No AccessLanguage, Speech, and Hearing Services in SchoolsResearch Article5 Jan 2022

Disparate Oral and Written Language Abilities in Adolescents With Cochlear Implants: Evidence From Narrative Samples

Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville

Abstract

Purpose:

In spite of improvements in language outcomes for children with hearing loss (HL) arising from cochlear implants (CIs), these children can falter when it comes to academic achievement, especially in higher grades. Given that writing becomes increasingly relevant to educational pursuits as children progress through school, this study explored the hypothesis that one challenge facing students with CIs may be written language.

Method:

Participants were 98 eighth graders: 52 with normal hearing (NH) and 46 with severe-to-profound HL who used CIs. Oral and written narratives were elicited and analyzed for morphosyntactic complexity and global narrative features. Five additional measures were collected and analyzed as possible predictors of morphosyntactic complexity: Sentence Comprehension of Syntax, Grammaticality Judgment, Expressive Vocabulary, Forward Digit Span, and Phonological Awareness.

Results:

For oral narratives, groups performed similarly on both morphosyntactic complexity and global narrative features; for written narratives, critical differences were observed. Compared with adolescents with NH, adolescents with CIs used fewer markers of morphosyntactic complexity and scored lower on several global narrative features in their written narratives. Adolescents with NH outperformed those with CIs on all potential predictor measures, except for Sentence Comprehension of Syntax. Moderately strong relationships were found between predictor variables and individual measures of morphosyntactic complexity, but no comprehensive pattern explained the results. Measures of morphosyntactic complexity and global narrative features were not well correlated, suggesting these measures are assessing separate underlying constructs.

Conclusions:

Adolescents with CIs fail to show writing proficiency at high school entry equivalent to that of their peers with NH, which could constrain their academic achievement. Interventions for children with CIs need to target writing skills, and writing assessments should be incorporated into diagnostic assessments.

Supplemental Material:

