Development of Phonological, Lexical, and Syntactic Abilities in Children With Cochlear Implants Across the Elementary Grades
Publication: Journal of Speech, Language, and Hearing Research
Volume 61, Number 10
Pages 2561-2577
Abstract
Purpose
This study assessed phonological, lexical, and morphosyntactic abilities at 6th grade for a group of children previously tested at 2nd grade to address 4 questions: (a) Do children with cochlear implants (CIs) demonstrate deficits at 6th grade? (b) Are those deficits greater, the same, or lesser in magnitude than those observed at 2nd grade? (c) How do the measured skills relate to each other? and (d) How do treatment variables affect outcome measures?
Participants
Sixty-two 6th graders (29 with normal hearing, 33 with CIs) participated, all of whom had their language assessed at 2nd grade.
Method
Data are reported for 12 measures obtained at 6th grade, assessing phonological, lexical, and morphosyntactic abilities. Between-groups analyses were conducted on 6th-grade measures and the magnitude of observed effects compared with those observed at 2nd grade. Correlational analyses were performed among the measures at 6th grade. Cross-lagged analyses were performed on specific 2nd- and 6th-grade measures of phonological awareness, vocabulary, and literacy to assess factors promoting phonological and lexical development. Treatment effects of age of 1st CI, preimplant thresholds, and bimodal experience were evaluated.
Results
Deficits remained fairly consistent in type and magnitude across elementary school. The largest deficits were found for phonological skills and the least for morphosyntactic skills, with lexical skills intermediate. Phonological and morphosyntactic skills were largely independent of each other; lexical skills were moderately related to phonological skills but not morphosyntactic skills. Literacy acquisition strongly promoted both phonological and lexical development. Of the treatment variables, only bimodal experience affected outcomes and did so positively.
Conclusions
Congenital hearing loss puts children at continued risk of language deficits, especially for phonologically based skills. Two interventions that appear to ameliorate that risk are providing a period of bimodal stimulation and strong literacy instruction.
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References
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.
Carrow-Woolfolk, E. (1999). Comprehensive Assessment of Spoken Language (CASL). Bloomington, MN: Pearson Assessments.
Charles-Luce, J., & Luce, P. A. (1990). Similarity neighbourhoods of words in young children's lexicons. Journal of Child Language, 17, 205–215.
Ching, T. Y., Dillon, H., Marnane, V., Hou, S., Day, J., Seeto, M., … Yeh, A. (2013). Outcomes of early- and late-identified children at 3 years of age: Findings from a prospective population-based study. Ear and Hearing, 34, 535–552.
Ching, T. Y., van Wanrooy, E., Hill, M., & Incerti, P. (2006). Performance of children with hearing aids or cochlear implants: Bilateral stimulation and binaural hearing. International Journal of Audiology, (Suppl. 45), S108–S112.
Dunn, C. C., Walker, E. A., Oleson, J., Kenworthy, M., Van Voorst, T., Tomblin, J. B., … Gantz, B. J. (2014). Longitudinal speech perception and language performance in pediatric cochlear implant users: The effect of age at implantation. Ear and Hearing, 35, 148–160.
Dunn, L., & Dunn, D. (1997). Peabody Picture Vocabulary Test–Third Edition (PPVT-III). Circle Pines, MN: AGS.
Gallego, C., Martín-Aragoneses, M. T., López-Higes, R., & Pisón, G. (2016). Semantic and syntactic reading comprehension strategies used by deaf children with early and late cochlear implantation. Research in Developmental Disabilities, 49–50, 153–170.
Geers, A. E., Davidson, L. S., Uchanski, R. M., & Nicholas, J. G. (2013). Interdependence of linguistic and indexical speech perception skills in school-age children with early cochlear implantation. Ear and Hearing, 34, 562–574.
Geers, A. E., & Hayes, H. (2011). Reading, writing, and phonological processing skills of adolescents with 10 or more years of cochlear implant experience. Ear and Hearing, 32, 49S–59S.
Geers, A. E., Nicholas, J., Tobey, E., & Davidson, L. (2016). Persistent language delay versus late language emergence in children with early cochlear implantation. Journal of Speech, Language, and Hearing Research, 59, 155–170.
Geers, A. E., & Nicholas, J. G. (2013). Enduring advantages of early cochlear implantation for spoken language development. Journal of Speech, Language, and Hearing Research, 56, 643–655.
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.
Harris, M., Terlektsi, E., & Kyle, F. E. (2017). Concurrent and longitudinal predictors of reading for deaf and hearing children in primary school. Journal of Deaf Studies and Deaf Education, 22, 233–242.
Hockett, C. F. (1960). The origin of speech. Scientific American, 203, 89–96.
Hogan, T. P., Bowles, R. P., Catts, H. W., & Storkel, H. L. (2011). The influence of neighborhood density and word frequency on phoneme awareness in 2nd and 4th grades. Journal of Communication Disorders, 44, 49–58.
Holt, R. F., & Svirsky, M. A. (2008). An exploratory look at pediatric cochlear implantation: Is earliest always best? Ear and Hearing, 29, 1–20.
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.
Kirk, K. I., Pisoni, D. B., & Osberger, M. J. (1995). Lexical effects on spoken word recognition by pediatric cochlear implant users. Ear and Hearing, 16, 470–481.
