Neurocognitive Risk in Children With Cochlear Implants

Abstract

IMPORTANCE Children who receive a cochlear implant (CI) for early severe to profound sensorineural hearing loss may achieve age-appropriate spoken language skills not possible before implantation. Despite these advances, reduced access to auditory experience may have downstream effects on fundamental neurocognitive processes for some children with CIs. OBJECTIVE To determine the relative risk (RR) of clinically significant executive functioning deficits in children with CIs compared with children with normal hearing (NH). DESIGN, SETTING, AND PARTICIPANTS In this prospective, cross-sectional study, 73 children at a hospital-based clinic who received their CIs before 7 years of age and 78 children with NH, with average to above average mean nonverbal IQ scores, were recruited in 2 age groups: preschool age (age range, 3–5 years) and school age (age range, 7–17 years). No children presented with other developmental, cognitive, or neurologic diagnoses. INTERVENTIONS Parent-reported checklist measures of executive functioning were completed during psychological testing sessions. MAIN OUTCOMES AND MEASURES Estimates of the RR of clinically significant deficits in executive functioning (≥ 1 SDs above the mean) for children with CIs compared with children with NH were obtained based on 2 parent-reported child behavior checklists of everyday problems with executive functioning. RESULTS In most domains of executive functioning, children with CIs were at 2 to 5 times greater risk of clinically significant deficits compared with children with NH. The RRs for preschoolers and school-aged children, respectively, were greatest in the areas of comprehension and conceptual learning (RR [95% CI], 3.56 [1.71–7.43] and 6.25 [2.64–14.77]), factual memory ( 4.88 [1.58–15.07] and 5.47 [2.03–14.77]), attention (3.38 [1.03–11.04] and 3.13 [1.56–6.26]), sequential processing (11.25 [1.55–81.54] and 2.44 [1.24–4.76]), working memory (4.13 [1.30–13.06] and 3.64 [1.61–8.25] for one checklist and 1.77 [0.82–3.83] and 2.78 [1.18–6.51] for another checklist), and novel problem-solving (3.93 [1.50–10.34] and 3.13 [1.46–6.67]). No difference between the CI and NH samples was found for visual-spatial organization (2.63 [0.76–9.03] and 1.04 [0.45–2.40] on one checklist and 2.86 [0.98–8.39] for school-aged children on the other checklist). CONCLUSIONS AND RELEVANCE A large proportion of children with CIs are at risk for clinically significant deficits across multiple domains of executive functioning, a rate averaging 2 to 5 times that of children with NH for most domains. Screening for risk of executive functioning deficits should be a routine part of the clinical evaluation of all children with deafness and CIs.

Early Expressive Language Skills Predict Long-Term Neurocognitive Outcomes in Cochlear Implant Users: Evidence from the MacArthur–Bates Communicative Development Inventories

“…As with previous findings, a great amount of variability can be found in verbal working memory (ranges from clinical deficits of −2 SD to above average), fluency speed (ranges from clinical deficits of −2 SD to above average), and inhibition concentration (ranges from clinical deficits of −4 SD to above average) performance. For more-stable estimates of the rate of executive functioning deficits based on a larger sample, see Kronenberger, Beer et al (2014) for performance data and Kronenberger, Colson et al (2014) for questionnaire-based data on relative risk. After controlling for nonverbal intelligence, the development of early expressive language, as indexed by vocabulary size obtained from the CDI, was found to be significantly associated with long-term performance-based, and questionnairebased measures of neurocognitive skills.…”

“…Parent-teacher interrater reliability is modest (r = 0.21-0.34 for eight of the 11 LEAF subscales). Additionally, construct validity between corresponding subscales on the LEAF and other behavior checklists is also strong (see Kronenberger, Beer et al, 2014, for comparisons of executive functioning skills in CI users and in NH children using the LEAF and another behavior checklist).…”

“…Delays and disturbances in the development of EFs have been documented in deaf children with CIs (Kronenberger, Beer, Castellanos, Pisoni, & Miyamoto, 2014) and in children with attention deficit/hyperactivity disorder (Barkley, 2012), spina bifida (O'Hara & Holmbeck, 2013), and traumatic a The Ohio State University, Columbus brain injuries (Horton, Soper, & Reynolds, 2010). In deaf children with CIs, the relations between language and EFs differ from the relations observed in typically developing normal-hearing (NH) children.…”

Social Maturity and Executive Function Among Deaf Learners

“…Research involving deaf individuals with and without CIs has indicated them frequently to report or demonstrate greater EF difficulties relative to hearing peers (e.g., Hauser, Lukomski, & Hillman, 2008;Hintermair, 2013;Kronenberger, Beer, Castellanos, Pisoni, & Miyamoto, 2014;Pisoni, Conway, Kronenberger, Henning, & Anaya, 2010). Samples of deaf children, adolescents, and young adults have been found to have difficulties (relative to hearing peers) in specific EF domains such as verbal working memory (Hintermair, 2013;Marschark, Sarchet, & Trani, 2016;Kronenberger, Beer et al, 2014;Kronenberger, Pisoni, Henning, & Colson, 2013), controlled fluency speed (controlled attention under time pressure; Kronenberger et al, 2013), inhibition versus impulsivity (Figueras, Edwards, & Langdon, 2008;Kronenberger et al, 2013), and concept formation (Castellanos et al, 2015;Figueras et al, 2008;Kronenberger, Beer et al, 2014). Other EF areas such as flexibility/shifting (Figueras et al, 2008;Hintermair, 2013;Kronenberger, Beer et al, 2014) and emotional control (Hintermair, 2013;Kronenberger, Beer et al, 2014) may be affected, although there is some inconsistency in findings for these domains particularly at young ages (Kronenberger, Beer et al, 2014).…”

“…Samples of deaf children, adolescents, and young adults have been found to have difficulties (relative to hearing peers) in specific EF domains such as verbal working memory (Hintermair, 2013;Marschark, Sarchet, & Trani, 2016;Kronenberger, Beer et al, 2014;Kronenberger, Pisoni, Henning, & Colson, 2013), controlled fluency speed (controlled attention under time pressure; Kronenberger et al, 2013), inhibition versus impulsivity (Figueras, Edwards, & Langdon, 2008;Kronenberger et al, 2013), and concept formation (Castellanos et al, 2015;Figueras et al, 2008;Kronenberger, Beer et al, 2014). Other EF areas such as flexibility/shifting (Figueras et al, 2008;Hintermair, 2013;Kronenberger, Beer et al, 2014) and emotional control (Hintermair, 2013;Kronenberger, Beer et al, 2014) may be affected, although there is some inconsistency in findings for these domains particularly at young ages (Kronenberger, Beer et al, 2014). Differences between deaf and hearing samples typically are not found on visuospatial working memory tasks (Marschark, Sarchet et al, 2016;Kronenberger et al, 2013) or visual-organizational EF tasks (Kronenberger, Beer et al, 2014;Kronenberger et al, 2013).…”