Psychosocial Outcomes in Long-Term Cochlear Implant Users

Abstract

Objectives: The objectives of this study were to investigate psychosocial outcomes in a sample of prelingually deaf, early-implanted children, adolescents, and young adults who are long-term cochlear implant (CI) users and to examine the extent to which language and executive functioning predict psychosocial outcomes.

Design: Psychosocial outcomes were measured using two well-validated, parent-completed checklists: the Behavior Assessment System for Children and the Conduct Hyperactive Attention Problem Oppositional Symptom. Neurocognitive skills were measured using gold standard, performance-based assessments of language and executive functioning.

Results: CI users were at greater risk for clinically significant deficits in areas related to attention, oppositional behavior, hyperactivity-impulsivity, and social-adaptive skills compared with their normal-hearing peers, although the majority of CI users scored within average ranges relative to Behavior Assessment System for Children norms. Regression analyses revealed that language, visual-spatial working memory, and inhibition-concentration skills predicted psychosocial outcomes.

Conclusions: Findings suggest that underlying delays and deficits in language and executive functioning may place some CI users at a risk for difficulties in psychosocial adjustment.

Figure 1.

Group difference in psychosocial outcomes. A, BASC parent-reported scales that significantly differ between CI and NH participants (collapsed across age). N = 57 CI users and N = 53 NH peers. Higher t scores on scales constituting the externalizing problem index, the internalizing problem index, and the behavioral symptoms index indicate behavioral deficits (scales to the left of vertical dashed line). Lower t scores on scales constituting the adaptive skills index indicate maladaptive behaviors (scales to the right of vertical dashed line). ***p < 0.001; **p < 0.01; *p < 0.05. B, CHAOS parent-reported scales that significantly differ between CI and NH participants (collapsed across age). N = 57 CI users and N = 52 NH peers. Higher raw scores indicate greater behavioral problems. ***p < 0.001; **p < 0.01. BASC indicates Behavior Assessment System for Children; CHAOS, Conduct Hyperactive Attention Problem Oppositional Symptom; CI, cochlear implant; NH, normal hearing.

Figure 2.

Number of elevated psychosocial scores. A, Number of elevated BASC index scores. The BASC contains 4 indices: externalizing problem, internalizing problem, behavioral symptoms, and adaptive skills. Percentages represent children with BASC t scores within the at-risk to clinically significant range. Externalizing problem index, internalizing problem index, and behavioral symptoms index (at-risk: t scores of 60–69; clinically significant: t scores ≥70); adaptive skills index (at-risk: t scores of 31–40; clinically significant: t scores ≤30). B, Number of elevated CHAOS subscale scores. The CHAOS contains 4 subscales: hyperactivity–impulsivity, oppositional behavior, conduct problems, and attention problems. Percentages represent children with CHAOS raw scores within the borderline problem (raw scores of 5–9) to problem (raw scores ≥10) range. BASC indicates Behavior Assessment System for Children; CHAOS, Conduct Hyperactive Attention Problem Oppositional Symptom.