Andrea D. Warner-Czyz

Background/Objectives: Even with the use of hearing aid or cochlear implant technologies, adults who are deaf or hard of hearing (DHH) exhibit difficulty perceiving musical characteristics compared to peers with typical hearing, but do not necessarily report a consistent decrease in appreciation of musical activities. This study addresses a gap in the literature by examining the effect of both hearing status (i.e., DHH versus typical hearing) and hearing technology (i.e., hearing aids versus cochlear implants) on both behavioral and subjective music abilities and ratings of music importance. Methods: Adults with typical hearing (n = 20), hearing aids (n = 10), or cochlear implants (n = 10) completed tasks on (a) behavioral measures of music perception including pitch perception, melody recognition, and timbre recognition; and (b) the Music-related Quality of Life questionnaire to assess subjective ratings of music abilities and music importance. Results: Adults with typical hearing outperformed the cochlear implant group on all behavioral music perception tasks, but they performed similarly to the hearing aid group. Although the two DHH groups subjectively rated their musical abilities less positively than adults with typical hearing, all three groups appraised the importance of music in their lives similarly. Conclusions: Music importance and appreciation do not depend on music abilities, implying that clinicians and researchers should incorporate metrics of subjective music quality of life to comprehensively assess and treat adults who are DHH to foster more positive quality of life.

Purpose: The purpose of this study was to examine the relationship among speech discrimination at 9 months of age, word recognition at 30 months of age, and mean length of utterance in morphemes (MLUm) at 33 months of age among children who are hard of hearing (CHH) and children with normal hearing (CNH). This study also explored early sociodemographic and audiological variables that may influence communication outcomes in CHH and CNH. Method: Participants included 18 CNH and 32 CHH with early and well-fit hearing aids (HAs). Measures included speech discrimination in response to vowel and consonant stimuli at 9 months, word recognition at 30 months, and a spontaneous language sample at 33 months. Results: Group-level differences were not observed in speech discrimination or word recognition but emerged for language outcomes. Specifically for language outcomes, CHH had shorter MLUms and produced fewer mental state verbs than CNH. Vowel discrimination and word recognition were related to each other, and word recognition was related to MLUm. Consonant discrimination did not relate to any other variables. Higher MLUm was related to maternal level of education, hearing status, and daily device use. Additionally, daily device use at both 9 and 30 months correlated with word recognition at 30 months. Conclusions: Early auditory measures (speech discrimination and daily device use) relate to later speech recognition and MLUm in young children wearing well-fit HAs. Clinicians should consider these early metrics, as well as spontaneous language samples to capture real-world conversational skills, to identify young CHH at risk for poorer language outcomes. Supplemental Material: https://doi.org/10.23641/asha.31212223

Adolescents who are Deaf or hard of hearing (DHH) face challenges beyond those typically encountered by teenagers. DHH teens have higher rates of social isolation and peer victimization compared with peers with typical hearing. Additionally, they need to develop self-advocacy skills to enhance accessibility across educational, employment, and social environments. Research studies often do not fully capture the full experience of adolescents who are DHH, or how living with hearing loss as a teenager has changed over time. This qualitative study explores the academic and social experiences during high school from the perspective of adults with hearing loss as they reflect on the past and current high school students as they reflect on their present situations. Participants included four adults (M = 48.8 years) and nine adolescents (M = 16.0 years) with congenital hearing loss, all of whom used hearing technology (i.e., hearing aid, cochlear implant) in high school. Participants responded in writing to prompts about challenges they encountered while in high school. Qualitative analysis was conducted to identify themes across essays. Peer interactions emerged as the most common struggle, regardless of generation, with self-advocacy relative to school technology and communication strategies as the second most common theme. Personal perspectives of having a hearing loss as an adolescent highlight the need for parents, clinical and educational professionals, and community programs to look beyond the medical and technology needs of those with hearing loss to understand the impact that a childhood diagnosis of DHH has on the whole person.

