Neuronal Development of Hearing and Language: Cochlear Implants and Critical Periods.

The modern cochlear implant (CI) is the most successful neural prosthesis developed to date. CIs provide hearing to the profoundly hearing impaired and allow the acquisition of spoken language in children born deaf. Results from studies enabled by the CI have provided new insights into (a) minimal representations at the periphery for speech reception, (b) brain mechanisms for decoding speech presented in quiet and in acoustically adverse conditions, (c) the developmental neuroscience of language and hearing, and (d) the mechanisms and time courses of intramodal and cross-modal plasticity. Additionally, the results have underscored the interconnectedness of brain functions and the importance of top-down processes in perception and learning. The findings are described in this review with emphasis on the developing brain and the acquisition of hearing and spoken language.

Focal Brain Lesions Causing Acquired Amusia Map to a Common Brain Network.

Music is a universal human attribute. The study of amusia, a neurologic music processing deficit, has increasingly elaborated our view on the neural organization of the musical brain. However, lesions causing amusia occur in multiple brain locations and often also cause aphasia, leaving the distinct neural networks for amusia unclear. Here, we utilized lesion network mapping to identify these networks. A systematic literature search was carried out to identify all published case reports of lesion-induced amusia. The reproducibility and specificity of the identified amusia network were then tested in an independent prospective cohort of 97 stroke patients (46 female and 51 male) with repeated structural brain imaging, specifically assessed for both music perception and language abilities. Lesion locations in the case reports were heterogeneous but connected to common brain regions, including bilateral temporoparietal and insular cortices, precentral gyrus, and cingulum. In the prospective cohort, lesions causing amusia mapped to a common brain network, centering on the right superior temporal cortex and clearly distinct from the network causally associated with aphasia. Lesion-induced longitudinal structural effects in the amusia circuit were confirmed as reduction of both gray and white matter volume, which correlated with the severity of amusia. We demonstrate that despite the heterogeneity of lesion locations disrupting music processing, there is a common brain network that is distinct from the language network. These results provide evidence for the distinct neural substrate of music processing, differentiating music-related functions from language, providing a testable target for noninvasive brain stimulation to treat amusia.

Acquired amusia after a right middle cerebral artery infarction - a case study.

A 62-year-old musician-MM-developed amusia after a right middle-cerebral-artery infarction. Initially, MM showed melodic deficits while discriminating pitch-related differences in melodies, musical memory problems, and impaired sensitivity to tonal structures, but normal pitch discrimination and spectral resolution thresholds, and normal cognitive and language abilities. His rhythmic processing was intact when pitch variations were removed. After 3 months, MM showed a large improvement in his sensitivity to tonality, but persistent melodic deficits and a decline in perceiving the metric structure of rhythmic sequences. We also found visual cues aided melodic processing, which is novel and beneficial for future rehabilitation practice.

Altered structural connectome of children with auditory processing disorder: a diffusion MRI study.

Auditory processing disorder (APD) is a listening impairment that some school-aged children may experience despite having normal peripheral hearing. Recent resting-state functional magnetic resonance imaging (MRI) has revealed an alteration in regional functional brain topology in children with APD. However, little is known about the structural organization in APD. We used diffusion MRI data to investigate the structural connectome of 58 children from 8 to 14 years old diagnosed with APD (n = 29) and children without hearing complaints (healthy controls, HC; n = 29). We investigated the rich-club organization and structural connection differences between groups. The APD group showed similar rich-club organization and edge-wise connection compared with the HC group. However, at the regional level, we observed increased average path length (APL) and betweenness centrality in the right inferior parietal lobule and inferior precentral gyrus, respectively, in the APD group. Only HCs demonstrated a positive association between APL and the listening-in-spatialized-noise-sentences task in the left orbital gyrus. In line with previous findings, the current results provide evidence for altered structural networks at the regional level in the APD group, suggesting the involvement of multimodal deficits and a role for structure-function alteration in the listening difficulties of children with APD.

Cross-Frequency Brain Network Dynamics Support Pitch Change Detection.

