Dissociating the Impact of Auditory Access and Language Access in Deaf Children’s Cognitive Development

Deaf and hard of hearing (DHH) children have been claimed to lag behind their hearing peers in various domains of cognitive development, especially in implicit learning, executive function, and working memory. Two major accounts of these deficits have been proposed: one based on a lack of auditory access, and one based on a lack of language access. This chapter reviews these theories in relation to the available evidence and concludes that there is little evidence of direct effects of diminished auditory access on cognitive development that could not also be explained by diminished language access. Specifically, reports of deficits in implicit learning are not broadly replicable. Some differences in executive function do stem from deafness itself but are not necessarily deficits. Where clinically relevant deficits in executive function are observed, they are inconsistent with the predictions of accounts based on auditory access, but consistent with accounts based on language access. Deaf–hearing differences on verbal working memory tasks may indicate problems with perception and/or language, rather than with working memory. Deaf–hearing differences on nonverbal tasks are more consistent with accounts based on language access, but much more study is needed in this area. The chapter concludes by considering the implications of these findings for psychological theory and for clinical/educational practice and by identifying high-priority targets for future research.

Why Are Children with Cochlear Implants at Risk for Executive Functioning Delays?

Prelingually deaf children with cochlear implants (CIs) have about 2 to 5 times more risk for delays in specific domains of executive functioning (EF) than normal-hearing (NH) children, with about 25% to 40% of children with CIs showing delays in specific EF subdomains. This chapter reviews the rationale and evidence for two theoretical approaches to explaining this elevated risk for EF delay: language-focused approaches and biopsychosocial systems theories, such as the auditory neurocognitive model. Research supporting language-focused approaches, which attribute risk of EF delays entirely to language delays, has significant limitations. Furthermore, results from an extensive data set of EF outcomes in CI users are inconsistent with language-focused approaches. In contrast, biopsychosocial systems theories, which attribute risk for EF delay to a system of factors, including auditory experience, language, family environment/experiences, fluid intelligence, and psychosocial influences, provide the strongest evidence and potential for explaining EF delays and outcomes in children with CIs.

It Is More Than Language

Deaf and hard-of-hearing (DHH) children who use spoken language face unique challenges when communicating with others who have typical hearing, particularly their peers. In such contexts, the social use of language has been recognized as an area of vulnerability among individuals in this population and has become a focus for research and intervention. The development of pragmatic skills intersects with many aspects of child development, including emotional intelligence and executive function, as well as social and emotional development. While all these areas are important, they are beyond the scope of this chapter, which highlights the impact of pragmatics on the specific area of cognition. Cognitive pragmatics is broadly defined as the study of the mental processes involved in the understanding of meaning in the context of a cooperative interaction. This chapter explores how DHH children and young people construe meaning in the context of conversations and expository interactions with their peers. The chapter aims to examine the role played by the cognitive processes of making inferences and comprehending implicature, within the overall display of pragmatic skills. Further, the authors use this lens in the analysis of interactions between DHH children and their peers in order to shed light on the development of pragmatic skills in children who are DHH.

Foundations of Language Development in Deaf and Hard-of-Hearing Infants

Copious evidence indicates that, even in the first year of life, children’s language development is beginning and is impacted by a wide array of cognitive and social processes. The extent to which these processes are dependent on early language input is a critical concern for most deaf and hard-of-hearing (DHH) children, who, unlike hearing children, are usually not immersed in a language-rich environment until effective interventions, such as hearing aids or cochlear implants, are implemented. Importantly, some cognitive and social processes are not dependent on the early availability of language input and begin to develop before children are fitted for hearing aids or cochlear implants. Interventions involving parent training may be helpful for enhancing social underpinnings of language and for maximizing DHH children’s language learning once effective hearing devices are in place. Similarly, cognitive training for DHH children may also provide benefit to bolster language development.

The Neurobiology of Reading Differs for Deaf and Hearing Adults

Recent neuroimaging and electrophysiological studies reveal how the reading system successfully adapts when phonological codes are relatively coarse-grained due to reduced auditory input during development. New evidence suggests that the optimal end-state for the reading system may differ for deaf versus hearing adults and indicates that certain neural patterns that are maladaptive for hearing readers may be beneficial for deaf readers. This chapter focuses on deaf adults who are signers and have achieved reading success. Although the left-hemisphere-dominant reading circuit is largely similar in both deaf and hearing individuals, skilled deaf readers exhibit a more bilateral neural response to written words and sentences than their hearing peers, as measured by event-related potentials and functional magnetic resonance imaging. Skilled deaf readers may also rely more on neural regions involved in semantic processing than hearing readers do. Overall, emerging evidence indicates that the neural markers for reading skill may differ for deaf and hearing adults.

