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Chapter 3 2018
Chapter 3 2018
Chapter 3
Cognitive Development
Uma G. Soman
I
t is well established
that childhood
Cognition
hearing loss
limits children’s The study of cognition
ability to hear the is the study of how
language in their human beings receive,
auditory environment process, integrate,
and has a negative and respond to
impact on language information. Attention,
acquisition. Without memory, executive
timely and appropriate function, convergent
intervention, children thinking, and divergent
who are deaf or hard Photo courtesy of NCHAM thinking are some of
of hearing (D/HH) the cognitive processes
might have limited language proficiency that also that have been studied in children with and without
impacts their ability to learn in school and engage disabilities. These cognitive processes are important
in successful social interactions. Often, the focus of for learning in and out of the classroom. In fact, the
intervention is ensuring adequate access to the speech common core standards were designed to help students
spectrum and promoting language development with develop “critical-thinking, problem-solving, and
the belief that once children have age-appropriate analytical skills” necessary for higher education and
language skills, performance in all other domains will employment (http://www.corestandards.org/). So in
be age appropriate. However, research conducted in addition to teaching infants, toddlers, and children to
the last two decades indicates that children who are listen and speak, teachers of the deaf are also responsible
D/HH who experience early auditory deprivation for teaching them to observe, describe, compare,
and have delayed language development continue classify, sequence, analyze, evaluate, interpret, predict,
to demonstrate delays and difficulties in certain summarize, hypothesize, imagine, and create.
areas of cognition. This chapter will provide an
overview of the difficulties that have been observed Cognitive development has been studied in the context
in cognitive development, factors that contribute to of several theories of cognitive development. Piaget’s
these difficulties, and how teachers of the deaf might development stage theory posited that a combination of
address these challenges in their classrooms. maturation and nonlinguistic experiences during early
childhood shape an individual’s cognitive development. the ability to receive and manipulate or “act on” the
He proposed that children are organizing the world information that is provided. It has been observed
around them through mental operations that become that certain executive function and memory skills are
more complex and adult-like by adolescence. Children “domain general” (i.e., apply to skills not just from the
progress from the sensorimotor stage of physical cognition domain but also from the motor domain and
exploration to the preoperational stage of creating language domain, such as sequencing words, symbols,
mental representations and engaging in role playing to and actions; Pisoni, Conway, Kronenberger, Henning,
the concrete and formal operational stages involving & Anaya, 2010). Additionally, certain cognitive skills
information organization, perspective taking, and are also considered to be “language mediated” (i.e.,
reasoning. individuals use language to implement the cognitive
skills). One common example is a preschooler’s self-talk
Vygotsky proposed that children develop their thinking during problem solving.
skills through social interactions with a tutor or
guide who can model behaviors or In addition to core cognitive constructs
strategies of organizing knowledge of executive function and memory,
and information. He also proposed As readers of convergent and divergent thinking
that children learn best when they this chapter are critical for thinking and learning
are taught within their “zone of successfully. Convergent thinking is the
proximal development” with a focus explore theories exercise of processing multiple pieces
on emerging skills rather than skills of cognitive of information to arrive at a single
that are too advanced. His theory piece of information (i.e., answering the
also emphasized language as a tool of development, question, “How are the sun, an orange,
sharing and organizing knowledge and they should and a ball alike?” with the response,
thoughts. A deeper understanding of “They are round”). Divergent thinking
each of these theories and how they examine how is the exercise of processing one prompt
influence cognitive development in congenital or piece of information to arrive
children is important but beyond the at multiple exemplars or responses
scope of this chapter. As readers of this hearing loss (i.e., answering the question, “Name
chapter explore theories of cognitive might impact three things that are yellow,” with the
development, they should examine how response, “Sunflower, egg yolk, banana”).
congenital hearing loss might impact cognitive
cognitive development. For example, development. Another aspect of cognition that is
how might hearing loss impact the relevant for teachers is social cognition
sensorimotor stage of development, or (i.e., applying cognitive skills to
how might hearing loss impact the use of language as a understand and participate in social situations). Theory
tool for thinking? These reflections will be helpful when of mind (i.e., an understanding of other’s emotions,
determining how you could teach a particular topic, beliefs, and perspective) is an important aspect of social
behavior, or skill to your students. cognition (de Villiers & de Villiers, 2012; Garfield,
Peterson, & Perry, 2001).
