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.     

The assessment and treatment of deaf children with psychiatric disorders

The assessment and treatment of deaf children with psychiatric disorder is intimately related to the individual child's communication, which in turn is affected by a number of factors, medical, social, and cultural. The deafness can be aetiologically related to the psychiatric disorder or can be incidental. Treatment strategies should be adapted to meet the individual child and family's needs. Deaf professionals have a vital role in mental health services for this population. The use of an interpreter can clarify communication and cultural issues for deaf and hearing children, families, and professionals.     

Parental decision making and the choice of communication modality for the child who is deaf

BACKGROUND: Early intervention decisions for a deaf or hard of hearing child are difficult to make, partly because of the lack of definitive proof of the superiority of any particular communication approach. OBJECTIVE: To compare the relative importance of the child's hearing loss and parental attitudes, beliefs, values, and aspirations in the decision process. METHODS: Eighty-three parents were surveyed about decision factors that may have affected their choice of communication modality, including resource availability, attitudes and beliefs about hearing loss, values, trade-offs, and goals. Parental preference ratings on hypothetical outcomes were also collected in 4 domains: communication, academic performance, social functioning, and emotional well-being. RESULTS: The child's extent of hearing loss was the most influential decision factor (P<.001). Beyond the extent of hearing loss, logistic regression further showed that parental cognitive-attitudinal factors were important in the inclination to favor an oral approach-if they believed that deafness can and should be corrected and if they desired the child to be able to speak (P =.03 and.04, respectively). Technology that aims at improving the child's ability to speak (eg, cochlear implants) had no significant impact on the decision to choose oral only training. CONCLUSIONS: Professionals who work with deaf children and their parents should recognize the presence of many relevant issues beyond the extent of the child's hearing loss. Interventions may be most effective if aimed at balancing parental beliefs and aspirations and audiologic considerations.     

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.     

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.     

Hearing impairment and cognitive development]

The study of the cognitive abilities of hearing-impaired children is important for both practical (e.g. to determine appropriate teaching strategies) and theoretical reasons (e.g. to examine the role of language in thought processes). The aim of this paper is to examine the cognitive function of hearing-impaired children from a review of the literature. If most studies show that deaf children are similar to normal children in virtually all aspects of cognitive function, many studies also emphasize pronounced differences in their academic achievement. Besides the degree of hearing loss and the age at onset of deafness, environmental factors (such as parental support and educational methods) seem to play an important role in the cognitive development and academic success of these children. This underlines the importance of the measures adopted for the deaf children as they may have a positive or negative impact on their development.     

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.     

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.     

Supporting communication in the child with a learning disability

Learning disabilities can result from a range of genetic, social and specific medical conditions. In addition to a restricted ability to learn, children may present with speech, language or communication difficulties of varying degrees. Associated physical, hearing or visual impairments will influence the nature and course of language development. Best practice in this area involves collaborative working between families, education and health professionals directed towards agreed functional communication goals. Augmentative and alternative communication techniques, such as signing, symbols and communication aids, can have a major role in the development of effective social communication, appropriate behaviour and curriculum access.     

Ethics for the pediatrician: the evolving ethics of cochlear implants in children

