Temperament in Toddlers With and Without Prelingual Hearing Loss.

PURPOSE: The purpose of this study is to examine parent-reported ratings of temperament in toddlers with and without prelingual hearing loss. METHOD: The parent-completed Early Childhood Behavior Questionnaire (ECBQ) was used to assess temperament in toddlers aged 18-36 months. Three dimensions of temperament were examined: surgency, negative affectivity, and effortful control. Analyses were conducted to (a) examine differences in temperament across toddlers with and without prelingual hearing loss; (b) examine possible associations between temperament, demographic, and communication factors; and (c) determine if the ECBQ is sensitive to differences in hearing, communication, and listening skills among toddlers with prelingual hearing loss. RESULTS: The parent-completed ECBQ revealed that toddlers with prelingual hearing loss differed from their hearing peers on some but not all dimensions of temperament. Specifically, children with prelingual hearing loss were rated as displaying higher levels of surgency and lower levels of effortful control but comparable levels of negative affectivity when compared to their hearing peers. Regression analyses revealed that chronological age and communication strategy predicted scores of effortful control in toddlers with prelingual hearing loss, whereas chronological age alone predicted scores of effortful control in toddlers with hearing. Finally, the ECBQ appears to contain "listening" items that skew (lower) levels of effortful control in toddlers with prelingual hearing loss, such that only the group effect of higher levels of surgency remained after removing these "listening" items. Correlations between the original and our modified ECBQ (removing the "listening" items) revealed strong associations, reflective of high construct validity. CONCLUSIONS: This was the first study to measure temperament in toddlers with prelingual hearing loss using the ECBQ. Our results revealed differences between children with and without prelingual hearing loss centering on the dimension of surgency. Examining differences in temperament during the toddler period of development may be particularly important and useful for predicting functional outcomes following prelingual hearing loss.

The effect of sentence length on question comprehension in children with cochlear implants.

OBJECTIVES: The present study investigated the comprehension of subject and object who and which questions in children with cochlear implants (CI). METHODS: Growth Curve Analysis (GCA) was used to compare eye gaze fixations and gaze patterns to the appropriate subject or object nouns within a four-picture array between 16 children with CI and 31 children with typical hearing (aged 7;0-12;0) on wh-questions with and without added adjectives to increase length. Offline accuracy was also compared. RESULTS: Findings indicated children with typical hearing exhibited more fixations to the target noun across all conditions, supporting higher comprehension accuracy. Both groups of children demonstrated more fixations to the target noun in object questions and questions without added length. Patterns of eye movement were significantly different between groups, suggesting different patterns of eye gaze across the array before fixation on the target noun. Children with CI exhibited fewer fixations, slower speed to fixation, and differences in gaze patterns that may imply the presence of processing limitations. Error analyses also suggested that children with CI frequently fixated on a picture similar to the target noun. CONCLUSIONS: Results indicate children with CI comprehend questions more slowly than their hearing peers, which may be related to limitations in working memory.

Interactive Effects of Temperament and Family-Related Environmental Confusion on Spoken Language in Children Who Are Deaf and Hard of Hearing.

PURPOSE: The aim of this study was to examine the influence of caregivers' reports of family-related environmental confusion-which refers to the level of overstimulation in the family home environment due to auditory and nonauditory (i.e., visual and cognitive) noise-on the relation between child temperament and spoken language outcomes in children who are deaf and hard of hearing (DHH) in comparison to age-matched children with typical hearing (TH). METHOD: Two groups of families with children between 3 and 7 years of age (TH = 59, DHH = 58) were sequentially recruited from a larger longitudinal study on developmental outcomes in children who are DHH. Caregivers (all TH) completed questionnaires measuring three dimensions of child temperament (i.e., effortful control, negative affectivity, and surgency-extraversion) and family-related environmental confusion. A norm-referenced language measure was administered to children. Testing took place within the families' homes. RESULTS: For children who are DHH, effortful control was positively related to spoken language outcomes, but only when levels of family-related environmental confusion were low to moderate. Family-related environmental confusion did not interact with temperament to influence spoken language in children with TH. CONCLUSIONS: Homes with low-to-moderate levels of environmental confusion provide an environment that supports DHH children with better effortful control to harness their self-regulatory skills to achieve better spoken language comprehension than those with lower levels of effortful control. These findings suggest that efforts to minimize chaos and auditory noise in the home create an environment in which DHH children can utilize their self-regulatory skills to achieve optimal spoken language outcomes.

