Rachael Frush Holt

Speech and language development in cognitively delayed children with cochlear implants.

Objective: The primary goals of this investigation were to examine the speech and language development of deaf children with cochlear implants and mild cognitive delay and to compare their gains with those of children with cochlear implants who do not have this additional impairment. Design: We retrospectively examined the speech and language development of 69 children with pre-lingual deafness. The experimental group consisted of 19 children with cognitive delays and no other disabilities (mean age at implantation = 38 months). The control group consisted of 50 children who did not have cognitive delays or any other identified disability. The control group was stratified by primary communication mode: half used total communication (mean age at implantation = 32 months) and the other half used oral communication (mean age at implantation = 26 months). Children were tested on a variety of standard speech and language measures and one test of auditory skill development at 6-month intervals. Results: The results from each test were collapsed from blocks of two consecutive 6-month intervals to calculate group mean scores before implantation and at 1-year intervals after implantation. The children with cognitive delays and those without such delays demonstrated significant improvement in their speech and language skills over time on every test administered. Children with cognitive delays had significantly lower scores than typically developing children on two of the three measures of receptive and expressive language and had significantly slower rates of auditory-only sentence recognition development. Finally, there were no significant group differences in auditory skill development based on parental reports or in auditory-only or multimodal word recognition. Conclusions: The results suggest that deaf children with mild cognitive impairments benefit from cochlear implantation. Specifically, improvements are evident in their ability to perceive speech and in their reception and use of language. However, it may be reduced relative to their typically developing peers with cochlear implants, particularly in domains that require higher level skills, such as sentence recognition and receptive and expressive language. These findings suggest that children with mild cognitive deficits be considered for cochlear implantation with less trepidation than has been the case in the past. Although their speech and language gains may be tempered by their cognitive abilities, these limitations do not appear to preclude benefit from cochlear implant stimulation, as assessed by traditional measures of speech and language development.

Spoken word recognition development in children with residual hearing using cochlear implants and hearing AIDS in opposite ears.

Objective: With broadening candidacy criteria for cochlear implantation, a greater number of pediatric candidates have usable residual hearing in their nonimplanted ears. This population potentially stands to benefit from continued use of conventional amplification in their nonimplanted ears. The purposes of this investigation were to evaluate whether children with residual hearing in their nonimplanted ears benefit from bilateral use of cochlear implants and hearing aids and to investigate the time course of adaptation to combined use of the devices together. Design: Pediatric cochlear implant recipients with severe sensorineural hearing loss in their nonimplanted ears served as participants. Ten children continued to use hearing aids in their nonimplanted ears after cochlear implantation; 12 children used their cochlear implants exclusively. Participants were tested longitudinally on spoken word recognition measures at 6-month intervals. The children who continued wearing hearing aids were tested in three sensory aid conditions: cochlear implants alone, hearing aids alone, and cochlear implants in conjunction with hearing aids. The children who did not continue hearing aid use were tested after surgery in their only aided condition, cochlear implant alone. Results: The results suggest that children with severe hearing loss who continued using hearing aids in their nonimplanted ears benefited from combining the acoustic input received from a hearing aid with the input received from a cochlear implant, particularly in background noise. However, this benefit emerged with experience. Conclusions: Our findings suggest that it is appropriate to encourage pediatric cochlear implant recipients with severe hearing loss to continue wearing an appropriately fitted hearing aid in the nonimplanted ear to maximally benefit from bilateral stimulation.

Auditory skills, language development, and adaptive behavior of children with cochlear implants and additional disabilities

Objective: The objective of this study was to evaluate the development of functional auditory skills, language, and adaptive behavior in deaf children with cochlear implants (CI) who also have additional disabilities (AD). Design: A two-group, pre-test versus post-test design was used. Study sample: Comparisons were made between 23 children with CIs and ADs, and an age-matched comparison group of 23 children with CIs without ADs (No-AD). Assessments were obtained pre-CI and within 12 months post-CI. Results: All but two deaf children with ADs improved in auditory skills using the IT-MAIS. Most deaf children in the AD group made progress in receptive but not expressive language using the preschool language scale, but their language quotients were lower than the No-AD group. Five of eight children with ADs made progress in daily living skills and socialization skills; two made progress in motor skills. Children with ADs who did not make progress in language, did show progress in adaptive behavior. Conclusions: Children with deafness and ADs made progress in functional auditory skills, receptive language, and adaptive behavior. Expanded assessment that includes adaptive functioning and multi-center collaboration is recommended to best determine benefits of implantation in areas of expected growth in this clinical population.

