Predictors of Psychosocial Outcomes in Hard-of-Hearing Preschool Children

Social-Emotional Functioning of Children With Different Hearing Status and Diverse Cultural Background

PURPOSE

The study investigated the social-emotional functioning of children with typical hearing and deaf and hard of hearing (D/HH) children from diverse cultural backgrounds in Israel through parental reports.

METHOD

A total of 242 parents from both Arabic and Jewish communities participated: 130 were parents of D/HH children and 112 were parents of children with typical hearing. The Strengths and Difficulties Questionnaire and a background questionnaire were used.

RESULTS

Results revealed increased total difficulties, emotional symptoms, and peer problems as reported by parents of D/HH children. Jewish parents of D/HH children reported greater total difficulties, conduct problems, and peer problems than Arab parents. Significant gender differences were found, with parents of boys reporting higher levels of hyperactivity/inattention and lower prosocial behavior. Among D/HH children, Arab parents reported higher peer problems among hearing aid users compared to cochlear implant users, whereas Jewish parents reported the opposite trend.

CONCLUSION

These findings highlight the significant social-emotional challenges faced by D/HH children, particularly in peer interactions, and underscore the need for tailored interventions that consider cultural differences.

Establishment of the Norwegian hearing register for children

Introduction

The Norwegian Directorate of Health approved the Norwegian Hearing Register for Children in 2022. The main objective of the register is to improve the quality of treatment for children with permanent hearing loss, by measures, follow-ups and monitoring the quality and results of the health care system.

Methods

Inclusion criteria are children who do not pass universal newborn hearing screening and/or children with permanent hearing loss <18 years of age. Hearing loss is defined as pure-tone audiometry threshold of (PTA4) > 20 dB in at least one ear. Data are registered at the Ear, Nose and Throat departments at inclusion and at follow-ups at the age of 3, 6, 10, and 15 years. The register collects information about the child within a holistic perspective. The key elements of the register are (a) data concerning newborn hearing screening; (b) data concerning hearing, medical information, hearing amplification and intervention (c) patient reported outcome measures registered by caregivers using three questionnaires; Pediatric Quality of Life Inventory, Strengths and Difficulties Questionnaire and Parents' Evaluation of Aural/Oral Performance of Children.

Results

The register has established four quality indicators regarding newborn hearing screening and early intervention (a) the rate of false positive neonatal screens; (b) testing for congenital cytomegalovirus within 3 weeks of age for children who do not pass newborn hearing screening; (c) audiological evaluation to confirm the hearing status no later than 3 months of age and (d) initiated intervention within 3 months after confirmation of hearing status.

Discussion

The register will include the total population of hearing impaired children over long time periods. Thus, the register enables each hospital to monitor their quality indicator scores continuously and compare them with national levels in real time. This facilitates and accelerates identification of improvement areas in the hospitals and will be an important contributor for quality improvement in NHS, diagnostics and hearing intervention for children in Norway. In addition, data from the register will be a unique source for research, and study designs with a long follow-up time can be applied.

Self-reported social well-being of children with hearing loss in 2023

OBJECTIVES

To study the level of social well-being for children with hearing loss (HL) using self-completed questionnaires.

METHODS

The data sample relates to a total of 22 children representing a new group of children with HL. This new group is defined as HL detected through neonatal hearing screening and fitted with hearing technology when relevant before 6 months, received bilateral cochlear implants before one year of age followed by specific educational training using the auditory-verbal practice. The age range was from 9 to 12 years. Two self-completed questionnaires were used: The California Bullying Victimisation Scale (CBVS) and the Strengths and Difficulties Questionnaire (SDQ). The project design was a prospective case series.

RESULTS

Self-completed assessments revealed levels of social well-being for both questionnaires comparable to populations with normal hearing. CBVS results showed that a total of 52.6% reported being 'not a victim', 36.8% peer victims and 10.5% bully victims. Results from SDQ revealed that 94.7% of the children reported being within the normal level for scores on both social strength and difficulties, 5.3% scored slightly raised/lowered and 0% had high/low scores or very high/low scores.

