Mental health problems in adolescents with cochlear implants: peer problems persist after controlling for additional handicaps

A systematic review on the impact of auditory functioning and language proficiency on psychosocial difficulties in children and adolescents with hearing loss

OBJECTIVE

Approximately 20% to 40% of children with hearing loss encounter psychosocial difficulties. This prevalence may be outdated, given the advancements in hearing technology and rehabilitation efforts to enhance the psychosocial well-being of these children. A systematic review of up-to-date literature can help to identify factors that may contribute to the children's psychosocial well-being.

DESIGN/STUDY SAMPLE

A systematic review was conducted. Original articles were identified through systematic searches in Embase, Medline, PsychINFO, and Web of Science Core Collection. The quality of the papers was assessed using the Newcastle-Ottawa Quality Assessment Scale and custom Reviewers' Criteria.

RESULTS

A search was performed on 20 October 2022. A total of 1561 articles were identified, and 36 were included for review. Critical appraisal led to 24 good to fair quality articles, and 12 poor quality articles.

CONCLUSION

Children with hearing loss have a twofold risk of experiencing psychosocial difficulties compared to normal hearing peers. Estimates for functioning in social interactions, like speech perception (in noise) or language proficiency, have proven to be more adequate predictors for psychosocial difficulties than the degree of hearing loss. Our findings can be useful for identifying children at risk for difficulties and offering them earlier and more elaborate psychological interventions.

Hearing and sociality: the implications of hearing loss on social life

Hearing is essential to the formation of social relationships and is the principal afferent of social life. Yet hearing loss, which is one of the most prevalent forms of sensory disability worldwide and is critical for social development, has received little attention from the social interventionalist perspective. The purpose of this mini-review is to describe the basic neurobiological principles of hearing and to explore the reciprocal relationships between social support, hearing loss, and its psychosocial comorbidities. We also discuss the role of social enrichment in sensorineural recovery and identify open questions within the fields of hearing physiology and social networks.

First results of the Strengths and Difficulties Questionnaire, applied as a screening tool for psychosocial difficulties in pediatric audiology

PURPOSE

Despite major improvements in rehabilitation possibilities, children with sensorineural hearing loss are at risk for psychosocial difficulties. These difficulties can impact their educational and career achievements and may be two to three times more common in children with hearing loss compared to those with normal hearing. Early identification of psychosocial difficulties can be facilitated using the Strengths and Difficulties Questionnaire (SDQ) and may improve outcomes and quality of life. We implemented the SDQ into the clinical follow-up of children with hearing loss in a tertiary referral hospital. With this, prevalence and severity of difficulties in specific psychosocial domains and several predictors were investigated.

METHODS

A retrospective, cross-sectional investigation was performed of the following factors in association with the SDQ results: type of hearing device, type and degree of hearing loss, speech perception in quiet and in noise, and type of schooling.

RESULTS

Between June 2020 and January 2022, parents of 312 children (age 4-18) completed the SDQ. An additional 113 child-reports were completed. The response rate of the parents was 69%. Problems with peer relationships and prosocial behavior were the most affected areas with clinically elevated scores in 22% of the children. Psychosocial difficulties were distributed similarly across types of hearing device, nature and degrees of hearing loss, and educational settings. Better speech perception in quiet was significantly associated with fewer parent-reported conduct problems.

CONCLUSION

The results of the present study suggest that children with hearing loss may be at risk of experiencing challenges with social interactions and attachment in social contexts. Using the SDQ in clinical follow-up may improve the chances for early psychological assessment and intervention. In addition, the study found that children's mental health may be impacted by their communication abilities.

Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants–not just cochlear implant-specific benefits–Perspective

Cochlear implants (CIs) are electronic medical devices that enable hearing in cases where traditional hearing aids are of minimal or no use. Quality of life (QoL) studies of children and adolescents with a CI have so far focused on the CI-specific benefits. However, the CI-specific risks listed by the U.S. Food and Drug Administration have not yet been considered. From this list, medical and device-related complications, lifelong dependency on the implanted device, and neurosecurity risks (CI technology is an interface technology) may be particularly relevant for young CI users. Medical and device-related complications can cause physical discomfort (e.g., fever, pain), as well as functioning problems (e.g., in speech discrimination, social behavior, and mood). In the worst case, reimplantation is required. Clinical experience shows that these complications are perceived as a burden for young CI users. Furthermore, many young patients are worried about possible complications. Additionally, CIs can be at least a temporary burden when children, typically at the age of 8–9 years, realize that they need the CI for life, or when they become peer victims because of their CI. Concerning neurosecurity risks, it is still unknown how young CI recipients perceive them. In summary, CI-specific risks can be perceived as a burden by young CI users that impairs their QoL. Therefore, they should not be ignored. There is an urgent need for studies on this topic, which would not only be important for professionals and parents, but also for the design of CI-specific QoL instruments.

Parent-reported quality of life in children with cochlear implants differs across countries

Pediatric cochlear implantation affects communication skills and quality of life, specifically how children interact with others and feel about themselves. Numerous studies worldwide examine well-being among pediatric cochlear implant users, but none to date compare condition-specific quality of life across countries. This retrospective study compares parent-reported cochlear implant-specific quality of life summary data across 14 published studies spanning 11 countries and 9 languages. Sample size ranged from 7 to 370 participants, and children across studies varied in mean chronologic age (3.1–12.2 years), implantation age (1.5–4.6 years), and cochlear implant experience (1.3–8.2 years). Parents completed the Children with Cochlear Implants: Parental Perspectives (CCIPP) questionnaire, an instrument assessing parent-reported cochlear implant-specific quality of life, in their home language. Analysis of variance tests were run for each CCIPP subscale across studies using summary data to determine significant differences between published manuscripts. Across countries, parents of children with cochlear implants appraise communication, social relations, and self-reliance most positively, and the effects of implantation and supporting the child least positively. Cross-country analyses revealed a significant effect of study (country) on quality of life ratings in each domain, with the largest differences in the communication domain. Limited access to implant-related accommodations, cultural awareness of hearing loss, and varying parent expectations may explain country differences in parental ratings of quality of life. Culturally sensitive psychoeducation for the entire family may foster improved life satisfaction for pediatric cochlear implant users and their families.

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.

Wellbeing as Capability: Findings in Hearing-Impaired Adolescents and Young Adults With a Hearing Aid or Cochlear Implant

In the Western world, for deaf and hard-of-hearing children, hearing aids or cochlear implants are available to provide access to sound, with the overall goal of increasing their wellbeing. If and how this goal is achieved becomes increasingly multifarious when these children reach adolescence and young adulthood and start to participate in society in other ways. An approach to wellbeing that includes personal differences and the relative advantages and disadvantages that people have, is the capability approach, as developed by Nobel Prize laureate Amartya Sen. Capability is the set of real opportunities people have to do and be things they have reason to value. We interviewed 59 young people, aged 13 through 25, with cochlear implants (37) or hearing aids (22) to capture their capability. We found that their hearing devices enabled them to actively participate in a predominantly hearing society, with few differences between cochlear implant and hearing aid recipients. They did, however, report challenges associated with prejudices and expectations, and with feeling poorly understood, all of which appeared to impact their capability. Through the lens of capability, alleged differences between hearing aid and cochlear implant recipients began to fade. We discuss the implications for initiatives focused on the long-term support young recipients of hearing devices to meet their specific requirements over time.

Cochlear Inflammaging in Relation to Ion Channels and Mitochondrial Functions

The slow accumulation of inflammatory biomarker levels in the body-also known as inflammaging-has been linked to a myriad of age-related diseases. Some of these include neurodegenerative conditions such as Parkinson's disease, obesity, type II diabetes, cardiovascular disease, and many others. Though a direct correlation has not been established, research connecting age-related hearing loss (ARHL)-the number one communication disorder and one of the most prevalent neurodegenerative diseases of our aged population-and inflammaging has gained interest. Research, thus far, has found that inflammatory markers, such as IL-6 and white blood cells, are associated with ARHL in humans and animals. Moreover, studies investigating ion channels and mitochondrial involvement have shown promising relationships between their functions and inflammaging in the cochlea. In this review, we summarize key findings in inflammaging within the auditory system, the involvement of ion channels and mitochondrial functions, and lastly discuss potential treatment options focusing on controlling inflammation as we age.

