Verbal working memory in children with cochlear implants and children with normal hearing was examined.


Ninety-three fourth graders (47 with normal hearing, 46 with cochlear implants) participated, all of whom were in a longitudinal study and had working memory assessed 2 years earlier.


A dual-component model of working memory was adopted, and a serial recall task measured storage and processing. Potential predictor variables were phonological awareness, vocabulary knowledge, nonverbal IQ, and several treatment variables. Potential dependent functions were literacy, expressive language, and speech-in-noise recognition.


Children with cochlear implants showed deficits in storage and processing, similar in size to those at second grade. Predictors of verbal working memory differed across groups: Phonological awareness explained the most variance in children with normal hearing; vocabulary explained the most variance in children with cochlear implants. Treatment variables explained little of the variance. Where potentially dependent functions were concerned, verbal working memory accounted for little variance once the variance explained by other predictors was removed.


The verbal working memory deficits of children with cochlear implants arise due to signal degradation, which limits their abilities to acquire phonological awareness. That hinders their abilities to store items using a phonological code.


  • Ambrose, S. E., Fey, M. E., & Eisenberg, L. S. (2012). Phonological awareness and print knowledge of preschool children with cochlear implants.Journal of Speech, Language, and Hearing Research, 55, 811–823.
  • Arehart, K. H., Souza, P., Baca, R., & Kates, J. M. (2013). Working memory, age, and hearing loss: Susceptibility to hearing aid distortion.Ear and Hearing, 34, 251–260.
  • Baddeley, A. D. (1992). Working memory.Science, 255, 556–559.
  • Baddeley, A. D. (2000). The episodic buffer: A new component of working memory?.Trends in Cognitive Sciences, 4, 417–423.
  • Baddeley, A. D. (2007). Working memory, thought and action. Oxford, United Kingdom: Oxford University Press.
  • Baddeley, A. D., & Hitch, G. J. (1974). Working memory.In G. Bower (Ed.), The psychology of learning and motivation: Advances in research and theory (pp. 47–89). New York, NY: Academic Press.
  • Baddeley, A., Lewis, V. J., & Vallar, G. (1984). Exploring the articulatory loop.The Quarterly Journal of Experimental Psychology, 36, 233–252.
  • Bar-Shalom, E. G., Crain, S., & Shankweiler, D. (1993). A comparison of comprehension and production abilities of good and poor readers.Applied Psycholinguistics, 14, 197–227.
  • Bharadwaj, S. V., Maricle, D., Green, L., & Allman, T. (2015). Working memory, short-term memory and reading proficiency in school-age children with cochlear implants.International Journal of Pediatric Otorhinolaryngology, 79, 1647–1653.
  • Brady, S., Shankweiler, D., & Mann, V. (1983). Speech perception and memory coding in relation to reading ability.Journal of Experimental Child Psychology, 35, 345–367.
  • Brownell, R. (2000). Expressive One-Word Picture Vocabulary Test–Third Edition (EOWPVT-3). Novato, CA: Academic Therapy Publications.
  • Burgess, N., & Hitch, G. J. (1999). Memory for serial order: A network model of the phonological loop and its timing.Psychological Review, 106, 551–581.
  • Burkholder, R. A., & Pisoni, D. B. (2003). Speech timing and working memory in profoundly deaf children after cochlear implantation.Journal of Experimental Child Psychology, 85, 63–88.
  • Campbell, R., & Dodd, B. (1980). Hearing by eye.Quarterly Journal of Experiemental Psychology, 32, 85–99.
  • Campbell, R., Dodd, B., & Brasher, J. (1983). The sources of visual recency: Movement and language in serial recall.Quarterly Journal of Experimental Psychology Section A-Human Experimental Psychology, 35(Pt 4), 571–587.
  • Conway, C. M., & Christiansen, M. H. (2005). Modality-constrained statistical learning of tactile, visual, and auditory sequences.Journal of Experimental Psychology: Learning, Memory, and Cognition, 31, 24–39.
