Effects of Age at Cochlear Implantation on Vocabulary and Grammar: A Review of the Evidence.

Purpose The increasing prevalence of pediatric cochlear implantation over the past 25 years has left little doubt that resulting improvements in hearing offer significant benefits to language development for many deaf children. Furthermore, given the documented importance of access to language from birth, there has been strong support for providing congenitally deaf children with implants as early as possible. Earliest implantation, in many ways, has become the "gold standard" in pediatric cochlear implantation, on the assumption that it is the key to language development similar to that of hearing children. Empirical evidence to support this assumption, however, appears more equivocal than generally is believed. This article reviews recent research aimed at assessing the impact of age at implantation on vocabulary and grammatical development among young implant users. Method Articles published between 2003 and 2018 that included age at implantation as a variable of interest and in which it was subjected to statistical analysis were considered. Effect sizes were calculated whenever possible; we conducted a multivariate meta-analysis to compare outcomes in different language domains. Results Taken together, findings from 49 studies suggest that age at implantation is just one of a host of variables that influence vocabulary and grammatical development, its impact varying with several factors including whether age at implantation is treated as a dichotomous or continuous variable. Results from a meta-analysis showed significant differences across language domains. Conclusion The pattern of results obtained indicates the importance of considering various child, family, and environmental characteristics in future research aimed at determining how early "early implantation" needs to be and the extent to which age at implantation, duration of implant use, and other factors influence language and language-related outcomes. Supplemental Material https://doi.org/10.23641/asha.9789041.

Are French Fries a Vegetable? Lexical Typicality Judgement Differences in Deaf and Hearing Learners.

Deaf and hard-of-hearing (DHH) learners are known to have vocabulary knowledge and language outcomes more heterogeneous than their hearing peers, with a greater incidence of difficulties presumably related (both as cause and effect) to documented challenges in academic domains. In particular, there is increasing evidence that differences may exist in the ways that semantic networks are structured and accessed in DHH and hearing learners. Individuals' judgments of word typicality offers a window into their semantic networks, revealing internal relationships in the mental lexicon. In the present study, 90 DHH and hearing college-aged learners provided typicality ratings at two points in time for 120 words common words considered to be central, borderline, or non-members of six categories. DHH and hearing participants differed in terms of their word knowledge, rating consistency, and rating magnitudes. Relative to hearing peers, DHH participants reported not knowing more of the words, but rated all words as being more typical than did hearing participants and rated the typicality of items more consistently over time. Implications of these findings for understanding mental lexicon structure for DHH and hearing learners, interpreting previous research, and constructing stimuli for future research are discussed.

Effects of Age at Cochlear Implantation on Learning and Cognition: A Critical Assessment.

Purpose Age at cochlear implantation frequently is assumed to be a key predictor of pediatric implantation benefits, but outcomes related to learning and cognition appear inconsistent. This critical assessment examines relevant literature in an effort to evaluate the impact of age at implantation in those domains for individuals who received their devices as children. Method We examined 44 peer-reviewed articles from 2003 to 2018 considering age at implantation and conducted statistical analyses regarding its impact on several domains, including literacy, academic achievement, memory, and theory of mind. Results Across 167 assessments in various experiments and conditions, only 21% of the analyses related to age at implantation yielded evidence in favor of earlier implantation, providing greater benefits to academic achievement, learning, or cognition compared to implantation later in childhood. Among studies that considered cognitive processing (e.g., executive function, memory, visual-spatial functioning), over twice as many analyses indicated significant benefits of earlier implantation when it was considered as a discrete rather than a continuous variable. Conclusion Findings raise methodological, practical, and theoretical questions concerning how "early" is defined in studies concerning early cochlear implantation, the impact of confounding factors, and the use of nonstandard outcome measures. The present results and convergent findings from other studies are discussed in terms of the larger range of variables that need to be considered in evaluating the benefits of cochlear implantation and question the utility of considering age at implantation as a "gold standard" with regard to evaluating long-term outcomes of the procedure as a medical treatment/intervention for hearing loss. Supplemental Material https://doi.org/10.23641/asha.8323625.

Work and Employment Characteristics of Deaf and Hard-of-Hearing Adults.

