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

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.

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 This prevalence may be outdated, given the advancements in hearing technology and rehabilitation efforts to enhance the psychosocial well-being of these children.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.

Development of visual sustained selective attention and response inhibition in deaf children

Studies of deaf and hard-of-hearing (henceforth, deaf) children tend to make comparisons with typically hearing children for the purpose of either identifying deficits to be remediated or understanding the impact of auditory deprivation on visual or domain general processing. Here, we eschew these clinical and theoretical aims, seeking instead to understand factors that explain variability in cognitive function within deaf children. A total of 108 bilingual deaf children ages 7-13 years who use both English and American Sign Language (ASL) participated in a longitudinal study of executive function (EF) development. We report longitudinal data from a visual continuous performance task that measured sustained selective attention and response inhibition. Results show that the impact of deafness on these processes is negligible, but that language skills have a positive relationship with both: better English abilities were associated with better selective sustained attention, and better ASL abilities with better response inhibition. The relationship between sustained selective attention and English abilities may reflect the cognitive demands of spoken language acquisition for deaf children, whereas better ASL abilities may promote an "inner voice," associated with improved response inhibition. The current study cannot conclusively demonstrate causality or directionality of effects. However, these data highlight the importance of studies that focus on atypical individuals, for whom the relationships between language and cognition may be different from those observed in typically developing populations.

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.

Effectiveness of unified protocols for online transdiagnostic treatment on social-emotional skills and parent-child interaction in school-aged children with cochlear implants

OBJECTIVES

Children with cochlear implants have limitations in emotional and cognitive social maturity which impact on their future emotional, social, and cognitive development. The main aim of this study was to evaluate the effect of a unified protocol for online transdiagnostic treatment program on social-emotional skills (self-regulation, social competence, responsibility, sympathy) and parent-child interaction (conflict, dependence, closeness) in children with cochlear implant.

MATERIALS AND METHODS

The present study was a quasi-experimental design with a pre-test-post-test and follow-up. Mothers of 18 children with cochlear implant aged from 8 to 11 years were randomly divided into experimental and control groups. 10 weeks of semi-weekly sessions for a total of 20 sessions around 90 min for children and 30 min for their parents were selected. Social-emotional assets, resilience scale (SEARS) and children parent relationship scale (CPRS) were selected to evaluate social-emotional skills and parent-child interaction respectively. We used Cronbach alpha, Chi-square test, independent sample t-test, and univariate ANOVA for statistical analyses.

RESULTS

Behavioral tests had relatively high internal reliability. Means scores in self-regulation was statistically different in pre-test and post-test conditions (p-value = 0.005) and pre-test and follow-up conditions (p-value = 0.024). Total means scores were showed a significant difference in pretest and post-test (p-value = 0.007) not in follow-up (p > 0.05). The interventional program could improve the parent-child relationship only in conflict and dependence (p < 0.05), and it was constant with time (p < 0.05).

CONCLUSION

Our study demonstrated an effect of online transdiagnostic treatment program on social-emotional skills of children with cochlear implants, especially in self-regulation and total score which were stable after three months in self-regulation. Moreover, this program could impact on the parent-child interaction only in conflict and dependence which was stable with time.

School adjustment of adolescents with sequential bilateral cochlear implants in mainstream school

OBJECTIVES

Little is known about the school adjustment of adolescents with sequential bilateral cochlear implants (CIs) in mainstream educational settings. This study aims to investigate the school adjustment of adolescents with sequential bilateral CIs, in comparison to those of age-matched adolescents with typical hearing (TH), to explore the relationships between individual variables and school adjustment in the bilateral CI group, and to assess the factors leading to strong school adjustment in the bilateral CI group.

METHODS

Twenty-five adolescents with sequential bilateral CIs and 30 adolescents with TH, aged 13-19 years, participated in this study. The adolescents completed the school adjustment scale (SAS).

RESULTS

The two groups were not significantly different on overall SAS scores. However, the TH group scored higher on the SAS than the sequential bilateral CI group with regard to communication skills and relationships with peers. In the bilateral CI group, SAS scores significantly correlated with open-set sentence and receptive vocabulary scores. Receptive vocabulary scores were a significant predictive factor for the level of school adjustment for the bilateral CI group.

CONCLUSION

Adolescents who received sequential bilateral CIs adapted well to mainstream schools. However, they did experience barriers to communication and to make friends in mainstream schools, and their level of school adjustment was affected by their receptive vocabulary skills.

