人工耳蜗植入儿童的认知、学习与执行功能行为

文献信息

中文摘要

目的：
儿童早期听力损失可影响语言、认知和执行功能（EF）的发育。尽管人工耳蜗植入（CI）可恢复听觉输入，但认知和学业结局仍存在相当大的变异性。本研究调查了CI儿童与典型听力同龄人相比的日常执行功能、学习和学业行为。

设计：
279名6至18岁儿童的家长（119名CI儿童，160名典型听力儿童）完成了学习、执行和注意力功能（LEAF）问卷。采用Wilcoxon检验和广义线性模型分析各分量表，以比较认知领域（认知-执行、认知-学习、学业），并探讨与言语识别结局的关联。

结果：
CI儿童在大多数领域表现出显著更高的LEAF评分，表明存在更大的执行功能和学业困难，即使在排除具有额外合并症的参与者后也是如此。最显著的组间差异出现在理解、概念学习和学业技能（阅读、写作和数学）方面。虽然整体执行功能表现（复合cLEAF）与言语识别不相关，但认知-学习领域——尤其是理解和概念学习——与噪声中言语表现呈负相关。CI儿童在认知子领域之间也表现出更大的个体内变异性。

结论：
尽管言语识别良好，CI儿童在执行功能和学业表现方面仍表现出领域特异性和异质性的挑战。这些困难不能完全由听觉或言语识别能力解释，强调了在临床评估和干预中解决更广泛神经认知因素的重要性。针对性的认知和教育支持可能有助于减少认知分散并改善功能结局。

英文摘要

OBJECTIVES: Hearing loss in early childhood can affect the development of language, cognition, and executive functions (EF). Although cochlear implantation (CI) restores auditory input, considerable variability in cognitive and academic outcomes remains. This study investigated everyday EF, learning, and academic behaviors in children with CIs compared with typically hearing peers.
DESIGN: Parents of 279 children aged 6 to 18 yr (119 children with CIs, 160 typical hearing) completed the Learning, Executive, and Attention Functioning (LEAF) questionnaire. Subscales were analyzed using Wilcoxon tests and generalized linear modeling to compare cognitive domains (Cognitive-Executive, Cognitive-Learning, Academic) and to explore associations with speech recognition outcomes.
RESULTS: Children with CIs showed significantly higher LEAF scores across most domains, indicating greater EF and academic difficulties, even after excluding participants with additional comorbidities. The strongest group differences occurred in comprehension, conceptual learning, and academic skills (reading, writing, and mathematics). While overall EF performance (composite cLEAF) was not correlated with speech recognition, the Cognitive-Learning domain-particularly comprehension and conceptual learning-was negatively associated with speech-in-noise performance. Children with CIs also exhibited greater intraindividual variability across cognitive subdomains.
CONCLUSIONS: Children with CIs, despite good speech recognition, demonstrate domain-specific and heterogeneous challenges in EF and academic performance. These difficulties are not fully explained by auditory or speech recognition abilities, underscoring the importance of addressing broader neurocognitive factors in clinical assessment and intervention. Targeted cognitive and educational support may help reduce cognitive scatter and improve functional outcomes.