Disability as a risk factor? Development of psychopathology in children with disabilities

Cognitive and language outcomes for pediatric hearing loss with otologic surgery

OBJECTIVES

To test the hypothesis that surgical otologic intervention for any type of pediatric hearing loss decreases the odds for incident adverse cognitive and linguistic developmental outcomes.

STUDY DESIGN

Retrospective cohort database study.

METHODS

Electronic medical record data from the TriNetX Research Network were queried for children with congenital, sensorineural, conductive, and mixed hearing loss (HL) between ages 0 and 5 years. Patients were further stratified by presence (HL + surgery) or absence (HL-surgery) of surgical intervention at any point following diagnosis, including cochlear implantation, tympanoplasty with or without mastoidectomy, and tympanostomy. Primary outcomes were defined as odds for new adverse cognitive or linguistic outcomes at any point given HL treatment status [odds ratio with 95% confidence interval, (OR; 95%CI, p-value)]. Cohorts were balanced using propensity-score matching (PSM) based on US census-defined demographics and clinically relevant congenital conditions.

RESULTS

Of 457,636 total patients included in the study, 118,576 underwent surgery (HL + surgery cohort) and 339,060 did not (HL-surgery). In matched cohorts, surgical otologic intervention significantly decreased the odds of developing cognitive disorders including scholastic, motor, psychological developmental disorders, and pervasive developmental delays (p < 0.01).

CONCLUSIONS

Surgical interventions for treatment of pediatric HL including cochlear implantation, tympanoplasty with or without mastoidectomy, and tympanostomy should be considered as they may prevent delays in development.

Quality of life and mental health in emerging adults with cerebral palsy compared to the general population

Background

While evidence concerning Quality of Life (QoL) in youth with cerebral palsy (CP) in comparison to the general population has been accumulating, there is a lack of studies exploring differences on a wider range of positive and negative mental health outcomes in emerging adults.

Methods

This binational case control study is part of the SPARCLE cohort study on QoL and participation of youth with CP. QoL (WHOQOL-BREF), depression (PHQ-9), anxiety (GAD-7) and self-efficacy (GSE) were assessed in 198 emerging adults with CP and 593 emerging adults from the general population, matched for country of residence, age and gender. ANCOVAs with impairment and pain as covariates were run.

Results

Similar levels of QoL were found in both samples, except for the environmental domain, with better QoL for emerging adults with CP compared to the general population. There were significant descriptive differences regarding depression with worse levels in the CP sample, however, also worse levels of self-efficacy. Pain as a covariate had a significant negative impact on all measures, leading to poorer self-efficacy while worsening depression and anxiety; impairment had a significant worsening impact on physical QoL and self-efficacy only.

Conclusion

Similar expressions of mental health outcomes in emerging adults with CP and the general population indicate the high adaptive capability of emerging adults with CP.

Mental health and behaviour in children with dystonia: Anxiety, challenging behaviour and the relationship to pain and self-esteem

PURPOSE

To ascertain whether young people with dystonia are more likely than the general population to have mental health and/or behavioural difficulties, and to explore factors that may contribute to these difficulties.

METHOD

Using a quasi-experimental design, 50 young people with dystonia aged 7-17 and their carers were recruited from the Evelina London Children's Hospital. Young people completed the Beck Youth Inventories and the Strengths and Difficulties Questionnaire. Carers completed the Strengths and Difficulties Questionnaire-Parent version and the Paediatric Pain Profile. Important medical factors, such as age of onset, motor severity and manual function were obtained from medical records.

RESULTS

One sample z tests showed young people with dystonia self-reported significantly higher levels of anxiety (p < .001) and prosocial difficulties (p < .01), with 48% experiencing clinically significant anxiety levels. They experienced significantly lower levels of anger, disruptive behaviour and conduct problems (all p ≤ .01). Carers reported significantly higher rates of emotional problems, hyperactivity and peer problems, and significantly lower prosocial behaviours (all p ≤ .01). Pearson's correlation coefficients showed lower levels of self-esteem were related to higher levels of anxiety (p = .015). High levels of pain were related to parent-rated conduct problems (p = .004). Age of dystonia onset and motor severity did not correlate with any of the psychological or behavioural measures.

INTERPRETATION/CONCLUSIONS

Our study suggests high rates of anxiety and behaviours that challenge in children with dystonia. Screening in movement clinics would be helpful in early identification and signposting for support.

