The Direct-to-Semantics Cross-Modal Compensatory Mechanism in Sublexical Processing Among Children With Cochlear Implants

Purpose: This study investigated the rapid sublexical processing mechanisms of Chinese children with cochlear implants (CIs) to understand how early altered auditory experience shapes cross-modal reading compensation. Method: Using an unmasked priming lexical decision paradigm (stimulus onset asynchrony = 150 ms) and a structural-violation pseudocharacter judgment task, 30 children with CIs were compared with 30 age-matched children with normal hearing (NH). Reaction times (RTs) and accuracy were analyzed using linear and generalized linear mixed-effects models. Results: Although children with NH demonstrated relative reliance on orthographic-phonological-semantic activation, children with CIs exhibited a highly specialized and asymmetrical processing pattern. Specifically, phonetic priming was absent in the CI group, indicating markedly attenuated sublexical phonetic decoding. Conversely, children with CIs demonstrated a substantial semantic facilitation effect (> 130 ms) that drastically amplified as whole-character frequency decreased. Furthermore, children with CIs incurred significantly higher cognitive costs (prolonged RTs and higher error rates) when processing highly similar pseudocharacters with spatial position conflicts. Conclusions: Driven by their altered auditory experience, children with CIs adaptively deploy a direct-to-semantics visual capture strategy, heavily reallocating finite cognitive resources toward semantic radicals. Although this structural reorganization successfully compensates for phonological imprecision, it entails a functional trade-off, rendering them susceptible to spatial structural interference. These neurobehavioral findings challenge traditional phonological deficit–driven educational models, providing evidence for adaptive interventions prioritizing morphological-semantic training and whole-character visual templates.