Processing auditory sequences involves multiple brain networks and is crucial to complex perception associated with music appreciation and speech comprehension. We used time-resolved cortical imaging in a pitch change detection task to detail the underlying nature of human brain network activity, at the rapid time scales of neurophysiology. In response to tone sequence presentation to the participants, we observed slow inter-regional signaling at the pace of tone presentations (2-4 Hz) that was directed from auditory cortex toward both inferior frontal and motor cortices. Symmetrically, motor cortex manifested directed influence onto auditory and inferior frontal cortices via bursts of faster (15-35 Hz) activity. These bursts occurred precisely at the expected latencies of each tone in a sequence. This expression of interdependency between slow/fast neurophysiological activity yielded a form of local cross-frequency phase-amplitude coupling in auditory cortex, which strength varied dynamically and peaked when pitch changes were anticipated. We clarified the mechanistic relevance of these observations in relation to behavior by including a group of individuals afflicted by congenital amusia, as a model of altered function in processing sound sequences. In amusia, we found a depression of inter-regional slow signaling toward motor and inferior frontal cortices, and a chronic overexpression of slow/fast phase-amplitude coupling in auditory cortex. These observations are compatible with a misalignment between the respective neurophysiological mechanisms of stimulus encoding and internal predictive signaling, which was absent in controls. In summary, our study provides a functional and mechanistic account of neurophysiological activity for predictive, sequential timing of auditory inputs.SIGNIFICANCE STATEMENT Auditory sequences are processed by extensive brain networks, involving multiple systems. In particular, fronto-temporal brain connections participate in the encoding of sequential auditory events, but so far, their study was limited to static depictions. This study details the nature of oscillatory brain activity involved in these inter-regional interactions in human participants. It demonstrates how directed, polyrhythmic oscillatory interactions between auditory and motor cortical regions provide a functional account for predictive timing of incoming items in an auditory sequence. In addition, we show the functional relevance of these observations in relation to behavior, with data from both normal hearing participants and a rare cohort of individuals afflicted by congenital amusia, which we considered here as a model of altered function in processing sound sequences.

Individuals with congenital amusia remember music they like.

Music is better recognized when it is liked. Does this association remain evident when music perception and memory are severely impaired, as in congenital amusia? We tested 11 amusic and 11 matched control participants, asking whether liking of a musical excerpt influences subsequent recognition. In an initial exposure phase, participants-unaware that their recognition would be tested subsequently-listened to 24 musical excerpts and judged how much they liked each excerpt. In the test phase that followed, participants rated whether they recognized the previously heard excerpts, which were intermixed with an equal number of foils matched for mode, tempo, and musical genre. As expected, recognition was in general impaired for amusic participants compared with control participants. For both groups, however, recognition was better for excerpts that were liked, and the liking enhancement did not differ between groups. These results contribute to a growing body of research that examines the complex interplay between emotions and cognitive processes. More specifically, they extend previous findings related to amusics' impairments to a new memory paradigm and suggest that (1) amusic individuals are sensitive to an aesthetic and subjective dimension of the music-listening experience, and (2) emotions can support memory processes even in a population with impaired music perception and memory.

Multisensory perceptual distortion including auditory distortions in Alice in Wonderland syndrome: a case report.

Alice in Wonderland syndrome (AIWS) is a rare perceptual disorder characterized mainly by perceptual distortions of visual objects and one's own body. While there are many case reports of visual and somatosensory distortions associated with AIWS, little is known about auditory distortion. Therefore, we present the case of a 22-year-old right-handed woman who described having auditory as well as visual and somatosensory distortion experiences and a family history of AIWS. The subject reported experiencing multisensory perceptual distortions, where she sees other people's faces as larger and hears their voices as louder at the same time. This particular case suggests that auditory distortion - which contributes to constructing the perception of the surrounding space and the body - may also be characterized as a perceptual symptom of AIWS.

Electrophysiological Testing for an Auditory Processing Disorder and Reading Performance in 54 School Students Aged Between 8 and 12 years.

BACKGROUND Learning to read and write depends on the effective functioning of various sensory systems, including the auditory system. Auditory information processing involves behavioral and electrophysiological processes. Electrophysiological procedures are used to investigate activity in the auditory pathway in response to sound stimuli, and the associated cortical activity in discrimination, integration, and attention. The study evaluated electrophysiological testing for an auditory processing disorder and reading performance in 54 school students aged between 8 and 12 years. MATERIAL AND METHODS The study involved 54 public school students aged between 8 and 12 years, who were divided into a study group and control group. All children underwent basic audiological assessment, rating of reading and writing ability, non-verbal intelligence, auditory brainstem response, long-latency auditory-evoked potentials (LLAEP), frequency following responses (FFR), and auditory training (AT). RESULTS The basic audiological evaluation showed a statistically significant difference between groups only for the frequency of 6 kHz. The LLAEP response had a statistically significant difference between groups for N1 latency, P300 latency, and amplitude. Finally, there was a statistically significant difference between pre-AT and post-AT to LLAEP for latencies of P2, N2, and P300 and amplitudes of N2 and P300, and to FFR for latency of wave C. CONCLUSIONS This study showed that electrophysiological tests are sensitive tools for identifying deficits in the auditory pathway. Moreover, latency measures can detect improvements from an auditory training program. In this way, an auditory intervention program might help children with reading and writing difficulties.

