Language Performance Of Children Research Articles

Correlation of screen exposure to stress, learning, cognitive and language performance in children.

The omnipresence of mobile screens and convenience to operate them has led to increased screen time for young children whereas the sequelae of prolonged exposure are not known yet. 70 refugee children (RG) and 111 children of a clinical comparison group (CG) from a help-seeking population (age: M = 5.10; SD = 1.11; range 3.00-6.97years) were assessed concerning their amount of daily screen exposure time in relation to parental education and distress. Salivary cortisol was collected as a marker for biological stress and children were tested concerning learning performance, non-verbal IQ and vocabulary with the Kaufmann Assessment Battery for Children (KABC-II). Language skills were assessed in educator rating. The amount of children's screen exposure was negatively related to parental education and positively to distress. In the CG, higher amounts of screen time were associated with elevated cortisol levels and lower learning scores. On both measures, the RG and CG only differed in the condition of screen time less than one hour/day, for higher amounts of screen time the CG approached the more problematic scores of the RG. Whereas in the whole sample the amount of screen time was negatively correlated to language performance, it was not correlated to non-verbal IQ-scores. As a higher amount of media exposure in our clinical comparison group is associated with elevated biological stress, decreased learning and lower language performance, it should be classified as a relevant environmental factor and regularly considered in clinical assessments of children and therapeutical interventions, especially in vulnerable subgroups. German clinical trials register, registration number: DRKS00025734, date: 07-23-2021.

Interactive roles of preterm-birth and socioeconomic status in cortical thickness of language-related brain structures: Findings from the Adolescent Brain Cognitive Development (ABCD) study

Preterm-born (PTB) children are at an elevated risk for neurocognitive difficulties in general and language difficulties more specifically. Environmental factors such as socio-economic status (SES) play a key role for Term children's language development. SES has been shown to predict PTB children's behavioral developmental trajectories, sometimes surpassing its role for Term children. However, the role of SES in the neurocognitive basis of PTB children's language development remains uncharted. Here, we aimed to evaluate the role of SES in the neural basis of PTB children's language performance. Leveraging the Adolescent Brain Cognitive Development (ABCD) Study, the largest longitudinal study of adolescent brain development and behavior to date, we showed that prematurity status (PTB versus Term) and multiple aspects of SES additively predict variability in cortical thickness, which is in turn related to children's receptive vocabulary performance. We did not find evidence to support the differential role of environmental factors for PTB versus Term children, underscoring that environmental factors are significant contributors to development of both Term and PTB children. Taken together, our results suggest that the environmental factors influencing language development might exhibit similarities across the full spectrum of gestational age.

Evocative effects on the early caregiving environment of genetic factors underlying the development of intellectual and academic ability.

This study examined gene-environment correlation (rGE) in intellectual and academic development in 561 U.S.-based adoptees (57% male; 56% non-Latinx White, 19% multiracial, 13% Black or African American, 11% Latinx) and their birth and adoptive parents between 2003 and 2017. Birth mother intellectual and academic performance predicted adoptive mother warmth at child age 6 (β = .14, p = .038) and 7 (β = .12, p = .040) but not 4.5 years, and adoptive father warmth at 7 (β = .18, p = .007) but not 4.5 or 6 years. These rGE effects were not mediated by children's language. Contrary to theory that rGE accounts for increasing heritability of intellectual ability, parenting did not mediate genetic effects on children's language or academic performance.