A Framework for Understanding the Relation Between Spoken Language Input and Outcomes for Children with Cochlear Implants.

Spoken language outcomes after cochlear implantation are highly variable. Some variance can be attributed to individual characteristics. Research with typically hearing children suggests that the amount of language directed to children may also play a role. However, several moderating factors may complicate the association between language input and language outcomes in children with cochlear implants. In this article, I present a conceptual framework that posits that the association between total language input directed to children and language outcomes is moderated by factors that influence what is accessible, attended to, and coordinated with the child. The framework also posits that children with cochlear implants exhibit more variability on those moderating factors, which explains why the relation between language input and language outcomes may be more complex even if language input is more important for successful language outcomes in this population.

Home Auditory Environments of Children With Cochlear Implants and Children With Normal Hearing.

OBJECTIVES: Early home auditory environment plays an important role in children's spoken language development and overall well-being. This study explored differences in the home auditory environment experienced by children with cochlear implants (CIs) relative to children with normal hearing (NH). DESIGN: Measures of the child's home auditory environment, including adult word count (AWC), conversational turns (CTs), child vocalizations (CVs), television and media (TVN), overlapping sound (OLN), and noise (NON), were gathered using the Language Environment Analysis System. The study included 16 children with CIs (M = 22.06 mo) and 25 children with NH (M = 18.71 mo). Families contributed 1 to 3 daylong recordings quarterly over the course of approximately 1 year. Additional parent and infant characteristics including maternal education, amount of residual hearing, and age at activation were also collected. RESULTS: The results showed that whereas CTs and CVs increased with child age for children with NH, they did not change as a function of age for children with CIs; NON was significantly higher for the NH group. No significant group differences were found for the measures of AWC, TVN, or OLN. Moreover, measures of CTs, CVs, TVN, and NON from children with CIs were associated with demographic and child factors, including maternal education, age at CI activation, and amount of residual hearing. CONCLUSIONS: These findings suggest that there are similarities and differences in the home auditory environment experienced by children with CIs and children with NH. These findings have implications for early intervention programs to promote spoken language development for children with CIs.

Parent-Child Joint Behaviors in Novel Object Play Create High-Quality Data for Word Learning.

This research takes a dyadic approach to study early word learning and focuses on toddlers' (N = 20, age: 17-23 months) information seeking and parents' information providing behaviors and the ways the two are coupled in real-time parent-child interactions. Using head-mounted eye tracking, this study provides the first detailed comparison of children's and their parents' behavioral and attentional patterns in two free-play contexts: one with novel objects with to-be-learned names (Learning condition) and the other with familiar objects with known names (Play condition). Children and parents in the Learning condition modified their individual and joint behaviors when encountering novel objects with to-be-learned names, which created clearer signals that reduced referential ambiguity and potentially facilitated word learning.

Using head-mounted eye-trackers to study sensory-motor dynamics of coordinated attention.

In this chapter, we introduce recent research using head-mounted eye-trackers to record sensory-motor behaviors at a high resolution and examine parent-child interactions at a micro-level. We focus on one important research topic in early social and cognitive development: how young children and their parents coordinate their visual attention in social interactions. We start by introducing head-mounted eye-tracking and recent studies conducted using this method. We then present two sets of novel analysis techniques that examine how manual actions of parents and children with and without hearing loss contribute to their attention coordination. In the first set of analyses, we investigated different pathways parents and children used to coordinate their visual attention in toy play. After that, we used Sankey diagrams to represent the temporal dynamics of parents' and children's manual actions prior to and during coordinated attention. These two sets of analyses allowed us to explore how participants' sensory-motor behaviors contribute to the establishment and maintenance of coordinated attention. More generally, head-mounted eye-tracking allows us to ask new questions and conduct new analyses that were not previously possible. With this new sensing technology, the results here highlight the importance of understanding early social interaction from a multimodal, embodied view.