Trajectories of psychiatric disorders in a cohort of children with cerebral palsy across four years

BACKGROUND

Risk of psychiatric disorders has been reported for children and adolescents with cerebral palsy (CP) at different ages, however little is known regarding the long-term trajectories of these disorders.

OBJECTIVE

The aim of this study was to assess the trajectories of psychiatric disorders in children with CP, and to explore their association to risk factors.

METHODS

We assessed a cohort of children with CP at age seven and again at age eleven with a child psychiatric diagnostic instrument, and parents were informants. We assessed type of CP, Gross Motor Function Classification System (GMFCS) levels, and co-occurring medical conditions in a medical examination, through the medical records, and in an interview with the parents at the onset of the study.

RESULTS

We found a significant increase in the prevalence of emotional disorders from seven to eleven years of age (p 0.01), whereas the prevalence of behavioral disorders was stable. Half of the cohort met criteria for a psychiatric disorder at both assessment points. Type of CP, spastic bilateral or unilateral, dyskinetic or ataxic, and co-occurring medical conditions were non-significant predictors of psychiatric disorders. Subthreshold psychiatric disorders at age seven were predictive of psychiatric disorders at age eleven.

CONCLUSIONS

We found a persistently elevated prevalence of psychiatric disorders in children with CP. Prevalence of behavioral disorders was stable, whereas we found a significant four-fold increase in emotional disorders. Sub-threshold psychiatric disorders predicted later psychiatric disorders. Increased focus on early mental health symptoms as well as more knowledge regarding emotional disorders in children with CP seems warranted.

Childhood hearing loss: Impact on parents and family life

BACKGROUND

Studies investigating the impact of having a child with hearing loss on the lives of parents and families have shown divergent results. Where some studies have reported that childhood hearing loss is associated with parental mental health problems, such as depression and stress, other studies report no impact on parental mental health and/or wellbeing.

OBJECTIVE

The aim of this study was to examine the association between child-related variables-degree of hearing loss, additional disabilities, sign language abilities, cochlear implants (CI), externalizing and internalizing emotional and behavioral difficulties measured by the Strength and Difficulties Questionnaire (SDQ)-and parent-related variables-parents living together, parents' mental health, spouse activities without children, and parents' experience of the child as being a burden for the family.

METHOD

Data of 257 parents of children with hearing loss from a national survey were included.

RESULTS

Only 18% of the children with hearing loss did not live with both parents, a figure significantly lower than that of the general population. The child variables of degree of hearing loss, having a CI or not, and sign language ability were not significantly associated with any of the parent variables investigated. The child having a disability in addition to hearing loss was found to be significantly associated with the frequency of spouses engaging in activities without children and reports that the child was a burden for the family. Both higher externalizing and internalizing scores on the SDQ were significantly associated with parental mental health problems, frequency of spouse activities without children, and the degree to which the child's difficulties were experienced as a burden for the family.

CONCLUSION

Children's hearing loss, per se, was found not to be significantly related to several key parent and family variables. However, children having additional disabilities and behavioral and emotional difficulties were significant with parent and family variables. This study thus underlines the need for further studies concerning relationships among factors related to childhood hearing loss and various family factors in order to better understand their impact on child development and family life.

A national survey on violence and discrimination among people with disabilities

Background

The aim of the study was to quantify levels of violence and discrimination among people with disabilities and analyze the effects of gender and the type and degree of disability.

Methods

The study analyzed data on self-reported violence and discrimination from a Danish national survey of 18,019 citizens, of whom 4519 reported a physical disability and 1398 reported a mental disability.

Results

Individuals with disabilities reported significantly higher levels of violence than those without. Specifically, individuals reporting a mental disability reported higher levels of violence and discrimination. Significant gender differences were found with regard to type of violence: while men with disabilities were more likely to report physical violence, women with disabilities were more likely to report major sexual violence, humiliation and discrimination. Neither severity nor visibility of disability was found to be a significant factor for risk of violence.

Conclusions

This large-scale study lends support to existing research showing that people with disabilities are at greater risk of violence than people without disabilities. Further, the study found that people with mental disabilities were significantly more likely to report all types of violence and discrimination than those with physical disabilities. The findings also show that gender is significant in explaining the type of violence experienced and the experience of discrimination.

Prevalence and characteristics of self-reported physical and mental disorders among adults with hearing loss in Denmark: a national survey

PURPOSE

Existing research shows that people with hearing loss have a high risk of additional physical and mental disorders. However, only a few population-based studies have been conducted. This study assesses the prevalence and characteristics of additional disorders among adults with hearing loss in Denmark and thereby contributes a population-based study to this area of research.