Studies have reported a higher level of unemployment among deaf and hard-of-hearing (DHH) adults compared to adults without hearing loss. However, little is known about factors explaining success in the labor market. This study presents the analysis of two data sets. The first was drawn from a survey of 804 DHH adults in Denmark. The second was a survey completed by 190 DHH adults with post-secondary qualification in the United States. In the Danish sample, among the spoken language users, higher ages, higher level of educational attainment, and no additional disabilities were associated with having a job. Among the sign language users, higher ages, higher level of educational attainment, earlier ages at hearing loss diagnosis, and not using cochlear implants were associated with having a job. In the US sample, male gender and better sign language skills were associated with having a job.

Measuring intelligibility in signed languages.

Intelligibility of spoken languages is a widely discussed construct; however, intelligibility, as it pertains to signed languages, has rarely been considered. This study provides an initial investigation of the construct of intelligibility in American Sign Language (ASL) and evaluates potential measures for self-report and expert ratings of sign intelligibility that examined the frequency of understanding, amount of understanding, and ease of understanding. Participants were 66 college students (42 Deaf, 24 hearing) who had self-rated ASL skills ranging from poor to excellent. Participants rated their own intelligibility in ASL and then provided a signed language sample through a picture description task. Language samples were reviewed by an expert rater and measures of intelligibility were completed. Results indicated that expert ratings of sign intelligibility across all measures were significantly and positively correlated. Understanding of the signer was predicted by the amount of understanding, frequency of understanding, and ASL production skills, while understanding the picture being described was predicted by ease of understanding and ASL grammar skills. Self- and expert ratings of sign intelligibility using the ASL version of the Intelligibility in Context Scale were not significantly different. Self-report of sign intelligibility for viewers of different familiarity using the ICS-ASL was found not to be feasible due to many participants not being in contact with ASL users in the relationships defined by the measure. In conclusion, this preliminary investigation suggests that sign intelligibility is a construct worthy of further investigation.

Childhood hearing loss: Impact on parents and family life.

BACKGROUND: Studies investigating the impact of having a child with hearing loss on the lives of parents and families have shown divergent results. Where some studies have reported that childhood hearing loss is associated with parental mental health problems, such as depression and stress, other studies report no impact on parental mental health and/or wellbeing. OBJECTIVE: The aim of this study was to examine the association between child-related variables-degree of hearing loss, additional disabilities, sign language abilities, cochlear implants (CI), externalizing and internalizing emotional and behavioral difficulties measured by the Strength and Difficulties Questionnaire (SDQ)-and parent-related variables-parents living together, parents' mental health, spouse activities without children, and parents' experience of the child as being a burden for the family. METHOD: Data of 257 parents of children with hearing loss from a national survey were included. RESULTS: Only 18% of the children with hearing loss did not live with both parents, a figure significantly lower than that of the general population. The child variables of degree of hearing loss, having a CI or not, and sign language ability were not significantly associated with any of the parent variables investigated. The child having a disability in addition to hearing loss was found to be significantly associated with the frequency of spouses engaging in activities without children and reports that the child was a burden for the family. Both higher externalizing and internalizing scores on the SDQ were significantly associated with parental mental health problems, frequency of spouse activities without children, and the degree to which the child's difficulties were experienced as a burden for the family. CONCLUSION: Children's hearing loss, per se, was found not to be significantly related to several key parent and family variables. However, children having additional disabilities and behavioral and emotional difficulties were significant with parent and family variables. This study thus underlines the need for further studies concerning relationships among factors related to childhood hearing loss and various family factors in order to better understand their impact on child development and family life.

Understanding Theory of Mind in Deaf and Hearing College Students.

Theory of Mind-the understanding that people have thoughts, wants, and beliefs that influence their interpersonal behavior-is an aspect of social cognition that develops with consistent, increasing complexity across age groups, languages, and cultures. Observed delays in theory of mind development among deaf children and others has led to a conversational account of theory of mind development and its delays in terms of the nature and amount of social communication experienced by children directly (conversationally) and indirectly (via overhearing). The present study explored theory of mind in deaf young adults by evaluating their understanding of sarcasm and advanced false belief (second-order false belief and double bluff), as well as related cognitive abilities. Consistent with previous studies, deaf participants scored significantly below hearing peers on all three theory of mind tasks. Performance was unrelated to their having had early access to social communication via either sign language (from deaf parents) or spoken language (through cochlear implants), suggesting that deaf participants' performance was not solely a function of access to social communication in early childhood. The finding of different predictors of theory of mind performance for deaf and hearing groups is discussed in terms of its language, social, and cognitive foundations.

