Discussion of Issues Related to Assessing the Signed and Spoken Language Skills of Bi/Multilingual Children

This chapter is a joint discussion of key items related to the assessment of bi-/multilingual deaf and hearing learners with and without a developmental language disorder that were presented in Chapters 6.1 and 6.2. While there is a growing body of evidence describing best practice in the assessment of bilingual children who use spoken languages, there is scant evidence or recommendations available regarding the assessment of bilingual children who use signed languages. This discussion outlines how knowledge from the assessment of spoken languages can be used to inform practice in assessing signed languages for bilingual deaf and hard-of-hearing (D/HH) children.

Cochlear Implants

Cochlear implants (CIs) are the most successful sensory implant in history, restoring the sensation of sound to thousands of persons who have severe to profound hearing loss. Implants do not recreate acoustic sound as most of us know it, but they instead convey a rough representation of the temporal envelope of signals. This sparse signal, derived from the envelopes of narrowband frequency filters, is sufficient for enabling speech understanding in quiet environments for those who lose hearing as adults and is enough for most children to develop spoken language skills. The variability between users is huge, however, and is only partially understood. CIs provide acoustic information that is sufficient for the recognition of some aspects of spoken language, especially information that can be conveyed by temporal patterns, such as syllable timing, consonant voicing, and manner of articulation. They are insufficient for conveying pitch cues and separating speech from noise. There is a great need for improving our understanding of functional outcomes of CI success beyond measuring percent correct for word and sentence recognitions. Moreover, greater understanding of the variability experienced by children, especially children and families from various social and cultural backgrounds, is of paramount importance. Future developments will no doubt expand the use of this remarkable device.

The Impact of Cumulative Cochlear Implant Wear Time on Spoken Language Outcomes at Age 3 Years

Purpose The purpose of this study was to analyze the impact of cumulative hearing hour percentage (HHP) on pediatric cochlear implant users' speech and language development at age 3 years and to determine an evidence-based wear time recommendation that yields typical spoken language standard scores. Method A retrospective chart review of 40 pediatric cochlear implant recipients was completed. Children met the following criteria: prelingually deafened, implanted at age 2 years or younger, utilized a speech processor with datalogging capabilities, a minimum of 1 year of cochlear implant use, and language testing completed at approximately age 3 years. Exclusion criteria included significant inner ear malformation (i.e., common cavity) or developmental delay that would preclude spoken language development. Results Multiple regression analysis revealed that age and implantation and HHP were predictive of spoken language skills at age 3 years. Further analysis yielded wear time recommendations associated with age-appropriate spoken language based on the age at implantation. Conclusions When the goal is age-appropriate spoken language, wear time recommendations should reflect a child's current age, age at implantation, and the comparative daily sound access of age-matched normal-hearing peers. The HHP measurement can help provide that information. The minimum wear time recommendation should be set to 80% HHP with the ultimate goal of 100% HHP to give pediatric cochlear implant recipients enough access to sound and language to achieve their spoken language goals.

I Should Do as I Say, Not as I Do

Research on outcomes following cochlear implantation has focused primarily on auditory and proximal spoken-language skills. More recently, however, evidence has emerged demonstrating that the effects of early auditory deprivation and language delays associated with deafness can have distal, cascading effects on neurocognitive and psychosocial outcomes. The few studies on psychosocial outcomes suggest that prelingually deaf cochlear implant (CI) users display highly variable outcomes, with some children demonstrating excellent adjustment and others struggling with emotional-behavioral problems and/or social deficits or delays. In this chapter, we describe how underlying neurocognitive processes, such as language and the self-regulation of cognitive and emotional responses, may account for unexplained individual differences in psychosocial outcomes in CI users. Furthermore, we identify the lack of psychometrically sound questionnaire measures of psychosocial functioning as a critical barrier to progress in the early identification and effective treatment of poor social, emotional, and behavioral outcomes in CI users.