https://doi.org/10.23641/asha.17139059

References

Albertini, J. A., & Schley, S. (2003). Writing: Characteristics, instruction, and assessment.In M. Marschark & P. E. Spencer (Eds.), Oxford handbook of deaf studies, language, and education (pp. 123–135). Oxford University Press.
Google Scholar
Arfé, B., Nicolini, F., & Pozzebon, E. (2014). The influence of verbal working memory on writing skills in children with hearing loss.In B. Arfé, J. Dockrell, & V. W. Berninger (Eds.), Writing development in children with hearing loss, dyslexia, or oral language problems (pp. 85–99). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199827282.003.0007
Crossref Google Scholar
Barnes, E. M., Grifenhagen, J. F., & Dickinson, D. K. (2016). Academic language in early childhood classrooms.Reading Teacher, 70(1), 39–48. https://doi.org/10.1002/trtr.1463
Crossref Google Scholar
Barr, C. D., Uccelli, P., & Phillips Galloway, E. (2019). Specifying the academic language skills that support text understanding in the middle grades: The design and validation of the Core Academic Language Skills Construct and Instrument.Language Learning, 69(4), 978–1021. https://doi.org/10.1111/lang.12365
Crossref Google Scholar
Beers, S. F., & Nagy, W. E. (2011). Writing development in four genres from grades three to seven: Syntactic complexity and genre differentiation.Reading and Writing, 24(2), 183–202. https://doi.org/10.1007/s11145-010-9264-9
Crossref Google Scholar
Bell, N., Angwin, A. J., Wilson, W. J., & Arnott, W. L. (2019). Reading development in children with cochlear implants who communicate via spoken language: A psycholinguistic investigation.Journal of Speech, Language, and Hearing Research, 62(2), 456–469. https://doi.org/10.1044/2018_JSLHR-H-17-0469
ASHAWire Google Scholar
Berman, R. A. (2014). Linguistic perspectives on writing development.In B. Arfé, J. Dockrell, & V. Berninger (Eds.), Writing development in children with hearing loss, dyslexia, or oral language problems (pp. 16–32). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199827282.003.0002
Crossref Google Scholar
Berninger, V. W., Nagy, W., & Beers, S. (2011). Child writers' construction and reconstruction of single sentences and construction of multi-sentence texts: Contributions of syntax and transcription to translation.Reading and Writing, 24(2), 151–182. https://doi.org/10.1007/s11145-010-9262-y
Crossref Medline Google Scholar
Boons, T., De Raeve, L., Langereis, M., Peeraer, L., Wouters, J., & van Wieringen, A. (2013a). Expressive vocabulary, morphology, syntax and narrative skills in profoundly deaf children after early cochlear implantation.Research in Developmental Disabilities, 34(6), 2008–2022. https://doi.org/10.1016/j.ridd.2013.03.003
Crossref Medline Google Scholar
Boons, T., De Raeve, L., Langereis, M., Peeraer, L., Wouters, J., & van Wieringen, A. (2013b). Narrative spoken language skills in severely hearing impaired school-aged children with cochlear implants.Research in Developmental Disabilities, 34(11), 3833–3846. https://doi.org/10.1016/j.ridd.2013.07.033
Crossref Medline Google Scholar
Boothroyd, A., Geers, A. E., & Moog, J. S. (1991). Practical implications of cochlear implants in children.Ear and Hearing, 12(4), 81S–89S. https://doi.org/10.1097/00003446-199108001-00010
Crossref Medline Google Scholar
Botting, N. (2002). Narrative as a tool for the assessment of linguistic and pragmatic impairments.Child Language Teaching and Therapy, 18(1), 1–21. https://doi.org/10.1191/0265659002ct224oa
Crossref Google Scholar
Bradham, T. S., Fonnesbeck, C., Toll, A., & Hecht, B. F. (2018). The listening and spoken language data repository: Design and project overview.Language, Speech, and Hearing Services in Schools, 49(1), 108–120. https://doi.org/10.1044/2017_LSHSS-16-0087
ASHAWire Google Scholar
Brimo, D., & Hall-Mills, S. (2019). Adolescents' production of complex syntax in spoken and written expository and persuasive genres.Clinical Linguistics & Phonetics, 33(3), 237–255. https://doi.org/10.1080/02699206.2018.1504987
Crossref Medline Google Scholar
Carrow-Woolfolk, E. (1999). Comprehensive Assessment of Spoken Language (CASL). Pearson.
Google Scholar
çizmeci, H., & çiprut, A. (2018). Evaluation of the reading and writing skills of children with cochlear implants.Journal of International Advanced Otology, 14(3), 359–364. https://doi.org/10.5152/iao.2018.4436
