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

Abstract

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.

Development of Grammatical Accuracy in English-Speaking Children With Cochlear Implants: A Longitudinal Study

“…To be included in the present study, children had to (a) receive cochlear implantation before age 30 months and have used the Nucleus CI 24R or Nucleus CI 24M devices (Cochlear Ltd., Sydney, Australia) with the processing strategy of the advanced combination encoder (ACE; Cochlear Ltd., 2010; excluding 39 children) and (b) participate in the story-retell task in the annual evaluation 3, 4, and 5 years after implantation and produce at least five utterances with verbs for analysis at each time point (Lahey, Liebergott, Chesnick, Menyuk, & Adams, 1992; excluding 20 children). We included children who received cochlear implantation before age 30 months in order to reduce the effect of age of implantation (Geers et al, 2016). Although the current population of pediatric CI users typically receives cochlear implantation before age 24 months, Nicholas and Geers (2007) indicate that children who received implantation between ages 12 and 30 months show a similar growth rate in language development, which supports the use of 30 months as the cutoff for age of implantation in the present study.…”

“…We want to point out that children with CIs in the present study all used the ACE processing strategy, which is still the default processing strategy for the Nucleus CI devices (Cochlear Ltd., 2010;Wolfe & Schafer, 2010). Although variation of CI technology may influence speech-language outcomes (Geers et al, 2016), to date there is no published evidence suggesting that different CI processors (e.g., SPRINT, CP910 in cochlear devices) with the same processing strategy (e.g., ACE) would result in significant differences in speech-language outcomes. Similarly, there is no published evidence indicating that different processing strategies from different makes in the same time period would lead to significantly different outcomes.…”

“…Furthermore, the early auditory deprivation may lead to delayed development of cognitive mechanisms for learning speech and language, such as working memory (Kral, Kronenberger, Pisoni, & O'Donoghue, 2016), executive function (Kronenberger, Colson, Henning, & Pisoni, 2014), and sequential learning (Conway, Pisoni, & Kronenberger, 2009). Although there is considerable individual variability, children with CIs tend, as a group, to show deficits in those cognitive mechanisms, which further compromises their speech and language outcomes (Geers, Nicholas, Tobey, & Davidson, 2016;Kral et al, 2016).…”

Early Sign Language Exposure and Cochlear Implantation Benefits

“…32 The relatively high proportion of children in the no sign language exposure group achieving scores within 1 SD of normal hearing agemates replicated results observed previously for a nationwide sample of 60 children who had no early sign language exposure, received a CI within the same age range (ie, by 38 months), and were approximately the same age at assessment near early and late elementary grades. 33 The percentage of children exhibiting a language delay that persisted through elementary grades was strikingly similar in these 2 studies (29% and 32%), indicating generalizability of this result.…”

From "Communication Mode" to "Language Access Profile" in Research with DHH Children

“…Similar patterns are evident wherever the full distribution of spoken language outcomes is reported (e.g. Ching et al, 2013;Geers et al, 2016;Niparko et al, 2010). Meanwhile, the likelihood of developing proficiency in ASL among DHH children who have partial access to ASL is virtually unknown, due in part to the fact that few studies distinguish natural sign languages from other forms of manual communication, and that even those few that make this distinction do not assess proficiency in the relevant sign language (e.g.…”