Lederberg, A. R., Miller, E. M., Easterbrooks, S. R., & Connor, C. M. (2014). Foundations for literacy: An early literacy intervention for deaf and hard-of-hearing children. Journal of Deaf Studies and Deaf Education, 19, 438–455.
Leigh, J., Dettman, S., Dowell, R., & Briggs, R. (2013). Communication development in children who receive a cochlear implant by 12 months of age. Otology and Neurotology, 34, 443–450.
Liberman, I. Y., Shankweiler, D., Fischer, F. W., & Carter, B. (1974). Explicit syllable and phoneme segmentation in the young child. Journal of Experimental Child Psychology, 18, 201–212.
Lund, E. (2016). Vocabulary knowledge of children with cochlear implants: A meta-analysis. Journal of Deaf Studies and Deaf Education, 21, 107–121.
Martin, N., & Brownell, R. (2011). Expressive One-Word Picture Vocabulary Test–Fourth Edition (EOWPVT-4). Novato, CA: Academic Therapy Publications.
Metsala, J. L., & Walley, A. C. (1998). Spoken vocabulary growth and the segmental rstructuring of lexical representations: Precursors to phonemic awareness and early reading ability. In Metsala, J. L. & Ehri, L. C. (Eds.), Word recognition in beginning literacy (pp. 89–120). Mahwah, NJ: Erlbaum.
Miller, J., & Iglesias, A. (2010). Systematic Analysis of Language Transcripts (Research Version 2010) [Computer software] . Madison, WI: SALT Software.
Miller, J., & Iglesias, A. (2016). Systematic Analysis of Language Transcripts (Research Version 16) [Computer software] . Madison, WI: SALT Software.
Moberly, A. C., Lowenstein, J. H., & Nittrouer, S. (2016). Early bimodal stimulation benefits language acquisition for children with cochlear implants. Otology & Neurotology, 37, 24–30.
Nittrouer, S. (2010). Early development of children with hearing loss. San Diego, CA: Plural.
Nittrouer, S. (2016). Integrated language intervention for children with hearing loss. In Young, N. & Kirk, K. I. (Eds.), Pediatric cochlear implantation: Learning and the brain (pp. 299–312). New York, NY: Springer.
Nittrouer, S., & Burton, L. (2002). The role of early language experience in the development of speech perception and language processing abilities in children with hearing loss. The Volta Review, 103, 5–37.
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., Lowenstein, J. H., Tarr, E., & Holloman, C. (2012). Emergent literacy in kindergartners with cochlear implants. Ear and Hearing, 33, 683–697.
Nittrouer, S., & Caldwell-Tarr, A. (2016). Language and literacy skills in children with cochlear implants: Past and present findings. In Young, N. & Kirk, K. I. (Eds.), Pediatric cochlear implantation: Learning and the brain (pp. 177–197). New York, NY: Springer.
Nittrouer, S., & Chapman, C. (2009). The effects of bilateral electric and bimodal electric-acoustic stimulation on language development. Trends in Amplification, 13, 190–205.
Nittrouer, S., & Lowenstein, J. H. (2013). Perceptual organization of speech signals by children with and without dyslexia. Research in Developmental Disabilities, 34, 2304–2325.
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.
Nittrouer, S., Shune, S., & Lowenstein, J. H. (2011). What is the deficit in phonological processing deficits: Auditory sensitivity, masking, or category formation? Journal of Experimental Child Psychology, 108, 762–785.
Noble, T. H. (1980). The day Jimmy's boa ate the wash. New York, NY: Dial Books for Young Readers.
Port, R. (2007). How are words stored in memory? Beyond phones and phonemes. New Ideas in Psychology, 25, 143–170.
Roid, G. H., & Miller, L. J. (2002). Leiter International Performance Scale–Revised (LIPS-R). Wood Dale, IL: Stoelting.
Semel, E., Wiig, E. H., & Secord, W. A. (2003). Clinical Evaluation of Language Fundamentals–Fourth Edition (CELF-4). San Antonio, TX: The Psychological Corporation.
Snowling, M. J. (2000). Dyslexia. Oxford, England: Blackwell.
Storkel, H. L. (2002). Restructuring of similarity neighbourhoods in the developing mental lexicon. Journal of Child Language, 29, 251–274.
Tobey, E. A., Thal, D., Niparko, J. K., Eisenberg, L. S., Quittner, A. L., & Wang, N. Y. (2013). Influence of implantation age on school-age language performance in pediatric cochlear implant users. International Journal of Audiology, 52, 219–229.
Wagner, R. K., & Torgesen, J. K. (1987). The nature of phonological processing and its causal role in the acquisition of reading skills. Psychological Bulletin, 101, 192–212.
Walley, A. C. (1993). The role of vocabulary development in children's spoken word recognition and segmentation ability. Developmental Review, 13, 286–350.
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.
Wilkinson, G. S., & Robertson, G. J. (2006). Wide Range Achievement Test 4 (WRAT4). Lutz, FL: Psychological Assessment Resources.
Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (2002). Preschool Language Scale–Fourth Edition (PLS-4). San Antonio, TX: The Psychological Corporation.
Information & Authors
Information
Published In
Journal of Speech, Language, and Hearing Research
Volume 61 • Number 10 • October 2018
Pages: 2561-2577
PubMed: 30242344
Copyright
Copyright © 2018 American Speech-Language-Hearing Association.
History
- Received: Feb 5, 2018
- Revised: Apr 12, 2018
- Accepted: Jun 3, 2018
- Published in issue: Oct 26, 2018
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