PurposeThe aim of this study was to investigate orthographic learning and reading skill in Swedis... more PurposeThe aim of this study was to investigate orthographic learning and reading skill in Swedish children with cochlear implants (CI) in comparison with normal hearing peers (NH), and to explore ...
Background Research for evidence-based interventions and strategies for implementation continues.... more Background Research for evidence-based interventions and strategies for implementation continues. Yet there is a continued shortage of qualified health care staff while stress and burnout are common. Health care professionals' individual perceptions towards change needs to be considered to succeed in organisational change. It is therefore relevant to investigate how implementation processes affect employees within the health care sector. Challenges to implementation are especially large in the field of disability care. The present study aims to investigate employees' experiences of an ongoing large-scale implementation, and what they perceived as important to succeed in a complex clinical setting. Methods Semi-structured focus group interviews were conducted with a self-selected sample of employees from a large and complex health care organisation responsible for public disability care in a centrally located Swedish region. A mixed-method approach adapted to content analysis was performed in a three-step process. In the first round, each unit of analysis was selected and then colour coded. In a second round, the coloured units were coded according to content analysis, and categories and concepts were compared and adjusted until the two researchers reached consensus. Finally, to further complement the content analysis, a quantitative analysis of the colour categories was made. Results In general, employees experienced the implementation as being insufficient, yet opinions of the process of implementation were mixed. Most positive experiences were found in relation to the outcomes that the new method had on work effectiveness and patient care. Closely related topics like time constraints, uncertainties concerning the method and the need for supportive functions reoccurred in several concepts suggesting a relationship between differing contextual factors, implementation activities and fidelity. Also evident in the results were the strain on organisational and social work environment and the importance of managers' active leadership. Conclusions Implementation processes are experienced as challenging for employees. Key facilitators are available support functions, clear leadership and time that is sufficient and kept sacrosanct. Leaders need to communicate how
Purpose The purpose of this pilot study was to explore the home language environment and language... more Purpose The purpose of this pilot study was to explore the home language environment and language outcome of Brazilian toddlers who were hard of hearing, (HH) and controls with typical hearing (TH), and investigate the reliability of using the LENA recording system within a Brazilian Portuguese context. Methods Fourteen families participated in the study (seven children who were HH and seven controls with TH. Each family contributed with one all-day recording. A smaller portion of the recordings of the typically hearing toddlers were manually transcribed by two transcribers. An interrater agreement was conducted, and then the human transcript results were compared against the LENA-generated data for three measures: Adult Words (AW), Child Vocalizations (CV) and Conversational Turns (CT). Results Data analyses revealed a moderate to strong interrater agreement for CV and AW. Weak to moderate agreement was found between the LENA estimates and the means of the human counts for CV and A...
The aim of the study was to examine grammatical sentence understanding (TROG-2) in 6-9 year old c... more The aim of the study was to examine grammatical sentence understanding (TROG-2) in 6-9 year old children with cochlear implants (CI), and compare their performance to age-matched children with normal hearing (NH). Receptive vocabulary, picture naming, semantic feature knowledge, word fluency, non-word discrimination (phonology), word learning and non-verbal cognitive ability were examined as possible predicting factors for TROG-2. Age at implantation, hearing age, and speech recognition were also investigated in children with CI. For TROG-2, 6-7 year old children with CI performed similar to controls, and 50 % of them reached one year or more above the age-equivalent norm level. Speech recognition and age at 2nd implantation were associated with better results on TROG-2. Non-verbal cognitive ability and picture naming predicted grammatical sentence understanding in children with CI. Earlier age at implantation and a shorter period between 1st and 2nd implantation might also have a p...
The present study examined reading fluency and orthographic learning in 40 childrenwith cochlear ... more The present study examined reading fluency and orthographic learning in 40 childrenwith cochlear implants. Their age range was 6;0-10;11.The children were implantedwith their (first) CI at 24 month ...
