Phonological discrimination and contrast detection in pupillometry.

Introduction: The perception of phonemes is guided by both low-level acoustic cues and high-level linguistic context. However, differentiating between these two types of processing can be challenging. In this study, we explore the utility of pupillometry as a tool to investigate both low- and high-level processing of phonological stimuli, with a particular focus on its ability to capture novelty detection and cognitive processing during speech perception. Methods: Pupillometric traces were recorded from a sample of 22 Danish-speaking adults, with self-reported normal hearing, while performing two phonological-contrast perception tasks: a nonword discrimination task, which included minimal-pair combinations specific to the Danish language, and a nonword detection task involving the detection of phonologically modified words within sentences. The study explored the perception of contrasts in both unprocessed speech and degraded speech input, processed with a vocoder. Results: No difference in peak pupil dilation was observed when the contrast occurred between two isolated nonwords in the nonword discrimination task. For unprocessed speech, higher peak pupil dilations were measured when phonologically modified words were detected within a sentence compared to sentences without the nonwords. For vocoded speech, higher peak pupil dilation was observed for sentence stimuli, but not for the isolated nonwords, although performance decreased similarly for both tasks. Conclusion: Our findings demonstrate the complexity of pupil dynamics in the presence of acoustic and phonological manipulation. Pupil responses seemed to reflect higher-level cognitive and lexical processing related to phonological perception rather than low-level perception of acoustic cues. However, the incorporation of multiple talkers in the stimuli, coupled with the relatively low task complexity, may have affected the pupil dilation.

Informational Masking and Listening Effort in Speech Recognition in Noise: The Role of Working Memory Capacity and Inhibitory Control in Older Adults With and Without Hearing Impairment.

PURPOSE: The study aimed to assess the relationship between (a) speech recognition in noise, mask type, working memory capacity (WMC), and inhibitory control and (b) self-rated listening effort, speech material, and mask type, in older adults with and without hearing impairment. It was of special interest to assess the relationship between WMC, inhibitory control, and speech recognition in noise when informational maskers masked target speech. METHOD: A mixed design was used. A group (N = 24) of older (Mage = 69.7 years) individuals with hearing impairment and a group of age normal-hearing adults (Mage = 59.3 years, SD = 6.5) participated in the study. The participants were presented with auditory tests in a sound-attenuated room and with cognitive tests in a quiet office. The participants were asked to rate listening effort after being presented with energetic and informational background maskers in two different speech materials used in this study (i.e., Hearing In Noise Test and Hagerman test). Linear mixed-effects models were set up to assess the effect of the two different speech materials, energetic and informational maskers, hearing ability, WMC, inhibitory control, and self-rated listening effort. RESULTS: Results showed that WMC and inhibitory control were of importance for speech recognition in noise, even when controlling for pure-tone average 4 hearing thresholds and age, when the maskers were informational. Concerning listening effort, on the other hand, the results suggest that hearing ability, but not cognitive abilities, is important for self-rated listening effort in speech recognition in noise. CONCLUSIONS: Speech-in-noise recognition is more dependent on WMC for older adults in informational maskers than in energetic maskers. Hearing ability is a stronger predictor than cognition for self-rated listening effort. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21357648.

The relationship between reasoning and language ability: comparing children with cochlear implants and children with typical hearing.

PURPOSE: Language has been suggested to play a facilitating role for analogical reasoning tasks, especially for those with high complexity. This study aims to evaluate if differences in analogical reasoning ability between children with cochlear implants (CI) and children with typical hearing (TH) might be explained by differences in language ability. METHODS: The analogical reasoning ability (verbal; non-verbal; complex non-verbal: high relational integration demand) of children with CI (N = 15, mean age = 6;7) was compared to two groups of children with TH: age and language matched (TH-A+L, N = 23, mean age = 6;5), and age matched (TH-A, N = 23, mean age = 6;5). RESULTS: Children with CI were found to perform comparable to Group TH-A+L on non-verbal reasoning tasks but significantly more poorly on a verbal analogical reasoning task. Children with CI were found to perform significantly more poorly on both the non-verbal analogical reasoning task with high relational integration demand and on the verbal analogical reasoning task compared to Group TH-A. For the non-verbal analogical reasoning task with lower relational integration demand only a tendency for a difference between group CI and Group TH-A was found. CONCLUSIONS: The results suggest that verbal strategies are influencing the performance on the non-verbal analogical reasoning tasks with a higher relational integration demand. The possible reasons for this are discussed. The verbal analogical reasoning task used in the current study partly measured lexical access. Differences between the children with CI and both groups of children with TH might therefore be explained by differences in expressive vocabulary skills.

