Istituto di Scienze e Tecnologie della Cognizione-CNR, Rome, Italy.
Int J Lang Commun Disord. 2013 Nov-Dec;48(6):715-25. doi: 10.1111/1460-6984.12046. Epub 2013 Jul 29.
An increasing number of deaf children received cochlear implants (CI) in the first years of life, but no study has focused on linguistic and pragmatic skills in children with CI younger than 3 years of age.
To estimate the percentage of children who had received a CI before 2 years of age whose linguistic skills were within the normal range; to compare linguistic skills of children implanted by 12 months of age with children implanted between 13 and 26 months of age; and to describe the relationship among lexical, grammar and pragmatic skills.
METHODS & PROCEDURES: The participants consisted of children who were included on the patient lists of the Service of Audio-Vestibology of the Circolo Hospital in Varese, Italy, and met the following criteria: chronological age between 18 and 36 months; CI activated between 8 and 30 months of age; absence of other reported deficits; hearing parents; and not less than 6 months of CI experience. Language development was evaluated through MacArthur-Bates CDI; pragmatic skills (assertiveness and responsiveness) were evaluated through the Social Conversational Skills Rating Scale. The scores obtained were transformed into z-scores and compared with normative data. The relationship among lexical, grammar and pragmatic skills were tested using Spearman Rho correlations. Children with CI were divided into groups based on the age at CI activation and the differences between the two groups were tested using the Student's t-test.
OUTCOMES & RESULTS: Data from 23 deaf children were collected. Fewer than half of the children were within the normal range for lexical production and use of sentences; more than one-third of them fell below the normal range for both lexical and grammar skills. No significant difference was found in vocabulary size or early grammar skills when comparing children who received the CI by 12 months of age with those implanted during the second year of life. Despite the strong relationship among lexical, grammar and pragmatic skills, the delays found for grammar and pragmatic skills were greater than expected based on the vocabulary size. Age at diagnosis of hearing loss was the only predictor of vocabulary size.
CONCLUSIONS & IMPLICATIONS: CI may provide deaf children with a good opportunity to develop language skills, but severe difficulties in early social experiences and interaction mediated by language still remain. Delays in these aspects suggest that interventions improving pragmatic skills are recommended even on very young children with CI.
越来越多的失聪儿童在生命的最初几年接受了人工耳蜗植入（CI），但尚无研究关注 3 岁以下接受 CI 的儿童的语言和语用技能。
评估在 2 岁之前接受 CI 的儿童中，语言技能处于正常范围内的比例；比较 12 个月内植入 CI 的儿童与 13 至 26 个月内植入 CI 的儿童的语言技能；并描述词汇、语法和语用技能之间的关系。
参与者包括意大利瓦雷泽 Circolo 医院听觉-前庭科患者名单中的儿童，符合以下标准：年龄在 18 至 36 个月之间；CI 在 8 至 30 个月之间激活；无其他报告的缺陷；听力正常的父母；并且接受 CI 治疗至少 6 个月。语言发育通过麦克阿瑟-巴西语 CDI 进行评估；语用技能（自信和响应性）通过社会会话技能评定量表进行评估。获得的分数转换为 z 分数，并与标准数据进行比较。使用 Spearman Rho 相关性检验词汇、语法和语用技能之间的关系。根据 CI 激活的年龄将 CI 儿童分为两组，并使用学生 t 检验比较两组之间的差异。
共收集了 23 名失聪儿童的数据。词汇生产和使用句子的正常范围内的儿童不到一半；超过三分之一的儿童在词汇和语法技能方面均低于正常范围。在比较 12 个月内接受 CI 的儿童与在生命第二年接受 CI 的儿童的词汇量或早期语法技能时，没有发现显著差异。尽管词汇、语法和语用技能之间存在很强的关系，但语法和语用技能的延迟程度大于根据词汇量预期的程度。听力损失的诊断年龄是词汇量的唯一预测因素。
CI 可能为失聪儿童提供发展语言技能的良好机会，但在早期社会经验和语言介导的互动方面仍然存在严重困难。这些方面的延迟表明，即使对非常年幼的接受 CI 的儿童，也推荐进行改善语用技能的干预措施。
