Reliability and validity of the Dutch-language version of the Viking Speech Scale in children with cerebral palsy.

PURPOSE: The Viking Speech Scale is used to classify speech performance in children with cerebral palsy (CP). A Dutch-language version (VSS-NL) has recently become available. This study aimed to determine the reliability and validity of the VSS-NL and the association with motor type of CP, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Communication Function Classification System (CFCS). METHODS: A total of 90 children with CP, recruited throughout the Netherlands, took part in the study. VSS-NL classifications by speech and language therapists unfamiliar (SLT1) and familiar (SLT2) with the child, parents and physicians were compared. Convergent and discriminant validity were determined with the Intelligibility in Context Scale-Dutch (ICS-NL) and the Computer Based Instrument for Low Motor Language Testing (C-BiLLT). Inter- and intrarater reliability were determined by weighted Kappa (ƙw ). Validity and associations between VSS-NL and GMFCS, MACS and CFCS were determined with Spearman's coefficient. Association between VSS-NL and motor type of CP was determined with Fisher's exact test. RESULTS: Interrater reliability was excellent between SLT1-SLT2 (ƙw  = 0.93, 95% confidence interval [CI] 0.87-0.99), good between SLT1-parent (ƙw = 0.71, 95% CI 0.60-0.83), SLT1-physician (ƙw = 0.70, 95% CI 0.58-0.81), SLT2-parent (ƙw = 0.71, 95% CI 0.57-0.84), SLT2-physician (ƙw = 0.73, 95% CI 0.62-0.85) and parent-physician (ƙ = 0.72, 95% CI 0.60-0.85). Intrarater reliability was excellent for SLTs familiar and unfamiliar to the child (ƙw = 1.00, 95% CI 1.00-1.00), and very good for physicians (ƙw = 0.89, 95% CI 0.75-1.00) and parents (ƙw = 0.72, 95% CI 0.62-1.00). Convergent validity was very strong (r = -0.81, p < 0.001) and discriminant validity moderate (r = -0.56, p < 0.001). Association with motor type of CP was significant (χ2 = 27.558, p < 0.001) and strong with GMFCS (r = 0.62, p < 0.001), MACS (r = 0.63, p < 0.01) and CFCS (r = 0.69, p < 0.001). CONCLUSION: The VSS-NL is a reliable and valid system to classify speech performance in children with cerebral palsy. Classifications can be performed by SLTs, parents and physicians.

The Influence of Cognitive, Affective, and Sociocultural Individual Differences on L2 Chinese Speech Performance: A Multiple Indicators Multiple Causes Approach.

Informed by Segalowitz's (Cognitive bases of second language fluency, Routledge, 2010) L2 speech production model and MacIntyre et al.'s (Mod Lang J 82(4):545-562, 1998. https://doi.org/10.1111/j.1540-4781.1998.tb05543.x ) L2 willingness to communicate model, this study sought to understand the influence of cognitive, affective and sociocultural individual differences on advanced learners' L2 Chinese speech performance. A total of 240 advanced L2 Chinese learners in China participated in the study. The participants' perceptions of the impact of cognitive, affective, and sociocultural factors on their L2 Chinese speech performance were measured by an adapted questionnaire. A speaking test, following the Hanyu Shuiping Kouyu Kaoshi (HSKK, an international standardized L2 Chinese speaking proficiency test for non-native speakers), was employed to evaluate the participants' L2 Chinese speech performance. The results of multiple indicators multiple causes (MIMIC) analysis show that (1) cognitive factors such as cognitive fluency, expression practice strategy, and assistance strategy, (2) affective factors such as speaking self-efficacy, speaking anxiety, and speaking motivation, and (3) sociocultural factors such as attitudes toward target language class and attitudes toward target language culture jointly influence advanced L2 Chinese learners' speech performance. Results and implications of the present study are discussed for enhancing learners' L2 Chinese speech performance.

Poor Performer: A Distinct Entity in Cochlear Implant Users?

