Salud Mental

Executive functions in children and adolescents with hearing loss: A systematic review of case-control, case series, and cross-sectional studies


Jesús David Charry-Sánchez
Sofía Ramírez-Guerrero
María Paula Vargas-Cuellar
María Alejandra Romero-Gordillo
Claudia Talero-Gutiérrez


Introduction. Children with hearing loss have been reported to perform lower in executive function and language tasks than their normal-hearing peers.

Objective. To describe EF performance profile in children and adolescents with hearing loss.

Method. Using different databases including PubMed, Scopus, and ScienceDirect, we conducted a systematic review of case-control, cross-sectional studies, and case series that evaluated executive function performance in children and adolescents with hearing loss with or without hearing aids, cochlear implants, and/or native sign language, since 2000 until April 2020. Fifteen studies were selected after quality assessment using Critical Appraisal Tools provided by Joanna Briggs Institute.

Results. The studies differed in the assessment tools, and the results obtained by different authors were inconsistent. However, these studies revealed that children and adolescents with hearing impairment have lower performance in working memory, inhibition, cognitive flexibility, and attention than their normal-hearing peers.

Discussion and conclusion. Executive function assessment tools are used indistinctively for both children with and without hearing loss. Consequently, as tools were designed for normal hearing population, results can significantly vary in the population with hearing impairment. Hence, it is important to establish a standardized protocol specifically adapted for this population.
Children, cochlear implant, executive functions, hearing aids, hearing loss


Download data is not yet available.


Acosta Rodríguez, V., Ramírez Santana, G. M., & Hernández Expósito, S. (2017). Executive functions and language in children with different subtypes of specific language impairment. Neurología (English Edition), 32(6), 355-362. doi: 10.1016/j.nrleng.2015.12.007

Al-Salim, S., Moeller, M. P., & McGregor, K. K. (2020). Performance of children with hearing loss on an audiovisual version of a nonword repetition task. Language, Speech, and Hearing Services in Schools, 51(1), 42-54. doi: 10.1044/2019_LSHSS-OCHL-19-0016

Ambrose, S. E., Fey, M. E., & Eisenberg, L. S. (2012). Phonological awareness and print knowledge of preschool children with cochlear implants. Journal of Speech, Language, and Hearing Research, 55(3), 811-823. doi: 10.1044/1092-4388(2011/11-0086)

American Speech Language Hearing Association, ASHA. (2016). Tipo, grado y configuración de la pérdida de audición. Retrieved from

Anderson, P. (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychology, 8(2), 71-82. doi: 10.1076/chin.

Ardila, A., & Ostrosky-Solís, F. (2008). Desarrollo histórico de las funciones ejecutivas. Revista Neuropsicología, Neuropsiquiatría y Neurociencias, 8(1), 1-21.

Beer, J., Kronenberger, W. G., & Pisoni, D. B. (2011). Executive function in everyday life: Implications for young cochlear implant users. Cochlear Implants International, 12(Suppl 1), S89-S91. doi: 10.1179/146701011X13001035752570

Beer, J., Kronenberger, W. G., Castellanos, I., Colson, B. G., Henning, S. C., & Pisoni, D. B. (2014). Executive functioning skills in preschool-age children with cochlear implants. Journal of Speech, Language, and Hearing Research: JSLHR, 57(4), 1521-1534. doi: 10.1044/2014_JSLHR-H-13-0054

Blair, C. (2017). Educating executive function. Wiley Interdiscip Rev Cogn Sci, 8(1-2), e1403. doi: 10.1002/wcs.1403

Botting, N., Jones, A., Marshall, C., Denmark, T., Atkinson, J., & Morgan, G. (2017). Nonverbal executive function is mediated by language: A study of deaf and hearing children. Child Development, 88(5), 1689-1700. doi: 10.1111/cdev.12659