Poor emotion recognition has been linked to social and emotional problems in everyday life. This may particularly affect teenagers navigating social scenes in adolescence, when peers become more important than family, and those with disabilities like hearing loss that may affect emotion recognition. This study investigates the effect of auditory status (deaf or hard of hearing using cochlear implant, CI, versus typical hearing, TH) on visual emotion recognition in adolescents, and its association with social relationships. Participants included 24 adolescents with TH (M = 13.7 years) and 34 adolescent long-term CI users (M = 13.3 years). Adolescents completed an emotion recognition task viewing video clips of faces morphing from a neutral expression to six facial expressions at 60, 80, or 100% emotion intensities via a gating task, and questionnaires about social relationships. Adolescents with TH significantly outperformed the CI group in the 80% emotion intensity condition (p = 0.02), but not the other conditions (p > 0.05). Better visual emotion recognition in CI users coincided with older age, better speech in noise ability, and more positive friendship quality. Significant performance differences with 80% emotion intensity suggest the CI group processes facial expressions qualitatively differently from TH peers, which has implications for therapeutic intervention for social skills in CI users.

When engaging with adolescents who are deaf or hard of hearing (DHH), the word transition often is interpreted as the preparation to complete one's high school education and move into postsecondary education and/or the workforce. Audiologists often work with an interdisciplinary team of professionals, including educators, state agencies, and high school counselors, to develop this transition plan. Rather than perpetuating this traditional view of transition planning focused on academic or occupational pursuits, we endorse a broader perspective that acknowledges the multifaceted transitions that teenagers who are DHH must navigate in this tumultuous, delicate, and malleable phase of life. For example, adolescents need to understand how their diagnosis as DHH and use of hearing technology intersects with driver's education and sports, social interactions, career prospects, and state assistance programs, among other typical adolescent milestones. Audiologists are uniquely poised to serve as a resource for these teenagers who are DHH to help them develop the knowledge of technology and opportunities, as well as to develop the confidence to advocate for themselves to optimize their lived experiences. In a best practice scenario, the adolescent who is DHH would have annual visits with an audiologist to monitor hearing abilities and assistive device function, as well as technological competence. These visits can serve as the foundation for independence in their hearing healthcare. Prior to this time of life, a parent or caregiver has typically taken the primary responsibility for decisions related to communication development, educational settings, peer socialization, medical/hearing care, and technology choices/troubleshooting. The extent to which parents and caregivers share these decision-making processes impacts the child's preparation toward independence from adolescence to adulthood. As proposed by Luterman (1987), a family's paradigm can influence the management of the challenges of rearing a child who is DHH. Some families adopt a paradigm characterized by the mantra, “We can get through this together and will do whatever it takes to help our child achieve their goals.” In contrast, some may consider the diagnosis of DHH negatively, still pining for dreams they had for a child with typical hearing. These paradigms and the potential to shift paradigms throughout the grieving process echo perspectives in the essay, “Welcome to Holland,” written by a parent of a child with a disability well before the medical and technological advances available today (Kingsley, 1987). In her essay, Kingsley presents a metaphor of an excited family on their vacation to Italy who experience disappointment when their plane lands unexpectedly in Holland. After reviewing the mixed feelings about the situation, she presents the conclusion that “if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.” She writes from her experience of watching her son with mental challenges progress to become a successful actor after she was told at his birth to deny his existence. Now consider this metaphor extending from the initial diagnosis to the beginning of adolescence. If the family adopts Kingsley's paradigm, they would explore the beauty of Holland, including the majesty of the windmills and the colorful fields of tulips. This experience may provide the child with a foundation of curiosity and delight in life challenges. In contrast, a family could resist exploration of Holland's wonders and focus their energies on trying to experience Italy through brief visits and focusing on unfavorable and negative aspects of Holland. Consider how the family's approach shapes the child's perspective and acceptance, particularly as that child enters adolescence and begins a journey to develop skills to manage new challenges independently. Ideally, interaction with many professionals during the early years prepares the family to guide their adolescent gradually toward greater autonomy in many areas. Audiologists may recognize that each adolescent has had their own unique experience throughout childhood, and as a result, presents their own individual needs as they encounter the transitions they face in their teenage years. Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Participation in extracurricular activities positively affects quality of life, including social satisfaction, but disabilities may influence the extent of involvement in adolescents. For example, a diagnosis such as Deaf or hard of hearing may coincide with communication deficits or accessibility challenges that could alter participation patterns. This study investigates the effect of auditory status on activity involvement in adolescents relative to the number and type of activities and the relationship between extracurricular engagement and quality of life. Participants included 113 adolescents (13–17 years) who either used a cochlear implant (n = 68) or had typical hearing (n = 45). Adolescents completed an online survey querying demographic characteristics (e.g., auditory history, self-rated communication skills, extracurricular activity involvement), temperament, and social satisfaction. Adolescents with typical hearing engaged in significantly more extracurricular activities than adolescents with cochlear implants, with significantly higher participation in performing arts, community service, and academic-based clubs than the cochlear implant group. Higher levels of activity engagement co-occur with social satisfaction. Clinicians should encourage participation in extracurricular activities to foster social interactions and positive quality of life in adolescents who are Deaf or hard of hearing.