INTRODUCTION: Several factors are known to influence speech perception in cochlear implant (CI) users. To date, the underlying mechanisms have not yet been fully clarified. Although many CI users achieve a high level of speech perception, a small percentage of patients does not or only slightly benefit from the CI (poor performer, PP). In a previous study, PP showed significantly poorer results on nonauditory-based cognitive and linguistic tests than CI users with a very high level of speech understanding (star performer, SP). We now investigate if PP also differs from the CI user with an average performance (average performer, AP) in cognitive and linguistic performance. METHODS: Seventeen adult postlingually deafened CI users with speech perception scores in quiet of 55 (9.32) % (AP) on the German Freiburg monosyllabic speech test at 65 dB underwent neurocognitive (attention, working memory, short- and long-term memory, verbal fluency, inhibition) and linguistic testing (word retrieval, lexical decision, phonological input lexicon). The results were compared to the performance of 15 PP (speech perception score of 15 [11.80] %) and 19 SP (speech perception score of 80 [4.85] %). For statistical analysis, U-Test and discrimination analysis have been done. RESULTS: Significant differences between PP and AP were observed on linguistic tests, in Rapid Automatized Naming (RAN: p = 0.0026), lexical decision (LexDec: p = 0.026), phonological input lexicon (LEMO: p = 0.0085), and understanding of incomplete words (TRT: p = 0.0024). AP also had significantly better neurocognitive results than PP in the domains of attention (M3: p = 0.009) and working memory (OSPAN: p = 0.041; RST: p = 0.015) but not in delayed recall (delayed recall: p = 0.22), verbal fluency (verbal fluency: p = 0.084), and inhibition (Flanker: p = 0.35). In contrast, no differences were found hereby between AP and SP. Based on the TRT and the RAN, AP and PP could be separated in 100%. DISCUSSION: The results indicate that PP constitute a distinct entity of CI users that differs even in nonauditory abilities from CI users with an average speech perception, especially with regard to rapid word retrieval either due to reduced phonological abilities or limited storage. Further studies should investigate if improved word retrieval by increased phonological and semantic training results in better speech perception in these CI users.

Feasibility of an implanted microphone for cochlear implant listening.

This study aimed at evaluating the feasibility of an implanted microphone for cochlear implants (CI) by comparison of hearing outcomes, sound quality and patient satisfaction of a subcutaneous microphone to a standard external microphone of a behind-the-ear sound processor. In this prospective feasibility study with a within-subject repeated measures design comparing the microphone modalities, ten experienced adult unilateral CI users received an implantable contralateral subcutaneous microphone attached to a percutaneous plug. The signal was pre-processed and fed into their CI sound processor. Subjects compared listening modes at home for a period of up to 4 months. At the end of the study the microphone was explanted. Aided audiometric thresholds, speech understanding in quiet, and sound quality questionnaires were assessed. On average thresholds (250, 500, 750, 1k, 2k, 3k, 4k and 6 kHz) with the subcutaneous microphone were 44.9 dB, compared to 36.4 dB for the external mode. Speech understanding on sentences in quiet was high, within approximately 90% of performance levels compared to hearing with an external microphone. Body sounds were audible but not annoying to almost all subjects. This feasibility study with a research device shows significantly better results than previous studies with implanted microphones. This is attributed to technology enhancements and careful fitting. Listening effort was somewhat increased with an implanted microphone. Under good sound conditions, speech performance is nearly similar to that of external microphones demonstrating that an implanted microphone is feasible in a range of normal listening conditions.

Long-term outcome of cochlear implant in patients with chronic otitis media: one-stage surgery is equivalent to two-stage surgery.

