Special Session: Cochlear Implantation and NeurodevelopmentThinking Fast and Slow: Speed of Information Processing, Executive Functioning, and Language Development in Children with Cochlear Implants Objectives: Children and adolescents with cochlear implants (CIs) show considerable variability in language outcomes, which is not fully explained by demographic, device, or hearing factors. Investigations of neurocognitive abilities in children with CIs have demonstrated that individual differences in speed of information processing and executive functioning account for a significant amount of this heretofore unexplained variance in language outcomes. In this presentation, a unifying model will be presented explaining how and why speed of information processing and executive functioning contribute significantly to language outcomes after cochlear implantation in prelingually deaf children. Design: The proposed model explains differences in language outcomes following implantation based on prior theories that the human brain processes information through two channels: (1) a fast-automatic channel characterized by rapid processing, little conscious awareness, and minimal mental effort and (2) a slow-controlled channel characterized by conscious systematic processing and considerable effort. While both channels require some access to speed of information processing and executive functioning, the fast channel is more reliant on speed of information processing whereas the slow channel is more reliant on executive functioning. Children with CIs have underspecified/fragile cognitive representations of speech and language which deteriorate more quickly, take longer to process, and require greater listening effort. As a result, their verbal speed of information processing is especially important in order to manage as much language as possible using the fast-automatic processing channel before deterioration of linguistic stimuli in awareness and memory. Conversely, they are more reliant on the slow-controlled processing channel using executive functioning to provide more intentional, effortful processing as they compensate for fragile, degraded, or delayed representations of language. Results: Empirical research will be reviewed to support this model by demonstrating that: (1) Children with CIs have slower verbal speed of information processing, on average, than typically hearing children and therefore process less language information in the same amount of time; (2) Children with CIs who have faster speed of information processing show better language outcomes because they can process more linguistic information through the fast-automatic channel; (3) Children with CIs who have stronger executive functioning skills experience better language outcomes because they are able to compensate for insufficient fast-automatic processing of language by engaging in more focused, intentional language processing effort using the slow-controlled channel of language processing. Conclusions: Fast-automatic information processing and slow-controlled information processing both contribute significantly to the development and quality of language skills in children and adolescents with cochlear implants. As a result, individual differences in the foundational neurocognitive abilities of speed of information processing (primarily supporting the fast channel) and executive functioning (primarily supporting the slow channel) explain variability in language outcomes following cochlear implantation. Interventions to improve skills or efficiency of speed of information processing and executive functioning therefore offer the potential to improve not only neurocognitive functioning but also speech-language outcomes in children and adolescents with cochlear implants. Examples of evidence-based interventions of these types will be provided.
William G. Kronenberger, Ph.D., is the Arthur B. Richter Professor of Child Psychiatry at Indiana University School of Medicine. He serves as Director of the Pediatric Psychology Testing Clinic and as the Pediatric Psychologist in the Deaf and Hard-of-Hearing Clinic at Riley Hospital for Children. Dr. Kronenberger received his B.S. from Xavier University. He received his M.A. and Ph.D. in Clinical Psychology (specializing in Pediatric Psychology) from Duke University, where he was a James B. Duke Fellow and Norman Guttman Named Instructor. He completed his internship at Indiana University School of Medicine, where he served as Chief Psychology Intern. Dr. Kronenberger’s research investigates influences on the development of executive functioning, memory, learning, and spoken language, particularly in children with hearing loss and cochlear implants. His clinical work involves assessment and treatment of executive functioning, language, and learning disorders. He is the developer of the EMBED executive functioning therapy program as well as several psychological tests that are used nationally and internationally. He has been a principal investigator or co-investigator on NIH-funded projects addressing neurocognitive and spoken language development in children with cochlear implants.
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