Purpose: The Joint Committee on Infant Hearing recommends hearing screening before 1 month of age, audiologic diagnosis before 3 months of age, and enrollment in early intervention before 6 months of age (1-3-6 benchmarks of Early Hearing Detection and Intervention [EHDI] programs). Nearly 98% of newborns have their hearing screened, but many, who do not pass or do not complete their newborn hearing screening, fail to complete the EHDI process. Historically, lower socioeconomic level, more complex infant health status, and farther geographical location reduce rates of EHDI follow-up, but levels vary widely across states. This study examined barriers to the EHDI process by comparing census-based variables at the state and regional levels to national and Texas EHDI outcomes, respectively. Method: We used correlational analysis to assess relationships between U.S. Census data (state- and region-specific population and geographic characteristics, sociodemographic and geographic factors, and health and health insurance) and EHDI data (newborn screening, audiologic diagnosis, and early intervention) at the national level and in Texas. Results: Nationally, higher labor force participation, lower unemployment rates, and presence of health insurance significantly correlated with higher rates of completing EHDI benchmarks. Larger population size and density and higher socioeconomic factors coincided with higher rates of completing the EHDI process and lower rates of loss to follow-up (LTF) or loss to documentation in Texas. Conclusions: Population, socioeconomic, and demographic factors significantly correlate with following through with the EHDI process, with weak correlations at the national level and strong correlations at the state level. These findings underscore the need to increase our attention to underserved, economically challenged, and/or geographically distanced families who have children with a higher risk of becoming LTF in the EHDI process.

This study investigated the acquisition of early expressive vocabulary among young children who are deaf and hard-of-hearing (DHH; n = 68) using auditory technology (hearing aids and cochlear implants). Parents completed a standardized vocabulary checklist, which allowed analyses of (i) the size of their child’s spoken vocabulary; (ii) composition of the expressive lexicon (e.g., parts of speech such as nouns and verbs; semantic categories such as routines and body parts); and (iii) demographic and audiologic factors (e.g., chronologic age, degree of hearing access) potentially associated with these metrics. Young children who are DHH and use auditory technology acquired fewer spoken words than peers with typical hearing (TH) matched for chronologic age but more spoken words than peers with TH matched for listening experience. Action verbs—not nouns—significantly increased the odds of a child who is DHH achieving a vocabulary quotient within the normative range. These findings support the exploration of early expressive vocabulary size and composition—especially the number of active verbs—to guide clinical management and decision-making for young children who are DHH.

Purpose: This study examined the extent to which prelingual cochlear implant (CI) users show a slowed speaking rate compared with typical-hearing (TH) talkers when repeating various speech stimuli and whether the slowed speech of CI users relates to their immediate verbal memory. Method: Participants included 10 prelingually deaf teenagers who received CIs before the age of 5 years and 10 age-matched TH teenagers. Participants repeated nonword syllable strings, word strings, and center-embedded sentences, with conditions balanced for syllable length and metrical structure. Participants' digit span forward and backward scores were collected to measure immediate verbal memory. Speaking rate data were analyzed using a mixed-design, repeated-measures analysis of variance, and the relationships between speaking rate and digit spans were evaluated by Pearson correlation. Results: Participants with CIs spoke more slowly than their TH peers during the sentence repetition task but not in the nonword string and word string repetition tasks. For the CI group, significant correlations emerged between speaking rate and digit span scores (both forward and backward) for the sentence repetition task but not for the nonword string or word string repetition task. For the TH group, no significant correlations were found. Conclusions: The findings indicate a relation between slowed speech production, reduced immediate verbal memory, and diminished language capabilities of prelingual CI users, particularly for syntactic processing. These results support theories claiming that immediate memory, including components of a central executive, influences the speaking rate of these talkers. Implications for therapies designed to increase speech fluency in CI recipients are discussed. Supplemental Material: https://doi.org/10.23641/asha.21644795