In this chapter, we will examine a few cognitive
processes that have a significant impact on cognitive Cognitive psychologists have proposed theories to
and language development of children who are deaf or understand and explain cognitive development. Two
hard of hearing. Executive function is a broad construct that are often implemented in educational settings are
that is important for conscious control of thought Piaget’s development stage theory and Vygotsky’s theory
and action (Zelazo & Müller, 2010) and is reflected of cognitive development.
in an individual’s ability to attend to tasks, inhibit
responses, create and follow rules, and solve problems.
It is also associated with proficiency in reading, math
Cognitive Development
(Blair & Razza, 2007), and social skills (Blakemore &
Choudhury, 2006). The construct of working memory— In the first few years of life, typically developing
often included as a part of executive function—is children progress from basic cognitive skills, such
as understanding cause and effect (e.g., the baby In the context of children who are D/HH, several factors
discovers that the toy lights up when Daddy pushes might influence development of cognitive skills:
the button and reaches to push the button herself)
and object permanence (e.g., the baby starts to learn Child Factors
that his favorite toy is still there even if he doesn’t
see it), to more complex skills, such as classification Characteristics related to the child’s hearing
(e.g., separating indoor toys and outdoor toys), simple loss, presence of other disabilities, overall
problem solving (e.g., fixing a ripped book with tape), development, and intervention.
and recalling sequences (e.g., remembering a set of
instructions for an art project; see developmental Caregiver Factors
milestones checklists available from CDC https://
www.cdc.gov/ncbddd/actearly/milestones/). These Characteristics of parental engagement as well as
skills develop naturally when children engage in age- quality and quantity of input provided by parents,
appropriate play activities. Often very little direct caregivers, and interventionists.
instruction in these skills is required for typically-
developing children. Environmental Factors
It is important to note that cognitive skills are
Includes situations, stresses, and supports present
developing in the context of other skills and abilities.
in the child’s environment.
For example, a baby reaching out to push the button on
a light-up toy is a combination of skills in the cognition
domain (understanding cause and effect) and motor Research on the precise impact of these factors
domain (reaching and pointing). If motor development individually and in combination is ongoing. However,
is delayed or if severe visual impairment does not allow examining the contribution of each of these factors
the baby to see the toy lighting up, development of to overall development—and cognitive development
the cognitive skill of understanding cause and effect in particular—is important for teachers of the deaf
in this context might be limited or delayed. Similarly, working with young children.
following instructions for an art activity might be
limited by difficulties in the language domain that affect Hearing loss limits a child’s access to her auditory
understanding of vocabulary and concepts necessary to environment, which negatively impacts the process
complete the activity. of language acquisition. The extent to which hearing
loss affects development might be dependent on how
Additionally, the experiences of the child and the quickly and how well the hearing loss is managed.
input received from adults and peers can also Researchers have discovered that lack of stimulation to
influence cognitive development. For example, if the auditory cortex in the first few years of life can alter
a toddler has minimal contact with a caregiver or brain development (Gilley, Sharma, & Dorman, 2008;
minimal exposure to developmentally appropriate Kral & Sharma, 2012; Sharma, Nash, & Dorman, 2009).
activities, she might show delays or difficulties in The differences in neural responses to sound in children
skill development. with and without hearing loss have been attributed to
A difficulty or delay lack of auditory input. If children who are D/HH receive
It is important in one domain for a auditory input (through a cochlear implant) before
to note that child who is D/HH 3.5 years of age after a period of auditory input, their
can create a responses to the presence of sound become similar to
cognitive skills developmental children with normal hearing (Sharma et al., 2009).
are developing dysynchrony across
domains. This Another fundamental process that might be disrupted
in the context dysynchrony should by lack of early auditory input is audiovisual integration.