A meta-analysis of the predictability of LENA™ automated measures for child language development.

Early language environment plays a critical role in child language development. The Language ENvironment Analysis (LENA™) system allows researchers and clinicians to collect daylong recordings and obtain automated measures to characterize a child's language environment. This meta-analysis evaluates the predictability of LENA's automated measures for language skills in young children. We systematically searched reports for associations between LENA's automated measures, specifically, adult word count (AWC), conversational turn count (CTC), and child vocalization count (CVC), and language skills in children younger than 48 months. Using robust variance estimation, we calculated weighted mean effect sizes and conducted moderator analyses exploring the factors that might affect this relationship. The results revealed an overall medium effect size for the correlation between LENA's automated measures and language skills. This relationship was largely consistent regardless of child developmental status, publication status, language assessment modality and method, or the age at which the LENA recording was taken; however, the effect was weakly moderated by the gap between LENA recordings and language measures taken. Among the three measures, there were medium associations between CTC and CVC and language, whereas there was a small-to-medium association between AWC and language. These findings extend beyond validation work conducted by the LENA Research Foundation and suggest certain predictive strength of LENA's automated measures for child language. We discussed possible mechanisms underlying the observed associations, as well as the theoretical, methodological, and clinical implications of these findings.

Lexical Repetition Properties of Caregiver Speech and Language Development in Children With Cochlear Implants.

Purpose Early language input plays an important role in child language and cognitive development (e.g., Gilkerson et al., 2018; Hart & Risley, 1995). In this study, we examined the effects of child's hearing status on lexical repetition properties of speech produced by their caregivers with normal hearing (NH). In addition, we investigated the relationship between maternal lexical repetition properties and later language skills in English-learning infants with cochlear implants (CIs). Method In a free-play session, 17 mothers and their prelingually deaf infants who received CIs before 2 years of age (CI group) were recorded at two post-CI intervals: 3 and 6 months postactivation; 18 hearing experience-matched infants with NH and their mothers and 14 chronological age-matched infants with NH group and their mothers were matched to the CI group. Maternal speech was transcribed from the recordings, and measures of maternal lexical repetition were obtained. Standardized language assessments were administered on children with CIs approximately two years after CI activation. Results The findings indicated that measures of lexical repetition were similar among the three groups of mothers, regardless of the hearing status of their infants. In addition, lexical repetition measures were correlated with later language skills in infants with CIs. Conclusions Infants with CIs receive the language input that contains similar lexical repetition properties as that in the speech received by their peers with NH, which is likely to play an important role in child speech processing and language development. These findings provide the knowledge for professionals to coach parents to implement specific language intervention strategies to support language development in infants with hearing loss. Supplemental Material https://doi.org/10.23641/asha.11936322.

What leads to coordinated attention in parent-toddler interactions? Children's hearing status matters.

Coordinated attention between children and their parents plays an important role in their social, language, and cognitive development. The current study used head-mounted eye-trackers to investigate the effects of children's prelingual hearing loss on how they achieve coordinated attention with their hearing parents during free-flowing object play. We found that toddlers with hearing loss (age: 24-37 months) had similar overall gaze patterns (e.g., gaze length and proportion of face looking) as their normal-hearing peers. In addition, children's hearing status did not affect how likely parents and children attended to the same object at the same time during play. However, when following parents' attention, children with hearing loss used both parents' gaze directions and hand actions as cues, whereas children with normal hearing mainly relied on parents' hand actions. The diversity of pathways leading to coordinated attention suggests the flexibility and robustness of developing systems in using multiple pathways to achieve the same functional end.

Effects of children's hearing loss on the synchrony between parents' object naming and children's attention.