Experience of Hearing Loss, Communication, Social Participation, and Psychological Well-Being Among Adolescents With Cochlear Implants.

Pediatric cochlear implantation has successfully provided many congenitally deaf children the opportunity to learn to hear and speak. However, outcomes are mostly assessed through formal audiological testing or by gathering perspectives of parents and teachers rather than the children themselves. Sixty-five children with cochlear implants (CIs) aged 11-15 years were asked about their CI use and other factors related to communication, experiences of hearing loss, social participation and friendships, and psychological well-being. The findings revealed diverse experiences; e.g., 55.4% of the children reported feeling different from others their age, while 18.5% reported trying to hide their CIs often or all the time. The findings also suggested diversity in communication needs: 41.5% reported being interested in learning more sign language. The study highlights the importance of providing tailored, flexible support for a heterogeneous population of children with varied strengths and needs.

Personality Traits, Self-Efficacy, and Cochlear Implant Use Among Deaf Young Adults.

A variety of studies have examined ways in which cognitive and social-emotional factors may be linked to and affected by hearing loss, use of cochlear implants (CIs), and sign language. A related domain that largely has been overlooked, however, is personality. This paper reports a study of personality traits and self-efficacy among deaf and hard-of-hearing (DHH; n = 223) college students, with and without CIs, as compared to hearing peers (n = 106). All participants completed (HEXACO) personality trait and self-efficacy inventories; DHH participants also completed a communication questionnaire. Hearing participants scored higher on the personality trait Conscientiousness than both DHH CI users and non-CI users, as well as higher on Openness to Experience compared to DHH CI users. Hearing participants also scored higher on self-efficacy compared to DHH non-CI users. Among DHH non-CI users, greater self-rated sign language skills were associated with higher Extraversion and Agreeableness scores. Among the DHH CI users, earlier sign language acquisition was associated with higher Openness to Experience scores, and earlier cochlear implantation was associated with greater Emotionality scores. Self-efficacy was associated with both better self-rated spoken language skills and a stronger preference for spoken language over sign language use among DHH CI users.

Communication skills of deaf and hard-of-hearing college students: Objective measures and self-assessment.

Objectively measured speech reception, speech production and expressive and receptive sign skills were compared with the self-assessment ratings of those skills in 96 college students with hearing loss. Participants with no aidable hearing used cochlear implants (CIs) or nothing. Participants with aidable hearing used either hearing aids (HAs) or nothing. Results revealed that individuals using CIs had speech reception and production skills that were as good as or better than students with more hearing who used HAs. Students using CIs or HAs had better speech reception and production skills than those without sensory aids. There was no difference in measured receptive sign skills across groups, despite differences in age of sign acquisition. Students typically provided accurate self-assessments of their communication skills with two notable exceptions: CI users overestimated their speech skills and nonusers overestimated their receptive sign skills. This study extends our knowledge regarding speech reception, production, sign skills and the ability to self-assess those skills in college students with hearing loss. Students who do not use sensory aids may be at academic risk with regard to receiving input via speech or sign.

The approximate number system and domain-general abilities as predictors of math ability in children with normal hearing and hearing loss.

Many children with hearing loss (CHL) show a delay in mathematical achievement compared to children with normal hearing (CNH). This study examined whether there are differences in acuity of the approximate number system (ANS) between CHL and CNH, and whether ANS acuity is related to math achievement. Working memory (WM), short-term memory (STM), and inhibition were considered as mediators of any relationship between ANS acuity and math achievement. Seventy-five CHL were compared with 75 age- and gender-matched CNH. ANS acuity, mathematical reasoning, WM, and STM of CHL were significantly poorer compared to CNH. Group differences in math ability were no longer significant when ANS acuity, WM, or STM was controlled. For CNH, WM and STM fully mediated the relationship of ANS acuity to math ability; for CHL, WM and STM only partially mediated this relationship. ANS acuity, WM, and STM are significant contributors to hearing status differences in math achievement, and to individual differences within the group of CHL. Statement of contribution What is already known on this subject? Children with hearing loss often perform poorly on measures of math achievement, although there have been few studies focusing on basic numerical cognition in these children. In typically developing children, the approximate number system predicts math skills concurrently and longitudinally, although there have been some contradictory findings. Recent studies suggest that domain-general skills, such as inhibition, may account for the relationship found between the approximate number system and math achievement. What does this study adds? This is the first robust examination of the approximate number system in children with hearing loss, and the findings suggest poorer acuity of the approximate number system in these children compared to hearing children. The study addresses recent issues regarding the contradictory findings of the relationship of the approximate number system to math ability by examining how this relationship varies across children with normal hearing and hearing loss, and by examining whether this relationship is mediated by domain-general skills (working memory, short-term memory, and inhibition).

