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.

Emerging Relations among Cognitive Constructs and Cochlear Implant Outcomes: A Systematic Review and Meta-Analysis.

OBJECTIVE: Hearing loss has a detrimental impact on cognitive function. However, there is a lack of consensus on the impact of cochlear implants on cognition. This review systematically evaluates whether cochlear implants in adult patients lead to cognitive improvements and investigates the relations of cognition with speech recognition outcomes. DATA SOURCES: A literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies evaluating cognition and cochlear implant outcomes in postlingual, adult patients from January 1996 to December 2021 were included. Of 2510 total references, 52 studies were included in qualitative analysis and 11 in meta-analyses. REVIEW METHODS: Proportions were extracted from studies of (1) the significant impacts of cochlear implantation on 6 cognitive domains and (2) associations between cognition and speech recognition outcomes. Meta-analyses were performed using random effects models on mean differences between pre- and postoperative performance on 4 cognitive assessments. RESULTS: Only half of the outcomes reported suggested cochlear implantation had a significant impact on cognition (50.8%), with the highest proportion in assessments of memory & learning and inhibition-concentration. Meta-analyses revealed significant improvements in global cognition and inhibition-concentration. Finally, 40.4% of associations between cognition and speech recognition outcomes were significant. CONCLUSION: Findings relating to cochlear implantation and cognition vary depending on the cognitive domain assessed and the study goal. Nonetheless, assessments of memory & learning, global cognition, and inhibition-concentration may represent tools to assess cognitive benefit after implantation and help explain variability in speech recognition outcomes. Enhanced selectivity in assessments of cognition is needed for clinical applicability.

The Impact of Neurocognitive Skills on Recognition of Spectrally Degraded Sentences.

BACKGROUND: Recent models theorize that neurocognitive resources are deployed differently during speech recognition depending on task demands, such as the severity of degradation of the signal or modality (auditory vs. audiovisual [AV]). This concept is particularly relevant to the adult cochlear implant (CI) population, considering the large amount of variability among CI users in their spectro-temporal processing abilities. However, disentangling the effects of individual differences in spectro-temporal processing and neurocognitive skills on speech recognition in clinical populations of adult CI users is challenging. Thus, this study investigated the relationship between neurocognitive functions and recognition of spectrally degraded speech in a group of young adult normal-hearing (NH) listeners. PURPOSE: The aim of this study was to manipulate the degree of spectral degradation and modality of speech presented to young adult NH listeners to determine whether deployment of neurocognitive skills would be affected. RESEARCH DESIGN: Correlational study design. STUDY SAMPLE: Twenty-one NH college students. DATA COLLECTION AND ANALYSIS: Participants listened to sentences in three spectral-degradation conditions: no degradation (clear sentences); moderate degradation (8-channel noise-vocoded); and high degradation (4-channel noise-vocoded). Thirty sentences were presented in an auditory-only (A-only) modality and an AV fashion. Visual assessments from The National Institute of Health Toolbox Cognitive Battery were completed to evaluate working memory, inhibition-concentration, cognitive flexibility, and processing speed. Analyses of variance compared speech recognition performance among spectral degradation condition and modality. Bivariate correlation analyses were performed among speech recognition performance and the neurocognitive skills in the various test conditions. RESULTS: Main effects on sentence recognition were found for degree of degradation (p = < 0.001) and modality (p = < 0.001). Inhibition-concentration skills moderately correlated (r = 0.45, p = 0.02) with recognition scores for sentences that were moderately degraded in the A-only condition. No correlations were found among neurocognitive scores and AV speech recognition scores. CONCLUSIONS: Inhibition-concentration skills are deployed differentially during sentence recognition, depending on the level of signal degradation. Additional studies will be required to study these relations in actual clinical populations such as adult CI users.

Can a Self-report Measure Be Used to Assess Cognitive Skills in Adults With Hearing Loss?

