Do you support children with hearing loss? Curious about why some children are tracking well on standardised assessments but continue to struggle in aspects of their day-to-day functioning? Here’s why you need to know about executive functions.
Put simply, executive function skills are a group of cognitive skills such as working memory, inhibition/self-regulation and cognitive flexibility which help us initiate, plan and execute goal directed activities (Kral et al 2016). They are essential in achieving positive life outcomes and supporting social, emotional and physical well-being (Moffit et al 2011). We are not born with executive function skills but learn them through experience for the better (or worse). When children don’t have good executive function, they are more likely to be distractible, socially immature, and just be out of step with their peers.
We now know that if all the right conditions are in place children with hearing loss can achieve outstanding outcomes in listening and spoken language and achieve social and education success (Mission Probable White Paper, 2019). Despite this, there continues to be huge variation in outcomes for these children. This is true even in countries, such as Australia, that have achieved 1, 3, 6 according to Early Hearing Detection and Intervention (EDHI) guidelines (2019) and advances in hearing aids and cochlear implants and expanding criteria for technology and intervention. Researchers across the world are interested in what variables are most essential to consider. In recent years, they have increasingly been looking at the neurocognitive aspects of language for possible explanations of this variation and to help shape interventions (Pisoni et al 2018). Executive functions are one such neurocognitive domain.
It has been understood for some time that executive function plays a supporting role in language acquisition and processing in typically hearing children. What has not been as well understood is whether children with hearing loss use executive function in the same way as their typically hearing peers. It turns out that executive function and language are bidirectional and reciprocal in their development in all children (Bohlman et al 2015) but even more so in Deaf/hard of hearing children (Kronenberger et al 2018).
This thought to be because in children with hearing loss, executive function is being used to compensate for reduced language exposure (quantity) and patchy phonological representations (quality) and it takes more of that resource to get what information is there (listening effort) (Kronenberger et al 2018). Typically hearing children do not need to spend their precious executive function resources on language processing because they are already doing this in a more automatic way which doesn’t require the same conscious control. A useful way to think of this is the difference between being a learner driver and one with years of experience in busy traffic, the amount you must ‘think’ about what you are doing when you drive changes drastically with more experience.
The great news about executive function is that those with the most to gain the most (Diamond 2012) and learning to listen engages executive function skills from infancy. For the past six years, we have been keenly interested in better understanding the role of executive function in our intervention programs and our professional learning offerings at The Shepherd Centre and through HearHub. Not only do we offer a unique targeted executive function program for 4-6 year olds and their parents, we run regular sessions for hearing health professionals and we hope to see you at one of those soon.
Want to learn more and support children with hearing loss with their executive function skills? Find out about The Ready Steady Think! facilitator group program available through subscription access to HearHub. This unique program targets imaginative play and emotional regulation in a supported group environment. The activities are fun and engaging and can be delivered online or face-to-face in a group setting.
Learn more about our professional learning opportunities that include the topic of executive function skills and hearing loss: Professional Development Hub – Hearhub
References:
Bohlmann, N. L., Maier, M. F., & Palacios, N. (2015). Bidirectionality in self‐regulation and expressive vocabulary: Comparisons between monolingual and dual language learners in preschool. Child development, 86(4), 1094-1111.
Diamond, A. (2012). Activities and programs that improve children’s executive functions. Current directions in psychological science, 21(5), 335-341.
Kral, A., Kronenberger, W. G., Pisoni, D. B., & O’Donoghue, G. M. (2016). Neurocognitive factors in sensory restoration of early deafness: a connectome model. The Lancet Neurology, 15(6), 610-621.
Kronenberger, W. G., Henning, S. C., Ditmars, A. M., & Pisoni, D. B. (2018). Language processing fluency and verbal working memory in prelingually deaf long-term cochlear implant users: A pilot study. Cochlear Implants International, 19(6), 312-323.
Kronenberger, W. G., & Pisoni, D. B. (2018). Neurocognitive functioning in deaf children with cochlear implants. Evidence-based practices in deaf education, 1, 363-396.
Mission Probable – https://www.hearingfirst.org/m/resources/7152
Pisoni, D. B., Broadstock, A., Wucinich, T., Safdar, N., Miller, K., Hernandez, L. R., … & Moberly, A. C. (2018). Verbal learning and memory after cochlear implantation in postlingually deaf adults: some new findings with the CVLT-II. Ear and hearing, 39(4), 720.
Pisoni, D. B., Kronenberger, W. G., Harris, M. S., & Moberly, A. C. (2017). Three challenges for future research on cochlear implants. World Journal of Otorhinolaryngology-Head and Neck Surgery, 3(04), 240-254.
(2019). Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Journal of Early Hearing Detection and Intervention, 4(2), 1-44. DOI: https://doi.org/10.15142/fptk-b748
