Mental health in children with severe hearing impairment

Comparative executive function analysis: Cochlear implants and normal hearing in 7- to 11-year-old children from Iran

OBJECTIVE

This study compares executive functioning in deaf children with cochlear implants and those with normal hearing. Individuals who lacked auditory stimulation during their early years might experience cognitive challenges that extend beyond just speech and language abilities.

METHODS

The executive functioning abilities of a group of 32 children who were born deaf and received cochlear implants before the age of 7 were contrasted with those of 30 children with normal hearing. Both sets of children underwent assessments using the Tower of London, BRIEF, and Stroop tests.

RESULTS

The average score on the Tower of London task reveals that children who received cochlear implants (4.03 ± 2.53) achieved lower scores than typically hearing children (8.37 ± 2.79). This group also exhibited higher errors in the Stroop test and slightly longer response times Additionally, in terms of emotional control assessed by the BRIEF, a higher score was recorded. Notably, significant differences between the two groups were identified for organizing materials (t(62) = -4.204, p = 0.00). The tests measuring phonemic fluency, categorical fluency, and working memory also revealed significant differences.

CONCLUSIONS

The significant differences in data between both groups suggest the influence of cochlear implantation on cognitive functions. This emphasizes the importance of a holistic approach to supporting the overall development of these children.

Cochlear Implants or Hearing Aids: Speech Perception, Language, and Executive Function Outcomes

OBJECTIVES

We aimed to determine whether children with severe hearing loss (HL) who use hearing aids (HAs) may experience added value in the perception of speech, language development, and executive function (EF) compared to children who are hard of hearing (HH) or children who are deaf and who use cochlear implants (CIs) and would benefit from CIs over HAs. The results contribute to the ongoing debate concerning CI criteria. We addressed the following research question to achieve this aim: Do children who are HH or deaf with CIs perform better than children with severe HL with HAs with respect to auditory speech perception, and receptive vocabulary and/or EF?

DESIGN

We compared two groups of children with severe HL, profound HL or deafness, with CIs or HAs, matched for gender, test age (range, 8 to 15 years), socioeconomic status, and nonverbal intelligence quotient. Forty-three children had CIs (pure-tone average at 2000 and 4000 Hz >85 dB HL), and 27 children had HAs (mean pure-tone average: 69 dB HL). We measured speech perception at the conversational level (65 dB SPL) and the soft speech perception level (45 dB SPL). We established receptive vocabulary using the Peabody Picture Vocabulary Test-III-NL. We tested EF using the Delis Kaplan Executive Function System battery and the Dutch Rey Auditory Verbal Learning Test. We employed the Mann-Whitney U test to compare data between the CI and HA groups. We used Chi-square goodness of fit tests to contrast the CI and HA group distributions with the norm data of children who are typically developing (TD). We harnessed Kendall's Tau-b to investigate relationships between the study variables.

RESULTS

Both groups of children, with CIs and Has, obtained ceiling scores for perception of speech on a conversational level. However, the HA group exhibited significantly lower perception on a soft speech level scores (68 %) than the CI group (87%). No difference was present between the receptive vocabulary distributions of the CI and HA groups. The median receptive vocabulary standard scores for both groups were well within the normal range (CI group: 93; HA group: 96). In addition, we did not find any difference in EF between the CI and HA groups. For planning and verbal memory, the distributions of observed scores for children with CIs were different from the expected distributions of children who are TD. In both groups, a large proportion of children obtained below-average scores for planning (CI: 44%; HA: 33%) and for long-term verbal memory (CI: 44%; HA: 35%). In the HA group, perception at a soft speech level was associated with receptive vocabulary and planning. In the CI group, we did not find any associations.

CONCLUSIONS

Both groups of children with severe and profound HL with HAs exhibit less favorable auditory perception on the soft speech level, but not at a conversational level, compared to children who are HH or deaf with CIs. Both groups, children with CIs and HAs, only exhibit more problems in planning and verbal memory than the norm groups of children who are TD. The results indicate that to obtain age-appropriate levels of receptive vocabulary and EF, the perception at the soft speech level is a necessary but not sufficient prerequisite.

