Susan Jerger

Current state of knowledge: Language and literacy of children with hearing impairment

The purpose of this paper is to provide a review of past and current research regarding language and literacy development in children with mild to severe hearing impairment. A related goal is to identify gaps in the empirical literature and suggest future research directions. Included in the language development review are studies of semantics (vocabulary, novel word learning, and conceptual categories), morphology, and syntax. The literacy section begins by considering dimensions of literacy and the ways in which hearing impairment may influence them. It is followed by a discussion of existing evidence on reading and writing, and highlights key constructs that need to be addressed for a comprehensive understanding of literacy in these children.

Speech Understanding in the Elderly

Both auditory and cognitive status were determined in 130 elderly persons, in the age range from 51 to 91 years. Data were analyzed from the standpoint of the congruence of auditory and cognitive deficits. The prevalence of central auditory processing disorder was 50%, and the prevalence of cognitive deficit was 41%. Findings in the two areas were congruent, however, in only 63% of the total sample. Central auditory status was abnormal in the presence of normal cognitive function in 23% of subjects. Central auditory status was normal in the presence of cognitive deficit in 14% of subjects. In general, results did not support the hypothesis that decline in speech understanding in the elderly can be explained as the consequence of concomitant cognitive decline.

Correlational analysis of speech audiometric scores, hearing loss, age, and cognitive abilities in the elderly.

A battery of speech audiometric measures and a battery of neuropsychological measures were administered to 200 elderly individuals with varying degrees of pure-tone sensitivity loss. Results were analyzed from the standpoint of the extent to which variation in speech audiometric scores could be predicted by knowledge of pure-tone hearing level, age, and cognitive status. For the four monotic test procedures (PB, SPIN-Low, SPIN-High, and SSI) degree of hearing loss bore the strongest relation to speech recognition score. Cognitive status accounted for little of the variance in any of these four speech audiometric scores. In the case of the single dichotic test procedure (DSI), both degree of hearing loss and speed of mental processing, as measured by the Digit Symbol subtest of the WAIS-R, accounted for significant variance. Finally, age accounted for significant unique variance only in the SSI score.

Development of speech intelligibility in children with recurrent otitis media.

This study defined developmental functions for Pediatric Speech Intelligibility word and sentence materials presented in quiet and in competition for 25 normal children and 25 children with recurrent otitis media. Ages ranged from 24 to 56 mos. In normal children, developmental functions for Pediatric Speech Intelligibility speech materials showed earlier development of performance (1) in quiet than in competition and (2) for words than for sentences (competing condition). In children with otitis media, developmental functions were normal for both words and sentences in quiet and for sentences in competition. However, developmental functions were grossly abnormal for words in competition.

Specific auditory perceptual dysfunction in a learning disabled child

An 111/2 year old child with learning disability was evaluated with a battery of auditory and linguistic test procedures: electrophysiologic (auditory brain stem, middle latency response, and late potentials), electroacoustic (stapedial reflexes), and behavioral (measures of phonetic-phonologic, syntactic, and semantic processing). The overall pattern of results suggested the presence of an isolated auditory-phonologic processing disorder. Results supported an auditory-perceptual, as opposed to a linguistic cognitive, model of learning disability.

Semantic and phonological influences on picture naming by children and teenagers

Abstract We investigated the stages of picture naming with a new childrens picture–word task. In Experiment 1, 24 normal children between 5 and 7 years named pictures while attempting to ignore auditory distractors. The relation between the onsets of the distractors and the pictures varied. Naming performance for semantic distractors showed interference when the distractors onset was before the pictures onset. Naming performance for phonological nonsense-syllable distractors showed facilitation (congruent distractors) or interference (conflicting distractors) at all onset asymmetries. Overall results resembled findings in teenagers (Experiment 2) and previous findings in adults. The nature of linguistic knowledge and the time course of lexical access, as indexed by performance on a picture–word task, is remarkably similar in children, teenagers, and adults.

