the methods and the results of the two studies, in an effort to explain the discrepant findings. It reports that the trained group in Moore et al. (2005) showed significantly greater improvements in phonological awareness following training than the trained group in Halliday et al. (2012). However, the control group in Halliday et al. (2012) showed significantly greater improvements in phonological awareness than the control group in Moore et al. (2005). The paper concludes that differences in the randomization, blinding, experimenter familiarity and treatment of trained and control groups contributed to the different outcomes of the two studies. The results indicate that a plethora of factors can contribute to training effects and highlight the importance of well-designed randomized controlled trials in assessing the efficacy of a given intervention

Variability in auditory processing performance is associated with reading difficulties rather than with history of otitis media

The nature and cause of auditory processing deficits in dyslexic individuals have been debated for decades. Auditory processing deficits were argued to be the first step in a causal chain of difficulties, leading to difficulties in speech perception and thereby phonological processing and literacy difficulties. More recently, it has been argued that auditory processing difficulties may not be causally related to language and literacy difficulties. This study compares two groups who have phonological processing impairments for different reasons: dyslexia and a history of otitis media (OM). We compared their discrimination thresholds and response variability to chronological age- and reading age-matched controls, across three auditory processing tasks: frequency discrimination, rise-time discrimination and speech perception. Dyslexic children showed raised frequency discrimination thresholds in comparison with age-matched controls but did not differ from reading age-matched controls or individuals with a history of OM. There were no group differences on speech perception or rise-time tasks. For the dyslexic children, there was an association between phonological awareness and frequency discrimination response variability, but no association with thresholds. These findings are not consistent with a ‘causal chain’ explanation but could be accounted for within a multiple deficits view of literacy difficulties

Motivation and intelligence drive auditory perceptual learning

Background: Although feedback on performance is generally thought to promote perceptual learning, the role and necessity of feedback remain unclear. We investigated the effect of providing varying amounts of positive feedback while listeners attempted to discriminate between three identical tones on learning frequency discrimination. Methodology/Principal Findings: Using this novel procedure, the feedback was meaningless and random in relation to the listeners’ responses, but the amount of feedback provided (or lack thereof) affected learning. We found that a group of listeners who received positive feedback on 10% of the trials improved their performance on the task (learned), while other groups provided either with excess (90%) or with no feedback did not learn. Superimposed on these group data, however, individual listeners showed other systematic changes of performance. In particular, those with lower non-verbal IQ who trained in the no feedback condition performed more poorly after training. Conclusions/Significance: This pattern of results cannot be accounted for by learning models that ascribe an external teacher role to feedback. We suggest, instead, that feedback is used to monitor performance on the task in relation to its perceived difficulty, and that listeners who learn without the benefit of feedback are adept at self-monitoring of performance, a trait that also supports better performance on non-verbal IQ tests. These results show that ‘perceptual’ learning is strongly influenced by top-down processes of motivation and intelligence

Feedback valence affects auditory perceptual learning independently of feedback probability.

Previous studies have suggested that negative feedback is more effective in driving learning than positive feedback. We investigated the effect on learning of providing varying amounts of negative and positive feedback while listeners attempted to discriminate between three identical tones; an impossible task that nevertheless produces robust learning. Four feedback conditions were compared during training: 90% positive feedback or 10% negative feedback informed the participants that they were doing equally well, while 10% positive or 90% negative feedback informed them they were doing equally badly. In all conditions the feedback was random in relation to the listeners' responses (because the task was to discriminate three identical tones), yet both the valence (negative vs. positive) and the probability of feedback (10% vs. 90%) affected learning. Feedback that informed listeners they were doing badly resulted in better post-training performance than feedback that informed them they were doing well, independent of valence. In addition, positive feedback during training resulted in better post-training performance than negative feedback, but only positive feedback indicating listeners were doing badly on the task resulted in learning. As we have previously speculated, feedback that better reflected the difficulty of the task was more effective in driving learning than feedback that suggested performance was better than it should have been given perceived task difficulty. But contrary to expectations, positive feedback was more effective than negative feedback in driving learning. Feedback thus had two separable effects on learning: feedback valence affected motivation on a subjectively difficult task, and learning occurred only when feedback probability reflected the subjective difficulty. To optimize learning, training programs need to take into consideration both feedback valence and probability.The research was funded by the Medical Research Council, UK (Grant U135097130; http://www.mrc.ac.uk/), which supported SA, DRM and KM through intramural funding

Use of auditory learning to manage listening problems in children

This paper reviews recent studies that have used adaptive auditory training to address communication problems experienced by some children in their everyday life. It considers the auditory contribution to developmental listening and language problems and the underlying principles of auditory learning that may drive further refinement of auditory learning applications. Following strong claims that language and listening skills in children could be improved by auditory learning, researchers have debated what aspect of training contributed to the improvement and even whether the claimed improvements reflect primarily a retest effect on the skill measures. Key to understanding this research have been more circumscribed studies of the transfer of learning and the use of multiple control groups to examine auditory and non-auditory contributions to the learning. Significant auditory learning can occur during relatively brief periods of training. As children mature, their ability to train improves, but the relation between the duration of training, amount of learning and benefit remains unclear. Individual differences in initial performance and amount of subsequent learning advocate tailoring training to individual learners. The mechanisms of learning remain obscure, especially in children, but it appears that the development of cognitive skills is of at least equal importance to the refinement of sensory processing. Promotion of retention and transfer of learning are major goals for further research

Functional brain alterations following mild-to-moderate sensorineural hearing loss in children.

