Impact of reading and writing skills on academic achievement among school-aged hearing-impaired children.

OBJECTIVES: Reading and writing skills are important for hearing-impaired children since these skills help them to develop their language skills, but the prevalence of reading/writing difficulties and its effects on language development aspects among them are unclear. In this study, we identified language development features and demographic factors of Japanese hearing-impaired children diagnosed as having reading/writing difficulties. METHODS: We analyzed data from a total of 546 sever-to-profound pre-school and elementary school hearing-impaired children for this study. Children with reading/writing difficulties (Group A) were defined as children obtaining low scores (-1.5 SD compared to others in the same grade) in the Screening Test of Reading and Writing for Japanese Primary School Children (STRAW), and we compared other language development features (communication ability, vocabulary, syntax and academic achievement) and demographic factors to those of hearing-impaired children with normal reading and writing skills (Group B). We assessed language development domains as outcomes using the Assessment of Language Development for Japanese Children (ALADJIN) package, and analyzed the results stratified by age groups (5-6, 7-8, 9-10, and 11-12 years) using multiple regression analyses. RESULTS: The prevalence of reading/writing difficulties was 20.1% among the participants. Almost all point estimates in each language development domain showed better odds ratios (OR) except Criterion Referenced Test -II (CRT-II) mathematics in 11- to 12-year-olds in fully-adjusted models. Among 9- to 10-year-olds, the ORs (95% confidence interval) for fair academic achievement measured by CRT-II were 2.60 (1.09-6.20) for Japanese and 3.02 (1.29-7.11) for mathematics in Group B, even after adjusting for possible confounding factors. CONCLUSIONS: Reading and writing are important for language development of hearing-impaired children, especially for academic achievement during the middle phase of elementary school. Screening for reading/writing difficulties is important for appropriate intervention and to prevent language and academic delays among hearing-impaired children.

Theory of mind and language development in Japanese children with hearing loss.

OBJECTIVE: This study investigates the development of theory of mind (ToM) in Japanese children with hearing loss (HL) and its relationship with language abilities using the data of a large sample size. METHODS: Participants were 369 children with HL, ranging from 4 to 12 years of age. The mean hearing level of the better ear was 100.7 dB. A "change in location"-type false belief task similar to the "Sally-Anne test" was given to the participants. RESULTS: The pass rates for the false belief task were in the 20% range for 4 to 6-year-olds, 35.6% for 7-year-olds, 47.6% for 8-year-olds, and 63.6% for 9-year-olds. However, no children, even 12-year-olds, achieved a pass rate of 70%. A logistic regression analysis showed that the significant independent predictors of the false belief task performance were vocabulary age and syntactic comprehension level, and chronological age, hearing level, syntactic production level, and nonverbal intelligence were excluded. CONCLUSION: The results demonstrate that there is a delay in the development of ToM in Japanese children with HL. This finding is consistent with findings in English-speaking countries. Additionally, it is suggested that language abilities play an important role in the acquisition of ToM for children with HL.

Impact of early intervention on comprehensive language and academic achievement in Japanese hearing-impaired children with cochlear implants.

OBJECTIVES: Early hearing detection and intervention (EHDI) is critical for achievement of age-appropriate speech perception and language development in hearing-impaired children. It has been 15 years since newborn hearing screening (NHS) was introduced in Japan, and its effectiveness for language development in hearing-impaired children has been extensively studied. Moreover, after over 20 years of cochlear implantation in Japan, many of the prelingual cochlear implant (CI) users have reached school age, and the effect of CI on language development have also been assessed. To identify prognostic factors for language development, audiological/language test scores and demographic factors were compared among prelingual severe-to-profound hearing-impaired children with CI divided into subgroups according to age at first hearing aid (HA) use and whether they received NHS. METHODS: Prelingual severe-to-profound deafened children from the Research on Sensory and Communicative Disorders (RSCD) project who met the inclusion criteria were divided into groups according to the age (in months) of HA commencement (before 6 months: group A, after 7 months: group B), and the presence or absence of NHS (groups C and D). Language development and socio-economic data were obtained from audiological/language tests and a questionnaire completed by caregivers, respectively. RESULTS: In total, 210 children from the RSCD project participated in this study. Group A (n=49) showed significantly higher scores on comprehensive vocabulary and academic achievement (p<0.05) than group B (n=161), with no difference in demographics except for significantly older age in group B. No differences in language scores were observed between group C (n=71) and group D (n=129), although participants of group D was significantly older and had used CIs longer (p<0.05). CONCLUSIONS: Early use of HAs until the CI operation may result in better language perception and academic achievement among CI users with prelingual deafness. A long-term follow-up is required to assess the usefulness of NHS for language development.

Assessment package for language development in Japanese hearing-impaired children (ALADJIN) as a test battery for the development of practical communication.

