Deafness Cognition and Language Research Centre Appropriate cognitive assessments for deaf children-Theory of Mind, Executive Functioning and memory skills. Tanya Denmark t.denmark@ucl.ac.uk

Deafness Cognition and Language Research Centre Deaf cognition Cognitive assessments have been developed for users of spoken languages they are often not appropriate for deaf children. Deaf and hearing children have different knowledge, cognitive strategies and experiences Deaf signers use a different modality, often acquired outside the normal timeframe for language acquisition 90%+ hearing parents-Language delay can cause cognitive difficulties Some organic causes of deafness (eg prematurity, rubella, meningitis) lead to further cognitive difficulties. Language has important effects on cognition. We have to remember that the background, experiences and knowledge of deaf students may not be the same as hearing-it is not just a different language. We have to be sensitive to the needs of deaf children. Different doesn’t mean deficient either can be strengths

Differences not impairments Deafness Cognition and Language Research Centre Differences not impairments Deaf children who use sign language often show above average performance on visuospatial tasks (Mayberry, 2002) They are faster at redirecting their visual attention from one location to another (Parasnis & Samar, 1985) They have greater attention to peripheral stimuli (Bavelier et al., 2000) They have advantages in face discrimination and mental rotation tasks (Bettger et al. 1997, Emmorey, 1998) Native signers (DOD) consistently do better than non native (DOD) and are more comparable to hearing groups. This reinforces the relationship between language and cognition. Cognition depends on language backgrounds and exposure... Not all difficulties

Theory of Mind

Theory of mind ToM develops at about 4 years of age in typical hearing children. ToM involves understanding others’ mental states, behaviours and intentions. Many ToM assessments/standard tests of false belief reasoning require rather sophisticated language skills and deaf children may not understand the task Shick et al (2007) tested 176 children aged 3-8 on ToM Children either used ASL or were oral, Doh and Dod

Standard false belief tasks The unexpected contents task (Perner, Leekam & Wimmer, 1987) The false belief questions in this task contain mental state verbs, embedded clauses, and if/then statements.

Standard false belief tasks The change-in-location task (Wimmer & Perner,1983), Even though the question is simpler, the child needs some linguistic and narrative sophistication in order to follow the story in the first place.

Shick found a significant delay in Doh, regardless of ASL or oral and type of task. Dod performed identically to same-aged hearing controls. DoH have delayed ToM due to language delay and lack of access to conversations

Deafness Cognition and Language Research Centre BSL ToM tasks Woolfe, Want & Siegal (2003) Two thought-picture tasks in BSL for DoD. Gave children pictures boy with his fishing rod who has caught a boot. To pass these tasks, children had to respond correctly to questions about the reality and belief. If both reality and belief questions were answered correctly, the child scored 1 point for each picture, giving a score from 0 to 2. 13/20 passed this task- keep it visual simple language minimal and use child’s preferred language more of a deaf friendly task- need to find appropriate measures

Eyetracking method younger preverbal (Meristo et al) Deafness Cognition and Language Research Centre Eyetracking method younger preverbal (Meristo et al) 10 deaf 10 hearing 23 months

Deafness Cognition and Language Research Centre Deaf still impaired- because of the language that parents use around them- doh dod. Arguments for different language exposure Could be language or incidental learning- asd- not just language free need to think about wider issues such as the background of the child etc..

Memory

Deaf Memory Deaf children have poorer sequential memory (Hall & Bavelier, 2010) Signs take up more space in working memory. Any memory tasks which involve signing lists or words will take deaf signers longer and may lead to shorter spans. Deaf signers are less affected by backward recall on digit span tasks (Bavelier et al., 2000)

Visual form of digit span Deafness Cognition and Language Research Centre Visual form of digit span Still in serial order so problematic but better than presenting live version due to number differences in sign language

Spatial span working memory Deafness Cognition and Language Research Centre Spatial span working memory preferable

Executive Function

Executive functions (EF) Deafness Cognition and Language Research Centre Executive functions (EF) fluency fluency switching switching working memory working memory inhibition inhibition planning planning Umbrella term covering many different topics that are linked to thinking and behavioural skills and cognition

BRIEF-teacher and parent forms Deafness Cognition and Language Research Centre BRIEF-teacher and parent forms 86 item quick checklist of child’s behaviour at school and home Rate behaviours as: never, sometimes, often Teacher Loses lunch box, lunch money, permission slips, homework etc. Parent Has trouble coming up with ideas for what to do in play or free time Acts wilder or sillier than others in groups (birthday parties, playtime) Standardly given to deaf childrens parents or teachers to measure their ef- this is not good enough on its own.

Deafness Cognition and Language Research Centre Deaf EF Deaf children (signing, oral and CI) impaired on BRIEF compared to age-matched hearing children(Figueras et al, 2008, Pisoni et al, 2008, Conrad et al, 2007, Conway et al., 2007, Hauser et al, 2006.) Higher levels of impulsivity in oral deaf children using BRIEF (Parasnis et al, 2003) One or two behavioural measures of EF have previously been used- card sorting task and colour trails (Hauser et al, 2006) Figueras et al (2008) language development and EF highly related in oral deaf 8-12 year olds Deaf children with Deaf Parents have better EF abilities than those with hearing parents (Harris, 1978, Oberg, 2007, Hauser et al (2007,2008) Parasnis- measures of continuous performance tasks- manipulations- parasnis. However, these studies failed to match for general intelligence or to control for cause of deafness, small sample sizes