Youth with hearing loss: Emotional and behavioral problems and quality of life

OBJECTIVES

To compare parent- and self-reported emotional and behavioral problems and quality of life (QoL) among youth with hearing loss (HL) to norms, and to investigate possible associations between emotional and behavioral problems and QoL among youth with HL.

METHODS

We used the Strengths and Difficulties questionnaire (SDQ) and the Inventory of Life Quality in Children and Adolescents (ILC) to measure emotional and behavioral problems and QoL in youth with HL (n = 317, ages 6-18), where 78% had bilateral HL, 22% unilateral HL, 16% had cochlear implants, and 59% conventional hearing aids.

RESULTS

The youth with HL had significantly more parent-reported (but not self-reported) emotional and behavioral problems and poorer parent- and self-reported QoL than hearing youth. SDQ and ILC total scores were significantly correlated (-0.47 to -0.63). Conclusion Emotional and behavioral problems and poor QoL appear closely related in youth with HL, suggesting that attending to these problems may improve QoL.

Social Capital, Loneliness, and Peer Relationships of Adolescents who are Deaf or Hard of Hearing

There are many documented benefits of social capital to adolescents in general, and for young people who are deaf or hard of hearing social capital can potentially have a buffering effect against adverse life outcomes. Using the Loneliness and Social Dissatisfaction Questionnaire ( Asher et al., 1984; Cassidy & Asher, 1992) and the Looman Social Capital Scale ( Looman, 2006), this research investigated changes in levels of social capital and loneliness and peer relationships of deaf or hard of hearing adolescents before attending a residential camp and then three, six- and 12-months post-camp. The camp was specifically for DHH adolescents whose primary communication mode was spoken language. The study also investigated associations between social capital and adolescents' perceptions of loneliness and peer relationships. Results indicated no statistically significant change in social capital and loneliness and peer relations over the four-time points. There was a significant association between one social capital scale, common good, and loneliness. Implications of these findings are discussed, and recommendations are made for enhancing social capital development within a residential camp experience.

Pragmatics and Peer Relationships Among Deaf, Hard of Hearing, and Hearing Adolescents

OBJECTIVES

The goals of the current study were to (1) examine differences in pragmatic abilities and peer relationship behaviors among deaf and hard of hearing (DHH) adolescents who use spoken language, in comparison with their hearing peers; and (2) explore the contribution of pragmatic skills and speech (ie, articulation and intelligibility [AI]) to social aspects of school functioning among DHH and typically hearing adolescents.

METHODS

Thirty-three DHH adolescents and 34 adolescents with typical hearing participated. All DHH adolescents attended mainstream school settings and used spoken language. Teacher reports were obtained on prosocial behaviors, peer problems, pragmatic abilities, and speech AI of the adolescents. Adolescents self-reported on the supportiveness of their peer relationships and their school emotional engagement.

RESULTS

Multiple hierarchical regression analyses revealed that DHH adolescents had greater difficulties with peers than their hearing counterparts. Increased pragmatic difficulties were related to more peer problems and decreased prosocial behaviors, regardless of adolescents' hearing status. A significant positive correlation was found between pragmatic competence and adolescents' perceptions of peers' support. Finally, better speech AI were associated with higher levels of school emotional engagement.

CONCLUSIONS

The results emphasize the significant role of pragmatics for both DHH and typically hearing adolescents. Medical care providers and allied health professionals should be aware of possible difficulties that DHH adolescents may have in complex and nuanced pragmatic skills. Some adolescents may require a referral to specialized services to support the development of their pragmatic understanding and their skills.

Emotional and behavioral problems in children and adolescents with hearing loss and their effects on quality of life

PURPOSE

Determination of mental functions in children with hearing loss is important in improving the quality of life of the child. Many scales have been developed for this purpose. In this study, it was aimed to determine the emotional and behavioral effects of both the child with hearing loss and the parent in the hearing loss and device process, and to investigate the effect of this situation on the quality of life.