Audiovisual spoken word recognition by children with cochlear implants

This study examined how prelingually deafened children with cochlear implants combine visual information from lip-reading with auditory cues in an open-set speech perception task. A secondary aim was to examine lexical effects on the recognition of words in isolation and in sentences. Fifteen children with cochlear implants served as participants in this study. Participants were administered two tests of spoken word recognition. The LNT assessed isolated word recognition in an auditory-only format. The AV-LNST assessed recognition of key words in sentences in a visual-only, auditory-only and audiovisual presentation format. On each test, lexical characteristics of the stimulus items were controlled to assess the effects of lexical competition. The children also were administered a test of receptive vocabulary knowledge. The results revealed that recognition of key words was significantly influenced by presentation format. Audiovisual speech perception was best, followed by auditory-only and visual-only presentation, respectively. Lexical effects on spoken word recognition were evident for isolated words, but not when words were presented in sentences. Finally, there was a significant relationship between auditory-only and audiovisual word recognition and language knowledge. The results demonstrate that children with cochlear implants obtain significant benefit from audiovisual speech integration, and suggest such tests should be included in test batteries intended to evaluate cochlear implant outcomes.

Developmental Effects of Family Environment on Outcomes in Pediatric Cochlear Implant Recipients

Objective To examine and compare the family environment of preschool- and school-age children with cochlear implants and assess its influence on children’s executive function and spoken language skills. Study Design Retrospective between-subjects design. Setting Outpatient research laboratory. Patients Prelingually deaf children with cochlear implants and no additional disabilities and their families. Intervention(s) Cochlear implantation and speech-language therapy. Main Outcome Measures Parents completed the Family Environment Scale and the Behavior Rating Inventory of Executive Function (or the preschool version). Children were tested using the Peabody Picture Vocabulary Test-4 and either the Preschool Language Scales-4 or the Clinical Evaluation of Language Fundamentals–4. Results The family environments of children with cochlear implants differed from normative data obtained from hearing children, but average scores were within 1 standard deviation of norms on all subscales. Families of school-age children reported higher levels of control than those of preschool-age children. Preschool-age children had fewer problems with emotional control when families reported higher levels of support and lower levels of conflict. School-age children had fewer problems with inhibition but more problems with shifting of attention when families reported lower levels of conflict. School-age children’s receptive vocabularies were enhanced by families with lower levels of control and higher levels of organization. Conclusion Family environment and its relation to language skills and executive function development differed across the age groups in this sample of children with cochlear implants. Because family dynamics is one developmental/environmental factor that can be altered with therapy and education, the present results have important clinical implications for family-based interventions for deaf children with cochlear implants.

Assessing Toddlers’ Speech-Sound Discrimination

OBJECTIVEnValid and reliable methods for assessing speech perception in toddlers are lacking in the field, leading to conspicuous gaps in understanding how speech perception develops and limited clinical tools for assessing sensory aid benefit in toddlers. The objective of this investigation was to evaluate speech-sound discrimination in toddlers using modifications to the Change/No-Change procedure [1].nnnMETHODSnNormal-hearing 2- and 3-year-olds discrimination of acoustically dissimilar (easy) and similar (hard) speech-sound contrasts were evaluated in a combined repeated measures and factorial design. Performance was measured in d. Effects of contrast difficulty and age were examined, as was test-retest reliability, using repeated measures ANOVAs, planned post hoc tests, and correlation analyses.nnnRESULTSnThe easy contrast (M=2.53) was discriminated better than the hard contrast (M=1.72) across all ages (p<.0001). The oldest group of children (M=3.13) discriminated the contrasts better than youngest (M=1.04; p<.0001) and the mid-age children (M=2.20; p=.037), who in turn discriminated the contrasts better than the youngest children (p=.010). Test-retest reliability was excellent (r=.886, p<.0001). Almost 90% of the children met the teaching criterion. The vast majority demonstrated the ability to be tested with the modified procedure and discriminated the contrasts. The few who did not were 2.5 years of age and younger.nnnCONCLUSIONSnThe modifications implemented resulted, at least preliminarily, in a procedure that is reliable and sensitive to contrast difficulty and age in this young group of children, suggesting that these modifications are appropriate for this age group. With further development, the procedure holds promise for use in clinical populations who are believed to have core deficits in rapid phonological encoding, such as children with hearing loss or specific language impairment, children who are struggling to read, and second-language learners.

Preschoolers Benefit From Visually Salient Speech Cues

PURPOSEnThis study explored visual speech influence in preschoolers using 3 developmentally appropriate tasks that vary in perceptual difficulty and task demands. They also examined developmental differences in the ability to use visually salient speech cues and visual phonological knowledge.nnnMETHODnTwelve adults and 27 typically developing 3- and 4-year-old children completed 3 audiovisual (AV) speech integration tasks: matching, discrimination, and recognition. The authors compared AV benefit for visually salient and less visually salient speech discrimination contrasts and assessed the visual saliency of consonant confusions in auditory-only and AV word recognition.nnnRESULTSnFour-year-olds and adults demonstrated visual influence on all measures. Three-year-olds demonstrated visual influence on speech discrimination and recognition measures. All groups demonstrated greater AV benefit for the visually salient discrimination contrasts. AV recognition benefit in 4-year-olds and adults depended on the visual saliency of speech sounds.nnnCONCLUSIONSnPreschoolers can demonstrate AV speech integration. Their AV benefit results from efficient use of visually salient speech cues. Four-year-olds, but not 3-year-olds, used visual phonological knowledge to take advantage of visually salient speech cues, suggesting possible developmental differences in the mechanisms of AV benefit.