Studies have limitedly considered children with early-identified unilateral hearing impairment (U... more Studies have limitedly considered children with early-identified unilateral hearing impairment (UHI), and clinical practices regarding screening, diagnostics and habilitation in this group are rarely documented. In this study, routines for newborns with UHI from screening to diagnostics and habilitation were explored in Norway, Sweden and Finland. An online survey was sent to hospitals responsible for the hearing diagnostics of children requesting information about their practices regarding congenital UHI. Responses covered 95% of the children born in the three included countries. The results revealed large variations in ways of organising healthcare and in clinical decisions regarding hearing screening, diagnostics and habilitation of children with congenital UHI. Finally, implications for policy making and research are also discussed.
Purpose: Kenett et al. (2013) report that the sematic networks of children with CI are less struc... more Purpose: Kenett et al. (2013) report that the sematic networks of children with CI are less structured compared to the sematic networks of children with TH. This study aims to evaluate if such differences are only evident if children with CI are compared to children with TH matched on chronological age, or also if they are compared to children with TH matched on hearing age. Method: The performance of a group of children with CI on a verbal fluency task was compared to the performance of a group of chronological-age matched children with TH. Subsequently, computational network analysis was used to compare the semantic network structure of the groups. The same procedure was applied to compare a group of children with CI to a group of hearing-age matched children with TH. Results: Children with CI perform on the same level on a sematic fluency task as children with TH matched on hearing age. There are significant differences in terms of the structure of the semantic network between th...
Lexical and semantic ability in children with cochlear implants in comparison to children with la... more Lexical and semantic ability in children with cochlear implants in comparison to children with language impairment or autism spectrum disorder
ABSTRACT This study examined verbal retrieval in participants with acquired moderate-to-severe se... more ABSTRACT This study examined verbal retrieval in participants with acquired moderate-to-severe sensorineural hearing impairment (M age = 63, M education level = 13 years) compared to participants with normal hearing thresholds (M age = 62, M education level = 14 years) using the letter and category fluency tasks. Analyses of number of words produced, clustering, and switching, were conducted. There was no significant difference between the groups in category fluency performance. In letter fluency, however, the participants with hearing impairment produced significantly fewer words than the normal hearing participants and their production was characterized by fewer switches. Regression analyses were conducted to examine the relationship between demographic, auditory, and cognitive variables and letter fluency performance in the two groups. Phonological skills and auditory acuity predicted letter fluency output only in participants with hearing impairment and a hearing-related link between phonological skills, working memory capacity, and letter fluency switching was found.
Aim: Although cytomegalovirus (CMV) is the most common congenital infection, existing research ha... more Aim: Although cytomegalovirus (CMV) is the most common congenital infection, existing research has not provided us with a full picture of how this can affect children in the future. The aim of this case-control study was to evaluate disabilities in a well-defined group of children with congenital cytomegalovirus (CMV) infection, who had been fitted with cochlear implants because of severe hearing impairment. Methods: A multidisciplinary team assessed 26 children with congenital CMV infection for balance difficulties, neurodevelopmental disabilities and language and visual impairment. We also included a control group of 13 children with severe hearing impairment due to connexin 26 mutations. Results: The majority of the children with congenital CMV infection (88%) displayed balance disturbances, including walking at a later age, but there were no cases in the control group. The CMV group also displayed frequent neurodevelopmental disabilities and feeding difficulties. Conclusion: Congenital CMV infection affects the general development of the brain and gives rise to a complex pattern of difficulties. Identifying comorbid conditions is very important, as children with associated difficulties and disabilities need more support than children with just hearing impairment. Congenital CMV infection needs to be considered in children with hearing impairment and/or balance disturbance and/or neurodevelopmental disabilities.
Word fluency was examined in 73 Swedish children aged 6-9 years divided into two age groups, 6-7 ... more Word fluency was examined in 73 Swedish children aged 6-9 years divided into two age groups, 6-7 and 8-9 years; 34 deaf children with cochlear implants (CI) (15 girls/19 boys) and 39 age-matched children with normal hearing (NH) (20 girls/19 boys). One purpose was to compare the ability to retrieve words in two different word fluency tasks; one phonemically based (FAS letter fluency) and one semantically based (animal fluency). A second purpose was to examine retrieval strategies in the two tasks by conducting an analysis of clustering and switching of word sequences. In general we found that age was an important factor for word fluency ability, in both the CI and the NH groups. It was also demonstrated that children with CI aged 8-9 years retrieved significantly fewer words and used less efficient strategies in the retrieval process, especially on the phonemically based task compared to children with NH of the same ages, whereas children 6-7 years performed similarly in both groups regarding number of retrieved words and use of strategies. The results are discussed with respect to factors such as age differences in performance for children with CI, especially for the phonemically based task.