Deaf Language Specialists: Delivering Language Therapy in Signed Languages

Deaf professionals, whom we term Deaf Language Specialists (DLS), are frequently employed to work with children and young people who have difficulties learning sign language, but there are few accounts of this work in the literature. Through questionnaires and focus groups, 23 DLSs described their work in this area. Deductive thematic analysis was used to identify how this compared to the work of professionals (typically Speech and Language Therapists/Pathologists, SLPs) working with hearing children with difficulties learning spoken language. Inductive thematic analysis resulted in the identification of two additional themes: while many practices by DLSs are similar to those of SLPs working with hearing children, a lack of training, information, and resources hampers their work; additionally, the cultural context of language and deafness makes this a complex and demanding area of work. These findings add to the limited literature on providing language interventions in the signed modality with clinical implications for meeting the needs of deaf and hard-of-hearing children who do not achieve expectations of learning a first language in their early years. The use of these initial results in two further study phases to co-deliver interventions and co-produce training for DLSs is briefly described.

Assessment of Behavioral Problems in Children Pre- and Post-Cochlear Implant: An Egyptian Study

OBJECTIVE

The present study aimed to detect the behavioral problems pre- and post-cochlear implantation in comparison to normal hearing group to be able to manage these problems to get more benefit from using cochlear implants.

METHODS

A case-control study included 53 children was done. They were divided into 2 groups, the control group included 28 healthy volunteers with normal hearing and the case group included 25 children with severe to profound hearing loss, fitted for cochlear implantation. The Arabic Child Behavior Checklist (CBCL) was used to detect different behavioral problems in both groups. Case group children were followed up and reassessed again by CBCL 3 months later after cochlear implantation.

RESULTS

There were highly significant differences regarding total scores of internalizing and externalizing domains of empirically based CBCL between the control group and the case group after cochlear implants (p=0.001). There were non-significant differences in children within case group (pre- and post-cochlear implantation) regarding emotional and behavioral problems on both empirically based and Diagnostic and Statistical Manual of Mental Disorders-based CBCL.

CONCLUSION

For better results, it is necessary to include a specialist of psychosomatic medicine in the cochlear rehabilitation teamwork.

Mental health support for children and adolescents with hearing loss: scoping review

Background

Children with hearing loss are at increased risk of mental health conditions, including behavioural problems, but there is limited evidence about available mental health support.

Aims

We aimed to map the evidence on mental health support for children and adolescents with hearing loss.

Method

Medline, Embase, PsycINFO and grey literature databases were searched until April 2021. Articles of any study design were eligible if they described an intervention supporting the mental health of children with hearing loss. No restrictions were placed on geography or publication date. Four reviewers independently screened results by title, abstract and full text. Study characteristics and outcome data were extracted, with results narratively synthesised.

Results

From 5629 search results, 27 articles were included. A large majority of the studies (81%, n = 22) were from high-income settings, with two-thirds (67%, n = 18) conducted in the USA. Less than half (41%, n = 11) of the articles adopted experimental research designs, and the majority of studies included small samples. The interventions presented were diverse, with the majority either therapy based (30%, n = 8) or skills training (30%, n = 8). Interventions included ice-skating, parent–child interaction therapy and resilience training. When measured, interventions demonstrated at least some evidence of effectiveness, although this was not always assessed with gold-standard methodology.

Conclusions

The evidence is lacking in breadth, study quality and geographical spread. That said, what is available indicates a range of effective approaches to support the mental health of children with hearing loss. Additional research is needed to improve the breadth of evidence on mental health support for this population.

Self-concept of children and adolescents with cochlear implants

OBJECTIVES

Communicative disorders can complicate social interactions and may be detrimental for one's self-concept. This study aims to assess the self-concept of children with Cochlear Implants (CI). Results of educational peer groups (special needs or typical) were compared. Correlations amongst speech perception, language comprehension, self-concept and other study variables are determined.

METHODS

This retrospectively patient file study contained 53 CI participants with a mean age of 14.2 (SD = 2.8). Self-concept was measured with the Dutch language version of the Self-Perception Profile for Children and Adolescents. Proportions of low, normal and high competence scores were compared to a normative sample. Outcomes were analyzed for the total CI group and for the two educational peer groups.