Social communication and quality of life in children using hearing aids.

OBJECTIVES: This study compared the parent-reported structural language and social communication skills-measured with the Children's Communication Checklist-2 (CCC-2)-and health-related quality of life (HR-QOL)-measured with the Pediatric Quality of Life Inventory (PedsQL)-of children who use hearing aids (HAs) and their typical-hearing (TH) peers. DESIGN: The participants were 88 children (age range of 5; 6 to 13; 1 (years; months)) and their parents: 45 children with bilateral moderate to severe hearing loss using HAs who had no additional disabilities and 43 children with typical hearing. The groups were matched based on chronological age, gender, nonverbal IQ, and parental education level. The parents completed questionnaires related to their children's communication skills, including subdomains structural language and social communication, and HR-QOL. RESULTS: The HA group had significantly poorer overall communication skills than the TH group (r = 0.49). The children in the HA group scored significantly lower than the TH group on both structural language (r = 0.37) and social communication (r = 0.41). Half of the children in the HA group had overall communication scores that either indicated concern or required further investigation according to the instrument's manual. In terms of psychosocial functioning, which was measured as HR-QOL, the subdomain school functioning was the main driver of the difference between groups, with the HA group being at least twice as likely (OR = 2.52) as the TH group to have poor HR-QOL in the school domain. Better parent-reported social communication was associated with better parent-reported psychosocial functioning in the children using HAs-even when background variables were taken into account. CONCLUSION: The results suggest that traditional assessments and interventions targeting structural aspects of language may overlook social communication difficulties in children with HAs, even those with no additional disabilities. As school functioning stood out as the most problematic domain for children with HAs, efforts to improve the well-being of these children should focus on this area.

The Contribution of Age, Working Memory Capacity, and Inhibitory Control on Speech Recognition in Noise in Young and Older Adult Listeners.

Purpose The study aimed to investigate the relationship between speech recognition in noise, age, hearing ability, self-rated listening effort, inhibitory control (measured with the Swedish Hayling task), and working memory capacity (WMC; measured with the Reading Span test). Two different speech materials were used: the Hagerman test with low semantic context and Hearing in Noise Test sentences with high semantic context, masked with either energetic or informational maskers. Method A mixed design was used. Twenty-four young normally hearing (M age = 25.6 years) and 24 older, for their age, normally hearing individuals (M age = 60.6 years) participated in the study. Speech recognition in noise in both speech materials and self-rated effort in all four background maskers were correlated with inhibitory control and WMC. A linear mixed-effects model was set up to assess differences between the two different speech materials, the four different maskers used in the study, and if age and hearing ability affected performance in the speech materials or the various background noises. Results Results showed that high WMC was related to lower scores of self-rated listening effort for informational maskers, as well as better performance in speech recognition in noise when informational maskers were used. The linear mixed-effects model revealed differences in performance between the low-context and the high-context speech materials, and the various maskers used. Lastly, inhibitory control had some impact on performance in the low-context speech material when masked with an informational masker. Conclusion Different background noises, especially informational maskers, affect speech recognition and self-rated listening effort differently depending on age, hearing ability, and individual variation in WMC and inhibitory control.

How Do We Allocate Our Resources When Listening and Memorizing Speech in Noise? A Pupillometry Study.