Distributional learning of musical pitch despite tone deafness in individuals with congenital amusia.

Congenital amusia is an innate and lifelong deficit of music processing. This study investigated whether adult listeners with amusia were still able to learn pitch-related musical chords based on stimulus frequency of statistical distribution, i.e., via distributional learning. Following a pretest-training-posttest design, 18 amusics and 19 typical, musically intact listeners were assigned to bimodal and unimodal conditions that differed in distribution of the stimuli. Participants' task was to discriminate chord minimal pairs, which were transposed to a novel microtonal scale. Accuracy rates for each test session were collected and compared between the two groups using generalized mixed-effects models. Results showed that amusics were less accurate than typical listeners at all comparisons, thus corroborating previous findings. Importantly, amusics-like typical listeners-demonstrated perceptual gains from pretest to posttest in the bimodal condition (but not the unimodal condition). The findings reveal that amusics' distributional learning of music remains largely preserved despite their deficient music processing. Implications of the results for statistical learning and intervention programs to mitigate amusia are discussed.

The use of the Feather Squadron to identify auditory processing disorders in South African children: a comparative study.

OBJECTIVE: Development of the Feather Squadron (FS) has created a cost-effective, accessible form of assessment through tele-audiology. As accessibility to reliable, cost-effective assessment of auditory processing (AP) skills is limited in South Africa (SA), this study aims to establish whether there is correlation between the FS and traditional tests of AP viz. Frequency Pattern and Dichotic Digits Test, and to establish its relevance to the SA population. DESIGN: Retrospective, within-subject, comparative design used to compare performance on the FS and the traditional tests. Data were considered in two ways: Firstly, using the traditional -2SD cut-off on some subtests of the FS compared to the same traditional tests, and secondly, by comparing the Z-scores obtained on the FS compared to Z-scores on the same traditional tests obtained by applying a double arcsine transformation. STUDY SAMPLE: Sixty-six subjects (35 males, 31 females) aged between 8.08 and 9.75 years (mean = 8.73; SD = 0.51) seen for AP assessments between 2016 and 2019. RESULTS: -2SD criteria yielded no significant association (p > 0.05). Z-score comparison suggested a statistically significant correlation (p < 0.05). CONCLUSION: A statistically significant correlation between certain subtests of FS with traditional tests of AP to merit its use in the SA population is suggested.

Children with amblyaudia show less flexibility in auditory cortical entrainment to periodic non-speech sounds.

OBJECTIVE: We investigated auditory temporal processing in children with amblyaudia (AMB), a subtype of auditory processing disorder (APD), via cortical neural entrainment. DESIGN AND STUDY SAMPLES: Evoked responses were recorded to click-trains at slow vs. fast (8.5 vs. 14.9/s) rates in n = 14 children with AMB and n = 11 age-matched controls. Source and time-frequency analyses (TFA) decomposed EEGs into oscillations (reflecting neural entrainment) stemming from bilateral auditory cortex. RESULTS: Phase-locking strength in AMB depended critically on the speed of auditory stimuli. In contrast to age-matched peers, AMB responses were largely insensitive to rate manipulations. This rate resistance occurred regardless of the ear of presentation and in both cortical hemispheres. CONCLUSIONS: Children with AMB show less rate-related changes in auditory cortical entrainment. In addition to reduced capacity to integrate information between the ears, we identify more rigid tagging of external auditory stimuli. Our neurophysiological findings may account for domain-general temporal processing deficits commonly observed in AMB and related APDs behaviourally. More broadly, our findings may inform communication strategies and future rehabilitation programmes; increasing the rate of stimuli above a normal (slow) speech rate is likely to make stimulus processing more challenging for individuals with AMB/APD.

Right ventral stream damage underlies both poststroke aprosodia and amusia.