RESULTS

In the Scholastic Competence, Athletic Competence, Physical Appearance and Behavioral Conduct domains larger proportions of high perceived competence levels were found in the CI Total group compared to the hearing normative sample. Children with CIs in the Mainstream educational subgroup were found to have larger proportions of high levels on these domains. Remarkably, children with CI in the Special hearing impaired educational subgroup reported comparable self-concept scores as their hearing peers. Speech perception and language comprehension were positively correlated to Scholastic Competence.

CONCLUSION

This study has shown that self-concept levels of profoundly hearing impaired children with CI are comparable to those of hearing peers. They are generally satisfied with their functioning in various domains. Better speech perception and language comprehension levels are related to higher outcomes in the Scholastic Competence domain.

Clinical communication and the 'triangle of care' in mental health and deafness: Sign language interpreters' perspectives

Objective To explore the processes by which therapeutic alliance develops in mental health consultations with Sign Language interpreters. Method Semi-structured interviews with 7 qualified interpreters were transcribed and analysed with interpretative phenomenological analysis. Results Two key themes were generated: (1) Nurturing the triangle of care, where the therapeutic process relied on collaboration, continuity, and trust; and (2) Shared vision and knowledge, in which participants felt misunderstood and unsupported; there was a lack of deaf awareness and clinicians appeared to feel deskilled. Conclusions Interpreters should be viewed as valued members of clinical teams and have access to clinical supervision so that they can be supported in interpreting emotional distressing content. Clinicians can aim to be collaborative with interpreters and improve their knowledge of mental health issues that are relevant to deaf people. Practice Implications An aide-memoire of the role and practicalities of working with SL interpreters should be developed and disseminated to relevant services to support collaborative working with clinicians. A core competence in SL interpreter training is reflexivity. This should be embedded in educational curricula and facilitated through clinical supervision. Funding by commissioning services should be subject to services being deaf aware and interpreters being mental health aware.

Frequencies of Behavioral Problems Reported by Parents and Teachers of Hearing-Impaired Children With Cochlear Implants

Background: Internalizing and externalizing behavioral problems were frequently reported in profoundly hearing-impaired (HI) children with hearing aids. Due to the positive effect of cochlear implants (CIs) on hearing and language development, a positive effect on behavioral problems was expected. However, there is no consensus about the frequency of behavioral problems in CI children, and studies are often based on one informant with the risk of missing behavioral problems in other contexts. Aims: The first aim of this study was to investigate the frequency of behavioral problems in children with CIs as compared to a hearing normative sample. The second aim was to measure the agreement between the parents' and teachers' rates on the behavioral problem scales. And the third aim was to investigate the relation between speech perception, language skills and the frequencies of reported behavioral problems. Methods: Of 71 CI children, 51% were girls and 49% were boys, and the mean age was 8.6 (SD = 3.3). Behavior was reported by parents using the Child Behavior Checklist (CBCL) and by teachers using the Teacher Report Form (TRF). Frequencies of behavioral problems of CI children (6-16 years) were compared to a normative sample with the chi square test. Parent-teacher agreement was measured with the intraclass correlation coefficient (ICC 2,1). Next CI children were divided into four ability level categories regarding speech perception and language skills. Frequencies of behavioral problems were compared between the categories with the chi square test. Results: Parents and teachers of CI children reported similar frequencies of behavioral problems to the normative sample. Fair to low parent-teacher agreements were found on the behavioral problem scales. A significantly higher frequency of behavioral problems was reported in children with low speech perception and receptive vocabulary at school. Conclusion: Parents and teachers report similar frequencies of behavioral problems children with CIs compared to a hearing normative sample. Children with lower speech perception and language levels are more at risk of developing behavioral problems at school. Adequate speech perception and language levels are found to be protective factors for the development of behavior.