Castellanos, I., Kronenberger, W. G., Beer, J., Colson, B. G., Henning, S. C., Ditmars, A., & Pisoni, D. B. (2015). Concept formation skills in long-term cochlear implant users. Journal of Deaf Studies and Deaf Education, 20(1), 27-40. doi: 10.1093/deafed/enu039

Chan, R. C. K., Shum, D., Toulopoulou, T., & Chen, E. Y. H. (2008). Assessment of executive functions: Review of instruments and identification of critical issues. Archives of Clinical Neuropsychology, 23(2), 201-216. doi: 10.1016/j.acn.2007.08.010

Clark, J. G. (1981). Uses and abuses of hearing loss classification. ASHA, 23(7), 493-500.

Colin, S., Leybaert, J., Ecalle, J., & Magnan, A. (2013). The development of word recognition, sentence comprehension, word spelling, and vocabulary in children with deafness: A longitudinal study. Research in Developmental Disabilities, 34(5), 1781-1793. doi: 10.1016/j.ridd.2013.02.001

Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166(2-3), 210-222. doi: 10.1016/j.psychres.2008.02.005

Daza, M. T., Phillips-Silver, J., Ruiz-Cuadra, M. del M., & López-López, F. (2014). Language skills and nonverbal cognitive processes associated with reading comprehension in deaf children. Research in Developmental Disabilities, 35(12), 3526-3533. doi: 10.1016/j.ridd.2014.08.030

Delgado-Mejía, I. D., & Etchepareborda, M. C. (2013). Trastornos de las funciones ejecutivas. Diagnóstico y tratamiento. Revista de Neurología, 57(Suppl 1), S95-S103.

Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168. doi: 10.1146/annurev-psych-113011-143750

Diamond, A., & Lee, K. (2011). Interventions shown to aid executive function development in children 4 to 12 years old. Science, 333(6045), 959-964. doi: 10.1126/science.1204529

Doebel, S. (2020). Rethinking Executive Function and Its Development. Perspectives on Psychological Science, 15(4), 942-956. doi: 10.1177/1745691620904771

Ead, B., Hale, S., DeAlwis, D., & Lieu, J. (2013). Pilot study of cognition in children with unilateral hearing loss. International Journal of Pediatric Otorhinolaryngology, 77(11), 1856-1860. doi: 10.1016/j.ijporl.2013.08.028

Figueras, B., Edwards, L., & Langdon, D. (2008). Executive function and language in deaf children. Journal of Deaf Studies and Deaf Education, 13(3), 362-377. doi: 10.1093/deafed/enm067

Flores-Lázaro, J. C., Castillo-Preciado, R. E., & Jiménez-Miramonte, N. A. (2014). Desarrollo de funciones ejecutivas, de la niñez a la juventud. Anales de Psicología, 30(2), 463-473. doi: 10.6018/analesps.30.2.155471

Flores-Lázaro, J. C., Ostrosky-Solís, F., & Lozano-Gutiérrez, A. (2008). Batería de Funciones Frontales y Ejecutivas: Presentación. Revista Neuropsicología, Neuropsiquiatría y Neurociencias, 8(1), 141-158.

Gilbert, S. J., & Burgess, P. W. (2008). Executive function. Current Biology, 18(3), R110-R114. doi: 10.1016/j.cub.2007.12.014

Goldstein, S., & Naglieri, J. A. (2014). Handbook of Executive Functioning (pp. 1-567). Springer Science + Business Media. doi: 10.1007/978-1-4614-8106-5

Goldstein, S., Naglieri, J. A., Princiotta, D., & Otero, T. M. (2014). Introduction: A history of executive functioning as a theoretical and clinical construct. In S. Goldstein & J. A. Naglieri (Eds.), Handbook of executive functioning (pp. 3-12). doi: 10.1007/978-1-4614-8106-5_1