#40 - - Chronic Stress, Hair Cortisol, and Language Performance in Children

#40 - - Chronic Stress, Hair Cortisol, and Language Performance in Children

Language performance and brain volumes, asymmetry, and cortical thickness in children born extremely preterm

BackgroundChildren born preterm are more prone to have language difficulties. Few studies focus on children born extremely preterm (EPT) and the structural differences in language-related regions between these children and children born at term.MethodsOur study used T1-weighted magnetic resonance imaging (MRI) scans to calculate the brain volumetry, brain asymmetry, and cortical thickness of language-related regions in 50 children born EPT and 37 term-born controls at 10 years of age. The language abilities of 41 of the children born EPT and 29 term-born controls were then assessed at 12 years of age, using the Wechsler Intelligence Scale for Children, Fifth Edition and the Clinical Evaluations of Language Fundamentals, Fourth Edition. The differences between MRI parameters and their associations with language outcomes were compared in the two groups.ResultsBrain volume and cortical thickness of language-related regions were reduced in children born EPT, but volumetric asymmetry was not different between children born EPT and at term. In children born EPT the brain volume was related to language outcomes, prior to adjustments for full-scale IQ.ConclusionsThese findings expand our understanding of the structural correlates underlying impaired language performance in children born with EPT.ImpactThe article expands understanding of the structure-function relationship between magnetic resonance imaging measurements of language-related regions and language outcomes for children born extremely preterm beyond infancy.Most literature to date has focused on very preterm children, but the focus in this paper is on extreme prematurity and language outcomes.While the brain volume and cortical thickness of language-related regions were reduced in children born EPT only the volume, prior to adjustment for full-scale IQ, was associated with language outcomes.We found no differences in volumetric asymmetry between children born EPT and at term.

Association between interruption of intervention and language performance in young children with language delay-a cohort study during COVID-19 pandemic.

To assess the association between a three-month interruption of language intervention programs and the language performance of children with language delay during the COVID-19 pandemic, and to identify which children are more vulnerable to such interruptions. This is a retrospective study involving 33 children with language delay who experienced a three-month suspension of language interventions due to the COVID-19 pandemic. We collected their demographic data and language performance scores from the Comprehensive Developmental Inventory for Infants and Toddlers-Diagnostic test (CDIIT-DT) at four different time points. The scores were analyzed using a Wilcoxon Signed Ranks test. The median scores of language comprehension and overall language ability showed a decreasing trend during the interruption period. However, resuming interventions post-interruption showed a statistically significant increase in all language domains. Children in the borderline delay group (CDIIT-DT DQ scores between 71 and 85) were more likely to experience a decline in their language abilities during the interruption. This is the first study to reveal a decreasing trend in language performance during interruption periods, and highlighting the significance of post-interruption language interventions in facilitating improvements. Furthermore, our study brings attention to the heightened vulnerability of children exhibiting borderline language delay in overall language ability tests when faced with interruptions in language interventions.

No influence of regular rhythmic priming on grammaticality judgment and sentence comprehension in English-speaking children

A growing body of research has demonstrated the association between music and language, particularly between rhythm and grammar skills in children. A compelling piece of evidence for the influence of music on language comes from findings that a brief exposure to regular musical rhythm improved subsequent syntactic language performance in children. Nevertheless, those observations were made on one particular task, i.e., grammaticality judgment, mostly with French-speaking children. Here, we sought to corroborate and extend the rhythmic priming effect with English-speaking children aged 7 to 12 years who underwent two different syntactic tasks on spoken sentences: one involving judgment on morphosyntactic well-formedness (grammaticality judgment) and the other requiring noun–verb relation analysis (sentence comprehension), both following either regular or irregular rhythmic priming. Half of the children were administered synthetic speech stimuli (Experiment 1), and the other half were presented with natural speech (Experiment 2). Across the two experiments, we did not find any rhythmic priming effect; children’s performance on both the grammaticality judgment and sentence comprehension tasks was comparable irrespective of the regularity in prior rhythms. These results imply that the positive influence of regular rhythmic priming on syntactic processing may be confined to specific language or age populations, warranting further investigation.

Parental reports on the lexicon of children from diverse bilingual populations.