OBJECTIVES: The measurement of language development in hearing-impaired children is an important step in assessing the appropriateness of an intervention. We proposed a set of language tests (the Assessment Package for Language Development in Japanese Hearing-Impaired Children [ALADJIN]) to evaluate the development of practical communication skills. This package consisted of communication skills (TQAID), comprehensive (PVT-R and SCTAW) and productive vocabulary (WFT), comprehensive and productive syntax (STA), and the STRAW. METHODS: A total of 638 children with greater than 70-dB hearing impairment were subjected to this set of language tests. Additional tests, including the PARS, the RCPM, and parental questionnaires, were administered to assess the backgrounds of the children. RESULTS: A trimodal distribution was observed among hearing-impaired children by the histogram-based analysis of each test. CONCLUSIONS: The ALADJIN is a useful Japanese-language evaluation kit for hearing-impaired children.

Language ability in the intermediate-scoring group of hearing-impaired children.

OBJECTIVES: Language development is a key issue in hearing-impaired children. However, interpersonal differences complicate our understanding of the situation. The bimodal or trimodal distribution of language scores in our other reports in this publication imply the presence of fundamental differences among these groups. The characteristic aspects of each group were profiled according to language data. METHODS: We divided 268 children with prelingual severe to profound hearing impairment into 3 groups according to their trimodal distribution observed on histogram-based analysis of their responses to the Test of Question-Answer Interaction Development. Test results in several language domains, including productive and comprehensive vocabulary, productive and comprehensive syntax, and academic achievement, were profiled and compared among these 3 groups. RESULTS: Significant differences were observed in the results of the Word Fluency Test, the Picture Vocabulary Test-Revised, and the Syntax Test of Aphasia among the 3 groups. No significant difference was observed between groups who were lower-scoring and intermediate-scoring on the academic achievement tests referred to as Criterion Referenced Test-II and the Standardized Comprehension Test for Abstract Words. Only the higher-scoring group showed excellent results. The demographic factors were not significantly different among the 3 groups. CONCLUSIONS: Relatively poor academic achievement despite fair language production was the dominant feature of the intermediate-scoring group. This profile might correlate with academic failure in school.

Language development, interpersonal communication, and academic achievement among Japanese children as assessed by the ALADJIN.

OBJECTIVES: Japanese-speaking children in a standard sample were subjected to a test battery (ALADJIN: Assessment Package for Language Development in Japanese Hearing-Impaired Children) to evaluate the effect of language development on both interpersonal communication skills and academic achievement. METHODS: A total of 414 preschool and school-age children without hearing impairment were included in this study. The following tests make up the ALADJIN: the Test of Question-Answer Interaction Development (TQAID), the Japanese Language by Criterion Referenced Test-II (CRT-II) for measuring academic achievement, the Picture Vocabulary Test-Revised (PVT-R), the Standardized Comprehension Test of Abstract Words (SCTAW), both parts of the Syntactic Processing Test for Aphasia (STA), and the Word Fluency Test (WFT). Means and standard deviations at each academic grade level were calculated, and a multiple regression analysis was performed. RESULTS: A ceiling effect was observed for the TQAID and the STA in children in grade 3 of elementary school, and the scores for the PVT-R, SCTAW, and WFT increased incrementally according to grade level. Multiple regression analysis revealed that the PVT-R, WFT, and STA (production) have predictive power for the results of the TQAID (R = 0.59; R2 = 0.58; p <0.0001), whereas the SCTAW and STA (comprehension) have predictive power for the results of the CRT-II. CONCLUSIONS: Both vocabulary and syntax are important in communication development among children. The results of our multiple regression analysis suggest that different language domains may play different roles in the development of interpersonal communication skills and in academic achievement. The development of interpersonal communication skills is largely based on productive vocabulary and syntax abilities, whereas academic achievement is largely based on comprehensive vocabulary and syntax abilities. Children who have difficulties in either area should be evaluated with detailed language assessment tools such as the ALADJIN in an effort to aid in the selection of appropriate intervention.

Syntactic development in Japanese hearing-impaired children.

OBJECTIVES: This study examined syntactic development of auditory comprehension of sentences in Japanese-speaking school-age children with and without hearing impairment. METHODS: In total, 592 preschool and school-age children (421 normal-hearing and 171 hearing-impaired) were included in this cross-sectional observation study conducted using the Syntactic Processing Test for Aphasia for Japanese language users. Linear regression analysis was used to determine the estimated age at which each syntactic structure was acquired. RESULTS: Acquisition of syntactic structures was observed in hearing-impaired and normal-hearing children. Basic word order sentences of agent-object-verb and the goal benefactive construction were acquired at preschool age (earlier group), whereas reverse word order sentences of object-agent-verb, source benefactive construction, passive voice, and relative clauses were acquired at school age (later group). The results showed that many hearing-impaired children may not acquire Japanese grammatical structures until the age of 12 years. CONCLUSIONS: Adequate screening for language development for school-age hearing-impaired children is required for an effective intervention.