Hall, M. L., Eigsti, I.-M., Bortfeld, H., & Lillo-Martin, D. (2017). Auditory deprivation does not impair executive function, but language deprivation might: Evidence from a parent-report measure in deaf native signing children. Journal of Deaf Studies and Deaf Education, 22(1), 9-21. doi: 10.1093/deafed/enw054

Hall, M. L., Eigsti, I.-M., Bortfeld, H., & Lillo-Martin, D. (2018). Executive function in deaf children: Auditory access and language access. Journal of Speech, Language, and Hearing Research, 61(8), 1970-1988. doi: 10.1044/2018_JSLHR-L-17-0281

Holt, R. F., Beer, J., Kronenberger, W. G., & Pisoni, D. B. (2013). Developmental effects of family environment on outcomes in pediatric cochlear implant recipients. Otology & Neurotology, 34(3), 388-395. doi: 10.1097/MAO.0b013e318277a0af

James, D., Rajput, K., Brinton, J., & Goswami, U. (2008). Phonological awareness, vocabulary, and word reading in children who use cochlear implants: Does age of implantation explain individual variability in performance outcomes and growth? Journal of Deaf Studies and Deaf Education, 13(1), 117-137. doi: 10.1093/deafed/enm042

Joanna Briggs Institute. (2017). Critical Appraisal Tools. Retrieved from

JTC. (2021). John Tracy Center. Retrieved from

Jurado, M. B., & Rosselli, M. (2007). The elusive nature of executive functions: A review of our current understanding. Neuropsychology Review, 17(3), 213-233. doi: 10.1007/s11065-007-9040-z

Kirby, B. J., Spratford, M., Klein, K. E., & McCreery, R. W. (2019). Cognitive abilities contribute to spectro-temporal discrimination in children who are hard of hearing. Ear and Hearing, 40(3), 645-650. doi: 10.1097/AUD.0000000000000645

Korver, A. M. H., Smith, R. J. H., Van Camp, G., Schleiss, M. R., Bitner-Glindzicz, M. A. K., Lustig, L. R., … Boudewyns, A. N. (2017). Congenital hearing loss. Nature Reviews. Disease Primers, 3, 16094. doi: 10.1038/nrdp.2016.94

Kronenberger, W. G., Pisoni, D. B., Henning, S. C., & Colson, B. G. (2013). Executive functioning skills in long-term users of cochlear implants: A case control study. Journal of Pediatric Psychology, 38(8), 902-914. doi: 10.1093/jpepsy/jst034

Kronenberger, W. G., Xu, H., & Pisoni, D. B. (2020). Longitudinal development of executive functioning and spoken language skills in preschool-aged children with cochlear implants. Journal of Speech, Language, and Hearing Research, 63(4), 1128-1147. doi: 10.1044/2019_JSLHR-19-00247

Lace, J. W., Merz, Z. C., Kennedy, E. E., Seitz, D. J., Austin, T. A., Ferguson, B. J., & Mohrland, M. D. (2020). Examination of five- and four-subtest short form IQ estimations for the Wechsler Intelligence Scale for Children-Fifth edition (WISC-V) in a mixed clinical sample. Applied Neuropsychology: Child, 1-12. doi: 10.1080/21622965.2020.1747021

Lewis, D. E., Smith, N. A., Spalding, J. L., & Valente, D. L. (2018). Looking behavior and audiovisual speech understanding in children with normal hearing and children with mild bilateral or unilateral hearing loss. Ear and Hearing, 39(4), 783-794. doi: 10.1097/AUD.0000000000000534

Lieu, J. E. C. (2004). Speech-language and educational consequences of unilateral hearing loss in children. Archives of Otolaryngology--Head & Neck Surgery, 130(5), 524-530. doi: 10.1001/archotol.130.5.524

Luria, A. R. (1977). Las funciones corticales superiores del hombre. Editorial Orbe.

