Processes that influence communicative impairments in deaf children using cochlear implants

Relationships between hearing, auditory processing, and communication in children diagnosed with auditory neuropathy spectrum disorder

OBJECTIVES

The objectives of this study were to evaluate the relationships between auditory processing, speech discrimination, and listening and communication abilities in children diagnosed with auditory neuropathy spectrum disorder (ANSD) compared to those with normal hearing.

METHODS

This was a case-control study involving seventeen participants with a diagnosis of ANSD who used spoken language as their primary mode of communication and wore hearing aids or were unaided and 21 normally hearing controls. All underwent a battery of behavioural measures of hearing, speech perception and auditory processing skills. Their parents filled in a series of questionnaires to evaluate listening and communication abilities. Group differences were evaluated, and hierarchical linear regression was carried out to assess the extent to which auditory measures predicted parent report scores.

RESULTS

Slow-rate amplitude modulation detection (AMD) was an important predictor of listening and communication abilities over and above the pure-tone audiogram in children diagnosed with ANSD. There was a significant relationship between the pure-tone audiogram and the ability to discriminate speech in quiet but not in noise. Children in the ANSD group had more difficulty completing tests of auditory processing ability or performed significantly more poorly than the control group for most tasks.

CONCLUSIONS

This study confirms that outcomes for children diagnosed with ANSD are heterogeneous, and provides new information about real world listening and communication abilities. These findings will be useful for clinicians counselling families of newly diagnosed infants and providing management for children with a diagnosis of ANSD.

Long-Term Device Satisfaction and Safety after Cochlear Implantation in Children

(1) Objectives: For full benefit in children implanted with a cochlear implant (CI), wearing the device all waking hours is necessary. This study focuses on the relationship between daily use and audiological outcomes, with the hypothesis that frequent daily device use coincides with high device satisfaction resulting in better functional gain (FG). Confounding factors such as implantation age, device experience and type of device were considered. (2) Results: Thirty-eight CI children (65 ears) were investigated. In total, 76.92% of the children were using their device for >12 h per day (h/d), 18.46% for 9−12 h/d, the remaining for 6−9 h/d and one subject reported 3 h/d. The revision rate up to the 90-month follow-up (F/U) was 4.6%. The mean FG was 59.00 ± 7.67 dB. The Audio Processor Satisfaction Questionnaire (APSQ) separated for single unit (SU) versus behind the ear (BTE) devices showed significantly better results for the latter in terms of wearing comfort (WC) (p = 0.00062). A correlation between device use and FG was found with a device experience of <2 years (n = 29; r2 = 0.398), whereas no correlation was seen with ≥2 years of device experience (n = 36; r2 = 0.0038). (3) Conclusion: This study found significant relationships between daily device use and FG, wearing comfort and long-term safety (90 months).

Association between CCC-2 and Structural Language, Pragmatics, Social Cognition, and Executive Functions in Children with Developmental Language Disorder

(1) Background: Developmental Language Disorder (DLD) is diagnosed when the child experiences problems in language with no known underlying biomedical condition and the information required for its correct evaluation must be obtained from different contexts. The Children's Communication Checklist (CCC-2) covers aspects of a child's communication related to structural language and pragmatic skills, which are linked to social cognition or executive functions. The aim of this article is to examine parents' reports using the Spanish version of the CCC-2 questionnaire and its association with different formal assessments related to communication. (2) Methods: 30 children with DLD (3; 10-9 years old) and 39 age-matched (AM) children with typical development were assessed using formal measures of structural language, pragmatics, social cognition, and executive functions. Parents of children with DLD answered the Spanish version of the CCC-2. (3) Results: The performance of children with DLD was lower in all the formal assessments in comparison to AM children. The CCC-2 was significantly correlated with all the direct child assessments, although only formal measures of structural language predicted both the structural language and pragmatics scales of the CCC-2. (4) Conclusions: The CCC-2 answered by parents was consistent with formal assessments in children with DLD, and structural language seemed to be the best predictor of all the subscales.

Modelling the early expressive communicative trajectories of infants/toddlers with early cochlear implants

For children with normal hearing (NH), early communication skills predict vocabulary, a precursor to grammar. Growth in early communication skills of infants with cochlear implants (CIs) was investigated using the Early Communication Indicator (ECI), a play-based observation measure. Multilevel linear growth modelling on data from six ECI sessions held at three-monthly intervals revealed significant growth overall, with a non-significant slower growth rate than that of children with NH (comparison age centred at 18 months). Analyses of gesture use and of nonword vocalisations revealed the CI group used significantly more of each, with more rapid growth. In contrast, the CI group used significantly fewer single words and multiword utterances, and with slower growth. Maternal education and time to achieve consistent CI use impacted significantly on growth for the CI sample. The results indicate that progression to vocabulary by young CI users can be supported by encouraging their use of prelinguistic communication.