This study compared long-term speech performance after cochlear implantation (CI) between surgical strategies in patients with chronic otitis media (COM). Thirty patients with available open-set sentence scores measured more than 2 yr postoperatively were included: 17 who received one-stage surgeries (One-stage group), and the other 13 underwent two-stage surgeries (Two-stage group). Preoperative inflammatory status, intraoperative procedures, postoperative outcomes were compared. Among 17 patients in One-stage group, 12 underwent CI accompanied with the eradication of inflammation; CI without eradicating inflammation was performed on 3 patients; 2 underwent CIs via the transcanal approach. Thirteen patients in Two-stage group received the complete eradication of inflammation as first-stage surgery, and CI was performed as second-stage surgery after a mean interval of 8.2 months. Additional control of inflammation was performed in 2 patients at second-stage surgery for cavity problem and cholesteatoma, respectively. There were 2 cases of electrode exposure as postoperative complication in the two-stage group; new electrode arrays were inserted and covered by local flaps. The open-set sentence scores of Two-stage group were not significantly higher than those of One-stage group at 1, 2, 3, and 5 yr postoperatively. Postoperative long-term speech performance is equivalent when either of two surgical strategies is used to treat appropriately selected candidates.

Deep Brain Stimulation Impact on Voice and Speech Quality in Parkinson's Disease: A Systematic Review.

OBJECTIVE: Deep brain stimulation (DBS) has considerable efficacy for the motor dysfunction of idiopathic Parkinson's disease (PD) on patient quality of life. However, the benefit of DBS on voice and speech quality remains controversial. We carried out a systematic review to understand the influence of DBS on parkinsonian dysphonia and dysarthria. DATA SOURCES: A PubMed/MEDLINE and Cochrane systematic review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Population, Intervention, Comparison, Outcome, Timing, and Setting (PICOTS) statements. REVIEW METHODS: Three investigators screened studies published in the literature from inception to May 2022. The following data were retrieved: age, demographic, sex, disease duration, DBS duration, DBS location, speech, and voice quality measurements. RESULTS: From the 180 studies identified, 44 publications met the inclusion criteria, accounting for 866 patients. Twenty-nine studies focused on voice/speech quality in subthalamic DBS patients, and 6 included patients with stimulation of pallidal, thalamic, and zona incerta regions. Most studies (4/6) reported a deterioration of the vocal parameters on subjective voice quality evaluation. For speech, the findings were more contrasted. There was an important heterogeneity between studies regarding the voice and speech quality outcomes used to evaluate the impact of DBS on voice/speech quality. CONCLUSION: The impact of DBS on voice and speech quality significantly varies between studies. The stimulated anatomical region may have a significant role since the stimulation of the pallidal area was mainly associated with voice quality improvement, in contrast with other regions. Future controlled studies comparing all region stimulation are needed to get reliable findings. LEVEL OF EVIDENCE: Level III: evidence from evidence summaries developed from systematic reviews.

Facial nerve stimulation in adult cochlear implant recipients with far advanced otosclerosis.

Objectives: The objective of this study was to predict occurrence of facial nerve stimulation (FNS) in cochlear implanted patients for far-advanced otosclerosis (FAO) by correlating preoperative computed tomography (CT)-scan data to FNS and to evaluate FNS impact on hearing outcomes. Methods: Retrospective analysis on 91 ears (76 patients) implanted for FAO. Electrodes were straight (50%) or perimodiolar (50%). Demographic data, extension of otosclerosis on preoperative CT scan, occurrence of FNS, and speech performance were analyzed. Results: Prevalence of FNS was 21% (19 ears). FNS appeared during the first month (21%), 1-6 months (26%), 6-12 months (21%), and over 1 year (32%) postimplantation. Cumulative incidence of FNS at 15 years was 33% (95% CI = [14-47%]). Extension of otosclerotic lesions on preimplantation CT-scan was more severe in FNS ears compared to No-FNS (p < .05): for Stage III, 13/19 (68%) and 18/72 (25%) ears for FNS and No-FNS groups, respectively (p < .05). Location of otosclerotic lesions relative to the facial nerve canal was similar whatever the presence or not of FNS. Electrode array had no impact on FNS occurrence. At 1 year post-implantation, duration of profound hearing loss (≥5 years) and previous stapedotomy were negatively associated with speech performance. FNS did not impact hearing outcomes, despite a lower percentage of activated electrodes (p < .01) in the FNS group. Nevertheless, FNS were associated with a decrease of speech performance both in quiet (p < .001) and in noise (p < .05). Conclusion: Cochlear implanted patients for FAO are at greater risk of developing FNS affecting speech performance over time, probably due to a higher percentage of deactivated electrodes. High resolution CT-scan is an essential tool allowing FNS prediction but not time of onset. Level of evidence: 2b, Laryngoscope Investigative Otolaryngology, 2022.

