Preschool children with hearing loss who use cochlear implants demonstrate vocabulary delays when compared to their peers without hearing loss. These delays may be a result of deficient word-learning abilities; children with cochlear implants perform more poorly on rapid word-learning tasks than children with normal hearing. This study explored the malleability of rapid word learning of preschoolers with cochlear implants by evaluating the effects of a word-learning training on rapid word learning. A single-subject, multiple probe design across participants measured the impact of the training on children’s rapid word-learning performance. Participants included 5 preschool children with cochlear implants who had an expressive lexicon of less than 150 words. An investigator guided children to identify, repeat, and learn about unknown sets of words in 2-weekly sessions across 10 weeks. The probe measure, a rapid word-learning task with a different set of words than those taught during training, was collected in the baseline, training, and maintenance conditions. All participants improved their receptive rapid word-learning performance in the training condition. The functional relation indicates that the receptive rapid word-learning performance of children with cochlear implants is malleable.
This research investigated the speech, language, and functional auditory outcomes of 119 3-year-old children with hearing loss and additional disabilities. Outcomes were evaluated using direct assessment and caregiver report. Multiple regressions revealed that type of additional disability and level of maternal education were significant predictors of language outcomes. Poorer outcomes were achieved in a combined group of children with autism, cerebral palsy, and/or developmental delay (DD) (Group A), compared with children with vision or speech output impairments, syndromes not entailing DD, or medical disorders (Group B). Better outcomes were associated with higher levels of maternal education. The association between better language outcomes and earlier cochlear implant switch-on approached significance. Further regression analyses were conducted separately for children with different types of additional disabilities. Level of maternal education was the only significant predictor of outcomes for Group A children, whereas degree of hearing loss was the strongest predictor for children in Group B. The findings highlight the variable impact that different types of additional disabilities can have on language development in children with hearing loss.
The present study evaluated the efficacy of a new preschool early literacy intervention created specifically for deaf and hard-of-hearing (DHH) children with functional hearing. Teachers implemented Foundations for Literacy with 25 DHH children in 2 schools (intervention group). One school used only spoken language, and the other used sign with and without spoken language. A “business as usual” comparison group included 33 DHH children who were matched on key characteristics with the intervention children but attended schools that did not implement Foundations for Literacy. Children’s hearing losses ranged from moderate to profound. Approximately half of the children had cochlear implants. All children had sufficient speech perception skills to identify referents of spoken words from closed sets of items. Teachers taught small groups of intervention children an hour a day, 4 days a week for the school year. From fall to spring, intervention children made significantly greater gains on tests of phonological awareness, letter–sound knowledge, and expressive vocabulary than did comparison children. In addition, intervention children showed significant increases in standard scores (based on hearing norms) on phonological awareness and vocabulary tests. This quasi-experimental study suggests that the intervention shows promise for improving early literacy skills of DHH children with functional hearing.
This study investigated the development of tense markers (e.g., past tense –ed) in children with cochlear implants (CIs) over a 3-year span. Nine children who received CIs before 30 months of age participated in this study at three, four, and five years postimplantation. Nine typical 3-, 4-, and 5-year- olds served as control groups. All children participated in a story-retell task. Percent correct of tense marking in the task was computed. Within the groups, percent correct of tense marking changed significantly in children with CIs and in typical children who had more hearing experience. Across the groups, children with CIs were significantly less accurate in tense marking than typical children at four and five years postimplantation. In addition, the performance of tense marking in children with CIs was correlated with their speech perception skills at earlier time points. Errors of tense marking tended to be omission rather than commission errors in typical children as well as in children with CIs. The findings suggested that despite the perceptual and processing constraints, children who received CIs may learn tense marking albeit with a delayed pattern.
This study provided a yearly record of consonant development for the initial 4 years of cochlear implant (CI) use and established a precedent for using a standardized articulation test, the Goldman–Fristoe Test of Articulation—2 (Goldman, R., & Fristoe, M. . Goldman–Fristoe Test of Articulation—2. Circle Pines, MN: American Guidance Services). The study used CI age as a referent for 32 children who received their CI before 30 months of age. Consonants produced by 70% of the children were listed, as were the most common error types, which were consonant omissions and substitutions. Using consonant repertoire lists and standard scores, the study revealed that children with CIs had acquisition patterns that were similar to their peers when the duration of CI experience was similar to the chronological age norms of typically developing children. The results revealed that CI users need time to coordinate their articulatory organizing principles with the input they receive from their CI. It is appropriate to use length of CI use as a proxy for chronological age during the first 4 years when comparing articulation development with hearing peers.
