The contribution of spectral processing to the acquisition of phonological sensitivity by adolescent cochlear implant users and normal-hearing controls.

This study tested the hypotheses that (1) adolescents with cochlear implants (CIs) experience impaired spectral processing abilities, and (2) those impaired spectral processing abilities constrain acquisition of skills based on sensitivity to phonological structure but not those based on lexical or syntactic (lexicosyntactic) knowledge. To test these hypotheses, spectral modulation detection (SMD) thresholds were measured for 14-year-olds with normal hearing (NH) or CIs. Three measures each of phonological and lexicosyntactic skills were obtained and used to generate latent scores of each kind of skill. Relationships between SMD thresholds and both latent scores were assessed. Mean SMD threshold was poorer for adolescents with CIs than for adolescents with NH. Both latent lexicosyntactic and phonological scores were poorer for the adolescents with CIs, but the latent phonological score was disproportionately so. SMD thresholds were significantly associated with phonological but not lexicosyntactic skill for both groups. The only audiologic factor that also correlated with phonological latent scores for adolescents with CIs was the aided threshold, but it did not explain the observed relationship between SMD thresholds and phonological latent scores. Continued research is required to find ways of enhancing spectral processing for children with CIs to support their acquisition of phonological sensitivity.

Children's suffix effects for verbal working memory reflect phonological coding and perceptual grouping.

When listeners recall order of presentation for sequences of unrelated words, recall is most accurate for first and final items. When a speech suffix is appended to the list, however, the advantage for final items is diminished. The usual interpretation is that listeners recover phonological structure from speech signals and use that structure to store items in a working memory buffer; the process of recovering phonological structure for a suffix interrupts that processing for the final list item. Although not mutually exclusive, another hypothesis suggests that perceptual grouping of list items and suffix based on common acoustic structure is necessary for the effect to occur. To evaluate these accounts as well as potential age-related differences, adults and 8-year-old children were asked to recall order of presentation for a closed set of nouns in five suffix conditions: none, auditory go, lipread go, a tone, and a colored circle. Overt articulation was prohibited, but attention to the suffix was mandated. Children's serial recall was generally poorer than that of adults, but patterns across list positions were similar for both age groups. Participants showed stronger effects for speech suffixes than for nonspeech suffixes regardless of whether suffixes were seen or heard, but effects were not restricted to final list items. And although effects of heard and lipread suffixes were similar for early list items, heard speech exerted greater effects on late list items. Outcomes suggest that some effect of heard and lipread speech suffixes arises from their shared phonological structure, but this effect is strongest when perceptual grouping occurs.

Word Recognition Variability With Cochlear Implants: "Perceptual Attention" Versus "Auditory Sensitivity".

OBJECTIVES: Cochlear implantation does not automatically result in robust spoken language understanding for postlingually deafened adults. Enormous outcome variability exists, related to the complexity of understanding spoken language through cochlear implants (CIs), which deliver degraded speech representations. This investigation examined variability in word recognition as explained by "perceptual attention" and "auditory sensitivity" to acoustic cues underlying speech perception. DESIGN: Thirty postlingually deafened adults with CIs and 20 age-matched controls with normal hearing (NH) were tested. Participants underwent assessment of word recognition in quiet and perceptual attention (cue-weighting strategies) based on labeling tasks for two phonemic contrasts: (1) "cop"-"cob," based on a duration cue (easily accessible through CIs) or a dynamic spectral cue (less accessible through CIs), and (2) "sa"-"sha," based on static or dynamic spectral cues (both potentially poorly accessible through CIs). Participants were also assessed for auditory sensitivity to the speech cues underlying those labeling decisions. RESULTS: Word recognition varied widely among CI users (20 to 96%), but it was generally poorer than for NH participants. Implant users and NH controls showed similar perceptual attention and auditory sensitivity to the duration cue, while CI users showed poorer attention and sensitivity to all spectral cues. Both attention and sensitivity to spectral cues predicted variability in word recognition. CONCLUSIONS: For CI users, both perceptual attention and auditory sensitivity are important in word recognition. Efforts should be made to better represent spectral cues through implants, while also facilitating attention to these cues through auditory training.

