Localization of Visual Targets Inside and Outside the Field of View: the Effect of Hearing Loss

In two experiments the eye and head localization responses of auditorially handicapped children to visual targets in a surrounding circular display were compared with the corresponding responses of age-matched controls (Experiment 1, mean age: 131 months, hearing loss of auditorially handicapped children greater than 90 dB; Experiment 2, two age groups with mean ages: 72 and 123 months, hearing loss of auditorially handicapped greater than 50 dB). It was hypothesized that an auditory deprivation results in a deficient spatial orientation to the regions outside the visual field. This in turn should affect the actual localization behaviour to visual targets situated within those regions. Differences between the auditorially handicapped and non-handicapped children were found with respect to the localization times of so-called 'reversal' responses of eye (Experiment 1) and head (Experiment 2) to targets situated outside the field of view. In the second experiment significant age-effects were present. The implications of these findings for the presence of specific differences in cognitive spatial abilities between auditorially handicapped and hearing children are discussed.     

Visual attention in deaf and hearing infants: the role of auditory cues

BACKGROUND: Successful communication with profoundly deaf children is heavily dependent on visual attention. Previous research has shown that mothers of deaf children--notably those who are deaf themselves--use a variety of strategies to gain their children's attention. This study compares patterns of visual attention in deaf and hearing children to determine how they are affected by the absence of auditory cues, especially when looking to the mother's face. METHOD: The visual attention of 18-month-old infants to their mothers was examined in two groups of deaf children (6 with deaf mothers and 6 with hearing mothers) and two of hearing children (6 with deaf mothers and 8 with hearing mothers). Dyads were observed in free play and 10 minutes of videorecorded interaction was analysed. All looks to the mother were classified as Spontaneous, Responsive (Child turns in response to something done by mother) or Elicited (Mother actively seeks to gain child's attention by, e.g., tapping or waving). The kind of event that attracted the child's attention in Responsive and Elicited episodes was also determined (e.g., object movement, speech, physical contact), as was the focus of the child's attention (e.g., mother's face, mother's body). RESULTS: Responsive looks to the mother were the most frequent for all groups but on only about 25% of occasions were they directed to her face. Elicited and spontaneous looks occurred less often but were frequently directed to the mother's face. Spontaneous looking occurred in all groups but elicited looking very seldom occurred in Hearing-Hearing dyads. Overall, there were fewer looks to the mother in the two groups where mother and child had congruent hearing status, although the proportion of the looks to the mother's face was similar. CONCLUSIONS: Both spontaneous and elicited looks are likely to involve attention to the mother's face. However, while active elicitation of attention is an important part of successful communication with young deaf children, this does not appear necessary for typically developing hearing children who turn to look at their mother's face on hearing her voice. The implications of these findings for differences in the dynamics of communication with young deaf and hearing children are discussed.     

Status of cochlear implantation in children. American Academy of Otolaryngology-Head and Neck Surgery Subcommittee on Cochlear implants

The cochlear implant is a medical device, part of which is placed surgically, that uses electrical stimulation to provide hearing. For almost a decade, investigational studies have been ongoing to define its safety and efficacy in profoundly deaf children. During this period, more than 500 children aged 2 through 17 years have been implanted with either a single-electrode or multielectrode device. Extensive auditory, speech, educational, and psychologic testing has been performed before and after implantation. Results show that the cochlear implant provides auditory detection over much of the speech signal. Compared with the preimplant period, there is significant improvement in auditory discrimination and speech production skills. Limited open-set word and sentence recognition is possible for at least some children. Complications with the device have been minimal. The cochlear implant can provide sound to deaf children unable to benefit from hearing aids. The complex assessment, rehabilitation, and parent counseling should be performed by centers with the multidisciplinary staffs necessary to provide effective care for patients with this specialized auditory prosthesis.     