OBJECTIVES: Actively following a conversation can be demanding and limited cognitive resources must be allocated to the processing of speech, retaining and encoding the perceived content, and preparing an answer. The aim of the present study was to disentangle the allocation of effort into the effort required for listening (listening effort) and the effort required for retention (memory effort) by means of pupil dilation. DESIGN: Twenty-five normal-hearing German speaking participants underwent a sentence final word identification and recall test, while pupillometry was conducted. The participants' task was to listen to a sentence in four-talker babble background noise and to repeat the final word afterward. At the end of a list of sentences, they were asked to recall as many of the final words as possible. Pupil dilation was recorded during different list lengths (three sentences versus six sentences) and varying memory load (recall versus no recall). Additionally, the effect of a noise reduction algorithm on performance, listening effort, and memory effort was evaluated. RESULTS: We analyzed pupil dilation both before each sentence (sentence baseline) as well as the dilation in response to each sentence relative to the sentence baseline (sentence dilation). The pupillometry data indicated a steeper increase of sentence baseline under recall compared to no recall, suggesting higher memory effort due to memory processing. This increase in sentence baseline was most prominent toward the end of the longer lists, that is, during the second half of six sentences. Without a recall task, sentence baseline declined over the course of the list. Noise reduction appeared to have a significant influence on effort allocation for listening, which was reflected in generally decreased sentence dilation. CONCLUSION: Our results showed that recording pupil dilation in a speech identification and recall task provides valuable insights beyond behavioral performance. It is a suitable tool to disentangle the allocation of effort to listening versus memorizing speech.

Auditory event-related potentials and mismatch negativity in children with hearing loss using hearing aids or cochlear implants - A three-year follow-up study.

OBJECTIVES: The primary aim was to examine how event-related potentials (ERPs) and mismatch negativity (MMN) change and develop over time among children with hearing loss (HL) using hearing aids (HAs) or cochlear implants (CIs). Children with normal hearing (NH) were tested as a reference group. METHODS: This three-year follow-up study included 13 children with sensorineural HL (SNHL); 7 children using bilateral HAs and 6 children using CIs; and 10 children with NH as a reference group. ERPs were recorded at baseline and after three years. At time for the original study the children were approximately 5-8 years old and at the follow-up study 8-11 years old. ERP recordings and data processing were identical in both sessions. A standard stimulus alternated with five different deviants (gap, intensity, pitch, location and duration), presented in a pseudorandom sequence, thus following the multi-feature paradigm, Optimum-1. MMN was calculated from the average ERP of each deviant minus the standard stimuli. Repeated measures ANOVA was used for the statistical analyses and the results were based on samples within a specific time interval; 80-224 ms. RESULTS: There was a statistically significant difference in the obligatory responses between the NH and HA groups at baseline, but this difference disappeared after three years in our follow-up study. The children with HA also showed a significant difference in mean ERP at baseline compared to follow-up, and significant differences between the deviants at follow-up but not at baseline. This suggests an improvement over time among the children with HAs. On the other hand, the children with CIs did not differ from the NH children at baseline, but after three years their mean ERP was significantly lower compared to both the children with HA and NH, indicating a reduced development of the central auditory system in this age span among the children with CIs. Regarding MMN, there was an interaction between the duration deviant and time for the children with HA, also indicating a possible improvement over time among the HA children. CONCLUSIONS: This three-year follow-up study shows neurophysiological differences between children with HL and children with NH. The results suggest a delay in the central auditory processing among the HA children compared to children with NH, but a possible catch-up, over time, and this potential may be worth to be utilized. Regarding the CI children, similar improvement in this age span is missing, meaning there are differences between the subgroups of children with HL, i.e. the children with HAs vs. CIs. The results highlight the importance of distinguishing between subgroups of children with HL in further research.

Computer-assisted reading intervention for children with hearing impairment using cochlear implants: Effects on auditory event-related potentials and mismatch negativity.

OBJECTIVES: The primary aim was to find out whether a computer-assisted reading intervention program with a phonic approach can affect event-related (ERPs) and mismatch negativity (MMN) in hearing impaired (HI) children using cochlear implants (CIs). METHODS: This study involved a test group of 15 HI children with CIs and a control group of 14 normal hearing (NH) children. The children were 4 years and 10 months to 8 years and 1 month old. ERPs were recorded immediately before and after 4 weeks of training with a computer-assisted reading intervention, GraphoGame. A multi-feature paradigm, Optimum-1, was used, i.e. a standard stimulus alternated with five different deviants: gap intensity, pitch, location and duration. MMN was calculated from the mean amplitude ERP of each deviant minus the standard stimulus response in a specific time interval, 80 - 224 ms. Repeated measures ANOVA was used for the statistical analysis. RESULTS: The results did not show any significant changes with the computerassisted training in the ERPs and MMNs among the HI children with CIs. The presence of both MMN and a positive mismatch response (pMMR), which might reflect an immaturity, complicates interpreting the results in this age group. Individually, there was a mix of MMNs and pMMRs among all participants, pre and post training, and the change of each deviant after intervention was not predictable. CONCLUSIONS: There are no significant changes in ERP or MMN after intervention, however lack of significances must be interpreted with caution. Besides the presence of both MMNs and pMMRs, only modest changes are to be expected on an individual basis and small samples hinder making statistical conclusions regarding the training's effects. The study contributes to some more descriptive pieces of ERPs and MMNs among the HI children with CIs. The issues of MMN and pMMR are highlighted.