BACKGROUND AND PURPOSE: This study was undertaken to determine and compare lesion patterns and structural dysconnectivity underlying poststroke aprosodia and amusia, using a data-driven multimodal neuroimaging approach. METHODS: Thirty-nine patients with right or left hemisphere stroke were enrolled in a cohort study and tested for linguistic and affective prosody perception and musical pitch and rhythm perception at subacute and 3-month poststroke stages. Participants listened to words spoken with different prosodic stress that changed their meaning, and to words spoken with six different emotions, and chose which meaning or emotion was expressed. In the music tasks, participants judged pairs of short melodies as the same or different in terms of pitch or rhythm. Structural magnetic resonance imaging data were acquired at both stages, and machine learning-based lesion-symptom mapping and deterministic tractography were used to identify lesion patterns and damaged white matter pathways giving rise to aprosodia and amusia. RESULTS: Both aprosodia and amusia were behaviorally strongly correlated and associated with similar lesion patterns in right frontoinsular and striatal areas. In multiple regression models, reduced fractional anisotropy and lower tract volume of the right inferior fronto-occipital fasciculus were the strongest predictors for both disorders, over time. CONCLUSIONS: These results highlight a common origin of aprosodia and amusia, both arising from damage and disconnection of the right ventral auditory stream integrating rhythmic-melodic acoustic information in prosody and music. Comorbidity of these disabilities may worsen the prognosis and affect rehabilitation success.

Tonal structures benefit short-term memory for real music: Evidence from non-musicians and individuals with congenital amusia.

Congenital amusia is a neurodevelopmental disorder of music processing, which includes impaired pitch memory, associated to abnormalities in the right fronto-temporal network. Previous research has shown that tonal structures (as defined by the Western musical system) improve short-term memory performance for short tone sequences (in comparison to atonal versions) in non-musician listeners, but the tonal structures only benefited response times in amusic individuals. We here tested the potential benefit of tonal structures for short-term memory with more complex musical material. Congenital amusics and their matched non-musician controls were required to indicate whether two excerpts were the same or different. Results confirmed impaired performance of amusic individuals in this short-term memory task. However, most importantly, both groups of participants showed better memory performance for tonal material than for atonal material. These results revealed that even amusics' impaired short-term memory for pitch shows classical characteristics of short-term memory, that is the mnemonic benefit of structure in the to-be-memorized material. The findings show that amusic individuals have acquired some implicit knowledge of regularities of their culture, allowing for implicit processing of tonal structures, which benefits to memory even for complex material.

Self-perceived stress and the personality of mothers of children with central auditory processing disorders - Differences from mothers of typically developing children.

PURPOSE: To investigate the relationship between self-perceived global stress and the personality traits of mothers of children with central auditory processing disorders (APD), and make a comparison with mothers of typically developing (TD) children. DESIGN AND METHODS: A cross-sectional study using two questionnaires - the Perceived Stress Scale (PSS-10) and the Short Big Five Markers (IPIP-BFM-20) - to assess five personality dimensions: extraversion, agreeableness, conscientiousness, emotional stability, and intellect/imagination. The study material included 187 mothers, of whom 108 were mothers of children with APD. The average age of the children with APD was 10 years. RESULTS: The average level of global stress was similar in mothers of children with APD and mothers of TD children. Mothers of APD children had significantly lower scores for personality dimensions such as: emotional stability, conscientiousness, and intellect/imagination. Increased perceived stress level in mothers of children with APD was inversely correlated with extraversion, conscientiousness, and emotional stability. However, for both groups of mothers, the only significant predictor of global stress level was emotional stability. CONCLUSION: Mothers of children with APD, despite having similar global stress levels to other mothers, were different in terms of three personality dimensions, and these, especially lowered emotional stability, may play a negative role in coping with global self-perceived stress. PRACTICE IMPLICATIONS: The results of this study might be helpful in parental support interventions, including psychological therapy and counselling, and also in parental implementation interventions aimed at mothers of children with APD, especially those mothers who have high global stress and/or low emotional stability.

The Relations Between Auditory Processing Scores and Cognitive, Listening and Reading Abilities.