Parental questionnaires have been widely used to assess children's vocabularies. The MacArthur-Bates Communicative Developmental Inventories (MB-CDI) have been adapted into over 100 languages, providing researchers with access to various languages. As the vocabularies of bilingual children are distributed across their two languages, language knowledge must be assessed in both languages. While this can be done with two questionnaires, one for each language, the present study makes use of a multicultural adaptation of the MB-CDI, within a single questionnaire, that was geared specifically for bilingual context. In order to explore the developmental trajectories of the vocabularies of 90 bilingual children from diverse linguistic populations (English-Hebrew (n = 30), French-Hebrew (n = 30), and Russian-Hebrew (n = 30) speaking families) parents reported on both the Home Language (HL) and the Societal Language-Hebrew (SL-Hebrew). Parents also provided background information about the child, the child's family, and exposure to each language. Our findings show no significant difference between vocabulary size of children from diverse bilingual populations in the HL and the SL, for both production and comprehension. Moreover, children from all three groups demonstrate balanced bilingualism at the group level. Correlations were found between both exposure to and use of each language by children, and various vocabulary measures across the three groups. The similar vocabulary levels demonstrated by the three groups as well as the balanced bilingualism can be explained by the relatively high prestige of all languages tested. Exposure to each language shows support in that language and a negative effect on the other language, demonstrating the crucial role exposure plays in bilingual children's language performance.

Vocabulary skills of bilingual children: The evidence for context‐dependent performance

AbstractMost bilingual children often display greater proficiency and preference for one of their two languages. Researchers refer to this asymmetry as language dominance. However, despite being possible to determine the overall language dominance in bilinguals, there may be substantial flexibility in their language use. In particular, the relative ease of using each language may depend on the sociolinguistic context and the language of the interlocutor which may affect the ease of accessing words in a given language. In the present work, we investigate whether and how the sociolinguistic context in an International English medium school influences bilingual children's vocabulary production. Specifically, we examine whether bilingual first‐grade children's expressive vocabulary skills vary as a function of the linguistic context (Home/School) and the language (English/Spanish) of their conversational partner. Results showed that contextual factors interacted with child's language performance. The participants' ability to name objects in Spanish was affected by the conversational partner's language, and their ability to name Home‐context words varied by language. The findings of this investigation highlight the importance of considering sociolinguistic factors when evaluating bilingual children's language skills.

School and language performance in children born with low birth weight

ObjectivesTo identify the impact of birth weight on the development of metalinguistic skills and performance in reading, writing, and arithmetic in students aged 6 to 10 years, enrolled from the 1st to the 4th grade of Elementary School in public schools of the metropolitan region of São Paulo. MethodsThe concurrent cohort included 315 students. Birth weight was the exposure variable, and the outcomes were performance in receptive and expressive language, oral metalinguistic skills, and performance in writing, arithmetic, and reading. The tools employed were the Test of Language Competence (TLC) and the School Performance Test (SPT). Students were grouped into quartiles by birth weight for data analysis (P1: < 2170 g, P2: from 2171 g to 2450 g, P3: from 2451 g to 3150 g, and P4: > 3150 g). ResultsThe authors observed a tendency for the lower performance of the two groups with lower birth weights in listening comprehension and oral expression. The lower-weight group tended to perform poorly compared to the other groups vis-à-vis reading. In the global result of the SPT, worse performance was observed in the students in the first quartile compared to the others (p = 0.019). The multivariate analysis revealed no association between birth weight and results in the tests applied after adjusting for maternal schooling. ConclusionsBirth weight can interfere with oral and written language development. However, the determination of these processes occurs in the face of complex interaction that includes sociodemographic factors, especially family support and maternal schooling.

Working memory training in children with developmental language disorder: Effects on complex syntax in narratives.

