Linda J. Spencer

Exploring the language and literacy outcomes of pediatric cochlear implant users.

Objective The principal goal of this study was to investigate the relationship between language and literacy (i.e., reading and writing) skills in pediatric cochlear implant users. A peripheral objective was to identify the childrens skills that were in need of remediation and subsequently to provide suggestions for remedial programming. It was predicted that the robust language skills often associated with children who have cochlear implant experience would facilitate the development of literacy skills. It was further proposed that the language and literacy skills of pediatric cochlear implant users would approximate the language and literacy skills of children with normal hearing. Design Sixteen pediatric cochlear implant users’ language and literacy skills were evaluated and then compared with a reference group of 16 age-matched, normal-hearing children. All 32 participants were educated in mainstream classes within the public school system in the Midwest. The “Sentence Formulation” and “Concepts and Directions” subtests of the Clinical Evaluation of Language Fundamentals-3 test were used to evaluate receptive and expressive language skills. Reading comprehension was evaluated with the “Paragraph Comprehension” subtest of the Woodcock Reading Mastery Test. Performance measures for the writing analyses included productivity, complexity and grammaticality measures. Results Children with cochlear implants performed within 1 SD of the normal-hearing, age-matched children on measures of language comprehension, reading comprehension and writing accuracy. However, the children with cochlear implants performed significantly poorer than the children with normal hearing on the expressive “Sentence Formulation” subtest. The cochlear implant users also produced fewer words on the written narrative task than did the normal-hearing children, although there was not a significant difference between groups with respect to total words per clause. Furthermore there was a strong correlation between language performance and reading performance, as well as language performance and total words produced on the written performance measure for the children using cochlear implants. Conclusions The results of this study suggest that the language skills of pediatric cochlear implant users are related to and correlated with the development of literacy skills within these children. Consequently, the performance of the cochlear implant users, on various language and literacy measures, compared favorably to an age-matched group of children with normal hearing. There were significant differences in the ability of the cochlear implant users to correctly utilize grammatical structures such as conjunctions and correct verb forms when they were required to formulate written and oral sentences. Given this information, it would be appropriate for their educational or remedial language programs to emphasize the use and development of these structures.

Evaluating Phonological Processing Skills in Children with Prelingual Deafness Who Use Cochlear Implants

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.

Outcomes and Achievement of Students Who Grew Up with Access to Cochlear Implants

Objectives/Hypothesis: To provide long‐term speech perception and production, educational, vocational, and achievement outcome data for pediatric cochlear implant recipients.

Early Listening and Speaking Skills Predict Later Reading Proficiency in Pediatric Cochlear Implant Users

Objectives: Previous studies have reported that children who use cochlear implants (CIs) tend to achieve higher reading levels than their peers with profound hearing loss who use hearing aids. The purpose of this study was to investigate the influences of auditory information provided by the CI on the later reading skills of children born with profound deafness. The hypothesis was that there would be a positive and predictive relationship between earlier speech perception, production, and subsequent reading comprehension. Design: The speech perception and production skills at the vowel, consonant, phoneme, and word level of 72 children with prelingual, profound hearing loss were assessed after 48 mos of CI use. The childrens reading skills were subsequently assessed using word and passage comprehension measures after an average of 89.5 mos of CI use. A regression analysis determined the amount of variance in reading that could be explained by the variables of perception, production, and socioeconomic status. Results: Regression analysis revealed that it was possible to explain 59% of the variance of later reading skills by assessing the early speech perception and production performance. The results indicated that early speech perception and production skills of children with profound hearing loss who receive CIs predict future reading achievement skills. Furthermore, the study implies that better early speech perception and production skills result in higher reading achievement. It is speculated that the early access to sound helps to build better phonological processing skills, which is one of the likely contributors to eventual reading success.

