Language Learning Activities in Educational Settings Incrementally Predict Language Ability Beyond Daily Conversation in Preschoolers with Cochlear Implants: A Comparative Study with Normal-Hearing Peers

Background/Objectives: This study examined how different types of language activities in educational settings predict language ability in preschoolers with cochlear implants (CIs) versus normal-hearing (NH) peers. Predictor variables included two dimensions of language activities (language learning activities: shared reading, word games, and story retelling; daily communication activities: routine conversations and free play talk), as well as auditory utilization status (awareness of sounds, perception of speech sounds, and attentive listening to teachers/peers), learning attentional state, and family socioeconomic status (SERS). The outcome variable was language ability, measured with the Mandarin Clinical Evaluation of Language for Preschoolers’ Core Scale (MCELP-CS), and control variables included age and, for the CI group only, age of implantation. Methods: Participants included 189 CI (mean age = 4.53 years, SD = 0.83) and 210 NH preschoolers (mean age = 4.64 years, SD = 0.83). All predictor and control variables were collected via teacher-reported questionnaires (self-compiled by the research team). Statistical analyses used hierarchical regression with separate models for each group. Results: For the CI group, after controlling for age and age of implantation, engagement in language learning activities emerged as the most stable and independent predictor of language ability. Auditory utilization status was another significant predictor, and its inclusion substantially increased the model’s R2. For the NH group, language ability was primarily predicted by age-related maturation, with language learning activities showing additional predictive value, while daily communication activities and learning attentional state contributed very little. Conclusions: Findings suggest that for educational rehabilitation of CI preschoolers: increasing engagement in language learning activities in classrooms may be more beneficial than relying on daily conversation or merely improving attention alone; meanwhile, auditory utilization skills should also be fostered synergistically. Importantly, language intervention models designed for NH preschoolers cannot be directly transferred to CI preschoolers.