Multilevel narrative assessment in children with early cochlear implants compared to typically hearing peers

Cochlear implants (CIs) provide auditory access that supports the development of oral language in deaf children with severe-to-profound hearing loss, especially when implantation occurs early. This study assessed narrative abilities in 16 school-aged children with early CIs compared to 16 typically hearing peers matched for age, using a multilevel framework encompassing productivity, microlinguistic, and macrolinguistic measures. Results indicated that productivity and grammatical accuracy were largely preserved in early CI users. In contrast, lexical diversity (the range of different words used) and informativeness (words that contribute essential information to discourse) emerged as residual weaknesses, with CI children producing less varied and informative narratives, particularly in the use of function words such as pronouns and clitics. Overall, the findings reveal specific difficulties among CI users that can be clinically assessed and addressed through multilevel evaluation tasks.