METHOD

Data on self-reported physical and mental disorders from a national survey of 772 adults with hearing loss were compared to corresponding data from a national survey of 18,017 adults from the general population.

RESULTS

People with hearing loss reported more physical and mental disorders than the general population. Specifically, they reported higher incidences of visual impairment, cerebral palsy, intellectual impairment, and "other mental disorders".

CONCLUSION

Adults with hearing loss have a greater risk of additional physical and mental disorders. It is important for clinicians to have some understanding of the communication needs and characteristics of deaf and hard-of-hearing patients, so that they can recognize and treat symptoms and provide appropriate support.

Mental Health and Spouse Support Among Older Couples Living With Sensory Loss

Objectives: The current study examined the mental health of couples living with and without sensory loss; compared the mental health of couples living with hearing, vision, or dual-sensory loss; and investigated the association between spouse support and the mental health of couples living with sensory loss. Method: The study included 513 couples with sensory loss and 1,079 couples without sensory loss. Actor–Partner Interdependence Models were used to examine associations between spouse support and mental health. Results: Controlling for potential covariates, individuals with sensory loss and their spouses were at a greater risk of mental health problems. Sensory loss modality (hearing and/or vision) did not explain any differences. Both actor and partner effects of spouse support on anxiety and depression were found. Discussion: The findings highlight the need to support the mental health of couples living with sensory loss and indicate the importance of considering the intimate relationship in future studies.

The Significance of Deaf Identity for Psychological Well-Being

Research has paid attention to how deaf identity affects life outcomes such as psychological well-being. However, studies are often carried out with small samples and without controlling for other variables. This study examined how different forms of identity-deaf, hearing, bicultural (deaf and hearing), and marginal (neither deaf nor hearing)-were associated with levels of psychological well-being and a number of other variables. The sample was 742 adults with hearing loss in Denmark. The study found that those with a deaf, hearing or bicultural identity had significantly higher levels of psychological well-being than those with a marginal identity. Further, it found that additional disability, educational level, and feeling discriminated against significantly and independently explained the degree of psychological well-being. Results are discussed here with respect to social identity theory and current deaf identity themes.

Associations between childhood hearing loss and behavioural and academic difficulties: A Danish cohort study

OBJECTIVE

Negative associations between hearing loss (HL) and behavioural and academic difficulties have been reported. However, most studies are based on small clinical samples. The aim of the present study was to investigate such associations using data from a large-scale non-clinical Danish birth cohort controlling for a large number of relevant confounding factors.

METHODS

The study applied data from the Aarhus Birth Cohort's 10-12-year-old follow-up (N = 7599). Associations between parent-reported HL on the one hand, and parent- and teacher-reported behavioural difficulties measured by the Strengths and Difficulties Questionnaire (SDQ) and parent-reported academic difficulties on the other hand, were investigated.

RESULTS

After controlling for relevant confounding factors, significant associations were observed between parent-reported HL and parent- and teacher-reported Externalising scores, and academic difficulties.

CONCLUSIONS

Childhood HL is associated with behavioural and academic difficulties. Parent reported HL in a non-clinical cohort is indicative for academic and behavioural difficulties.

Level of Educational Attainment Among Deaf Adults Who Attended Bilingual-Bicultural Programs

In Scandinavia and some other countries, a bilingual-bicultural approach to deaf education was celebrated in national programs from the mid-1980s until the broad popularity of cochlear implantation in middle 2000s created a shift back to an emphasis on spoken language for many deaf children. At the same time, only a few studies evaluated the long-term outcomes of bilingual-bicultural education, and several of their findings have raised questions about benefits of the approach. This study examined the level of educational attainment of 408 deaf individuals who attended primary school either before or during the period of bilingual-bicultural education in Denmark, both relative to a comparable hearing cohort. Beyond group comparisons, three logistic regression models were created to evaluate the prediction of educational attainment by a number of relevant variables. Compared to the hearing population, the deaf population had a significantly lower level of educational attainment both before and after the introduction of bilingual-bicultural education. Signed language and spoken language abilities, the kind of school attended, degree of hearing loss, parental hearing loss, and gender were found significantly to explain levels of educational attainment in the deaf population.

Satisfaction of users with assistive technology service delivery: An exploratory analysis of experiences of parents of children with physical and multiple disabilities

OBJECTIVE

To describe experience of assistive technology service delivery (ATSD) by parents of children with physical or multiple disabilities (aged 3-18 years).