  • Conway, C. M., Pisoni, D. B., & Kronenberger, W. G. (2009). The importance of sound for cognitive sequencing abilities: The auditory scaffolding hypothesis.Current Directions in Psychological Science, 18, 275–279.
  • Crain, S. (1989). Why poor readers misunderstand spoken sentences.In D. Shankweiler & I. Y. Liberman (Eds.), Phonology and reading disability: Solving the reading puzzle (pp. 133–165). Ann Arbor, MI: The University of Michigan Press.
  • Crain, S., Shankweiler, D., Macaruso, P., & Bar-Shalom, E. G. (1990). Working memory and sentence comprehension: Investigations of children with reading disorder.In G. Vallar & T. Shallice (Eds.), Neuropsychological impairments of short-term memory (pp. 477–508). Cambridge, United Kingdom: Cambridge University Press.
  • Daza, M. T., Phillips-Silver, J., Ruiz-Cuadra, M. M., & López-López, F. (2014). Language skills and nonverbal cognitive processes associated with reading comprehension in deaf children.Research in Developmental Disabilities, 35, 3526–3533.
  • Edwards, L., Aitkenhead, L., & Langdon, D. (2016). The contribution of short-term memory capacity to reading ability in adolescents with cochlear implants.International Journal of Pediatric Otorhinolaryngology, 90, 37–42.
  • Fagan, M. K., Pisoni, D. B., Horn, D. L., & Dillon, C. M. (2007). Neuropsychological correlates of vocabulary, reading, and working memory in deaf children with cochlear implants.Journal of Deaf Studies & Deaf Education, 12, 461–471.
  • Fey, M. E., Catts, H. W., Proctor-Williams, K., Tomblin, J. B., & Zhang, X. (2004). Oral and written story composition skills of children with language impairment.Journal of Speech, Language, and Hearing Research, 47, 1301–1318.
  • Füllgrabe, C., & Rosen, S. (2016). Investigating the role of working memory in speech-in-noise identification for listeners with normal hearing.Advances in Experimental Medicine and Biology, 894, 29–36.
  • Hall, J. W., Wilson, K. P., Humphreys, M. S., Tinzmann, M. B., & Bowyer, P. M. (1983). Phonemic-similarity effects in good vs. poor readers.Memory & Cognition, 11, 520–527.
  • Harrison Bush, A. L., Lister, J. J., Lin, F. R., Betz, J., & Edwards, J. D. (2015). Peripheral hearing and cognition: Evidence from the Staying Keen in Later Life (SKILL) study.Ear and Hearing, 36, 395–407.
  • Hirsh, I. J., Reynolds, E. G., & Joseph, M. (1954). Intelligibility of different speech materials.The Journal of the Acoustical Society of America, 26, 530–538.
  • Hirshorn, E. A., Dye, M. W., Hauser, P., Supalla, T. R., & Bavelier, D. (2015). The contribution of phonological knowledge, memory, and language background to reading comprehension in deaf populations.Frontiers in Psychology, 6, 1153.
  • James, D., Rajput, K., Brown, T., Sirimanna, T., Brinton, J., & Goswami, U. (2005). Phonological awareness in deaf children who use cochlear implants.Journal of Speech, Language, and Hearing Research, 48, 1511–1528.
  • Just, M. A., & Carpenter, P. A. (1992). A capacity theory of comprehension: Individual differences in working memory.Psychological Review, 99, 122–149.
  • Katz, R. B., Shankweiler, D., & Liberman, I. Y. (1981). Memory for item order and phonetic recording in the beginning reader.Journal of Experimental Child Psychology, 32, 474–484.
  • Kronenberger, W. G., Colson, B. G., Henning, S. C., & Pisoni, D. B. (2014). Executive functioning and speech-language skills following long-term use of cochlear implants.Journal of Deaf Studies & Deaf Education, 19, 456–470.