Auditory deprivation in the form of deafness during development leads to lasting changes in central auditory system function. However, less is known about the effects of mild-to-moderate sensorineural hearing loss (MMHL) during development. Here, we used a longitudinal design to examine late auditory evoked responses and mismatch responses to nonspeech and speech sounds for children with MMHL. At Time 1, younger children with MMHL (8-12 years; n = 23) showed age-appropriate mismatch negativities (MMNs) to sounds, but older children (12-16 years; n = 23) did not. Six years later, we re-tested a subset of the younger (now older) children with MMHL (n = 13). Children who had shown significant MMNs at Time 1 showed MMNs that were reduced and, for nonspeech, absent at Time 2. Our findings demonstrate that even a mild-to-moderate hearing loss during early-to-mid childhood can lead to changes in the neural processing of sounds in late childhood/adolescence

Simulating vocal learning of spoken language: Beyond imitation

Computational approaches have an important role to play in understanding the complex process of speech acquisition, in general, and have recently been popular in studies of vocal learning in particular. In this article we suggest that two significant problems associated with imitative vocal learning of spoken language, the speaker normalisation and phonological correspondence problems, can be addressed by linguistically grounded auditory perception. In particular, we show how the articulation of consonant-vowel syllables may be learnt from auditory percepts that can represent either individual utterances by speakers with different vocal tract characteristics or ideal phonetic realisations. The result is an optimisation-based implementation of vocal exploration – incorporating semantic, auditory, and articulatory signals – that can serve as a basis for simulating vocal learning beyond imitation

Late, not early mismatch responses to changes in frequency are reduced or deviant in children with dyslexia: an event-related potential study.

BACKGROUND: Developmental disorders of oral and written language have been linked to deficits in the processing of auditory information. However, findings have been inconsistent, both for behavioural and electrophysiological measures. METHODS: In this study, we examined event-related potentials (ERPs) in 20 6- to 14-year-old children with developmental dyslexia and 20 age-matched controls, divided into younger (6-11 years, n = 10) and older (11-14 years, n = 10) age bands. We focused on early (mismatch negativity; MMN) and late (late discriminative negativity; LDN) conventional mismatch responses and associated measures derived from time-frequency analysis (inter-trial coherence and event-related spectral perturbation). Responses were elicited using an auditory oddball task, whereby a stream of 1000-Hz standards was interspersed with rare large (1,200 Hz) and small (1,030 Hz) frequency deviants. RESULTS: Conventional analyses revealed no significant differences between groups in the size of the MMN to either large or small frequency deviants. However, the younger age band of children with dyslexia showed an enhanced inter-trial coherence in the theta frequency band over the time window corresponding to the MMN to small deviants. By contrast, these same children showed a reduced-amplitude LDN for the small deviants relative to their age-matched controls, whilst the older children with dyslexia showed a shorter and less intense period of event-related desynchronization over this time window. CONCLUSIONS: Initial detection and discrimination of auditory frequency change appears normal or even enhanced in children with dyslexia. Rather, deficits in late-stage auditory processing appear to be a feature of this population

White matter microstructural abnormalities in children with severe congenital hypothyroidism.

This study assessed white matter microstructural integrity and behavioral correlates for children with severe congenital hypothyroidism (CH) who were identified and treated early following newborn screening. Eighteen children with severe CH and 21 healthy controls underwent a battery of behavioral measures of hearing, language and communication, along with diffusion MR imaging. Tract-based spatial statistics were performed on standard diffusion parameters of fractional anisotropy and diffusivity metrics. Microscopic diffusion anisotropy mapping based on the Spherical Mean Technique was also used to evaluate biologically specific metrics. Compared with age-matched controls, children with severe CH had poorer hearing and communication skills, albeit generally within normal limits. Children with severe CH had fractional anisotropy that was significantly lower in the cerebellum, bilateral thalami and right temporal lobe, and radial diffusivity that was significantly higher in the cerebellum and bilateral thalami. Microscopic fractional anisotropy and intra-neurite volume fraction were also significantly decreased, and transverse microscopic diffusivity was significantly increased, in the CH group in areas including the cerebellum, thalamus, occipital lobe, and corpus callosum, and in the white matter adjacent to sensorimotor cortex, particularly in the left hemisphere. Significant and widespread correlations were observed between behavioral measures and measures of white matter microstructural integrity in children with CH. The results indicate that children with severe CH who are identified through newborn screening may have significant brain white matter microstructural abnormalities despite early treatment.This work was supported by a NIHR/CSO Healthcare Science Doctoral Research Fellowship, Hannah Cooper, NIHR-HCS-D12-03-05. We also acknowledge funding from the NIHR Biomedical Research Centre at Great Ormond Street Hospital and the Great Ormond Street Institute of Child Health, University College London, as well as at University College London Hospitals. Enrico Kaden was supported by grants UK EPSRCEP/M020533/1, EP/N018702/1 and EU H2020 634541-2