Theory-of-mind development in oral deaf children with cochlear implants or conventional hearing aids

BACKGROUND: In the context of the established finding that theory-of-mind (ToM) growth is seriously delayed in late-signing deaf children, and some evidence of equivalent delays in those learning speech with conventional hearing aids, this study's novel contribution was to explore ToM development in deaf children with cochlear implants. Implants can substantially boost auditory acuity and rates of language growth. Despite the implant, there are often problems socialising with hearing peers and some language difficulties, lending special theoretical interest to the present comparative design. METHODS: A total of 52 children aged 4 to 12 years took a battery of false belief tests of ToM. There were 26 oral deaf children, half with implants and half with hearing aids, evenly divided between oral-only versus sign-plus-oral schools. Comparison groups of age-matched high-functioning children with autism and younger hearing children were also included. RESULTS: No significant ToM differences emerged between deaf children with implants and those with hearing aids, nor between those in oral-only versus sign-plus-oral schools. Nor did the deaf children perform any better on the ToM tasks than their age peers with autism. Hearing preschoolers scored significantly higher than all other groups. For the deaf and the autistic children, as well as the preschoolers, rate of language development and verbal maturity significantly predicted variability in ToM, over and above chronological age. CONCLUSIONS: The finding that deaf children with cochlear implants are as delayed in ToM development as children with autism and their deaf peers with hearing aids or late sign language highlights the likely significance of peer interaction and early fluent communication with peers and family, whether in sign or in speech, in order to optimally facilitate the growth of social cognition and language.     

Communication between Parents and Deaf Children: Implications for Social-emotional Development

Parent-child communication plays a central role in social growth, as it does in other domains of development. Over 90 % of deaf children, however, have hearing parents who frequently do not have a fully effective means of communicating with them. This paper examines the role of effective parent-child communication in the social and emotional development of deaf children. Evidence concerning relations between early communication and social-emotional development of deaf children is reviewed, and superficial differences in the ways that parents interact with deaf versus hearing children are distinguished from differences that may have more significant and enduring effects. Hearing parents and their deaf children are found to develop alternative, often nonverbal, interaction strategies. Of primary interest is the extent to which those strategies have impact comparable to the strategies of hearing parents with hearing children or deaf parents with deaf children.     

Phonological awareness of syllables, rhymes, and phonemes in deaf children

Phonological awareness is important for reading development in hearing children, in whom it develops at the three consecutive levels of the syllable, rhyme, and phoneme. Deaf children typically have literacy difficulties, and previous research has been equivocal about whether deaf children can develop phonological awareness. Three experiments are presented that investigate the phonological skills of deaf children (mean age 11 years) at the three linguistic levels of syllable, rhyme, and phoneme. The first experiment showed that deaf children's syllable awareness can be equivalent to that of chronological age-matched hearing controls. In the second experiment, deaf children's ability to make rhyme judgements was above chance, but poorer than that of younger reading-matched hearing controls. The third experiment showed that deaf children could phonologically recode nonsense words at a level above chance, suggesting that they could draw on phonemic skills in certain conditions. We conclude that deaf children can develop phonological awareness, but that their phonological skills lag those of hearing children and may develop in different ways. Differences between our tasks and those used in other studies are discussed.     

The effect of age on physical fitness of deaf elementary school children

The aim of this study was to measure physical fitness of deaf Dutch elementary school children compared with hearing children and to investigate the influence of age on physical fitness. Deaf children were physically less fit than hearing children. Overall, physical fitness increased with age in deaf children, but no significant differences were found between the age groups of 9-10 years and 11-12 years on most of the Eurofit items. The difference in performance between deaf and hearing children, favoring the latter, increased with age in handgrip strength and the 20-m endurance shuttle run. More attention should be paid to developing and maintaining an adequate level of physical fitness in deaf children.     

The problem of deafness in children

Conclusion In a severly deaf child it is extremely important to make a very early diagnosis of his condition. Simple diagnostic methods given above can be used. The auditory training should be commenced in the first year of life, that is during the physiological period of readiness to listen. In severely deafened children a small monopack hearing aid is fitted for constant use. They should not be placed in schools for the deaf and dumb as in such a place even a normal child would suffer from retardation of speech. Stress should be laid on auditory training rather than on lip reading. From the G. R. Medical College, Gwalior.     

