Psychosocial Outcomes in Long-Term Cochlear Implant Users

OBJECTIVES: The objectives of this study were to investigate psychosocial outcomes in a sample of prelingually deaf, early-implanted children, adolescents, and young adults who are long-term cochlear implant (CI) users and to examine the extent to which language and executive functioning predict psychosocial outcomes. DESIGN: Psychosocial outcomes were measured using two well-validated, parent-completed checklists: the Behavior Assessment System for Children and the Conduct Hyperactive Attention Problem Oppositional Symptom. Neurocognitive skills were measured using gold standard, performance-based assessments of language and executive functioning. RESULTS: CI users were at greater risk for clinically significant deficits in areas related to attention, oppositional behavior, hyperactivity-impulsivity, and social-adaptive skills compared with their normal-hearing peers, although the majority of CI users scored within average ranges relative to Behavior Assessment System for Children norms. Regression analyses revealed that language, visual-spatial working memory, and inhibition-concentration skills predicted psychosocial outcomes. CONCLUSIONS: Findings suggest that underlying delays and deficits in language and executive functioning may place some CI users at a risk for difficulties in psychosocial adjustment

Assessment of Working Memory Capacity in Preschool Children Using the Missing Scan Task

The purpose of this study was to investigate the feasibility and validity of a modified version of Buschke's missing scan methodology, the Missing Scan Task (MST), to assess working memory capacity (WMC) and cognitive control processes in preschool children 3-6 years in age. Forty typically developing monolingual English-speaking children between 36 and 84 months in age participated in the study. The children were tested on measures of WMC (MST), verbal and nonverbal memory (NEPSY Narrative Memory and Memory for Designs subtests), and language skills (Peabody Picture Vocabulary Test, fourth edition). Children showed increased working memory capacity scores with age, as measured by the MST, with significant differences between 3- and 5-year-olds and 3- and 6-year-olds. Significant correlations were also found between the MST and language and verbal and nonverbal memory scores. MSTscores still remained significantly correlated with the other measures of memory even after age and global language were accounted for in a regression analysis, demonstrating that the MST captures unique variance related specifically to WMC and cognitive control processes used to retrieve and scan information in short-term memory (STM). The results of this study demonstrate that the MST is a feasible and valid methodology for assessing WMC in preschool children as young 3 years of age

Long-term musical experience and auditory and visual perceptual abilities under adverse conditions

Musicians have been shown to have enhanced speech perception in noise skills. It is unclear whether these improvements are limited to the auditory modality, as no research has examined musicians' visual perceptual abilities under degraded conditions. The current study examined associations between long-term musical experience and visual perception under noisy or degraded conditions. The performance of 11 musicians and 11 age-matched nonmusicians was compared on several auditory and visual perceptions in noise measures. Auditory perception tests included speech-in-noise tests and an environmental sound in noise test. Visual perception tasks included a fragmented sentences task, an object recognition task, and a lip-reading measure. Participants' vocabulary knowledge and nonverbal reasoning abilities were also assessed. Musicians outperformed nonmusicians on the speech perception in noise measures as well as the visual fragmented sentences task. Musicians also displayed better vocabulary knowledge in comparison to nonmusicians. Associations were found between perception of speech and visually degraded text. The findings show that long-term musical experience is associated with modality-general improvements in perceptual abilities. Possible systems supporting musicians' perceptual abilities are discussed

Verbal Processing Speed and Executive Functioning in Long-Term Cochlear Implant Users

Purpose: The purpose of this study was to report how verbal rehearsal speed (VRS), a form of covert speech used to maintain verbal information in working memory, and another verbal processing speed measure, perceptual encoding speed, are related to 3 domains of executive function (EF) at risk in cochlear implant (CI) users: verbal working memory, fluency-speed, and inhibition-concentration. Method: EF, speech perception, and language outcome measures were obtained from 55 prelingually deaf, long-term CI users and matched controls with normal hearing (NH controls). Correlational analyses were used to assess relations between VRS (articulation rate), perceptual encoding speed (digit and color naming), and the outcomes in each sample. Results: CI users displayed slower verbal processing speeds than NH controls. Verbal rehearsal speed was related to 2 EF domains in the NH sample but was unrelated to EF outcomes in CI users. Perceptual encoding speed was related to all EF domains in both groups. Conclusions: Verbal rehearsal speed may be less influential for EF quality in CI users than for NH controls, whereas rapid automatized labeling skills and EF are closely related in both groups. CI users may develop processing strategies in EF tasks that differ from the covert speech strategies routinely employed by NH individuals

Short-Term and Working Memory Impairments in Early-Implanted, Long-Term Cochlear Implant Users Are Independent of Audibility and Speech Production

OBJECTIVE: To determine whether early-implanted, long-term cochlear implant (CI) users display delays in verbal short-term and working memory capacity when processes related to audibility and speech production are eliminated. DESIGN: Twenty-three long-term CI users and 23 normal-hearing controls each completed forward and backward digit span tasks under testing conditions that differed in presentation modality (auditory or visual) and response output (spoken recall or manual pointing). RESULTS: Normal-hearing controls reproduced more lists of digits than the CI users, even when the test items were presented visually and the responses were made manually via touchscreen response. CONCLUSIONS: Short-term and working memory delays observed in CI users are not due to greater demands from peripheral sensory processes such as audibility or from overt speech-motor planning and response output organization. Instead, CI users are less efficient at encoding and maintaining phonological representations in verbal short-term memory using phonological and linguistic strategies during memory tasks

