Purpose: Executive functioning in deaf and hard-of-hearing individuals is known to be variable and at risk due to delays in access to language. In this study, we sought to characterize a range of executive function profiles in deaf and hard-of-hearing individuals ranging in age from 18 to 30 years.
Method: The executive function skills of 56 typically hearing young adults was compared to that of 212 DHH peers in a cross-sectional study using the NIH Toolbox Cognition Battery. Performance was analyzed using an estimation-based approach to determine the influence of language acquisition history, including considerations of exposure to American Sign Language and cochlear implantation. This was supplemented by a latent profile analysis to determine data-driven sub-classes of participant based upon task performance.
Results: Overall, DHH participants demonstrated executive function weakness when compared to typically hearing peers. These deficits were especially apparent in DHH late signers who had delayed access to American Sign Language and who had never received a cochlear implant. DHH participants with early exposure to ASL and those who received a cochlear implant before the age of three years performed the best. The latent profile analysis revealed four distinct profiles: high, typical and executive function profiles, plus a profile that displayed specific deficits in inhibition and shifting. DHH groups were not equally distributed across profiles.
Conclusions: Executive function in deaf and hard-of-hearing adolescents and young adults was highly variable but appeared to be supported by early access to perceivable natural language early in development. The combination of person-centered and group-level analyses sheds new light on how variability in the cognitive performance of DHH individuals can be meaningfully categorized. Future research is needed to prospectively validate the profiles identified here and to determine developmental trajectories.