Personality Traits of Profoundly Hearing Impaired Adolescents with Cochlear Implants - A Comparison with Normal Hearing Peers

The aim of this study was to compare the personality traits of adolescents with cochlear implants (CIs) to a reference group (normal-hearing peers). In the past, the personality development of hearing impaired adolescents was severely compromised. Improved speech perception with CI significantly increased their perspectives. In addition, differences between the reference group and CI users were investigated on personality traits according to level of speech perception skills (high/low) and level of language comprehension (adequate/poor). A cohort of 59 adolescents was assessed 10 years after CI implantation. Personality traits were measured using the standardized Dutch Personality Questionnaire, which consists of 5 scales: Inadequacy, Social Inadequacy, Recalcitrance (RE), Perseverance, and Dominance. Speech perception and language comprehension were tested with standardized tests. The distributions of personality scores, in the clinical or non-clinical range, for the CI group were compared to the reference group using the Chi-Square test for Goodness of Fit. Adolescents with CI showed normal or favorable distributions on all personality scales except for the RE scale. There was a significant influence of speech perception and language comprehension on this scale. Consequently, adolescents with CI who demonstrated high speech perception and adequate language comprehension scores showed similar distribution patterns as the reference group on all personality scales. In conclusion; personality traits that reflect social relations, self-conscience, and school- and task orientation in adolescents with CI are similar to those in normal-hearing peers. This holds, despite variations in speech perception ability and language comprehension levels, for the CI group. On the RE scale, the adolescents with CI with low speech perception and poor language comprehension scores are more likely to score in the clinical deviant range and are at risk.

Language and reading comprehension in middle childhood predicts emotional and behaviour difficulties in adolescence for those with permanent childhood hearing loss

BACKGROUND

Permanent childhood hearing loss (PCHL) is associated with an elevated level of emotional and behaviour difficulties (EBD). In children and adolescents with PCHL, EBD has been found to be linked to language ability in children with PCHL. The present study was designed to test whether childhood language and/or reading comprehension abilities of children with PCHL predict subsequent EBD in adolescence.

METHODS

Language comprehension (LC) and reading comprehension (RC) were measured at ages 6-10 years (Time 1) and 13-20 years (Time 2) in participants with PCHL who preferred to communicate using spoken language (n = 57) and a hearing comparison group (n = 38). EBD was measured at both time points by parent and by teacher ratings on the Strengths and Difficulties Questionnaire.

RESULTS

Within the PCHL group there were negative correlations between EBD scores and concurrent LC and RC scores at Time 1 and at Time 2. Cross-lagged latent variable models fitted to the longitudinal data indicated that the associations between LC, RC and teacher-rated EBD were more likely to arise from the impact of LC and RC on behaviour rather than the other way around.

CONCLUSIONS

In those with PCHL, poor language and reading comprehension in middle childhood increased the risk of emotional and behaviour difficulties at school in the teenage years. The results suggest that effective language and literacy interventions for children with hearing loss may also bring benefits to their mental health.

Deaf people: What every clinician needs to know

Deafness is a common and varied medical, social and psychological construct that affects a significant proportion of the population. Restricted communication and uninformed attitudes have adverse effects on the physical and mental health of deaf people. Clinicians need to know how to recognise and resolve these difficulties.

Learning Objectives

• Be aware of the high prevalence and diverse nature of deafness

• Recognise the importance of effective communication and how to achieve this with deaf people

• Understand the potential impact of deafness on mental and physical health

Psychological well-being of parents and family caregivers of children with hearing impairment in south India: influence of behavioural problems in children and social support

Parents of children with hearing impairment are at increased risk of mental health morbidities. We examined the predictive factors associated with caregiver's strain and psychological morbidities in parents and family caregivers of children with hearing impairment. In total, n = 201 parents and family caregivers of children with and without hearing impairment aged 3 to 16 years were recruited. Caregiver's strain and psychological morbidities were measured using the Zarit Burden scale and the World Health Organization's Self-Reporting Questionnaire (SRQ-20). Presence of behavioural problems in children was measured using the Strengths and Difficulties Questionnaire. After adjustment, low educational attainment and domestic violence were found to be associated with caregiving strain, whereas dissatisfaction with social support from family, behavioural problems in children, and domestic violence strongly predicted psychological morbidities. Addressing the mental healthcare needs of parents may help in downsizing the impact of psychological morbidities on the well-being of children with hearing impairment.