METHODS

Forty-five children aged 7-17 years with sensorineural hearing loss with audiometric methods and 32 healthy controls without hearing problem were included in the study. All children received a Powers-Weakness Questionnaire-Self-Reporting Scale, Strengths and Difficulties Questionnaire, Child Anxiety and Depression Scale, and Kid-KINDL Quality of Life Scale. In all parents, the Parental Statement of Powers-Weaknesses Questionnaire and the Kid-KINDL Quality of Life Scale parental form questionnaires were applied.

RESULTS

In the patient group, both mother (p = 0.001) and father (p = 0.027) education levels were significantly lower than the control group. The success rate of the sick children was lower than that of healthy children (p = 0.013). According to the surveys, the quality of life scale and all subscales were significantly lower in the patient group than in the control group (p < 0.05 for each). Child depression inventory score was also significantly higher in the patient group (p = 0.005).

CONCLUSIONS

Data obtained in the study indicate that children with hearing disabilities should be closely monitored and undergo a better rehabilitation process in terms of both anxiety and depression and their quality of life. According to our findings, since the parents of hearing-impaired children are observed to have a low level of education, it is seen that these families should be educated more closely in approaching children and improving their quality of life.

The influence of cochlear implantation on aggression behaviors in children

OBJECTIVE

It has been suggested that children with higher degree of hearing loss may show more severe externalizing (e.g., aggression) and internalizing (e.g., depression and anxiety) behavioral problems compared to that of their normally hearing peers. The purpose of this study was to investigate the influence of sound amplification through cochlear implants (CIs) on aggressive behaviors in Persian children.

METHODS

During a prospective study design, 72 children (40 girls, 32 boys) who underwent unilateral implantation and 72 (40 girls, 32 boys) age-matched normally hearing children (control group) participated. All CI children had age of <4 years at the time of implantation. The Aggression Scale for Preschoolers (ASFP) was utilized to measure various types of aggression including verbal aggression, physical aggression, relational aggression, and impulsive anger. The speech performance of children was also evaluated using Speech Intelligibility Rating (SIR). The ASFP and SIR measurements were conducted at the pre-implantation phase and at 6, 12, and 18 months post-implantation period.

RESULTS

A repeated measures analysis of variance showed significant reduction in ASFP scores from "pre-operation" to "post-operative" conditions in CI group. However, aggression level in CI recipients were significantly higher than children in control group. In the analyses of ASFP subscales, we found a reduction and a consequent improvement in verbal aggression, physical aggression and impulsive anger. However, no significant difference was found in relational aggression across various time intervals. Furthermore, children who received CI before 2 years old exhibited better aggression level than children who received their devices at later ages. The significantly negative correlation (r = -0.76, p < 0.001) was found between the SIR and ASFP scores, so that lower speech intelligibity ability scores were associated with more aggressive behavior problems.

CONCLUSION

This study suggests that young children with noticeable degree of hearing loss may experience higher level of aggression compared to normally hearing peers. However, when they undergo early implantation and attend at regular post-operative rehabilitation programs, their aggression status will improve seriously.

Restricted Speech Recognition in Noise and Quality of Life of Hearing-Impaired Children and Adolescents With Cochlear Implants - Need for Studies Addressing This Topic With Valid Pediatric Quality of Life Instruments

Cochlear implants (CI) support the development of oral language in hearing-impaired children. However, even with CI, speech recognition in noise (SRiN) is limited. This raised the question, whether these restrictions are related to the quality of life (QoL) of children and adolescents with CI and how SRiN and QoL are related to each other. As a result of a systematic literature research only three studies were found, indicating positive moderating effects between SRiN and QoL of young CI users. Thirty studies addressed the quality of life of children and adolescents with CI. Following the criteria of the World Health Organization (WHO) for pediatric health related quality of life HRQoL (1994) only a minority used validated child centered and age appropriate QoL instruments. Moreover, despite the consensus that usually children and adolescents are the most prominent informants of their own QoL (parent-reports complement the information of the children) only a minority of investigators used self-reports. Restricted SRiN may be a burden for the QoL of children and adolescents with CI. Up to now the CI community does not seem to have focused on a possible impairment of QoL in young CI users. Further studies addressing this topic are urgently needed, which is also relevant for parents, clinicians, therapists, teachers, and policy makers. Additionally investigators should use valid pediatric QoL instruments. Most of the young CI users are able to inform about their quality of life themselves.