Children's attentional state during parent-child interactions is important for word learning. The current study examines the real-time attentional patterns of toddlers with and without hearing loss (N = 15, age range: 12-37 months) in parent-child interactions. High-density gaze data recorded from head-mounted eye-trackers were used to investigate the synchrony between parents' naming of novel objects and children's sustained attention on the named objects in joint play. Results show that the sheer quantities of parents' naming and children's sustained attention episodes were comparable in children with hearing loss and their peers with normal hearing. However, parents' naming and children's sustained attention episodes were less synchronized in the hearing loss group compared to children with normal hearing. Possible implications are discussed.

Novel word learning at 21 months predicts receptive vocabulary outcomes in later childhood.

Several aspects of early language skills, including parent-report measures of vocabulary, phoneme discrimination, speech segmentation, and speed of lexical access predict later childhood language outcomes. To date, no studies have examined the long-term predictive validity of novel word learning. We examined whether individual differences in novel word learning at 21 months predict later childhood receptive vocabulary outcomes rather than generalized cognitive abilities. Twenty-eight 21-month-olds were taught novel words using a modified version of the Intermodal Preferential Looking Paradigm. Seventeen children (range 7-10 years) returned to participate in a longitudinal follow-up. Novel word learning in infancy uniquely accounted for 22% of the variance in childhood receptive vocabulary but did not predict later childhood visuospatial ability or non-verbal IQ. These results suggest that the ability to associate novel sound patterns to novel objects, an index of the process of word learning, may be especially important for long-term language mastery.

Statistical distributions of consonant variants in infant-directed speech: evidence that /t/ may be exceptional.

Statistical distributions of phonetic variants in spoken language influence speech perception for both language learners and mature users. We theorized that patterns of phonetic variant processing of consonants demonstrated by adults might stem in part from patterns of early exposure to statistics of phonetic variants in infant-directed (ID) speech. In particular, we hypothesized that ID speech might involve greater proportions of canonical /t/ pronunciations compared to adult-directed (AD) speech in at least some phonological contexts. This possibility was tested using a corpus of spontaneous speech of mothers speaking to other adults, or to their typically-developing infant. Tokens of word-final alveolar stops - including /t/, /d/, and the nasal stop /n/ - were examined in assimilable contexts (i.e., those followed by a word-initial labial and/or velar); these were classified as canonical, assimilated, deleted, or glottalized. Results confirmed that there were significantly more canonical pronunciations in assimilable contexts in ID compared with AD speech, an effect which was driven by the phoneme /t/. These findings suggest that at least in phonological contexts involving possible assimilation, children are exposed to more canonical /t/ variant pronunciations than adults are. This raises the possibility that perceptual processing of canonical /t/ may be partly attributable to exposure to canonical /t/ variants in ID speech. Results support the need for further research into how statistics of variant pronunciations in early language input may shape speech processing across the lifespan.

Parental Linguistic Input and Its Relation to Toddlers' Visual Attention in Joint Object Play: A Comparison Between Children with Normal Hearing and Children With Hearing Loss.

Parent-child interactions are multimodal, often involving coordinated exchanges of visual and auditory information between the two partners. The current work focuses on the effect of children's hearing loss on parent-child interactions when parents and their toddlers jointly played with a set of toy objects. We compared the linguistic input received by toddlers with hearing loss (HL) and their chronological age-matched (CA) and hearing age-matched (HA) normal-hearing peers. Moreover, we used head-mounted eye trackers to examine how different parental linguistic input affected children's visual attention on objects when parents either led or followed children's attention during joint object play. Overall, parents of children with HL provided comparable amount of linguistic input as parents of the two normal-hearing groups. However, the types of linguistic input produced by parents of children with HL were similar to the CA group in some ways and similar to the HA group in other ways. Interestingly, the effects of different types of linguistic input on extending the attention of children with HL qualitatively resembled the patterns seen in the CA group, even though the effects were less pronounced in the HL group. We discuss the implications of these results for our understanding of the reciprocal, dynamic, and multi-factored nature of parent-child interactions.

How does aging affect recognition of spectrally degraded speech?

