Jean L. DesJardin

Comprehensive Evaluation of a Child With an Auditory Brainstem Implant

Objective: We had an opportunity to evaluate an American child whose family traveled to Italy to receive an auditory brainstem implant (ABI). The goal of this evaluation was to obtain insight into possible benefits derived from the ABI and to begin developing assessment protocols for pediatric clinical trials. Study Design: Case study. Setting: Tertiary referral center. Patient: Pediatric ABI Patient 1 was born with auditory nerve agenesis. Auditory brainstem implant surgery was performed in December, 2005, in Verona, Italy. The child was assessed at the House Ear Institute, Los Angeles, in July 2006 at the age of 3 years 11 months. Follow-up assessment has continued at the HEAR Center in Birmingham, Alabama. Intervention: Auditory brainstem implant. Main Outcome Measures: Performance was assessed for the domains of audition, speech and language, intelligence and behavior, quality of life, and parental factors. Results: Patient 1 demonstrated detection of sound, speech pattern perception with visual cues, and inconsistent auditory-only vowel discrimination. Language age with signs was approximately 2 years, and vocalizations were increasing. Of normal intelligence, he exhibited attention deficits with difficulty completing structured tasks. Twelve months later, this child was able to identify speech patterns consistently; closed-set word identification was emerging. These results were within the range of performance for a small sample of similarly aged pediatric cochlear implant users. Conclusion: Pediatric ABI assessment with a group of well-selected children is needed to examine risk versus benefit in this population and to analyze whether open-set speech recognition is achievable.

Relationships between speech perception abilities and spoken language skills in young children with hearing loss

The goal of this study was to examine the relationships between scores obtained from measures of speech perception and language in a group of young children with hearing loss (HL). Eighteen children (mean age = 4.3 years) and their mothers participated in this study. Speech perception was measured using the online imitative test of speech pattern contrast perception (OLIMSPAC). Standardized language age equivalent scores were obtained using the Reynell developmental language scales-III. Number of word tokens, word types, and mean length of utterance (MLU) were extracted from the childrens spontaneous language samples. Significant positive relationships were observed between childrens OLIMSPAC scores and both standardized language scores (r ranging from 0.60 to 0.69; p <0.01) and all measures derived from childrens spontaneous language samples (r ranging from 0.80 to 0.86; p<0.01). After controlling for child age, OLIMSPAC scores explained 34.1% of the variance in childrens MLU. Using a new speech perception measure with reduced language demands, strong positive correlations were evident between speech perception and language skills for a young group of children with HL.

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

The aims of this study were to examine the development of visual attention in deaf and hearing infants and toddlers, and assess whether improvements in visual attention were observed in the deaf sample after 12 months of cochlear implantation. A novel puppet task, based on a measure of attention developed with normally hearing infants, was administered to 88 deaf and 42 normal-hearing children at three time points: baseline, six and 12 months post-implantation for the deaf sample. At baseline, deaf children demonstrated significantly more inattentive looks during the puppet skits than hearing children, and these looks were of longer duration, confirming the results of prior studies which have documented deficits in visual attention in deaf children. Longitudinal analyses showed significant decreases in the frequency of inattentive looks for both groups, with a significant decrease in the duration of inattentive looks only for the cochlear implant group. The largest decrease in duration of off-task looks occurred at six months post-implantation, indicating that improvements occurred rapidly after restoration of auditory input. These results provided support for the ‘division of labor’ hypothesis which suggests that deaf children with no access or limited access to sound must monitor their environment visually, making it difficult for them to focus and attend to specific tasks. Cochlear implantation appeared to alter the developmental trajectory of visual attention in a positive manner. The clinical implications of visual attention for the development of early language, reading and social skills are discussed.

Developmental outcomes of early-identified children who are hard of hearing at 12 to 18 months of age

AIMS To examine the developmental outcomes of early-identified children who are hard of hearing, at 12 to 18 months of age, compared to those for children of similar age with normal hearing; and to investigate parent and child factors that are associated with these developmental outcomes. METHODS As part of a prospective study, 28 children with mild to severe hearing loss between the ages of 12 and 18 months and 42 children with normal hearing of similar age completed a comprehensive assessment battery. All children with hearing loss were identified by newborn hearing screening and amplified, on average, by 5 months of age. Outcome measures included: Mullen Scales of Early Learning; Preschool Language Scale-4th Ed; MacArthur-Bates Communicative Development Inventory; Infant-Toddler Social and Emotional Assessment; Vineland Adaptive Behavior Scales, Second Edition; Parenting Stress Index-Short Form; and Maternal Self-Efficacy Scale. RESULTS Children with hearing loss scored comparably to children with normal hearing on select outcome measures, with mean scores for both groups falling within normal limits. Greater maternal self-efficacy was associated with childrens better language skills, adaptive behavior, social-emotional competence, and fewer problem behaviors. CONCLUSION Very young children with mild to severe hearing loss, who are identified early and provided prompt intervention that includes amplification, can demonstrate age appropriate development in multiple domains. Results also underscore the significance of parenting factors, especially perceived maternal self-efficacy, in relation to positive developmental outcomes for these children early in life.