Persistent Language Delay Versus Late Language Emergence in Children With Early Cochlear Implantation

PURPOSE

The purpose of the present investigation is to differentiate children using cochlear implants (CIs) who did or did not achieve age-appropriate language scores by midelementary grades and to identify risk factors for persistent language delay following early cochlear implantation.

MATERIALS AND METHOD

Children receiving unilateral CIs at young ages (12-38 months) were tested longitudinally and classified with normal language emergence (n = 19), late language emergence (n = 22), or persistent language delay (n = 19) on the basis of their test scores at 4.5 and 10.5 years of age. Relative effects of demographic, audiological, linguistic, and academic characteristics on language emergence were determined.

RESULTS

Age at CI was associated with normal language emergence but did not differentiate late emergence from persistent delay. Children with persistent delay were more likely to use left-ear implants and older speech processor technology. They experienced higher aided thresholds and lower speech perception scores. Persistent delay was foreshadowed by low morphosyntactic and phonological diversity in preschool. Logistic regression analysis predicted normal language emergence with 84% accuracy and persistent language delay with 74% accuracy.

CONCLUSION

CI characteristics had a strong effect on persistent versus resolving language delay, suggesting that right-ear (or bilateral) devices, technology upgrades, and improved audibility may positively influence long-term language outcomes.

Mental health problems in adolescents with cochlear implants: peer problems persist after controlling for additional handicaps

The aims of the present multi-center study were to investigate the extent of mental health problems in adolescents with a hearing loss and cochlear implants (CIs) in comparison to normal hearing (NH) peers and to investigate possible relations between the extent of mental health problems of young CI users and hearing variables, such as age at implantation, or functional gain of CI. The survey included 140 adolescents with CI (mean age = 14.7, SD = 1.5 years) and 140 NH adolescents (mean age = 14.8, SD = 1.4 years), their parents and teachers. Participants were matched by age, gender and social background. Within the CI group, 35 adolescents were identified as “risk cases” due to possible and manifest additional handicaps, and 11 adolescents were non-classifiable. Mental health problems were assessed with the Strengths and Difficulties Questionnaire (SDQ) in the versions “Self,” “Parent,” and “Teacher.” The CI group showed significantly more “Peer Problems” than the NH group. When the CI group was split into a “risk-group” (35 “risk cases” and 11 non-classifiable persons) and a “non-risk group” (n = 94), increased peer problems were perceived in both CI subgroups by adolescents themselves. However, no further differences between the CI non-risk group and the NH group were observed in any rater. The CI risk-group showed significantly more hyperactivity compared to the NH group and more hyperactivity and conduct problems compared to the CI non-risk group. Cluster analyses confirmed that there were significantly more adolescents with high problems in the CI risk-group compared to the CI non-risk group and the NH group. Adolescents with CI, who were able to understand speech in noise had significantly less difficulties compared to constricted CI users. Parents, teachers, and clinicians should be aware that CI users with additionally special needs may have mental health problems. However, peer problems were also experienced by CI adolescents without additional handicaps.

Ten questions about terminology for children with unexplained language problems

BACKGROUND

In domains other than language, there is fairly consistent diagnostic terminology to refer to children's developmental difficulties. For instance, the terms 'dyslexia', 'attention deficit hyperactivity disorder' and 'autistic spectrum disorder' are used for difficulties with reading, attention or social cognition, respectively. There is no agreed label, however, for children with unexplained language problems.

AIMS

To consider whether we need labels for unexplained language problems in children, and if so, what terminology is appropriate.

MAIN CONTRIBUTION

There are both advantages and disadvantages to labels, but they are important to ensure children receive services, and to increase our knowledge of the nature and causes of such problems. A survey of labels in current use found 132 different terms, 33 of which had 600 or more returns on Google Scholar between 1994 and 2013. Many of these labels were too general to be useful. Of the remainder, the term 'specific language impairment' was the most commonly used.

CONCLUSIONS

The current mayhem in diagnostic labels is unsustainable; it causes confusion and impedes research progress and access to appropriate services. We need to achieve consensus on diagnostic criteria and terminology. The DSM-5 term 'language disorder' is problematic because it identifies too wide a range of conditions on an internet search. One solution is to retain specific language impairment, with the understanding that 'specific' means idiopathic (i.e., of unknown origin) rather than implying there are no other problems beyond language. Other options are the terms 'primary language impairment', 'developmental language disorder' or 'language learning impairment'.

