Expressive vocabulary word categories of children who are deaf and hard-of-hearing.

This study investigated the acquisition of early expressive vocabulary among young children who are deaf and hard-of-hearing (DHH; n = 68) using auditory technology (hearing aids and cochlear implants). Parents completed a standardized vocabulary checklist, which allowed analyses of (i) the size of their child's spoken vocabulary; (ii) composition of the expressive lexicon (e.g., parts of speech such as nouns and verbs; semantic categories such as routines and body parts); and (iii) demographic and audiologic factors (e.g., chronologic age, degree of hearing access) potentially associated with these metrics. Young children who are DHH and use auditory technology acquired fewer spoken words than peers with typical hearing (TH) matched for chronologic age but more spoken words than peers with TH matched for listening experience. Action verbs-not nouns-significantly increased the odds of a child who is DHH achieving a vocabulary quotient within the normative range. These findings support the exploration of early expressive vocabulary size and composition-especially the number of active verbs-to guide clinical management and decision-making for young children who are DHH.

Parent-reported quality of life in children with cochlear implants differs across countries.

Pediatric cochlear implantation affects communication skills and quality of life, specifically how children interact with others and feel about themselves. Numerous studies worldwide examine well-being among pediatric cochlear implant users, but none to date compare condition-specific quality of life across countries. This retrospective study compares parent-reported cochlear implant-specific quality of life summary data across 14 published studies spanning 11 countries and 9 languages. Sample size ranged from 7 to 370 participants, and children across studies varied in mean chronologic age (3.1-12.2 years), implantation age (1.5-4.6 years), and cochlear implant experience (1.3-8.2 years). Parents completed the Children with Cochlear Implants: Parental Perspectives (CCIPP) questionnaire, an instrument assessing parent-reported cochlear implant-specific quality of life, in their home language. Analysis of variance tests were run for each CCIPP subscale across studies using summary data to determine significant differences between published manuscripts. Across countries, parents of children with cochlear implants appraise communication, social relations, and self-reliance most positively, and the effects of implantation and supporting the child least positively. Cross-country analyses revealed a significant effect of study (country) on quality of life ratings in each domain, with the largest differences in the communication domain. Limited access to implant-related accommodations, cultural awareness of hearing loss, and varying parent expectations may explain country differences in parental ratings of quality of life. Culturally sensitive psychoeducation for the entire family may foster improved life satisfaction for pediatric cochlear implant users and their families.

American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children.

This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child's skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

Quantitative and Qualitative Perspectives of Siblings of Children With Cochlear Implants.

Purpose The sibling relationship teaches children to navigate social interactions with their peers. However, the presence of an exceptionality, such as hearing loss, in one child can affect the dynamic of this relationship. This article examines quantitative and qualitative effects of having a brother or sister with a cochlear implant (CI) on siblings with typical hearing (TH) to determine how children with TH perceive their sibling with a CI and how having a CI user in the family affects the sibling's activities, emotions, and parental attention. Method Participants include 36 siblings with TH (M age = 11.6 years) of CI users (M age = 11.9 years) who completed quantitative measures of their perspectives of their brother/sister with CIs and the effect of hearing loss on themselves. Siblings with TH also could express their opinions via open-ended prompts. Results Overall, siblings with TH express positive perspectives of their brother/sister with CIs and report having a CI user in the family does not affect them much, particularly if the CI user has adequate communication skills. Responses to both quantitative and qualitative items converge on the close relationship between siblings but diverge relative to differential attention from parents (i.e., open-ended responses suggest parents spend more time with the CI user than the sibling with TH). Additionally, siblings acknowledge the presence of social communication deficits of the CI user in real-world situations. Conclusion This nuanced look at relationships among the parent, CI user, and sibling with TH highlights the importance of understanding the family system when working with children with hearing loss.

Relationships Between Daily Device Use and Early Communication Outcomes in Young Children With Cochlear Implants.