Impact of SNR, peripheral auditory sensitivity, and central cognitive profile on the psychometric relation between pupillary response and speech performance in CI users.

Despite substantial technical advances and wider clinical use, cochlear implant (CI) users continue to report high and elevated listening effort especially under challenging noisy conditions. Among all the objective measures to quantify listening effort, pupillometry is one of the most widely used and robust physiological measures. Previous studies with normally hearing (NH) and hearing-impaired (HI) listeners have shown that the relation between speech performance in noise and listening effort (as measured by peak pupil dilation) is not linear and exhibits an inverted-U shape. However, it is unclear whether the same psychometric relation exists in CI users, and whether individual differences in auditory sensitivity and central cognitive capacity affect this relation. Therefore, we recruited 17 post-lingually deaf CI adults to perform speech-in-noise tasks from 0 to 20 dB SNR with a 4 dB step size. Simultaneously, their pupillary responses and self-reported subjective effort were recorded. To characterize top-down and bottom-up individual variabilities, a spectro-temporal modulation task and a set of cognitive abilities were measured. Clinical word recognition in quiet and Quality of Life (QoL) were also collected. Results showed that at a group level, an inverted-U shape psychometric curve between task difficulty (SNR) and peak pupil dilation (PPD) was not observed. Individual shape of the psychometric curve was significantly associated with some individual factors: CI users with higher clinical word and speech-in-noise recognition showed a quadratic decrease of PPD over increasing SNRs; CI users with better non-verbal intelligence and lower QoL showed smaller average PPD. To summarize, individual differences in CI users had a significant impact on the psychometric relation between pupillary response and task difficulty, hence affecting the interpretation of pupillary response as listening effort (or engagement) at different task difficulty levels. Future research and clinical applications should further characterize the possible effects of individual factors (such as motivation or engagement) in modulating CI users' occurrence of 'tipping point' on their psychometric functions, and develop an individualized method for reliably quantifying listening effort using pupillometry.

Correlation between cortical auditory evoked potential and auditory speech performance in children with cochlear implants.

OBJECTIVES: This study aimed to explore the correlation between the characteristics of cortical auditory evoked potential (CAEP) of children with cochlear implants (CIs) and auditory and speech rehabilitation performance by an objective evaluation technique and subjective auditory and speech skills measurements. METHODS: All participants were recruited from Beijing Children's Hospital, Beijing, China. 19 children with CIs had their responses to the CAEP and MMN recorded. The LittlEARs® Auditory Questionnaire (LEAQ), Categories of Auditory Performance (CAP), Speech Intelligibility Rating Scale (SIR), Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), and Meaningful Use of Speech Scale (MUSS) measures were taken to assess the children's speech and hearing abilities. RESULTS: P1 and MMN of CAEP were negatively related to the duration of CI usage. The duration of CI usage and scores of auditory-verbal assessment questionnaires all showed significant relationships. Additionally, scores of these questionnaires were significantly inversely associated with the latency of P1 and MMN. CONCLUSION: P1 and MMN could be used as objective methods to evaluate the effectiveness of hearing and speech rehabilitation in children with CIs. In particular to those who cannot give effectively feedback of auditory and verbal effects, these methods might have a certain guiding significance.

Feasibility of Virtual Reality Audiological Testing: Prospective Study.