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.

Using recurrent neural networks to improve the perception of speech in non-stationary noise by people with cochlear implants

Speech-in-noise perception is a major problem for users of cochlear implants (CIs), especially with non-stationary background noise. Noise-reduction algorithms have produced benefits but relied on a priori information about the target speaker and/or background noise. A recurrent neural network (RNN) algorithm was developed for enhancing speech in non-stationary noise and its benefits were evaluated for speech perception, using both objective measures and experiments with CI simulations and CI users. The RNN was trained using speech from many talkers mixed with multi-talker or traffic noise recordings. Its performance was evaluated using speech from an unseen talker mixed with different noise recordings of the same class, either babble or traffic noise. Objective measures indicated benefits of using a recurrent over a feed-forward architecture, and predicted better speech intelligibility with than without the processing. The experimental results showed significantly improved intelligibility of speech in babble noise but not in traffic noise. CI subjects rated the processed stimuli as significantly better in terms of speech distortions, noise intrusiveness, and overall quality than unprocessed stimuli for both babble and traffic noise. These results extend previous findings for CI users to mostly unseen acoustic conditions with non-stationary noise.

Effect of auditory status on visual emotion recognition in adolescents

Adolescents with severe to profound hearing loss who wear cochlear implants (CIs) experience significantly more peer problems compared to peers with typical hearing (TH). Differences in peer social dynamics may relate to perception not only of message content, but also message intent based on a speaker's emotion from visual (e.g. facial expressions) and auditory (e.g. prosody) cues. Pediatric CI users may experience greater difficulty with auditory emotion recognition due to an impoverished signal representation provided by the device, but the effect of auditory status on visual emotion recognition yields conflicting results.

OBJECTIVES

The current study examined accuracy and speed of visual emotion recognition in adolescents with CIs and peers with TH.

METHODS

Participants included 58 adolescents (10-18 years) stratified by auditory status: 34 CI users and 24 TH peers. Participants identified the intended emotion (i.e. happiness, sadness, anger, fear, disgust, and surprise) of static images of faces displayed on a computer screen.

RESULTS

No significant differences by auditory status emerged for response accuracy, response time to all trials, or response time to correct trials. Type of emotion significantly affected both accuracy and response time.

CONCLUSION

Adolescents with CIs show similar accuracy and response time in recognizing static facial expressions compared to TH peers. Future studies should explore the association between visual emotion recognition and social well-being to determine the relationship between emotion recognition and overall quality of life in adolescents with CIs.

Child labor and mental health status of in-school adolescents in a municipal local government area of Lagos state, Nigeria

BACKGROUND

Child labor (CL) is on the increase in developing countries with its adverse consequences. Many studies have related CL to physical and social well-being and not mental health (MH). This study was designed to assess the experience of CL and mental health status (MHS) among in-school adolescents and determine the association between them, if any, in a metropolitan area of Lagos state, Nigeria.

METHODS

A descriptive cross-sectional study was conducted in eight private and four public secondary schools using a two-stage cluster sampling method. A semi-structured, self-administered questionnaire was used to obtain information on CL and MH. Experience of CL was assessed through a "yes" or "no" response to whether respondents had ever worked or were currently working in exchange for money or not. MHS was measured with the Strength and Difficulty Questionnaire (SDQ). The SDQ is a 25-item instrument with two subdivisions: strength (prosocial) and difficulty scales. Difficulty scale is categorized into emotional, conduct, hyperactivity and peer problems. Each category of the subdivision was scored as normal (low need), borderline (some need) and abnormal (high need). The scores were modified into "positive" (low need) and "negative" (some need and high need). Total difficulty was scored "positive" (0-15) and "negative" (16-40) and prosocial behavior was scored "positive" (6-10) and "negative" (0-5). Data were analyzed with descriptive statistics, Chi-squared test and logistic regression at α < 0.05.