OBJECTIVES: Children with significant hearing loss can gain access to sound via a cochlear implant (CI), but they must wear the device to reap the communication benefits of the device. That is, poor daily device use may result in underdeveloped perceptual and language skills in children and adolescents using CIs. This retrospective study focuses on the relationship between daily CI use and communication performance (auditory skills, speech recognition, expressive and receptive language) in young children, with the hypothesis that greater daily device use coincides with better communication outcomes. DESIGN: The authors conducted a clinical chart review of patients with CIs younger than 5 years old who used at least 1 CI speech processor with datalogging technology. Participants (n = 65) had a mean chronologic age of 3.5 years, mean implantation age of 1.9 years, and mean device experience of 1.6 years. Approximately one quarter of participants had additional disabilities. Daily device use (i.e., datalogging information), child characteristics (e.g., age at CI), and assessments of communication skills (i.e., parent questionnaires, speech recognition tests, standardized language assessments) were obtained from each child's records. The investigators performed correlational analyses to examine relationships between communication outcomes and daily device use, and they employed group comparisons and correlations to identify child characteristics that were significantly associated with daily device use (p < 0.05, corrections for family-wise error). RESULTS: Young children with CIs used their device, on average, 6.7 hr/d, with 63% below full-time use (<8 hr/d). Children without additional disabilities who wore their CI more hours per day had significantly better auditory, speech recognition, and language skills. A significant correlation also emerged between daily device use and early auditory skills in young CI users with additional disabilities, though relationships were more complicated for this subsample. Longer daily device use significantly correlated with younger age at CI and longer device experience. Differences in device use occurred in regards to absence versus presence of additional disabilities, bilateral versus unilateral device configuration, sign versus spoken language, and private versus government-assisted insurance. CONCLUSIONS: The strong relationship between daily device use and early communication suggests clinicians and parents should focus on increasing the number of hours per day young children wear their CIs to enhance auditory and language outcomes. However, intervention strategies must consider barriers to consistent device use and goals of the family to efficiently and effectively support families of young children with CIs who struggle with inconsistent device use.

Music Perception and Speech-in-Noise Skills of Typical Hearing and Cochlear Implant Listeners.

Purpose Adult cochlear implant (CI) users rate music as one of the most important auditory stimuli, second to speech perception. However, few studies simultaneously examine music perception and speech-in-noise perception in adult CI recipients. This study explores the effect of auditory status on music perception and speech-in-noise perception recognition in noise as well as the relationship among music engagement, music perception, and speech-in-noise perception. Method Participants include 10 adults with typical hearing (TH) and 10 adults with long-term CI use. All participants completed the Music-Related Quality of Life Questionnaire, which assesses subjective music experiences and their importance; the Pitch Direction Discrimination, Familiar Melody Recognition, and Timbre Recognition subtests of the Clinical Assessment of Music Perception for Cochlear Implants; the Unfamiliar Melody Recognition subtest of the Profile of Music Perception Skills; and the Bamford-Kowal-Bench Speech-in-Noise Test. Results The TH group significantly outperformed the CI group for speech-in-noise perception and on all four music perception tasks. The CI group exhibited not only significantly poorer mean scores but also greater variability in performance compared to the TH group. Only Familiar Melody Recognition and Unfamiliar Melody Recognition subtests significantly correlated with speech-in-noise scores. Conclusions Patients and professionals should not assume speech perception and music perception in adult CI users derive from the same auditory or cognitive foundations. The lack of significant relationships among music engagement, music perception, and speech-in-noise perception scores in adult CI users suggests this population enjoys music despite poor and variable performance in discrete music tasks.

Stress in Parents of School-Age Children and Adolescents With Cochlear Implants.

Parents of children with cochlear implants (CIs) face unique challenges in caring for their child, potentially fostering parental stress. Most studies of stress in parents of CI users do not examine stress specific to having a deaf and hard-of-hearing (DHH) child. This study compares general and condition-specific stress (via the Family Stress Scale) in 31 parents of CI users (8-16 years) to previously published samples of DHH children, and it examines child- and CI-related factors associated with parental stress. Parents of modern-day CI users reported significantly lower stress than parents of children using older-generation CI technology and similar levels of overall stress to parents of young children preimplantation. However, significant item-level differences emerged (e.g., communication, device management) pre- versus postimplant. Child temperament significantly predicted parental stress after controlling for other variables. Intervention strategies for children with CIs should engage a family systems approach to reduce parental stress and better support the child.