Crossref Medline Google Scholar
Crosson, J., & Geers, A. (2001). Analysis of narrative ability in children with cochlear implants.Ear and Hearing, 22(5), 381–394. https://doi.org/10.1097/00003446-200110000-00003
Crossref Medline Google Scholar
Durrant, P., Brenchley, M., & Clarkson, R. (2020). Syntactic development across genres in children's writing: The case of adverbial clauses.Journal of Writing Research, 12(2), 419–452. https://doi.org/10.17239/jowr-2020.12.02.04
Crossref Google Scholar
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(6), 1301–1318. https://doi.org/10.1044/1092-4388(2004/098)
ASHAWire Google Scholar
Galloway, E. P., & Uccelli, P. (2015). Modeling the relationship between lexico-grammatical and discourse organization skills in middle grade writers: Insights into later productive language skills that support academic writing.Reading and Writing, 28(6), 797–828. https://doi.org/10.1007/s11145-015-9550-7
Crossref Google Scholar
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(Suppl. 1), 49S–59S. https://doi.org/10.1097/aud.0b013e3181fa41fa
Crossref Medline Google Scholar
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(2), 643–655. https://doi.org/10.1044/1092-4388(2012/11-0347)
ASHAWire Google Scholar
Geers, A. E., Nicholas, J. G., 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(1), 155–170. https://doi.org/10.1044/2015_JSLHR-H-14-0173
ASHAWire Google Scholar
Gillam, S. L., & Gillam, R. B. (2016). Narrative discourse intervention for school-aged children with language impairment.Topics in Language Disorders, 36(1), 20–34. https://doi.org/10.1097/TLD.0000000000000081
Crossref Google Scholar
Huttunen, K., & Ryder, N. (2012). How children with normal hearing and children with a cochlear implant use mentalizing vocabulary and other evaluative expressions in their narratives.Clinical Linguistics & Phonetics, 26(10), 823–844. https://doi.org/10.3109/02699206.2012.682836
Crossref Medline Google Scholar
Jones, A. C., Toscano, E., Botting, N., Marshall, C. R., Atkinson, J. R., Denmark, T., Herman, R., & Morgan, G. (2016). Narrative skills in deaf children who use spoken English: Dissociations between macro and microstructural devices.Research in Developmental Disabilities, 59, 268–282. https://doi.org/10.1016/j.ridd.2016.09.010
Crossref Medline Google Scholar
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 and Deaf Education, 19(4), 456–470. https://doi.org/10.1093/deafed/enu011
Crossref Medline Google Scholar
Kronenberger, W. G., & Pisoni, D. B. (2019). Assessing higher order language processing in long-term cochlear implant users.American Journal of Speech-Language Pathology, 28(4), 1537–1553. https://doi.org/10.1044/2019_AJSLP-18-0138
ASHAWire Google Scholar
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(3), 443–450. https://doi.org/10.1097/MAO.0b013e3182814d2c
Crossref Medline Google Scholar
Loban, W. (1976). Language development: Kindergarten through grade twelve. National Council of Teachers of English.
Google Scholar
Lowenstein, J. H., & Nittrouer, S. (2021). The devil in the details can be hard to spot: Malapropisms and children with hearing loss.Language, Speech, and Hearing Services in Schools, 52(1), 335–353. https://doi.org/10.1044/2020_LSHSS-20-00033
ASHAWire Google Scholar
Marschark, M., Rhoten, C., & Fabich, M. (2007). Effects of cochlear implants on children's reading and academic achievement.Journal of Deaf Studies and Deaf Education, 12(3), 269–282. https://doi.org/10.1093/deafed/enm013
Crossref Medline Google Scholar
Marschark, M., Shaver, D. M., Nagle, K. M., & Newman, L. A. (2015). Predicting the academic achievement of deaf and hard-of-hearing students from individual, household, communication, and educational factors.Exceptional Children, 81(3), 350–369. https://doi.org/10.1177/0014402914563700
Crossref Medline Google Scholar
Martin, N., & Brownell, R. (2011). Expressive One-Word Picture Vocabulary Test–Fourth Edition (EOWPVT-4). Academic Therapy Publications.
Google Scholar
Mayer, C., & Trezek, B. J. (2018). Literacy outcomes in deaf students with cochlear implants: Current state of the knowledge.Journal of Deaf Studies and Deaf Education, 23(1), 1–16. https://doi.org/10.1093/deafed/enx043
Crossref Medline Google Scholar
Mayer, C., & Trezek, B. J. (2019). Writing and deafness: State of the evidence and implications for research and practice.Education Sciences, 9(3), 185. https://doi.org/10.3390/educsci9030185