RESULTS

The mean age of respondents was 14.1 ± 1.9 years with 61.4% aged 14 years and above and 59.2% were female. About a quarter (23.8%) experienced CL with apprenticeship being the most common form (55%) followed by street trading (10%). About 20% of the respondents had negative MHS on the overall difficulty scale and 8.0% on the prosocial scale. Based on the ratings of the difficulty scale, 39.1% of them had problems with peers, 19.3% had emotional problems, 17.2% had conduct problems and 7.6% were hyperactive. Sex, mothers' and fathers' levels of education, and school absenteeism were predictors of CL experience. Respondents who lived with both parents had lower odds of having negative MHS [adjusted odds ratio (AOR) = 0.39; 95% confidence interval (CI) = 0.187-0.815].

CONCLUSION

The study revealed that among in-school adolescents in the study area, a considerable percentage of children were involved in CL and had poor MHS especially peer and conduct problems. Concerted efforts at reducing the menace of CL and interventions to promote the MH of in-school adolescents are hereby advocated.

Self-esteem in the deaf who have become cochlear implant users as adults

Objective

Self-esteem is a good predictor of mental health and is crucial for well-being and psychological functioning. It is especially important in situations where there are potential mental health problems, such as in people suffering from hearing loss or total deafness. This study aims to gauge the level of self-esteem in adults with hearing problems, in particular those who, in adulthood, had received a cochlear implant (CI). The subjects had different onset (pre-lingual/post-lingual) and amount (deafness/partial deafness) of hearing loss, and their current level of self-esteem was compared to that of the general population. The association of self-esteem with other deafness-related variables (e.g. satisfaction with their CI or whether they also used a hearing aid) and sociodemographic factors was also investigated.

Methods

Data were obtained from questionnaires mailed to patients who, when adult, had received a CI. The subjects were divided into four subgroups: subjects with pre-lingual deafness, post-lingual deafness, pre-lingual partial deafness, and post-lingual partial deafness. To evaluate their self-esteem, the Rosenberg Self-Esteem Scale (RSES) was used. For data on sociodemographic status and information related to deafness and CI, we used our own Information Inquiry form. For statistical analysis of the results, we compared means (t-test, ANOVA), investigated correlations, and applied linear regression.

Results

The self-esteem of deaf and partially deaf CI users was significantly lower than in the general population, especially for post-lingually deafened subjects. The only factor related to deafness and CIs that explained self-esteem was self-rated satisfaction with the CI–meaning that higher satisfaction was associated with higher self-esteem. The major sociodemographic factor that explained self-esteem was marital/partnership status (being in a relationship was helpful). Also men had higher self-esteem than women. Those with higher levels of education, and those working or studying, had higher self-esteem than those who did not. RSES was found to have a single-factor structure.

Conclusion

Deafness and partial deafness appear to be risk factors for lower self-esteem, a finding that rehabilitation, medical, educational, and employment communities should be made aware of. Medical intervention in the form of a CI supplies the person with improved hearing, but it is not a panacea: their self-esteem is still vulnerable, and reinforcement of self-esteem is an aspect that professionals should focus on. Psychological, psycho-educational, and psychotherapeutic interventions have important roles to play for CI recipients.

Parents' Perception of Health-Related Quality of Life in Children With Cochlear Implants: The Impact of Language Skills and Hearing

PURPOSE

The study compared how parents of children with cochlear implants (CIs) and parents of children with normal hearing perceive their children's health-related quality of life (HR-QOL).

METHOD

The sample consisted of 186 Norwegian-speaking children in the age span of 5;0-12;11 (years;months): 106 children with CIs (53% boys, 47% girls) and 80 children with normal hearing (44% boys, 56% girls). No children had known additional disabilities affecting language, cognitive development, or HR-QOL. Parents completed the generic questionnaire Pediatric Quality of Life Inventory (Varni, Seid, & Kurtin, 2001), whereas children completed a test battery measuring different aspects of language and hearing.