Early Vocabulary Profiles of Young Deaf Children Who Use Cochlear Implants.

Purpose This study examined vocabulary profiles in young cochlear implant (CI) recipients and in children with normal hearing (NH) matched on receptive vocabulary size to improve our understanding of young CI recipients' acquisition of word categories (e.g., common nouns or closed-class words). Method We compared receptive and expressive vocabulary profiles between young CI recipients (n = 48; mean age at activation = 15.61 months, SD = 4.20) and children with NH (n = 48). The two groups were matched on receptive vocabulary size as measured by the MacArthur-Bates Communicative Development Inventories (Fenson et al., 2006): Words and Gestures form. The CI group had, on average, 8.98 months of hearing experience. The mean chronological age at completing the MacArthur-Bates Communicative Development Inventories was 23.99 months (SD = 5.14) for the CI group and 13.72 months (SD = 1.50) for the NH group. Results The CI group had a larger expressive vocabulary size than the receptive vocabulary size-matched NH group. The larger expressive vocabulary size was associated with the group difference in social words but not with common nouns. The analyses for predicate words and closed-class words included only children who produced the target categories. The CI group had a larger proportion of predicate words than the NH group, but no difference was found in closed-class words in expressive vocabulary. Conclusions Differences found in expressive vocabulary profiles may be affected by spoken vocabulary size and their age. A further examination is warranted using language samples to understand the effect of language input on children's vocabulary profiles.

Effect of auditory status on visual emotion recognition in adolescents.

Adolescents with severe to profound hearing loss who wear cochlear implants (CIs) experience significantly more peer problems compared to peers with typical hearing (TH). Differences in peer social dynamics may relate to perception not only of message content, but also message intent based on a speaker's emotion from visual (e.g. facial expressions) and auditory (e.g. prosody) cues. Pediatric CI users may experience greater difficulty with auditory emotion recognition due to an impoverished signal representation provided by the device, but the effect of auditory status on visual emotion recognition yields conflicting results. OBJECTIVES: The current study examined accuracy and speed of visual emotion recognition in adolescents with CIs and peers with TH. METHODS: Participants included 58 adolescents (10-18 years) stratified by auditory status: 34 CI users and 24 TH peers. Participants identified the intended emotion (i.e. happiness, sadness, anger, fear, disgust, and surprise) of static images of faces displayed on a computer screen. RESULTS: No significant differences by auditory status emerged for response accuracy, response time to all trials, or response time to correct trials. Type of emotion significantly affected both accuracy and response time. CONCLUSION: Adolescents with CIs show similar accuracy and response time in recognizing static facial expressions compared to TH peers. Future studies should explore the association between visual emotion recognition and social well-being to determine the relationship between emotion recognition and overall quality of life in adolescents with CIs.

Inconsistent device use in pediatric cochlear implant users: Prevalence and risk factors.

OBJECTIVES: Cochlear implants (CIs) afford an opportunity for children with a significant hearing loss to access spoken language through auditory input, but challenges post-implantation could impede success. Inconsistent device use occurs when a child wears their device less than full-time (<8 hours per day). Previous studies may underestimate the prevalence of inconsistent device use in pediatric CI users due to methodological issues (subjective parent report vs. objective measures). METHODS: This retrospective chart review identifies risk factors (demographic, audiologic, and device) associated with poorer daily device use in children with CI using objective datalogging. Non-parametric correlations, Mann-Whitney U, and Kruskal-Wallis H tests were used to evaluate effects of demographic, audiologic, and device factors on daily device use via datalogging. RESULTS: Participants included 71 children (age M = 7.0 years) with mean implantation age of 4.0 years and mean device experience of 3.0 years. Children with CIs used their device, on average, 7.6 hours/day (range: 0.1-15.5 hours). Half of the participants wore their device less than full-time. Fewer hours of device use coincided with younger chronologic age, presence of additional disabilities, lower maternal education, younger age at CI, use of Medicaid, and smaller dynamic range. DISCUSSION: The prevalence of inconsistent device use may exceed previous estimations based on parent report. CONCLUSION: Professionals working with pediatric CI users should consider incorporating datalogging into clinical practice to counsel families at risk for poorer device use. Future studies should compare objective device use with communication outcomes in pediatric CI users.

