Cochlear implants: the effects of age on outcomes.

INTRODUCTION: Cochlear implants (CIs) provide access to sound for children and adults who do not receive adequate benefit from hearing aids. Age at implantation is known to affect outcomes across the lifespan. AREAS COVERED: The effects of age on CI outcomes are examined for infants, children, adolescents, and older adults. A variety of outcome measures are considered, including speech perception, language, cognition, and quality of life measures. EXPERT OPINION/COMMENTARY: For those meeting candidacy criteria, CIs are beneficial at any age. In general, younger age is related to greater benefit when considering pre-lingual deafness. Other factors such as additional disabilities, may mitigate this effect. Post-lingually deafened adults demonstrate similar benefit regardless of age, though the oldest individuals (80+) may see smaller degrees of improvement from preoperative scores. Benefit can be measured in many ways, and the areas of greatest benefit may vary based on age: young children appear to see the greatest effects of age at implantation on language measures, whereas scores on cognitive measures appear to be most impacted for the oldest population. Future research should consider implantation at extreme ages (5-9 months or > 90 years), unconventional measures of CI benefit including qualitative assessments, and longitudinal designs.

Satisfaction with life in a sample of prelingually deaf cochlear implant users with a good command of spoken Polish as the primary language.

INTRODUCTION: This study investigated the level of satisfaction with life (SWL) in a group of cochlear implant (CI) users who had been prelingually deaf but were orally educated. They had received one or two CIs (as a child, adolescent, or adult) and were highly competent Polish speakers. This study looked at three factors that may affect SWL - psychosocial, deafness/hearing and communication related, and sociodemographic. METHODS: The participants were prelingually deaf CI users who had learned highly competent spoken Polish as their primary language. They had been educated in mainstream or integrated schools (not schools for the deaf), and had no other disability or severe illness. Measurements were done with 5 questionnaires: the Satisfaction With Life Scale (SWLS), the I-Others Questionnaire, the Patient Health Questionnaire (PHQ-9), the Deaf Identity Development Scale (DIDS), and the Nijmegen Cochlear Implant Questionnaire (NCIQ). RESULTS: The SWL level of the group was similar to that of the standard Polish population. SWL was positively related to positive self-perception, acceptance of oneself as a deaf person, and to perceiving the benefits of having a CI (as measured by three NCIQ domains: self-esteem, activity limitations, and social interactions). On the other hand, negative self-perception, marginal deaf identity, and depressive symptoms were negatively related to SWL. There was no relationship between SWL and knowledge of sign language. Lower depressive symptoms and greater hearing loss were both significant predictors of SWL, although those who used two CIs generally had a lower SWL. CONCLUSIONS: Prelingually deaf CI users with low SWL require psychological support in many spheres, including working through problems of deaf identity, self-acceptance, and depression. Additional research should involve diverse DHH CI users, including those with limited spoken Polish competency or sign language skills, as well as members of the Polish Deaf community.

Hearing and Cognition in Childhood. / Hören und Kognition im Kindesalter.

The human brain shows extensive development of the cerebral cortex after birth. This is extensively altered by the absence of auditory input: the development of cortical synapses in the auditory system is delayed and their degradation is increased. Recent work shows that the synapses responsible for corticocortical processing of stimuli and their embedding into multisensory interactions and cognition are particularly affected. Since the brain is heavily reciprocally interconnected, inborn deafness manifests not only in deficits in auditory processing, but also in cognitive (non-auditory) functions that are affected differently between individuals. It requires individualized approaches in therapy of deafness in childhood.

Deaf and hard-of-hearing children and adolescents' mental health, Quality of Life and communication.

Mental health problems and lower Quality of Life (QoL) are more common in deaf and hard-of-hearing - (D)HH - children than in typically hearing (TH) children. Communication has been repeatedly linked to both mental health and QoL. The aims of this study were to compare mental health and QoL between signing deaf and hard-of-hearing (DHH), hard-of-hearing (HH) and TH children and to study associations between mental health/QoL and severity of hearing loss and communication. 106 children and adolescents (mean age 11;8; SD = 3.42), 59 of them DHH and 47 HH, and their parents reported child mental health and QoL outcomes. Parents also provided information about their children's communication, hearing loss and education while their children's cognitive ability was assessed. Although (D)HH and their parents rated their mental health similar to their TH peers, about twice as many (D)HH children rated themselves in the clinical range. However, (D)HH children rated their QoL as similar to their TH peers, while their parents rated it significantly lower. Associations between communicative competence, parent-reported mental health and QoL were found, whereas severity of hearing loss based on parent-report had no significant association with either mental health or QoL. These results are in line with other studies and emphasise the need to follow up on (D)HH children's mental health, QoL and communication.