RESULTS

Parents of children with CIs reported statistically significantly poorer HR-QOL in their children, on Pediatric Quality of Life Inventory total score and the subdomains social functioning and school functioning. Roughly 50% of parents of children with CIs reported HR-QOL levels (total score) within normal limits. No significant differences between groups emerged on the physical health and emotional functioning subscales. For the children in the group with CIs, better speech perception in everyday situations was associated with higher proxy-ratings of HR-QOL. Better spoken language skills were weakly to moderately associated with higher HR-QOL.

CONCLUSIONS

The findings suggest that the social and school situation is not yet resolved satisfactorily for children with CIs. Habilitation focusing on spoken language skills and better sound environment may improve social interactions with peers and overall school functioning.

Psychosocial development of 5-year-old children with hearing loss: Risks and protective factors

OBJECTIVE

The aims of this paper were to report on the global psychosocial functioning of 5-year-old DHH children and examine the risk and protective factors that predict outcomes.

DESIGN

A cross-sectional analysis of data collected from a prospective, population-based longitudinal study.

STUDY SAMPLE

Parents/caregivers of 356 children completed questionnaires on psychosocial development (CDI, SDQ), functional communication (PEACH) and demographic information. Children completed standardized assessments of non-verbal cognitive ability (WNV) and language (PLS-4).

RESULTS

On average, global psychosocial functioning was within the range of typically developing children; however, variability was high and 12% of children had scores that were more than 2 SDs below the norm. Non-verbal cognitive ability, presence of additional disabilities, language and functional communication significantly predicted outcomes. In contrast, type of hearing device, severity of hearing loss and age at intervention did not.

CONCLUSION

The global psychosocial functioning of this cohort of 5-year-old DHH children fell within the range of typically developing children. The findings suggest that spoken language ability and functional communication skills are vital for healthy psychosocial development.

Psychosocial Development in 5-Year-Old Children With Hearing Loss Using Hearing Aids or Cochlear Implants

This article reports on the psychosocial development and factors influencing outcomes of 5-year-old children with cochlear implants (CIs) or hearing aids (HAs). It further examines differences between children with CIs and HAs with similar levels of hearing loss. Data were collected as part of the Longitudinal Outcomes of Children with Hearing Impairment study-a prospective, population-based study. Parents/caregivers of children completed the Strengths and Difficulties Questionnaire ( n = 333), the Social Skills subscale from the Child Development Inventory ( n = 317), and questionnaires on functional auditory behavior (Parents' Evaluation of Aural/oral performance of Children), and demographics. Children completed assessments of nonverbal cognitive ability (Wechsler Non-verbal Scale of Ability) and language (Preschool Language Scale - fourth edition). On average, parent-rated Strengths and Difficulties Questionnaire scores on emotional or behavioral difficulties were within 1 SD of the normative mean; however, Child Development Inventory scores on social skills were more than 1 SD below the norm. Children with severe-to-profound hearing losses using HAs had significantly more behavioral problems than children with CIs. Regression analyses showed that non-verbal cognitive ability, language, and functional auditory behavior were significantly associated with psychosocial outcomes for children with HAs, whereas outcomes for children with CIs were associated with functional auditory behavior and the presence of additional disabilities. Age at hearing intervention, severity of hearing loss, and communication mode were not associated with outcomes. The results suggest that even children who develop good language ability with the help of a HA or CI may have psychosocial problems if they exhibit difficulties with listening and communicating in everyday environments. The findings have implications for developing interventions for young children with hearing loss.

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.

Emotional and behaviour difficulties in teenagers with permanent childhood hearing loss

OBJECTIVES

It is known that during the middle childhood years those with permanent childhood hearing loss (PCHL) are at increased risk of showing emotional and behaviour difficulties (EBD). It has yet to be established whether this risk continues into the late teenage years. There is a paucity of longitudinal studies on the association between PCHL and EBD.

METHODS

The Strengths and Difficulties Questionnaire (SDQ) was used to measure EBD based on parent, teacher and self-ratings in 76 teenagers with PCHL and 38 in a hearing comparison group (HCG) from a population sample of children that was followed up from birth to adolescence.