HYPOTHESES: Adult cochlear implant candidates would self-report their executive functioning abilities as poorer than normal-hearing peers. These executive function abilities would correlate with laboratory-based cognitive tests. Lastly, executive functioning (EF) abilities would be associated with hearing-related quality of life. BACKGROUND: Executive function refers to cognitive abilities involved in behavioral regulation during goal-directed activity. Pediatric and adult users have demonstrated delays and deficits in executive function skills compared with normal-hearing peers. This study aimed to compare self-report executive function in adult cochlear implant candidates and normal-hearing peers and to relate executive function skills to laboratory-based cognitive testing and hearing-related quality of life. METHODS: Twenty-four postlingually deaf adult cochlear implant candidates were enrolled, along with 42 normal-hearing age-matched peers. Participants completed self-reports of executive function using the Behavior Rating Inventory of Executive Function- Adult (BRIEF-A). Participants were also tested using laboratory-based cognitive measures, as well as assessment of hearing-related quality of life on the Nijmegen Cochlear Implant Questionnaire. Groups were compared on BRIEF-A scores, and relations between BRIEF-A and lab-based cognitive measures as well as Nijmegen Cochlear Implant Questionnaire scores were examined. RESULTS: Self-report executive function on the BRIEF-A was not significantly different between groups. Consistent relations of self-report executive function and nonverbal reasoning were identified. Strong relations were not found between self-report executive function and hearing-related quality of life. CONCLUSIONS: Executive function as measured by BRIEF-A demonstrates some relation with a laboratory-based metric of nonverbal reasoning, but not other cognitive measures. Hearing-impaired individuals did not report poorer EF than normal-hearing controls. EF additionally did not correlate with quality of life. Our findings provide preliminary, partial validation of the BRIEF-A instrument in the preoperative evaluation of adult cochlear implant candidates.

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.

How Does Nonverbal Reasoning Affect Sentence Recognition in Adults with Cochlear Implants and Normal-Hearing Peers?

BACKGROUND: Previous research has demonstrated an association of scores on a visual test of nonverbal reasoning, Raven's Progressive Matrices (RPM), with scores on open-set sentence recognition in quiet for adult cochlear implant (CI) users as well as for adults with normal hearing (NH) listening to noise-vocoded sentence materials. Moreover, in that study, CI users demonstrated poorer nonverbal reasoning when compared with NH peers. However, it remains unclear what underlying neurocognitive processes contributed to the association of nonverbal reasoning scores with sentence recognition, and to the poorer scores demonstrated by CI users. OBJECTIVES: Three hypotheses were tested: (1) nonverbal reasoning abilities of adult CI users and normal-hearing (NH) age-matched peers would be predicted by performance on more basic neurocognitive measures of working memory capacity, information-processing speed, inhibitory control, and concentration; (2) nonverbal reasoning would mediate the effects of more basic neurocognitive functions on sentence recognition in both groups; and (3) group differences in more basic neurocognitive functions would explain the group differences previously demonstrated in nonverbal reasoning. METHOD: Eighty-three participants (40 CI and 43 NH) underwent testing of sentence recognition using two sets of sentence materials: sentences produced by a single male talker (Harvard sentences) and high-variability sentences produced by multiple talkers (Perceptually Robust English Sentence Test Open-set, PRESTO). Participants also completed testing of nonverbal reasoning using a visual computerized RPM test, and additional neurocognitive assessments were collected using a visual Digit Span test and a Stroop Color-Word task. Multivariate regression analyses were performed to test our hypotheses while treating age as a covariate. RESULTS: In the CI group, information processing speed on the Stroop task predicted RPM performance, and RPM scores mediated the effects of information processing speed on sentence recognition abilities for both Harvard and PRESTO sentences. In contrast, for the NH group, Stroop inhibitory control predicted RPM performance, and a trend was seen towards RPM scores mediating the effects of inhibitory control on sentence recognition, but only for PRESTO sentences. Poorer RPM performance in CI users than NH controls could be partially attributed to slower information processing speed. CONCLUSIONS: Neurocognitive functions contributed differentially to nonverbal reasoning performance in CI users as compared with NH peers, and nonverbal reasoning appeared to partially mediate the effects of these different neurocognitive functions on sentence recognition in both groups, at least for PRESTO sentences. Slower information processing speed accounted for poorer nonverbal reasoning scores in CI users. Thus, it may be that prolonged auditory deprivation contributes to cognitive decline through slower information processing.

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.

Intersensory redundancy promotes infant detection of prosody in infant-directed speech.

