Congenitally deafblind children and cochlear implants: effects on communication

Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language

PURPOSE

The purpose of this study is to determine whether and how learning American Sign Language (ASL) is associated with spoken English skills in a sample of ASL-English bilingual deaf and hard of hearing (DHH) children.

METHOD

This cross-sectional study of vocabulary size included 56 DHH children between 8 and 60 months of age who were learning both ASL and spoken English and had hearing parents. English and ASL vocabulary were independently assessed via parent report checklists.

RESULTS

ASL vocabulary size positively correlated with spoken English vocabulary size. Spoken English vocabulary sizes in the ASL-English bilingual DHH children in the present sample were comparable to those in previous reports of monolingual DHH children who were learning only English. ASL-English bilingual DHH children had total vocabularies (combining ASL and English) that were equivalent to same-age hearing monolingual children. Children with large ASL vocabularies were more likely to have spoken English vocabularies in the average range based on norms for hearing monolingual children.

CONCLUSIONS

Contrary to predictions often cited in the literature, acquisition of sign language does not harm spoken vocabulary acquisition. This retrospective, correlational study cannot determine whether there is a causal relationship between sign language and spoken language vocabulary acquisition, but if a causal relationship exists, the evidence here suggests that the effect would be positive. Bilingual DHH children have age-expected vocabularies when considering the entirety of their language skills. We found no evidence to support recommendations that families with DHH children avoid learning sign language. Rather, our findings show that children with early ASL exposure can develop age-appropriate vocabulary skills in both ASL and spoken English.

Interventions for children with deafblindness-An integrative review

BACKGROUND

Deafblindness is a rare condition, and its prevalence has been reported to be approximately 1 in 27 000 new-borns worldwide. For individuals with deafblindness, lifelong interventions and support are needed to be able to develop communication, be active and preserve a good quality of life. Because little is known about what kind of support and interventions can be offered to children with deafblindness, the aim was to summarize and disseminate research findings regarding this topic.

METHODS

Integrative review principles were employed. Systematic searches in eight databases and additional manual searches were conducted. The inclusion criteria were as follows: original studies published between 2000 and 2021 examining either interventions for children between 0 and 18 years of age with deafblindness or interventions aimed at children with deafblindness but offered to their relatives or professionals working with them. Studies on support for family members were also sought. Study characteristics were described, and key findings were synthesized into categories based on their similarities.

RESULTS

Of the 6268 identified original studies, 32 were included. The key outcomes from the included studies were synthesized into three categories, with two categories illustrating the goal/intention of the intervention (social interaction and communication, motivation and participation) and one focusing on or identifying the action taken to benefit the child (adaptation of the educational environment). Social interaction and communication was the dominant category, covering 24 of the 32 included studies.

CONCLUSIONS

This review concludes that there are a limited number of evaluated interventions for children with deafblindness. In many cases, the interventions were adapted to the individual child's needs, and most of them were found within the area of social interaction and communication. More research is needed to strengthen the level of evidence for interventions for children with deafblindness.

The relation between sensory loss and communicative and cognitive development in children with congenital deafblindness

People with congenital deafblindness (CDB) are a heterogenic group, and CDB is defined in a variety of ways in the scientific literature. In this study, we aim to examine whether some of the heterogeneity may be more easily resolved from the perspective of ability than from the perspective of impairment. In order to do this, we take as a starting point for our investigations the communication systems that are used and the different sense modalities they require. Information about almost the entire known population of children with CDB in Denmark (age = 3–18 years, N = 71) was collected using a questionnaire form, covering degree of visual and hearing impairments, intellectual disability, level of expressive communication and use of communication systems. No correlation was found between severity of CDB based on degree of sensory impairment and level of intellectual and communicative disability within the population. However, whether or not the child with CDB was able to make use of residual senses to access a linguistic culture (spoken or signed) correlated significantly with both cognitive and communicative ability. In addition, the two groups had inverse correlations between number of systems used for communication and communicative ability. The actual systems used for communication may be useful for categorizing people with CDB into severity subgroups for scientific study and for intervention planning. In addition, the acquisition of a tactile language for the subgroup of people with CDB who do not utilize a visual or auditory linguistic culture should be given special attention in research and practice.