CONCLUSION

The new group of children with HL presented with self-completed scores comparable to peers with normal hearing. It is time to raise expectations for children with HL in terms of not only outcomes on audition and spoken language but also most importantly on levels of social well-being. Furthermore, it is discussed whether this new group can also be defined as a new generation of children with HL.

Deaf and hard-of-hearing children and adolescents' mental health, Quality of Life and communication

Mental health problems and lower Quality of Life (QoL) are more common in deaf and hard-of-hearing - (D)HH - children than in typically hearing (TH) children. Communication has been repeatedly linked to both mental health and QoL. The aims of this study were to compare mental health and QoL between signing deaf and hard-of-hearing (DHH), hard-of-hearing (HH) and TH children and to study associations between mental health/QoL and severity of hearing loss and communication. 106 children and adolescents (mean age 11;8; SD = 3.42), 59 of them DHH and 47 HH, and their parents reported child mental health and QoL outcomes. Parents also provided information about their children's communication, hearing loss and education while their children's cognitive ability was assessed. Although (D)HH and their parents rated their mental health similar to their TH peers, about twice as many (D)HH children rated themselves in the clinical range. However, (D)HH children rated their QoL as similar to their TH peers, while their parents rated it significantly lower. Associations between communicative competence, parent-reported mental health and QoL were found, whereas severity of hearing loss based on parent-report had no significant association with either mental health or QoL. These results are in line with other studies and emphasise the need to follow up on (D)HH children's mental health, QoL and communication.

Features of Cognitive Ability and Central Auditory Processing of Preschool Children With Minimal and Mild Hearing Loss

OBJECTIVE

This study aimed to investigate the current status of cognitive development and central auditory processing development of preschool children with minimal and mild hearing loss (MMHL) in Nanjing, China.

METHOD

We recruited 34 children with MMHL and 45 children with normal hearing (NH). They completed a series of tests, including cognitive tests (i.e., Wechsler Preschool and Primary Scale of Intelligence and Continuous Performance Test), behavioral auditory tests (speech-in-noise [SIN] test and frequency pattern test), and objective electrophysiological audiometry (speech-evoked auditory brainstem response and cortical auditory evoked potential). In addition, teacher evaluations and demographic information and questionnaires completed by parents were collected.

RESULTS

Regarding cognitive ability, statistical differences in the verbal comprehensive index, full-scale intelligence quotient, and abnormal rate of attention test score were found between the MMHL group and the NH group. The children with MMHL performed poorer on the SIN test than the children with NH. As for the auditory electrophysiology of the two groups, the latency and amplitude of some waves of the speech-evoked auditory brainstem response and cortical auditory evoked potential were statistically different between the two groups. We attempted to explore the relationship between some key indicators of auditory processing and some key indicators of cognitive development.

CONCLUSIONS

Children with MMHL are already at increased developmental risk as early as preschool. They are more likely to have problems with attention and verbal comprehension than children with NH. This condition is not compensated with increasing age during the preschool years. The results suggest a possible relationship between the risk of cognitive deficit and divergence of auditory processing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22670473.

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.

Social communication and quality of life in children using hearing aids

OBJECTIVES

This study compared the parent-reported structural language and social communication skills-measured with the Children's Communication Checklist-2 (CCC-2)-and health-related quality of life (HR-QOL)-measured with the Pediatric Quality of Life Inventory (PedsQL)-of children who use hearing aids (HAs) and their typical-hearing (TH) peers.

DESIGN

The participants were 88 children (age range of 5; 6 to 13; 1 (years; months)) and their parents: 45 children with bilateral moderate to severe hearing loss using HAs who had no additional disabilities and 43 children with typical hearing. The groups were matched based on chronological age, gender, nonverbal IQ, and parental education level. The parents completed questionnaires related to their children's communication skills, including subdomains structural language and social communication, and HR-QOL.