The Outcome of Unilateral Cochlear Implantation in Adults: Speech Recognition, Health-Related Quality of Life and Level of Anxiety and Depression: a One- and Three-Year Follow-Up Study

Abstract Introduction Hearing impairment is a common disease worldwide, with a comprehensive impact, and cochlear implantation (CI) is an intervention for profound hearing impairment. Objective To study the outcome one and three years after unilateral CI on hearing, health-related quality of life and level of depression and anxiety, and the correlation between the outcomes. Second, to study whether age, gender, etiology, operated side, residual hearing or cognitive performance can predict the outcome. Methods A prospective longitudinal study including adults with profound postlingual hearing impairment, with respect to hearing (speech recognition), health-related quality of life (Health Utilities Index 3) and level of depression and anxiety (Hospital Anxiety and Depression scale), pre-CI, and one and three years post-CI. The total sample was composed of 40 participants (40% of men), with a mean age of 71 years. Results Speech recognition and the overall health-related quality of life improved one year post-CI (p= 0.000), without correlation (ρ= 0.27), and with no difference three years post-CI. The hearing attribute (in the health-related quality of life instrument) improved one and three years post-CI (p= 0.000). The level of anxiety did not change one and three years post-CI. The level of depression improved one year post-CI (p= 0.036), and deteriorated three years post-CI (p= 0.031). Age, etiology, operated side, residual hearing and cognitive performance did not predict the outcome, but the female gender did significantly improve speech recognition compared with men (p= 0.009). Conclusion The CI significantly improved speech recognition, health-related quality of life and level of depression one year post-CI without mutual correlation, and women performed significantly better than men. There were no further improvements three years post-CI, apart from the hearing attribute.

The Outcome of Unilateral Cochlear Implantation in Adults: Speech Recognition, Health-Related Quality of Life and Level of Anxiety and Depression: a One- and Three-Year Follow-Up Study.

Introduction Hearing impairment is a common disease worldwide, with a comprehensive impact, and cochlear implantation (CI) is an intervention for profound hearing impairment. Objective To study the outcome one and three years after unilateral CI on hearing, health-related quality of life and level of depression and anxiety, and the correlation between the outcomes. Second, to study whether age, gender, etiology, operated side, residual hearing or cognitive performance can predict the outcome. Methods A prospective longitudinal study including adults with profound postlingual hearing impairment, with respect to hearing (speech recognition), health-related quality of life (Health Utilities Index 3) and level of depression and anxiety (Hospital Anxiety and Depression scale), pre-CI, and one and three years post-CI. The total sample was composed of 40 participants (40% of men), with a mean age of 71 years. Results Speech recognition and the overall health-related quality of life improved one year post-CI ( p = 0.000), without correlation (ρ= 0.27), and with no difference three years post-CI. The hearing attribute (in the health-related quality of life instrument) improved one and three years post-CI ( p = 0.000). The level of anxiety did not change one and three years post-CI. The level of depression improved one year post-CI ( p = 0.036), and deteriorated three years post-CI ( p = 0.031). Age, etiology, operated side, residual hearing and cognitive performance did not predict the outcome, but the female gender did significantly improve speech recognition compared with men ( p = 0.009). Conclusion The CI significantly improved speech recognition, health-related quality of life and level of depression one year post-CI without mutual correlation, and women performed significantly better than men. There were no further improvements three years post-CI, apart from the hearing attribute.