Visual-spatial sequence learning and memory in trained musicians

Previous research has shown that musicians have enhanced visual-spatial abilities and sensorymotor skills. As a result of their long-term musical training and their experience-dependent activities, musicians may learn to associate sensory information with fine motor movements. Playing a musical instrument requires musicians to rapidly translate musical symbols into specific sensory-motor actions while also simultaneously monitoring the auditory signals produced by their instrument. In this study, we assessed the visual-spatial sequence learning and memory abilities of long-term musicians. We recruited 24 highly trained musicians and 24 nonmusicians, individuals with little or no musical training experience. Participants completed a visual-spatial sequence learning task as well as receptive vocabulary, nonverbal reasoning, and short-term memory tasks. Results revealed that musicians have enhanced visual-spatial sequence learning abilities relative to nonmusicians. Musicians also performed better than nonmusicians on the vocabulary and nonverbal reasoning measures. Additional analyses revealed that the large group difference observed on the visualspatial sequencing task between musicians and nonmusicians remained even after controlling for vocabulary, nonverbal reasoning, and short-term memory abilities. Musicians' improved visualspatial sequence learning may stem from basic underlying differences in visual-spatial and sensorymotor skills resulting from long-term experience and activities associated with playing a musical instrument

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

Relations of Social Maturity, Executive Function, and Self-Efficacy Among Deaf University Students

This study explored possible associations of social maturity, executive function (EF), self-efficacy, and communication variables among deaf university students, both cochlear implant (CI) users and nonusers. Previous studies have demonstrated differences between deaf and hearing children and young adults in EF and EF-related social and cognitive functioning. EF differences also have been demonstrated between hearing children and deaf children who use CIs. Long-term influences of cochlear implantation in the social domain largely have not been explored, but were examined in the present study in terms of social maturity, as it might be related to EF and communication variables. Replicating and extending recent findings, social maturity was found to be related to somewhat different aspects of EF in CI users, deaf nonusers, and hearing students, but unrelated to hearing status, CI use, or deaf students' use of sign language versus spoken language. Self-efficacy proved a predictor of self-reported socially mature and immature behaviours for all groups. Individuals' beliefs about their parents' views of such behaviours was a potent predictor of behaviours for deaf CI users and those deaf students who reported sign language as their best form of communication

Epilepsy and attention-deficit hyperactivity disorder: links, risks, and challenges.

Attention-deficit hyperactivity disorder (ADHD) has a prevalence rate of 7%–9% in the general population of children. However, in children with epilepsy, ADHD has been found to be present in 20%–50% of patients. This paper provides a review of ADHD prevalence in pediatric epilepsy populations and reviews data on specific symptom presentation and attention deficits in patients with epilepsy. This paper also reviews evidence-based treatments for ADHD and specifically the treatment of ADHD as a comorbid condition in children with epilepsy

Some Neurocognitive Correlates of Noise-Vocoded Speech Perception in Children With Normal Hearing: A Replication and Extension of )

OBJECTIVES: Noise-vocoded speech is a valuable research tool for testing experimental hypotheses about the effects of spectral degradation on speech recognition in adults with normal hearing (NH). However, very little research has utilized noise-vocoded speech with children with NH. Earlier studies with children with NH focused primarily on the amount of spectral information needed for speech recognition without assessing the contribution of neurocognitive processes to speech perception and spoken word recognition. In this study, we first replicated the seminal findings reported by ) who investigated effects of lexical density and word frequency on noise-vocoded speech perception in a small group of children with NH. We then extended the research to investigate relations between noise-vocoded speech recognition abilities and five neurocognitive measures: auditory attention (AA) and response set, talker discrimination, and verbal and nonverbal short-term working memory. DESIGN: Thirty-one children with NH between 5 and 13 years of age were assessed on their ability to perceive lexically controlled words in isolation and in sentences that were noise-vocoded to four spectral channels. Children were also administered vocabulary assessments (Peabody Picture Vocabulary test-4th Edition and Expressive Vocabulary test-2nd Edition) and measures of AA (NEPSY AA and response set and a talker discrimination task) and short-term memory (visual digit and symbol spans). RESULTS: Consistent with the findings reported in the original ) study, we found that children perceived noise-vocoded lexically easy words better than lexically hard words. Words in sentences were also recognized better than the same words presented in isolation. No significant correlations were observed between noise-vocoded speech recognition scores and the Peabody Picture Vocabulary test-4th Edition using language quotients to control for age effects. However, children who scored higher on the Expressive Vocabulary test-2nd Edition recognized lexically easy words better than lexically hard words in sentences. Older children perceived noise-vocoded speech better than younger children. Finally, we found that measures of AA and short-term memory capacity were significantly correlated with a child's ability to perceive noise-vocoded isolated words and sentences. CONCLUSIONS: First, we successfully replicated the major findings from the ) study. Because familiarity, phonological distinctiveness and lexical competition affect word recognition, these findings provide additional support for the proposal that several foundational elementary neurocognitive processes underlie the perception of spectrally degraded speech. Second, we found strong and significant correlations between performance on neurocognitive measures and children's ability to recognize words and sentences noise-vocoded to four spectral channels. These findings extend earlier research suggesting that perception of spectrally degraded speech reflects early peripheral auditory processes, as well as additional contributions of executive function, specifically, selective attention and short-term memory processes in spoken word recognition. The present findings suggest that AA and short-term memory support robust spoken word recognition in children with NH even under compromised and challenging listening conditions. These results are relevant to research carried out with listeners who have hearing loss, because they are routinely required to encode, process, and understand spectrally degraded acoustic signals