RESULTS

The HA group had significantly poorer overall communication skills than the TH group (r = 0.49). The children in the HA group scored significantly lower than the TH group on both structural language (r = 0.37) and social communication (r = 0.41). Half of the children in the HA group had overall communication scores that either indicated concern or required further investigation according to the instrument's manual. In terms of psychosocial functioning, which was measured as HR-QOL, the subdomain school functioning was the main driver of the difference between groups, with the HA group being at least twice as likely (OR = 2.52) as the TH group to have poor HR-QOL in the school domain. Better parent-reported social communication was associated with better parent-reported psychosocial functioning in the children using HAs-even when background variables were taken into account.

CONCLUSION

The results suggest that traditional assessments and interventions targeting structural aspects of language may overlook social communication difficulties in children with HAs, even those with no additional disabilities. As school functioning stood out as the most problematic domain for children with HAs, efforts to improve the well-being of these children should focus on this area.

Cost-Effectiveness of Screening Preschool Children for Hearing Loss in Australia

OBJECTIVES

While all newborns in Australia are tested for congenital hearing loss through universal newborn hearing screening programs, some children will acquire hearing loss in their first five years of life. Delayed diagnosed or undiagnosed hearing loss in children can have substantial immediate- and long-term consequences. It can significantly reduce school readiness, language and communication development, social and emotional development, and mental health. It can also compromise lifetime educational achievements and employment opportunities and future economic contribution to society through lost productivity. The need for a universal hearing screening program for children entering their first year of primary school has been noted in two separate Australian Government hearing inquiries in the last decade. Sound Scouts is a hearing screening application (app) that tests for hearing loss in children using a tablet or mobile device, supervised by parents at home. It tests for sensorineural or permanent conductive hearing loss and central auditory processing disorder in children. In 2018 the Australian Government funded the roll-out of Sound Scouts to allow up to 600,000 children to test their hearing using Sound Scouts. This study estimated the cost-effectiveness of screening 5-year-old children for hearing loss using Sound Scouts at home, compared with no screening.

DESIGN

A decision-analytic model was developed to estimate the incremental costs and quality-adjusted life years (QALYs) of administering Sound Scouts over a 20-year time horizon. Testing accuracy was based on comparing Sound Scouts test results to clinical test results while other parameters were based on published data. Costs were estimated from the perspective of the Australian health care system. Univariate and probabilistic sensitivity analyses were undertaken.

RESULTS

Sound Scouts is estimated to result in an average incremental cost of A$61.02 and an average incremental increase in QALYs of 0.01. This resulted in an incremental cost-effectiveness ratio of A$5392 per QALY gained, which is likely to be considered cost-effective by Australian decision makers. Screening with Sound Scouts was found to have a 96.2 per cent probability of being cost-effective using a threshold of A$60,000 per QALY gained.

CONCLUSIONS

Using Sound Scouts to screen five-year-old children for hearing loss (at home) is likely to be cost-effective. Screening children using Sound Scouts will result in early identification and intervention in childhood hearing loss, thereby reducing early childhood disadvantage through cumulative gains in quality of life, education, and economic outcomes over their lifetime.

Emotions in Deaf and Hard-of-Hearing and Typically Hearing Children

For deaf and hard-of-hearing (DHH) children living in an environment where their access to linguistic input and social interactions is compromised, learning emotions could be difficult, which may further affect social functioning. To understand the role of emotion in DHH children's social life, this study investigated emotional functioning (i.e., emotion recognition, empathy, emotion expression), and its relation with social functioning (i.e., social competence and externalizing behaviors), in 55 DHH children and 74 children with typical hearing (aged 3-10 years; Mage = 6.04). Parental reports on children's emotional and social functioning and factors related to DHH children's hearing were collected. Results showed similar levels of emotional and social functioning in children with and without hearing loss. Use of auditory intervention and speech perception did not correlate with any measures in DHH children. In both groups, higher levels of empathy related to higher social competence and fewer externalizing behaviors; emotion recognition and positive emotion expression were unrelated to either aspect of social functioning. Higher levels of negative emotion expression related to lower social competence in both groups, but to more externalizing behaviors in DHH children only. DHH children in less linguistically accessible environments may not have adequate knowledge for appropriately expressing negative emotions socially.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