OBJECTIVES/HYPOTHESIS: Cochlear implants (CIs) restore auditory sensation to patients with moderate-to-profound sensorineural hearing loss. However, the benefits to speech recognition vary considerably among patients. Advancing age contributes to this variability in postlingual adult CI users. Similarly, older individuals with normal hearing (NH) perform more poorly on tasks of recognition of spectrally degraded speech. The overarching hypothesis of this study was that the detrimental effects of advancing age on speech recognition can be attributed both to declines in auditory spectral resolution as well as declines in cognitive functions. STUDY DESIGN: Case-control study. METHODS: Speech recognition was assessed in CI users (in the clear) and NH controls (spectrally degraded using noise-vocoding), along with auditory spectral resolution using the Spectral-Temporally Modulated Ripple Test. Cognitive skills were assessed using nonauditory visual measures of working memory, inhibitory control, speed of lexical/phonological access, nonverbal reasoning, and perceptual closure. Linear regression models were tested for mediation to explain aging effects on speech recognition performance. RESULTS: For both groups, older age predicted poorer sentence and word recognition. The detrimental effects of advancing age on speech recognition were partially mediated by declines in spectral resolution and in some measures of cognitive function. CONCLUSIONS: Advancing age contributes to poorer recognition of degraded speech for CI users and NH controls through declines in both auditory spectral resolution and cognitive functions. Findings suggest that improvements in spectral resolution as well as cognitive improvements may serve as therapeutic targets to optimize CI speech recognition outcomes. LEVEL OF EVIDENCE: 3b Laryngoscope, 2018.

Preference for Infant-Directed Speech in Infants With Hearing Aids: Effects of Early Auditory Experience.

Purpose: It is well established that (a) infants prefer listening to infant-directed speech (IDS) over adult-directed speech (ADS), and (b) IDS facilitates speech, language, and cognitive development, compared with ADS. The main purpose of this study was to determine whether infants with hearing aids (HAs), similar to their peers with normal hearing (NH), show a listening preference for IDS over ADS. Method: A total of 42 infants participated in the study. In Experiment 1, 9 infants with hearing loss, who had approximately 12 months of experience (mean chronological age of 17.57 months) with HAs, and 9 infants with NH, who had similar chronological age (17.54 months), were tested. In Experiment 2, 10 infants with hearing loss, who had approximately 4 months of experience (mean chronological age of 9.86 months) with HAs, and 14 infants with NH, who had similar chronological age (9.09 months), were tested. Infants were tested on their listening preference in 3 randomized blocks: IDS versus silence, ADS versus silence, and IDS versus ADS blocks, using the central fixation preference procedure. Results: Experiment 1 showed that infants with HAs, similar to their peers with NH, listened longer to both IDS and ADS relative to silence; however, neither infants with HAs nor infants with NH showed a listening preference for IDS over ADS. In Experiment 2, both infants with HAs and infants with NH showed a listening preference for IDS and ADS relative to silence; in addition, both groups preferred listening to IDS over ADS. Conclusions: Infants with HAs appear to have sufficient access to the acoustic cues in the speech that allow them to develop an age-equivalent IDS preference. This may be attributed to a combination of being able to use the hearing they do have before receiving HAs and early device fitting. Given previously demonstrated positive associations between IDS preference and language development, this research encourages early interventions focusing on maximizing early auditory experience in infants with hearing loss. Supplemental Material: https://doi.org/10.23641/asha.6906365.

Attention to speech and spoken language development in deaf children with cochlear implants: a 10-year longitudinal study.

Early auditory/language experience plays an important role in language development. In this study, we examined the effects of severe-to-profound hearing loss and subsequent cochlear implantation on the development of attention to speech in children with cochlear implants (CIs). In addition, we investigated the extent to which attention to speech may predict spoken language development in children with CIs. We tested children with CIs and compared them to chronologically age-matched peers with normal hearing (NH) on their attention to speech at four time points post implantation; specifically, less than 1 month, 3 to 6 months, 12 months, and 18 months post implantation. We also collected a variety of well-established speech perception and spoken language measures from the children with CIs in a 10-year longitudinal study. Children with CIs showed reduced attention to speech as compared to their peers with NH at less than 1 month post implantation, but a similar degree of attention to speech as their NH peers during later time points. In addition, attention to speech at 3 to 6 months post implantation predicts speech perception in children with CIs. These results inform language acquisition theories and bring insights into our understanding of early severe-to-profound hearing loss on infants' attention to speech skills. In addition, the findings have significant clinical implications for early intervention on hearing loss, which emphasizes the importance of developing strong listening skills. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=f7xiYo3Ua08&feature=youtu.be.