Crossref Google Scholar
Mayer, C., Watson, L., Archbold, S., Ng, Z. Y., & Mulla, I. (2016). Reading and writing skills of deaf pupils with cochlear implants.Deafness and Education International, 18(2), 71–86. https://doi.org/10.1080/14643154.2016.1155346
Crossref Google Scholar
Miller, J. F., & Iglesias, A. (2010). Systematic Analysis of Language Transcripts (Research Version 2010) [Computer software]. SALT Software.
Google Scholar
Miller, J. F., & Iglesias, A. (2016). Systematic Analysis of Language Transcripts (Research Version 2016) [Computer software]. SALT Software.
Google Scholar
Nippold, M. A., Fantz-Kaspar, M. W., & Vigeland, L. M. (2017). Spoken language production in young adults: Examining syntactic complexity.Journal of Speech, Language, and Hearing Research, 60(5), 1339–1347. https://doi.org/10.1044/2016_JSLHR-L-16-0124
ASHAWire Google Scholar
Nippold, M. A., Hesketh, L. J., Duthie, J. K., & Mansfield, T. C. (2005). Conversational versus expository discourse.Journal of Speech, Language, and Hearing Research, 48(5), 1048–1064. https://doi.org/10.1044/1092-4388(2005/073)
ASHAWire Google Scholar
Nippold, M. A., Mansfield, T. C., Billow, J. L., & Tomblin, J. B. (2008). Expository discourse in adolescents with language impairments: Examining syntactic development.American Journal of Speech-Language Pathology, 17(4), 356–366. https://doi.org/10.1044/1058-0360(2008/07-0049)
ASHAWire Google Scholar
Nittrouer, S. (2010). Early development of children with hearing loss. Plural.
Google Scholar
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(1), 29–63. https://doi.org/10.1016/j.jcomdis.2004.03.006
Crossref Medline Google Scholar
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(8), 1148–1158. https://doi.org/10.1016/j.ijporl.2012.04.024
Crossref Medline Google Scholar
Nittrouer, S., Caldwell-Tarr, A., Low, K. E., & Lowenstein, J. H. (2017). Verbal working memory in children with cochlear implants.Journal of Speech, Language, and Hearing Research, 60(11), 3342–3364. https://doi.org/10.1044/2017_JSLHR-H-16-0474
ASHAWire Google Scholar
Nittrouer, S., Caldwell-Tarr, A., Tarr, E., Lowenstein, J. H., Rice, C., & Moberly, A. C. (2013). Improving speech-in-noise recognition for children with hearing loss: Potential effects of language abilities, binaural summation, and head shadow.International Journal of Audiology, 52(8), 513–525. https://doi.org/10.3109/14992027.2013.792957
Crossref Medline Google Scholar
Nittrouer, S., & Lowenstein, J. H. (2021). When language outgrows them: Comprehension of ambiguous sentences in children with normal hearing and children with hearing loss.International Journal of Pediatric Otorhinolaryngology, 141, Article 110514. https://doi.org/10.1016/j.ijporl.2020.110514
Crossref Medline Google Scholar
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(6), 1520–1532. https://doi.org/10.1044/2016_JSLHR-H-15-0404
ASHAWire Google Scholar
Nittrouer, S., Muir, M., Tietgens, K., Moberly, A. C., & Lowenstein, J. H. (2018). Development of phonological, lexical, and syntactic abilities in children with cochlear implants across the elementary grades.Journal of Speech, Language, and Hearing Research, 61(10), 2561–2577. https://doi.org/10.1044/2018_JSLHR-H-18-0047
ASHAWire Google Scholar
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(5), 506–518. https://doi.org/10.1097/AUD.0000000000000051
Crossref Medline Google Scholar
Parker, M. D., & Brorson, K. (2005). A comparative study between mean length of utterance in morphemes (MLUm) and mean length of utterance in words (MLUw).First Language, 25(3), 365–376. https://doi.org/10.1177/0142723705059114
Crossref Google Scholar
Pisoni, D. B., & Kronenberger, W. G. (2021). Recognizing spoken words in semantically-anomalous sentences: Effects of executive control in early-implanted deaf children with cochlear implants.Cochlear Implants International,( 22(4), 223–236. https://doi.org/10.1080/14670100.2021.1884433
Crossref Medline Google Scholar
Qi, S., & Mitchell, R. E. (2012). Large-scale academic achievement testing of deaf and hard-of-hearing students: Past, present, and future.Journal of Deaf Studies and Deaf Education, 17(1), 1–18. https://doi.org/10.1093/deafed/enr028
Crossref Medline Google Scholar