This study assesses the impact of a working memory training program on the syntactic complexity of the spontaneous speech of French-speaking children with Developmental Language Disorder (DLD). Thirty-nine 6- to 12-year-old children with DLD were allocated to a WM training (DLDMM, N = 20) or an active control group (DLDSQULA, N = 19). The computerized training sessions took place three times a week, yielding 12 training hours per participant. Syntactic complexity was assessed in storytelling, measuring mean length of utterances, use of embedded clauses and rate of errors in complex utterances. The performance of participants with DLD was first compared to previous spontaneous data of 40 typically-developing (TD) children of the same age. Then, intragroup (pre- vs. post-test) and intergroup (DLDMM vs. DLDSQULA) comparisons were made to assess the impact of the working memory training on the language measures. Global results confirmed syntactic impairment in children with DLD, as opposed to TD children, with large differences for the use of embedded clauses. Findings also suggested gains in the mastery of embedded clauses in children who participated in the WM training, whereas no gains were observed in the DLD control group. These findings confirm deficits in complex syntax in children with DLD, in particular in embedded clauses, and may encourage the clinical use of language sample analysis, which provides an ecological account of children's language performance. While our results should be replicated on a larger scale, they also suggest positive transfer effects of working memory training on the capacity of participants with DLD to produce embedded clauses, in line with previous studies showing a positive effect of WM training on tasks of expressive syntax. It thus seems that working memory training can yield benefits for language, which leaves open the door to new therapeutic approaches for children with DLD.

Is epileptiform activity related to developmental language disorder? Findings from the HelSLI study

ObjectiveTo study if interictal epileptiform discharges (IEDs) are associated with language performance or pre-/perinatal factors in children with developmental language disorder (DLD). MethodsWe recorded routine EEG in wake and sleep in 205 children aged 2.9–7.1 years with DLD, without neurologic diseases or intellectual disability. We examined the language performance of the children and collected data on pre-/perinatal factors. ResultsInterictal epileptiform discharges were not associated with lower language performance. Children with so-called “rolandic”, i.e. centrotemporoparietal, IEDs had better language skills, but age explained this association. Most pre-/perinatal factors evaluated did not increase the risk of rolandic IEDs, except for maternal smoking (OR 4.4, 95% CI 1.4–14). We did not find electrical status epilepticus during slow-wave sleep (ESES)/spike-and-wave activation in sleep (SWAS) in any children. ConclusionsInterictal epileptiform discharges are not associated with lower language performance, and ESES/SWAS is not common in children with DLD. SignificanceRoutine EEGs do not bring additional information about language performance in children with DLD who do not have any neurologic diseases, seizures, intellectual disability, or regression of language development.

Attachment Styles and Language Performance in Middle Childhood; Investigating the Predictive Potential for Clinical Diagnosis

Objective: By exploring the language abilities of primary school children in attachment narratives and uncover potential associations between attachment styles and expressive indicators, this study investigated whether language performance can serve as a primary predictive measure for diagnosing attachment styles and injuries, particularly in cases where traditional assessment methods fall short. Methods and Materials: This descriptive and qualitative research involved a statistical population of 100 elementary school children selected through random sampling from four locations in Tehran between 2017 and 2019. Attachment styles of the children were assessed using the Finzi questionnaire. Subsequently, two story prompts devised for Iranian children, following the MacArthur Story Completion approach, were administered according to the prescribed protocol. Qualitative coding was employed to analyze all stages of recording, implementation, and children's language performance. Then, the frequency of codes within each attachment style was assessed. Findings: "Speech coherence" emerged as a significant indicator for secure children, while avoidant children displayed "briefness of expression" and "avoidance of response." Anxious children exhibited "talkativeness," "jumping from branch to branch," and "argument slippage," while disorganized children demonstrated "inability to respond" and "ambiguity" as key traits for early diagnosis of attachment style. Furthermore, only disorganized children showed a noticeable difference in the number of words expressed between the two stories. The primary distinction between these stories pertained to the presence of threats from parents or strangers. Conclusion: This study suggests that attachment styles can be predicted through language performance within this sample size. Specifically, "talkative" in anxious attachment style, "avoidance of response" in avoidant attachment style, and "ambiguity and confusion" in disorganized attachment style are noteworthy indicators. Expanding the research to a larger sample size is likely to yield more precise results.