Factors that influence the participation of parents in the oral rehabilitation process of children with cochlear implants: a systematic review

PURPOSE

To identify and analyze factors that influence the participation of parents in the rehabilitation process of children with cochlear implants (CI).

RESEARCH STRATEGY

Question formulation and articles selection in three databases using the following keywords: cochlear implant (implante coclear) and parents (pais).

SELECTION CRITERIA

Complete original articles published in Brazilian Portuguese or English, with direct participation of parents of children with CI.

DATA ANALYSIS

Articles were fully read. Data regarding characterization of the centers, research methodology and content were analyzed.

RESULTS

Thirteen articles were selected based on the established criteria. The types of studies were cross-sectional and case-control (interview technique). The following influential factors were identified: pre-CI surgery factors (knowledge about CI, quality and quantity of information, specialist's advices, ethical and biomedical aspects, rehabilitation engagement, contact with experienced families, social service support and overall costs); rehabilitation aspects (CI use, oral communication modality, regular school, other disabilities, social and demographic aspects and rehabilitation program's effectiveness); other important influential processes (communication modality, auditory and language development, second oral language learning, as well as parent's behavior and satisfaction).

CONCLUSION

The engagement of parents in the rehabilitation process of children with CI depends on several distinct influential factors which audiologists should understand and consider when elaborating a rehabilitation program.

Listening difficulties in children: bottom-up and top-down contributions

The brain mechanisms of hearing include large regions of the anterior temporal, prefrontal, and inferior parietal cortex, and an extensive network of descending connections between the cortex and sub-cortical components of what is presently known as the auditory system. One important function of these additional ('top-down') mechanisms for hearing is to modulate the ascending, sensory ('bottom-up') auditory information from the ear. In children, normal, immature hearing during the first decade of life is more strongly influenced by top-down mechanisms than in adulthood. In some children, impaired top-down function presents a significant challenge to their auditory perception, often associated with a range of language and learning difficulties and sometimes called auditory processing disorder.

Factor structure of the Serbian version of the Children's Communication Checklist-2

Keeping in mind that traditional tests were largely insensitive to pragmatic impairment, Bishop (2003) created a second version of the Children's Communication Checklist (CCC-2) in order to identify pragmatic deficits in children with communication problems. Unfortunately, it was revealed that certain subscales of the Serbian version of the CCC-2 have unacceptably low internal consistency. Because dividing the test into original subscales did not apply for the Serbian population, the aim of this paper was to determine the factor structure of the CCC-2. The sample consisted of 1344 typically developing, monolingual participants of both sexes, aged from 4 to 17 (M = 9.52; SD = 2.72). Participants were recruited from three statistical regions in Serbia. All participants attended regular kindergarten, elementary or secondary schools. CCC-2 factor analysis was determined by using the principal component method, with Varimax rotation of principal axes. A factor analysis showed that the CCC-2 had three factors (General Communication Ability, Pragmatics and Structural Language Aspects), which accounted for 29.39% of the total variance. A three-factor solution should be further confirmed in the course of a clinical validation of the CCC-2.

Training speech-in-noise perception in mainstream school children

OBJECTIVE

Auditory training has been advocated as a management strategy for children with hearing, listening or language difficulties. Because poor speech-in-noise perception is commonly reported, previous research has focused on the use of complex (word/sentence) stimuli as auditory training material to improve sentence-in-noise perception. However, some evidence suggests that engagement with the training stimuli is more important than the type of stimuli used for training. The aim of this experiment was to assess if sentence-in-noise perception could be improved using simpler auditory training stimuli.

METHODS

We recruited 41 typically developing, normal-hearing children aged 8-10 years divided into four groups. Groups 1-3 trained over 4 weeks (12 × 30 min sessions) on either: (1) pure-tone frequency discrimination (FD), (2) FD in a modulated noise (FDN) or, (3) mono-syllabic words in a modulated noise (WN). Group 4 was an untrained Control. In the training tasks, either tone frequency (Group 1), or tone (Group 2) or speech (Group 3) level was varied adaptively. All children completed pre- and post-training tests of sentence perception in modulated (SMN) and unmodulated (SUN) noise and a probe measure of each training task.

RESULTS

All trained groups improved significantly on the trained tasks. Transfer of training occurred between FDN training and FD, WN and SMN testing, and between WN training and SMN testing. A significant performance suppression on the SUN test resulted from FD and FDN training.

CONCLUSION

The pattern of training-induced improvement, relative to Controls, suggests that transfer of training is more likely when some stimulus dimensions (tone frequency, speech, modulated noise) are shared between training tasks and outcomes. This and the finding of suppressed post-training performance, relative to Controls, between tasks not sharing a stimulus dimension both favour the use of outcome-specific material for auditory training.