Prosody, or the intonation contours of speech, conveys emotion and intention to the listener and provides infants with an early basis for detecting meaning in speech. Infant-directed speech (IDS) is characterized by exaggerated prosody, slower tempo, and elongated pauses, all amodal properties detectable across the face and voice. Although speech is an audiovisual event, it has been studied primarily as a unimodal auditory stream without the synchronized dynamic face of the speaker. According to the intersensory redundancy hypothesis, redundancy across the senses facilitates perceptual learning of amodal information, including prosody. We predicted that young infants who are still learning to discriminate and categorize prosodic information would detect prosodic changes better in the presence of intersensory redundancy (i.e., synchronous audiovisual speech) than in its absence (i.e., unimodal auditory or asynchronous audiovisual speech). To test this hypothesis, 72 4-month-old infants were habituated to recordings of women reciting passages in IDS with prosody conveying either approval or prohibition and then were tested with recordings of a novel passage with either a change or no change in prosody. Infants who received bimodal synchronous stimulation exhibited significant visual recovery to the novel passage with a change in prosody, but not to a novel passage with no change in prosody. Infants in the unimodal auditory and bimodal asynchronous conditions did not exhibit visual recovery in either condition. Results support the hypothesis that intersensory redundancy facilitates detection and abstraction of invariant prosody across changes in linguistic content and likely serves as an early foundation for the detection of meaning in fluent speech.

Visual habituation in deaf and hearing infants.

Early cognitive development relies on the sensory experiences that infants acquire as they explore their environment. Atypical experience in one sensory modality from birth may result in fundamental differences in general cognitive abilities. The primary aim of the current study was to compare visual habituation in infants with profound hearing loss, prior to receiving cochlear implants (CIs), and age-matched peers with typical hearing. Two complementary measures of cognitive function and attention maintenance were assessed: the length of time to habituate to a visual stimulus, and look-away rate during habituation. Findings revealed that deaf infants were slower to habituate to a visual stimulus and demonstrated a lower look-away rate than hearing infants. For deaf infants, habituation measures correlated with language outcomes on standardized assessments before cochlear implantation. These findings are consistent with prior evidence suggesting that habituation and look-away rates reflect efficiency of information processing and may suggest that deaf infants take longer to process visual stimuli relative to the hearing infants. Taken together, these findings are consistent with the hypothesis that hearing loss early in infancy influences aspects of general cognitive functioning.

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.

Nonverbal Reasoning as a Contributor to Sentence Recognition Outcomes in Adults With Cochlear Implants.

HYPOTHESIS: Significant variability in speech recognition persists among postlingually deafened adults with cochlear implants (CIs). We hypothesize that scores of nonverbal reasoning predict sentence recognition in adult CI users. BACKGROUND: Cognitive functions contribute to speech recognition outcomes in adults with hearing loss. These functions may be particularly important for CI users who must interpret highly degraded speech signals through their devices. This study used a visual measure of reasoning (the ability to solve novel problems), the Raven's Progressive Matrices (RPM), to predict sentence recognition in CI users. METHODS: Participants were 39 postlingually deafened adults with CIs and 43 age-matched normal-hearing (NH) controls. CI users were assessed for recognition of words in sentences in quiet, and NH controls listened to eight-channel vocoded versions to simulate the degraded signal delivered by a CI. A computerized visual task of the RPM, requiring participants to identify the correct missing piece in a 3×3 matrix of geometric designs, was also performed. Particular items from the RPM were examined for their associations with sentence recognition abilities, and a subset of items on the RPM was tested for the ability to predict degraded sentence recognition in the NH controls. RESULTS: The overall number of items answered correctly on the 48-item RPM significantly correlated with sentence recognition in CI users (r = 0.35-0.47) and NH controls (r = 0.36-0.57). An abbreviated 12-item version of the RPM was created and performance also correlated with sentence recognition in CI users (r = 0.40-0.48) and NH controls (r = 0.49-0.56). CONCLUSIONS: Nonverbal reasoning skills correlated with sentence recognition in both CI and NH subjects. Our findings provide further converging evidence that cognitive factors contribute to speech processing by adult CI users and can help explain variability in outcomes. Our abbreviated version of the RPM may serve as a clinically meaningful assessment for predicting sentence recognition outcomes in CI users.

Neurocognitive Factors Contributing to Cochlear Implant Candidacy.