RESULTS

On parent-rated SDQ, the PCHL group had significantly higher Total Difficulties score than the HCG (Standardised mean difference (SMD) = +0.39, 95%CI 0.00 to 0.79). Amongst the PCHL group the presence of disabilities other than hearing loss had a substantial impact on the level of parent-rated EBD (SMD = +1.68, 1.04 to 2.33). There was a relationship between receptive language ability and EBD in both the HCG (r = -0.33, 95%CI -0.59 to -0.01) and the PCHI group (r = -0.33, 95%CI -0.53 to -0.02). The effect of PCHL on EBD became non-significant when receptive language was included as a covariate (F = 0.12, df = 1,95, p = 0.729). Early confirmation of hearing loss (i.e. before 9 months of age) did not have a significant effect on EBD scores (SMD = +0.31, 95%CI -0.15 to 0.77).

CONCLUSIONS

PCHL continues to be associated with elevated EBD scores as measured by parent rated SDQ into the late teenage years but the degree of this elevation is less than in childhood and is not apparent on teacher or self-ratings. Poor receptive language ability appeared to account for these elevated EBD scores in the group with PCHL. Particular attention needs to be paid to the mental health of children and adolescents with PCHL that is accompanied by other disabilities and to those with poor receptive language ability. However, the majority of teenagers with PCHL do not show clinically significant elevated levels of EBD.

Severe hearing impairment and risk of depression: A national cohort study

Objective

Hearing impairment is suggested to be associated with depression in the elderly. The present study evaluated the risk of depression after hearing impairment in all age groups matched by age, sex, income, and region of residence.

Methods

The Korean Health Insurance Review and Assessment Service—National Patient Samples were collected for a period from 2002 to 2013. Hearing impairment was defined as a hearing threshold ≥ 60 dB in both ears or as ≥ 80 dB in one ear and ≥ 40 dB in one ear. Hearing-impaired participants performed a pure tone audiometry test 3 times and an auditory brainstem response threshold test once. The 6,136 hearing-impaired participants were matched 1:4 with 24,544 controls with no reported hearing impairment for age, sex, income, and region of residence. Depression was investigated based on the International Classification of Disease-10 codes F31 (bipolar affective disorder) through F39 (unspecified mood disorder) by a psychiatrist from 2002 through 2013. The crude (simple) and adjusted (age, sex, income, region of residence, dementia, hypertension, diabetes, and dyslipidemia) hazard ratio (HR) of hearing impairment on depression were analyzed using Cox-proportional hazard model.

Results

The rate of depression was significantly higher in the severe hearing-impaired group than in the control group (7.9% vs. 5.7%, P < 0.001). Severe hearing impairment increased the risk of depression (adjusted HR = 1.37, 95% confidence interval [CI] = 1.24–1.52, P < 0.001). In a subgroup analysis, young (0–29 years old), middle-aged (30–59 years old), and old (≥ 60 years old) severe hearing-impaired groups showed significantly increased risk of depression compared to controls with no reported hearing impairment. In accordance with income level, severe hearing impairment elevated depression in the low and high income groups, but not in the middle income group.

Conclusion

Severe hearing impairment increased the risk of depression independently of age, sex, region, past medical histories, and income (in low and high income persons but not in middle income persons).

Schooling Relates to Mental Health Problems in Adolescents with Cochlear Implants-Mediation by Hearing and Family Variables

Aim of this multicenter study was to investigate whether schooling relates to mental health problems of adolescents with cochlear implants (CI) and how this relationship is mediated by hearing and family variables. One hundred and forty secondary school students with CI (mean age = 14.7 years, SD = 1.5), their hearing parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ). Additional audiological tests (speech comprehension tests in quiet and noise) were performed. Students of special schools for hearing impaired persons (SSHIs) showed significantly more conduct problems (p < 0.05) and a significantly higher total difficulty score (TDS) (p < 0.05) compared to students of mainstream schools. Mental health problems did not differ between SSHI students with sign language education and SSHI students with oral education. Late implanted students and those with indication for additional handicaps were equally distributed among mainstream schools and SSHIs. However, students in SSHIs were more restricted to understand speech in noise, had a lower social background and were more likely to come from single-parent families. These factors were found to be partial mediators of the differences in mental health problems between the two school types. However, no variable could explain comprehensively, why students of SSHIs have more mental health problems than mainstream pupils.