Comparison of Expressive Spoken Language Skills in Children With Cochlear Implants and Children With Typical Hearing.

When children start formal education, they are expected to be able to express complex thoughts. However, in order to do so, they need to be able to use both complex grammatical structures and a variety of words. One group that is at risk of having a delay in terms of their expressive language ability is children with cochlear implants (CI). In this study, we evaluated whether children with CI perform comparably to children with typical hearing (TH) on a standard expressive spoken grammar and a standard expressive spoken vocabulary task when the groups were matched on non-verbal intelligence and working memory capacity. It was found that the children with CI in this study performed more poorly on a standard expressive spoken vocabulary task but not on a standard expressive spoken grammar task when compared to the children with TH. Differences in terms of expressive spoken vocabulary do not seem to be explained by differences in cognitive ability. In addition, the variation in terms of expressive spoken language ability was larger in the children with CI compared to the children with TH. This might be explained by additional confounding factors, like the time of language deprivation or by a greater influence of cognitive differences for the acquisition of spoken language for children with CI.

Health-Related Quality of Life With Cochlear Implants: The Children's Perspective.

OBJECTIVES: The objective of this study was to assess self-reported health-related quality of life (HR-QOL) in a group of children with cochlear implants (CIs) and to compare their scores to age- and gender-matched controls. The authors also assessed the agreement between proxy- and self-reported HR-QOL in the CI group and examined individual and environmental variables that could be associated with higher or lower self-reported HR-QOL in the CI group. DESIGN: The sample consisted of 168 children between the ages of 5;6 and 13;1 (years;months), where 84 children had CIs (CI group) and 84 were age- and gender-matched controls with normal hearing (NH group). HR-QOL was assessed with the generic questionnaire Pediatric Quality of Life Inventory. Parents of the children in the CI group completed the same questionnaire as the children. In addition, the children in the CI group completed tests of language, hearing, and nonverbal I.Q. and background variables such as age at implantation and socioeconomic status were assessed. RESULTS: On average, children with CIs rated their HR-QOL lower than peers with normal hearing on school functioning, social functioning, and overall HR-QOL. A higher percentage of children with CIs reported low levels of HR-QOL than did those in the NH group, 27% and 12%, respectively. The differences between groups were small, and fewer children than parents reported concerningly low HR-QOLs. Better spoken-language skills and older age at the time of testing was associated with better HR-QOL. CONCLUSIONS: Most children with CIs in this study reported HR-QOLs that were close to those of their age- and gender-matched normal-hearing peers. The children, however, reported concerns about social and school functioning, indicating that these areas require more attention to ensure children with CIs have good HR-QOL. Improving spoken-language skills in children with CIs may contribute to improved HR-QOL.

Predictors of Reading Comprehension in Children With Cochlear Implants.

Children with a profound hearing loss who have been implanted with cochlear implants (CI), vary in terms of their language and reading skills. Some of these children have strong language skills and are proficient readers whereas others struggle with language and both the decoding and comprehension aspects of reading. Reading comprehension is dependent on a number of skills where decoding, spoken language comprehension and receptive vocabulary have been found to be the strongest predictors of performance. Children with CI have generally been found to perform more poorly than typically hearing peers on most predictors of reading comprehension including word decoding, vocabulary and spoken language comprehension, as well as working memory. The purpose of the current study was to investigate the relationships between reading comprehension and a number of predictor variables in a sample of twenty-nine 11-12-year-old children with profound hearing loss, fitted with CI. We were particularly interested in the extent to which reading comprehension in children with CI at this age is dependent on decoding and receptive vocabulary. The predictor variables that we set out to study were word decoding, receptive vocabulary, phonological skills, and working memory. A second purpose was to explore the relationships between reading comprehension and demographic factors, i.e., parental education, speech perception and age of implantation. The results from these 29 children indicate that receptive vocabulary is the most influential predictor of reading comprehension in this group of children although phonological decoding is, of course, fundamental.

Pragmatic Language Skills: A Comparison of Children With Cochlear Implants and Children Without Hearing Loss.

