University of Oulu

Välimaa, T., Kunnari, S., Laukkanen-Nevala, P., Lonka, E. and (2018), Early vocabulary development in children with bilateral cochlear implants. International Journal of Language & Communication Disorders, 53: 3-15.

Early vocabulary development in children with bilateral cochlear implants

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Author: Välimaa, Taina1; Kunnari, Sari1; Laukkanen‐Nevala, Päivi2;
Organizations: 1Faculty of Humanities, Research Unit of Logopedics/Child Language Research Center, University of Oulu, Oulu, Finland
2Tilastoneuvonta, Oulu, Finland
3Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: John Wiley & Sons, 2018
Publish Date: 2019-08-28


Background: Children with unilateral cochlear implants (CIs) may have delayed vocabulary development for an extended period after implantation. Bilateral cochlear implantation is reported to be associated with improved sound localization and enhanced speech perception in noise. This study proposed that bilateral implantation might also promote early vocabulary development. Knowledge regarding vocabulary growth and composition in children with bilateral CIs and factors associated with it may lead to improvements in the content of early speech and language intervention and family counselling.

Aims: To analyse the growth of early vocabulary and its composition during the first year after CI activation and to investigate factors associated with vocabulary growth.

Methods & Procedures: The participants were 20 children with bilateral CIs (12 boys; eight girls; mean age at CI activation = 12.9 months). Vocabulary size was assessed with the Finnish version of the MacArthur Communicative Development Inventories (CDI) Infant Form and compared with normative data. Vocabulary composition was analysed in relation to vocabulary size. Growth curve modelling was implemented using a linear mixed model to analyse the effects of the following variables on early vocabulary growth: time, gender, maternal education, residual hearing with hearing aids, age at first hearing aid fitting and age at CI activation.

Outcomes & Results: Despite clear vocabulary growth over time, children with bilateral CIs lagged behind their age norms in receptive vocabulary during the first 12 months after CI activation. In expressive vocabulary, 35% of the children were able to catch up with their age norms, but 55% of the children lagged behind them. In receptive and expressive vocabularies of 1–20 words, analysis of different semantic categories indicated that social terms constituted the highest proportion. Nouns constituted the highest proportion in vocabularies of 101–400 words. The proportion of verbs remained below 20% and the proportion of function words and adjectives remained below 10% in the vocabularies of 1–400 words. There was a significant main effect of time, gender, maternal education and residual hearing with hearing aids before implantation on early receptive vocabulary growth. Time and residual hearing with hearing aids had a significant main effect also on expressive vocabulary growth.

Conclusions & Implications: Vocabulary development of children with bilateral CIs may be delayed. Thus, early vocabulary development needs to be assessed carefully in order to provide children and families with timely and targeted early intervention for vocabulary acquisition.

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Series: International journal of language & communication disorders
ISSN: 1368-2822
ISSN-E: 1460-6984
ISSN-L: 1368-2822
Volume: 53
Issue: 1
Pages: 3 - 15
DOI: 10.1111/1460-6984.12322
Type of Publication: A1 Journal article – refereed
Field of Science: 6121 Languages
616 Other humanities
3125 Otorhinolaryngology, ophthalmology
217 Medical engineering
Funding: Funding Information: Kulttuurin ja Yhteiskunnan Tutkimuksen Toimikunta. Grant Number: 252006.
Academy of Finland Grant Number: 252006
Detailed Information: 252006 (Academy of Finland Funding decision)
Copyright information: © 2017 Royal College of Speech and Language Therapists. This is the peer reviewed version of the following article: Välimaa, T. , Kunnari, S. , Laukkanen‐Nevala, P. , Lonka, E. and , (2018), Early vocabulary development in children with bilateral cochlear implants. International Journal of Language & Communication Disorders, 53: 3-15, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.