Context Cochlear implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL). Objective To prospectively assess spoken language acquisition following cochlear implantation in young children. Design, setting, and participants Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent cochlear implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004. Follow-up completed between November 2005 and May 2008. Main outcome measures Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales). Results Children undergoing cochlear implantation showed greater improvement in spoken language performance (10.4; 95% confidence interval [CI], 9.6-11.2 points per year in comprehension; 8.4; 95% CI, 7.8-9.0 in expression) than would be predicted by their preimplantation baseline scores (5.4; 95% CI, 4.1-6.7, comprehension; 5.8; 95% CI, 4.6-7.0, expression), although mean scores were not restored to age-appropriate levels after 3 years. Younger age at cochlear implantation was associated with significantly steeper rate increases in comprehension (1.1; 95% CI, 0.5-1.7 points per year younger) and expression (1.0; 95% CI, 0.6-1.5 points per year younger). Similarly, each 1-year shorter history of hearing deficit was associated with steeper rate increases in comprehension (0.8; 95% CI, 0.2-1.2 points per year shorter) and expression (0.6; 95% CI, 0.2-1.0 points per year shorter). In multivariable analyses, greater residual hearing prior to cochlear implantation, higher ratings of parent-child interactions, and higher socioeconomic status were associated with greater rates of improvement in comprehension and expression. Conclusion The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.

https://jamanetwork.com/journals/jama/articlepdf/185710/joc05034_1498_1506.pdf

Spoken language development in children following cochlear implantation

Objective: This study investigated factors contributing to the comprehension and production of English language by children with prelingual deafness after 4 to 7 yr of multichannel cochlear implant use. The analysis controlled for the effects of child and family characteristics so that educational factors most conducive to maximum implant benefit could be identified. Design: A battery of language tests were administered to 181 8- and 9-yr-old children from across the United States and Canada who received a cochlear implant by age 5. Tests of comprehension, verbal reasoning, narrative ability and spontaneous language production were administered either in speech and sign or in the child’s preferred communication mode. These constituted the Total Language measures. Spoken Language measures were derived from a speech-only language sample. Type and amount of educational intervention since implantation constituted the independent variables. Characteristics of the child and the family were considered intervening variables. A series of multiple regression analyses determined the amount of variance in Total Language and Spoken Language ability accounted for by the intervening variables and the amount of additional variance attributable to the independent variables. Results: More than half of the children (with performance intelligence quotients in the average range) exhibited language skills that were similar to those of hearing 8 to 9 yr olds on measures of verbal reasoning, narrative ability, utterance length, and lexical diversity. Significant predictors of language ability were similar for Total and for Spoken Language outcomes and included greater nonverbal intelligence, smaller family size, higher socio-economic status and female gender. Age at receiving an implant did not affect language outcome. After the variance due to these variables was controlled, the primary rehabilitative factors associated with linguistic outcome were amount of mainstream class placement and an educational emphasis on speech and auditory skills. Conclusions: Use of a cochlear implant has had a dramatic impact on the linguistic competence of profoundly hearing-impaired children. More than half of the children in this sample with average learning ability produced and understood English language at a level comparable with that of their hearing age mates. Such mature language outcomes were not typical of children with profound hearing loss who used hearing aids. Use of a visual (i.e., sign) language system did not provide the linguistic advantage that had been anticipated. Children educated without use of sign exhibited a significant advantage in their use of narratives, the breadth of their vocabulary, in their use of bound morphemes, in the length of their utterances and in the complexity of the syntax used in their spontaneous language. An oral educational focus provided a significant advantage for both spoken and total language skills. (Ear & Hearing 2003;24;46S–58S)

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Language skills of children with early cochlear implantation.

We are grateful to the following oral programs across the United States that identified participants and either submitted test results or facilitated our conducting the necessary testing: Auditory/Oral School of New York (Brooklyn, NY), Beth Israel Medical Center (New York, NY), Bolesta Center (Tampa, FL), Bucks County Intermediate Unit #22, Hearing Support Program (Doylestown, PA), Buffalo Hearing and Speech Center (Buffalo, NY), Concord Area Special Education Collaborative Speech, Hearing, Language Impaired Program (Concord, MA), Children's Choice for Hearing and Talking, CCHAT Center (Sacramento, CA), Charlotte Eye, Ear, Nose and Throat Associates (Charlotte, NC), Child's Voice (Chicago, IL), Central Institute for the Deaf (St. Louis, MO), Clarke School East (Canton, MA), Clarke Jacksonville Auditory/Oral Center (Jacksonville, FL), The Clarke School for the Deaf (Northampton, MA), Clarke Pennsylvania Auditory/Oral Center (Bryn Mawr, PA), DePaul School for Hearing and Speech (Pittsburgh, PA), Desert Voices Oral Learning Center (Phoenix, AZ), Echo Horizon School (Culver City, CA), HEAR in New Hampshire (Hooksett, NH), Hearing Impaired Program (HIP) of Bergen County Special Services (Midland Park, NJ), John Tracy Clinic (Los Angeles, CA), June A. Reynolds, Inc., Auditory-Verbal Inclusion Program for Hearing Impaired Children (Beverly, MA), Jean Weingarten Peninsula Oral School for the Deaf (Redwood City, CA), Listen and Learn (San Jose, CA), Listen and Talk (Seattle, WA), Magnolia Speech School (Jackson, MS), Moog Center for Deaf Education (St. Louis, MO), The Moog School (Columbia, MO), Northern Voices (Roseville, MN), Ohio Valley Voices (Loveland, OH), Omaha Hearing School (Omaha, NE), Oralingua School for the Hearing Impaired (Whittier, CA), Orange County Auditory―Oral Program for the Hearing Impaired (Orlando, FL), St. Joseph's Institute for the Deaf (St. Louis, MO), St. Joseph's Institute for the Deaf at Carle (Urbana, IL), St. Joseph's Institute for the Deaf (Kansas City, KS), Summit Speech School (New Providence, NJ), Sunshine Cottage School for Deaf Children (San Antonio, TX), Tucker Maxon Oral School (Portland, OR), The Hearing Impaired Program of the School District of Waukesha (Waukesha, WI). We also thank the parents who granted permission for their child's results to be included in this database. Statistical analyses were conducted by Dr. Michael J. Strube, Psychology Department, Washington University (St. Louis, MO). These data were presented in April 2007 at the 11th Cochlear Implant Conference (Charlotte, NC). No conflicts of interest were reported. Correspondence should be sent to Ann Geers, 167 Rocky Knob Road, Clyde, NC 28721 (e-mail: ageers@earthlink.net).