Ravid, D., & Berman, R. A. (2010). Developing noun phrase complexity at school age: A text-embedded cross-linguistic analysis.First Language, 30(1), 3–26. https://doi.org/10.1177/0142723709350531
Crossref Google Scholar
Ravid, D., & Tolchinsky, L. (2002). Developing linguistic literacy: A comprehensive model.Journal of Child Language, 29(2), 417–447. https://doi.org/10.1017/s0305000902005111
Crossref Medline Google Scholar
Roid, G. H., & Miller, L. J. (2002). Leiter International Performance Scale–Revised (LIPS-R). Stoelting.
Google Scholar
Sarant, J. Z., Harris, D. C., & Bennet, L. A. (2015). Academic outcomes for school-aged children with severe–profound hearing loss and early unilateral and bilateral cochlear implants.Journal of Speech, Language, and Hearing Research, 58(3), 1017–1032. https://doi.org/10.1044/2015_JSLHR-H-14-0075
ASHAWire Google Scholar
Scott, C. M., & Balthazar, C. H. (2010). The grammar of information: Challenges for older students with language impairments.Topics in Language Disorders, 30(4), 288–307. https://doi.org/10.1097/tld.0b013e3181f90878
Crossref Medline Google Scholar
Scott, C. M., & Windsor, J. (2000). General language performance measures in spoken and written narrative and expository discourse of school-age children with language learning disabilities.Journal of Speech, Language, and Hearing Research, 43(2), 324–339. https://doi.org/10.1044/jslhr.4302.324
ASHAWire Google Scholar
Smith, G. N. L., Pisoni, D. B., & Kronenberger, W. G. (2019). High-variability sentence recognition in long-term cochlear implant users: Associations with rapid phonological coding and executive functioning.Ear and Hearing, 40(5), 1149–1161. https://doi.org/10.1097/AUD.0000000000000691
Crossref Medline Google Scholar
Snow, C. E. (2010). Academic language and the challenge of reading for learning about science.Science, 328(5977), 450–452. https://doi.org/10.1126/science.1182597
Crossref Medline Google Scholar
Snow, C. E., & Uccelli, P. (2009). The challenge of academic language.In D. R. Olson & N. Torrance (Eds.), The Cambridge handbook of literacy (pp. 112–133). Cambridge University Press. https://doi.org/10.1017/cbo9780511609664.008
Crossref Google Scholar
Spencer, L. J., Barker, B. A., & Tomblin, J. B. (2003). Exploring the language and literacy outcomes of pediatric cochlear implant users.Ear and Hearing, 24(3), 236–247. https://doi.org/10.1097/01.AUD.0000069231.72244.94
Crossref Medline Google Scholar
Spencer, L. J., Gantz, B. J., & Knutson, J. F. (2004). Outcomes and achievement of students who grew up with access to cochlear implants.Laryngoscope, 114(9), 1576–1581. https://doi.org/10.1097/00005537-200409000-00014
Crossref Medline Google Scholar
Svirsky, M. A., Robbins, A. M., Kirk, K. H., Pisoni, D. B., & Miyamoto, R. T. (2000). Language development in profoundly deaf children with cochlear implants.Psychological Science, 11(2), 153–158. https://doi.org/10.1111/1467-9280.00231
Crossref Medline Google Scholar
Tomblin, J. B., Spencer, L. J., Flock, S., Tyler, R., & Gantz, B. (1999). A comparison of language achievement in children with cochlear implants and children using hearing aids.Journal of Speech, Language, and Hearing Research, 42(2), 497–511. https://doi.org/10.1044/jslhr.4202.497
ASHAWire Google Scholar
Wang, Y., Sibaii, F., Lee, K., Gill, M. J., & Hatch, J. L. (2021). Meta-analytic findings on reading in children with cochlear implants.Journal of Deaf Studies and Deaf Education, 26(3), 336–350. https://doi.org/10.1093/deafed/enab010
Crossref Medline Google Scholar
Wechsler, D. (1991). Wechsler Intelligence Scale for Children–Third Edition. The Psychological Corporation.
Google Scholar
Woodcock, R., & Johnson, M. B. (1990). Woodcock-Johnson Tests of Achievement. Riverside.
Google Scholar
Woodcock, R., McGrew, K., & Mather, N. (2001). Woodcock-Johnson III Tests of Achievement. Riverside.
Google Scholar
Wu, C. M., Ko, H. C., Chen, Y. A., Tsou, Y. T., & Chao, W. C. (2015). Written language ability in Mandarin-speaking children with cochlear implants.BioMed Research International, 2015, 1–8. https://doi.org/10.1155/2015/282164
Google Scholar
Zamani, P., Soleymani, Z., Rashedi, V., Farahani, F., Lotfi, G., & Rezaei, M. (2018). Spoken and written narrative in Persian-speaking students who received cochlear implant and/or hearing aid.Clinical and Experimental Otorhinolaryngology, 11(4), 250–258. https://doi.org/10.21053/ceo.2017.01011
Crossref Medline Google Scholar