Outcomes of early intervention for deaf children with additional needs following an Auditory Verbal approach to communication

OBJECTIVES

To determine and compare the rates of progress made by pre-school aged children with all degrees and types of hearing impairment and deafness, both with and without additional needs as catalogued using SNOMED CT, at the end of a non-statutory programme of individualised Auditory Verbal (AV) intervention.

METHODS

An audit was conducted using a retrospective and comparative study design to examine spoken language outcomes in children who had spent more than two years on an AV programme and had completed their programmes between January 2007 and December 2017. The children were stratified according to i) whether they achieved age appropriate language (AAL) (n =102) or not (n =27); ii) whether they had deafness alone (n = 77) or deafness with additional needs (n =52); and iii) whether children with additional needs achieved AAL (n= 27) or not (n =25). Children undertook standardised spoken language assessments on joining the AV programme and then at intervals of at least 6 months for the duration of their programme. Derived measures of rates of language development (RLD) were used to compare the groups at i) the outset (initial RLD), and ii) the conclusion of the AV programme (programme RLD).

RESULTS

Overall, 79% of children within this cohort achieved age appropriate spoken language scores. Children with additional needs (40%) embarked on a non-statutory AV programme at a significantly older age (corrected for prematurity), with significantly lower initial RLD and, as a group, attained significantly lower programme RLD compared with children with deafness alone. One in two of the children with additional needs reached AAL by the end of their individualised programme. The children with additional needs also demonstrated a highly significant increase in their mean programme RLD compared with the mean initial RLD indicating an acceleration in acquiring spoken language competencies while on the AV programme.

CONCLUSIONS

For deaf children with additional needs who stay on an AV programme for more than two years, listening and spoken communication is significantly enhanced. Specific access to the AV approach in addition to generic, statutory early intervention could facilitate deaf children with additional needs to achieve or approach AAL. Ensuring families have access to effective early intervention increases the chances that i) a suitable communication approach is adopted at the earliest opportunity, and ii) a child with additional needs acquires listening and spoken language at a rate commensurate with their full potential. Applying the SNOMED CT framework as a means of categorising children's additional needs will enable more effective comparisons across studies from different centres around the world.

Communication and language profiles of children with congenital deafblindness

To be born deaf and blind creates both communicative and language acquisition barriers for a child. Although case studies, research, and practical reports have described the severe communicative delay that children with congenital deafblindness (CDB) often experience, to date, no population studies have given a systematic overview of the characteristics of communication, language use, and language acquisition. This study investigates modes of communication and level of language acquisition among 71 children with CDB using the Rowland Communication Matrix and a questionnaire form. Results show heterogeneity in use of communication mode, vocabulary, and level of language development. Communication was distributed across modalities with 23% using tactile language, 32% oral language, and 39% visual sign language. With regard to the level of language acquisition, 41% used pre-verbal communication, 42% verbal communication (tactile, visual, or oral) but with delay, and 18% verbal communication (tactile, visual, or oral) without any delay. Similar heterogeneity was reflected on vocabulary count and score on the Rowland Communication Matrix. Children with CDB are not a uniform group, and more research is needed in order to map out the diversity found.

Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age

OBJECTIVE

This study examined language and speech outcomes in young children with hearing loss and additional disabilities.

DESIGN

Receptive and expressive language skills and speech output accuracy were evaluated using direct assessment and caregiver report. Results were analysed first for the entire participant cohort, and then to compare results for children with hearing aids (HAs) versus cochlear implants (CIs).

STUDY SAMPLE

A population-based cohort of 146 five-year-old children with hearing loss and additional disabilities took part.