Verbal and visual serial-order memory in deaf signers and hearing nonsigners: A systematic review and meta-analysis.

Previous research suggests Deaf signers may have different short-term and working memory processes compared with hearing nonsigners due to prolonged auditory deprivation. The direction and magnitude of these reported differences, however, are variable and dependent on memory modality (e.g., visual, verbal), stimulus type, and research design. These discrepancies have made consensus difficult to reach which, in turn, slows progress in areas such as education, medical decision-making, and cognitive sciences. The present systematic review and meta-analysis included 35 studies (N = 1,701 participants) that examined verbal (n = 15), visuospatial (n = 10), or both verbal and visuospatial (n = 10) serial-memory tasks comparing nonimplanted, Deaf signers to hearing nonsigners across the life span. Multivariate meta-analyses indicated a significant, negative effect of deafness on verbal short-term memory (forward recall), g = -1.33, SE = 0.17, p < .001, 95% CI [-1.68, -0.98], and working memory (backward recall), g = -0.66, SE = 0.11, p < .001, 95% CI [-0.89, -0.45], but no significant effect of deafness on visuospatial short-term memory, g = -0.055, SE = 0.17, p = 0.75, 95% CI [-0.39, 0.28]. Visuospatial working memory was not analyzed due to limited power. Population estimates for verbal and visuospatial short-term memory were moderated by age wherein studies with adults demonstrated a stronger hearing advantage than studies with children/adolescents. Quality estimates indicated most studies were of fair quality, with only 38% of studies involving Deaf authors. Findings are discussed in the context of both Deaf equity and models of serial memory.

Cognitive pragmatics: Insights from homesign conversations.

Homesign is a visual-gestural form of communication that emerges between deaf individuals and their hearing interlocutors in the absence of a conventional sign language. I argue here that homesign conversations form a perfect testcase to study the extent to which pragmatic competence is foundational rather than derived from our linguistic abilities.

Working with Persons Involved in the Legal System Who Are Deaf.

Between 2006 and 2016, the team at Whiting Forensic Hospital saw seven defendants who were deaf or hard of hearing for restoration to competence to stand trial. As a result of this experience, the team developed expertise in understanding Deaf Culture, the effects of hearing loss on psychological development and evaluation and treatment techniques for this population. Based on the team's experiences, we discuss best practices to ensure that deaf defendants have the same access as hearing persons to fair treatment by the legal system and to the education and treatment required for restoration.

Development of visual sustained selective attention and response inhibition in deaf children.

Studies of deaf and hard-of-hearing (henceforth, deaf) children tend to make comparisons with typically hearing children for the purpose of either identifying deficits to be remediated or understanding the impact of auditory deprivation on visual or domain general processing. Here, we eschew these clinical and theoretical aims, seeking instead to understand factors that explain variability in cognitive function within deaf children. A total of 108 bilingual deaf children ages 7-13 years who use both English and American Sign Language (ASL) participated in a longitudinal study of executive function (EF) development. We report longitudinal data from a visual continuous performance task that measured sustained selective attention and response inhibition. Results show that the impact of deafness on these processes is negligible, but that language skills have a positive relationship with both: better English abilities were associated with better selective sustained attention, and better ASL abilities with better response inhibition. The relationship between sustained selective attention and English abilities may reflect the cognitive demands of spoken language acquisition for deaf children, whereas better ASL abilities may promote an "inner voice," associated with improved response inhibition. The current study cannot conclusively demonstrate causality or directionality of effects. However, these data highlight the importance of studies that focus on atypical individuals, for whom the relationships between language and cognition may be different from those observed in typically developing populations.

Health-related quality of life among mothers of children with cochlear implants with and without developmental disabilities.

BACKGROUND: Cochlear implants (CIs) are widely used among children with severe to profound hearing loss. Raising a child with a CI presents unique challenges to the family, especially when the child has a developmental disability (CI-DD). AIMS: This study aimed to elucidate the relations between the functioning of children with CIs, their mothers' coping resources (i.e., social support and family-centered care), and maternal health-related quality of life (HRQoL). Also, it examined whether the presence of a DD in addition to the child's deafness moderated these relations. METHODS AND PROCEDURES: A sample of 100 mothers of children with CIs (54 in the CI-DD group) completed questionnaires regarding perceived social support, family-centered care, and HRQoL. OUTCOMES AND RESULTS: Mothers of deaf children with CIs and DD experienced lower levels of family functioning and HRQoL across all dimensions compared to mothers of deaf children with CIs without DD. In addition, social support was positively related to HRQoL only among mothers of children in the CI-DD group, indicating the protective role of social support. CONCLUSIONS AND IMPLICATIONS: Social support is an important coping resource, and psychosocial support is needed for mothers of children with CIs, especially for mothers whose children also have a DD.

