Effects of early auditory experience on the spoken language of deaf children at 3 years of age
Effects of early auditory experience on the spoken language of deaf children at 3 years of age
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DOI：
10.1097/01.aud.0000215973.76912.c6
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发表时间：
2006-06-01
期刊：
影响因子：
3.7
通讯作者：
Geers, Ann E.
中科院分区：
文献类型：
--
作者：
Nicholas, Johanna Grant;Geers, Ann E.
目标：到3岁时，正常发育的儿童已经获得了广泛的词汇和句法技能，促进了认知和社会发展。重度至重度耳聋儿童在口语习得方面存在显著延迟，即使是那些接受过听觉口语训练和早期使用助听器的儿童。这项研究记录了接受口头教育的3岁儿童的口语技能，这些儿童在1至30个月大的时候被诊断出重度听力损失，并安装了助听器，在12至38个月大的时候接受了人工耳蜗植入。分析的目的是检查年龄、持续时间和早期听觉体验类型对3.5岁儿童口语能力的影响。设计：通过标准化的30分钟语言样本分析、家长填写的词汇表和教师语言评定量表，对76名使用人工耳蜗至少7个月的儿童的口语技能进行评估。这些儿童是从美国各地的口腔教育项目或治疗实践中招募和注册的。纳入标准包括：假定自出生以来就失聪，英语为家中主要语言，无其他已知的干扰语言/语言发展的条件，参加了使用口语教育方法的项目，并且没有已知的耳蜗植入问题持续超过30天。结果：各语言测量指标之间存在较强的相关性。因此，主成分分析被用于得出每个孩子的单一语言因素得分。研究了许多可能的语言预后预测因素，包括识别和使用助听器干预时的年龄、使用助听器的持续时间、使用助听器的植入前纯音平均（PTA）阈值、使用人工耳蜗的PTA阈值和使用人工耳蜗的持续时间/植入年龄（后两个变量实际上是相同的，因为所有儿童都是在40至44个月之间进行测试的）。通过多元回归分析对这些预测因素的独立影响进行检验，结果显示，人工耳蜗植入前辅助PTA阈值和人工耳蜗使用时间（即人工耳蜗年龄）占语言因子评分方差的58%。与植入前辅助阈值相关的显著负系数表明，植入前听力较差的儿童在3.5岁时表现出较差的语言技能。同样，与植入物使用时间相关的强正系数表明，使用植入物时间较长的儿童(即：在3.5岁时表现出更好的语言能力。识别和放大的年龄与语言结果无关，与人工耳蜗辅助阈值无关。使用人工耳蜗的时间与语言评分之间的关系呈显著的二次曲线，表明在使用人工耳蜗的第一个12个月后，每多使用一个月，语言技能（在3.5岁时）就会稳步提高。随着时间的推移，长时间使用植入物对语言的好处变得更加明显。结论：在婴儿期和幼儿期长时间使用人工耳蜗会显著影响3岁的重度失聪儿童所表现出的口语量。在这个样本中，使用助听器植入前的干预量与3.5岁时的语言结果无关。更确切地说，在年轻时植入人工耳蜗有助于提高口语能力。先前发现的早期识别听力障碍和早期教育干预的语言促进因素可能不足以优化深度耳聋儿童的口语，除非它导致早期人工耳蜗植入。
Objective: By age 3, typically developing children have achieved extensive vocabulary and syntax skills that facilitate both cognitive and social development. Substantial delays in spoken language acquisition have been documented for children with severe to profound deafness, even those with auditory oral training and early hearing aid use. This study documents the spoken language skills achieved by orally educated 3-yr-olds whose profound hearing loss was identified and hearing aids fitted between 1 and 30 mo of age and who received a cochlear implant between 12 and 38 mo of age. The purpose of the analysis was to examine the effects of age, duration, and type of early auditory experience on spoken language competence at age 3.5 yr.Design: The spoken language skills of 76 children who had used a cochlear implant for at least 7 mo were evaluated via standardized 30-minute language sample analysis, a parent-completed vocabulary checklist, and a teacher language-rating scale. The children were recruited from and enrolled in oral education programs or therapy practices across the United States. Inclusion criteria included presumed deaf since birth, English the primary language of the home, no other known conditions that interfere with speech/language development, enrolled in programs using oral education methods, and no known problems with the cochlear implant lasting more than 30 days.Results: Strong correlations were obtained among all language measures. Therefore, principal components analysis was used to derive a single Language Factor score for each child. A number of possible predictors of language outcome were examined, including age at identification and intervention with a hearing aid, duration of use of a hearing aid, pre-implant pure-tone average (PTA) threshold with a hearing aid, PTA threshold with a cochlear implant, and duration of use of a cochlear implant/ age at implantation (the last two variables were practically identical because all children were tested between 40 and 44 mo of age). Examination of the independent influence of these predictors through multiple regression analysis revealed that pre-implant-aided PTA threshold and duration of cochlear implant use (i.e., age at implant) accounted for 58% of the variance in Language Factor scores. A significant negative coefficient associated with preimplant-aided threshold indicated that children with poorer hearing before implantation exhibited poorer language skills at age 3.5 yr. Likewise, a strong positive coefficient associated with duration of implant use indicated that children who had used their implant for a longer period of time (i.e., who were implanted at an earlier age) exhibited better language at age 3.5 yr. Age at identification and amplification was unrelated to language outcome, as was aided threshold with the cochlear implant. A significant quadratic trend in the relation between duration of implant use and language score revealed a steady increase in language skill (at age 3.5 yr) for each additional month of use of a cochlear implant after the first 12 mo of implant use. The advantage to language of longer implant use became more pronounced over time.Conclusions: Longer use of a cochlear implant in infancy and very early childhood dramatically affects the amount of spoken language exhibited by 3-yr-old, profoundly deaf children. In this sample, the amount of pre-implant intervention with a hearing aid was not related to language outcome at 3.5 yr of age. Rather, it was cochlear implantation at a younger age that served to promote spoken language competence. The previously identified language-facilitating factors of early identification of hearing impairment and early educational intervention may not be sufficient for optimizing spoken language of profoundly deaf children unless it leads to early cochlear implantation.