In the education of students who are deaf and hard of hearing (DHH), there is much debate about how placement affects educational outcomes and quality of life. This study examined the relationship between quality of life and educational placement that include and do not include other DHH youth. Participants included 221 DHH youth, ages 11–18 with bilateral hearing loss. Results showed that there were few differences in quality of life related to school placement (with age, gender, depression symptoms, and hearing level as covariates). For both participation and perceived stigma, there was an interaction between school placement and parent hearing status, with no single school placement showing the best results. DHH youth with hearing parents in schools specifically for DHH students scored lower than DHH with deaf parents in some domains (Participation and Perceived Stigma). When the DHH youth were compared with the general population, those in schools that included DHH students scored lower in some aspects of quality of life, particularly Self and Relationships. This study demonstrates that DHH students may not differ much in terms of quality of life across schools placements, but that there may be differences in subsets of DHH youth.
The frequency-lag hypothesis proposes that bilinguals have slowed lexical retrieval relative to monolinguals and in their nondominant language relative to their dominant language, particularly for low-frequency words. These effects arise because bilinguals divide their language use between 2 languages and use their nondominant language less frequently. We conducted a picture-naming study with hearing American Sign Language (ASL)–English bilinguals (bimodal bilinguals), deaf signers, and English-speaking monolinguals. As predicted by the frequency-lag hypothesis, bimodal bilinguals were slower, less accurate, and exhibited a larger frequency effect when naming pictures in ASL as compared with English (their dominant language) and as compared with deaf signers. For English there was no difference in naming latencies, error rates, or frequency effects for bimodal bilinguals as compared with monolinguals. Neither age of ASL acquisition nor interpreting experience affected the results; picture-naming accuracy and frequency effects were equivalent for deaf signers and English monolinguals. Larger frequency effects in ASL relative to English for bimodal bilinguals suggests that they are affected by a frequency lag in ASL. The absence of a lag for English could reflect the use of mouthing and/or code-blending, which may shield bimodal bilinguals from the lexical slowing observed for spoken language bilinguals in the dominant language.
The long-term educational/vocational, affiliation, and quality-of-life outcomes of the first and second cohorts of children with bilateral, profound hearing loss who received cochlear implants under a large National Institutes of Health–funded study was investigated in 41 of 61 eligible participants. Educational and vocational outcomes were collected from user survey data. Affiliation and quality-of-life data were collected from the Satisfaction-with-Life scale and the Deaf Identity Scale. Qualitative results indicated that compared with their hearing, adult-age peers, this group obtained high educational achievement, and they reported a very high satisfaction of life. With respect to forming an identity in these first 2 cohorts of cochlear implant users, we found that most of the individuals endorsed a dual identity, which indicates they feel just as comfortable with Deaf individuals as they do with hearing individuals. Quantitative results revealed a significant relationship between ability to hear and ability to speak, in addition to consistency of device use. Additional relationships were found between mother’s and the individual’s educational statuses, hearing scores, and communication system used. Younger individuals scored higher on satisfaction-with-life measures, and they also tended to endorse a dual identity more often. Taken together, these findings diminish concerns that profoundly deaf individuals growing up with cochlear implants will become culturally bereft and unable to function in the hearing world.
Understanding the cultural and linguistic diversity of young children with hearing loss informs the provision of assessment, habilitation, and education services to both children and their families. Data describing communication mode, oral language use, and demographic characteristics were collected for 406 children with hearing loss and their caregivers when children were 3 years old. The data were from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study, a prospective, population-based study of children with hearing loss in Australia. The majority of the 406 children used spoken English at home; however, 28 other languages also were spoken. Compared with their caregivers, the children in this study used fewer spoken languages and had higher rates of oral monolingualism. Few children used a spoken language other than English in their early education environment. One quarter of the children used sign to communicate at home and/or in their early education environment. No associations between caregiver hearing status and children’s communication mode were identified. This exploratory investigation of the communication modes and languages used by young children with hearing loss and their caregivers provides an initial examination of the cultural and linguistic diversity and heritage language attrition of this population. The findings of this study have implications for the development of resources and the provision of early education services to the families of children with hearing loss, especially where the caregivers use a language that is not the lingua franca of their country of residence.
