Behavior problems in children with cochlear implants

doi:10.1016/j.ijporl.2015.02.006

International Journal of Pediatric Otorhinolaryngology

Volume 79, Issue 5, May 2015, Pages 648-653

https://doi.org/10.1016/j.ijporl.2015.02.006 Get rights and content

Abstract

Objectives

(1) To examine behavior problems in Mandarin-speaking children with cochlear implants (CIs); (2) to investigate the associated factors of problem behaviors; (3) to understand the relationships between behavior problems and parenting stress.

Methods and materials

Sixty patients (25 boys, 35 girls) aged 6–18 years (mean = 12.2 ± 3.2) who used CIs for a mean duration of eight years participated in the study. Behavior problems were assessed by Achenbach's child behavior checklist (CBCL). Categorical auditory performance (CAP) and speech intelligibility rating (SIR) scales were utilized to investigate auditory performance and speech production intelligibility. Parenting stress index (PSI) was filled out by parents to measure parenting stress level.

Results

Significantly more CI subjects had problems with ‘Withdrawn/Depressed’ (p = 0.010), ‘Social Problems’ (p < 0.001), ‘Thought Problems’ (p < 0.001), ‘Attention Problems’ (p < 0.001), ‘Aggressive Behavior’ (p = 0.010) and ‘Overall Behavior’ (p = 0.001) than the normative sample did. ‘Social Problems’ was the most common problem and could be independently associated with gender, socioeconomic status and CAP (R² = 0.361). CAP score was also associated with Overall Behaviors (R² = 0.081). The results of PSI had a significant positive correlation with almost all CBCL subscales (p < 0.05).

Conclusion

The CI subjects still exhibit social and attention problems, which may in turn increase parenting stress. Good family support as well as aural–verbal rehabilitation are of particular importance in determining behavioral outcomes in CI children.

Introduction

Development is under considerable influence of language as language mediates social relations and aids in behavioral control [1], [2]. As a result, language delay may be an underlying cause of problem behaviors [3], [4]. Children with sensorineural hearing loss were thus often reported to exhibit more severe behavioral problems than their hearing peers did [4], [5]. These patients not only showed more externalizing behavior problems (e.g., rule-breaking and aggressive behaviors) than the hearing children (30–50% vs. 3–18%) [6], [7], [8], but demonstrated higher rates of internalizing problems (e.g., anxiety and depression; 25–38% vs. 2–17%) [6], [7], [9]. They also exhibited more attention problems and had less parent–child communication [5].

With the restoration of hearing via a cochlear implant (CI) [10], a significant reduction in behavioral, emotional and social problems was observed in many studies [4], [11], [12]. Preschoolers with CIs were reported to perform similarly to their hearing age mates on the child behavior checklist (CBCL) after one year of implant use [13]. It was also found that CIs increased self-sufficiency and stabilized family and social relationships [14], [15]. However, there were still studies indicating behavioral problems in CI children, such as externalizing behavior problems [16] and emotional and peer problems [17]. These problems were reported to have an association with worse oral language performance and/or age at implantation [16], [17], suggesting that auditory experience and the resulting development of oral language may have crucial effects on CI children's behaviors.

Although parents of CI children generally held a positive view toward the outcomes of cochlear implantation [15], they still experienced greater stress than parents of normal-hearing children did [18]. Our previous study [19] showed that these parents actually experienced the highest stress level during the post-implant 0–2 years, and more parents suffered from stress related to child characteristics than from stress related to parent characteristics. It shows that the post-implant adjustment problems of the implanted children may be the main source of parenting stress.

Therefore, the present study aimed (1) to cross-sectionally investigate the behavior problems in the Mandarin-speaking children with CIs aged 6–18 years, (2) to find out the associated factors of problem behaviors, and (3) to understand the relationship between behavior problems and parenting stress.

Section snippets

Participants

Sixty Mandarin-speaking patients (25 boys and 35 girls) with CIs who met the following criteria participated in this study: (1) the subjects aged 6–18 years; (2) the subjects did not have developmental/neurological difficulties; (3) the subjects went to mainstream schools; (4) the subjects used oral communication; (5) the subjects returned all the questionnaires. They aged 12.2 ± 3.2 years (range = 6.9–18.1 years) at the time of the study. They received CIs at the mean age of 4.0 ± 2.5 years (range =

Parent-reported behavioral problems in CI students

‘Social Problems’ and ‘Attention Problems’ were reported by the parents to be of the highest intensity among the other behavioral issues (see Table 2), respectively with 30% and 18.3% of the subjects falling within the problematic range (i.e., scoring 1.5 SD lower than the mean of the normative sample). There was no significant difference between the ‘Internalizing Behavior’ and the ‘Externalizing Behavior’ scales.