Tickets for the Inclusive Museum

In recent years, museums of various kinds have broadened their mission and made systematic efforts to develop a dynamic role in learning by offering a wide range of less formal experiences for individuals with diverse characteristics, including individuals who are deaf or hard-of-hearing (DHH). Despite the worthwhile efforts, in the case of DHH individuals, museums frequently neglect to consider their unique communication, cognitive, cultural, and learning characteristics, thus limiting their access and opportunities for fully experiencing what museums have to offer. This chapter examines the potential for creating accessible museum environments and methods that reflect an understanding of the diverse communication, cognitive, cultural, and learning needs of DHH visitors, all of which enhance their access and participation in the museum activities. The role of the physical features of museum spaces for the access and behavior of DHH visitors is emphasized, together with attention to exhibition methods and the communication and cognitive challenges that need to be considered so DHH visitors can get the maximum benefit. The chapter emphasizes the right of individuals who are DHH to nonformal learning and analyzes how museums could become more accessible to DHH individuals by designing, from the beginning, participatory learning experiences that address their diverse needs.

The Influence of Explicit and Implicit Memory Processes on the Spoken–Written Language Learning of Children with Cochlear Implants

Recent improvements in cochlear implants (CIs) and hearing aid technology are providing deaf children better access to sounds, yet many children with CIs and digital hearing aids continue to experience significant difficulties in verbal language learning, reading, and writing. It has been shown that explicit and intentional memory processes, like verbal rehearsal or semantic organizational strategies, can explain the language and literacy outcomes of CI and hearing aid users. More recently, however, researchers have suggested also an involvement of implicit memory, and particularly implicit sequence learning (SL), in the language and literacy delay of these children. This chapter reviews and discusses studies bringing evidence of the involvement of inefficient explicit memory processes and implicit SL in the language and literacy development of children with CIs. It is argued that the interaction between explicit and implicit memory processes (verbal rehearsal and implicit SL) can better account for CI users’ problems with language and literacy acquisition.

Theory of Mind and Conversation in Deaf and Hearing Children

Conversation in a shared language (spoken or signed) is not only a pleasurable social activity but also a fundamental building block for the growth of social cognition, including theory of mind (ToM). Participating in informal conversations at home and at school fosters cognitive development of ToM, which, in turn, fosters reciprocated friendship, peer-group popularity, leadership, and social skills, while protecting against loneliness and social isolation. These interconnections between ToM and conversation are explored with a special focus on deaf children, a population of key theoretical significance for the understanding of ToM development generally. Timely ToM growth is linked with (a) having access from birth to a language (spoken or signed) that all family members can fluently share, (b) frequent family discussions of cognitive mental states, (c) school-based access to varied peer and adult conversational partners, and (d) children’s own eagerness to participate in conversations exposing them to different mental viewpoints.

Developmental, Cognitive, and Neurocognitive Perspectives on Language Development in Children Who Use Cochlear Implants

Newborn hearing screening programs and early diagnosis allow deaf children to receive hearing aids and/or cochlear implants very early in life. However, even within these early intervention scenarios, deaf children remain at risk of delays in spoken language acquisition despite what is expected based on their hearing recovery scores. The first part of this chapter offers an overview of recent studies on the role of specific factors (i.e., age at diagnosis, age at cochlear implant activation, family environment, and exposure to sign language) in affecting communicative and linguistic development. The second part examines to what extent current cognitive neuroscience research is contributing to refinement of the concept of critical or sensitive periods for the development of the acoustic system and language in deaf children. Clinical and educational implications for promoting language development in deaf children are discussed.

Triggering, Configuration, and Engagement

Word learning and vocabulary knowledge, although related, represent distinct constructs. The process by which a child learns new words will affect both the quantity of words learned and the quality of word representations in a child’s lexicon. Children with normal hearing experience predictable patterns of learning via the processes of triggering, configuration, and engagement. Children with hearing loss may experience, for various reasons, disruptions at all three levels. Those difficulties with the process of word learning may then lead to delays and differences in vocabulary knowledge, with cascading effects on other linguistic and academic skill development. Cultivating an understanding of how hearing loss affects not only vocabulary outcomes but also word-learning processes in children with hearing loss may provide avenues for future educational interventions that interrupt the adverse consequences of poor lexical knowledge. This chapter addresses the process of spoken word learning in children with normal hearing and the ways in which hearing loss affects this the subprocesses of triggering, configuration and engagement. The consequences of word-learning differences on other later-developing skills, such as phonological awareness, are discussed.