SRF301 - Longitudinal Executive Functioning and Language Development in Children Who Are Deaf or Hard-of-Hearing

Abstract:
Deaf or hard-of-hearing (DHH) children who use hearing technology and auditory-oral communication display considerable variability in spoken language and executive functioning outcomes. Furthermore, language and executive functioning skills are strongly associated with each other in DHH children, which may be relevant for explaining this variability in outcomes. However, longitudinal investigations in early childhood in DHH children are rare. This study extended findings in this area by examining the predictive associations between executive functioning and spoken language in young school-age DHH children over one year. Novel findings include executive functioning behaviors predicting later spoken language, but not the reverse.

Summary:
Deaf or hard-of-hearing (DHH) children who use hearing technology and auditory-oral communication display considerable variability in spoken language and executive functioning (EF) outcomes. Furthermore, language and EF are strongly associated with each other in DHH children, which may be relevant for explaining this variability. However, longitudinal investigations of language and EF during the important early childhood period of development in DHH children are rare. Previous research in typically hearing (TH) children has suggested that small bidirectional, transactional relationships between language and EF scaffold each other over time in early development. Limited research in DHH early childhood has suggested that expressive vocabulary plays a role in later EF. However, the possibility of EF supporting language development is likely given the neurocognitive skills needed to consistently process degraded auditory signals to understand language, as in DHH children. This study examined the predictive, reciprocal associations between EF and spoken language over a 1-year period in samples of 53 DHH and 59 TH children between ages 3–8 years at baseline. Participants were assessed on measures of receptive spoken language (vocabulary, sentence comprehension, and following spoken directions) and caregiver-completed EF child behavior checklists during two in-person home visits 1 year apart. Statistical analyses were descriptive statistics, bivariate Pearson correlations of EF and language at different time points, and regression analyses controlling for respective baseline EF or language skills. In the sample of DHH children, better EF at baseline (Time 1) was associated with better performance on the higher-order language measures (sentence comprehension and following spoken directions) 1 year later (Time 2). In contrast, none of the Time 1 language measures were associated with better EF in Time 2 in the DHH sample. TH children showed no significant language-EF correlations over the 1-year study period. In regression analyses controlling for Time 1 language, Time 1 EF predicted Time 2 language in the combined DHH and TH samples, and for vocabulary, that association was stronger in the DHH than in the TH sample. Conversely, after controlling for Time 1 EF, none of the regression analyses predicting Time 2 EF from Time 1 language were statistically significant. These results are the first findings to demonstrate that everyday parent-rated EF behaviors predict basic (vocabulary) and higher-order (comprehension, following directions) spoken language development 1 year later in young (3–8 year old) DHH children, even after accounting for initial baseline language skills. These findings have significant clinical implications by suggesting that interventions to improve EF in everyday behavior at early ages may provide an opportunity to enhance language outcomes in DHH children and should be considered. These findings are also relevant for clinical audiologists to consider when making recommendations for children’s communication access at home and at school. First, these findings provide additional support for clinicians to educate caregivers and educators that dysregulated behaviors and listening fatigue of DHH children may affect each other in a feedback loop. Consequently, audiologists should recommend strategies to maximize auditory access and easier language processing in educational and informational settings to minimize difficulty.