Cochlear implantation before age one or after: cognitive flexibility, planning, and problem-solving in pediatric recipients

PURPOSE: This study investigated the association between age at cochlear implantation and executive function outcomes, including cognitive flexibility (CF) and planning and problem-solving (PPS), in school-age children with cochlear implants (CIs). Demographic, cognitive, and audiological factors associated with these outcomes were also examined. METHODS: Sixty-one children with CIs aged 8-10 years were divided into Infancy CI (implanted within the first year of life; n = 30) and Toddlerhood CI groups (implanted between 13 and 24 months; n = 31). CF was assessed using the Modified Card Sorting Test and PPS using the Tower of London Test. Group comparisons, correlations, and hierarchical regression analyses were performed. RESULTS: The Infancy CI group showed significantly better CF and PPS performance than the Toddlerhood CI group (p < 0.01). CF was associated with maternal education, nonverbal intelligence, receptive vocabulary, and CI thresholds, whereas PPS was associated with receptive vocabulary and CI hearing thresholds. Regression analyses revealed different predictor patterns. Age at implantation predicted CF initially but was no longer significant after controlling for receptive vocabulary, CI thresholds, nonverbal intelligence, and maternal education; receptive vocabulary was the only independent predictor of CF. In contrast, age at implantation and CI thresholds independently predicted PPS (p < 0.05). CONCLUSION: Earlier cochlear implantation is associated with better executive function outcomes, although different domains appear to be influenced by distinct factors. CF may be more closely related to language development, whereas PPS may be more strongly associated with implantation timing and auditory access.