Developmental Outcomes in Early-Identified Children Who Are Hard of Hearing at 2 to 3 Years of Age

OBJECTIVES

This study examined the psychosocial, adaptive behavior, and language outcomes of young children who are hard of hearing (HH) without additional disabilities or neurocognitive impairments. Relations between early developmental outcomes and child and parent demographic variables, and parenting stress and self-efficacy were also explored.

DESIGN

Participants were 39 children with early identified, permanent mild to severe hearing loss, between the ages of 2 and 3 years, and a comparison group of 47 children with normal hearing (NH). Developmental outcomes were measured using clinician-administered standardized tests and parent-completed behavior rating instruments specific to language, psychosocial functioning, and adaptive behavior. Mothers completed self-report measures that assess parenting stress and maternal self-efficacy.

RESULTS

The children who are HH were similar to the children with NH in terms of their psychosocial functioning and adaptive behavior, with the exception of their socialization skills. As a group, the children who are HH performed significantly worse than their peers with NH on all measures of language ability. Among the children who are HH, maternal self-efficacy showed a strong positive correlation with adaptive behavior outcomes; however, it failed to contribute unique variance above that explained by language ability and gender. Maternal self-efficacy was also significantly correlated with better psychosocial outcomes, but only parenting stress proved to be a significant predictor of child behavioral problems once other variables considered were in the model.

CONCLUSIONS

Early-identified young children who are HH can demonstrate age-appropriate development in multiple domains, including language, psychosocial, and adaptive behavior. However, mild to severe hearing loss places young children with no additional disabilities or neurocognitive impairments at risk for language delays. Although the children who are HH demonstrated no more emotional or behavioral problems than their same-age peers with NH, results suggest that language delays increase their vulnerability for delays in various aspects of social competence.

Developmental outcomes of young deaf children and the self-perceived parental role of their hearing mothers

BACKGROUND

There is little research into the relationship between a deaf child's developmental outcomes and their mother's self-perceived parental role. The aim of this study was to find out whether the different levels of global psychomotor development in young deaf children who had a cochlear implant (CI), or were candidates for a CI, were related to particular family factors: the self-perceived parental role and the family quality of life (FQoL) as gauged by their hearing mothers, as well as the child's sociodemographic and deafness-related factors and the sociodemographic characteristics of the mothers.

METHODS

The study was conducted on a group of 64 children with bilateral severe or profound sensorineural hearing loss (SNHL) who were CI users (36 children) or qualified for cochlear implantation (28 children) and their hearing mothers. The age of the children ranged from 6.5 to 47 months (M = 23.6; SD = 10.1), among whom 55% were girls (n = 35). The mothers of the children were aged 24-48 years (M = 32.7; SD = 5.3). Information was collected via the Children Development Scale (CDS), the Self-Perception of Parental Role (S-PPR), the Family Quality of Life Survey (FQOLS-2006), and an additional information questionnaire which included questions about sociodemographic variables of the child and the mother, as well as questions related to deafness, the CI, and the child's rehabilitation.

RESULTS

Based on results of the CDS, the deaf children were divided into two groups: those who had a low level of global psychomotor development (Low global psychomotor development subgroup - LGPD) and others with medium or high scores (Medium/high global psychomotor development subgroup - MHGPD). The mothers of deaf children in the LGPD group assessed their investment in motherhood lower than did mothers from the MHGPD group. The mothers of the LGPD group rated their satisfaction with the child's rehabilitation lower than did mothers from the MHGPD group. The two subgroups did not differ in FQOLS-2006 domains except for community interactions, which were significantly higher in the MHGPD families.

