The social and emotional adjustment of children with impaired hearing attending ordinary classes

Otitis media and child development: should we worry?

Persistent middle ear effusion in infancy and early childhood has been blamed for impairments of speech, language, cognition and psychosocial development later in life. Whether that blame is justified remains unresolved and a matter of controversy, because studies of the relationships involved have been limited and often contradictory and because none was designed so as to address the issue of causality. At issue in particular is the common practice of subjecting infants and young children with persistent otitis media with effusion (OME) to tympanostomy tube placement specifically to reduce the risk of developmental impairment. Currently children younger than age 3 years undergo an estimated 313000 tympanostomy tube placement operations per year, at a cost of about $750 million. If a causal association between early life OME and later developmental impairment were to be established, answers would also be needed to the questions whether the adverse effects of OME are linear or threshold, whether they are permanent or transient and whether they are preventable by timely tube placement. A prospective study designed to address all of these questions is currently under way at Children's Hospital of Pittsburgh. The study involves enrolling a large, demographically diverse sample of normal infants before 2 months of age; monitoring them for the presence or absence of otitis media throughout the first 3 years of life; identifying those in whom OME has persisted for specified minimum periods; randomly assigning those subjects either to prompt tube placement or to delayed tube placement if OME persists; and administering a battery of standardized developmental tests to those subjects and to a sample of the others at ages 3, 4 and 6 years. Details of the study design and procedures are described in this report.

Detection of behavioural and emotional problems in deaf children and adolescents: comparison of two rating scales

The aim of this study was to establish rates of behavioural and emotional problems, and of social maladjustment, in a population of deaf children, particularly in relation to different methods of communication. The parents of 84 children who attended two schools for the deaf took part. They completed the parents' checklist (PCL), a behaviour rating scale for deaf children, and the Child Behaviour Checklist (CBCL), a measure widely used in the general population. The two instruments were significantly correlated on the severity of behavioural and emotional problems, but their previously established cut-off scores detected different rates of possible clinical cases, i.e. children with mental health disorders. According to the CBCL, 40% of children were within the clinical range, and 82% were socially dysfunctional compared with the general population. The PCL identified a much higher percentage (77%) of caseness. Behavioural and emotional problems were significantly higher in Asian children. Although all subjects used sign language, the additional use of speech, which may indicate increased hearing ability, had a protective effect for adolescents. The findings are discussed in relation to the validation of the instruments and the development of intervention programmes for deaf children.

Conductive hearing loss effects on children's language and scholastic skills. A review of the literature

A review of available studies investigating the consequences of conductive hearing loss for language acquisition and scholastic performance was carried out. It uncovered no study that met the standards of rigor needed to provide a definitive answer to this question, although the burden of the evidence is that a persistent mild hearing loss, especially if present since infancy, probably has a measurably deleterious effect on the language of most but not all children. Diagnostic criteria documenting the severity, age of occurrence and duration of middle ear effusions were lacking. Measures of the detrimental effects of conductive losses on linguistic skills frequently were limited to the number of grades children were retained in school, their reading or vocabulary level on achievement tests, or a comparison of their scores on the verbal and performance scales of intelligence tests. Very few studies followed the acquisition of language in affected children or examined its structure. Very few considered the interaction between the socioeconomic and cultural environment of the child and the consequences of his hearing loss. The review underscored the need for prospective multidisciplinary studies in order to evaluate the actual impact of this common pediatric problem.

Integration

The problems of intergrating the disabled child in the ordinary school are examined. The child's adaptation and adjustment are briefly discussed and the influence on these of the home, medical and educational services is considered. Handicap is seen to be created by a combination of the functional limitations imposed by the disability and by the reaction of society to it. Successful integration is considered to be in some way dependent upon efforts which will reduce both this secondary socially induced handicap and also any peer group stigmatization. Positive professional attitudes and intensive family centered support and guidance are considered essential to the successful habilitation of the disabled child.

Common ear diseases: recognition and management

External otitis is directly related to patient habit patterns. It is easily treated, but the habits must be changed to effect permanent cure. Serous otitis media is the most common cause of conductive hearing loss, and its presence my predispose to development of purulent otitis media. Removal of middle ear fluid may be advisable in persistent serous otitis and is recommended in acute purulent otitis.

Pediatrician's view of middle ear effusions: more questions than answers

Although middle ear effusion is the most common of the chronic conditions encountered in pediatric practice, it frequently goes unrecognized, and relatively little is known about its epidemiology or its natural history. More importantly, the impact of middle ear effusion on the overall well-being of infants and children, and on their cognitive and language development, remains essentially unexplored. In part because of these gaps in our knowledge, and also because prospective, controlled treatment trials have not been reported, uncertainty and controversy exist concerning: 1) the necessity, in many instances, of treating middle ear effusion; 2) the choice of various treatment methods; and 3) the timing of those treatments that are undertaken. Finally, the widespread use of adenoidectomy to prevent middle ear inflammation is seriously lacking in supporting evidence. A few reported studies bear on some of these questions, but both their scope and the information they provide are limited. In order to resolve important prognostic and treatment issues concerning middle ear effusion during infancy and childhood, carefully designed epidemiologic and clinical studies of types not hitherto reported are urgently needed.