HYPOTHESIS: Clinical adult cochlear implant (CI) candidacy evaluations rely heavily on measures of sentence recognition under the best-aided listening conditions. The hypothesis tested in this study was that nonauditory measures of neurocognitive processes would contribute to scores on preoperative sentence recognition for CI candidates, above and beyond hearing ability as assessed using pure-tone average (PTA). Support for this hypothesis would suggest that best-aided sentence recognition is not simply a measure of hearing ability; rather, neurocognitive functions contribute to performance and should be considered while counseling patients during CI candidacy evaluation about postoperative rehabilitative and outcome expectations. BACKGROUND: Neurocognitive functions, such as working memory capacity, inhibition-concentration, information processing speed, and nonverbal reasoning contribute to aided speech recognition outcomes in adults with hearing loss. This study examined the roles of these neurocognitive factors on preoperative speech recognition performance in adults evaluated for CI candidacy. METHODS: Thirty-one postlingually deafened adult CI candidates were enrolled. Participants were assessed using nonauditory measures of working memory capacity, inhibition-concentration, information processing speed, and nonverbal reasoning. Measures of sentence recognition in quiet and in multitalker babble (AzBio sentences) as well as sentences from the City University of New York in quiet were collected under best-aided conditions. RESULTS: AzBio sentence recognition scores in babble were predicted significantly by scores of working memory capacity after accounting for PTA. Similarly, the City University of New York sentence recognition scores were predicted significantly by nonverbal reasoning after accounting for PTA. CONCLUSIONS: Findings support the idea that clinical measures of sentence recognition may be affected to varying degrees by neurocognitive functions, and these functions should be considered during evaluation for CI candidacy.

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.

Relations Between Self-reported Executive Functioning and Speech Perception Skills in Adult Cochlear Implant Users.

HYPOTHESIS: As a result of their hearing loss, adults with cochlear implants (CIs) would self-report poorer executive functioning (EF) skills than normal-hearing (NH) peers, and these EF skills would be associated with performance on speech recognition tasks. BACKGROUND: EF refers to a group of high order neurocognitive skills responsible for behavioral and emotional regulation during goal-directed activity, and EF has been found to be poorer in children with CIs than their NH age-matched peers. Moreover, there is increasing evidence that neurocognitive skills, including some EF skills, contribute to the ability to recognize speech through a CI. METHODS: Thirty postlingually deafened adults with CIs and 42 age-matched NH adults were enrolled. Participants and their spouses or significant others (informants) completed well-validated self-reports or informant-reports of EF, the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A). CI users' speech recognition skills were assessed in quiet using several measures of sentence recognition. NH peers were tested for recognition of noise-vocoded versions of the same speech stimuli. RESULTS: CI users self-reported difficulty on EF tasks of shifting and task monitoring. In CI users, measures of speech recognition correlated with several self-reported EF skills. CONCLUSION: The present findings provide further evidence that neurocognitive factors, including specific EF skills, may decline in association with hearing loss, and that some of these EF skills contribute to speech processing under degraded listening conditions.

"Product" Versus "Process" Measures in Assessing Speech Recognition Outcomes in Adults With Cochlear Implants.

HYPOTHESES: 1) When controlling for age in postlingual adult cochlear implant (CI) users, information-processing functions, as assessed using "process" measures of working memory capacity, inhibitory control, information-processing speed, and fluid reasoning, will predict traditional "product" outcome measures of speech recognition. 2) Demographic/audiologic factors, particularly duration of deafness, duration of CI use, degree of residual hearing, and socioeconomic status, will impact performance on underlying information-processing functions, as assessed using process measures. BACKGROUND: Clinicians and researchers rely heavily on endpoint product measures of accuracy in speech recognition to gauge patient outcomes postoperatively. However, these measures are primarily descriptive and were not designed to assess the underlying core information-processing operations that are used during speech recognition. In contrast, process measures reflect the integrity of elementary core subprocesses that are operative during behavioral tests using complex speech signals. METHODS: Forty-two experienced adult CI users were tested using three product measures of speech recognition, along with four process measures of working memory capacity, inhibitory control, speed of lexical/phonological access, and nonverbal fluid reasoning. Demographic and audiologic factors were also assessed. RESULTS: Scores on product measures were associated with core process measures of speed of lexical/phonological access and nonverbal fluid reasoning. After controlling for participant age, demographic and audiologic factors did not correlate with process measure scores. CONCLUSION: Findings provide support for the important foundational roles of information processing operations in speech recognition outcomes of postlingually deaf patients who have received CIs.

Questionnaire-based assessment of executive functioning: Case studies.

Delays in the development of executive functioning skills are frequently observed in pediatric neuropsychology populations and can have a broad and significant impact on quality of life. As a result, assessment of executive functioning is often relevant for the development of formulations and recommendations in pediatric neuropsychology clinical work. Questionnaire-based measures of executive functioning behaviors in everyday life have unique advantages and complement traditional neuropsychological measures of executive functioning. Two case studies of children with spina bifida are presented to illustrate the clinical use of a new questionnaire measure of executive and learning-related functioning, the Learning, Executive, and Attention Functioning Scale (LEAF). The LEAF emphasizes clinical utility in assessment by incorporating four characteristics: brevity in administration, breadth of additional relevant content, efficiency of scoring and interpretation, and ease of availability for use. LEAF results were consistent with another executive functioning checklist in documenting everyday behavior problems related to working memory, planning, and organization while offering additional breadth of assessment of domains such as attention, processing speed, and novel problem-solving. These case study results demonstrate the clinical utility of questionnaire-based measurement of executive functioning in pediatric neuropsychology and provide a new measure for accomplishing this goal.