When compared with the normative sample, significantly more CI subjects fell

Discussion

Hearing-impaired patients are often reported to have more severe behavioral problems than their hearing peers by many previous studies. However, studies on the Mandarin-speaking patient group are limitedly available. The current study investigates the behavioral problems in Mandarin-speaking children with CIs, and finds that their social- and attention-related behaviors are the most problematic compared to the normative sample with normal hearing. Their behavioral problems are found to be

Conclusion

After using the implants for a mean duration of eight years, our Mandarin-speaking CI subjects exhibit normal internalizing and externalizing behaviors. However, their social- and attention-related behavioral problems are significantly more severe than those in the normal-hearing children, which can in turn increase parenting stress. Good family support and hence good family background as well as (re)habilitation are of particular importance in determining behavioral outcomes in CI children,

Conflict of interest statement

None.

Financial disclosures

None.

Acknowledgements

This study was supported by the Chang-Gung Memorial Hospital Research Program (CMRPG3B183, CMRPG3B1141, CMRPG3C1401). The authors would like to thank all the children and their parents and teachers who participated in this study.

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Auditory evoked response to an oddball paradigm in children wearing cochlear implants
2023, Clinical Neurophysiology
Although children with cochlear implants (CI) achieve remarkable success with their device, considerable variability remains in individual outcomes. Here, we explored whether auditory evoked potentials recorded during an oddball paradigm could provide useful markers of auditory processing in this pediatric population.
High-density electroencephalography (EEG) was recorded in 75 children listening to standard and odd noise stimuli: 25 had normal hearing (NH) and 50 wore a CI, divided between high language (HL) and low language (LL) abilities. Three metrics were extracted: the first negative and second positive components of the standard waveform (N1-P2 complex) close to the vertex, the mismatch negativity (MMN) around Fz and the late positive component (P3) around Pz of the difference waveform.
While children with CIs generally exhibited a well-formed N1-P2 complex, those with language delays typically lacked reliable MMN and P3 components. But many children with CIs with age-appropriate skills showed MMN and P3 responses similar to those of NH children. Moreover, larger and earlier P3 (but not MMN) was linked to better literacy skills.
Auditory evoked responses differentiated children with CIs based on their good or poor skills with language and literacy.
This short paradigm could eventually serve as a clinical tool for tracking the developmental outcomes of implanted children.
Effectiveness of unified protocols for online transdiagnostic treatment on social-emotional skills and parent-child interaction in school-aged children with cochlear implants
2023, International Journal of Pediatric Otorhinolaryngology
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.
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.
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).
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.
Development of auditory and language skills in children using cochlear implants with two signal processing strategies
2020, Brazilian Journal of Otorhinolaryngology
Citation Excerpt :
With the technological advancements in this area, it was possible to observe an improvement in the auditory performance among users, not only due to expansion of the indications for cochlear implantation, but also to technological improvements in the implants themselves, in the electrode bundle, microphone technology, signal processing strategies and preprocessing algorithms.1 The auditory and language performance of CI users is closely related to factors that include age at surgery,2,3 duration of sensory deprivation,4,5 effective device use,6 the hearing loss etiology,7–9 the child’s cognitive skills,10 family participation in the therapeutic process,11 specialized speech-language therapy,12 and the optimization of programming parameters,13–16 and other factors. Among the different programming parameters adjusted at the moment of the mapping, the adopted signal processing strategy defines how the acoustic information will be converted into an electric stimulus.
The increase in the spectral information offered by the sound processing strategy HiRes 120 has led to great expectations for the pediatric population. Due to a shorter duration of auditory deprivation and higher neural plasticity, children could benefit more substantially from the spectral information of this sound processing strategy.
To compare auditory and language skills in Brazilian children with cochlear implants using the HiRes and HiRes 120 sound processing strategies.
Thirty children, aged 1–3 years, with congenital hearing loss, were divided into two groups, according to the signal processing strategy adjusted at the time of the cochlear implant activation. The assessed children were matched according to chronological age and the time of the cochlear implant use. The auditory and language skills were evaluated longitudinally through the Infant-Toddler Meaningful Auditory Integration Scale and Production Infant Scale Evaluation, carried out before surgery, and 3, 6 and 12 months after device implantation. The Mann–Whitney test was applied for the comparison between the two groups with a 5% significance level.
The findings indicated development of hearing and language skills in the first year of cochlear implant use; however, there was no statistically significant difference in the evolution of such skills due to the adjusted processing strategy in the activation of the cochlear implant electrodes.
The development of auditory and language skills in the assessed children was similar during the entire study period, regardless of which signal processing strategy was used.
O aumento das informações espectrais proporcionado pela estratégia de processamento de sinal HiRes 120 gera expectativas em relação à população pediátrica, uma vez que devido ao curto período de privação sensorial e da maior plasticidade neural, as crianças poderiam se beneficiar de forma mais substancial das informações espectrais dessa estratégia de processamento de sinal.
Comparar as habilidades auditivas e de linguagem em crianças usuárias de implante coclear, com a estratégia de processamento de sinal HiRes e HiRes 120.
Trinta crianças de um a três anos e com perda auditiva congênita foram divididas em dois grupos, de acordo com a estratégia de processamento de sinal ajustada no momento da ativação do implante coclear. As crianças avaliadas foram pareadas de acordo com a idade cronológica e o tempo de uso do implante coclear. As habilidades auditivas e de linguagem foram avaliadas, longitudinalmente, por meio do Infant-Toddler Meaningful Auditory Integration Scale e Production Infant Scale Evaluation, antes do implante coclear e com 3, 6 e 12 meses de uso do dispositivo. O teste estatístico de Mann-Whitney foi aplicado para comparar os resultados dos grupos, com nível de significância de 5%.
Os achados indicaram desenvolvimento das habilidades auditivas e de linguagem no primeiro ano de uso do implante coclear, porém, sem diferença estatisticamente significante na evolução de tais habilidades em função da estratégia de processamento ajustada na ativação dos eletrodos do implante coclear.
O desenvolvimento das habilidades auditivas e de linguagem das crianças avaliadas foi semelhante durante o período do presente estudo, independente da estratégia de processamento de sinal utilizada.
The influence of cochlear implantation on aggression behaviors in children
2019, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
It is also indicated that auditory performance and speech comprehension skills of hearing impaired children are correlated with their behavior problems because of the inability to communicate their needs appropriately and to control their behavior when behavioral inhibition is necessary [14,24–26]. Chao et al. [16] reported that children who underwent cochlear implantation for more than 8 years still show attentional and social problems, which may in return enhance parental stress levels. They also indicated that appropriate family support in addition to regular attendance at aural rehabilitation programs playing an important role in determining behavioral outcomes in implanted children.
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.
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.
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.
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.
Towards a methodology for user experience assessment of serious games with children with cochlear implants
2018, Telematics and Informatics
Information technology is transforming different areas, such as rehabilitation, in such a way that serious games are finding a use as an alternative in hearing therapies for children with cochlear implants, creating a motivating experience in children. As a result, the design of products oriented to children depends on the skills they have to interact, because if they have a better user experience they may have a better learning experience. Most existing methods of assessment are aimed at adults, although some have been adapted for children with special needs, including children with cochlear implants. This article presents a methodology for User Experience Assessment (UXA), that provides support for following the necessary guidelines and choosing techniques adapted to the characteristics of the child with cochlear implant. The methodology has been applied in a case study with 23 children with cochlear implants in the Institute for Blind and Deaf Children in Colombia, where different methods have been used and adapted to assess the user experience.
Current trends in outcome studies for children with hearing loss and the need to establish a comprehensive framework of measuring outcomes in children with hearing loss in China
2016, Journal of Otology
Since the 1970s, outcome studies for children with hearing loss expanded from focusing on assessing auditory awareness and speech perception skills to evaluating language and speech development. Since the early 2000s, the multi-center large scale research systematically studied outcomes in the areas of auditory awareness, speech-perception, language development, speech development, educational achievements, cognitive development, and psychosocial development. These studies advocated the establishment of baseline and regular follow-up evaluations with a comprehensive framework centered on language development. Recent research interests also include understanding the vast differences in outcomes for children with hearing loss, understanding the relationships between neurocognitive development and language acquisition in children with hearing loss, and using outcome studies to guide evidence-based clinical practice. After the establishment of standardized Mandarin language assessments, outcomes research in Mainland China has the potential to expand beyond auditory awareness and speech perception studies.

