Psychosocial adjustment in adolescents who have used cochlear implants since preschool

Abstract

Objectives: This study examined psychosocial characteristics of students who had used a cochlear implant (CI) since preschool and were evaluated when they were in elementary grades and again in high school. The study had four goals: (1) to determine the extent to which psychosocial skills documented in elementary grades were maintained into high school; (2) to assess the extent to which long-term CI users identified with the Deaf community or the hearing world or both; (3) to examine the association between group identification and the student's sense of self-esteem, preferred communication mode, and spoken language skills; and (4) to describe the extracurricular world of the teenagers who were mainstreamed with hearing age-mates for most of their academic experience.

Design: As part of a larger study, 112 CI students (aged 15.0 to 18.6 yrs) or their parents completed questionnaires describing their social skills, and a subsample of 107 CI students completed group identification and self-esteem questionnaires. Results were compared with either a control group of hearing teenagers (N = 46) or age-appropriate hearing norms provided by the assessment developer.

Results: Average psychosocial ratings from both parents and students at both elementary grades and high school indicated a positive self-image throughout the school years. Seventy percent of the adolescents expressed either strong identification with the hearing community (32%) or mixed identification with both deaf and hearing communities (38%). Almost all CI students (95%) were mainstreamed for more than half of the day, and the majority of students (85%) were in the appropriate grade for their age. Virtually all CI students (98%) reported having hearing friends, and a majority reported having deaf friends. More than 75% of CI students reported that they used primarily spoken language to communicate and that good spoken language skills enabled them to participate more fully in all aspects of their lives. Identification with the hearing world was not associated with personal or social adjustment problems but was associated with better speech perception and English language skill. Ninety-four percent were active participants in high school activities and sports, and 50% held part-time jobs (a rate similar to that documented for hearing teens).

Conclusions: The majority of these early-implanted adolescents reported strong social skills, high self-esteem, and at least mixed identification with the hearing world. However, these results must be viewed in light of possible sources of sample selection bias and may not represent the psychosocial characteristics of the entire population of children receiving CIs.

Fig. 1

Mean ratings of 112 CI-HS students on the parent rating form and the student rating form of the Social Skills Rating Scale converted to a z score based on norms for typically developing (NS-TD) age mates. Error bars indicate SDs, and asterisks indicate means that are significantly higher (indicating better social skills) than the NS-TD: cooperation student rating (t[1,111] = 3.25; p < 0.002); self-control parent rating (t[1,108] = 3.09; p < 0.003); student rating (t[1,111] = 4.03; p < 0.0001).