Variation in Auditory Experience Affects Language and Executive Function Skills in Children Who Are Hard of Hearing

Abstract

Objective: Children who are hard of hearing (CHH) experience delays in spoken language and executive function, but the mechanisms for these deficits remain unresolved. Differences in auditory experience and language skills have been examined as contributing factors to deficits in executive function, primarily with children who are deaf and children with cochlear implants. The theoretical model of cumulative auditory experience quantifies auditory dosage as how much speech is audible and how often children wear their hearing aids. CHH with higher auditory dosage have better language outcomes than peers with less auditory dosage. However, the effects of auditory experience on executive function have not been studied in CHH. The goal of this study was to examine the influences of auditory experience and language skills on the development of executive function in CHH. Design: We collected measures of aided speech audibility, hearing aid use, executive function, and receptive vocabulary in 177 CHH and 86 children with typical hearing who were 5- to 10 years old and matched for socioeconomic status and nonverbal intelligence. Auditory dosage was calculated by combining each child’s average hours of hearing aid use with their audibility for speech to create a variable that quantifies individual differences in auditory access. Results: CHH had lower receptive vocabulary and deficits in executive function related to working memory and selective attention compared to peers with typical hearing. CHH with greater auditory dosage had higher receptive vocabulary than CHH with lower auditory dosage. Better receptive vocabulary was associated with better scores on executive function measures related to working memory and attention. Auditory dosage was also directly associated with measures of verbal working memory. Conclusions: CHH have deficits in language and some, but not all, areas of executive function related to working memory and attention. Auditory dosage was associated with language abilities and verbal working memory. Language was associated with individual differences in executive function skills related to attention and working memory. These results provide support for systems theories regarding the development of executive function in CHH. Interventions that improve auditory access and language may be effective for improving executive function related to working memory and attention in CHH.

Amount of Hearing Aid Use Impacts Neural Oscillatory Dynamics Underlying Verbal Working Memory Processing for Children With Hearing Loss

“…Future studies should expand this work into a larger and more diverse sample, to enable additional variables such as vocabulary or socioeconomic status to be considered. In addition, recent work suggests that auditory dosage, which is the cumulative effect of both hearing aid use and the quality of hearing aid fit, may be a more crucial component to behavioral outcomes in CHL than hearing aid use by itself (McCreery & Walker, in press; Walker et al 2020). Future studies should include measures of hearing aid fit and other auditory experience parameters when determining the impact of hearing aid use on neural activity in CHL.…”

Auditory experience modulates fronto-parietal theta activity serving fluid intelligence

“…Given the increasing evidence that consistent hearing aid use moderates language, executive function, and academic outcomes in CHH 12 , 18 , 26 and may have cascading effects on cognitive neurophysiology, 27 we next sought to determine whether the number of hours that CHH wore their hearing aids also modified their neural dynamics underlying abstract reasoning. To this end, the total number of hours of hearing aid use (Monday–Sunday, during the school year) were entered into a voxel-wise whole-brain correlation analysis with theta ERS and alpha ERD maps separately, with BEPTA acting as a covariate.…”

“…Indeed, findings in other studies are mixed; some show specific non-verbal cognitive decrements (e.g. fluid intelligence, attention, executive function 17 , 18 ), whereas others show no difference groupwise between CHH and CNH. 19 However, numerous studies have shown that non-verbal intelligence predicts language ability in children with and without hearing loss, suggesting that fluid intelligence may moderate academic and language outcomes in this population.…”

“… 26 Recent studies have found that CHH who have more consistent hearing aid use have better academic and language outcomes than CHH who have fewer hours of hearing aid use per day. 12 , 18 , 26 Crucially, we recently reported that the amount of hearing aid use also significantly relates to neurophysiological markers of cognitive processing in CHH, such that greater hearing aid use (especially more than ∼8.5 h per day) served to significantly normalize patterns of neural activity during working memory processing in CHH. 27 Nonetheless, the effects of individual differences in auditory experience on non-verbal intelligence have rarely been described in previous studies, and to date, there has been no investigation of the underlying neurophysiology.…”

“…CHH is increasingly identified with hearing loss via newborn hearing screening programmes and then fitted with hearing aids and enroled in early intervention within months of birth. 25 However, 30–40% of early identified CHH experience persistent deficits in language, 9 executive function 18 and academic outcomes. 26 Recent studies have found that CHH who have more consistent hearing aid use have better academic and language outcomes than CHH who have fewer hours of hearing aid use per day.…”