of other be understood and Speech perception is an audiovisual activity that involves
addressed to listening to speech and watching the talker’s face to
skills and minimize long-term integrate auditory and visual cues present in a spoken
abilities. impact. language (Kuhl & Meltzoff, 1982; Lewkowicz, 2010;
Sumby & Pollack, 1954). Infants who have normal hearing Additionally, they might receive limited input for
rely on auditory and visual cues when learning the home other reasons, such as caregivers’ hesitance or lack of
language(s). Individuals with hearing loss demonstrate knowledge regarding providing rich input or living
differences in their ability to integrate auditory and visual in an impoverished environment where exposure to
cues in the context of speech and spoken language. It developmentally-appropriate activities is limited. In
has been proposed that difficulties in these fundamental other words, for a variety of reasons, many children who
developmental processes might have a long-term impact are D/HH might not have adequate opportunities for
on language learning and processing. Cognitive delays developing cognitive skills. For children who are
are not caused by reduced hearing levels but by a lack D/HH, quality and quantity of input can sometimes be
of access to language. Many students who are D/HH limited by the child’s language proficiency. Often the
display cognitive development commensurate with their focus of intervention might be learning words of objects
hearing peers if they have age-appropriate language skills. and action. Certain types of activities or conversations
might not be conducted, because the child doesn’t have
Teachers of the These developmental enough language to understand and respond. However,
processes can be activities that promote cognition can also support
deaf would benefit further impacted by language development. Strategies to target cognition
from understanding the presence of other and language development through age-appropriate
sensory or neurological activities will be discussed later in this chapter.
the underlying challenges. The
cognitive constructs, presence of visual
impairment in
Impact of Hearing Loss on
challenges that addition to hearing Cognitive Development
children who are loss can significantly
affect development Over the last few decades, the impact of auditory and
D/HH might face, of audiovisual language deprivation on neurocognitive development
and how they integration for speech and psychosocial development has been an area of
perception and how growing research. It has been widely observed that
manifest in their the child engages with having age-appropriate language skills does not
learning and the environment in guarantee age-appropriate skills in other domains.
general. The presence It has been proposed that difficulties in cognitive
behavior. of a neurological skills might in fact be related to an earlier period of
disorder, such as auditory and language deprivation and not the child’s
cerebral palsy in which current language proficiency (Pisoni et al., 2010).
motor difficulties might impede cognitive and language Teachers of the deaf would benefit from understanding
development or autism spectrum disorder in which the the underlying cognitive constructs, challenges that
desire to engage in social interaction is diminished, can children who are D/HH might face, and how they
further impact development. manifest in their learning and behavior.
In addition to the characteristics of the child, caregiver Researchers are interested in understanding if and how
characteristics and environmental factors also influence hearing loss impacts processes that do not rely on or
cognitive development. Child development across require language and are applicable across multiple
domains is influenced by the child’s experiences and domains (domain-general skills) but are “executive-
inputs received. The quality and quantity of language organizational-integrative” processes (Beer, Pisoni, &
input can have an impact on children’s vocabulary Kronenberger, 2009; Pisoni et al., 2010). For example,
development. Children who receive less and/or poor- sequencing is a process that is present in verbal as well
quality input often have smaller vocabularies than their as nonverbal forms (e.g., repeating a series of words,
peers (Hart & Risley, 1995; Huttenlocher, Vasilyeva, executing a series of actions). In line with the hypothesis
Cymerman, & Levine, 2002). Children who are D/HH that early auditory and language deprivation might
typically receive less language input depending on impact cognitive development, Conway and colleagues
how consistently they wear their hearing aids and/or proposed the “auditory scaffolding hypothesis,” which
cochlear implants. posited that early auditory experience of processing
speech as a temporal and sequential signal contributes as motor sequences (finger-tapping) and visual-spatial
to learning sequence processing across verbal, sequences (series of lights on a grid), and discovered
nonverbal, and motor domains (Conway, Pisoni, & that children who are D/HH had difficulty with the
Kronenberger, 2009. Difficulties in auditory, visual, and nonverbal stimuli—reinforcing the hypotheses that
motor sequencing demonstrated by children who are memory for sequences is impaired across domains for
D/HH suggest that early auditory deprivation disrupts children who are D/HH, presumably due to limited
development of sequence processing (Conway et al., exposure to auditory scaffolding (Conway et al., 2009).