Verbal working memory and inhibition-concentration in adults with cochlear implants.

Objectives: Neurocognitive functions contribute to speech recognition in postlingual adults with cochlear implants (CIs). In particular, better verbal working memory (WM) on modality-specific (auditory) WM tasks predicts better speech recognition. It remains unclear, however, whether this association can be attributed to basic underlying modality-general neurocognitive functions, or whether it is solely a result of the degraded nature of auditory signals delivered by the CI. Three hypotheses were tested: 1) Both modality-specific and modality-general tasks of verbal WM would predict scores of sentence recognition in speech-shaped noise; 2) Basic modality-general neurocognitive functions of controlled fluency and inhibition-concentration would predict both modality-specific and modality-general verbal WM; and 3) Scores on both tasks of verbal WM would mediate the effects of more basic neurocognitive functions on sentence recognition. Study Design: Cross-sectional study of 30 postlingual adults with CIs and thirty age-matched normal-hearing (NH) controls. Materials and Methods: Participants were tested for sentence recognition in speech-shaped noise, along with verbal WM using a modality-general task (Reading Span) and an auditory modality-specific task (Listening Span). Participants were also assessed for controlled fluency and inhibition-concentration abilities. Results: For CI users only, Listening Span scores predicted sentence recognition, and Listening Span scores mediated the effects of inhibition-concentration on speech recognition. Scores on Reading Span were not related to sentence recognition for either group. Conclusion: Inhibition-concentration skills play an important role in CI users' sentence recognition skills, with effects mediated by modality-specific verbal WM. Further studies will examine inhibition-concentration and WM skills as novel targets for clinical intervention. Level of Evidence: 4.

Infant-Directed Speech Enhances Attention to Speech in Deaf Infants With Cochlear Implants.

Purpose: Both theoretical models of infant language acquisition and empirical studies posit important roles for attention to speech in early language development. However, deaf infants with cochlear implants (CIs) show reduced attention to speech as compared with their peers with normal hearing (NH; Horn, Davis, Pisoni, & Miyamoto, 2005; Houston, Pisoni, Kirk, Ying, & Miyamoto, 2003), which may affect their acquisition of spoken language. The main purpose of this study was to determine (a) whether infant-directed speech (IDS) enhances attention to speech in infants with CIs, as compared with adult-directed speech (ADS), and (b) whether the degree to which infants with CIs pay attention to IDS is associated with later language outcomes. Method: We tested 46 infants-12 prelingually deaf infants who received CIs before 24 months of age and had 12 months of hearing experience (CI group), 22 hearing experience-matched infants with NH (NH-HEM group), and 12 chronological age-matched infants with NH (NH-CAM group)-on their listening preference in 3 randomized blocks: IDS versus silence, ADS versus silence, and IDS versus ADS. We administered the Preschool Language Scale-Fourth Edition (PLS-4; Zimmerman, Steiner, & Pond, 2002) approximately 18 months after implantation to assess receptive and expressive language skills of infants with CIs. Results: In the IDS versus silence block, all 3 groups looked significantly longer to IDS than to silence. In the ADS versus silence block, both the NH-HEM and NH-CAM groups looked significantly longer to ADS relative to silence; however, the CI group did not show any preference. In the IDS versus ADS block, whereas both the CI and NH-HEM groups preferred IDS over ADS, the NH-CAM group looked equally long to IDS and ADS. IDS preference quotient among infants with CIs in the IDS versus ADS block was associated with PLS-4 Auditory Comprehension and PLS-4 Expressive Communication measures. Conclusions: Two major findings emerge: (a) IDS enhances attention to speech in deaf infants with CIs; (b) the degree of IDS preference over ADS relates to language development in infants with CIs. These results support a focus on input in developing intervention strategies to mitigate the effects of hearing loss on language development in infants with hearing loss.