Auditory interhemispheric transfer deficits, hearing difficulties, and brain magnetic resonance imaging abnormalities in children with congenital aniridia due to PAX6 mutations

OBJECTIVE: To assess auditory processing, hearing difficulties, and brain magnetic resonance (MR) imaging abnormalities in children with panocular developmental aniridia due to PAX6 mutations. DESIGN: Case-control study. SETTING: Great Ormond Street Hospital and Institute of Child Health. PARTICIPANTS: Eleven case subjects with PAX6 mutations and 11 age-matched and sex-matched healthy control subjects. INTERVENTIONS: All subjects completed a structured hearing questionnaire, baseline audiometry, and central auditory tests (dichotic speech tests, frequency and duration pattern tests, and gaps-in-noise test). Case subjects underwent brain MR imaging with volumetry, and the results were compared with those of age-matched and sex-matched healthy control subjects randomly selected from the Radiology and Physics Unit database. MAIN OUTCOME MEASURES: Brain MR imaging, central auditory test results, and questionnaire scores. RESULTS: The corpus callosum area was significantly smaller on brain volumetry in the cases compared with the controls. The anterior commissure was small in 7 cases and was normal in 3 cases on visual inspection of brain MR images (conducted in 10 of 11 cases). Audiograms showed no abnormalities in any of the children. Central auditory test results were normal in all the controls and were abnormal in all the cases except for 1 case with a pattern of abnormalities consistent with reduced auditory interhemispheric transfer. The cases had greater difficulty localizing sound and understanding speech in noise than the controls. CONCLUSIONS: Despite normal audiograms, children with PAX6 mutations may experience auditory interhemispheric transfer deficits and have difficulty localizing sound and understanding speech in noise. In view of their additional visual difficulties, thorough audiological evaluation of these children is indicated to initiate appropriate management.     

Longitudinal improvements in communication and socialization of deaf children with cochlear implants and hearing aids: evidence from parental reports

BACKGROUND: Research has shown that the cochlear implant may improve deaf children's speech and communication skills. However, little is known about its effect on children's ability to socialize with hearing peers. METHODS: Using a standardized psychological measure completed by parents and a longitudinal design, this study examined the development of communication, socialization, and daily living skills of children who used hearing aids or cochlear implants for an average of 11 and 6 years, respectively. RESULTS: Results show that children with cochlear implants, who were more delayed than children with hearing aids at the outset, made significant progress over time. Children with both devices achieved age-appropriate development after years of hearing aid or cochlear implant use. CONCLUSIONS: The pattern of results suggests that cochlear implants may be effective in improving deaf children's communication and social skills.     

Relation between deaf children's phonological skills in kindergarten and word recognition performance in first grade

BACKGROUND: The aim of the present study was twofold: 1) to determine whether phonological skills measured in deaf prereaders predict their later phonological and reading skills after one year of reading instruction as is the case for hearing children; 2) to examine whether the age of exposure to a fully specified phonological input such as Cued Speech may explain the inter-individual differences observed in deaf children's phonological and word recognition levels. METHOD: Twenty-one 6-year-old deaf prereaders and 21 hearing children of the same chronological age performed two phonological tasks (rhyme decision and generation tasks); they were re-assessed 12 months later and presented with other phonological tasks (rhyme decision and common unit identification tasks) and a written word choice test. RESULTS: Phonological skills measured before learning to read predicted the written word recognition score the following year, both for hearing and for deaf participants. Age of onset of exposure to Cued Speech was also a strong predictor of phonological and written word recognition scores in beginning deaf readers. CONCLUSIONS: The evidence broadly supports the idea of a capacity for acquiring phonological skills in deaf children. Deaf children who are able to develop an implicitly structured phonological knowledge before learning to read will be better readers when this knowledge becomes explicit under the pressure of reading instruction.     