Examination of Language, Behavioral, Academic, and Social Skills of Cochlear Implant Users in Early Primary Education

BACKGROUND

 Cochlear implants (CIs) improve spoken language skills as well as social and academic performance in children with severe and profound sensorineural hearing loss.

PURPOSE

 We compare the social skills, academic competence, and problem behaviors in children with CIs and their typical-hearing peers and investigate the relationship between language skills and social skills, academic competence, and problem behaviors in children with CIs.

RESEARCH DESIGN

 Thirty-two children with CIs were divided into two groups according to implantation age: early (n = 17) and late-implanted group (n = 15). The control group was formed by the inclusion of five same-sex classmates of each implanted child selected by the teachers of the children with CIs. Thus, 160 typical-hearing children were included in the control group.

STUDY SAMPLE

 Thirty-two children with CIs and 160 typical-hearing children participated in this study.

DATA COLLECTION AND ANALYSIS

 Primary school teachers rated the children's social skills, academic competence, and problem behaviors using the Social Skills Rating System (SSRS). The language skills of the children with CIs were assessed with the Turkish Expressive and Receptive Language Test (TIFALDI).

RESULTS

 A statistically significant difference was found between the SSRS scores of the study and control groups, which was mostly due to lower social skills, and academic competence, and higher problem behavior ratings in the late-implanted group. In the study group, there was a statistically significant correlation between TIFALDI and SSRS scores.

CONCLUSION

 Early cochlear implantation provides advantages in social skills and vocabulary for children with profound congenital hearing loss. Late-implanted children need special support in different developmental areas despite attending mainstream education.

Receptive Vocabulary of Children With Bilateral Cochlear Implants From 3 to 16 Years of Age

OBJECTIVES

The vocabulary of children with cochlear implants is often smaller than that of their peers with typical hearing, but there is uncertainty regarding the extent of the differences and potential risks and protective factors. Some studies indicate that their receptive vocabulary develops well at first, but that they fail to keep up with their typical hearing peers, causing many CI users to enter school with a receptive vocabulary that is not age-appropriate. To better understand the receptive vocabulary abilities of children with cochlear implants this study explored age-related differences to matched children with typical hearing and associations between vocabulary skills and child-level characteristics.

DESIGN

A retrospective cross-sectional study with matched controls was conducted at the Norwegian national cochlear implant center at Oslo University Hospital. Eighty-eight children (mean age 8.7 years; range 3.2 to 15.9; 43 girls, 45 boys) who had received bilateral cochlear implants before 3 years of age were compared with two groups of children with typical hearing. One group was matched for maternal education, sex, and chronological age, the other group was matched for maternal education, sex, and hearing age. Receptive vocabulary performance was measured with the British Picture Vocabulary Scale.

RESULTS

Cochlear implant users' receptive vocabulary was poorer than that of age-matched children with typical hearing ( M = 84.6 standard points, SD = 21.1; children with typical hearing: M = 102.1 standard points, SD = 15.8; mean difference -17.5 standard points, 95% CI [-23.0 to -12.0], p < 0.001; Hedges's g = -0.94, 95% CI [-1.24 to -0.62]), and children with cochlear implants were significantly more likely to perform below the normative range (risk ratio = 2.2, 95% CI [1.42 to 3.83]). However, there was a significant nonlinear U-shaped effect of age on the scores of cochlear implant users, with the difference to the matched typical hearing children being largest (23.9 standard points, on average) around 8.7 years of age and smaller toward the beginning and end of the age range. There was no significant difference compared with children with typical hearing when differences in auditory experience were accounted for. Variability was not significantly different between the groups. Further analysis with a random forest revealed that, in addition to chronological age and hearing age, simultaneous versus sequential implantation, communication mode at school, and social integration were predictors of cochlear implant users' receptive vocabulary.

CONCLUSIONS

On average, the receptive vocabulary of children with cochlear implants was smaller than that of their typical hearing peers. The magnitude of the difference was changing with age and was the largest for children in early primary school. The nonlinear effect of age might explain some of the ambiguity in previous research findings and could indicate that better intervention is required around school entry. The results emphasize that continuous monitoring and support are crucial to avoid far-reaching negative effects on the children's development and well-being.