OBJECTIVES: To investigate associations between auditory processing abilities, cognitive abilities, listening ability, and reading ability in children. DESIGN: This was a cross-sectional study involving 155 children (105 referred for auditory processing assessment and 50 with no reported listening concerns) aged between 7 and 13 years. Each child was assessed on auditory processing tests, cognitive tests, and a reading test. Additional data on reading ability were provided by the reading score from a national test. Questionnaires about the child's listening ability were completed by a parent, a teacher, and the child. RESULTS: Structural equation models relating auditory processing abilities, cognitive abilities, listening ability, and reading ability were developed. There was evidence that listening and reading abilities were associated with cognitive abilities when adjusting for auditory processing abilities, but little evidence that listening and reading abilities were associated with auditory processing abilities when adjusting for cognitive abilities. CONCLUSIONS: It should not be assumed that auditory processing tests and cognitive tests measure separate abilities. When investigating the association between auditory processing abilities and real-world abilities, it is important to adjust for cognitive abilities. Children with listening difficulties should undergo cognitive assessments in addition to auditory processing assessments.

Separating the Causes of Listening Difficulties in Children.

Auditory processing disorder, defined here as a deficit in the way sounds are analyzed by the brain, has remained a controversial topic within audiology for decades. Some of the controversy concerns what it is called. More substantively, even its existence has been questioned. That view has likely emerged because there has not been sufficient rigor in determining when difficulty in understanding speech has been the consequence of some type of auditory processing deficit, versus when it is the consequence of a cognitive deficit or a language deficit. This article suggests that the field use the term "listening difficulty" as an umbrella term to indicate a reported deficit in recognizing sounds or understanding speech, one possible cause of which is an auditory processing disorder. Other possible causes are hearing deficits, cognitive deficits, and language deficits. This article uses a plausible, and hopefully noncontroversial, model of speech understanding that comprises auditory processing, speech processing, and language processing, all potentially affected by the degree of attention applied and the listener's memory ability. In a fresh approach to the construction of test batteries, the stages of the model are linked to tests designed to assess either all or selected parts of the processes involved. For two of the stages, a listener's performance is quantified as the additional signal to noise ratio that he or she needs to function equivalently to his or her age peers. Subtraction of the deficits revealed by each test enables the contributions of each processing stage to a listening deficit to be quantified. As a further novel contribution, the impact of memory and attention on each test score is quantitatively allowed for, by an amount that depends on each test's dependence on memory and attention. Attention displayed during the test is estimated from the fluctuations in performance during the test. The article concludes with a summary of the research that must be conducted before the structured tests can be used to quantify the extent to which different potential causes of listening difficulties are responsible for real-life difficulties in an individual child.

Auditory processing disorder in children: the value of a multidisciplinary assessment.

PURPOSE: Auditory processing disorder (APD) may affect 0.2-5% of the paediatric population. The diagnosis of APD remains difficult because of polymorphic symptoms possibly entangled with other difficulties. The purpose of this study was to evaluate a new multi-disciplinary assessment in the French language. METHODS: The battery of tests was composed of: (a) APD targeted speech assessment: speech perception in noise, a dichotic test, temporal processing tests (patterns); (b) Psychometric assessment: sustained auditory attention, sustained visual attention, evaluation of cognitive functions; (c) phonemic identification and discrimination; (d) ENT examination, tonal and vocal audiometry and ABR recordings. The diagnosis was made if two of the targeted speech tests were 2 standard deviations (SDs) below the mean or if only one of the tests was 3 SDs below. The auditory attention tests, as well as the phonemic identification and discrimination tests were complementary to the diagnostic battery. However, they did not allow for the diagnosis of APD. RESULTS: 50 children suspected of APD benefited from this protocol, and 12 were excluded from the study. A diagnosis of APD was confirmed in 17 children (45%). 59% of the patients had associated disorders. The most effective tests for diagnosing APD were dichotic testing (p = 0.001) and pattern recognition (frequency, p = 0.001). The sustained auditory attention test (p = 0.01) and the phonemic identification and discrimination test reinforced the diagnosis of APD. CONCLUSION: It seems important to evaluate children suspected of APD with a multi-disciplinary protocol. It makes it possible to diagnose APD children, but also to identify attentional difficulties and cognitive disorders that may be associated.

[Development of Auditory Processing and Perception Skills with and without APD in Primary School Age]. / Entwicklung auditiver Verarbeitungs- und Wahrnehmungsleistungen mit und ohne AVWS im Grundschulalter.