Third-party disability in cochlear implant users.

OBJECTIVE: To date, auditory rehabilitation mainly focuses on the person with hearing impairment (PHI). This study aimed to analyse the burden of hearing loss on significant others (SOs), and to explore the impact of contextual and mediating psychosocial co-factors and auditory rehabilitation by cochlear implantation (CI). DESIGN AND STUDY SAMPLE: Third-party disability (SOS-HEAR) and quality of life (Nijmegen Cochlear Implant Questionnaire) were evaluated in 41 PHI scheduled for CI surgery and their close partners pre- and 6-month post-implantation. Further, age, hearing status, educational level, depressive symptoms (GDS-15), coping strategies (Brief-COPE), resilience (RS-13), stress (PSQ) of SOs and PHI were studied. RESULTS: Hearing loss imposes a burden on SOs, particularly in relation to changes in communication and socialisation. Third-party disability was higher in SOs of PHI with lower educational background (p = 0.04) and of advanced age (p = 0.008). Hearing status of SOs negatively correlated with SOS-HEAR (p = 0.04). After CI, quality of life of PHI and third-party disability of SOs improved (p < 0.001), except in relationship changes. SOs with higher pre-operative burden also experienced more third-party disability afterwards (p ≤ 0.003). CONCLUSION: Audiological rehabilitation should expand to include SOs in the rehabilitation process, as the burden experienced by SOs might persist even after CI.

Vygotskian Resonances With the African Worldview of Ubuntu for Decolonial Deaf Education.

The African worldview of Ubuntu predates Vygotskian theory, but the Ubuntu view that the community defines the person aligns uncannily with Vygotsky's biosocial proposition and contemporary conceptions of deaf ontology and epistemology. Unlike prevailing Euro-American thought, Ubuntu accentuates the view that it is not any physical or psychological characteristic of the individual that defines personhood. Instead, Ubuntu aphorisms, the containers of meaning in African epistemology, indicate that the reality of the communal world is at least equal if not superior to individual life histories. The author teases out similarities between Vygotskian thought and Ubuntu, illustrating deaf children's development along a different axis, facilitated by a holistic, diversified biosocial process in which neither their deafness nor disability indicates inferiority or coloniality. Grounded on the African principle No language is complete without other languages, the present article contributes to a nascent indigenous theorization of contemporary deaf education.

Parents' Perspectives on the Outcome of Cochlear Implantation for the Deaf Child and the Family in Saudi Arabia.

The researchers investigated parents' perspectives on the outcome of cochlear implantation on the deaf child and the family in Saudi Arabia with respect to linguistic, social, psychological, and educational aspects. They also explored potential factors influencing parents' perspectives on the outcome of a cochlear implant (CI). Seventy-seven parents completed the questionnaire, and multiple linear regression and descriptive statistics were used to answer the research questions. Most of the parents (88.5%) reported choosing a CI for their deaf child because they wanted their child to be part of the hearing world. About half of the parents (49.4%) expressed the belief that the CI would help their child find a better job in the future. The study also found that, overall, the model was not significant, and the independent variables explained little of the variance in parents' perspectives on the outcome of their child's cochlear implantation.

Virtual Assessment of Deaf and Hard of Hearing Students in the Schools.

The COVID-19 pandemic placed stress on all aspects of the educational system. Many state departments of education acknowledged the disruption to individualized education program evaluation and implementation but insisted that evaluation timelines and services continue undisrupted. School psychologists were therefore forced to navigate the viability of virtual assessment without established research supporting this type of student evaluation. Formal assessments used in the identification of learning disabilities and other areas of disability were not standardized with virtual administration procedures; however, many test publishers have offered guidelines for online administration. These guidelines may not be suitable for test administration with deaf and hard of hearing (DHH) children. Through the presentation of two case studies, this article explores some of the available administration guidelines and evaluates their appropriateness for use with DHH children. Information in this article informs current practice of school psychology in a virtual environment.

Reflections From the Pandemic: Lessons Learned.