Early prelingual auditory and language development in children with simultaneous bilateral and unilateral cochlear implants.

This current study aimed to explore early prelingual auditory development (EPLAD) and early language development in Mandarin-speaking children who received simultaneous bilateral cochlear implants (BICI) during the first year of cochlear implantation and compare the performance of the children who received BICI with those received unilateral cochlear implant (UCI). 39 Mandarin-speaking children who received BICIs simultaneously and 36 children with UCIs were enrolled in this study. To access the EPLAD, the Infant-Toddler Meaningful Auditory Integration Scale (IT/MAIS) was conducted, and a subtest of the simplified short-form version of the Mandarin Communicative Development Inventory (SSF-MCDI) was used to evaluate the development of expressive and receptive vocabulary for the children at indicated time points after surgery. In both the simultaneous BICI and UCI groups, we observed significantly increased scores of the SSF-MCDI and IT/MAIS 1 year after the surgery. There are indications of early advantages in children with BICI in IT/MAIS scores (at 1, 3, and 6 months after activation). For early development of language, a great difference between the expressive vocabulary scores and the receptive vocabulary scores was observed in both groups. We found there were not significant differences between the two groups on expressive or receptive vocabulary scores, the use of more differentiated measures might be required in future research. We further found that the development of the receptive or expressive vocabulary is dramatically correlated with the age at implantation and the total scores of IT/MAIS for children with simultaneous BICIs. These results may supplement the skills development of early language and auditory in Mandarin-native children with simultaneous CIs. It is obvious that children with normal hearing have mastery of receptive vocabulary before that of expressive vocabulary, which is the same as children with unilateral and bilateral CIs in this research. IT/MAIS total scores and age at CI were important factors for early language performance in children with simultaneous BICIs.

Children With Unilateral Hearing Loss After Newborn Hearing Screening in Taiwan.

We explored the intervention characteristics and language outcomes of children with unilateral hearing loss (UHL) in Taiwan after the implementation of universal newborn hearing screening (UNHS) to highlight changes in attitudes and actions toward hearing-related treatments. Data of 132 children with UHL in birth cohorts from 2012 to 2019 were included. This retrospective study examined differences in age at identification, hearing aid (HA) fitting, and seeking supportive services. Commonly requested attributes of services, reasons for HA rejection, and children's language performance were investigated. The age at identification decreased from 50.3 months in 2012 to 2.6 months in 2019. Similar trends of declining age were obtained for the age at HA fitting and age at first service contact. In addition, 40% of the parents did not seek support until the child became older (M = 30.5 months) and showed more noticeable behaviors related to hearing loss, and only 64% of the children were consistent HA users. Children with UHL enrolled in the intervention programs approximated the average language performance of the assessment norm; however, they showed depressed language levels when compared to the norm group at the 75th percentile. UNHS had a positive impact on early identification and intervention in children with UHL. Compared to parents of children with all types of hearing loss, parents of children with UHL seemed to be more uncertain about aural habilitation at the early stage.

Relationship between parental report of language skills and children's performance among 3-year-olds: Implications for screening language among preschoolers