Introduction: Two important events have changed the prerequisites for children with severe-profou... more Introduction: Two important events have changed the prerequisites for children with severe-profound hearing impairment (HI). The first is the universal newborn hearing screening (UNHS) that enables early detection and identification of congenital or earlyacquired HI. The second factor is the possibility of cochlear implant (CI) intervention at younger ages. There has been little previous interest in studying lexical-semantic ability in the new generation of children with CI who are implanted at a fairly young age, often bilaterally, in relation to the cognitive capacities that influence on use and knowledge of words. Aim: The general aim was to explore lexical-semantic ability and development in a group of school-aged children with CI and in comparison with age-matched normal hearing (NH) children. Method: The four studies examined different aspects of lexical-semantic ability in children aged 6-9 years. The cohort consisted of 34 children with CI and 39 agematched children with NH (Study I-IV). In addition, two other clinical groups: children with language impairment (LI) (n=12) and children with autism spectrum disorder (ASD) (n=12) participated in Study II. A broad test battery was used, especially examining lexical-semantic ability but also non-verbal cognitive ability as well as phonological and learning ability. An error response analysis was conducted on a picture-naming test and a linguistic cluster analysis was performed on two different word fluency tasks with the purpose of examining strategies that the participants used when they retrieved words from their long-term-memory (LTM). Study IV had a partly longitudinal approach where a subgroup of children with CI (n=18) were examined more closely over time and in comparison with other age-matched groups at the age of 8-9 years. Statistical analyses were made primarily to examine group differences. Results: Many children with CI reached age-equivalent lexical-semantic ability at the age of 8-9 years. Semantic knowledge and non-verbal cognitive ability predicted grammatical sentence understanding (GSU) in both groups (CI and NH). Children with CI used age-appropriate learning strategies and had similar cognitive capacities necessary for managing use and knowledge of words as NH controls. In addition, children with CI showed better outcome than children with LI or ASD. However, an atypical developmental pattern was found in Study II where children with CI had better expressive than receptive vocabulary compared to typically developed children with NH. Also, the variation of the outcome was overall greater in children with CI (Study I-IV). An age-related CI subgroup-pattern was found in Study I that lead to the planning of a follow-up study, also examining retrospective, early spoken language development (Study IV). Children in the subgroup with higher group mean age at 1 st CI had significantly poorer results on receptive vocabulary, phonemically based letter word fluency and GSU than NH controls. Despite of these results, the whole sample of children with CI had an age-appropriate level of expressive vocabulary and semantic feature knowledge. Semantic knowledge was demonstrated as an adequate ability to recognize semantic features and to use semantically relevant responses when lacking the lexical term while naming pictures (Study III). Children with an younger group mean age at 1 st CI had better early expressive language use, two years after CIoperation, than the other subgroup, and they were also able to catch up after school entry on receptive vocabulary and phonemically based letter word fluency ability (Study IV). Conclusions: Children with CI and typical non-verbal cognitive ability did not have specific deficiencies in cognitive processing of lexical-semantic items, but some children had deficiencies with phonological and lexical-semantic knowledge. The results indicate that age at 1 st CI is important as a starter engine of spoken language development through listening, but that other more linguistic-related factors and strategies also are important for development of lexical-semantic ability. There was a greater variation of the spoken language outcome in children with CI, and some atypical developmental patterns were found in the sample. Future studies of lexicalsemantic ability in children with CI should therefore have a longitudinal approach and also explore the influence of environmental factors.