The identification and management of deaf children

Deafness is defined as the inability to use hearing as a primary channel for receiving speech, even with amplification.¹ Hearing loss, on the other hand, is hearing impairment of various degrees that could be unilateral or bilateral. In the United States, approximately one out of every 1,000 children is born deaf with 3–5 being born with less severe degrees of hearing impairment2. Deafness present at birth could be due to genetic abnormalities or due to injury to the developing auditory system or due to developmental anomalies of this system. Deafness can also develop after birth and, in broad terms, the cause can be toxic, infectious, neoplastic, traumatic or degenerative. The purpose of this paper is to : (1) review the effects of deafness on the child, (2) discuss the causes of deafness, (3) describe the clinical characteristics which allow early diagnosis and the algorithm otolaryngologists use to investigate a child suspected to be deaf, (4) describe the management of the deaf child and finally, (5) review the results of rehabilitation.     

Rehabilitative treatment of severe sensory disorders. Description of 2 cases

The aim of the work has been to verify the efficacy of a psychomotor rehabilitative treatment undertaken at a late age in two children with multiple handicaps: sensorial (visual and hearing impairment), motor (apostural-akinetic stage) and relational (autistic behavior). Methods: Salvatore C, and Ivan S., admitted to the "G. Gaslini" Institute after discharge from an Institution for homeless infants, were affected by prenatal rubella sequelae. They were taken in charge at age 11 and 24 months. Treatment: manipulation and body-to-body interaction to reassure the children, relieve their feelings of fright and reduce the stereotyped behaviour; stimulation of the acquisition of the body-image; strengthening of the unimpaired sensorial skills and of the residual auditory and visual possibilities; postural and motor stimulation, following the autogenetic development; stimulation to achieve spatial organization and orientation; adjusting of interventional and relation modalities common to all the persons interacting with the children. Results: we obtained a significant reduction of stereotyped behaviour and progressive improvement of the active research of productive interaction with the environment in both children; Salvatore C. was able to walk with little aid after one year of treatment; furthermore he reached a lively and organized motility, supported by a motivational drive. Ivan S. was able to walk with bilateral help after 4 months of treatment; the cognitive development improved at a slower pace; the child became able to reach for objects but used them only in stereotyped or elementary activities. From this observation it seems possible to confirm our hypothesis that psychomotor education is useful even if undertaken lately and in the absence of a supporting family.(ABSTRACT TRUNCATED AT 250 WORDS)     

学龄期轻度孤独症谱系障碍儿童注意力特征分析

目的 探讨学龄期轻度孤独症谱系障碍 （ASD）儿童的注意力特征,为临床治疗提供依据。方法 收集学龄期轻度ASD儿童20例,使用整合视听持续性操作测试 （IVA-CPT）进行注意力评估。选取20名注意缺陷多动障碍 （ADHD）儿童和40名正常儿童作为对照。结果 与正常对照组比较,ASD组的综合注意、综合控制、视/ 听觉综合控制力、视/听觉谨慎、听觉毅力、视觉一致性、视/听觉警醒、视觉注意力、视觉速度商数,视/听觉正确反应数和视觉二、三阶段平均反应时得分低 （P <0.05）。与ADHD组比,ASD 组的综合控制力、听觉一致性、商数得分高 （P <0.05）,而视觉警醒、视觉速度商数得分低 （P <0.05）。结论 学龄期轻度ASD儿童存在注意缺陷,以注意集中能力缺陷为主且与ADHD 儿童受损相当,而注意控制能力受损相对较轻且优于ADHD儿童;视觉注意集中能力缺陷重于听觉,而视/听觉注意控制能力缺陷无明显差别。     

Hearing impaired neonate: role of the paediatrician

Electrophysiological screening of the hearing of newborn infants has demonstrated that hearing impaired infants can be successfully detected soon after birth.(1) There is much evidence to support the belief that the early fitting of hearing aids when needed (at less than 6 months of age) and guided early language stimulation can result in good outcomes in the language of deaf children.(2,3) The paediatrician and family doctor play key roles in ensuring these outcomes.     