BACKGROUND: It has been noted in the literature that there is a gap between clinical assessment and real-world performance. Real-world conversations entail visual and audio information, yet there are not any audiological assessment tools that include visual information. Virtual reality (VR) technology has been applied to various areas, including audiology. However, the use of VR in speech-in-noise perception has not yet been investigated. OBJECTIVE: The purpose of this study was to investigate the impact of virtual space (VS) on speech performance and its feasibility to be used as a speech test instrument. We hypothesized that individuals' ability to recognize speech would improve when visual cues were provided. METHODS: A total of 30 individuals with normal hearing and 25 individuals with hearing loss completed pure-tone audiometry and the Korean version of the Hearing in Noise Test (K-HINT) under three conditions-conventional K-HINT (cK-HINT), VS on PC (VSPC), and VS head-mounted display (VSHMD)-at -10 dB, -5 dB, 0 dB, and +5 dB signal-to-noise ratios (SNRs). Participants listened to target speech and repeated it back to the tester for all conditions. Hearing aid users in the hearing loss group completed testing under unaided and aided conditions. A questionnaire was administered after testing to gather subjective opinions on the headset, the VSHMD condition, and test preference. RESULTS: Provision of visual information had a significant impact on speech performance between the normal hearing and hearing impaired groups. The Mann-Whitney U test showed statistical significance (P<.05) between the two groups under all test conditions. Hearing aid use led to better integration of audio and visual cues. Statistical significance through the Mann-Whitney U test was observed for -5 dB (P=.04) and 0 dB (P=.02) SNRs under the cK-HINT condition, as well as for -10 dB (P=.007) and 0 dB (P=.04) SNRs under the VSPC condition, between hearing aid and non-hearing aid users. Participants reported positive responses across almost all items on the questionnaire except for the weight of the headset. Participants preferred a test method with visual imagery, but found the headset to be heavy. CONCLUSIONS: Findings are in line with previous literature that showed that visual cues were beneficial for communication. This is the first study to include hearing aid users with a more naturalistic stimulus and a relatively simple test environment, suggesting the feasibility of VR audiological testing in clinical practice.

Mirror Mechanism Behind Visual-Auditory Interaction: Evidence From Event-Related Potentials in Children With Cochlear Implants.

The mechanism underlying visual-induced auditory interaction is still under discussion. Here, we provide evidence that the mirror mechanism underlies visual-auditory interactions. In this study, visual stimuli were divided into two major groups-mirror stimuli that were able to activate mirror neurons and non-mirror stimuli that were not able to activate mirror neurons. The two groups were further divided into six subgroups as follows: visual speech-related mirror stimuli, visual speech-irrelevant mirror stimuli, and non-mirror stimuli with four different luminance levels. Participants were 25 children with cochlear implants (CIs) who underwent an event-related potential (ERP) and speech recognition task. The main results were as follows: (1) there were significant differences in P1, N1, and P2 ERPs between mirror stimuli and non-mirror stimuli; (2) these ERP differences between mirror and non-mirror stimuli were partly driven by Brodmann areas 41 and 42 in the superior temporal gyrus; (3) ERP component differences between visual speech-related mirror and non-mirror stimuli were partly driven by Brodmann area 39 (visual speech area), which was not observed when comparing the visual speech-irrelevant stimulus and non-mirror groups; and (4) ERPs evoked by visual speech-related mirror stimuli had more components correlated with speech recognition than ERPs evoked by non-mirror stimuli, while ERPs evoked by speech-irrelevant mirror stimuli were not significantly different to those induced by the non-mirror stimuli. These results indicate the following: (1) mirror and non-mirror stimuli differ in their associated neural activation; (2) the visual-auditory interaction possibly led to ERP differences, as Brodmann areas 41 and 42 constitute the primary auditory cortex; (3) mirror neurons could be responsible for the ERP differences, considering that Brodmann area 39 is associated with processing information about speech-related mirror stimuli; and (4) ERPs evoked by visual speech-related mirror stimuli could better reflect speech recognition ability. These results support the hypothesis that a mirror mechanism underlies visual-auditory interactions.