The Production of English Inflectional Morphology, Speech Production and Listening Performance in Children with Cochlear Implants

Objective: To compare how children who use either cochlear implants (CIs) or hearing aids (HAs) express English inflectional morphemes during conversation, i.e., with voice, with sign, or with both. A secondary objective was to investigate the relationship between morpheme use in pediatric CI users and their speech perception skills, length of experience with the device, and accuracy of phoneme production. Design: Group 1 consisted of 25 children who used CIs, and Group 2 consisted of 13 children who used HAs. All children were prelingually deafened and all used simultaneous communication. A 12 minute spontaneous conversation was elicited, transcribed and coded. Between group comparisons were performed to evaluate differences in modality and number of morphemes used. Additionally, use of morpheme endings was related to length of CI experience, accuracy of phoneme production, and closed‐set speech recognition performance. Results: Children who had CI experience produced significantly more English inflected morphemes than children in the HA group. CI participants also expressed the inflected endings by using voice‐only mode 91% of the time, whereas HA participants used voice‐only mode 1% of the time. In the CI group, a strong relationship was found between number of morpheme endings used and speech recognition scores, length of CI experience and accuracy of phoneme production. The results of this study indicate that input from the CI facilitates childrens ability to perceive and comprehend bound morphemes.

Language and Reading Acquisition in Children with and without Cochlear Implants

These data provide a coherent view of the spoken language and reading skills of children receiving cochlear implants. The data reveal both spoken language gains and clear benefit to these children with regard to reading. Improvement in reading is consistent with predictions based on prior research demonstrating a strong association between spoken language and reading. An intervention such as a cochlear implant has a direct effect on spoken language, and this can subsequently affect reading performance. This provides some of the first experimental evidence supporting the causal relationship between spoken language and reading.

Acquisition of Tense Marking in English-Speaking Children with Cochlear Implants: A Longitudinal Study

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.

Consonant Development in Pediatric Cochlear Implant Users Who Were Implanted Before 30 Months of Age

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. [2000]. 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.

Are Young Children With Cochlear Implants Sensitive to the Statistics of Words in the Ambient Spoken Language

PURPOSE The purpose of this study was to determine whether children with cochlear implants (CIs) are sensitive to statistical characteristics of words in the ambient spoken language, whether that sensitivity changes in expected ways as their spoken lexicon grows, and whether that sensitivity varies with unilateral or bilateral implantation. METHOD We analyzed archival data collected from the parents of 36 children who received cochlear implantation (20 unilateral, 16 bilateral) before 24 months of age. The parents reported their childrens word productions 12 months after implantation using the MacArthur Communicative Development Inventories: Words and Sentences (Fenson et al., 1993). We computed the number of words, out of 292 possible monosyllabic nouns, verbs, and adjectives, that each child was reported to say and calculated the average phonotactic probability, neighborhood density, and word frequency of the reported words. RESULTS Spoken vocabulary size positively correlated with average phonotactic probability and negatively correlated with average neighborhood density, but only in children with bilateral CIs. CONCLUSION At 12 months postimplantation, children with bilateral CIs demonstrate sensitivity to statistical characteristics of words in the ambient spoken language akin to that reported for children with normal hearing during the early stages of lexical development. Children with unilateral CIs do not.

Don’t Assume Deaf Students are Visual Learners

In the education of deaf learners, from primary school to postsecondary settings, it frequently is suggested that deaf students are visual learners. That assumption appears to be based on the visual nature of signed languages—used by some but not all deaf individuals—and the fact that with greater hearing losses, deaf students will rely relatively more on vision than audition. However, the questions of whether individuals with hearing loss are more likely to be visual learners than verbal learners or more likely than hearing peers to be visual learners have not been empirically explored. Several recent studies, in fact, have indicated that hearing learners typically perform as well or better than deaf learners on a variety of visual-spatial tasks. The present study used two standardized instruments to examine learning styles among college deaf students who primarily rely on sign language or spoken language and their hearing peers. The visual-verbal dimension was of particular interest. Consistent with recent indirect findings, results indicated that deaf students are no more likely than hearing students to be visual learners and are no stronger in their visual skills and habits than their verbal skills and habits, nor are deaf students’ visual orientations associated with sign language skills. The results clearly have specific implications for the educating of deaf learners.