Moeller, M. P., & Tomblin, J. B. (2015). An introduction to the outcomes of children with hearing loss study. Ear and Hearing, 36(Suppl 1), 4S-13S. doi: 10.1097/AUD.0000000000000210

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Medicine, 6(7), e1000097. doi: 10.1371/journal.pmed.1000097

Morton, C. C., & Nance, W. E. (2006). Newborn hearing screening—A silent revolution. New England Journal of Medicine, 354(20), 2151-2164. doi: 10.1056/NEJMra050700

Nicholas, J. G., & Geers, A. E. (2007). Will they catch up? The role of age at cochlear implantation in the spoken language development of children with severe-profound hearing loss. Journal of Speech, Language, and Hearing Research, 50(4), 1048-1062. doi: 10.1044/1092-4388(2007/073)

Niparko, J. K., Tobey, E. A., Thal, D. J., Eisenberg, L. S., Wang, N.-Y., Quittner, A. L., … CDaCI Investigative Team. (2010). Spoken language development in children following cochlear implantation. JAMA, 303(15), 1498-1506. doi: 10.1001/jama.2010.451

Nittrouer, S., Caldwell, A., Lowenstein, J. H., Tarr, E., & Holloman, C. (2012). Emergent literacy in kindergartners with cochlear implants. Ear and Hearing, 33(6), 683-697. doi: 10.1097/AUD.0b013e318258c98e

Nunes, T., Bryant, P., Burman, D., Bell, D., Evans, D., & Hallett, D. (2009). Deaf children’s informal knowledge of multiplicative reasoning. Journal of Deaf Studies and Deaf Education, 14(2), 260-277. doi: 10.1093/deafed/enn040

Pagliaro, C. M., & Ansell, E. (2012). Deaf and hard of hearing students’ problem-solving strategies with signed arithmetic story problems. American Annals of the Deaf, 156(5), 438-458. doi: 10.1353/aad.2012.1600

Paluch, P., Kochański, B., Ganc, M., Cieśla, K., Milner, R., Pluta, A., & Lewandowska, M. (2019). Early general development and central auditory system maturation in children with cochlear implants – A case series. International Journal of Pediatric Otorhinolaryngology, 126, 109625. doi: 10.1016/j.ijporl.2019.109625

Pearson Assessment. (2018). WISC--V Efficacy Research Report - April (pp. 1-42).

Perszyk, D. R., & Waxman, S. R. (2018). Linking Language and Cognition in Infancy. Annual Review of Psychology, 69, 231-250. doi: 10.1146/annurev-psych-122216-011701

Petersen, I. T., Bates, J. E., & Staples, A. D. (2014). The role of language ability and self-regulation in the development of inattentive-hyperactive behavior problems. Development and Psychopathology, 27(1), 221-237. doi: 10.1017/S0954579414000698

Roldán, L. A. (2016). Inhibition and updating in text comprehension: A review. Universitas Psychologica, 15(2), 87-95. doi: 10.11144/Javeriana.upsy15-2.iact

Ropovik, I. (2014). Do executive functions predict the ability to learn problem-solving principles? Intelligence, 44, 64-74. doi: 10.1016/j.intell.2014.03.002

Royall, D. R., Lauterbach, E. C., Cummings, J. L., Reeve, A., Rummans, T. A., Kaufer, D. I., … Coffey, C. E. (2002). Executive control function: A review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. Journal of Neuropsychiatry and Clinical Neurosciences, 14(4), 377-405. doi: 10.1176/jnp.14.4.377

Sabat, C., Arango, P., Tassé, M. J., & Tenorio, M. (2020). Different abilities needed at home and school: The relation between executive function and adaptive behaviour in adolescents with Down syndrome. Scientific Reports, 10(1), 1683. doi: 10.1038/s41598-020-58409-5

Schmithorst, V., Plante, E., & Holland, S. K. (2014). Unilateral deafness in children affects development of multi-modal modulation and default mode networks. Frontiers in Human Neuroscience, 8, 164. doi: 10.3389/fnhum.2014.00164