Speech perception of sine-wave signals by children with cochlear implants.

Children need to discover linguistically meaningful structures in the acoustic speech signal. Being attentive to recurring, time-varying formant patterns helps in that process. However, that kind of acoustic structure may not be available to children with cochlear implants (CIs), thus hindering development. The major goal of this study was to examine whether children with CIs are as sensitive to time-varying formant structure as children with normal hearing (NH) by asking them to recognize sine-wave speech. The same materials were presented as speech in noise, as well, to evaluate whether any group differences might simply reflect general perceptual deficits on the part of children with CIs. Vocabulary knowledge, phonemic awareness, and "top-down" language effects were all also assessed. Finally, treatment factors were examined as possible predictors of outcomes. Results showed that children with CIs were as accurate as children with NH at recognizing sine-wave speech, but poorer at recognizing speech in noise. Phonemic awareness was related to that recognition. Top-down effects were similar across groups. Having had a period of bimodal stimulation near the time of receiving a first CI facilitated these effects. Results suggest that children with CIs have access to the important time-varying structure of vocal-tract formants.

Measuring the effects of spectral smearing and enhancement on speech recognition in noise for adults and children.

Broadened auditory filters associated with sensorineural hearing loss have clearly been shown to diminish speech recognition in noise for adults, but far less is known about potential effects for children. This study examined speech recognition in noise for adults and children using simulated auditory filters of different widths. Specifically, 5 groups (20 listeners each) of adults or children (5 and 7 yrs), were asked to recognize sentences in speech-shaped noise. Seven-year-olds listened at 0 dB signal-to-noise ratio (SNR) only; 5-yr-olds listened at +3 or 0 dB SNR; and adults listened at 0 or -3 dB SNR. Sentence materials were processed both to smear the speech spectrum (i.e., simulate broadened filters), and to enhance the spectrum (i.e., simulate narrowed filters). Results showed: (1) Spectral smearing diminished recognition for listeners of all ages; (2) spectral enhancement did not improve recognition, and in fact diminished it somewhat; and (3) interactions were observed between smearing and SNR, but only for adults. That interaction made age effects difficult to gauge. Nonetheless, it was concluded that efforts to diagnose the extent of broadening of auditory filters and to develop techniques to correct this condition could benefit patients with hearing loss, especially children.

Benefits of preserving stationary and time-varying formant structure in alternative representations of speech: implications for cochlear implants.

Cochlear implants have improved speech recognition for deaf individuals, but further modifications are required before performance will match that of normal-hearing listeners. In this study, the hypotheses were tested that (1) implant processing would benefit from efforts to preserve the structure of the low-frequency formants and (2) time-varying aspects of that structure would be especially beneficial. Using noise-vocoded and sine-wave stimuli with normal-hearing listeners, two experiments examined placing boundaries between static spectral channels to optimize representation of the first two formants and preserving time-varying formant structure. Another hypothesis tested in this study was that children might benefit more than adults from strategies that preserve formant structure, especially time-varying structure. Sixty listeners provided data to each experiment: 20 adults and 20 children at each of 5 and 7 years old. Materials were consonant-vowel-consonant words, four-word syntactically correct, meaningless sentences, and five-word syntactically correct, meaningful sentences. Results showed that listeners of all ages benefited from having channel boundaries placed to optimize information about the first two formants, and benefited even more from having time-varying structure. Children showed greater gains than adults only for time-varying formant structure. Results suggest that efforts would be well spent trying to design processing strategies that preserve formant structure.

Low-frequency signals support perceptual organization of implant-simulated speech for adults and children.