Pragmatic language ability refers to the ability to use language in a social context. It has been found to be correlated with success in general education for deaf and hard of hearing children. It is therefore of great importance to study why deaf and hard of hearing children often perform more poorly than their hearing peers on tests measuring pragmatic language ability. In the current study the Pragmatics Profile questionnaire from the CELF-IV battery was used to measure pragmatic language ability in children using cochlear implants (N = 14) and children without a hearing loss (N = 34). No significant difference was found between the children with cochlear implants (CI) and the children without hearing loss (HL) for the sum score of the pragmatics language measure. However, 35.71% of the children with CI performed below age norm, while only 5.89% of the children without HL performed below age norm. In addition, when dividing the sum score into three sub-measures: Rituals and Conversational skills (RCS), Asking for, Giving, and Responding to Information (AGRI), and Nonverbal Communication skills (NCS), significant differences between the groups were found for the NCS measure and a tendency for a difference was found for the RCS measure. In addition, all three sub-measures (NCS, AGRI, RCS) were correlated to verbal fluency in the children with CI, but not the children without HL.

Visual Rhyme Judgment in Adults With Mild-to-Severe Hearing Loss.

Adults with poorer peripheral hearing have slower phonological processing speed measured using visual rhyme tasks, and it has been suggested that this is due to fading of phonological representations stored in long-term memory. Representations of both vowels and consonants are likely to be important for determining whether or not two printed words rhyme. However, it is not known whether the relation between phonological processing speed and hearing loss is specific to the lower frequency ranges which characterize vowels or higher frequency ranges that characterize consonants. We tested the visual rhyme ability of 212 adults with hearing loss. As in previous studies, we found that rhyme judgments were slower and less accurate when there was a mismatch between phonological and orthographic information. A substantial portion of the variance in the speed of making correct rhyme judgment decisions was explained by lexical access speed. Reading span, a measure of working memory, explained further variance in match but not mismatch conditions, but no additional variance was explained by auditory variables. This pattern of findings suggests possible reliance on a lexico-semantic word-matching strategy for solving the rhyme judgment task. Future work should investigate the relation between adoption of a lexico-semantic strategy during phonological processing tasks and hearing aid outcome.

Correlates of Orthographic Learning in Swedish Children With Cochlear Implants.

This study set out to explore the cognitive and linguistic correlates of orthographic learning in a group of 32 deaf and hard of hearing children with cochlear implants, to better understand the factors that affect the development of fluent reading in these children. To date, the research about the mechanisms of reading fluency and orthographic learning in this population is scarce. The children were between 6:0 and 10:11 years of age and used oral language as their primary mode of communication. They were assessed on orthographic learning, reading fluency and a range of cognitive and linguistic skills including working memory measures, word retrieval and paired associate learning. The results were analyzed in a set of correlation analyses. In line with previous findings from children with typical hearing, orthographic learning was strongly correlated with phonological decoding, receptive vocabulary, phonological skills, verbal-verbal paired-associate learning and word retrieval. The results of this study suggest that orthographic learning in children with CI is strongly dependent on similar cognitive and linguistic skills as in typically hearing peers. Efforts should thus be made to support phonological decoding skill, vocabulary, and phonological skills in this population.

Prosodic aspects of repetition in Swedish-speaking children with developmental language disorder.

Purpose: To examine repetition of stress and tonal word accents in real words and non-words in Swedish-speaking children with developmental language disorder (DLD), and to investigate the relation of prosodic repetition to measures of language ability.Method: A cross-sectional study was undertaken with 30 monolingual Swedish-speaking children with DLD, mean age 4;11 (years;months) and 29 age-matched controls, mean age 5;1, who repeated words and non-words with systematically varying prosody. Group differences for the repetition of prosodic features, and correlations between repetition and phonology, grammar, and vocabulary, were explored.Result: Children with DLD performed below controls on repetition of prosodic features of words and non-words. Repetition of stress and tonal word accent was not correlated with phonological production or receptive vocabulary, but a significant correlation was found between stress repetition in words and expressive grammar.Conclusion: Repetition of stress and tonal word accents is challenging for children with DLD acquiring Swedish as their first language, but may not be a good indicator of general language ability. Prosody should be taken into account when interpreting results from clinically used word repetition (WR) and non-word repetition (NWR) tasks.

Computer-assisted reading intervention for children with sensorineural hearing loss using hearing aids: Effects on auditory event-related potentials and mismatch negativity.

