Language Structures Used by Kindergartners With Cochlear Implants

Abstract

Objective Listeners use their knowledge of how language is structured to aid speech recognition in everyday communication. When it comes to children with congenital hearing loss severe enough to warrant cochlear implants (CIs), the question arises of whether these children can acquire the language knowledge needed to aid speech recognition, in spite of only having spectrally degraded signals available to them. That question was addressed in the current study. Specifically there were three goals: (1) to compare the language structures used by children with CIs to those of children with normal hearing (NH); (2) to assess the amount of variance in the language measures explained by phonological awareness and lexical knowledge; and (3) to assess the amount of variance in the language measures explained by factors related to the hearing loss itself and subsequent treatment. Design Language samples were obtained and transcribed for 40 children who had just completed kindergarten: 19 with NH and 21 with CIs. Five measures were derived from Systematic Analysis of Language Transcripts (SALT): (1) mean length of utterance in morphemes, (2) number of conjunctions, excluding and, (3) number of personal pronouns, (4) number of bound morphemes, and (5) number of different words. Measures were also collected on phonological awareness and lexical knowledge. Statistics examined group differences, as well as the amount of variance in the language measures explained by phonological awareness, lexical knowledge, and factors related to hearing loss and its treatment for children with CIs. Results Mean scores of children with CIs were roughly one standard deviation below those of children with NH on all language measures, including lexical knowledge, matching outcomes of other studies. Mean scores of children with CIs were closer to two standard deviations below those of children with NH on two out of three measures of phonological awareness (specifically those related to phonemic structure). Lexical knowledge explained significant amounts of variance on three language measures, but only one measure of phonological awareness (sensitivity to word-final phonemic structure) explained any significant amount of unique variance beyond that, and on only one language measure (number of bound morphemes). Age at first implant, but no other factors related to hearing loss or its treatment, explained significant amounts of variance on the language measures, as well. Conclusion In spite of early intervention and advances in implant technology, children with CIs are still delayed in learning language, but grammatical knowledge is less affected than phonological awareness. Because there was little contribution to language development measured for phonological awareness independent of lexical knowledge, it was concluded that children with CIs could benefit from intervention focused specifically on helping them learn language structures, in spite of the likely phonological deficits they experience as a consequence of having degraded inputs.

Phonological Awareness at 5 years of age in Children Who Use Hearing Aids or Cochlear Implants

“…This finding was consistent with previous studies (Nittrouer, Caldwell, Lowenstein, Tarr, & Holloman, 2012). In contrast to previous studies that reported mean performance levels of −1.5 SD (James, et al, 2008; Nittrouer, et al, 2012; Nittrouer, et al, 2014), the present study found that performance was on average within 1 SD of the mean of the normative population. The enhanced performance of children in the present study may be related to the early age of intervention, the up-to-date hearing technology fitted to the children, and the high-quality hearing service provided by AH, the government-funded national provider of hearing services to all children with hearing loss in Australia.…”

“…This complements the predominately high-frequency information transmitted by the cochlear implant to enhance consonant perception (Ching, 2011; Incerti, Ching, & Hill, 2011). It has also been shown that bimodal experience is beneficial for language development in young children with one or two cochlear implants (Nittrouer & Chapman, 2009; Nittrouer, Sansom, Low, Rice, & Caldwell-Tarr, 2014). …”

“…On average, scores for the syllable test were within the normal range, those for the rhyme test were at 1 SD below the normative mean, and those for the phoneme test were below 1.5 SD of the normative mean. Nittrouer et al (2014) assessed performance of 27 children with CIs at 82 months of age, using tasks that required them to count syllables in a word, judge whether initial consonants of pairs of words were the same or different, and choose one out of three words that have the same final consonant as a target word. The study found that children with CIs did not differ significantly from children with normal hearing in the syllable counting task, but were more than 1.5 SD below the mean of the normative population in tasks that required judgments of initial and final consonants.…”

Literacy Outcomes for Primary School Children Who Are Deaf and Hard of Hearing: A Cohort Comparison Study

“…Tobey et al (2003) report that phonological coding ability and linguistic competence were both predictive skills for reading and Spencer & Oleson (2008) found that speech production and comprehension skills 48 months after implantation accounted for 59% of the variance in written word comprehension three years later. However, detailed assessment of phonological skills in DHH children has shown that they are still lower than those of hearing peers (Herman et al, 2014;Spencer & Tomblin, 2009); and that the benefits of implant technology are greater for language than for phonological skills (Nittrouer, Sansom, Low, Rice, & Caldwell-Tarr, 2014). Nittrouer et al argue that the signal quality available to CI users makes the acquisition of phonological structure problematic for children in comparison to the learning of grammar and vocabulary.…”

Functional near‐infrared spectroscopy as a tool for assessing speech and spoken language processing in pediatric and adult cochlear implant users

“…Prelingually deafened children with cochlear implants often present with difficulties that include performing below grade level on phonological awareness, on sentence comprehension, and on reading (Johnson & Goswami, 2010;Lund, 2016;Nittrouer, Sansom, Low, Rice, & Caldwell-Tarr, 2014). Thus, having a tool to identify early sound processing problems, which may form the foundation for these subsequent difficulties, is both theoretically and clinically beneficial, and there is now substantial evidence that fNIRS can be used to examine a range of issues relevant to the development of early language processing abilities.…”