2009). This finding is important for teachers, because
sequence processing is a prerequisite to learning a Difficulties in working memory and with learning
variety of skills, including learning the vocabulary and sequences are correlated with poor speech and language
grammar of a language and motor planning for writing outcomes (Conway et al., 2009; Houston et al., 2012).
letters. Converging evidence indicates that children It is easy to imagine how a student who has difficulty
who are D/HH who use cochlear implants demonstrate with listening to and remembering information might
difficulties in working memory, fluency, and inhibition. struggle in the classroom with routine activities, such
Additionally, difficulties in these as listening comprehension, solving
areas can manifest as challenges in story problems using mental math, and
academic achievement as well as social It is easy to following a set of complex directions.
competence. The ability to receive, Research on evaluating interventions
retain, and recall information is imagine how a that might facilitate development
important for learning. student who has of working memory are ongoing
(Kronenberger, Pisoni, Henning,
Working memory and the ability difficulty with Colson, & Hazzard, 2011).
to receive, retain, and manipulate listening to and
information has been often evaluated Another area that is examined is
using the digit span task in which remembering fluency and speed of processing
children are asked to repeat sequences information information. Children who used
of numbers in the reverse order that cochlear implants were less proficient
they were presented. Multiple studies might struggle than their hearing peers when
have demonstrated that cochlear in the classroom performing tasks requiring verbal
implant users have difficulty compared fluency (naming words), visual fluency
to their hearing peers (Houston et al., with routine (identifying or matching pictures),
2012; Kronenberger, Pisoni, Harris, et activities. and motor fluency (drawing symbols;
al., 2013; Pisoni, Kronenberger, Roman, Kronenberger, Pisoni, Henning, &
& Geers, 2011). These difficulties Colson, 2013). Anecdotal data from
have been observed in long-term users who were early parents and teachers often suggest that children who
implanted, indicating that duration of deafness and are D/HH need extra time to process a question or
duration of auditory experience might not contribute formulate an answer. We can speculate that these
much to development of working memory skills. difficulties in fluency might contribute to needing more
Additionally, there is a lot of variability in working time to process information.
memory abilities across children suggesting that
some children have age-appropriate working memory A third area where difficulties have been observed is
skills—demonstrating that it is possible to develop age- executive function, especially inhibition, which is the
appropriate working memory skills. ability to suppress automatic responses to follow a
certain set of rules. The Stroop Word Color test is often
Responses of parent questionnaires, such as the used to examine the ability to substitute a familiar
Behavior Rating Inventory of Executive Function, are or over-rehearsed response, such as names of colors
aligned with findings from experimental tasks and and numbers, with another response (Kronenberger,
also indicate difficulties in working memory (Beer, Pisoni, Henning, et al., 2013; Pisoni et al., 2010).
Kronenberger, & Pisoni, 2011). Given that hearing loss Children who use cochlear implants demonstrate
negatively impacts language development, some studies difficulties in the ability to inhibit a response (i.e.,
have examined memory for nonverbal stimuli, such override an automatic response). We can speculate
Table 1
Strategies to Support Cognitive Skill Development
Strategy 1: Familiarize yourself with age-appropriate cognitive skills for your students.
Refer to developmental checklists and grade-level learning standards. However, do not base your expectations on
chronological age or grade level alone. Take into account the child’s hearing age as well as language proficiency. For
example, even though by age 4, children are expected to engage in cooperative problem solving, a child with hearing
loss who has the language skills of a 2-year-old will have difficulty achieving this goal—not because of her inability to
problem solve but her inability to communicate with her peers about problem solving. Similarly, a fourth-grade student
who reads and writes at a second-grade level might have trouble summarizing a story due to difficulties with the skill
of summarizing as well as a limited proficiency with reading and writing. The Cottage Acquisition Scales for Listening,
Language, and Speech (CASLLS) are a useful resource for monitoring a child’s cognition, play, listening, and language
development.
Strategy 2: Identify the cognitive skills required in the various activities your students participate in.
Age-appropriate play activities and routine classroom activities rely on particular language and cognitive skills (see chart below).
Strategy 3: Observe your students and identify if any difficulties are attributable to listening skills,
limited language proficiency, and/or underdeveloped cognitive skills.