Early development of brainstem auditory evoked potentials in Down's syndrome

Early development of brainstem auditory pathway was studied in 14 children with Down's syndrome (age range from 1 month to 3 years). The brainstem auditory evoked potentials (BAEP) during infancy was characterized by elevated threshold and poorly differentiated wave I. All children within 2 years had elevated threshold in one or both ears, suggesting a high incidence of peripheral hearing deficits. Follow-up tests showed that as age increased up to 3 years the elevated threshold gradually decreased and the differentiation of wave I improved. The I-V interpeak interval was slightly shorter and the amplitude of wave V was smaller than the normal controls, which existed continuously during follow-up studies. Our findings suggest that the development of peripheral hearing is delayed, although persistent hearing deficits cannot be excluded, and the functioning and development of the brainstem auditory pathway may also be abnormal in Down's syndrome children.     

Childhood Leukemia and Lymphoma: Long-Term Sequelae in Visual, Auditory and Vestibular Function

Twenty-six children in continuous complete remission from leukemia or lymphoma and no longer receiving chemotherapy were studied to determine the long-term sequelae in visual, auditory and vestibular function. Ophthalmologic examination revealed cataracts in five patients and an abnormality in the retina in one patient. These abnormalities were not associated with any disturbance of visual acuity. By otorhinolaryngologic examination, slight hearing loss was observed in five patients and an abnoormal righting reflex in one patient. The etiologies of these abnormal findings in visual, auditory and vestibular function were discussed.     

Deaf children's understanding of emotions: desires take precedence

Deaf children frequently have trouble understanding other people's emotions. It has been suggested that an impaired theory of mind can account for this. This research focused on the spontaneous use of mental states in explaining other people's emotions by 6- and 10-year-old deaf children as compared to their hearing peers. Within both age-groups deaf children referred to others' beliefs as often as their hearing peers and their references to desires even exceeded those of hearing children. This relative priority for the expression of desires is discussed in terms of possible communicative patterns of deaf children. The specific problems that deaf children meet in their daily communication might explain their abundance of desire-references: plausibly, they give a high priority to stress their own desires and needs unambiguously.     

Understanding theory of mind in children who are deaf

Research on theory of mind began in the context of determining whether chimpanzees are aware that individuals experience cognitive and emotional states. More recently, this research has involved various groups of children and various tasks, including the false belief task. Based almost exclusively on that paradigm, investigators have concluded that although "normal" hearing children develop theory of mind by age 5, children who are autistic or deaf do not do so until much later, perhaps not until their teenage years. The present study explored theory of mind by examining stories told by children who are deaf and hearing (age 9-15 years) for statements ascribing behaviour-relevant states of mind to themselves and others. Both groups produced such attributions, although there were reliable differences between them. Results are discussed in terms of the cognitive abilities assumed to underlie false belief and narrative paradigms and the implications of attributing theory of mind solely on the basis of performance on the false belief task.     

Cochlear implants in deaf children

The results to date with the 3M/House cochlear implant in children have been extremely encouraging. Statistically and clinically significant changes show that the implant can provide improvements in auditory detection and discrimination as well as in speech production. As with any intervention, results range from outstanding for some children (open-set speech discrimination and/or intelligible speech) to minimal for others (no stimulation or little improvement in speech). Until long-term studies can be completed, the implant will undoubtedly remain controversial. However, professionals involved in the care of a child who is hearing-impaired should be informed that the field of cochlear implantation is rapidly expanding. A number of different cochlear implants are currently undergoing clinical trials in adults. Besides the 3M/House device, the FDA has recently approved a second device, the Nucleus Multichannel Cochlear Implant, for investigation in children. The treatment of profound deafness is changing in children with the cochlear implant as an option for those not benefiting significantly from hearing aids. However, some important aspects of a deaf child's management have not changed and will not change: the need for early diagnosis and multidisciplinary management. The first five years of life are the language acquisition years. Proper management during these years is critical if the hearing-impaired child's handicap is not to dominate his or her future and limit potential for a successful, happy life.