Children who are deaf or hard of hearing (DHH) are at an increased risk of speech and language de... more Children who are deaf or hard of hearing (DHH) are at an increased risk of speech and language deficits. Nonword repetition (NWR) is a potential predictor of problems with phonology, grammar and lexicon in DHH children. The aim of the present study was to examine repetition of prosodic features and segments in nonwords by DHH children compared to children with normal hearing (NH) and to relate NWR performance to measures of language ability and background variables. In this cross-sectional study, 14 Swedish-speaking children with mild-profound sensorineural hearing loss, aged 4-6 years, and 29 age-matched controls with NH and typical language development participated. The DHH children used cochlear implants (CI), hearing aids or a combination of both. The assessment materials included a prosodically controlled NWR task, as well as tests of phonological production, expressive grammar and receptive vocabulary. The DHH children performed below the children with NH on the repetition of tonal word accents, stress patterns, vowels and consonants, with consonants being hardest, and tonal word accents easiest, to repeat. NWR performance was also correlated with language ability, and to hearing level, in the DHH children. Both prosodic and segmental features of nonwords are problematic for Swedish-speaking DHH children compared to children with NH, but performance on tonal word accent repetition is comparably high. NWR may have potential as a clinically useful tool for identification of children who are in need of speech and language intervention.
Congenital cytomegalovirus (cCMV) infection is the most common cause of progressive hearing impai... more Congenital cytomegalovirus (cCMV) infection is the most common cause of progressive hearing impairment. In our previous study around 90% of children with a cCMV infection and CI had severely damaged balance functions (Karltorp et al., 2014). Around 20% had vision impairment, 15% were diagnosed with Autism-Spectrum-Disorder, and 20% with ADHD. One clinical observation was that children with cCMV infection had problems with executive functioning (EF), while controls with a genetic cause of deafness (Connexin 26 mutations; Cx26) did not have similar difficulties. A follow-up study was therefore initiated with the main objective to examine EF and pragmatic skills in relation to mental health in children with a cCMV infection and to draw a comparison with matched controls with Cx26 mutations (age, sex, hearing, non-verbal cognitive ability, vocabulary, and socioeconomic status level). Ten children with a cCMV infection and CI (4.8-12:9 years) and seven children with CI (4:8-12:8 years) participated in the study, which had a multidisciplinary approach. Executive functioning was assessed both with formal tests targeting working memory and attention, parent and teacher questionnaires, and a systematic observation by a blinded psychologist during one test situation. Pragmatics and mental health were investigated with parent and teacher reports. In addition, the early language outcome was considered in non-parametric correlation analyses examining the possible relationships between later EF skills, pragmatics, and mental health. Children with cCMV had a statistically significant worse pragmatic outcome and phonological working memory than controls despite their groups having similar non-verbal cognitive ability and vocabulary. However, there were no statistical differences between the groups regarding their EF skills in everyday settings and mental health. There were associations between early language outcomes and later EF skills and pragmatics in the whole sample. Conclusion: Children with a cCMV infection are at risk of developing learning difficulties in school due to difficulties with phonological working memory and pragmatic skills in social interactions.
International Journal of Pediatric Otorhinolaryngology
The objective of the current study was to investigate possible differences in word count use per ... more The objective of the current study was to investigate possible differences in word count use per day (number of adult words) by caregivers of different gender, in a sample of Norwegian children (N = 17) with hearing impairment (HI) (n = 8) and normal hearing (NH) (n = 9), aged 18-56 months. The current study had a cross-sectional, descriptive study design. One all-day recording with the LENA technology was conducted to measure adult word use in the home environment (Md length: 12.46 h, 9.13-16 h). Female caregivers used a significantly higher amount of words than male caregivers close to the children, regardless of their hearing status, HI: p = .01, NH: p = .01. All children were exposed to a higher number of adult words from female caregivers. There is a need to conduct more and further research about possible caregiver differences, and investigate not only the quantity of word use, but also the qualitative interaction patterns between caregivers of different gender and young children with HI, and in relation to early intervention actions.
Lohmander (2020) Babbling and consonant production in children with hearing impairment who use he... more Lohmander (2020) Babbling and consonant production in children with hearing impairment who use hearing aids or cochlear implants-a pilot study, Logopedics
The importance that early auditory stimulation has on the infant's plastic brain with regard to o... more The importance that early auditory stimulation has on the infant's plastic brain with regard to optimal listening and language development is well-known. 1,2 During the first year of life, infants with normal hearing start to pay attention to the acoustic features of the speech they are surrounded by. They also develop phonology and acquire the statistical patterns that are important for word segmentation. 3 Children with congenital hearing loss are now identified earlier because of universal hearing screening programmes for newborn infants. 4 The recommended practice for newborn infants with hearing
PurposeThe aim of this study was to investigate orthographic learning and reading skill in Swedis... more PurposeThe aim of this study was to investigate orthographic learning and reading skill in Swedish children with cochlear implants (CI) in comparison with normal hearing peers (NH), and to explore ...