Benefit of directional microphones for unilateral, bilateral and bimodal cochlear implant users.

OBJECTIVE: To compare the standard T-Mic setting to UltraZoom and StereoZoom in 10 unilateral cochlear implant (CI) users, 10 bimodal device users and 10 bilateral CI users as well as a normal hearing (NH) reference group (n = 10). METHOD: Speech reception thresholds were measured using the Oldenburg sentence test in noise. Speech was presented from the front at 0°, noise was presented from five loudspeakers spaced at ±60°, ±120°, 180° (setup A) or from four loudspeakers in the front hemisphere at ±30°, ±60° and one at 180° (setup B). RESULTS: There was a significant advantage for UltraZoom and StereoZoom for all groups in both setups. The largest advantage was for StereoZoom in the bilateral group (setup A, 5.2 dB, P < 0.001 and B, 3.4 dB, P < 0.001) There was a significant advantage for StereoZoom over UltraZoom in the bimodal group (setup A, P < 0.01 and B, P < 0.05) and in the bilateral group (P < 0.01, setup B only). The bilateral group performed as well as the normally hearing group in both setups and the bimodal group performed as well in setup A. There was a significant benefit of 1.8 dB for ClearVoice over UltraZoom alone for the unilateral group. CONCLUSIONS: UltraZoom and StereoZoom provided a clinically and statistically significant benefit over the T-Mic condition. The largest gain was shown for StereoZoom in the bimodal and bilateral groups. The use of StereoZoom enabled the bilateral group to perform as well as the normally hearing group in both the challenging speaker setups. However, real life environments might provide an even greater challenge than the conditions tested here.

Electrical dynamic range is only weakly associated with auditory performance and speech recognition in long-term users of cochlear implants.

OBJECTIVE: The electrical dynamic range (EDR) has been suggested to be related to auditory performance in cochlear implant (CI) users. However, few reports have evaluated postlingual CI users who have used CIs for long periods in comparison with prelingual CI users. Here, we evaluated auditory perception and speech performance in terms of the EDR in long-term CI users. The EDR, and auditory and speech performances, were compared between pre- and post-lingual CI users. METHODS: We enrolled all patients who received CIs from April 2000 to December 2010 at Seoul National University Hospital, and who had ≥5 years of experience with CIs. The EDRs affording subjective responses at the threshold level (T-level) and comfortable level (C-level) were analyzed in terms of their relationships with pure tone audiometry levels, speech evaluation scores, including those on the Phonetically Balanced (PB) Word List test, vowel and consonant tests, a sentence test, and the Korean version of the Central Institute for the Deaf (K-CID) test; we also calculated Category in Auditory Performance (CAP) scores. RESULTS: We found no significant difference in the average EDR, CAP, K-CID, PB word, consonant, or vowel scores between pre- and post-lingual CI users. The EDR was weakly associated with the PB word (P = 0.003, r = 0.462) and consonant scores (P = 0.005, r = 0.438). Other speech evaluations, such as the CAP, K-CID, and vowel scores, were not significantly associated with the EDR T-level. We found no association between pure tone thresholds at 0.5, 1, or 2 kHz, and the speech evaluation scores or EDRs of low-, middle-, or high-frequency channels. CONCLUSIONS: The EDR was only weakly associated with speech performance, such as scores on consonant and PB word tests in long-term CI users, irrespective of pre- or post-lingual deafness status.

Intelligence development of pre-lingual deaf children with unilateral cochlear implantation.