Automated analyses of full-day recordings were used to determine whether young children who are hard-of-hearing (HH) received similar levels of exposure to adult words and conversational interactions as age-matched peers with normal-hearing (NH). Differences in adult input between children in this study and in a normative database were considered. Finally, factors were examined that may have contributed to individual differences in the input characteristics of families. Results indicated that the NH and HH groups were exposed to similar numbers of adult words and conversational turns. However, both the NH and HH groups were exposed to more adult words and engaged in more conversational turns than the NH children in the normative sample. Considering only the HH group, both quantity of adult words and conversational exchanges were correlated with children’s auditory characteristics. Children’s receptive language ability was correlated with conversational exchanges but not with adult word counts.
British Sign Language (BSL) signers use a variety of structures, such as constructed action (CA), depicting constructions (DCs), or lexical verbs, to represent action and other verbal meanings. This study examines the use of these verbal predicate structures and their gestural counterparts, both separately and simultaneously, in narratives by deaf children with various levels of exposure to BSL (ages 5;1 to 7;5) and deaf adult native BSL signers. Results reveal that all groups used the same types of predicative structures, including children with minimal BSL exposure. However, adults used CA, DCs, and/or lexical signs simultaneously more frequently than children. These results suggest that simultaneous use of CA with lexical and depicting predicates is more complex than the use of these predicate structures alone and thus may take deaf children more time to master.
In hearing children, reading skills have been found to be closely related to phonological awareness. We used several standardized tests to investigate the reading and phonological awareness skills of 27 deaf school-age children who were experienced cochlear implant users. Approximately two-thirds of the children performed at or above the level of their hearing peers on the phonological awareness and reading tasks. Reading scores were found to be strongly correlated with measures of phonological awareness. These correlations remained the same when we statistically controlled for potentially confounding demographic variables such as age at testing and speech perception skills. However, these correlations decreased even after we statistically controlled for vocabulary size. This finding suggests that lexicon size is a mediating factor in the relationship between the children’s phonological awareness and reading skills, a finding that has also been reported for typically developing hearing children.
This investigation examined the time course and sequence of prelinguistic vocal development during the first year of cochlear implant (CI) experience. Thirteen children who were implanted between 8 and 35 months and 11 typically developing (TD) infants participated in this longitudinal study. Adult–child play interactions were video- and audio-recorded at trimonthly intervals for each group, and child utterances were classified into categories representing progressively more mature productions: Precanonical Vocalizations, Basic Canonical Syllables, and Advanced Form vocalizations. Young CI recipients met the 20% criterion for establishment of the Basic Canonical Syllables and Advanced Forms levels with fewer months of robust hearing experience than the TD infants. Most CI recipients followed the sequence of development predicted by the Stark Assessment of Early Vocal Development—Revised. The relatively rapid progress of the CI children suggests that an earlier period of auditory deprivation did not have negative consequences for prelinguistic vocal development. It also supports the notion that young CI recipients comparatively advanced maturity facilitated expeditious auditory-guided speech development.
The present study is aimed to translate 3 widely used clinical assessment measures into British Sign Language (BSL), to pilot the BSL versions, and to establish their validity and reliability. These were the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the Work and Social Adjustment Scale (WSAS). The 3 assessment measures were translated into BSL and piloted with the Deaf signing population in the United Kingdom (n = 113). Participants completed the PHQ-9, GAD-7, WSAS, and Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) online. The reliability and validity of the BSL versions of PHQ-9, GAD-7, and WSAS have been examined and were found to be good. The construct validity for the PHQ-9 BSL version did not find the single-factor solution as found in the hearing population. The BSL versions of PHQ-9, GAD-7, and WSAS have been produced in BSL and can be used with the signing Deaf population in the United Kingdom. This means that now there are accessible mental health assessments available for Deaf people who are BSL users, which could assist in the early identification of mental health difficulties.
