Tanya Denmark t.denmark@ucl.ac.uk

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

2. Deaf cognition • Cognitive assessmentshave 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.

3. 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.

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. 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.

10. Eyetracking method younger preverbal (Meristo et al)

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

15. Spatial span working memory

17. Executive Function

18. Executive functions (EF) fluency fluency switching switching working memory working memory inhibition inhibition planning planning

19. 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)

20. Deaf EF • Deaf children (signing, oral and CI) impaired on BRIEF compared to age-matched hearing children(Figueraset 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 (Parasniset 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)

21. 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.

22. We aim to collect data from 200+ children using a battery of different EF tasks and different groups

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

24. Design fluency • Make as many different patterns in 1 minute Correct designs, repetitions and errors are scored.

25. Colour Trails Test-switching

26. Colour Trails Test-switching

27. 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

29. 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. 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! • 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.

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. 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?