RESULTS

Across all participants, multiple regressions showed that better language outcomes were associated with milder hearing loss, use of oral communication, higher levels of cognitive ability and maternal education, and earlier device fitting. Speech output accuracy was associated with use of oral communication only. Average outcomes were similar for children with HAs versus CIs, but their associations with demographic variables differed. For HA users, results resembled those for the whole cohort. For CI users, only use of oral communication and higher cognitive ability levels were significantly associated with better language outcomes.

CONCLUSIONS

The results underscore the importance of early device fitting for children with additional disabilities. Strong conclusions cannot be drawn for CI users given the small number of participants with complete data.

Rehabilitation and Research Priorities in Deafblindness for the Next Decade

Purpose

Previous studies have guided the development of deafblindness rehabilitation by reporting on the priorities of researchers and of deafblind individuals; however, service and care providers may be able to bring a different and important perspective to shaping the development of this clinical field and its research. The present study aims to give them a voice in this process.

Methods

We conducted a qualitative survey in which 68 stakeholders in deaf-blind rehabilitation from 6 countries described their perceived research and rehabilitation priorities for the coming decade. Verbatim transcripts were analyzed using thematic analysis through open coding, creating categories, and abstraction.

Results

Three categories of priorities emerged: those common to rehabilitation and research (such as assistive technology, communication services, and interdisciplinarity), those unique to rehabilitation (such as augmented service provision), and those unique to research (such as recruitment databases and measurement tools).

Conclusions

When viewing the findings from within the context of the existing research literature, the overlap indicated that research and rehabilitation efforts are moving in a congruent direction for researchers, service providers, and persons with deafblindness. Future efforts should focus on information exchange in order to improve evidence-based rehabilitation practice.

Symptoms of autism among children with congenital deafblindness

Associations between congenital deafness or blindness and autism have been found. The main consequences of congenital sensory impairment, being barriers for communication, language and social interaction development, may lead to symptoms of autism. To date only few studies have been reported concerning individuals with congenital deafblindness. This study examines symptoms of autism among 71 children with congenital deafblindness using the Autism Behavior Checklist. The cohort of children with congenital deafblindness was found to have symptoms of autism on a level similar to children with another developmental disorder than autism for example intellectual disability. No association was found between severity of congenital sensory impairment and severity or type of symptoms of autism.

Definitions of deafblindness and congenital deafblindness

In order to compile knowledge on deafblindness (DB) and congenital deafblindness (CDB), one important factor is comparison of results between different scientific studies. In an attempt to do a systematic review of the literature on cognitive assessment and CDB, considerable difficulties in determining eligibility of the studies were encountered due to heterogeneity in definitions and inclusion criteria used in the articles. The present systematic review aims to provide both an overview of this terminological and methodological heterogeneity and suggestions for better future research practices. A systematic review of definitions used in (N=30) studies employing psychological assessment of people with CDB served as a sample of the scientific literature on DB and CDB. Absent or heterogeneous definitions and inclusion criteria regarding both DB and CDB are evident in the sample. Fifty percent of the studies reported no definition of DB and 76.7% reported no definition of CDB. Main discrepancies are: (1) medical/functional versus ability/functioning definitions regarding DB; and (2) different criteria for onset of DB in the case of defining CDB (e.g. age versus developmental level). The results of this study call attention to a scientifically inadequate approach to the study of DB and CDB. Findings indicate that clear guidelines for sample descriptions of the DB and/or CDB populations are needed. It is suggested that studies including DB and CDB participants provide the following information: definitions of DB and CDB used; severity of sensory impairments; level of sensory ability in relation to mobility, access to information, and communication; age at onset of DB; and communication as well as language ability at onset of DB.

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.

Outcomes of 3-year-old children with hearing loss and different types of additional disabilities

This research investigated the speech, language, and functional auditory outcomes of 119 3-year-old children with hearing loss and additional disabilities. Outcomes were evaluated using direct assessment and caregiver report. Multiple regressions revealed that type of additional disability and level of maternal education were significant predictors of language outcomes. Poorer outcomes were achieved in a combined group of children with autism, cerebral palsy, and/or developmental delay (DD) (Group A), compared with children with vision or speech output impairments, syndromes not entailing DD, or medical disorders (Group B). Better outcomes were associated with higher levels of maternal education. The association between better language outcomes and earlier cochlear implant switch-on approached significance. Further regression analyses were conducted separately for children with different types of additional disabilities. Level of maternal education was the only significant predictor of outcomes for Group A children, whereas degree of hearing loss was the strongest predictor for children in Group B. The findings highlight the variable impact that different types of additional disabilities can have on language development in children with hearing loss.