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Spoken language scores of children using cochlear implants compared to hearing age-mates at school entry.

Objective: The present study sought to document the word reading and comprehension levels attained by children who were implanted by 5 yr of age. It was hypothesized that the improved speech perception abilities acquired with cochlear implantation would promote phonological coding skills and facilitate the acquisition of beginning reading skills. Design: Three subtests from diagnostic reading assessment batteries standardized on hearing children were administered to 181 children between 8 yr 0 mo and 9 yr 11 mo of age who had 4 to 6 yr of implant experience. In addition, a battery of processing measures was administered including a lexical decision task, a rhyme task and the digit span subtest of the Wechsler Intelligence Scale for Children. Results: Over half of the children scored within the average range for their age compared with the normative data for hearing children. Reading competence was associated with higher nonverbal intelligence, higher family socio-economic status, female gender and later onset of deafness (between birth and 36 mo). After variance due to these child and family characteristics was removed, reading competence was associated with mainstream educational placement, use of an updated implant speech processor with a wide dynamic range, and speech processing characteristics that included longer memory span and use of phonological coding strategies. Reading outcome was most highly predicted by linguistic competence and, secondarily, by speech production skill. Conclusion: Children who experience severe to profound deafness early in their development have a better prognosis for normal literacy development than ever before. To the extent that use of a cochlear implant is associated with greater use of phonological coding strategies for decoding print, longer working memory spans for short-term storage of phonemes, words and sentences and accelerated language development for reading comprehen

Predictors of reading skill development in children with early cochlear implantation.

Childhood hearing loss presents challenges to language development, especially spoken language In this article, we review existing literature on deaf and hard-of-hearing (DHH) children's patterns and trajectories of language as well as development of theory of mind and literacy Individual trajectories vary significantly, reflecting access to early identification/intervention, advanced technologies (eg, cochlear implants), and perceptually accessible language models DHH children develop sign language in a similar manner as hearing children develop spoken language, provided they are in a language-rich environment This occurs naturally for DHH children of deaf parents, who constitute 5% of the deaf population For DHH children of hearing parents, sign language development depends on the age that they are exposed to a perceptually accessible 1st language as well as the richness of input Most DHH children are born to hearing families who have spoken language as a goal, and such development is now feasible for many children Some DHH children develop spoken language in bilingual (sign-spoken language) contexts For the majority of DHH children, spoken language development occurs in either auditory-only contexts or with sign supports Although developmental trajectories of DHH children with hearing parents have improved with early identification and appropriate interventions, the majority of children are still delayed compared with hearing children These DHH children show particular weaknesses in the development of grammar Language deficits and differences have cascading effects in language-related areas of development, such as theory of mind and literacy development

Language and literacy development of deaf and hard-of-hearing children: successes and challenges.

Objective This study investigated speech production outcomes and the factors influencing the outcomes in children who had 4 to 6 yr of experience with a multichannel cochlear implant. Production variables examined included speech intelligibility, accuracy of consonant and vowel production, percentage of plosives and fricatives produced, duration of sentences, percentage of time involved in communication breakdowns during a communication sample, and responses to a speech usage questionnaire. Design 181 children between the ages of 8 and 9 yr who received a multichannel cochlear implant before age 5 yr participated as subjects. Independent variables were the amount and type of educational intervention and intervening variables were distributed across child, family and implant characteristics. Multiple regression analyses provided a measure of the amount of variance associated with speech production skills accounted for by the intervening and independent variables. Results Performance for the key words in the speech intelligibility measured averaged 63.5% for the group of children. Accuracy of phoneme production was higher for consonants (68.0%) than for vowels (61.6%) for the group. More plosives were present for acoustic analyses (91.6%) than were fricatives (78.4%). Duration for the speech intelligibility sentences averaged 2572.3 msec. Communication breakdowns occurred on average 14.5% of the time involved in a language sample. Significant predictors of high levels of oral communication skills included higher nonverbal intelligence, gender, longer use of SPEAK processing strategy, a fully active electrode array, greater dynamic range, and greater growth of loudness. The primary rehabilitative factors contributing to high levels of oral communication were an emphasis on oral-aural communication and classrooms that emphasized dependence on speech and listening. Conclusions Speech production performance in children with cochlear implants is influenced by nonverbal intelligence, gender, implant characteristics including the length of time using the newest speech processing strategies, and educational programs emphasizing oral-aural communication. Factors previously thought to be major contributors to speech production performance, such as age of onset of deafness and age of implantation, did not appear to play significant roles in predicting levels of speech production performance.

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Factors associated with development of speech perception skills in children implanted by age five.

Purpose This study explores the relationship between age and resting-state regional cerebral blood flow (rCBF) in regions associated with higher order language skills using a population of normal c...

Dianne Altuna

Papers

Factors associated with development of speech perception skills in children implanted by age five.

Maturation of speech and language functional neuroanatomy in pediatric normal controls.