1. Deafness Cognition and Language Research Centre
Appropriate cognitive assessments for deaf children-Theory of Mind, Executive Functioning and memory skills.
Tanya Denmark

2. 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

3. 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

4. Theory of Mind

5. 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

6. 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.

7. 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.

8. 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

9. 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

10. 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

11. 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..

12. Memory

13. 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)

14. 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

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

17. Executive Function

18. 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

19. 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.

20. 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

21. 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

22. 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
N= 90 (30 6-7, 8-9, 10-11)
Deaf (oral, SSE, BSL) 7-11
N= 120 (40 7-8, 9-10, 11)
Hearing
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.

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

24. 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

25. 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.

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

27. 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

29. 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

30. 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...

31. 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.

32. 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.

33. 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.

34. 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

35. 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

36. Thank you
Questions?