Background Research for evidence-based interventions and strategies for implementation continues.... more Background Research for evidence-based interventions and strategies for implementation continues. Yet there is a continued shortage of qualified health care staff while stress and burnout are common. Health care professionals' individual perceptions towards change needs to be considered to succeed in organisational change. It is therefore relevant to investigate how implementation processes affect employees within the health care sector. Challenges to implementation are especially large in the field of disability care. The present study aims to investigate employees' experiences of an ongoing large-scale implementation, and what they perceived as important to succeed in a complex clinical setting. Methods Semi-structured focus group interviews were conducted with a self-selected sample of employees from a large and complex health care organisation responsible for public disability care in a centrally located Swedish region. A mixed-method approach adapted to content analysis was performed in a three-step process. In the first round, each unit of analysis was selected and then colour coded. In a second round, the coloured units were coded according to content analysis, and categories and concepts were compared and adjusted until the two researchers reached consensus. Finally, to further complement the content analysis, a quantitative analysis of the colour categories was made. Results In general, employees experienced the implementation as being insufficient, yet opinions of the process of implementation were mixed. Most positive experiences were found in relation to the outcomes that the new method had on work effectiveness and patient care. Closely related topics like time constraints, uncertainties concerning the method and the need for supportive functions reoccurred in several concepts suggesting a relationship between differing contextual factors, implementation activities and fidelity. Also evident in the results were the strain on organisational and social work environment and the importance of managers' active leadership. Conclusions Implementation processes are experienced as challenging for employees. Key facilitators are available support functions, clear leadership and time that is sufficient and kept sacrosanct. Leaders need to communicate how
Purpose The purpose of this pilot study was to explore the home language environment and language... more Purpose The purpose of this pilot study was to explore the home language environment and language outcome of Brazilian toddlers who were hard of hearing, (HH) and controls with typical hearing (TH), and investigate the reliability of using the LENA recording system within a Brazilian Portuguese context. Methods Fourteen families participated in the study (seven children who were HH and seven controls with TH. Each family contributed with one all-day recording. A smaller portion of the recordings of the typically hearing toddlers were manually transcribed by two transcribers. An interrater agreement was conducted, and then the human transcript results were compared against the LENA-generated data for three measures: Adult Words (AW), Child Vocalizations (CV) and Conversational Turns (CT). Results Data analyses revealed a moderate to strong interrater agreement for CV and AW. Weak to moderate agreement was found between the LENA estimates and the means of the human counts for CV and A...
The aim of the study was to examine grammatical sentence understanding (TROG-2) in 6-9 year old c... more The aim of the study was to examine grammatical sentence understanding (TROG-2) in 6-9 year old children with cochlear implants (CI), and compare their performance to age-matched children with normal hearing (NH). Receptive vocabulary, picture naming, semantic feature knowledge, word fluency, non-word discrimination (phonology), word learning and non-verbal cognitive ability were examined as possible predicting factors for TROG-2. Age at implantation, hearing age, and speech recognition were also investigated in children with CI. For TROG-2, 6-7 year old children with CI performed similar to controls, and 50 % of them reached one year or more above the age-equivalent norm level. Speech recognition and age at 2nd implantation were associated with better results on TROG-2. Non-verbal cognitive ability and picture naming predicted grammatical sentence understanding in children with CI. Earlier age at implantation and a shorter period between 1st and 2nd implantation might also have a p...
The present study examined reading fluency and orthographic learning in 40 childrenwith cochlear ... more The present study examined reading fluency and orthographic learning in 40 childrenwith cochlear implants. Their age range was 6;0-10;11.The children were implantedwith their (first) CI at 24 month ...