BACKGROUND: We examined two student age groups (1st and 4th class) in a control-group comparison whether the maturation processes of the central hearing system in typically developing children are also present in children with Central Auditory Processing Disorders (CAPD) at primary-school age. MATERIALS AND METHODS: The analyses included results of a behavioral test battery from 82 first graders (40 with CAPD; 42 healthy controls) and 65 fourth graders (35 with CAPD; 30 healthy controls). An ANOVA with the total value of the following 7 standardized examinations, and subsequently a MANOVA with the detailed test results were carried out: Speech (words) in Noise Recognition (Göttinger Sprachaudiometrie II); Dichotic Word Pair Understanding (Uttenweiler-Test); Heidelberger Phoneme Discrimination Subtests: Phoneme Discrimination, Phoneme Identification, Phoneme Analysis; the Subtest Auditory Sequential Memory for Digits of the Illinois Test of Psycholinguistic Abilities (German version); Mottier's Nonword Repetition Test. RESULTS: The ANOVA showed significant main effects of "class" (1st versus 4th; p < 0.001, η²â€Š= 0.418) and "group" (CAPD versus healthy controls; p < 0.001; η²â€Š= 0.690), but no interaction effects between both. The result of the MANOVA was similar. Main effects, but only for two tests (phoneme identification; phoneme analysis) as well as the interaction of "class" and "group" were statistically significant, with statistically small effect sizes of 3 and 6 %. DISCUSSION: Based on this cross-sectional study, the difference between the two study groups appears to be independent of the school class level. CONCLUSION: At primary-school age, there is evidence of maturation of the central hearing system for both children with CAPD and healthy children.

[Auditory processing in children and adolescents with cleft palate]. / Auditive Verarbeitung und Wahrnehmung bei Kindern und Jugendlichen mit Gaumenspalte.

BACKGROUND: Patients with cleft palate often suffer from recurrent otitis media chronica with effusion during infancy. The consecutive binaural conductive hearing loss is seen as a risk factor for developing auditory processing disease. Since there are just a few studies examining auditory processing in this population this study aimed to investigate on an own patient cohort with different cleft manifestations in terms of auditory processing disorders in context to given studies. MATERIAL AND METHODS: This study included 48 patients (5-16 years): all patients had a non-syndromic cleft palate and normal peripheral hearing at the time of examination. The protocol included otoscopy, pure tone audiogram, speech intelligibility in noise, dichotic speech discrimination, auditory short-term memory and a parental questionnaire. RESULTS: The majority of the parents did not indicate problems in the parental questionnaire. 69 % of the participants showed conspicuous results in the speech intelligibility in noise, whereas the dichotic speech discrimination and the auditory short-term memory were suspicious in 16.7 % only. The results in both tests proved mainly a problem in younger children. Noticeable results in speech intelligibility in noise were found in all age groups. CONCLUSION: Children and adolescents with cleft palate are at risk to develop auditory processing disorders. In this study population speech intelligibility in noise was the most common problem. 90 % of the children had received a speech therapy which could have already compensated problems concerning dichotic speech discrimination and the auditory short-term memory but not problems in speech intelligibility in noise.

Emotion processing in congenital amusia: the deficits do not generalize to written emotion words.

Congenital amusia is a lifelong impairment in musical ability. Individuals with amusia are found to show reduced sensitivity to emotion recognition in speech prosody and silent facial expressions, implying a possible cross-modal emotion-processing deficit. However, it is not clear whether the observed deficits are primarily confined to socio-emotional contexts, where visual cues (facial expression) often co-occur with auditory cues (emotion prosody) to express intended emotions, or extend to linguistic emotion processing. In order to better understand the underlying deficiency mechanism of emotion processing in individuals with amusia, we examined whether reduced sensitivity to emotional processing extends to the recognition of emotion category and valence of written words in individuals with amusia. Twenty Cantonese speakers with amusia and 17 controls were tested in three experiments: (1) emotion prosody rating, in which participants rated how much each spoken sentence was expressed in each of the four emotions on 7-point rating scales; (2) written word emotion recognition, in which participants recognized the emotion of written emotion words; and (3) written word valence judgment, in which participants judged the valence of written words. Results showed that participants with amusia preformed significantly less accurately than controls in emotion prosody recognition; in contrast, the two groups showed no significant difference in accuracy rates in both written word tasks (emotion recognition and valence judgment). The results indicate that the impairment of individuals with amusia in emotion processing may not generalize to linguistic emotion processing in written words, implying that the emotion deficit is likely to be restricted to socio-emotional contexts in individuals with amusia.