AimThe study compared parental ratings of children's language abilities at 3-years of age with observations of children's language performance by Speech Language Pathologists (SLPs). MethodChildren (n=85) around 3-years of age were recruited from a child development clinic. Detailed speech and language assessments were completed during a one-hour semi-structured clinician-child interactive session. Language assessment was carried out using a criterion-referenced checklist and the language sections of the Bayley Scale for Infant Development- 3rd Edition (BSID-III). All parents rated their children's language skills using seven statements related to reception and expression domains of language on a 7-point rating scale. The language status of the child (typical language vs delay) determined by the parental report was matched with the language status as per the child's performance during the SLP assessment. Results and discussionMean parental ratings of children assessed as having language delay by an SLP were significantly lower than children with typical language. Total parental rating score correlated highly with overall language scores on BSID-III; the highest correlation was observed for ratings of statements related to expressive language skills focusing on formation of sentences. Parental report of below normal performance on any one of the seven statements demonstrated acceptable sensitivity (0.95) and a high negative predictive value (0.98) with the child's performance as the gold standard. ConclusionParental ratings of language skills correlated with child's performance at 3-years of age with a higher agreement for identifying children with delays. Parental reports can be useful to red-flag children for further assessment and continued monitoring of language development in busy developmental clinics and preschools, especially in the context of low-resource settings.

Age-related language performance and device use in children with very early bilateral cochlear implantation

ObjectivesPaediatric cochlear implantation within the first year of life results in better outcome in auditory and language skills. Beside individual, audiological and social factors, quantity and quality of daily cochlear implant (CI) use also seem to be an influencing factor. The purpose of this study was to evaluate children's early receptive and expressive language performance considering bilingual language development as well as quantity and quality of daily CI use and intraoperative objective measurements. MethodsThe retrospective analysis included data from 35 very early bilaterally cochlear-implanted children (age at CI M = 8.4 ± 1.5 months). Language performance was assessed by the German standardised test SETK-2 (age at testing M = 29.4 ± 4.0 months). The CI system-integrated data-logging was analysed with regard to daily CoilOn-time, CoilOff and exposure to classified listening scenes. Intraoperatively measured thresholds of evoked compound action potentials (T-ECAPs) were analysed to ensure CI functionality. ResultsThe cohort showed language performance within the normal range for word comprehension, sentence comprehension and word production, level of sentence production was reduced. Overall, bilingual children performed less well than monolingual children. Intraoperative T-ECAPs were recorded for the total cohort and no anomalies were detected. Children used their CI for about 8.7 ± 1.4 h per day, most of this time spent in a quiet environment (38%). Word production was significantly correlated with the daily duration of CI use (CoilOn-time) and with exposure to the listening environment Speech. No correlation was found between number of daily coil disconnections (CoilOff) and language performance. ConclusionVery early bilateral cochlear implantation may result in age-appropriate language skills already at the age of 2 years. Monolingualism seems to a better condition for early language development with CI than bilingualism. Especially for word production, the daily duration of CI use and exposure time in a speech-characterised environment seem to be additional positive factors. Monitoring the data-logs should be one important focus of professionals during the postoperative rehabilitation process to detect potential benefits and risks. These findings should be integrated into rehabilitative therapy and parent counselling.

Children with Auditory Brainstem Implant: How Do They Perform in Motor and Language Skills?

Background: Young children are able to explore new objects and practice language through the acquisition of motor skills that lead to their overall development. Congenital hearing loss and total vestibular loss may contribute to the delay in speech and motor skill development. Objectives: To investigate the relationship between motor development performance, speech perception, and language performance in children with auditory brainstem implant (ABI). Method: Ten children, aged 4–17 years (mean age 9.76 ± 4.03), fitted with unilateral ABI for at least 2 years due to the presence of labyrinthine aplasia and rudimentary otocyst at least 1 side were included in the study. Several standardized tests, such as Bruininks-Oseretsky Motor Proficiency Test-2 (BOT-2), Children’s Auditory Perception Test Battery, Meaningful Auditory Integration Scale (MAIS), and Test of Early Language Development-3, were performed to evaluate their skills of fine motor control, balance, manual dexterity, language, and auditory perception. Results: A significant correlation was established between the BOT-2 manual dexterity and MAIS scores (r = 0.827, p < 0.05) and between the manual dexterity and language skills (for expressive language, r = 0.762, p < 0.05; for receptive language, r = 0.650, p < 0.05). Some of the BOT-2 balance tasks, such as standing on 1 leg on a line with eyes closed, standing on 1 leg on a balance beam with eyes open, standing heel-to-toe on a balance beam, and walking forward heel-to-toe on a line, showed a strong correlation with their receptive and expressive language performance (p < 0.05). Conclusion: The current study has indicated that significantly poor manual and balance performances are associated with poor speech perception and language skills in children with ABI. The authors recommend performing a vestibular assessment before and after ABI surgery and the use of a holistic rehabilitation approach, including auditory and vestibular rehabilitation, to support development of the children with ABI.