OBJECTIVES: The primary aim was to investigate whether computer-assisted reading intervention somehow can affect event-related potentials (ERP) and mismatch negativity (MMN) in hearing impaired (HI) children with hearing aids (HAs) and normal hearing (NH) children. METHODS: The study included 15 HI children with sensorineural hearing loss (SNHL) using bilateral HAs and 14 NH children as a reference group; all children between the ages of 5 and 8. A multi-feature MMN-paradigm, Optimum-1, with a standard stimulus alternating with 5 different deviants was used. ERPs were recorded pre and post intervention, i.e. one month of repeatedly computer-assisted training (GraphoGame). MMN was calculated from the average ERP of each deviant minus standard. Data were based on samples within a specific time interval, 80-224 ms, and repeated measures ANOVA was used to analyze possible interactions. RESULTS: There was a significant difference between groups before training, though, the mean obligatory responses or MMN was not statistically significantly different before versus after training, neither among the NH nor the HI children. Further, the HI children did generally achieve lower levels in GraphoGame compared to the NH children. Altogether, our findings indicate differences between the groups and that training may affect the neurophysiological processing in the brain, gaining the HI children. Both MMN and positive mismatch response (pMMR) were seen among both the HA and NH children, irrespective to deviant type. Individually, changes of the MMN and pMMR after training seem unpredictable. CONCLUSION: There are statistically significant differences in both the obligatory responses in ERP and the MMNs between the NH and HI groups before the computer-assisted training. Though, these differences disappear after the intervention. This suggests possible training effects regarding the central auditory processing among the HI children.

Orthographic Learning in Children Who Are Deaf or Hard of Hearing.

Purpose The purpose of the current study was to investigate the relationship between orthographic learning and language, reading, and cognitive skills in 9-year-old children who are deaf or hard of hearing (DHH) and to compare their performance to age-matched typically hearing (TH) controls. Method Eighteen children diagnosed with moderate-to-profound hearing loss who use hearing aids and/or cochlear implants participated. Their performance was compared with 35 age-matched controls with typical hearing. Orthographic learning was evaluated using a spelling task and a recognition task. The children were assessed on measures of reading ability, language, working memory, and paired-associate learning. Results On average, the DHH group performed more poorly than the TH controls on the spelling measure of orthographic learning, but not on the recognition measure. For both groups of children, there were significant correlations between orthographic learning and phonological decoding and between visual-verbal paired-associate learning and orthographic learning. Conclusions Although the children who are DHH had lower scores in the spelling test of orthographic learning than their TH peers, measures of their reading ability revealed that they acquired orthographic representations successfully. The results are consistent with the self-teaching hypothesis in suggesting that phonological decoding is important for orthographic learning.

Parents' Perception of Health-Related Quality of Life in Children With Cochlear Implants: The Impact of Language Skills and Hearing.

Purpose: The study compared how parents of children with cochlear implants (CIs) and parents of children with normal hearing perceive their children's health-related quality of life (HR-QOL). Method: The sample consisted of 186 Norwegian-speaking children in the age span of 5;0-12;11 (years;months): 106 children with CIs (53% boys, 47% girls) and 80 children with normal hearing (44% boys, 56% girls). No children had known additional disabilities affecting language, cognitive development, or HR-QOL. Parents completed the generic questionnaire Pediatric Quality of Life Inventory (Varni, Seid, & Kurtin, 2001), whereas children completed a test battery measuring different aspects of language and hearing. Results: Parents of children with CIs reported statistically significantly poorer HR-QOL in their children, on Pediatric Quality of Life Inventory total score and the subdomains social functioning and school functioning. Roughly 50% of parents of children with CIs reported HR-QOL levels (total score) within normal limits. No significant differences between groups emerged on the physical health and emotional functioning subscales. For the children in the group with CIs, better speech perception in everyday situations was associated with higher proxy-ratings of HR-QOL. Better spoken language skills were weakly to moderately associated with higher HR-QOL. Conclusions: The findings suggest that the social and school situation is not yet resolved satisfactorily for children with CIs. Habilitation focusing on spoken language skills and better sound environment may improve social interactions with peers and overall school functioning.