Ferenc Bunta

Health disparities in monolingual and bilingual children with hearing loss who use cochlear implants

Large individual variability in speech and language outcomes in children with hearing loss who use cochlear implants are well-documented in the literature (e.g., Boons et al., 2012; Dettman et al., 2016; Van Wieringen & Woulters, 2015). Age at implantation, duration of implant use, amount and type of treatment, and other child-specific factors have been found to affect communicative outcomes. However, socioeconomic as well as cultural and linguistic factors have received relatively less attention despite them contributing to health disparities. In our on-going study, we are investigating the effects of these factors on speech outcome measures in monolingual English-speaking children and their bilingual peers who use cochlear implants, and we report our preliminary findings in the present study.

Pilot data from 8 children with hearing loss who use cochlear implants (ages 4;3 to 7;9) have been analyzed. Participants included 6 monolingual English-speaking children and 2 children from households where Spanish was the predominant language with varying socio-economic backgrounds as measured by family income and education level of the primary caregiver. Survey data on demographic information have been collected (including household income, education level of the primary caregiver, age of the child, age of implant activation, and others). A single-word speech sample was also collected from the children. The dependent variables were consonant accuracy (percentage of consonants correctly produced, PCC) as well as phonological whole-word measures such as Phonological Mean Length of Utterance (pMLU) and Proportion on Whole-Word Proximity (PWP) (cf. Ingram, 2002). Exploratory measures included correlations and regression analyses to explore the relationships between the independent and dependent variables.

Preliminary analyses indicate that household income affects speech outcome measures at a statistically significant level (PCC: R2 = 0.928 at F (4, 7) = 9.653 at p = 0.046; pMLU: R2 = 0.954 at F (4, 7) = 15.488 at p = 0.024, and PWP: R2 = 0.965 at F (4, 7) = 20.802 at p = 0.016). None of the other demographic factors had statistically significant effects on the speech outcome measures. A closer investigation appears to indicate that children whose families are in the highest income bracket performed relatively well on speech outcome measures overall while children whose families were in lower income brackets displayed more varied performance in terms of PCC, pMLU, and PWP.

Being mindful of the preliminary nature of our analyses, it seems that among the demographic variables we investigated, family income stood out as the factor that had a statistically significant effect on speech outcome measures. It is also important to note that while children whose families were in the highest income bracket generally performed well on speech outcome measures, some of the children from lower income households also displayed relatively high levels of speech performance but there was more variability in the latter groups when it came to speech outcome measures.