Studies have limitedly considered children with early-identified unilateral hearing impairment (U... more Studies have limitedly considered children with early-identified unilateral hearing impairment (UHI), and clinical practices regarding screening, diagnostics and habilitation in this group are rarely documented. In this study, routines for newborns with UHI from screening to diagnostics and habilitation were explored in Norway, Sweden and Finland. An online survey was sent to hospitals responsible for the hearing diagnostics of children requesting information about their practices regarding congenital UHI. Responses covered 95% of the children born in the three included countries. The results revealed large variations in ways of organising healthcare and in clinical decisions regarding hearing screening, diagnostics and habilitation of children with congenital UHI. Finally, implications for policy making and research are also discussed.
Purpose: Kenett et al. (2013) report that the sematic networks of children with CI are less struc... more Purpose: Kenett et al. (2013) report that the sematic networks of children with CI are less structured compared to the sematic networks of children with TH. This study aims to evaluate if such differences are only evident if children with CI are compared to children with TH matched on chronological age, or also if they are compared to children with TH matched on hearing age. Method: The performance of a group of children with CI on a verbal fluency task was compared to the performance of a group of chronological-age matched children with TH. Subsequently, computational network analysis was used to compare the semantic network structure of the groups. The same procedure was applied to compare a group of children with CI to a group of hearing-age matched children with TH. Results: Children with CI perform on the same level on a sematic fluency task as children with TH matched on hearing age. There are significant differences in terms of the structure of the semantic network between th...
Lexical and semantic ability in children with cochlear implants in comparison to children with la... more Lexical and semantic ability in children with cochlear implants in comparison to children with language impairment or autism spectrum disorder
ABSTRACT This study examined verbal retrieval in participants with acquired moderate-to-severe se... more ABSTRACT This study examined verbal retrieval in participants with acquired moderate-to-severe sensorineural hearing impairment (M age = 63, M education level = 13 years) compared to participants with normal hearing thresholds (M age = 62, M education level = 14 years) using the letter and category fluency tasks. Analyses of number of words produced, clustering, and switching, were conducted. There was no significant difference between the groups in category fluency performance. In letter fluency, however, the participants with hearing impairment produced significantly fewer words than the normal hearing participants and their production was characterized by fewer switches. Regression analyses were conducted to examine the relationship between demographic, auditory, and cognitive variables and letter fluency performance in the two groups. Phonological skills and auditory acuity predicted letter fluency output only in participants with hearing impairment and a hearing-related link between phonological skills, working memory capacity, and letter fluency switching was found.
Aim: Although cytomegalovirus (CMV) is the most common congenital infection, existing research ha... more Aim: Although cytomegalovirus (CMV) is the most common congenital infection, existing research has not provided us with a full picture of how this can affect children in the future. The aim of this case-control study was to evaluate disabilities in a well-defined group of children with congenital cytomegalovirus (CMV) infection, who had been fitted with cochlear implants because of severe hearing impairment. Methods: A multidisciplinary team assessed 26 children with congenital CMV infection for balance difficulties, neurodevelopmental disabilities and language and visual impairment. We also included a control group of 13 children with severe hearing impairment due to connexin 26 mutations. Results: The majority of the children with congenital CMV infection (88%) displayed balance disturbances, including walking at a later age, but there were no cases in the control group. The CMV group also displayed frequent neurodevelopmental disabilities and feeding difficulties. Conclusion: Congenital CMV infection affects the general development of the brain and gives rise to a complex pattern of difficulties. Identifying comorbid conditions is very important, as children with associated difficulties and disabilities need more support than children with just hearing impairment. Congenital CMV infection needs to be considered in children with hearing impairment and/or balance disturbance and/or neurodevelopmental disabilities.
Word fluency was examined in 73 Swedish children aged 6-9 years divided into two age groups, 6-7 ... more Word fluency was examined in 73 Swedish children aged 6-9 years divided into two age groups, 6-7 and 8-9 years; 34 deaf children with cochlear implants (CI) (15 girls/19 boys) and 39 age-matched children with normal hearing (NH) (20 girls/19 boys). One purpose was to compare the ability to retrieve words in two different word fluency tasks; one phonemically based (FAS letter fluency) and one semantically based (animal fluency). A second purpose was to examine retrieval strategies in the two tasks by conducting an analysis of clustering and switching of word sequences. In general we found that age was an important factor for word fluency ability, in both the CI and the NH groups. It was also demonstrated that children with CI aged 8-9 years retrieved significantly fewer words and used less efficient strategies in the retrieval process, especially on the phonemically based task compared to children with NH of the same ages, whereas children 6-7 years performed similarly in both groups regarding number of retrieved words and use of strategies. The results are discussed with respect to factors such as age differences in performance for children with CI, especially for the phonemically based task.
