The relationship between executive functions and daily auditory behaviors in preschool cochlear implant users

Objective: This study aims to investigate the relationship between parent-reported daily life auditory behaviors and teacher-evaluated executive functions in preschool children using cochlear implants (CIs). Material and Methods: Forty-seven children (23 girls, 24 boys) aged 4–6 years with bilateral CIs participated. The clinical profile showed successful auditory access (aided thresholds: 24.8 dB HL; word recognition: 82.5%). Auditory Behavior in Everyday Life (ABEL) and the Childhood Executive Functioning Inventory (CHEXI) scales were used. Data were analyzed using correlation, hierarchical regression, and mediation analyses. Results: Duration of CI use correlated significantly with auditory behaviors (r = .50, p < .01) and working memory (WM) (r = .48, p < .01). Regression analysis showed WM explained an additional 22% of variance in auditory performance (β = .45, p < .001). Mediation analysis confirmed auditory behaviors partially mediate the relationship between device experience and WM development (β = .22, p = .014). Girls demonstrated significantly higher WM scores than boys (p = .032). Conclusion: WM is a vital neurocognitive resource operating in synergy with auditory experience. Clinical protocols should include integrated strategies supporting WM capacity to maximize developmental potential.