Age at implantation, learning, and cognition (Marschark et al., 2019)

Purpose: Age at cochlear implantation frequently is assumed to be a key predictor of pediatric implantation benefits, but outcomes related to learning and cognition appear inconsistent. This critical assessment examines relevant literature in an effort to evaluate the impact of age at implantation in those domains for individuals who received their devices as children.

Method: We examined 44 peer-reviewed articles from 2003 to 2018 considering age at implantation and conducted statistical analyses regarding its impact on several domains, including literacy, academic achievement, memory, and theory of mind.

Results: Across 167 assessments in various experiments and conditions, only 21% of the analyses related to age at implantation yielded evidence in favor of earlier implantation, providing greater benefits to academic achievement, learning, or cognition compared to implantation later in childhood. Among studies that considered cognitive processing (e.g., executive function, memory, visual–spatial functioning), over twice as many analyses indicated significant benefits of earlier implantation when it was considered as a discrete rather than a continuous variable.

Conclusion: Findings raise methodological, practical, and theoretical questions concerning how “early” is defined in studies concerning early cochlear implantation, the impact of confounding factors, and the use of nonstandard outcome measures. The present results and convergent findings from other studies are discussed in terms of the larger range of variables that need to be considered in evaluating the benefits of cochlear implantation and question the utility of considering age at implantation as a “gold standard” with regard to evaluating long-term outcomes of the procedure as a medical treatment/intervention for hearing loss.

Supplemental Material S1. Effects of age at implantation on literacy and academic achievement with age as continuous variable: Information provided by authors for cochlear implant (CI) users and correlation coefficients, if provided, as estimates of effect size.

Supplemental Material S2. Effects of age at implantation on literacy and academic achievement with age as discrete variable: Information provided (cochlear implant [CI] users only) by authors and calculated effect sizes.

Supplemental Material S3. Effects of age at implantation and cognitive functioning with age as continuous variable: Information provided by authors for cochlear implant (CI) users and correlation coefficients, if provided, as estimates of effect size.

Supplemental Material S4. Effects of age at implantation and cognitive functioning with age as a discrete variable: Information provided by authors for CI users and calculated effect sizes.

Marschark, M., Duchesne, L., & Pisoni, D. (2019). Effects of age at cochlear implantation on learning and cognition: A critical assessment. American Journal of Speech-Language Pathology, 28, 1318–1334. https://doi.org/10.1044/2019_AJSLP-18-0160