  • Leslie, L., & Caldwell, J. (2006). Qualitative Reading Inventory–Fourth Edition. New York, NY: Pearson.
  • Luce, P. A., & Pisoni, D. B. (1998). Recognizing spoken words: The neighborhood activation model.Ear and Hearing, 19, 1–36.
  • Lunner, T. (2003). Cognitive function in relation to hearing aid use.International Journal of Audiology, 42(Suppl. 1), S49–S58.
  • Mann, V. A., & Liberman, I. Y. (1984). Phonological awareness and verbal short-term memory.Journal of Learning Disabilities, 17, 592–599.
  • Miller, G. A., Heise, G. A., & Lichten, W. (1951). The intelligibility of speech as a function of the context of the test materials.Journal of Experimental Psychology, 41, 329–335.
  • Nilsson, M., Soli, S. D., & Sullivan, J. A. (1994). Development of the Hearing in Noise Test for the measurement of speech reception thresholds in quiet and in noise.The Journal of the Acoustical Society of America, 95, 1085–1099.
  • Nittrouer, S. (2006). Children hear the forest.The Journal of the Acoustical Society of America, 120, 1799–1802.
  • Nittrouer, S. (2010). Early development of children with hearing loss. San Diego, CA: Plural Publishing.
  • Nittrouer, S., & Burton, L. T. (2005). The role of early language experience in the development of speech perception and phonological processing abilities: Evidence from 5-year-olds with histories of otitis media with effusion and low socioeconomic status.Journal of Communication Disorders, 38, 29–63.
  • Nittrouer, S., Caldwell, A., & Holloman, C. (2012). Measuring what matters: Effectively predicting language and literacy in children with cochlear implants.International Journal of Pediatric Otorhinolaryngology, 76, 1148–1158.
  • Nittrouer, S., Caldwell-Tarr, A., & Lowenstein, J. H. (2013). Working memory in children with cochlear implants: Problems are in storage, not processing.International Journal of Pediatric Otorhinolaryngology, 77, 1886–1898.
  • Nittrouer, S., Caldwell-Tarr, A., Moberly, A. C., & Lowenstein, J. H. (2014). Perceptual weighting strategies of children with cochlear implants and normal hearing.Journal of Communication Disorders, 52, 111–133.
  • Nittrouer, S., & Lowenstein, J. H. (2015). Weighting of acoustic cues to a manner distinction by children with and without hearing loss.Journal of Speech, Language, and Hearing Research, 58, 1077–1092.
  • Nittrouer, S., Lowenstein, J. H., & Holloman, C. (2016). Early predictors of phonological and morphosyntactic skills in second graders with cochlear implants.Research in Developmental Disablities, 55, 143–160.
  • Nittrouer, S., Lowenstein, J. H., Wucinich, T., & Moberly, A. C. (2016). Verbal working memory in older adults: The roles of phonological capacities and processing speed.Journal of Speech, Language, and Hearing Research, 59, 1520–1532.
  • Nittrouer, S., & Miller, M. E. (1999). The development of phonemic coding strategies for serial recall.Applied Psycholinguistics, 20, 563–588.
  • Nittrouer, S., Sansom, E., Low, K., Rice, C., & Caldwell-Tarr, A. (2014). Language structures used by kindergartners with cochlear implants: Relationship to phonological awareness, lexical knowledge and hearing loss.Ear and Hearing, 35, 506–518.
  • Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York, NY: McGraw-Hill.
  • Pisoni, D. B., & Cleary, M. (2004). Learning, memory and cognitive processes in deaf children following cochlear implantation.In F. G. Zeng, A. N. Popper, & R. R. Fay (Eds.), Cochlear implants: Auditory prostheses and electric hearing (pp. 377–426). Springer handbook of auditory research. New York, NY: Springer-Verlag.
  • Pisoni, D. B., Kronenberger, W. G., Chandramouli, S. H., & Conway, C. M. (2016). Learning and memory processes following cochlear implantation: The missing piece of the puzzle.Frontiers in Psychology, 7, 493.