Identifying which skill needs to be addressed is not easy and requires some observation and analysis on the teacher’s part. For
example, a student who struggles with retelling a sequence-based story (e.g., Very Hungry Caterpillar, Little Red Hen) might have
difficulty with remembering the sequence of events and/or formulating the sentences to retell the story. One way to further evaluate the
student’s skill would be to provide the student with visuals of the sequence and ask to retell. If the student retells the story successfully,
it is indicative of his difficulty with remembering a sequence of events. If he doesn’t benefit from the visuals, additional probing
is required, such as asking him to retell a story or event that is less complicated or more familiar. Observing student performance
on activities that do and don’t require certain cognitive skills can provide insight into their language and cognitive abilities.
Strategy 4: Evaluate how your lessons and teaching strategies promote development of cognitive skills.
This exercise will help you see that there might be several skills you have been targeting all along! The next step is to be more
mindful and explicit about those targets and ensure that you are addressing a wide variety of skills. For example, you might be
working on making predictions—“What will happen next?”—every time you read a story but might not be targeting making
deductions—“Why do you think the boy’s hair is wet?” The following prompts might be useful in helping you evaluate your teaching:
Often, there is an emphasis on teaching the labels for In an effort to build vocabulary, it is easy to ask questions
objects and actions. While that is most definitely the first about the here and now. Questions about here and now can
step in acquiring a foundation for language, the next step promote cognitive skills of observing—describing what is
should be using the language to promote thinking. Asking being seen. It is important to ask questions beyond what
a variety of questions can be a useful technique. is observable, such as questions that prompt comparing—
“Did you have a yellow cake at your birthday party, like the
girl in the story?” While the answer might be a simple yes
or no, the skills that are used here are that of understanding
the question, recalling the birthday event, comparing
personal experience with the one in the story, and coming
to a conclusion. The chart below lists some cognitive skills
and the prompts/question you can use to foster these skills.
Strategy 5: Develop activities that focus on specific cognitive skills while addressing listening and
language targets.
Once you have identified the cognitive skills that are developmentally appropriate for your students and your students’
current proficiency, you can incorporate cognitive skills into your auditory and language activities. The following are
some sample activities for key cognitive skills.
Memory
Many children who are D/HH have difficulties in memory. allow children to practice and develop compensatory
Working memory interventions haven’t been particularly strategies. Playing a simple game of “telephone” can help
beneficial, and it is unknown if practicing strategies for students practice attending to and retaining information.
remembering sequences or separate pieces of information Learning an action song, like the Macarena, and doing
is beneficial. However, implementing activities that the actions in a forwards then backwards sequence can
incorporates memory practice in a natural manner can provide practice with motor sequencing.
Observing
Children need to practice carefully observing various and adjectives. The chart below lists activities that are
features using all of their senses. Observation activities appropriate for preschoolers.
can provide natural opportunities to talk about nouns
Activity Observation/Dialog
Present the students with a small plant. Teacher: What do you see?
Student: I see hair.
Teacher: Yes, those have a special name. They are called
“roots.” They help the plant get water from the dirt.
Pass the plant to the next student. This interaction can also Student: I see green circles.
promote social interactions. Teacher: Yes, those are called “leaves.” And look, this leaf is
longer. The shape is like a circle but longer. It is an oval.
Also ask students to draw the plant and help them label. This will promote cognition, fine motor, and language skills.
Each student’s drawing can then be made into a puzzle. This will help students practice part-to-whole concepts.
The teacher could further extend this as an auditory For example, “Find the roots,” or “Find the part that helps
activity with language targets. the plant get water from the dirt.”
Students are expected to be able to sort, categorize, The purpose of the activity in the chart below is to
compare, and compute data. These skills do not require categorize objects based on a feature—shape, color,
very advanced language skills and can be incorporated in function, etc. This activity, while focused on cognition,
routine activities. allows the teacher to target concepts and language
important for math—sort, most, least, column, etc.
Activity Observation/Dialog
During snack, give each student graph paper with large Teacher: Sort the snack into groups. “Sort” means make
squares; then serve Frootloops or colored Goldfish. groups of things that go together.
If students do not have enough language to follow these Teacher: Student 1, tell me what groups you made.
directions, demonstrate and teach the target language. Student 1: I have red, yellow, blue, orange.
Allow students to work independently. Teacher: Great. You sorted by color.
Student 2: I sorted by color too.
Teacher: Great! Now can you organize it in a column?