Sound Beginnings Supporting Families of Young Deaf Children With Cochlear Implants

For many families of young children who are deaf, a cochlear implant may be the most viable option for promoting spoken language development. Children may qualify for a cochlear implant as young as 12 months if they have demonstrated minimal benefit from conventional amplification. In order for oral language to occur, however, parents need to be fully involved in their childrens early-intervention program. This article presents 2 family constructs that are associated with language learning in young children with cochlear implants: parental involvement and maternal self-efficacy. After reviewing the theoretical and clinical applications of these family constructs, we provide practical suggestions for professionals working with families who have young children with cochlear implants.

Maternal Perceptions of Self-Efficacy and Involvement in the Auditory Development of Young Children with Prelingual Deafness

Maternal ratings of self-efficacy and involvement in early intervention were compared across two groups of mothers with young children with prelingual deafness: 24 mothers of children with hearing aids and 30 mothers of children with a cochlear implant. Although mothers of children with cochlear implants rated their childs early intervention program lower in quality, they perceived themselves as more efficacious in the care and maintenance of their childs sensory device and their involvement in developing their childs speech-language skills. Mothers of children with hearing aids had lower self-ratings of self-efficacy related to their childs sensory device and involvement in their childs early intervention program. Implications for early interventionists are discussed.

Parental Support for Language Development During Joint Book Reading for Young Children With Hearing Loss

Parent and child joint book reading (JBR) characteristics and parent facilitative language techniques (FLTs) were investigated in two groups of parents and their young children; children with normal hearing (NH; n = 60) and children with hearing loss (HL; n = 45). Parent–child dyads were videotaped during JBR interactions, and parent and child behaviors were coded for specific JBR behaviors using a scale developed for this study. Children’s oral language skills were assessed using the Preschool Language Scale–4 (PLS-4). Parents of children with HL scored higher on two of the four subscales of JBR: Literacy Strategies and Teacher Techniques. Parents of children with NH utilized higher level FLTs with their children who had higher language skills. Higher level FLTs were positively related to children’s oral language abilities. Implications are discussed for professionals who work with families of very young children with HL.

The Importance of the Home Literacy Environment for Developing Literacy Skills in Young Children Who Are Deaf or Hard of Hearing.

Four-year-old Olivia, who is deaf and has used a cochlear implant for 3 years, and her mother, Laura, enjoy looking at storybooks together at home. During storybook reading, Laura notices that Olivia tries to imitate some words that she reads to her yet does not seem to understand many words or story events. Laura is unsure whether to stop the storybook interaction and encourage Olivia’s attempts at word imitation and directly teach her the new vocabulary or continue reading the story for pleasure. Olivia’s preschool teacher, Ms. Lynn, also notices that Olivia displays a keen interest in storybook reading but is not able to answer or ask simple questions about the story. What can Laura and Ms. Lynn do collaboratively to support Olivia’s emerging language and literacy skills to better prepare Olivia for her upcoming transition into kindergarten?

Relationships Between Early Child Factors and School Readiness Skills in Young Children With Hearing Loss

The goal of this longitudinal study is to examine the relationships between early child factors (i.e., age at identification, enrollment in early intervention, oral language skills) and school readiness skills (i.e., conceptual knowledge) in a group of young children with hearing loss (HL). Standardized language, cognition, and conceptual knowledge measures were administered to eight preschool children with HL (age M = 4.0 years). Significant negative relationships were observed between age at identification and enrollment in early intervention and later school readiness skills. Positive associations emerged between children’s early oral language scores and later school readiness abilities. Individual analyses revealed that children who had lower language standard scores at Time 1 had low school readiness skills 1 year later (Time 2), especially in the area of mathematical concepts. Guidelines for early intervention professionals are provided to support school readiness skills in young children with HL.

Electric charge requirements of pediatric cochlear implant recipients enrolled in the childhood development after cochlear implantation study

Objective: To evaluate mapping characteristics of children with cochlear implants who are enrolled in the Childhood Development After Cochlear Implantation (CDACI) multicenter study. Study Design: Longitudinal evaluation during 24 months of speech processor maps of children with cochlear implants prospectively enrolled in the study. Setting: Six tertiary referral centers. Subjects: One hundred eighty-eight children enrolled in the CDACI study who were 5 years old or younger at the time of enrollment. Of these children, 184 received unilateral implants, and 4 received simultaneous bilateral implants. Intervention: Children attended regular mapping sessions at their implant clinic as part of the study protocol. Maps were examined for each subject at 4 different time intervals: at device activation and 6, 12, and 24 months postactivation. Main Outcome Measures: Mean C/M levels (in charge per phase) were compared for 4 different time intervals, for 3 different devices, for 6 different implant centers, and for children with normal and abnormal cochleae. Results: All 3 types of implant devices demonstrate significant increases in C/M levels between device activation and the 24-month appointment. Significant differences in mean C/M levels were noted between devices. Children with cochlear anomalies demonstrate significantly greater C/M levels than children with normal cochleae. Conclusion: The CDACI study has enabled us to evaluate the mapping characteristics of pediatric patients who use 3 different devices and were implanted at a variety of implant centers. Analysis of such data enables us to better understand the mapping characteristics of children with cochlear implants.