OBJECTIVE: The present study aims to test whether deaf children with unilateral cochlear implantation (CI) have higher intelligence quotients (IQ). We also try to find out the predictive factors of intelligence development in deaf children with CI. METHODS: Totally, 186 children were enrolled into this study. They were divided into 3 groups: CI group (N = 66), hearing loss group (N = 54) and normal hearing group (N = 66). All children took the Hiskey-Nebraska Test of Learning Aptitude to assess the IQ. After that, we used Deafness gene chip, Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) methods to evaluate the genotype, auditory and speech performance, respectively. RESULTS: At baseline, the average IQ of hearing loss group (HL), CI group, normal hearing (NH) group were 98.3 ± 9.23, 100.03 ± 12.13 and 109.89 ± 10.56, while NH group scored higher significantly than HL and CI groups (p < 0.05). After 12 months, the average IQ of HL group, CI group, NH group were99.54 ± 9.38,111.85 ± 15.38, and 112.08 ± 8.51, respectively. No significant difference between the IQ of the CI and NH groups was found (p > 0.05). The growth of SIR was positive correlated with the growth of IQ (r = 0.247, p = 0.046), while no significant correlation were found between IQ growth and other possible factors, i.e. gender, age of CI, use of hearing aid, genotype, implant device type, inner ear malformation and CAP growth (p > 0.05). CONCLUSIONS: Our study suggests that CI potentially improves the intelligence development in deaf children. Speech performance growth is significantly correlated with IQ growth of CI children. Deaf children accepted CI before 6 years can achieve a satisfying and undifferentiated short-term (12 months) development of intelligence.

A false sense of security: safety behaviors erode objective speech performance in individuals with social anxiety disorder.

In the current study, 55 participants with a diagnosis of generalized social anxiety disorder (SAD), 23 participants with a diagnosis of an anxiety disorder other than SAD with no comorbid SAD, and 50 healthy controls completed a speech task as well as self-reported measures of safety behavior use. Speeches were videotaped and coded for global and specific indicators of performance by two raters who were blind to participants' diagnostic status. Results suggested that the objective performance of people with SAD was poorer than that of both control groups, who did not differ from each other. Moreover, self-reported use of safety behaviors during the speech strongly mediated the relationship between diagnostic group and observers' performance ratings. These results are consistent with contemporary cognitive-behavioral and interpersonal models of SAD and suggest that socially anxious individuals' performance skills may be undermined by the use of safety behaviors. These data provide further support for recommendations from previous studies that the elimination of safety behaviors ought to be a priority in cognitive behavioral therapy for SAD.

Speech performance in pediatric users of Nurotron ® Venus™ cochlear implants.

OBJECTIVES: The primary purpose of this study was to investigate the longitudinal speech performance over 3 years in pediatric users of the Nurotron(®) cochlear implant system. The secondary purpose was to compare the speech performances of younger and older children with cochlear implants (CIs). METHODS: The Mandarin Early Speech Perception (MESP), Meaningful Use of Speech Scale (MUSS), and Putonghua Chinese Communicative Development Inventory (PCDI) were used to evaluate speech performance of 22 Mandarin-speaking pediatric CI users throughout the first 36 months post-implantation. The subjects were grouped according to the age at implantation, i.e., younger CI group (<3 years) and older CI group (>3 years). RESULTS: All the subjects demonstrated improvement in speech performance throughout the first 3 years of implant use with mean scores reaching the maximum performance at 36 months post-implantation. The median categories of MESP increased from 0.23 pre-implantation to 5.57 three years post-implantation. Likewise, the median percentage of MUSS was 5.57% to 73.75%; the median performance of PCDI was 55 to 400 for PCDI-comprehension and 32 to 384 for PCDI-production at the same interval. At nearly all test intervals, the older group performed better than the younger group except 24 months post-implantation, at which the MUSS score of the younger CI group was higher than that of the older CI group. CONCLUSION: The children with Nurotron(®) Venus™ CI system showed considerable gains in speech and language development including tone performance which improved with hearing age. Earlier implantations haven't presented significantly positive performances until 24 months post-implantation in all the tests.

Threat Interference Biases Predict Socially Anxious Behavior: The Role of Inhibitory Control and Minute of Stressor.