Given the important role of parent–youth communication in adolescent well-being and quality of life, we sought to examine the relationship between specific communication variables and youth perceived quality of life in general and as a deaf or hard-of-hearing (DHH) individual. A convenience sample of 230 youth (mean age = 14.1, standard deviation = 2.2; 24% used sign only, 40% speech only, and 36% sign + speech) was surveyed on communication-related issues, generic and DHH-specific quality of life, and depression symptoms. Higher youth perception of their ability to understand parents’ communication was significantly correlated with perceived quality of life as well as lower reported depressive symptoms and lower perceived stigma. Youth who use speech as their single mode of communication were more likely to report greater stigma associated with being DHH than youth who used both speech and sign. These findings demonstrate the importance of youths’ perceptions of communication with their parents on generic and DHH-specific youth quality of life.
The relation between reading ability and phonological coding and awareness (PCA) skills in individuals who are severely and profoundly deaf was investigated with a meta-analysis. From an initial set of 230 relevant publications, 57 studies were analyzed that experimentally tested PCA skills in 2,078 deaf participants. Half of the studies found statistically significant evidence for PCA skills and half did not. A subset of 25 studies also tested reading proficiency and showed a wide range of effect sizes. Overall PCA skills predicted 11% of the variance in reading proficiency in the deaf participants. Other possible modulating factors, such as task type and reading grade level, did not explain the remaining variance. In 7 studies where it was measured, language ability predicted 35% of the variance in reading proficiency. These meta-analytic results indicate that PCA skills are a low to moderate predictor of reading achievement in deaf individuals and that other factors, most notably language ability, have a greater influence on reading development, as has been found to be the case in the hearing population.
Early deafness is thought to affect low-level sensorimotor processing such as selective attention, whereas bilingualism is thought to be strongly associated with higher order cognitive processing such as attention switching under cognitive load. This study explores the effects of bimodal-bilingualism (in American Sign Language and written English) on attention switching, in order to contrast the roles of bilingual proficiency and age of acquisition in relation to cognitive flexibility among deaf adults. Results indicated a strong high-proficiency bilingual advantage in the higher order attention task. The level of proficiency in 2 languages appears to be the driving force for cognitive flexibility. However, additional data are needed to reach conclusive interpretation for the influence of age of second language acquisition on higher order attention-switching ability and associated cognitive flexibility.
This article examines the relationship between cultural affiliation and deaf adults’ motivations for genetic testing for deafness in the first prospective, longitudinal study to examine the impact of genetic counseling and genetic testing on deaf adults and the deaf community. Participants (n = 256), classified as affiliating with hearing, Deaf, or both communities, rated interest in testing for 21 reasons covering 5 life domains. Findings suggest strong interest in testing to learn why they are deaf, but little interest in using it for decisions about a partner or having children. Culturally mediated variation was also demonstrated. Deaf and both communities groups viewed testing as useful for more life domains than the hearing community group. Deaf and both communities had similar motivations related to further exploration, understanding, or strengthening of deafness. Motivations related to “hearing” were also relevant for both communities. We conclude that cultural affiliation is an important factor for constructing motivations for genetic testing.
This article investigated the relationship between age at onset of canonical babbling and audibility of amplified speech in children with hearing impairment. Thirteen children with severe–profound hearing impairment and two children with normal hearing participated in a longitudinal investigation of vocalization development. A nonconcurrent multiple baseline design was used to analyze vocalization recordings obtained during two phases (hearing aid [HA] and cochlear implant [CI]). Audibility during HA and CI use was calculated using the Speech Intelligibility Index (SII). Earlier ages of canonical babble onset were related to greater audibility of the speech signal during HA use. Children who developed canonical babble had an SII of .35 or greater. SII was a statistically significant predictor of age of onset of canonical babble. Results support the concept of an “essential” level of audibility for onset of canonical babble. Findings are discussed relative to their methodological and clinical implications regarding treatment decision making.
