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Attention to speech and spoken language development in deaf children with cochlear implants: a 10-year longitudinal study.

ABSTRACT: Early auditory/language experience plays an important role in language development. In this study, we examined the effects of severe-to-profound hearing loss and subsequent cochlear implantation on the development of attention to speech in children with cochlear implants (CIs). In addition, we investigated the extent to which attention to speech may predict spoken language development in children with CIs. We tested children with CIs and compared them to chronologically age-matched peers with normal hearing (NH) on their attention to speech at four time points post implantation; specifically, less than 1 month, 3 to 6 months, 12 months, and 18 months post implantation. We also collected a variety of well-established speech perception and spoken language measures from the children with CIs in a 10-year longitudinal study. Children with CIs showed reduced attention to speech as compared to their peers with NH at less than 1 month post implantation, but a similar degree of attention to speech as their NH peers during later time points. In addition, attention to speech at 3 to 6 months post implantation predicts speech perception in children with CIs. These results inform language acquisition theories and bring insights into our understanding of early severe-to-profound hearing loss on infants' attention to speech skills. In addition, the findings have significant clinical implications for early intervention on hearing loss, which emphasizes the importance of developing strong listening skills. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=f7xiYo3Ua08&feature=youtu.be.

SUBMITTER: Wang Y

PROVIDER: S-EPMC6202126 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Attention to speech and spoken language development in deaf children with cochlear implants: a 10-year longitudinal study.

Wang Yuanyuan Y Shafto Carissa L CL Houston Derek M DM

Developmental science 20180515 6

Early auditory/language experience plays an important role in language development. In this study, we examined the effects of severe-to-profound hearing loss and subsequent cochlear implantation on the development of attention to speech in children with cochlear implants (CIs). In addition, we investigated the extent to which attention to speech may predict spoken language development in children with CIs. We tested children with CIs and compared them to chronologically age-matched peers with no ...[more]

PMID: 29761835

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Project description: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).To prospectively assess spoken language acquisition following cochlear implantation in young children.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.Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales).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.The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.

Project description:ObjectivesEarly hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes.DesignSpoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance.ResultsAt the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA0.5-4 kHz, had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills.ConclusionsAt the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.

Project description:Purpose Differences across language environments of prelingually deaf children who receive cochlear implants (CIs) may affect language acquisition; yet, whether mothers show individual differences in how they modify infant-directed (ID) compared with adult-directed (AD) speech has seldom been studied. This study assessed individual differences in how mothers realized speech modifications in ID register and whether these predicted differences in language outcomes for children with CIs. Method Participants were 36 dyads of mothers and their children aged 0;8-2;5 (years;months) at the time of CI implantation. Mothers' spontaneous speech was recorded in a lab setting in ID or AD conditions before ~15 months postimplantation. Mothers' speech samples were characterized for acoustic-phonetic and lexical properties established as canonical indices of ID speech to typically hearing infants, such as vowel space area differences, fundamental frequency variability, and speech rate. Children with CIs completed longitudinal administrations of one or more standardized language assessment instruments at variable intervals from 6 months to 9.5 years postimplantation. Standardized scores on assessments administered longitudinally were used to calculate linear regressions, which gave rise to predicted language scores for children at 2 years postimplantation and language growth over 2-year intervals. Results Mothers showed individual differences in how they modified speech in ID versus AD registers. Crucially, these individual differences significantly predicted differences in estimated language outcomes at 2 years postimplantation in children with CIs. Maternal speech variation in lexical quantity and vowel space area differences across ID and AD registers most frequently predicted estimates of language attainment in children with CIs, whereas prosodic differences played a minor role. Conclusion Results support that caregiver language behaviors play a substantial role in explaining variability in language attainment in children receiving CIs. Supplemental Material https://doi.org/10.23641/asha.12560147.

Project description:Previous research has provided evidence for a speechreading advantage in congenitally deaf adults compared to hearing adults. A 'perceptual compensation' account of this finding proposes that prolonged early onset deafness leads to a greater reliance on visual, as opposed to auditory, information when perceiving speech which in turn results in superior visual speech perception skills in deaf adults. In the current study we tested whether previous demonstrations of a speechreading advantage for profoundly congenitally deaf adults with hearing aids, or no amplificiation, were also apparent in adults with the same deafness profile but who have experienced greater access to the auditory elements of speech via a cochlear implant (CI). We also tested the prediction that, in line with the perceptual compensation account, receiving a CI at a later age is associated with superior speechreading skills due to later implanted individuals having experienced greater dependence on visual speech information. We designed a speechreading task in which participants viewed silent videos of 123 single words spoken by a model and were required to indicate which word they thought had been said via a free text response. We compared congenitally deaf adults who had received CIs in childhood or adolescence (N = 15) with a comparison group of hearing adults (N = 15) matched on age and education level. The adults with CI showed significantly better scores on the speechreading task than the hearing comparison group. Furthermore, within the group of adults with CI, there was a significant positive correlation between age at implantation and speechreading performance; earlier implantation was associated with lower speechreading scores. These results are both consistent with the hypothesis of perceptual compensation in the domain of speech perception, indicating that more prolonged dependence on visual speech information in speech perception may lead to improvements in the perception of visual speech. In addition our study provides metrics of the 'speechreadability' of 123 words produced in British English: one derived from hearing adults (N = 61) and one from deaf adults with CI (N = 15). Evidence for the validity of these 'speechreadability' metrics come from correlations with visual lexical competition data.

Project description:Music perception of cochlear implants (CI) users is constrained by the absence of salient musical pitch cues crucial for melody identification, but is made possible by timing cues that are largely preserved by current devices. While musical timing cues, including beats and rhythms, are a potential route to music learning, it is not known what extent they are perceptible to CI users in complex sound scenes, especially when pitch and timbral features can co-occur and obscure these musical features. The task at hand, then, becomes one of optimizing the available timing cues for young CI users by exploring ways that they might be perceived and encoded simultaneously across multiple modalities. Accordingly, we examined whether training tasks that engage active music listening through dance might enhance the song identification skills of deaf children with CIs. Nine CI children learned new songs in two training conditions: (a) listening only (auditory learning), and (2) listening and dancing (auditory-motor learning). We examined children's ability to identify original song excerpts, as well as mistuned, and piano versions from a closed-set task. While CI children were less accurate than their normal hearing peers, they showed greater song identification accuracies in versions that preserved the original instrumental beats following learning that engaged active listening with dance. The observed performance advantage is further qualified by a medium effect size, indicating that the gains afforded by auditory-motor learning are practically meaningful. Furthermore, kinematic analyses of body movements showed that CI children synchronized to temporal structures in music in a manner that was comparable to normal hearing age-matched peers. Our findings are the first to indicate that input from CI devices enables good auditory-motor integration of timing cues in child CI users for the purposes of listening and dancing to music. Beyond the heightened arousal from active engagement with music, our findings indicate that a more robust representation or memory of musical timing features was made possible by multimodal processing. Methods that encourage CI children to entrain, or track musical timing with body movements, may be particularly effective in consolidating musical knowledge than methods that engage listening only.

Dataset Information

Attention to speech and spoken language development in deaf children with cochlear implants: a 10-year longitudinal study.

Publications

Attention to speech and spoken language development in deaf children with cochlear implants: a 10-year longitudinal study.

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