OBJECTIVE: Using signals processed to simulate speech received through cochlear implants and low-frequency extended hearing aids, this study examined the proposal that low-frequency signals facilitate the perceptual organization of broader, spectrally degraded signals. DESIGN: In two experiments, words and sentences were presented in diotic and dichotic configurations as four-channel noise-vocoded signals (VOC-only), and as those signals combined with the acoustic signal below 0.25 kHz (LOW-plus). Dependent measures were percent correct recognition, and the difference between scores for the two processing conditions given as proportions of recognition scores for VOC-only. The influence of linguistic context was also examined. STUDY SAMPLE: Participants had normal hearing. In all, 40 adults, 40 seven-year-olds, and 20 five-year-olds participated. RESULTS: Participants of all ages showed benefits of adding the low-frequency signal. The effect was greater for sentences than words, but no effect of diotic versus dichotic presentation was found. The influence of linguistic context was similar across age groups, and did not contribute to the low-frequency effect. Listeners who had poorer VOC-only scores showed greater low-frequency effects. CONCLUSION: The benefit of adding a low-frequency signal to a broader, spectrally degraded signal derives in some part from its facilitative influence on perceptual organization of the sensory input.

Dynamic spectral structure specifies vowels for adults and children.

The dynamic specification account of vowel recognition suggests that formant movement between vowel targets and consonant margins is used by listeners to recognize vowels. This study tested that account by measuring contributions to vowel recognition of dynamic (i.e., time-varying) spectral structure and coarticulatory effects on stationary structure. Adults and children (four- and seven-year-olds) were tested with three kinds of consonant-vowel-consonant syllables: (I) unprocessed; (2) sine waves that preserved both stationary coarticulated and dynamic spectral structure; and (3) vocoded signals that primarily preserved that stationary, but not dynamic structure. Sections of two lengths were removed from syllable middles: (I) half the vocalic portion; and (2) all but the first and last three pitch periods. Adults performed accurately with unprocessed and sine-wave signals, as long as half the syllable remained; their recognition was poorer for vocoded signals, but above chance. Seven-year-olds performed more poorly than adults with both sorts of processed signals, but disproportionately worse with vocoded than sine-wave signals. Most four-year-olds were unable to recognize vowels at all with vocoded signals. Conclusions were that both dynamic and stationary coarticulated structures support vowel recognition for adults, but children attend to dynamic spectral structure more strongly because early phonological organization favors whole words.

Early otitis media puts children at risk for later auditory and language deficits.

BACKGROUND: Otitis media is a common disorder of early childhood suspected of hindering auditory and language development, but evidence regarding these effects has been contradictory. To examine potential sources of these contradictory past results and explore in more detail the effects of early otitis media on auditory and language development, three specific hypotheses were tested: (1) Variability in children's general attention could influence results, especially for measures of auditory functioning, leading to spurious findings of group differences; (2) Different language skills may be differentially affected, evoking different effects across studies depending on skills assessed; and (3) Different mechanisms might account for the effects of otitis media on acquisition of different language skills, a finding that would affect treatment choices. METHOD: Children 5-10 years old participated: 49 with and 68 without significant histories of otitis media. The auditory function examined was temporal modulation detection, using games designed to maintain children's attention; two additional measures assessed that attention. Measures of lexical knowledge and phonological sensitivity served as the language measures. RESULTS: Sustained attention was demonstrated equally across groups of children with and without histories of otitis media. Children with histories of otitis media performed more poorly than peers without those histories on the auditory measure and on both sets of language measures, but effects were stronger for phonological sensitivity than lexical knowledge. Deficits in temporal modulation detection accounted for variability in phonological sensitivity, but not in lexical knowledge. CONCLUSION: When experimental factors are tightly controlled, evidence emerges showing effects of otitis media early in life on both auditory and language development. Mechanism of effects on language acquisition appear to involve both delayed auditory development and diminished access to the ambient language.

Improving speech-in-noise recognition for children with hearing loss: potential effects of language abilities, binaural summation, and head shadow.