Age and gender differences in children and adolescents' attitudes toward noise.

OBJECTIVE: Most school-aged children experience exposure to hazardous sound levels via high-risk noise activities (e.g. loud music/concerts, firearms). Little information exists regarding factors influencing pediatric engagement in these activities and use of hearing protection devices. This study explores effects of age, gender, and attitudes toward noise on participation in acoustic risk-taking behaviors and hearing conservation practices in children and adolescents. DESIGN: Cross-sectional. STUDY SAMPLE: Children and adolescents (10-19 years) with normal hearing. RESULTS: Most children and adolescents (86.5%) participate in at least one potentially high-risk noise behavior. The most frequently cited activities include sporting events, concerts, and playing a musical instrument. Use of hearing protection devices varies by activity, with consistent wear while using firearms but inconsistent application during all other activities. Gender, but not age, influences acoustic risk-taking behaviors: Boys engage in significantly more high-risk noise activities than girls. Participants expressed a neutral attitude toward noise that persisted across age and gender, but a trend shifting toward a pro-noise attitude emerges in later adolescence. CONCLUSIONS: The proliferation of acoustic risk-taking behaviors and lack of hearing conservation practices in children and adolescents requires attention at an early age to prevent future noise-induced hearing loss and subsequent quality of life effects.

Self-esteem in children and adolescents with hearing loss.

Children with hearing loss are at risk for lower self-esteem due to differences from hearing peers relative to communication skills, physical appearance, and social maturity. This study examines the influence of generic factors unrelated to hearing loss (e.g., age, gender, temperament) and specific factors associated with hearing loss (e.g., age at identification, communication skills) on how children with hearing loss wearing cochlear implants or hearing aids appraise self-esteem. Fifty children with hearing loss wearing cochlear implants or hearing aids participated (Mean age: 12.88 years; mean duration of device use: 3.43 years). Participants independently completed online questionnaires to assess communication skills, social engagement, self-esteem, and temperament. Children with hearing loss rated global self-esteem significantly more positively than hearing peers, t = 2.38, p = .02. Self-esteem ratings attained significant positive correlations with affiliation (r = .42, p = .002) and attention (r = .45, p = .001) temperaments and a significant negative association with depressive mood (r = - .60, p < .0001). No significant correlations emerged between self-esteem and demographic factors, communication skills, or social engagement. Because successful communication abilities do not always co-occur with excellent quality of life, clinicians and professionals working with children with hearing loss need to understand components contributing to self-esteem to improve identification, counseling, and external referrals for children in this population.

Vowel discrimination by hearing infants as a function of number of spectral channels.

Reduced spectral resolution negatively impacts speech perception, particularly perception of vowels and consonant place. This study assessed impact of number of spectral channels on vowel discrimination by 6-month-old infants with normal hearing by comparing three listening conditions: Unprocessed speech, 32 channels, and 16 channels. Auditory stimuli (/ti/ and /ta/) were spectrally reduced using a noiseband vocoder and presented to infants with normal hearing via visual habituation. Results supported a significant effect of number of channels on vowel discrimination by 6-month-old infants. No differences emerged between unprocessed and 32-channel conditions in which infants looked longer during novel stimulus trials (i.e., discrimination). The 16-channel condition yielded a significantly different pattern: Infants demonstrated no significant difference in looking time to familiar vs novel stimulus trials, suggesting infants cannot discriminate /ti/ and /ta/ with only 16 channels. Results support effects of spectral resolution on vowel discrimination. Relative to published reports, young infants need more spectral detail than older children and adults to perceive spectrally degraded speech. Results have implications for development of perception by infants with hearing loss who receive auditory prostheses.

