Assessing the use of speech and language measures in relation to parental perceptions of development after early cochlear implantation

Abstract

Objective: Clinicians and investigators use multiple outcome measures after early cochlear implantation (CI) to assess auditory skills, speech, and language effects. Are certain outcome measures better associated with optimal childhood development from the perspective of parents? We studied the association between several commonly used outcome instruments and a measure of parental perceptions of development to gain insight into how our clinical tests reflect parental perceptions of a child's developmental status.

Study design: Cross-sectional analysis.

Setting: Six academic centers.

Patients: One hundred eighty-eight deaf children (<6 yr) 1 year after CI activation enrolled in the longitudinal Childhood Development after CI study.

Main outcome measures: Measures of auditory skills, speech, and language. Parental perceptions of development quantified with a visual analogue scale (visual analogue scale-development).

Methods: Nonparametric and parametric regression methods were used to model the relationship between outcome measures and visual analogue scale-development scores.

Results: All outcome measures were positively associated with parental perceptions of development, but more robust associations were observed with language measures and a parent-report scale of auditory skills than with a selected measure of closed-set speech. For speech and language data, differences were observed in the trajectories of associations among younger (2-3 yr) versus older (4-5 yr) children.

Conclusion: Our results demonstrate the importance of measuring multiple outcome measures after early pediatric CI. The degree to which an outcome measure reflects childhood development as perceived by parents may be affected by the child's age. Measures that are based on parental report and broader outcome measures focused on verbal language offer the potential for a fuller understanding of the true effectiveness of early implantation.

FIG. 1

Simplified model of domains of development hypothesized to result from cochlear implantation (Cl) of prelingually deaf children. Outcome measures used with CI can target multiple points along this cascade, with most current measures focused on auditory skills, speech, and language. Measures of communication and childhood development are less well defined. MAIS indicates meaningful auditory integration scale; ESP, Early Speech Perception Test; PSI, Pediatric Speech Intelligibility Test; PBK, Phonetically Balanced Kindergarten Word List; HINT, Hearing in Noise Test; OWLS, Oral and Written Language Scales. The various psychological measures used to assess child development can include measures of visual attention, social skills, and child behavior.

FIG. 2

Nonparametric trajectory of VAS-development over MacArthur and Reynell language scores. Solid circle indicates MacArthur (2–3 yr old); hollow circle, Reynell (2–3 yr old); solid triangle, MacArthur (4–6 yr old); hollow triangle, Reynell (4–6 yr old).

FIG. 3

Box plots of VAS-development scores stratified by ESP test scores. ESP categories 1 to 2 indicate none to some pattern perception; ESP categories 3 to 4, some to consistent word identification.

FIG. 4

Nonparametric trajectory of VAS-development over MAIS scores. Hollow circle indicates 2 to 3 years old; solid circle, 4 to 5 years old.