METHOD

Forty-seven of 115 parents participated in a postal survey assessing satisfaction with the ATSD process, employing the QUEST 2.0 and the KWAZO scales. Six of these participated in two focus groups. Descriptive statistics were used for satisfaction scores. The focus group transcripts were coded and combined with survey results by two independent researchers.

RESULTS

Low satisfaction scores were reported for follow-up, AT delivery, maintenance services, access to services, coordination, and efficiency of ATSD. Several barriers to and facilitators of ATSD were mentioned and solutions to improve ATSD quality were identified.

CONCLUSION

Evaluation of parents' service experience is central for identifying shortcomings in ATSD. Health professionals are advised to utilize validated instruments and strategies to assess effectiveness of technological interventions and to assure ATSD quality.

Psychometric Properties of the Strengths and Difficulties Questionnaire and Mental Health Problems Among Children With Hearing Loss

More knowledge is needed about the characteristics of mental health problems among deaf or hard of hearing (D/HH) children. This study investigates the factor structure of one of the most widely used screening tools, the Strengths and Difficulties Questionnaire (SDQ), and the prevalence of mental health problems among D/HH children. Our data were derived from two independent samples of D/HH children, one from 2007 of children (N = 334) in bilingual/bicultural educational programs and another from 2014 of children (N = 233) in mostly mainstream oral educational programs with cochlear implants. Teacher-SDQs were collected for the 2007 sample and parent-SDQs for the 2014 sample. The factor structure of the SDQ was examined from both Exploratory Factor Analytic (EFA) and Confirmatory Factor Analytic (CFA) perspectives and internal consistency was examined. Mean problem scores were presented. The five-factor structure of the SDQ was overall found for both the 2007 and the 2014 samples using EFA. However, problems with the Conduct scale and the reversed items loading onto the Prosocial scale were observed. The five-factor model was superior to a one- and a two-factor model from a CFA perspective in both samples. Better internal consistency was observed for the 2007 sample rated by teachers. Both samples showed higher mean scores on all SDQ problem subscales compared to a cohort of Danish children without hearing loss. The five-factor structure of the SDQ is recommended to be used among D/HH children.

Screening for psychopathology in a national cohort of 8- to 15-year-old children with cerebral palsy

Cerebral palsy (CP) is often accompanied by psychopathology and learning disability.

AIMS

(1) to evaluate the prevalence of psychopathology as estimated by the Child Behavior Checklist (CBCL) parental questionnaire in 8- to 15-year-old Danish children with CP and to analyze its association with cognitive ability and families' social characteristics; (2) to examine to what extent children with CP had been evaluated by a child psychiatrist and/or psychologist.

METHOD

The parents of 462 children with CP answered a questionnaire about their child's treatment and the family's characteristics and 446 the CBCL. The cutoff for psychopathology was the Total CBCL score or DSM-oriented scores above the 93rd percentile in an age- and gender-stratified population.

RESULTS

The psychopathology screening was positive in 46.2% (CI 41.6-50.8%) against 15.1% in general population. Cognitive disability was associated with an increased prevalence of psychopathology (odds ratio (OR) 2.6, CI 1.4-4.6, for Developmental Quotient of cognitive function (DQ) 50-85 and OR 3.0, CI 1.3-7.0, for DQ<50). Children with CP and a single parent showed increased odds for a positive CBCL screening compared to children living with two parents (OR 2.1, 95% CI 1.1-4.0). Children with DQ 50-85 more often had a psychological evaluation. A positive CBCL screening was strongly associated with a psychiatric assessment (21% vs. 7%, p<0.01).

CONCLUSION

The high prevalence of emotional and behavioral problems indicates that screening for psychopathology should be a part of multidisciplinary follow-up of CP. The CBCL can be used as a screening instrument in children with CP without severe motor and cognitive disability.

Deafblindness: a review of the literature

BACKGROUND

Deafblindness or dual sensory loss is a rare condition among young people, but more frequent among older people. Deafblindness is a heterogeneous condition that varies with regard to time of onset and degree of vision and hearing impairment, as well as communication mode, medical aetiology, and number and severity of co-morbidity.

METHOD

We conducted a comprehensive review of public health issues related to deafblindness.

RESULTS

Deafblindness often lead to barriers in language and communication, access to information and social interaction, which can lead to a number of health-related difficulties. Some of the reported consequences are a higher risk of depression, cognitive decline, developmental disorder in children and psychological distress.

CONCLUSIONS

Deafblindness is associated with a number of health-related issues and more knowledge is needed about the impact of dual sensory loss to be able to offer the best support.