CONCLUSIONS

Among the determinants of the global psychomotor development of a young deaf child, the most important ones relate to the use of a CI, but maternal investment in parenting is also important. Community interactions of the family with a deaf child are also crucial, as they create a framework for social network and support for the deaf child's optimal development. Any psychological diagnosis should include, apart from psychomotor development of the deaf child, an assessment of how the mother is coping with their parenting. Mothers of deaf children, especially those with LPGD, need additional support in parenting.

Prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents: a systematic review protocol

INTRODUCTION

Little is known of the prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents. Research suggests that this is a vulnerable population group at high risk of these disorders. However, little is known of correlates of prevalence estimates of these mental disorders and it seems that heterogeneous tools have been used to derive these estimates. Given the heterogeneity of studies measuring the prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents, we seek to systematically examine and synthesise observational epidemiological evidence in this area to articulate a more detailed account of these symptoms and disorders and their correlates among this population group.

METHODS AND ANALYSIS

We will conduct a systematic search of the following electronic databases to identify published observational epidemiological studies examining the prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents: EBSCOhost, ERIC, PsycARTICLES, PsycINFO, PubMED, ScienceDirect, SCOPUS and Web of Science. As research in this area is limited, eight databases have been included to widen our search to include as many articles as possible. The search terms will be related to mental and neurodevelopmental symptoms and disorders as well as deaf children and adolescents. Two reviewers will review and extract data from each article independently and, where relevant, discuss differences to reach consensus. Additionally, the reviewers will assess overall study quality and risk of bias using a quality appraisal scale. Findings from studies will be synthesised to produce a quantitative review that summarises existing evidence on mental and neurodevelopmental symptoms and disorders among deaf children and adolescents and their correlates. The publication date of studies will not be restricted so that as much data as possible that fit our inclusion criteria can be sourced. We will conduct our searches between August 2020 and March 2021.

ETHICS AND DISSEMINATION

This systematic review will use publicly available data and therefore does not require a direct ethical review. The protocol was however submitted for ethics waiver clearance with Stellenbosch University Health Research Ethics Committee. The protocol will be disseminated in a peer-reviewed journal. The review protocol was registered with the PROSPERO International Prospective Register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO).

PROSPERO REGISTRATION NUMBER

CRD42020189403.

Perception of vocal emotional prosody in children with hearing impairment

PURPOSE

The study aimed at testing the effect of supra segmental training on vocal emotional prosody perception of children with hearing impairment. The objectives of the study were to compare the perception of vocal emotional prosody (happy, sad, and neutral) in children with hearing impairment with and without a short-term prosody training and to draw correlations between the vocal emotional prosody perception scores and the subject factors - chronological age, age of hearing aid fitting, duration of the intensive intervention (speech, language and auditory training without breaks more than 30 days) and language age in children with hearing impairment.

METHOD

Thirty children with hearing impairment in the age range of 4.1-9.2 years with a language age of 3-7 years participated in the study. The authors formulated 24 concrete Malayalam sentences and their picture representations and these were recorded under three emotional variations (happy, sad, and neutral). Using random sampling, the thirty participants were divided into the control group (CWHI) and the experimental (CWHIt) group. The study was carried out in two phases; phase 1 (training) attended by only the experimental group and phase 2 (testing) attended by both the groups.

RESULTS

There was a significant difference between CWHI and CWHIt in the happy, sad, and neutral vocal emotional prosody conditions. Chronological age, duration of speech-language-auditory training, and language age showed a positive correlation with the vocal emotional prosody perception scores; and no correlation was found between the age of fitting of hearing aids and the emotion perception scores.

CONCLUSION

The results of the study points out that with adequate prosody training, the children with hearing impairment using benefiting hearing aids could improve their vocal emotional prosody perception. Owing to the role of prosody perception in speech & language, social and cognitive development, the supra segmental training should be made an integral part of the assessment and management intervention strategies.