The current study brings together two typically distinct lines of research. First, social anxiety is inconsistently associated with behavioral deficits in social performance, and the factors accounting for these deficits remain poorly understood. Second, research on selective processing of threat cues, termed cognitive biases, suggests these biases typically predict negative outcomes, but may sometimes be adaptive, depending on the context. Integrating these research areas, the current study examined whether conscious and/or unconscious threat interference biases (indexed by the unmasked and masked emotional Stroop) can explain unique variance, beyond self-reported anxiety measures, in behavioral avoidance and observer-rated anxious behavior during a public speaking task. Minute of speech and general inhibitory control (indexed by the color-word Stroop) were examined as within-subject and between-subject moderators, respectively. Highly socially anxious participants (N=135) completed the emotional and color-word Stroop blocks prior to completing a 4-minute videotaped speech task, which was later coded for anxious behaviors (e.g., speech dysfluency). Mixed-effects regression analyses revealed that general inhibitory control moderated the relationship between both conscious and unconscious threat interference bias and anxious behavior (though not avoidance), such that lower threat interference predicted higher levels of anxious behavior, but only among those with relatively weaker (versus stronger) inhibitory control. Minute of speech further moderated this relationship for unconscious (but not conscious) social-threat interference, such that lower social-threat interference predicted a steeper increase in anxious behaviors over the course of the speech (but only among those with weaker inhibitory control). Thus, both trait and state differences in inhibitory control resources may influence the behavioral impact of threat biases in social anxiety.

Does attention bias modification improve attentional control? A double-blind randomized experiment with individuals with social anxiety disorder.

People with anxiety disorders often exhibit an attentional bias for threat. Attention bias modification (ABM) procedure may reduce this bias, thereby diminishing anxiety symptoms. In ABM, participants respond to probes that reliably follow non-threatening stimuli (e.g., neutral faces) such that their attention is directed away from concurrently presented threatening stimuli (e.g., disgust faces). Early studies showed that ABM reduced anxiety more than control procedures lacking any contingency between valenced stimuli and probes. However, recent work suggests that no-contingency training and training toward threat cues can be as effective as ABM in reducing anxiety, implying that any training may increase executive control over attention, thereby helping people inhibit their anxious thoughts. Extending this work, we randomly assigned participants with DSM-IV diagnosed social anxiety disorder to either training toward non-threat (ABM), training toward threat, or no-contingency condition, and we used the attention network task (ANT) to assess all three components of attention. After two training sessions, subjects in all three conditions exhibited indistinguishably significant declines from baseline to post-training in self-report and behavioral measures of anxiety on an impromptu speech task. Moreover, all groups exhibited similarly significant improvements on the alerting and executive (but not orienting) components of attention. Implications for ABM research are discussed.

Attention bias modification for social anxiety: A systematic review and meta-analysis.

Research on attention bias modification (ABM) for social anxiety disorder (SAD) is inconclusive, with some studies finding clear positive effects and other studies finding no significant benefit relative to control training procedures. In this meta-analysis, we assessed the efficacy of ABM for SAD on symptoms, reactivity to speech challenge, attentional bias (AB) toward threat, and secondary symptoms at posttraining as well as SAD symptoms at 4-month follow-up. A systematic search in bibliographical databases uncovered 15 randomized studies involving 1043 individuals that compared ABM to a control training procedure. Data were extracted independently by two raters. The Q statistic was used to assess homogeneity across trials. All analyses were conducted on intent-to-treat data. ABM produced a small but significant reduction in SAD symptoms (g=0.27), reactivity to speech challenge (g=0.46), and AB (g=0.30). These effects were moderated by characteristics of the ABM procedure, the design of the study, and trait anxiety at baseline. However, effects on secondary symptoms (g=0.09) and SAD symptoms at 4-month follow-up (g=0.09) were not significant. Although there was no indication of significant publication bias, the quality of the studies was substandard and wedged the effect sizes. From a clinical point of view, these findings imply that ABM is not yet ready for wide-scale dissemination as a treatment for SAD in routine care. Theoretical implications for the integration of AB in the conceptualization of SAD are discussed.