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¹: Co-first author.

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Behavior problems in children with cochlear implants

Abstract

Objectives

Methods and materials

Results

Conclusion

Introduction

Section snippets

Participants

Parent-reported behavioral problems in CI students

Discussion

Conclusion

Conflict of interest statement

Financial disclosures

Acknowledgements

Int. J. Pediatr. Otorhinolaryngol.

Early Hum. Dev.

An objective approach to the study of the abnormal child

Am. J. Orthopsychiatry

Thought and Language

Behavioral problems in school-aged hearing-impaired children: the influence of sociodemographic, linguistic, and medical factors

Eur. Child. Adolesc. Psychiatry

Parenting stress among parents of deaf and hearing children: associations with language delays and behavior problems

Parent. Sci. Pract.

Predicting behavior problems in deaf and hearing children: the influences of language, attention, and parent–child communication

Dev. Psychopathol.

Mental health problems of deaf Dutch children as indicated by parents’ responses to the child behavior checklist

Am. Ann. Deaf

Detection of behavioural and emotional problems in deaf children and adolescents: comparison of two rating scales

Child Care Health Dev.

A multimethod study of attention and behavior problems in hearing-impaired children

J. Clin. Child Psychol.

Childhood anxiety disorders

Cochlear implants: current status

Expert Rev. Med. Dev.

Improvements in visual attention in deaf infants and toddlers after cochlear implantation

Audiol. Med.

Exploration of the cognitive and behavioural consequences of paediatric cochlear implantation

Cochlear Implants Int.

The cognition and behaviour of children with cochlear implants, children with hearing aids and their hearing peers: a comparison

Audiol. Neurotol.

Cochlear implants in special cases: deafness in the presence of disabilities and/or associated problems

Acta Otolaryngol. Suppl.

Personal, social, and family adjustment in school-aged children with a cochlear implant

Ear Hear.

Psychological consequences of pediatric cochlear implant use

Ann. Otol. Rhinol. Laryngol.

Cochlear implants in children: a study of parental stress and adjustment

Am. J. Otol.

Parental stress in raising Mandarin-speaking children with cochlear implants

Laryngoscope

Two-Factor Index of Social Position