Relations of Social Maturity, Executive Function, and Self-Efficacy Among Deaf University Students.

This study explored possible associations of social maturity, executive function (EF), self-efficacy, and communication variables among deaf university students, both cochlear implant (CI) users and nonusers. Previous studies have demonstrated differences between deaf and hearing children and young adults in EF and EF-related social and cognitive functioning. EF differences also have been demonstrated between hearing children and deaf children who use CIs. Long-term influences of cochlear implantation in the social domain largely have not been explored, but were examined in the present study in terms of social maturity, as it might be related to EF and communication variables. Replicating and extending recent findings, social maturity was found to be related to somewhat different aspects of EF in CI users, deaf nonusers, and hearing students, but unrelated to hearing status, CI use, or deaf students' use of sign language versus spoken language. Self-efficacy proved a predictor of self-reported socially mature and immature behaviours for all groups. Individuals' beliefs about their parents' views of such behaviours was a potent predictor of behaviours for deaf CI users and those deaf students who reported sign language as their best form of communication.

Numerical and Real-World Estimation Abilities of Deaf and Hearing College Students.

Various studies have examined possible loci of deaf learners' documented challenges with regard to reading, usually focusing on language-related factors. Deaf students also frequently struggle in mathematics and science, but fewer studies have examined possible reasons for those difficulties. The present study examined numerical and non-numerical (real-world) estimation skills among deaf and hearing college students, together with several cognitive abilities likely to underlie mathematics performance. Drawing on claims in the literature and some limited evidence from research involving deaf children, the study also considered the possibility that the use of sign language and/or the use of cochlear implants and spoken language might facilitate deaf college students' estimation skills and mathematics achievement more broadly. Results indicated relatively little impact of cochlear implant use or language modality on either estimation skills or overall mathematics ability. Predictors of those abilities differed for deaf and hearing learners. Results suggest the need to guard against overgeneralisations either within the diverse population of deaf learners or between deaf and hearing learners. They further emphasise the need for evidence-based practice in mathematics instruction appropriate for older deaf learners, rather than making assumptions from studies involving younger or narrowly-selected samples.

Language and Psychosocial Functioning among Deaf Learners with and without Cochlear Implants.

Various studies have examined psychosocial functioning and language abilities among deaf children with and without cochlear implants (CIs). Few, however, have explored how relations among those abilities might change with age and setting. Most relevant studies also have failed to consider that psychosocial functioning among both CI users and nonusers might be influenced by having language abilities in both signed and spoken language. The present investigation explored how these variables might influence each other, including the possibility that deaf individuals' psychosocial functioning might be influenced differentially by perceived and actual signed and spoken language abilities. Changes in acculturation and quality of life were examined over their first year in college, together with changes in perceived and assessed language abilities. Students with and without CIs differed significantly in some aspects of psychosocial functioning and language ability, but not entirely in the directions expected based on studies involving school-aged deaf students. Participants' cultural affiliations were related as much or more to perceived language abilities as to the reality of those abilities as indicated by formal assessments. These results emphasize the need to consider the heterogeneity of deaf learners if they are to receive the support services needed for personal and academic growth.

Achievement, Language, and Technology Use Among College-Bound Deaf Learners.

Deaf learners are a highly heterogeneous group who demonstrate varied levels of academic achievement and attainment. Most prior research involving this population has focused on factors facilitating academic success in young deaf children, with less attention paid to older learners. Recent studies, however, have suggested that while factors such as early cochlear implantation and early sign language fluency are positively associated with academic achievement in younger deaf children, they no longer predict achievement once children reach high school age. This study, involving data from 980 college-bound high school students with hearing loss, examined relations between academic achievement, communication variables (audiological, language), and use of assistive technologies (e.g., cochlear implants [CIs], FM systems) and other support services (e.g., interpreting, real-time text) in the classroom. Spoken language skills were positively related to achievement in some domains, while better sign language skills were related to poorer achievement in others. Among these college-bound students, use of CIs and academic support services in high school accounted for little variability in their college entrance examination scores.