Extra- and Intra-Axial Brain Stem Auditory Disorders

Auditory symptoms of brain stem disorder depend on the nature of the lesion. This study compared auditory test results in 28 patients with extra-axial, 11 patients with intra-axial, and 6 patients with combined extra-axial and intra-axial brain stem disorders. Patients with extra-axial lesions usually demonstrated (1) sensitivity loss, (2) marked adaptation on Békésy audiometry, (3) impairment in PBmax scores, and (4) auditory symptoms on the ear ipsilateral to the radiographic abnormality. Patients with intra-axial brain stem lesions usually showed (1) slight, if any, sensitivity loss, (2) normal Békésy audiograms, (3) relatively good PBmax scores, and (4) suditory symptoms on both ears or on the ear contralateral to the radiographic disorders. In the patients with combined extra-axial and intra-axial disorders, auditory findings varied in relation to the extent of extra-axial involvement.

Current state of knowledge : Perceptual processing by children with hearing impairment

Perception concerns the identification and interpretation of sensory stimuli in our external environment. The purpose of this review is to survey contemporary views about effects of mild to severe sensorineural hearing impairment (HI) in children on perceptual processing. The review is one of a series of papers resulting from a workshop on Outcomes Research in Children with Hearing Loss sponsored by The National Institute on Deafness and Other Communication Disorders/National Institutes of Health. Children with HI exhibit heterogeneous patterns of results. In general, however, perceptual processing of the(a) auditory properties of nonspeech reveals some problems in processing spectral information, but not temporal information;(b) auditory properties of speech reveals some problems in processing temporal sequences, variation in spatial location, and voice onset times, but not in processing talker-gender, weighting acoustic cues, or covertly orienting to the spatial location of sound;(c) linguistic properties of speech reveals some problems in processing general linguistic content, semantic content, and phonological content. The normalcy/abnormalcy of results varies as a function of degree of loss and task demands. As a general rule, children with severe HI have more abnormalities than children with mild to moderate HI. Auditory linguistic properties are also generally processed more abnormally than auditory nonverbal properties. This outcome implies that childhood HI has less effect on more physical, developmentally earlier properties that are characterized by less contingent processing. Some perceptual properties that are processed in a more automatic manner by normal listeners are processed in a more controlled manner by children with HI. This outcome implies that deliberate perceptual processing in the presence of childhood HI requires extra effort and more mental resources, thus limiting the availability of processing resources for other tasks.

Effects of extended release methylphenidate treatment on ratings of attention-deficit/hyperactivity disorder (ADHD) and associated behavior in children with autism spectrum disorders and ADHD symptoms.

OBJECTIVE The purpose of this study was to examine the behavioral effects of four doses of psychostimulant medication, combining extended-release methylphenidate (MPH) in the morning with immediate-release MPH in the afternoon. METHOD The sample comprised 24 children (19 boys; 5 girls) who met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV-TR) criteria for an autism spectrum disorder (ASD) on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS), and had significant symptoms of attention-deficit/hyperactivity disorder (ADHD). This sample consisted of elementary school-age, community-based children (mean chronological age=8.8 years, SD=1.7; mean intelligence quotient [IQ]=85; SD=16.8). Effects of four dose levels of MPH on parent and teacher behavioral ratings were investigated using a within-subject, crossover, placebo-controlled design. RESULTS MPH treatment was associated with significant declines in hyperactive and impulsive behavior at both home and school. Parents noted significant declines in inattentive and oppositional behavior, and improvements in social skills. No exacerbation of stereotypies was noted, and side effects were similar to those seen in typically developing children with ADHD. Dose response was primarily linear in the dose range studied. CONCLUSIONS The results of this study suggest that MPH formulations are efficacious and well-tolerated for children with ASD and significant ADHD symptoms.

Developmental shifts in children's sensitivity to visual speech: A new multimodal picture-word task

This research developed a multimodal picture-word task for assessing the influence of visual speech on phonological processing by 100 children between 4 and 14 years of age. We assessed how manipulation of seemingly to-be-ignored auditory (A) and audiovisual (AV) phonological distractors affected picture naming without participants consciously trying to respond to the manipulation. Results varied in complex ways as a function of age and type and modality of distractors. Results for congruent AV distractors yielded an inverted U-shaped function with a significant influence of visual speech in 4-year-olds and 10- to 14-year-olds but not in 5- to 9-year-olds. In concert with dynamic systems theory, we proposed that the temporary loss of sensitivity to visual speech was reflecting reorganization of relevant knowledge and processing subsystems, particularly phonology. We speculated that reorganization may be associated with (a) formal literacy instruction and (b) developmental changes in multimodal processing and auditory perceptual, linguistic, and cognitive skills.