Seel, N. M. (2012). Concept formation: Characteristics and functions. In N. M. Seel (Ed.), Encyclopedia of the Sciences of Learning (pp. 723-728). Boston, MA: Springer. doi: 10.1007/978-1-4419-1428-6_1866

Soprano, A. (2003). Evaluación de las funciones ejecutivas en el niño. Revista de Neurologia, 37(1), 44-50. doi: 10.33588/rn.3701.2003237

Stevens, G., Flaxman, S., Brunskill, E., Mascarenhas, M., Mathers, C. D., Finucane, M., & The Global Burden of Disease Hearing Loss Expert Group. (2013). Global and regional hearing impairment prevalence: An analysis of 42 studies in 29 countries. European Journal of Public Health, 23(1), 146-152. doi: 10.1093/eurpub/ckr176

Surowiecki, V. N., Sarant, J., Maruff, P., Blamey, P. J., Busby, P. A., & Clark, G. M. (2002). Cognitive processing in children using cochlear implants: The relationship between visual memory, attention, and executive functions and developing language skills. Annals of Otology, Rhinology & Laryngology, 111(Suppl 5), 119-126. doi: 10.1177/00034894021110s524

Svirsky, M. A., Robbins, A. M., Kirk, K. I., Pisoni, D. B., & Miyamoto, R. T. (2000). Language development in profoundly deaf children with cochlear implants. Psychological Science, 11(2), 153-158. doi: 10.1111/1467-9280.00231

The Joint Committee of Infant Hearing. (2019). Year 2019 position statement: Principles and guidelines for early hearing detection and intervention programs. Journal of Early Hearing Detection and Intervention, 4(2), 1-44. doi: 10.15142/fptk-b748

Ustárroz, J. T., Molina, A. G., Lario, P. L., García, A. V., & Lago, M. R. (2012). Corteza prefrontal, funciones ejecutivas y regulación de la conducta. In J. T. Ustárroz, A. G. Molina, M. R. Lago, & A. A. Ardila (Coord.), Neuropsicología de la corteza prefrontal y las funciones ejecutivas (pp. 87-120), ISBN 978-84-92931-13-2. Retrieved from

Wang, J., & Napier, J. (2013). Signed language working memory capacity of signed language interpreters and deaf signers. Journal of Deaf Studies and Deaf Education, 18(2), 271-286. doi: 10.1093/deafed/ens068

Watkin, P., & Baldwin, M. (2012). The longitudinal follow up of a universal neonatal hearing screen: The implications for confirming deafness in childhood. International Journal of Audiology, 51(7), 519-528. doi: 10.3109/14992027.2012.673237

Werfel, K. L. (2017). Emergent literacy skills in preschool children with hearing loss who use spoken language: Initial findings from the Early Language and Literacy Acquisition (ELLA) study. Language, Speech, and Hearing Services in Schools, 48(4), 249-259. doi: 10.1044/2017_LSHSS-17-0023

World Health Organization. (2020). Grades of hearing impairment. WHO; World Health Organization. Retrieved from 18 May 2020

Xuan, B., Li, P., Zhang, A., & Yang, L. (2018). Decision-making in adolescents with profound hearing loss. Journal of Deaf Studies and Deaf Education, 23(3), 219-227. doi: 10.1093/deafed/eny001

Yoshida, H., & Smith, L. B. (2003). Shifting ontological boundaries: How Japanese- and English-speaking children generalize names for animals and artifacts. Developmental Science, 6(1), 1-17. doi: 10.1111/1467-7687.00247_1

Yoshinaga-Itano, C., Sedey, A. L., Wiggin, M., & Mason, C. A. (2018). Language outcomes improved through early hearing detection and earlier cochlear implantation. Otology & Neurotology, 39(10), 1256-1263. doi: 10.1097/MAO.0000000000001976