OBJECTIVE: This study examined speech recognition in noise for children with hearing loss, compared it to recognition for children with normal hearing, and examined mechanisms that might explain variance in children's abilities to recognize speech in noise. DESIGN: Word recognition was measured in two levels of noise, both when the speech and noise were co-located in front and when the noise came separately from one side. Four mechanisms were examined as factors possibly explaining variance: vocabulary knowledge, sensitivity to phonological structure, binaural summation, and head shadow. STUDY SAMPLE: Participants were 113 eight-year-old children. Forty-eight had normal hearing (NH) and 65 had hearing loss: 18 with hearing aids (HAs), 19 with one cochlear implant (CI), and 28 with two CIs. RESULTS: Phonological sensitivity explained a significant amount of between-groups variance in speech-in-noise recognition. Little evidence of binaural summation was found. Head shadow was similar in magnitude for children with NH and with CIs, regardless of whether they wore one or two CIs. Children with HAs showed reduced head shadow effects. CONCLUSION: These outcomes suggest that in order to improve speech-in-noise recognition for children with hearing loss, intervention needs to be comprehensive, focusing on both language abilities and auditory mechanisms.

Asynchronies in Auditory and Language Development Obscure Connections to Phonological Deficits in Children.

PURPOSE: For half a century, psycholinguists have been exploring the idea that developmental language disorders may have their roots in suprathreshold auditory dysfunctions, but results are inconclusive. Typical studies focus on relationships between temporal processing abilities and measures of various language skills at the time of testing, a proximal account. This study expanded that focus by testing three novel hypotheses: (a) Spectral processing impairments may be more responsible for language-learning deficits than temporal processing impairments. (b) Phonological sensitivity is likely the specific language skill most strongly affected by auditory (dys)functions. (c) Poor auditory functioning observed at young ages may wholly or partly recover, reducing the magnitude of relationship between those recovered functions and persistent language skills at older ages. METHOD: Sixty-six children (31 boys, 35 girls) 7-10 years of age participated: 36 with typical language and 30 with reading or speech disorder; from this sample two subsamples were designated: younger (7-8 years) and older (9-10 years) children. Four auditory measures were obtained of spectral modulation detection (0.5 and 2.0 cycles per octave) and temporal modulation detection (16 and 64 Hz). Four language measures were obtained, two lexicosyntactic and two phonological. RESULTS: Younger children showed deficits in all auditory skills, but most strongly for spectral modulation detection at 0.5 cycles per octave; that measure was the only one for which older children showed deficits. Spectral modulation detection was the auditory function most strongly correlated with a language skill, and that language skill was phonological sensitivity. CONCLUSIONS: Early impairments in suprathreshold auditory functions, especially spectral processing, interfere with language acquisition at early stages, especially phonological sensitivity. Although auditory functions can recover to some extent, impairments in language skills persist, indicating that a distal account may more appropriately explain the relationship. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24730128.

Recognition of Sentences With Complex Syntax in Speech Babble by Adolescents With Normal Hearing or Cochlear Implants.

PURPOSE: General language abilities of children with cochlear implants have been thoroughly investigated, especially at young ages, but far less is known about how well they process language in real-world settings, especially in higher grades. This study addressed this gap in knowledge by examining recognition of sentences with complex syntactic structures in backgrounds of speech babble by adolescents with cochlear implants, and peers with normal hearing. DESIGN: Two experiments were conducted. First, new materials were developed using young adults with normal hearing as the normative sample, creating a corpus of sentences with controlled, but complex syntactic structures presented in three kinds of babble that varied in voice gender and number of talkers. Second, recognition by adolescents with normal hearing or cochlear implants was examined for these new materials and for sentence materials used with these adolescents at younger ages. Analyses addressed three objectives: (1) to assess the stability of speech recognition across a multiyear age range, (2) to evaluate speech recognition of sentences with complex syntax in babble, and (3) to explore how bottom-up and top-down mechanisms account for performance under these conditions. RESULTS: Results showed: (1) Recognition was stable across the ages of 10-14 years for both groups. (2) Adolescents with normal hearing performed similarly to young adults with normal hearing, showing effects of syntactic complexity and background babble; adolescents with cochlear implants showed poorer recognition overall, and diminished effects of both factors. (3) Top-down language and working memory primarily explained recognition for adolescents with normal hearing, but the bottom-up process of perceptual organization primarily explained recognition for adolescents with cochlear implants. CONCLUSIONS: Comprehension of language in real-world settings relies on different mechanisms for adolescents with cochlear implants than for adolescents with normal hearing. A novel finding was that perceptual organization is a critical factor. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21965228.