The story of the ethical controversy over cochlear implants is unique in some ways and paradigmatic in others. It is unique in the ways that it was shaped by the history of deafness, and of cultural responses to deafness, in the United States. The story is paradigmatic in two ways. First, cochlear implantation was an innovative therapy that was introduced into practice without adequate study. Promising early trials led to FDA approval, although long-term outcome data from rigorous studies were lacking. In this respect, the story of cochlear implants is similar to the history of other innovations that were introduced without rigorous evaluation, innovations such as supplemental oxygen, extracorporeal membrane oxygenation, or corticosteroids for bronchopulmonary dysplasia. Cochlear implants also are paradigmatic of a particular type of ethical dilemma in which advocacy groups claim to know better what is best for children than do the children's parents or doctors. This controversy happened during the Baby Doe debate in the 1980s, when advocacy groups claimed that doctors and parents were conspiring to discriminate against children with disabilities. Ultimately, the US Supreme Court invalidated that interpretation of disability rights. Instead, parents and doctors working together are given discretion to make decisions about what is best for children. With regard to cochlear implants for children, the NAD realizes that they are walking a fine line. As one NAD spokesperson said, "We don't say that hearing parents aren't qualified to make decisions about their deaf children. We say that they need to have contact with deaf people if they're going to make educated decisions". The same could be said for pediatricians. There are 4,000 to 8,000 infants born each year in the United States with severe hearing impairment. Their parents will have to make decisions about what is best. Pediatricians need to understand the options and be prepared to help parents sort through the complex data and multiple options in order to arrive at the decision that is best for themselves and their child. Understanding the ethical controversy over cochlear implants will help.     

Use of the ages and stages questionnaire in young children who are deaf/hard of hearing as a screening for additional disabilities

Background

Children with sensorineural hearing loss have a high rate of additional disabilities beyond those expected by the impact of hearing loss on language and are identified later than children without hearing loss. Identifying these developmental delays and allowing earlier implementation of interventions specific to these concerns would improve care.

Aims

To determine whether the Ages and Stages Questionnaire© (ASQ) can identify unmet needs or unidentified developmental delays among young children with bilateral sensorineural hearing loss.

Subjects

Fifty children with any degree of bilateral sensorineural hearing loss, 6 months to 36 months of age recruited from a tertiary referral center and regional early intervention programs for children who are deaf/hard of hearing.

Outcome measures

The ASQ and comprehensive developmental evaluations with the Revised Gesell Developmental Schedules.

Study design

Sensitivities and specificities of the ASQ were calculated.

Results

While 32% of our population had a developmental delay outside the domain of communication, the ASQ had poor sensitivity on the overall score without the communication domain as well as for fine motor, cognitive, personal–social domains. It had good sensitivity for the domains of communication and gross motor skills and good specificity (ranging 83–85%) on specific domains as well as for the overall score (70%).

Conclusions

The ASQ does not provide an effective mean for identifying additional developmental concerns in young children with bilateral sensorineural hearing loss. Further studies are needed to determine how to identify additional disabilities in a timely manner among young children with hearing loss.     

Child mental health and deafness

Mental health problems are more common in deaf children. Increased risk factors can be understood using a biopsychosocial model of mental health. Biological risk factors are more common in acquired deafness and perhaps some syndromes. These need to be identified and treated. The cultural model of deafness can be used to understand and manage many psychosocial issues and to prevent future mental health problems. Support for parents and early communication strategies are crucial. A comprehensive mental health assessment needs to incorporate the medical and cultural model of deafness and adaptations in the assessment process will need to be made. Further research is needed to establish which treatment approaches are most effective and how these may need to be adapted.     

Knowledge of display rules in prelingually deaf and hearing children

Deaf children of elementary and secondary school age participated in a study designed to examine their understanding of display rules, the principles governing the expression and concealment of emotion in social situations. The results showed that deaf children's knowledge of display rules, as measured by their reported concealment of emotion, was comparable to that of hearing children of the same age. However, deaf children were less likely to report that they would conceal happiness and anger. They were also less likely to produce reasons for concealing emotion and a smaller proportion of their reasons were prosocial, that is, relating to the feelings of others. The results suggest that the understanding of display rules (which function to protect the feelings of other people) may develop more gradually in deaf children raised in a spoken language environment than it does in hearing children.     

Management of the child with sensorineural hearing loss. Medical, surgical, hearing aids, cochlear implants

Optimal comprehensive management of a child with SNHL involves constructive dialogue and coordination with the child's family and teachers. Not all children with SNHL benefit from conventional amplification, even after parents have invested significant amounts of money in hearing aids. Parents may encounter frustration and disappointment if their children fail to achieve communicative and academic goals they have established in their own mind. If the child is a potential candidate for cochlear implantation, this decision not only involves the risks (albeit modest) of surgery but also often a substantial financial commitment to help defray the cost of this sophisticated electronic device. The parents may encounter conflicting advice from friends and members of the adult deaf community about the benefit of cochlear implantation. Throughout the course of all of these difficult considerations, the health professionals caring for a child with hearing loss should be a source for information, guidance, and support to the family.     