Questionnaire-based assessment of executive functioning: Psychometrics.

The psychometric properties of the Learning, Executive, and Attention Functioning (LEAF) scale were investigated in an outpatient clinical pediatric sample. As a part of clinical testing, the LEAF scale, which broadly measures neuropsychological abilities related to executive functioning and learning, was administered to parents of 118 children and adolescents referred for psychological testing at a pediatric psychology clinic; 85 teachers also completed LEAF scales to assess reliability across different raters and settings. Scores on neuropsychological tests of executive functioning and academic achievement were abstracted from charts. Psychometric analyses of the LEAF scale demonstrated satisfactory internal consistency, parent-teacher inter-rater reliability in the small to large effect size range, and test-retest reliability in the large effect size range, similar to values for other executive functioning checklists. Correlations between corresponding subscales on the LEAF and other behavior checklists were large, while most correlations with neuropsychological tests of executive functioning and achievement were significant but in the small to medium range. Results support the utility of the LEAF as a reliable and valid questionnaire-based assessment of delays and disturbances in executive functioning and learning. Applications and advantages of the LEAF and other questionnaire measures of executive functioning in clinical neuropsychology settings are discussed.

Verbal Learning and Memory After Cochlear Implantation in Postlingually Deaf Adults: Some New Findings with the CVLT-II.

OBJECTIVES: Despite the importance of verbal learning and memory in speech and language processing, this domain of cognitive functioning has been virtually ignored in clinical studies of hearing loss and cochlear implants in both adults and children. In this article, we report the results of two studies that used a newly developed visually based version of the California Verbal Learning Test-Second Edition (CVLT-II), a well-known normed neuropsychological measure of verbal learning and memory. DESIGN: The first study established the validity and feasibility of a computer-controlled visual version of the CVLT-II, which eliminates the effects of audibility of spoken stimuli, in groups of young normal-hearing and older normal-hearing (ONH) adults. A second study was then carried out using the visual CVLT-II format with a group of older postlingually deaf experienced cochlear implant (ECI) users (N = 25) and a group of ONH controls (N = 25) who were matched to ECI users for age, socioeconomic status, and nonverbal IQ. In addition to the visual CVLT-II, subjects provided data on demographics, hearing history, nonverbal IQ, reading fluency, vocabulary, and short-term memory span for visually presented digits. ECI participants were also tested for speech recognition in quiet. RESULTS: The ECI and ONH groups did not differ on most measures of verbal learning and memory obtained with the visual CVLT-II, but deficits were identified in ECI participants that were related to recency recall, the buildup of proactive interference, and retrieval-induced forgetting. Within the ECI group, nonverbal fluid IQ, reading fluency, and resistance to the buildup of proactive interference from the CVLT-II consistently predicted better speech recognition outcomes. CONCLUSIONS: Results from this study suggest that several underlying foundational neurocognitive abilities are related to core speech perception outcomes after implantation in older adults. Implications of these findings for explaining individual differences and variability and predicting speech recognition outcomes after implantation are discussed.

Psychosocial Outcomes in Long-Term Cochlear Implant Users.

OBJECTIVES: The objectives of this study were to investigate psychosocial outcomes in a sample of prelingually deaf, early-implanted children, adolescents, and young adults who are long-term cochlear implant (CI) users and to examine the extent to which language and executive functioning predict psychosocial outcomes. DESIGN: Psychosocial outcomes were measured using two well-validated, parent-completed checklists: the Behavior Assessment System for Children and the Conduct Hyperactive Attention Problem Oppositional Symptom. Neurocognitive skills were measured using gold standard, performance-based assessments of language and executive functioning. RESULTS: CI users were at greater risk for clinically significant deficits in areas related to attention, oppositional behavior, hyperactivity-impulsivity, and social-adaptive skills compared with their normal-hearing peers, although the majority of CI users scored within average ranges relative to Behavior Assessment System for Children norms. Regression analyses revealed that language, visual-spatial working memory, and inhibition-concentration skills predicted psychosocial outcomes. CONCLUSIONS: Findings suggest that underlying delays and deficits in language and executive functioning may place some CI users at a risk for difficulties in psychosocial adjustment.