During the COVID-19 pandemic, many children experienced multiple challenges while transitioning from traditional to online schooling. Teachers, administrators, and parents were expected to work together to provide students an optimal educational experience through those turbulent times. This experience generated new insights into how to teach deaf and hard of hearing (DHH) students and assess their knowledge. New tools were invented and used during the pandemic, and though teachers and students are slowly returning to traditional learning environments, educators now know that alternative forms of teaching and learning exist. We acknowledge the ways teachers, administrators, and parents can innovate and bring new knowledge to the table. The present article introduces an American Annals of the Deaf Special Issue that offers further research and discussion in the event that another, comparable challenge occurs. Multiple issues must be considered in DHH education, from academic rigor to social-emotional wellness.

Chinese Grammatical Development of Deaf and Hard of Hearing Children in a Sign Bilingualism and Coenrollment Program.

The literacy development of d/Deaf and hard of hearing (d/Dhh) children has always been a matter of grave concern among educators, and grammatical knowledge is said to constitute a major component such development. The present article reports on a study that examined the development of Chinese grammar among groups of d/Dhh and hearing children who received education through a sign bilingualism and coenrollment (SLCO) approach. Findings from administration of a prestandardized assessment tool showed that while the d/Dhh children generally lagged behind their hearing peers at all levels, the gap began to narrow from Primary 2 onward, and they caught up with their hearing peers in most except for a few grammatical constructions by Primary 4. Qualitative analysis revealed a similar developmental profile and similar degrees of difficulty in mastering the more complex constructions in written Chinese between the two groups of children.

Reading Habits of Deaf and Hard of Hearing Adults.

Few studies exist on the reading habits of the deaf population, and most of those that do were published more than 20 years ago. Hence, changes in reading habits due to the availability to the deaf population of online reading material and portable electronic devices have likely occurred. Additionally, in the hearing population, confinement causes changes in reading habits. We used an online questionnaire to compare the reading habits of 102 deaf and hard of hearing adult residents of Spain both before and during COVID-19 confinement. In general, more reading occurred during confinement, although not all participants showed this pattern: Regular readers read more during lockdown. Motivations for reading were largely unaffected by confinement. Furthermore, the time spent reading was not related to the availability of books at home: More was read in digital format during confinement.

Voices of Young Deaf Adults: Supporting Adolescent Social Capital Development.

For most young people, social capital plays an important role in transitioning to postsecondary education and employment. For youth who are deaf or hard of hearing (DHH), social capital can mitigate negative effects of challenges they will likely encounter after high school. In phase 2 of a two-phase qualitative study in Australia, we investigated DHH young adults' perspectives on how DHH adolescents could best be supported to develop and use social capital to benefit their postschool transition. Nine university students whose primary communication mode was spoken language participated in semistructured interviews, discussing practical ways educators and families could assist DHH high school students. We close by recommending ways schools and families can facilitate social capital development of DHH adolescents in preparation for postsecondary education and employment. Importantly, this research gives voice to young DHH adults with the objective of improving DHH adolescents' outcomes.

Investigating the Writing Achievement of Deaf Learners.

This study investigated writing achievement in a Canadian cohort of school-aged deaf learners (N = 64). In the current context, in which most students are educated in inclusive settings and use hearing technologies, the goal was to establish whether outcomes approach those of hearing-age peers and identify demographic factors (e.g., gender, grade, additional disability, home language, hearing loss, hearing technology, auditory perception) influencing performance. Results indicated that a high percentage of participants performed in the average range or higher on a standardized, norm-referenced assessment, the Test of Written Language-Fourth Edition (TOWL-4, Hammill & Larsen, 2009). Grade, type of hearing loss, higher auditory perception scores, and absence of an additional disability were identified as variables of significance. As auditory access continues to improve, additional investigations of writing achievement in this population will be essential to further inform educational policy and pedagogical practice.

Explicating the Relationship Between ASL and English in Text Comprehension.

The discussion on the role of American Sign Language (ASL) in deaf students' reading development has been long and contentious. The students' limited knowledge of English has been commonly perceived as a culprit in making reading difficult. However, a more nuanced explanation of reading performance and its relationship with competence in ASL's potential role is needed. In the present study, multivariate analyses of the variance in the ASL and English comprehension performance of 91 middle school students at an ASL-English bilingual school revealed some important insights. Inference-making skills in ASL are an important predictor. For the students with hearing parents, the quality of communicative access at home contributed significantly to the overall explanation of the variance in English passage comprehension; along with the age at exposure to ASL, it accounted for a large part of the variance in the ASL passage comprehension.