Organization resources for families of children with deafness or hearing loss

National health and education mandates emphasize the value of and need for early identification and intervention for children who are deaf and hard of hearing. Pediatricians in collaboration with other professionals in a multidisciplinary approach play a vital role in linking families to appropriate care. Understanding the concept of choices in communication and education resources and the process of parental and caregiver grieving enables the pediatrician to assist the family in finding needed services, agencies, and resources.     

INFLUENCE OF YORUBA BELIEFS ABOUT ABNORMALITY ON THE SOCIALIZATION OF DEAF CHILDREN: A RESEARCH NOTE

The study examines patterns of communication modes of guidance and discipline and affectional bonds between 176 Yoruba hearing mothers and their deaf children. Results relating to communication support earlier findings about the frustrations inherent in such endeavour. Contrary to other published reports, the Yoruba mothers studied perceived expressive linguistic abilities of deaf children more negatively than receptive abilities. Communication difficulties affected mothers' guidance and discipline, particularly since the culturally preferred modes of discipline rely very heavily on children's age-related language competence. Mothers' verbal claims of affectional bonds were not supported by evidence from other sources close to and including the deaf children.     

Cochlear implantation for progressive hearing loss.

The concept of neural plasticity and the early natural abilities of hearing children to acquire speech and language without instruction have led many authorities to advocate cochlear implantation before the age of 5 years in congenital deafness. Older children therefore become lower priority for scarce public funds because they are perceived to have passed the "window of opportunity" to learn speech, even if hearing is restored, and continue to rely on sign language. This paper shows that a subgroup of congenitally deaf children exists, who, having made good progress with conventional hearing aids, suffer a sudden or progressive hearing deterioration which arrests the speech development. Sixty children have been implanted in the Cambridge Programme, half for meningitis or other acquired losses and half for congenital prelingual deafness. Six of this latter group were congenital but progressive; their progress, deterioration, and improvement after implantation are summarised.     

Cochlear implantation for progressive hearing loss

The concept of neural plasticity and the early natural abilities of hearing children to acquire speech and language without instruction have led many authorities to advocate cochlear implantation before the age of 5 years in congenital deafness. Older children therefore become lower priority for scarce public funds because they are perceived to have passed the "window of opportunity" to learn speech, even if hearing is restored, and continue to rely on sign language. This paper shows that a subgroup of congenitally deaf children exists, who, having made good progress with conventional hearing aids, suffer a sudden or progressive hearing deterioration which arrests the speech development. Sixty children have been implanted in the Cambridge Programme, half for meningitis or other acquired losses and half for congenital prelingual deafness. Six of this latter group were congenital but progressive; their progress, deterioration, and improvement after implantation are summarised.     

Auditory Perception and the Control of Spatially Coordinated Action of Deaf and Hearing Children

From birth onwards, auditory stimulation directs and intensifies visual orientation behaviour. In deaf children, by definition, auditory perception cannot take place and cannot, therefore, make a contribution to visual orientation to objects approaching from outside the initial field of view. In experiment 1, a difference in catching ability is demonstrated between deaf and hearing children (10-13 years of age) when the ball approached from the periphery or from outside the field of view. No differences in catching ability between the two groups occurred when the ball approached from within the field of view. A second experiment was conducted in order to determine if differences in catching ability between deaf and hearing children could be attributed to execution of slow orientating movements and/or slow reaction time as a result of the auditory loss. The deaf children showed slower reaction times. No differences were found in movement times between deaf and hearing children. Overall, the findings suggest that a lack of auditory stimulation during development can lead to deficiencies in the coordination of actions such as catching which are both spatially and temporally constrained.     

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.