Deafness Cognition and Language Research Centre Deaf EF How is it assessed? Often measures are English based or sound based, or responses are not comparable for deaf and hearing children Important to use measures where hearing and deaf children can respond in similar ways- i.e. not compare sign and spoken reaction times but button press responses. We have used a number of measures which we feel are appropriate for comparing deaf and hearing groups across different modalities. Ef is relevant for learning, examples of ef skills- deaf education and language 1/3 project 36 children- group them- language scores Older better language Native vs non native Add 5 slides to improve leeds Education and cog development-edit video clips. Methods- videos doing test Scatter- language, ef-correlations sample sizes.test 2 time periods halfway through period 1 now Know tests work well with all groups-preliminary analysis... Gm-important things in primary school for learning. EF problems can be seen at any age, but it tends to become more apparent as children go through school. This is when the demands of completing schoolwork independently can trigger signs of a problem with executive function. No disadvantages

Deafness Cognition and Language Research Centre We aim to collect data from 200+ children using a battery of different EF tasks and different groups Time 1 Time 2 (2 years later) Deaf (oral, SSE, BSL) 6-11 N= 120 (40 6-7, 8-9, 10-11) Hearing 6-11 N= 90 (30 6-7, 8-9, 10-11) Deaf (oral, SSE, BSL) 7-11 N= 120 (40 7-8, 9-10, 11) Hearing 7-11 N= 90 (30 7-8, 9-10, 11) Executive Function measures Language measures We aim to look at language and EF with bigger groups of deaf children (min 120 deaf children) We will look at deaf children across different communication modes- BSL, SSE, oral We plan to monitor each child’s progress over time (with a follow up visit one year later) We will also include hearing children for comparison This is a grid to highlight what we plan to do in the project over the 3 years we will spend from sept onwards recruiting and doing the first phase of testing time 1. Deaf children of varying language backgrounds and ages, then analysis and writing then time 2 same process again... Important to do longitudinal research to measure the change in individual children in the same tasks and relationship between language and tasks as their language skills grow.

Nonverbal: Pictures Test (Davidson et al Nonverbal: Pictures Test (Davidson et al., 2006) Test of Inhibition - congruent - incongruent

Deafness Cognition and Language Research Centre Design fluency Make as many different patterns in 1 minute Correct designs, repetitions and errors are scored. Fluency generation measures perseverations and attention to rules

Colour Trails Test-switching Deafness Cognition and Language Research Centre Colour Trails Test-switching In Trail 1 participants alternate between colours In Trail 2 they have to suppress the interfering colour Time taken for participants to complete each Trail is measured Any errors are also noted.

Colour Trails Test-switching Deafness Cognition and Language Research Centre Colour Trails Test-switching

Deafness Cognition and Language Research Centre Tower-planning 1-5 discs gets harder per item Participants must make the end-point pictured in each item Responses are timed, excess moves counted Test of planning and rules do monkey demo too as alternative

Deafness Cognition and Language Research Centre Other measures Language Narrative-BSL test of production (Herman et al., 2004). Vocabulary measure- Expressive one word picture vocabulary test (Martin & Brownell, 2010) Parent/teacher checklist-LPP2 (Bebko & McKinnon, 1993) covers form, content, reference, cohesion and use-works as a screen. Non language measures Symbol search- processing speed Non verbal ability-Matrix reasoning

Deafness Cognition and Language Research Centre Parent questionnaire Born/became deaf Cause of deafness Language preference at school/home Cochlear implants/hearing aids Other home languages Level of deafness Family deafness/ family communication School type Plus many more important background variables...

Findings to date-hot off the press! Deafness Cognition and Language Research Centre Findings to date-hot off the press! Tested 82 children to date aged between 6-11 49 deaf 33 hearing Language and EF measures work well across modalities and age groups for deaf and hearing children. We have found some indication that language and EF are related in BSL users to date... Need to check other groups e.g. nonsigners. We are starting to get some normative data about different groups of deaf children on EF measures which can be used in the future. 25 signers-mixed abilities- SSE, BSL Tested 54 children to date aged between 6-11 30 deaf (5 non signers, 25 signers) 24 hearing Language and EF measures work well across modalities and age groups for deaf and hearing children.

Non verbal methods Non verbal measures are optimal for assessing deaf children It is important to have additional suitable verbal measures too in sign language these are lacking in research Verbal measures often give a greater predictive power to academic success and a greater overview of child’s ability.

Tests Ensure tests are not at ceiling or floor Change presentation format- visual images, signs or pictures rather than oral or English written words Allow for more time Use an array of different suitable tests not just one test to get an overview.

Deafness Cognition and Language Research Centre Recommendations Use the child’s preferred language, all assessors should be trained in language and culture of the child. Look at child’s full developmental history and background carefully-hearing loss severity and aetiology, preferred language, age of onset, amplification etc. Receive input from informants across contexts: teacher, parents get broad overview. Need formal and informal assessments, select assessment tools carefully Ensure you are trained in administration, scoring and interpretation of assessment

Recommendations Be mindful of deaf multi disability issue Ensure the same instructions are given to different groups e.g. deaf oral and deaf signers Limit visual distractions/ quiet room Film assessments so you can check them and score again later Get a 2nd scorer- preferably blind scorer, seek feedback from deaf professionals Be wary of tests normed on hearing children Lot to consider but without assessments we have no norms

Thank you Questions?