Peer-Victimization of Young Children With Developmental and Behavioral Difficulties-A Population-Based Study

OBJECTIVE

The aim is to investigate if young children with developmental and behavioral difficulties (DBDs) have greater risk of peer-victimization compared with typically developing (TD) children.

METHOD

The sample was drawn from the Norwegian Mother and Child Cohort Study (MoBa). MoBa has collected population-based data on children's health and development for 114,500 children. We included children that were 5 years of age (n = 41,609). Multivariate logistic regression was used to estimate the effect of different DBDs and of co-occurring DBDs on peer-victimization compared with TD children. Categories of DBDs included autistic traits, emotional difficulties, behavioral difficulties, general learning difficulties, attention difficulties/impulsive behavior, motor development difficulties, language difficulties, and hearing and vision difficulties. Results were adjusted for socioeconomic status and the child's sex.

RESULTS

Peer-victimization was 2.8% (933) among TD children, and 8.0% (615) among children with DBD. The highest risk of peer-victimization was found among children with autistic traits and children with five or more co-occurring DBDs (adjusted odds ratios [ORs] = 12.76; 95% confidence interval [CI] 8.64-18.84; p ≤ .001) and 17.37 (95% CI 12.15-24.82; p ≤ .001)], respectively. The lowest risk was found among children with hearing and vision difficulties and children with only one DBD [adjusted ORs = 1.98 (95% CI 1.71-2.29; p ≤ .001) and 1.95 (95% CI 1.70-2.22; p ≤ .001)].

CONCLUSION

Children with DBD have a substantially higher risk of peer-victimization compared with TD children. Peer-victimization varies with type of DBD and increases cumulatively by number of DBDs.

Peer Relationship Experiences Of Deaf And Hard-Of-Hearing Adolescents

Deaf and hard-of-hearing adolescents (DHH) experience more peer problems and lower levels of friendships than their hearing peers. This study used a qualitative approach to identify their experiences of peer problems and factors influencing them. A sample of 30, 13-19 year-old DHH adolescents with a moderate to profound hearing loss, drawn from a population-based cohort study in which their receptive language and social-emotional skills had been assessed, underwent semi-structured interviews. Interviews were analyzed using thematic analysis. Participants reported that, overall, they had developed positive and rewarding relationships with their peers, notwithstanding their earlier experience of being bullied. Conflicts and infrequency of interaction in their friendships were mainly reported by girls. Adolescents with moderate hearing loss were identified as facing the same or even more barriers than adolescents with severe to profound hearing loss in making new friends. Implications for educational practice are discussed.

Talk with me! Parental linguistic input to toddlers with moderate hearing loss

This study examined the quantity and quality of parental linguistic input to toddlers with moderate hearing loss (MHL) compared with toddlers with normal hearing (NH). The linguistic input to eighteen toddlers with MHL and twenty-four toddlers with NH was examined during a 10-minute free-play activity in their home environment. Results showed that toddlers with MHL were exposed to an equivalent amount of parental linguistic input compared to toddlers with NH. However, parents of toddlers with MHL used less high-level facilitative language techniques, used less mental state language, and used shorter utterances than parents of toddlers with NH. Quantity and quality measures of parental linguistic input were positively related to the expressive language abilities of toddlers with MHL.

Cochlear Implantation and Social-Emotional Functioning of Children with Hearing Loss

This study examined the contribution of cochlear implants (CIs) to the social-emotional functioning of children who are deaf or hard of hearing (dhh). Sixty-three parents of children who are dhh participated in the study. Thirty children were CI users and 32 used hearing aids (HAs). They completed the Strengths and Difficulties Questionnaire and a background questionnaire. Parents of children with CIs reported lower levels of hyperactivity/inattention and higher levels of pro-social behavior compared to parents of children with HAs. Additionally, older age when hearing loss was detected was related to more pro-social behavior, and age at implantation among CI users was negatively correlated with children's hyperactivity/inattention and conduct problems. These findings add to the existing knowledge about the many benefits of CIs for individuals with hearing loss and emphasize the possible impact of early implantation to children's social-emotional functioning.