Introduction: Two important events have changed the prerequisites for children with severe-profou... more Introduction: Two important events have changed the prerequisites for children with severe-profound hearing impairment (HI). The first is the universal newborn hearing screening (UNHS) that enables early detection and identification of congenital or earlyacquired HI. The second factor is the possibility of cochlear implant (CI) intervention at younger ages. There has been little previous interest in studying lexical-semantic ability in the new generation of children with CI who are implanted at a fairly young age, often bilaterally, in relation to the cognitive capacities that influence on use and knowledge of words. Aim: The general aim was to explore lexical-semantic ability and development in a group of school-aged children with CI and in comparison with age-matched normal hearing (NH) children. Method: The four studies examined different aspects of lexical-semantic ability in children aged 6-9 years. The cohort consisted of 34 children with CI and 39 agematched children with NH (Study I-IV). In addition, two other clinical groups: children with language impairment (LI) (n=12) and children with autism spectrum disorder (ASD) (n=12) participated in Study II. A broad test battery was used, especially examining lexical-semantic ability but also non-verbal cognitive ability as well as phonological and learning ability. An error response analysis was conducted on a picture-naming test and a linguistic cluster analysis was performed on two different word fluency tasks with the purpose of examining strategies that the participants used when they retrieved words from their long-term-memory (LTM). Study IV had a partly longitudinal approach where a subgroup of children with CI (n=18) were examined more closely over time and in comparison with other age-matched groups at the age of 8-9 years. Statistical analyses were made primarily to examine group differences. Results: Many children with CI reached age-equivalent lexical-semantic ability at the age of 8-9 years. Semantic knowledge and non-verbal cognitive ability predicted grammatical sentence understanding (GSU) in both groups (CI and NH). Children with CI used age-appropriate learning strategies and had similar cognitive capacities necessary for managing use and knowledge of words as NH controls. In addition, children with CI showed better outcome than children with LI or ASD. However, an atypical developmental pattern was found in Study II where children with CI had better expressive than receptive vocabulary compared to typically developed children with NH. Also, the variation of the outcome was overall greater in children with CI (Study I-IV). An age-related CI subgroup-pattern was found in Study I that lead to the planning of a follow-up study, also examining retrospective, early spoken language development (Study IV). Children in the subgroup with higher group mean age at 1 st CI had significantly poorer results on receptive vocabulary, phonemically based letter word fluency and GSU than NH controls. Despite of these results, the whole sample of children with CI had an age-appropriate level of expressive vocabulary and semantic feature knowledge. Semantic knowledge was demonstrated as an adequate ability to recognize semantic features and to use semantically relevant responses when lacking the lexical term while naming pictures (Study III). Children with an younger group mean age at 1 st CI had better early expressive language use, two years after CIoperation, than the other subgroup, and they were also able to catch up after school entry on receptive vocabulary and phonemically based letter word fluency ability (Study IV). Conclusions: Children with CI and typical non-verbal cognitive ability did not have specific deficiencies in cognitive processing of lexical-semantic items, but some children had deficiencies with phonological and lexical-semantic knowledge. The results indicate that age at 1 st CI is important as a starter engine of spoken language development through listening, but that other more linguistic-related factors and strategies also are important for development of lexical-semantic ability. There was a greater variation of the spoken language outcome in children with CI, and some atypical developmental patterns were found in the sample. Future studies of lexicalsemantic ability in children with CI should therefore have a longitudinal approach and also explore the influence of environmental factors.