Longitudinal Development of Executive Functioning and Spoken Language Skills in Preschool-Aged Children With Cochlear Implants

Purpose Auditory deprivation has downstream effects on the development of language and executive functioning (EF) in prelingually deaf children with cochlear implants (CIs), but little is known about the very early development of EF during preschool ages in children with CIs. This study investigated the longitudinal development of EF and spoken language skills in samples of children with normal hearing (NH; N = 40) or CIs ( N = 41) during preschool ages. Method Participants were enrolled in the study between ages 3 and 6 years and evaluated annually up to the age of 7 years. Mixed-effects models were used to evaluate and predict growth of spoken language and EF skills over time. Results Children with CIs scored lower than NH peers on language measures but improved significantly over time. On performance-based neurocognitive measures of controlled attention, inhibition, and working memory, children with CIs scored more poorly than the sample of NH peers but comparable to norms, whereas on a parent report behavior checklist, children with CIs scored more poorly than both NH peers and norms on inhibition and working memory. Children with CIs had poorer EF than the sample of NH peers in most domains even after accounting for language effects, and language predicted only the verbal working memory domain of EF. In contrast, EF skills consistently predicted language skills at subsequent visits. Conclusions Findings demonstrate that, despite significant improvement over time, some domains of EF (particularly parent-reported EF) and language skills in children with CIs lag behind those of children with NH during preschool ages. Language delays do not fully explain differences in EF development between children with CIs and NH peers during preschool ages, but EF skills predict subsequent language development in children with CIs.

A Case Study of Student Experiences of Multi-modal Net-based Language Learning

This article presents the results of a case study of student attitudes toward the development of language skills through net-based language learning, and especially through a multi-modal platform, Adobe Connect. Research has demonstrated that language skills can be developed through different net-based set-ups, but that technology can sometimes be a barrier. An online survey was conducted with students on net-based English courses at a Swedish university. Informants reported that they had positive experiences of such learning, but that they felt that speaking skills were difficult to develop, often due to connection problems. Listening was a particular problem during so-called hybrid seminars, where net-based students interacted with campus students. Informants felt that the main pedagogical issues for net-based language learning were the attitudes of the instructors and students. The set-up of courses can help develop spoken language skills, including interaction, but also the willingness of fellow students to interact orally rather than through text chat is important.

Constructing Knowledge-Based Feedback in the Context of an Interactive Spoken CALL Application

Modern Computer Assisted Language Learning (CALL) systems use speech recognition to give students the opportunity to build up their spoken language skills through interactive practice with a mechanical partner. Besides the obvious benefits that these systems can offer, e.g. flexible and inexpensive learning, user interaction in this context can often be problematic. In this article, the authors introduce a parallel layer of feedback in a CALL application, which can monitor interaction, report errors and provide advice and suggestions to students. This mechanism combines knowledge accumulated from four different inputs in order to decide on appropriate feedback, which can be customized and adapted in terms of phrasing, style and language. The authors report the results from experiments conducted at six lower secondary classrooms in German-speaking Switzerland with and without this mechanism. After analyzing approximately 13,000 spoken interactions it can be reasonably argued that their parallel feedback mechanism in L2 actually does help students during interaction and contributes as a motivation factor.

Effects of Early Acoustic Hearing on Speech Perception and Language for Pediatric Cochlear Implant Recipients

Purpose The overall goal of the current study was to identify an optimal level and duration of acoustic experience that facilitates language development for pediatric cochlear implant (CI) recipients—specifically, to determine whether there is an optimal duration of hearing aid (HA) use and unaided threshold levels that should be considered before proceeding to bilateral CIs. Method A total of 117 pediatric CI recipients (ages 5–9 years) were given speech perception and standardized tests of receptive vocabulary and language. The speech perception battery included tests of segmental perception (e.g., word recognition in quiet and noise, and vowels and consonants in quiet) and of suprasegmental perception (e.g., talker and stress discrimination, and emotion identification). Hierarchical regression analyses were used to determine the effects of speech perception on language scores, and the effects of residual hearing level (unaided pure-tone average [PTA]) and duration of HA use on speech perception. Results A continuum of residual hearing levels and the length of HA use were represented by calculating the unaided PTA of the ear with the longest duration of HA use for each child. All children wore 2 devices: Some wore bimodal devices, while others received their 2nd CI either simultaneously or sequentially, representing a wide range of HA use (0.03–9.05 years). Regression analyses indicate that suprasegmental perception contributes unique variance to receptive language scores and that both segmental and suprasegmental skills each contribute independently to receptive vocabulary scores. Also, analyses revealed an optimal duration of HA use for each of 3 ranges of hearing loss severity (with mean PTAs of 73, 92, and 111 dB HL) that maximizes suprasegmental perception. Conclusions For children with the most profound losses, early bilateral CIs provide the greatest opportunity for developing good spoken language skills. For those with moderate-to-severe losses, however, a prescribed period of bimodal use may be more advantageous for developing good spoken language skills.