  • Pollack, I., Rubenstein, H., & Decker, L. (1959). Intelligibility of known and unknown message sets.The Journal of the Acoustical Society of America, 31, 273–279.
  • Ramus, F., Rosen, S., Dakin, S. C., Day, B. L., Castellote, J. M., White, S., & Frith, U. (2003). Theories of developmental dyslexia: Insights from a multiple case study of dyslexic adults.Brain, 126, 841–865.
  • Reinhart, P. N., & Souza, P. E. (2016). Intelligibility and clarity of reverberant speech: Effects of wide dynamic range compression release time and working memory.Journal of Speech, Language, and Hearing Research, 59, 1543–1554.
  • Ritchie, S. J., Bates, T. C., & Plomin, R. (2015). Does learning to read improve intelligence? A longitudinal multivariate analysis in identical twins from age 7 to 16.Child Development, 86, 23–26.
  • Roid, G. H., & Miller, L. J. (2002). Leiter International Performance Scale–Revised (LIPS-R). Wood Dale, IL: Stoelting.
  • Rönnberg, J. (2003). Cognition in the hearing impaired and deaf as a bridge between signal and dialogue: A framework and a model.International Journal of Audiology, 42(Suppl 1), S68–S76.
  • Rönnberg, J., Lunner, T., Zekveld, A., Sörqvist, P., Danielsson, H., Lyxell, B., … Rudner, M. (2013). The ease of language understanding (ELU) model: Theoretical, empirical, and clinical advances.Frontiers in Systems Neuroscience, 7, 31.
  • Rudner, M., Lunner, T., Behrens, T., Thorén, E. S., & Rönnberg, J. (2012). Working memory capacity may influence perceived effort during aided speech recognition in noise.Journal of the American Academy of Audiology, 23, 577–589.
  • Shand, M. A., & Klima, E. S. (1981). Nonauditory suffix effects in congenitally deaf signers of American Sign Language.Journal of Experimental Psychology-Human Learning and Memory, 7, 464–474.
  • Shankweiler, D., Liberman, I. Y., Mark, L. S., Fowler, C. A., & Fischer, F. W. (1979). The speech code and learning to read.Journal of Experimental Psychology-Human Learning and Memory, 5, 531–545.
  • Snowling, M. J. (2000). Dyslexia. Oxford, United Kingdom: Blackwell.
  • Souza, P., & Arehart, K. (2015). Robust relationship between reading span and speech recognition in noise.International Journal of Audiology, 54, 705–713.
  • Spencer, L. J., & Tomblin, J. B. (2009). Evaluating phonological processing skills in children with prelingual deafness who use cochlear implants.Journal of Deaf Studies and Deaf Education, 14, 1–21.
  • Sperlich, A., Meixner, J., & Laubrock, J. (2016). Development of the perceptual span in reading: A longitudinal study.Journal of Experimental Child Psychology, 146, 181–201.
  • Spoehr, K. T., & Corin, W. J. (1978). The stimulus suffix effect as a memory coding phenomenon.Memory & Cognition, 6, 583–589.
  • Vellutino, F. R., Fletcher, J. M., Snowling, M. J., & Scanlon, D. M. (2004). Specific reading disability (dyslexia): What have we learned in the past four decades?.Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 2–40.
  • Walley, A. C., Metsala, J. L., & Garlock, V. M. (2003). Spoken vocabulary growth: Its role in the development of phoneme awareness and early reading ability.Reading and Writing: An Interdisciplinary Journal, 16, 5–20.
  • Walley, A. C., Smith, L. B., & Jusczyk, P. W. (1986). The role of phonemes and syllables in the perceived similarity of speech sounds for children.Memory & Cognition, 14, 220–229.
  • Woynaroski, T., Yoder, P., & Watson, L. R. (2016). Atypical cross-modal profiles and longitudinal associations between vocabulary scores in initially minimally verbal children with ASD.Autism Research, 9, 301–310.

Additional Resources