A comparative study of psychosocial development in children who receive cochlear implants.

OBJECTIVES: This study assessed self-reported quality of life of children with a cochlear implant (CI), comparing results with two published reports from the past decade. METHODS: Participants included 33 pediatric CI recipients with a mean age of 10.12 years (SD = 3.59), mean implantation age of 1.36 years (SD = 0.46), and mean CI experience of 6.23 years (SD = 1.75). Children in all three studies completed a self-report quality-of-life questionnaire that included seven benefit and six problem items, rated on a 5-point Likert scale. RESULTS: Outcomes revealed agreement across studies in overall benefit and problem ratings. Environmental awareness and frustration reduction were the most and least positively rated outcomes, respectively. Items contributing to overall ratings differed across studies. Current CI recipients rated speech production, making new friends, and understanding speech more positively and taking extra care of the device more negatively than previous generations of pediatric CI users. DISCUSSION: Overall, benefits outweigh problems of the device, according to children using CI. Differences in issues motivating self-report ratings reflect changes in CI candidacy, technology, and social participation over the past decade. These findings emphasize the need for clinicians to address not only communication needs, but also quality-of-life issues to optimize outcomes in children using CI.

Health-related quality of life in children and adolescents who use cochlear implants.

OBJECTIVE: Examination of health-related quality of life (HRQoL) in children and adolescents who wear a cochlear implant (CI) primarily has depended on parent proxy report of the child's HRQoL rather than child self-report and generic domains rather than CI-specific issues. This study simultaneously assessed self-report ratings on a generic HRQoL instrument and a preliminary CI module in pediatric CI users. The impact of demographic factors (chronologic age, age at CI, and CI experience) on HRQoL also was explored. METHODS: This cross-sectional study included 138 children grouped by chronologic age: 4-7, 8-11 and 12-16 years. The KINDL(R) questionnaire for measuring HRQoL in children and adolescents (generic) and a preliminary CI module (specific) were completed as a researcher-administered interview (4-7 years) or self-administered questionnaire (8-16 years) at CI summer camp or home. Scores were transformed to a 100-point scale with 100 representing the most positive response. The impact of chronologic age group on HRQoL ratings was evaluated using Analysis of Variance. Spearman rank-order correlations and point-biserial correlations tested associations between demographic factors and HRQoL scores. Principal factor analysis was used to discover the factor structure and internal consistency of the preliminary CI module. RESULTS: The youngest group (M=82.8) rated generic HRQoL significantly more positively than older children (8-11 years: M=75.3; 12-16 years: M=70.4). Similar significant results emerged on the overall CI module (4-7 years: M=79.8; 8-11 years: M=77.8; 12-16 years: M=71.3). The youngest group rated CI-specific items on friends and self-image more positively than older groups, but reported greater difficulties hearing teachers at school. The oldest group provided more consistent responses than younger groups on the CI module (Cronbach α=0.72). Generic and CI module scores correlated positively (r=0.19, p=.03) but this association reflects the strong correlation in the oldest group (r=0.49, p=0.0033) and camouflages non-significant results in younger groups. CONCLUSION: Chronologic age impacts self-report of HRQoL for pediatric CI users such that younger children rate HRQoL more positively than older children and adolescents on a generic instrument and preliminary CI module. Older children provide more consistent responses on the CI module. Results support the need for further development of a CI-specific self-report HRQoL instrument.

The children speak: an examination of the quality of life of pediatric cochlear implant users.

OBJECTIVE: To examine the results of health-related quality-of-life questionnaire scores from profoundly deaf children fitted with at least one cochlear implant (CI) and to compare their responses with those of normal-hearing mates of similar age and their parents. STUDY DESIGN: Cross-sectional study utilizing a generic quality-of-life questionnaire designed to be completed by both parents and children independently of each other. SETTING: Questionnaires completed at various summer camps designed for children with CIs in Texas and Colorado. SUBJECTS AND METHODS: Eighty-eight families from 16 states were divided into two subgroups by age of cochlear implantation: an eight- to 11-year-old group and a 12- to 16-year-old group. The KINDL-R Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents was distributed, and CI participants completed the questionnaire independently of their participating family member. RESULTS: CI users in both age groups scored similarly to their normal-hearing peers and their parents. Younger CI users scored their family domain lower compared with their normal-hearing peers. Teen CI users scored the school domain lower compared with their parents. Among CI participants, earlier implantation and longer CI use resulted in higher quality-of-life scores. CONCLUSION: Children with CIs experience quality of life similar to that of normal-hearing peers. Parents are reliable reporters on the status of their child's overall quality of life.