The relationship between body movements and qualities of social interaction between a boy with severe developmental disabilities and his caregiver

Research in social interaction and nonverbal communication among individuals with severe developmental disabilities also includes the study of body movements. Advances in analytical technology give new possibilities for measuring body movements more accurately and reliably. One such advance is the Qualisys Motion Capture System (QMCS), which utilizes optical markers to capture body movements. The aim of this study was to explore the practicality of measuring body movements in the nonverbal communication of a child with severe developmental disabilities. A preliminary case study has been undertaken. The social interaction between a boy with developmental disabilities and his teacher was analyzed (1) using observer ratings on psychological aspects of the social interaction and (2) measuring body positions, velocity, and angles of body movements using the QMCS. Associations between observer ratings and measured body movements were examined. This preliminary case study has indicated that emotional response and attention level during the social interaction corresponded with local, synchronized movements and face-to-face orientation. Measurement of motor behavior is suggested as being a potentially useful methodological approach to studying social interaction and communication development.

Development and characteristics of children with Usher syndrome and CHARGE syndrome

OBJECTIVE

Individuals with Usher syndrome or CHARGE syndrome are faced with a number of difficulties concerning hearing, vision, balance, and language development. The aim of the study is to describe the developmental characteristics of children with Usher syndrome and CHARGE syndrome, respectively.

METHOD

Data about the developmental characteristics of 26 children with Usher syndrome and 17 children with CHARGE syndrome was obtained. Associations between deafblindness (dual sensory loss), motor development (age of walking), language abilities, and intellectual outcome of these children were explored for each group independently.

RESULTS

Both groups of children face a number of difficulties associated with vision, hearing, language, balance and intellectual outcome. Intellectual disability and/or language delay was found among 42% of the children with Usher syndrome and among 82% of the children with CHARGE syndrome. Intellectual disability was associated with language delay and age of walking for both groups.

CONCLUSIONS

Even though Usher and CHARGE are two different genetic syndromes, both groups are challenged with a number of similar developmental delays. Clinicians need to be aware of several developmental issues in order to offer adequate support to children with Usher or CHARGE syndrome.

Identification of congenital deafblindness

For many reasons an accurate and straightforward identification of congenital deafblindness can be difficult. This article reports on the assessment procedures and experience in Denmark where medical examinations were combined with functional assessments performed through direct observation. The study evaluated the assessment procedure of 190 children and adults found to be congenitally deafblind. Among the 190 individuals 76 percent were determined using functional assessment in addition to medical examination. A case example involving a 12-year-old child is also presented to illustrate the complexity in identifying congenital deafblindness. It is concluded that determining deafblindness should not be limited to medical procedures (vision and hearing tests) alone, but may also involve a lengthy process to assess the level of sense functioning the individual possesses.

Mental and behavioral disorders among people with congenital deafblindness

The population of people with congenital deafblindness faces challenges concerning communication and mobility. Due to the significance of the sensory loss it is difficult to diagnose mental and behavioral disorders. This article investigates the prevalence of mental and behavioral disorders among 95 congenitally deafblind adults. Seventy-four percent were found to have a mental and/or behavioral diagnose. Mental retardation was found among 34%, psychosis among 13%. Mental and behavioral disorders, especially with symptoms of psychosis and mental retardation, are common among people with congenital deafblindness. Clinical experience is needed, as well as cross-disciplinary cooperation and specialized diagnostic methods together with a observation and intervention period in order to be able to assess and differentiate mental and behavioral symptoms from sensory deprivation in people with congenital deafblindness.