Emergent literacy in kindergartners with cochlear implants.

OBJECTIVE: A key ingredient to academic success is being able to read. Deaf individuals have historically failed to develop literacy skills comparable with those of their normal-hearing (NH) peers, but early identification and cochlear implants (CIs) have improved prospects such that these children can learn to read at the levels of their peers. The goal of this study was to examine early, or emergent, literacy in these children. METHOD: Twenty-seven deaf children with CIs, who had just completed kindergarten were tested on emergent literacy, and on cognitive and linguistic skills that support emergent literacy, specifically ones involving phonological awareness, executive functioning, and oral language. Seventeen kindergartners with NH and eight with hearing loss, but who used hearing aids served as controls. Outcomes were compared for these three groups of children, regression analyses were performed to see whether predictor variables for emergent literacy differed for children with NH and those with CIs, and factors related to the early treatment of hearing loss and prosthesis configuration were examined for children with CIs. RESULTS: The performance of children with CIs was roughly 1 SD or more below the mean performance of children with NH on all tasks, except for syllable counting, reading fluency, and rapid serial naming. Oral language skills explained more variance in emergent literacy for children with CIs than for children with NH. Age of first implant explained moderate amounts of variance for several measures. Having one or two CIs had no effect, but children who had some amount of bimodal experience outperformed children who had none on several measures. CONCLUSIONS: Even deaf children who have benefitted from early identification, intervention, and implantation are still at risk for problems with emergent literacy that could affect their academic success. This finding means that intensive language support needs to continue through at least the early elementary grades. Also, a period of bimodal stimulation during the preschool years can help boost emergent literacy skills to some extent.

Children weight dynamic spectral structure more than adults: evidence from equivalent signals.

Earlier work using sine-wave and noise-vocoded signals suggests that dynamic spectral structure plays a greater role in speech recognition for children than adults [Nittrouer and Lowenstein. (2010). J. Acoust. Soc. Am. 127, 1624-1635], but questions arise concerning whether outcomes can be compared because sine waves and wide noise bands are different in nature. The current study addressed that question using narrow noise bands for both signals, and applying a difference ratio to index the contribution made by dynamic spectral structure. Results replicated earlier findings, supporting the idea that dynamic spectral structure plays a critical role in speech recognition, especially for children.

Beyond Recognition: Visual Contributions to Verbal Working Memory.

PURPOSE: It is well recognized that adding the visual to the acoustic speech signal improves recognition when the acoustic signal is degraded, but how that visual signal affects postrecognition processes is not so well understood. This study was designed to further elucidate the relationships among auditory and visual codes in working memory, a postrecognition process. DESIGN: In a main experiment, 80 young adults with normal hearing were tested using an immediate serial recall paradigm. Three types of signals were presented (unprocessed speech, vocoded speech, and environmental sounds) in three conditions (audio-only, audio-video with dynamic visual signals, and audio-picture with static visual signals). Three dependent measures were analyzed: (a) magnitude of the recency effect, (b) overall recall accuracy, and (c) response times, to assess cognitive effort. In a follow-up experiment, 30 young adults with normal hearing were tested largely using the same procedures, but with a slight change in order of stimulus presentation. RESULTS: The main experiment produced three major findings: (a) unprocessed speech evoked a recency effect of consistent magnitude across conditions; vocoded speech evoked a recency effect of similar magnitude to unprocessed speech only with dynamic visual (lipread) signals; environmental sounds never showed a recency effect. (b) Dynamic and static visual signals enhanced overall recall accuracy to a similar extent, and this enhancement was greater for vocoded speech and environmental sounds than for unprocessed speech. (c) All visual signals reduced cognitive load, except for dynamic visual signals with environmental sounds. The follow-up experiment revealed that dynamic visual (lipread) signals exerted their effect on the vocoded stimuli by enhancing phonological quality. CONCLUSIONS: Acoustic and visual signals can combine to enhance working memory operations, but the source of these effects differs for phonological and nonphonological signals. Nonetheless, visual information can support better postrecognition processes for patients with hearing loss.

