Cognitive, Learning, and Executive Function Behaviors in Children With Cochlear Implants

Hearing loss in early childhood can affect the development of language, cognition, and executive functions (EF). Although cochlear implantation (CI) restores auditory input, considerable variability in cognitive and academic outcomes remains. This study investigated everyday EF, learning, and academic behaviors in children with CIs compared with typically hearing peers.

Parents of 279 children aged 6 to 18 yr (119 children with CIs, 160 typical hearing) completed the Learning, Executive, and Attention Functioning (LEAF) questionnaire. Subscales were analyzed using Wilcoxon tests and generalized linear modeling to compare cognitive domains (Cognitive-Executive, Cognitive-Learning, Academic) and to explore associations with speech recognition outcomes.

Children with CIs showed significantly higher LEAF scores across most domains, indicating greater EF and academic difficulties, even after excluding participants with additional comorbidities. The strongest group differences occurred in comprehension, conceptual learning, and academic skills (reading, writing, and mathematics). While overall EF performance (composite cLEAF) was not correlated with speech recognition, the Cognitive-Learning domain-particularly comprehension and conceptual learning-was negatively associated with speech-in-noise performance. Children with CIs also exhibited greater intraindividual variability across cognitive subdomains.

Children with CIs, despite good speech recognition, demonstrate domain-specific and heterogeneous challenges in EF and academic performance. These difficulties are not fully explained by auditory or speech recognition abilities, underscoring the importance of addressing broader neurocognitive factors in clinical assessment and intervention. Targeted cognitive and educational support may help reduce cognitive scatter and improve functional outcomes.