Executive function in everyday life: implications for young cochlear implant users

Abstract

Cochlear implants (CIs) provide significant speech and language benefits to many prelingually deaf children (Geers et al., 2008). However, CIs do not provide optimal benefits to all children who receive them. Identification of pre-implant predictors of CI outcomes is critical to providing appropriate expectations to parents and in decision making regarding intervention, assessment, management, and focused habilitation throughout childhood. A growing body of research findings suggests that deafness and degraded auditory experience may affect not only speech and language skills, but also other neurocognitive functions (Pisoni et al., 2010). We adopt the working hypothesis (supported by recent findings from our center) that many profoundly deaf children who use CIs, especially the low-performing users, may have other neural, cognitive, and affective sequelae resulting from a period of auditory deprivation combined with a delay in language development before implantation. For example, compared to hearing peers, young CI users show differences in short-term and Working Memory capacity and have slower processing speeds for rehearsing and retrieving verbal information (Pisoni et al., 2010). Robust speech perception and spoken language processing are highly dependent on these underlying core neurocognitive building blocks. Executive function (EF) is an umbrella construct from research in neuropsychology and cognitive neuroscience representing a complex set of cognitive processes such as organization, planning, working memory, inhibition, and flexibility, involved in the control of thought, action, and emotion (Gioia et al., 2001). There is general agreement among cognitive psychologists and neuroscientists that several different aspects of EF play important roles in language perception and production via top-down feedback and control of processing activities in a wide range of behavioral tasks (Pisoni et al., 2010). In addition, language itself serves an EF because through verbal mediation processes it can be used by the child to exercise control over thoughts, actions, and emotions with self-directed speech (Muller et al., 2009). For these reasons, knowledge of the developmental relations between EF and language processes in children with CIs is critical to understanding not only outcomes proximal to language, but also more distal outcomes such as learning, self-regulation, and social cognition. The two objectives of this study were to identify areas of EF vulnerability in children with CI’s using a behavior rating scale completed by parents, and to determine if these areas of vulnerability are associated with conventional speech and language outcomes.