Social Dominance Orientation, Language Orientation, and Deaf Identity.

The notion of the Deaf community as a linguistic-cultural minority has been increasingly recognized and studied over the last two decades. However, significant differences of opinion and perspective within that population typically have been neglected in the literature. Social dominance orientation (SDO), a theoretical construct, typically focusing on intergroup perceptions and relations, is one aspect that has been left unexplored and might prove particularly enlightening. The present study investigated SDO among 119 deaf and 49 hearing young adults through a standardized SDO questionnaire. SDO was examined with regard to cultural identities (deaf, hearing, bicultural, and marginal), cochlear implant use, and language orientation (sign language or spoken language). The deaf participants were found to be more egalitarian than hearing individuals overall. Deaf individuals who held the strongest deaf identities, those who were sign language oriented, and not cochlear implant users, were the most egalitarian.

Use of technological aids and interpretation services among children and adults with hearing loss.

OBJECTIVES: The technological development of communication aids for people with hearing loss has progressed rapidly over the last decades. Quality has improved and the number of different types of aids has increased. However, few studies have examined the prevalence of technology use and interpreting services use among people with hearing loss as they relate to demographic characteristics of this population. DESIGN: This study reports from national surveys of children and adults with hearing loss. Use of hearing aids, cochlear implants, other aids and interpreting services were analysed with regard to gender, age, degree of hearing loss, mode of communication, having an additional disability, level of educational achievement among adults, and whether or not children lived together with both of their parents. STUDY SAMPLE: 269 children (0-15 years of age) and 839 adults (16-65 years of age). RESULTS: Differences in technology and service use were associated with age, degree of hearing loss, and mode of communication among children and adults, and gender and level of educational achievement among adults. CONCLUSION: Individual and social factors have an impact on technological hearing aid and interpreter use. More research about individual differences and clinical implications of support services is needed.

Don't Assume Deaf Students are Visual Learners.

In the education of deaf learners, from primary school to postsecondary settings, it frequently is suggested that deaf students are visual learners. That assumption appears to be based on the visual nature of signed languages-used by some but not all deaf individuals-and the fact that with greater hearing losses, deaf students will rely relatively more on vision than audition. However, the questions of whether individuals with hearing loss are more likely to be visual learners than verbal learners or more likely than hearing peers to be visual learners have not been empirically explored. Several recent studies, in fact, have indicated that hearing learners typically perform as well or better than deaf learners on a variety of visual-spatial tasks. The present study used two standardized instruments to examine learning styles among college deaf students who primarily rely on sign language or spoken language and their hearing peers. The visual-verbal dimension was of particular interest. Consistent with recent indirect findings, results indicated that deaf students are no more likely than hearing students to be visual learners and are no stronger in their visual skills and habits than their verbal skills and habits, nor are deaf students' visual orientations associated with sign language skills. The results clearly have specific implications for the educating of deaf learners.

Simultaneous communication supports learning in noise by cochlear implant users.

OBJECTIVES: This study sought to evaluate the potential of using spoken language and signing together (simultaneous communication, SimCom, sign-supported speech) as a means of improving speech recognition, comprehension, and learning by cochlear implant (CI) users in noisy contexts. METHODS: Forty eight college students who were active CI users, watched videos of three short presentations, the text versions of which were standardized at the 8th-grade reading level. One passage was presented in spoken language only, one was presented in spoken language with multi-talker babble background noise, and one was presented via simultaneous communication with the same background noise. Following each passage, participants responded to 10 (standardized) open-ended questions designed to assess comprehension. Indicators of participants' spoken language and sign language skills were obtained via self-reports and objective assessments. RESULTS: When spoken materials were accompanied by signs, scores were significantly higher than when materials were spoken in noise without signs. Participants' receptive spoken language skills significantly predicted scores in all three conditions; neither their receptive sign skills nor age of implantation predicted performance. DISCUSSION: Students who are CI users typically rely solely on spoken language in the classroom. The present results, however, suggest that there are potential benefits of simultaneous communication for such learners in noisy settings. For those CI users who know sign language, the redundancy of speech and signs potentially can offset the reduced fidelity of spoken language in noise. CONCLUSION: Accompanying spoken language with signs can benefit learners who are CI users in noisy situations such as classroom settings. Factors associated with such benefits, such as receptive skills in signed and spoken modalities, classroom acoustics, and material difficulty need to be empirically examined.