Inattention, Impulsivity, and Hyperactivity in Deaf Children Are Not Due to Deficits in Inhibitory Control, but May Reflect an Adaptive Strategy

The present study had two main aims: (1) to determine whether deaf children show higher rates of key behaviors of ADHD (inattentive, hyperactive, and impulsive behaviors) and of Conduct Disorder—CD—(disruptive, aggressive, or antisocial behaviors) than hearing children, also examining whether the frequency of these behaviors in deaf children varied based on cochlear implant (CI) use, type of school (regular vs. specific for deaf) and level of receptive vocabulary; and (2) to determine whether any behavioral differences between deaf and hearing children could be explained by deficits in inhibitory control. We measured behaviors associated with ADHD and CD in 34 deaf and hearing children aged 9–10 years old, using the revised Spanish version of the Conners scale. We then assessed inhibitory control ability using a computerized Stroop task and a short version of the Attention Network Test for children. To obtain a measure of the level of receptive vocabulary of the deaf children we used a Spanish version of the Carolina Picture Vocabulary Test for Deaf and hearing-impaired children. Deaf children showed significantly higher rates of behaviors associated with ADHD and CD, and over 85% of cases detected with high risk of ADHD-inattentive type in the entire present sample were deaf children. Further, in the group of deaf children a negative correlation was found between receptive vocabulary and frequency of disruptive, aggressive, or antisocial behaviors associated with CD. However, inhibitory control scores did not differ between deaf and hearing children. Our results suggested that the ADHD-related behaviors seen in deaf children were not associated with a deficit in inhibitory control, at least in the interference suppression subcomponent. An alternative explanation could be that these behaviors are reflecting an adaptive strategy that permits deaf children to access information from their environment which is not available to them via audition.

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.

Psychomotor development of 4-year-old deaf children with cochlear implants: Three case studies

OBJECTIVES

Hearing is one of our most important senses, and hearing ability has an enormous impact on a child's psychomotor development. Children with auditory perception disorders may show abnormal development in terms of speech, language, and communication skills, as well as other disorders involving the cognitive sphere, social-emotional interactions, and motor development. This paper describes different paths of psychomotor development in three 4-year-old children. All were born with bilateral profound sensorineural hearing loss and were implanted early on with a cochlear implant. A longitudinal study of the children's psychomotor development was done for 3 years from the time of cochlear implantation.

METHODS

We present three children with congenital, profound bilateral sensorineural hearing loss. Psychomotor development was evaluated using the Children Development Scale (CDS) and the Psychomotor Development Evaluation Cards (PDEC). The three children were: Girl A (4 years 2 months 17 days) - a user of one CI, last assessment of psychomotor development (PDEC) was 37 months after CI activation; Boy B (4 years 3 months 21 days) - a user of two CIs, last assessment of psychomotor development (PDEC) was 39 months after activation of first CI; Boy C (4 years 1 month 5 days) - user of two CIs, last assessment of psychomotor development (PDEC) was 36 months after activation of the first CI.

RESULTS

Analysis of the results from Girl A showed very poor dynamics of development from the age of 12 months, when the first CDS evaluation was performed, up to the PDEC evaluation performed at age 4 years. The CDS score of Boy B showed a very high level of psychomotor development. The PDEC evaluation performed after 39 months of using the first CI showed that the psychomotor development of Boy B was consistent with his chronological age. Boy C presented an average level of psychomotor development (compared to typically developing children) in his CDS scores in the perioperative period and then at 4, 9, and 14 months after cochlear implantation. After 24 months, his CDS scores showed a high level of psychomotor development. After 3 years of CI use, the PDEC evaluation showed that Boy C had an average score in five tested areas, a high score in the area of fine motor skills and lateralization, and a low score in knowledge and learning competencies.

CONCLUSIONS

Children with bilateral profound hearing loss can present different paths of psychomotor development. Children who receive a CI may show an age-appropriate level of psychomotor development compared to typically developing children. However, a hearing, speech, and language rehabilitation specialist responsible for the child still needs to perform regular checkups to monitor all areas of psychomotor development. Also, the effects of the deaf child's environmental determinants on psychomotor development should be studied in detail. These determinants include the parents' emotional state, the parents' involvement in the child's rehabilitation, the family's quality of life, and the presence of deaf siblings. In particular, the difficulties encountered by the mother (or father) in being the parent of a deaf child may hinder the family from receiving adequate support.