Accuracy of consonant-vowel syllables in young cochlear implant recipients and hearing children in the single-word period.

PURPOSE: Attaining speech accuracy requires that children perceive and attach meanings to vocal output on the basis of production system capacities. Because auditory perception underlies speech accuracy, profiles for children with hearing loss (HL) differ from those of children with normal hearing (NH). METHOD: To understand the impact of auditory history on emergence of speech capacities, the authors compared consonant-vowel (CV) syllable accuracy in early words in 4 NH children and 4 children with HL who received cochlear implantation (CI) before age 2 years. Participants were video-recorded monthly for 6 months following word onset. CV vocalizations were coded perceptually with broad phonetic transcription. Observed-to-expected ratios of CV productions and accuracy were tested with chi-square analysis. An ordered multinomial model tested level of accuracy, including both accuracy and error patterns. RESULTS: Most frequently produced sequences were most accurately produced across group and time. NH children were more accurate overall than children with CI. Both groups improved accuracy over time by decreasing partially accurate productions (accurate consonant-inaccurate vowel). Both groups favored CV patterns with compatible place of articulation between consonant and vowel in absolute frequency and level of accuracy. CONCLUSION: Differences in emergence of CV syllable accuracy arise from differences in auditory perception between the NH and CI groups.

Parent versus child assessment of quality of life in children using cochlear implants.

OBJECTIVE: Children with hearing loss who use cochlear implants have lower quality of life (QoL) in social situations and lower self-esteem than hearing peers. The child's QoL has been assessed primarily by asking the parent rather than asking the child. This poses a problem because parents have difficulty judging less observable aspects like self-esteem and socio-emotional functioning, the domains most affected by hearing loss. METHODS: This case-control study evaluated QoL in 50 preschoolers using a cochlear implant and their parents with the Kiddy KINDL(®), an established QoL measure. Children's responses were compared to a hearing control group and correlated with demographic variables. We used a questionnaire for parents and a face-to-face interview with children. T-tests were used to compare (a) paired parent-child ratings and (b) children with cochlear implants versus normal hearing. Pearson rank correlations were used to compare QoL with demographic variables. RESULTS: Children using cochlear implants rated overall QoL significantly more positively than their parents (M(Difference)=4.22, p=.03). Child rating of QoL did not differ significantly by auditory status (cochlear implant (82.8) vs. hearing (80.8), p=.42). Overall QoL correlated inversely with cochlear implant experience and chronologic age, but did not correlate with implantation age. CONCLUSIONS: Preschool children using cochlear implants can assess adequately their own QoL, but parents afford valuable complementary perspective on the child's socio-emotional and physical well-being. Preschool children using cochlear implants rate overall QoL measures similar to hearing peers. A constellation of QoL measures should be collected to yield a better understanding of general QoL as well as specific domains centered on hearing loss.

The emergence of segmental accuracy in young cochlear implant recipients.

In the first steps toward intelligible speech, children must match sounds they can produce with salient word targets from their environment. Differences in auditory history between normal-hearing children (NH) and children receiving cochlear implants (CI) before the age of 24 months afford examination of the production system and auditory perceptual effects on the emergence of early segmental accuracy. Consonant and vowel inventories, accuracy and error patterns during the single-word period were examined in four NH and four CI children. NH and CI groups differed significantly on consonant accuracy, shifting from omissions to correct productions. Vowel productions improved from partially correct to correct. Both groups improved over time and showed similar patterns for segmental accuracy. Results suggest resilience of the production system to differences in auditory history.