Nonverbal Intelligence Predicts Performance of Preschool Children With Hearing Loss on Norm-Referenced Language Measures But Not Language Sample Analysis.

The purpose of this study was to explore the effects of nonverbal intelligence on spoken language performance in children with hearing loss who use amplification and spoken language. Specifically, we compared language performance measured by norm-referenced measures compared with spontaneous language sample measures. Nonverbal intelligence and spoken language skills were analyzed using norm-referenced nonverbal intelligence and language assessments and language sample analyses in 92 children ages 3 to 6 who varied by hearing and nonverbal intelligence status. All children had nonverbal intelligence within the average or above-average range. Regression analyses revealed that, after controlling for maternal education and hearing status, nonverbal intelligence contributed unique variance to norm-referenced language measures but not spontaneous language measures. Performance on norm-referenced language measures is influenced by nonverbal intelligence, whereas functional language use measured by spontaneous language samples is not. These findings suggest that spontaneous language measures may contribute additional value to language assessment batteries that are independent of nonverbal intelligence.

Long-Term Language Development in Children With Early Simultaneous Bilateral Cochlear Implants.

Objectives:This longitudinal study followed the language development of children who received the combination of early (5 to 18 months) and simultaneous bilateral cochlear implants (CIs) throughout the first 6 years after implantation. It examined the trajectories of their language development and identified factors associated with language outcomes.Design:Participants were 21 Norwegian children who received bilateral CIs between the ages of 5 and 18 mo and 21 children with normal hearing (NH) who were matched to the children with CIs on age, sex, and maternal education. The language skills of these two groups were compared at 10 time points (3, 6, 9, 12, 18, 24, 36, 48, 60, and 72 months after implantation) using parent reports and standardized measures of general language skills, vocabulary, and grammar. In addition, assessments were made of the effects of age at CI activation, speech recognition abilities, and mothers’ education on language outcomes 6 years after implantation.Results:During the first 4 years after implantation, the gap in general expressive and receptive language abilities between children with CIs and children with NH gradually closed. While at the initial five to six assessments (3 to 36 months after implantation), significant differences between children with CIs and children with NH were observed; at 4 years after implantation, there were no longer any significant group differences in general language skills and most children with CIs achieved scores within 1 SD of the tests’ normative means. From 2 to 3 years after implantation onward, expressive vocabulary and receptive grammar skills of children with CIs were similar to those of the reference group. However, from 4 years after implantation until the end of the observation period, 6 years after implantation, expressive grammar skills of children with CIs were lower than those of children with NH. In addition, a gap in receptive vocabulary appeared and grew increasingly larger from 4 to 6 years postimplantation. At the final assessment, the children with CIs had an average receptive vocabulary score around 1 SD below the normative mean. Regression analysis indicated that the children’s language outcomes at 6 years after implantation were related to their speech recognition skills, age at CI activation, and maternal education.Conclusions:In the first 4 years after implantation, the language performance of children with CIs became increasingly similar to that of their NH peers. However, between 4 and 6 years after implantation, there were indications of challenges with certain aspects of language, specifically receptive vocabulary and expressive grammar. Because these challenges first appeared after the 4-year assessment, the findings underline the importance of long-term language intervention to increase the chances of a continued language development comparable to that of NH peers. They also indicate that there is a need for comprehensive longitudinal studies of the language development of children with CIs beyond 4 years after implantation.