Children who are deaf or hard of hearing (DHH) are at an increased risk of speech and language de... more Children who are deaf or hard of hearing (DHH) are at an increased risk of speech and language deficits. Nonword repetition (NWR) is a potential predictor of problems with phonology, grammar and lexicon in DHH children. The aim of the present study was to examine repetition of prosodic features and segments in nonwords by DHH children compared to children with normal hearing (NH) and to relate NWR performance to measures of language ability and background variables. In this cross-sectional study, 14 Swedish-speaking children with mild-profound sensorineural hearing loss, aged 4-6 years, and 29 age-matched controls with NH and typical language development participated. The DHH children used cochlear implants (CI), hearing aids or a combination of both. The assessment materials included a prosodically controlled NWR task, as well as tests of phonological production, expressive grammar and receptive vocabulary. The DHH children performed below the children with NH on the repetition of tonal word accents, stress patterns, vowels and consonants, with consonants being hardest, and tonal word accents easiest, to repeat. NWR performance was also correlated with language ability, and to hearing level, in the DHH children. Both prosodic and segmental features of nonwords are problematic for Swedish-speaking DHH children compared to children with NH, but performance on tonal word accent repetition is comparably high. NWR may have potential as a clinically useful tool for identification of children who are in need of speech and language intervention.
Congenital cytomegalovirus (cCMV) infection is the most common cause of progressive hearing impai... more Congenital cytomegalovirus (cCMV) infection is the most common cause of progressive hearing impairment. In our previous study around 90% of children with a cCMV infection and CI had severely damaged balance functions (Karltorp et al., 2014). Around 20% had vision impairment, 15% were diagnosed with Autism-Spectrum-Disorder, and 20% with ADHD. One clinical observation was that children with cCMV infection had problems with executive functioning (EF), while controls with a genetic cause of deafness (Connexin 26 mutations; Cx26) did not have similar difficulties. A follow-up study was therefore initiated with the main objective to examine EF and pragmatic skills in relation to mental health in children with a cCMV infection and to draw a comparison with matched controls with Cx26 mutations (age, sex, hearing, non-verbal cognitive ability, vocabulary, and socioeconomic status level). Ten children with a cCMV infection and CI (4.8-12:9 years) and seven children with CI (4:8-12:8 years) participated in the study, which had a multidisciplinary approach. Executive functioning was assessed both with formal tests targeting working memory and attention, parent and teacher questionnaires, and a systematic observation by a blinded psychologist during one test situation. Pragmatics and mental health were investigated with parent and teacher reports. In addition, the early language outcome was considered in non-parametric correlation analyses examining the possible relationships between later EF skills, pragmatics, and mental health. Children with cCMV had a statistically significant worse pragmatic outcome and phonological working memory than controls despite their groups having similar non-verbal cognitive ability and vocabulary. However, there were no statistical differences between the groups regarding their EF skills in everyday settings and mental health. There were associations between early language outcomes and later EF skills and pragmatics in the whole sample. Conclusion: Children with a cCMV infection are at risk of developing learning difficulties in school due to difficulties with phonological working memory and pragmatic skills in social interactions.
International Journal of Pediatric Otorhinolaryngology
The objective of the current study was to investigate possible differences in word count use per ... more The objective of the current study was to investigate possible differences in word count use per day (number of adult words) by caregivers of different gender, in a sample of Norwegian children (N = 17) with hearing impairment (HI) (n = 8) and normal hearing (NH) (n = 9), aged 18-56 months. The current study had a cross-sectional, descriptive study design. One all-day recording with the LENA technology was conducted to measure adult word use in the home environment (Md length: 12.46 h, 9.13-16 h). Female caregivers used a significantly higher amount of words than male caregivers close to the children, regardless of their hearing status, HI: p = .01, NH: p = .01. All children were exposed to a higher number of adult words from female caregivers. There is a need to conduct more and further research about possible caregiver differences, and investigate not only the quantity of word use, but also the qualitative interaction patterns between caregivers of different gender and young children with HI, and in relation to early intervention actions.
Lohmander (2020) Babbling and consonant production in children with hearing impairment who use he... more Lohmander (2020) Babbling and consonant production in children with hearing impairment who use hearing aids or cochlear implants-a pilot study, Logopedics
The importance that early auditory stimulation has on the infant's plastic brain with regard to o... more The importance that early auditory stimulation has on the infant's plastic brain with regard to optimal listening and language development is well-known. 1,2 During the first year of life, infants with normal hearing start to pay attention to the acoustic features of the speech they are surrounded by. They also develop phonology and acquire the statistical patterns that are important for word segmentation. 3 Children with congenital hearing loss are now identified earlier because of universal hearing screening programmes for newborn infants. 4 The recommended practice for newborn infants with hearing
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