The emergence of bifurcated structure in children's language.

Human language is unique among animal communication systems, in part because of its dual patterning in which meaningless phonological units combine to form meaningful words (phonological structure) and words combine to form sentences (lexicosyntactic structure). Although dual patterning is well recognized, its emergence in language development has been scarcely investigated. Chief among questions still unanswered is the extent to which development of these separate structures is independent or interdependent, and what supports acquisition of each level of structure. We explored these questions by examining growth of lexicosyntactic and phonological structure in children with normal hearing (n = 49) and children with hearing loss who use cochlear implants (n = 56). Multiple measures of each kind of structure were collected at 2-year intervals (kindergarten through eighth grade), and used to construct latent scores for each type of structure. Growth curve analysis assessed (a) the relative independence of development for each level of structure; (b) interactions between these two levels of structure in real-time language processing; and (c) contributions to growth of each level of structure made by auditory input, socioeconomic status (as proxy for linguistic experience), and speech motor control. Findings suggested that phonological and lexicosyntactic structure develop largely independently. Auditory input, socioeconomic status, and speech motor control help shape these language structures, with the last two factors exerting stronger effects for children with cochlear implants. Only for children with cochlear implants were interdependencies in real-time processing observed, reflecting compensatory mechanisms likely present to help them handle the disproportionately large phonological deficit they exhibit. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Disparate Oral and Written Language Abilities in Adolescents With Cochlear Implants: Evidence From Narrative Samples.

PURPOSE: In spite of improvements in language outcomes for children with hearing loss (HL) arising from cochlear implants (CIs), these children can falter when it comes to academic achievement, especially in higher grades. Given that writing becomes increasingly relevant to educational pursuits as children progress through school, this study explored the hypothesis that one challenge facing students with CIs may be written language. METHOD: Participants were 98 eighth graders: 52 with normal hearing (NH) and 46 with severe-to-profound HL who used CIs. Oral and written narratives were elicited and analyzed for morphosyntactic complexity and global narrative features. Five additional measures were collected and analyzed as possible predictors of morphosyntactic complexity: Sentence Comprehension of Syntax, Grammaticality Judgment, Expressive Vocabulary, Forward Digit Span, and Phonological Awareness. RESULTS: For oral narratives, groups performed similarly on both morphosyntactic complexity and global narrative features; for written narratives, critical differences were observed. Compared with adolescents with NH, adolescents with CIs used fewer markers of morphosyntactic complexity and scored lower on several global narrative features in their written narratives. Adolescents with NH outperformed those with CIs on all potential predictor measures, except for Sentence Comprehension of Syntax. Moderately strong relationships were found between predictor variables and individual measures of morphosyntactic complexity, but no comprehensive pattern explained the results. Measures of morphosyntactic complexity and global narrative features were not well correlated, suggesting these measures are assessing separate underlying constructs. CONCLUSIONS: Adolescents with CIs fail to show writing proficiency at high school entry equivalent to that of their peers with NH, which could constrain their academic achievement. Interventions for children with CIs need to target writing skills, and writing assessments should be incorporated into diagnostic assessments. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.17139059.

What is the deficit in phonological processing deficits: auditory sensitivity, masking, or category formation?

Although children with language impairments, including those associated with reading, usually demonstrate deficits in phonological processing, there is minimal agreement as to the source of those deficits. This study examined two problems hypothesized to be possible sources: either poor auditory sensitivity to speech-relevant acoustic properties, mainly formant transitions, or enhanced masking of those properties. Adults and 8-year-olds with and without phonological processing deficits (PPD) participated. Children with PPD demonstrated weaker abilities than children with typical language development (TLD) in reading, sentence recall, and phonological awareness. Dependent measures were word recognition, discrimination of spectral glides, and phonetic judgments based on spectral and temporal cues. All tasks were conducted in quiet and in noise. Children with PPD showed neither poorer auditory sensitivity nor greater masking than adults and children with TLD, but they did demonstrate an unanticipated deficit in category formation for nonspeech sounds. These results suggest that these children may have an underlying deficit in perceptually organizing sensory information to form coherent categories.