This study investigated receptive vocabulary delay in deaf children with cochlear implants. Participants were 23 children with profound hearing loss, ages 6–14 years, who received a cochlear implant between ages 1.4 and 6 years. Duration of cochlear implant use ranged from 3.7 to 11.8 years. Peabody Picture Vocabulary Test, Third Edition (PPVT-III) data were analyzed first by examining children’s errors for evidence of difficulty in specific lexical content areas, and second by calculating standard scores with reference to hearing age (HA) (i.e., chronological age [CA] − age at implantation) rather than CA. Participants showed evidence of vocabulary understanding across all PPVT-III content categories with no strong evidence of disproportionate numbers of errors in any specific content area despite below-average mean standard scores. However, whereas mean standard scores were below the test mean established for hearing children when based on CA, they were within the average range for hearing children when calculated based on HA. Thus, children’s vocabulary knowledge was commensurate with years of cochlear implant experience, providing support for the role of spoken language experience in vocabulary acquisition.
This article concerns a parent-report repeat questionnaire to evaluate the quality of multiprofessional early intervention following early identification of deafness. It discusses the rationale for the design of the instrument, its theoretical underpinnings, its psychometric properties, and its usability. Results for the validity and reliability of the instrument are based on completion by 82 parents. The questionnaire is divided into four sections. “The description of the structure of professional services” demonstrated good face and content validity; the “content of intervention scale” yielded high internal consistency (Cronbach's α = 0.88) and reliability (6-month test–retest correlations, rho = 0.88, r = .68; 12-month test–retest correlations, rho = 0.60, r = .82); the “process of intervention” scale yielded high internal consistency (Cronbach's α = 0.93) and high reliability on test–retest administration (6-month test–retest correlations, r = 0.64; 12 month test–retest correlations, r = .82); and the short “overall impact” questions were answered well. The Trait Emotional Intelligence Questionnaire was used to control for influence of parental disposition on ratings of quality of intervention. Evaluating the goodness of fit between early intervention and parental priorities/values is discussed as a vital component in improving child and family outcomes.
This study investigated the phonological processing skills of 29 children with prelingual, profound hearing loss with 4 years of cochlear implant experience. Results were group matched with regard to word-reading ability and mother’s educational level with the performance of 29 hearing children. Results revealed that it is possible to obtain a valid measure of phonological processing (PP) skills in children using CIs. They could complete rhyming tasks and were able to complete sound-based tasks using standard test materials provided by a commercial test distributor. The CI children completed tasks measuring PP, but there were performance differences between the CI users and the hearing children. The process of learning phonological awareness (PA) for the children with CIs was characterized by a longer, more protracted learning phase than their counterparts with hearing. Tests of phonological memory skills indicated that when the tasks were controlled for presentation method and response modality, there were no differences between the performance of children with CIs and their counterparts with hearing. Tests of rapid naming revealed that there were no differences between rapid letter and number naming between the two groups. Results yielded a possible PP test battery for children with CI experience.
The working memory model for Ease of Language Understanding (ELU) predicts that processing differences between language modalities emerge when cognitive demands are explicit. This prediction was tested in three working memory experiments with participants who were Deaf Signers (DS), Hearing Signers (HS), or Hearing Nonsigners (HN). Easily nameable pictures were used as stimuli to avoid confounds relating to sensory modality. Performance was largely similar for DS, HS, and HN, suggesting that previously identified intermodal differences may be due to differences in retention of sensory information. When explicit processing demands were high, differences emerged between DS and HN, suggesting that although working memory storage in both groups is sensitive to temporal organization, retrieval is not sensitive to temporal organization in DS. A general effect of semantic similarity was also found. These findings are discussed in relation to the ELU model.
This study examined the effect of hearing status on role salience and anticipated work–family relations among 101 unmarried young adults aged 20–33 years: 35 with hearing loss (19 hard of hearing and 16 deaf) and 66 hearing. Participants completed the Life Role Salience scale, anticipated conflictual relations scale, anticipated facilitory relations scale, and a background questionnaire. The deaf participants demonstrated a significantly higher level of commitment to work but anticipated the significantly lowest level of conflict. Hearing status was a significant variable in predicting anticipated conflictual relations among all participants. Mode of communication was a significant predictor of conflictual relations among the hearing loss group. Implications for theory and practice were discussed.