Hearing and ear status of Pacific children aged 11 years living in New Zealand: the Pacific Islands families hearing study

OBJECTIVE

This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems.

DESIGN

A cross-sectional observational study design nested within a birth cohort was employed.

STUDY SAMPLE

Nine-hundred-twenty Pacific children aged 11 years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20 dB hearing loss. Hearing loss was mild (20-39 dB) in most cases; 2% of ears had moderate to moderate-severe (40-69 dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2 years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11 years.

CONCLUSIONS

Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children.

Effectiveness of intervention with visual templates targeting tense and plural agreement in copula and auxiliary structures in school-aged children with complex needs: a pilot study

This pilot study aims to evaluate the effectiveness of a school-based intervention using visual strategies for improving accurate use of auxiliary and copula marking in singular and plural, past and present tense by students with moderate learning disability and complex needs. Eleven students, aged 10-14 years, in a specialist school based in the UK, participated in the study. A within participants design was used which included testing at baseline, pre- and post-intervention to consider progress with intervention as compared with progress during a baseline period of similar length. The experimental intervention consisted of eight, bi-weekly, 20 minute sessions, over a four week period, in small groups, in a classroom setting. Half of the participants focused on the auxiliary and half on the copula, but all were tested on both. Techniques included the use of visual templates and rules (the Shape Coding^TM system) to support explicit instruction. Eight participants made greater progress during the intervention term than during the baseline term and this was significant at a group level (d = 0.92). A comparison of progress to zero was not significant during the baseline period (d = 0.15) but was during the intervention period (d = 1.07). Progress also appeared to generalise from the targeted to non-targeted structure. This pilot study therefore provides preliminary evidence that older students with complex needs can make progress with morphology when intervention includes explicit instruction and visual templates and that generalisation may be observed.

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

OBJECTIVE

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

DESIGN

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

STUDY SAMPLE

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

RESULTS

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

CONCLUSION

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

Emotional and behaviour difficulties in teenagers with permanent childhood hearing loss

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Emotion Understanding in Preschool Children with Mild-to-Severe Hearing Loss

Deaf and hard of hearing school-aged children are at risk for delayed development of emotion understanding; however, little is known about this during the preschool years. We compared the level of emotion understanding in a group of 35 4-5-year-old children who use hearing aids to that of 130 children with typical hearing. Moreover, we investigated the parents' perception of their child's level of emotion understanding. Children were assessed with the Test of Emotion Comprehension. Parents were presented with the same test and asked to guess what their child answered on each item. The results showed that children with hearing loss performed at the same level as typically hearing children, despite having lower vocabulary scores. Parents of children with hearing loss were more accurate in their estimations of their child's competence, and higher accuracy was associated with better emotion understanding. These findings may have implications for early intervention planning.

Mental Disorders in Deaf and Hard of Hearing Adult Outpatients: A Comparison of Linguistic Subgroups

Deaf and hard of hearing (DHH) individuals who use signed language and those who use spoken language face different challenges and stressors. Accordingly, the profile of their mental problems may also differ. However, studies of mental disorders in this population have seldom differentiated between linguistic groups. Our study compares demographics, mental disorders, and levels of distress and functioning in 40 patients using Norwegian Sign Language (NSL) and 36 patients using spoken language. Assessment instruments were translated into NSL. More signers were deaf than hard of hearing, did not share a common language with their childhood caregivers, and had attended schools for DHH children. More Norwegian-speaking than signing patients reported medical comorbidity, whereas the distribution of mental disorders, symptoms of anxiety and depression, and daily functioning did not differ significantly. Somatic complaints and greater perceived social isolation indicate higher stress levels in DHH patients using spoken language than in those using sign language. Therefore, preventive interventions are necessary, as well as larger epidemiological and clinical studies concerning the mental health of all language groups within the DHH population.