When language outgrows them: Comprehension of ambiguous sentences in children with normal hearing and children with hearing loss.

BACKGROUND: In spite of recent gains in language development made by children with hearing loss (HL) as a result of improved auditory prostheses and earlier starts to intervention, these children continue to struggle academically at higher grade levels. We hypothesize that one reason for these incongruent outcomes for language and academics may be that the language demands of school escalate as grade level increases, outstripping the language abilities of children with HL. We tested that hypothesis by examining a higher level skill that is essential for success with academic language, the ability to access multiple interpretations for a sentence. METHOD: 122 children participated at the end of middle school: 56 with normal hearing (NH), 15 with moderate HL who used hearing aids (HAs), and 51 with severe-to-profound HL who used cochlear implants (CIs). Children's abilities to provide more than one interpretation for an ambiguous sentence were assessed. These sentences were ambiguous due either to words having multiple meanings or to syntactic structure that could evoke more than one interpretation. Potential predictors of those abilities were evaluated, including expressive vocabulary, comprehension of syntactic structures, grammaticality judgments, forward digit span, and several audiologic factors. RESULTS: Children with NH performed best, children with CIs performed poorest, and children with HAs performed intermediately to those groups. Children in all groups achieved higher scores on the multiple meanings than on the syntactic structure items. The variables that were associated with performance varied across groups. Audiologic factors did not explain any variability in performance on the ambiguous sentences task for children with HL. CONCLUSIONS: The kind of linguistic flexibility needed to consider more than one interpretation for sentences lacking immediate, real-world context is essential to processing academic language. Children with HL - especially those with severe-to-profound HL who required CIs - showed deficits in this skill, which could contribute to their ongoing academic struggles. Continued language support is needed for these children to allow them to acquire the higher level language skills necessary for success through all of their years in school.

The Devil in the Details Can Be Hard to Spot: Malapropisms and Children With Hearing Loss.

Purpose Better auditory prostheses and earlier interventions have led to remarkable improvements in spoken language abilities for children with hearing loss (HL), but these children often still struggle academically. This study tested a hypothesis for why this may be, proposing that the language of school becomes increasingly disconnected from everyday discourse, requiring greater reliance on bottom-up phonological structure, and children with HL have difficulty recovering that structure from the speech signal. Participants One hundred nineteen fourth graders participated: 48 with normal hearing (NH), 19 with moderate losses who used hearing aids (HAs), and 52 with severe-to-profound losses who used cochlear implants (CIs). Method Three analyses were conducted. #1: Sentences with malapropisms were created, and children's abilities to recognize them were assessed. #2: Factors contributing to those abilities were evaluated, including phonological awareness, phonological processing, vocabulary, verbal working memory, and oral narratives. #3: Teachers' ratings of students' academic competence were obtained, and factors accounting for those ratings were evaluated, including the five listed above, along with word reading and reading comprehension. Results #1: Children with HAs and CIs performed more poorly on malapropism recognition than children with NH, but similarly to each other. #2: All children with HL demonstrated large phonological deficits, but they were especially large for children with CIs. Phonological awareness explained the most variance in malapropism recognition for children with CIs. Vocabulary knowledge explained malapropism recognition for children with NH or HAs, but other factors also contributed. #3: Teachers rated academic competence for children with CIs more poorly than for children with NH or HAs, and variance in those ratings for children with CIs were primarily explained by malapropism scores. Conclusion Children with HL have difficulty recognizing acoustic-phonetic detail in the speech signal, and that constrains their abilities to follow conversations in academic settings, especially if HL is severe enough to require CIs. Supplemental Material https://doi.org/10.23641/asha.13133018.