Help with creating a bar graph. Teacher: Tell me which color do you have the most?
Student 2: The red ones.
Teacher: Student 3, which color do you have the most of and
which color do you have the least of?
Student 3: Most of my Frootloops are green; only a few are blue.
Once students are familiar with concept, make task harder by Such an activity can also provide opportunities for students
serving a snack with more features (i.e., Chex Mix), sorting to share their thinking (e.g., “I sorted based on texture”).
by shape, texture, salty/not salty, solid/hole in middle, etc.
Using information that has been provided to deduce or person’s emotions and thoughts. As can be seen in the
infer other information is important for academic tasks example, certain activities provide opportunities to target
as well as social interactions. The activity in the chart multiple cognitive skills and language structures, such as
below provides opportunities for practicing inferring a compound and complex sentences, and mental state verbs.
Activity Observation/Dialog
Choose a picture book in which Teacher: What do you see on this page? (Observation)
characters go through a series of Student: Flora and her brothers and sisters.
emotions (e.g., Flora’s Surprise by Teacher: How do you think they feel? (Making an inference)
Debi Gliori). Student: Excited!
Teacher: How do you know they are excited? (Making a deduction)
Student: They have big smiles and big eyes.
Teacher: What do you think they are excited about? Look for some clues on this page.
Student: I see seeds. Maybe they are excited about planting their flowers.
Teacher: (Turn page) You are right. They are planting flowers and vegetables. But look, Flora
is planting a brick! She wants it to grow into a house. Do you think it will grow into a house?
Student: No, bricks are nonliving things. They cannot grow. (Predicting, applying principles)
Teacher: Look at this page. How does Flora feel now?
Student: She is sad.
Teacher: Why do you think she is sad?
Student: Because the brick is not growing.
There aren’t many tests that can be administered to children to evaluate specific cognitive abilities, but you might be able
to create a set of tasks for your students. For example, when working with young children, it is important to evaluate their
ability to sort objects based on features. You can have a box with multiple objects and tell the child to make two groups—
maybe the child will sort by color, shapes, function, etc. For a child who has limited language abilities, it is important
that the concept of sorting has been explored and demonstrated beforehand. To evaluate cognitive skills, you might use
a picture of a scene from books, such as 1001 Things to Spot on the Farm, and develop a set of questions that require
students to observe, infer, predict, etc. Asking the same questions at the end of every grading period can provide insight
into development of these cognitive skills, as well as the language skills required to respond to the questions.
However, it is possible that, even with extensive efforts to develop cognitive skills, children who are D/HH continue to
have difficulties. Identifying learning strategies that can compensate for these difficulties will be important. For students
who have difficulty remembering sequences or manipulating multiple pieces of information, providing visual strategies,
such as counting the number of items on fingers or writing/drawing the information, could be beneficial. Using graphic
organizers, such as webs or Venn diagrams, can help with practicing describing, categorizing, etc.
Suggested Readings
Pisoni, D. B., Conway, C. M., Kronenberger, W. G., Henning, S. C., & Anaya, E. M. Executive function, cognitive
control, and sequence learning in deaf children with cochlear implants.
Houston, D. M., Beer, J., Bergeson, T. R., Chin, S. B., Pisoni, D. B., & Miyamoto, R. T. (2012, June). The ear is
connected to the brain: Some new directions in the study of children with cochlear implants at Indiana
University. Journal of the American Academy of Audiology, 6, 446–463. doi: 10.3766/jaaa.23.6.7
Resources
These videos from the Association of American Medical Colleges and the Khan Academy provide overviews of the
topics:
References
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Beer, J., Pisoni, D. B., & Kronenberger, W. (2009). Executive function in children with cochlear implants: The role of
organizational-integrative processes. Volta Voices, 16(3), 18–23.
Blair, C., & Razza, R. P. (2007). Relating effortful control, executive function, and false belief understanding to
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working memory growth predict speech and language development in children with cochlear implants. Journal
of Speech, Language, and Hearing Research, 56(3), 805–825. https://doi.org/10.1044/1092-4388(2012/11-0356)
Kronenberger, W. G., Pisoni, D. B., Henning, S. C., & Colson, B. G. (2013). Executive functioning skills in long-term
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