Phonological,

Lexical, and
Syntactic Abilities in
Children with
Cochlear Implants
Emma Hinzman
 Research Aims

1. Are there language deficits in children

with CIs in the 3 language levels?
2. What is the magnitude of the possible
language deficit in 6th grade
compared to 2nd grade?
3. How do the 3 levels of language
relate to one another in children with
cochlear implants?
4. What is the effect of treatment
measures on the language levels?
Language Abilities Assessed

● Phonological Level
○ Involves sounds and their structure
○ Important for understanding spoken
language
● Lexical Level
○ Focuses on words and vocabulary
○ Essential for building language
comprehension
● Morpho-Syntactic Level
○ Concerns sentence structure and
grammar
○ Crucial for constructing and
understanding sentences
Participants

● 62 participants, 29 with NH and 33 with CIs

● No conditions other than hearing loss
affecting language learning
● All participants from English-speaking
homes and children of normal-hearing
parents
● Similar demographics: 48% males, similar
age, socioeconomic status, and IQ scores
Special Considerations

● Some children in the cochlear implant

group used bimodal experience (one
cochlear implant and one hearing aid)
● 10 children in the cochlear implant group
received sign language early intervention
programs, but at the time of testing, none
of the children relied on sign language
Early Identification and Interventions

● Children with cochlear implants received

intervention soon after identification of a
hearing loss, at least once a week until up
to 3 years old
● From 3 years old until the start of
elementary school, these children were
enrolled in preschool programs specifically
for children with hearing loss for an
average of 16 hours a week
● Once the children started elementary
school, they were in regular classrooms
Methodology

● Children with NH: hearing screenings with

pure tones at octave frequencies between
250 Hz and 8 kHz, at 20-dB hearing level to
each ear separately
● Testing was done at the end of both 2nd
grade and 6th grade and all done in sound
booths
● 3 phonological awareness tasks
presented, 1 verbal working memory
task, 4 standardized tests, and a
narrative sample for productive
morphosyntax measures
Phonological Awareness Tasks
● Final consonant choice task with
one-syllable words — The child would
hear and see a target word in the booth.
Once they repeated the word, 3 more
words would be presented in audio-visual
format, and the child would have to
choose which word ended in the same
sound as the first word
● Pig Latin Task — A word was presented
and the child had to repeat it correctly. The
child was then asked to say the first
segment of any initial cluster to the end of
the word (Repeat a word correctly and
segment the initial cluster)
● Backward words activity — It was one and
two-syllable words. They were presented
with a target word and instructed to say it
backwards
Verbal Working Memory Task
● The verbal working memory task
presented six words, and the child would
have to repeat the sequence
 Standardized Tests
● The Word Reading subtest of the Wide
Range Achievement Test 4: read a list
of words in isolation
● The Expressive One-Word Picture
Vocabulary Test (EOWPVT): tested
vocabulary knowledge
● The Grammaticality Judgment subtest
of the CASL had the child listen to an
audio recording of a sentence and they
had to tell if it was correct or not
● The Sentence Comprehension subtest
of the CASL gave the children an audio
recording of two sentences and they
had to say whether they had the same
meaning or not
 Morpho-Syntax
● Productive morphosyntax was measured
through the narrative sample "The Day
Jimmy’s Boa Ate the Wash."
● Child was instructed to watch the
video when the examiner gets a
“phone call” and the child is
instructed to narrate once the
examiner comes back
● 15-minute narrative sample collected,
transcribed, and submitted for
analysis by SALT
 Findings
● Children with cochlear implants lag behind in language development compared to those
with normal hearing.
● In 2nd grade, children with cochlear implants showed deficits in all three language levels
(phonological, lexical, and morphosyntactic).
● By age 10, most children with cochlear implants reached normal limits for morphology and
syntax.
● Phonological level exhibited the largest deficit
○ Standardized tests like the Peabody Picture Vocabulary Test and Lexical Neighborhood Test
might miss phonological deficits
● Phonological struggles pose threats to academic achievement, crucial for verbal working
memory and literacy.
● History of bimodal stimulation (using a hearing aid in the opposite ear at the time of
getting the first cochlear implant) was beneficial for language development.
○ Specifically advantageous for phonological and lexical skills compared to those without a
history of bimodal stimulation.
 Strengths & Weaknesses

● Study strengths:
● Long-term perspective (2nd to 6th grade)
● Diverse testing and assessment tools
● Larger sample size
● Study weaknesses:
● Limited diversity in the study population
● Need for more exploration of the benefits of bimodal
experience
 RESOURCES

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