The impact of language underperformance on social and communication functioning in children with cochlear implants

Transcription

1 The impact of language underperformance on social and communication functioning in children with cochlear implants Jareen Meinzen-Derr, Susan Wiley, Sandra Grether, Holly Barnard, Julie Hibner, Daniel Choo, Laura Smith

2 Background Social and communication functional skills are essential for independence Skills require language Research in deaf/hard of hearing limited Functional performance commonly used to describe functional hearing Literature supports language acquisition, but often omits practical benefits of language

3 Objective To assess how language levels impact social and communication functioning in young children with cochlear implants Does having a language level that is lower than your cognitive abilities impact your daily functional skills?

4 Eligibility 3-6 Years Bilateral hearing loss NVIQ prelingual Nonverbal IQ >40 NVIQ >80 Balanced regarding degree of hearing loss and age

5 Assessment Tools Language Assessment: Preschool Language Scales -5 Neurocognitive Assessment: Leiter International Performance Scale-R, Behavioral Rating Inventory of Executive Function Functional Assessment Pediatric Evaluation of Disability Inventory Vineland Adaptive Behavior Scales

6 Outcome Measure Pediatric Evaluation of Disability Inventory Comprehensive standardized measure of essential daily functional activities 197 discrete functional skill items Self-care, mobility, social function Standard (mean 50+10) and Scaled Scores Useful in treatment planning and identifying specific areas where assistance is needed

7 Social Function Domain Comprehension Word Meanings Comprehension of Sentence Complexity Functional Use of Communication Complexity of Expressive Communication Problem-resolution Social Interactive Play (adults) Peer Interaction (child of similar age) Play with Objects Self-Information Time Orientation Household Chores Self-Protection Community Function

8 Outcome Measure Vineland Adaptive Behavior Scales Reflects the individual s personal and social skills as he/she interacts with environment 383 items Communication, Daily living skills, socialization, motor skills Standard scores (mean ) Can measure adaptive behavior in different subgroups

9 Defined Language Gap Language abilities relative to cognitive abilities Receptive Language standard score LANGUAGE:COGNITIVE RATIO Nonverbal IQ standard score LANGUAGE = 80 IQ = /100 or (0.80*100)=80 >50% have a language to cognitive ratio <80

10 Characteristics n=41 Mean Age of study (months) 58.5 SD 13 Male 20 49% Etiology of HL unknown 18 44% Born premature 3 7.3% Duration of Implant in months Bilateral CI % Maternal education Insurance HS/GED Some college College Post graduate Private Public Combo % 36.5% 19.5% 27% 39% 41.5% 19.5% Income <$50, %

11 Functional Skill Outcomes Vineland Adaptive Behavior Scales (mean of 100) Pediatric Evaluation of Disability Inventory (t-score of 50) V A B S S ta n d a r d S c o r e s Commun. Social Daily Motor Adaptive P E D I S ta n d a r d S c o r e Self Care Mobility Social Function

12 Vineland Adaptive Behavior Scales (mean of 100) Pediatric Evaluation of Disability Inventory (t-score of 50) CI HA CI HA 50-5

13 Communication and Social Function among Children with CI VABS COMMUN. β P-VALUE PARTIAL R 2 TOTAL R 2 NONVERBAL IQ RECEPTIVE: IQ WORKING MEMORY SES SCORE PEDI SOCIAL β P-VALUE PARTIAL R 2 TOTAL R 2 NONVERBAL IQ 0.48 < RECEPTIVE: IQ PREMATURE UNKNOWN ETIOLOGY NS: receiving therapy, aided SRT/SAT, duration with implant, age of implant, mom education

14 Adjusted mean PEDI social function scores (adjusted to scale of 100) PEDI Social Function Score p=0.007 COMMENSURATE LANGUAGE LOW LANGUAGE TOTAL IQ >95 IQ IQ <80 Range of Nonverbal IQ

15 Adjusted Mean Vineland Communication Scores Communication Function Score p=0.008 COMMENSURATE LANGUAGE LOW LANGUAGE TOTAL IQ >95 IQ IQ <80 Range of Nonverbal IQ

16 In Summary Low language performance has functional impact on communication and social skills Impact among a broad range of IQ Language does not have to be sub-normal Strive to meet a child s potential, but be cognizant of the role sub-optimal language levels Consider interventions specific for improving pragmatic language and social skills

17 What does this mean? Language is directly related to social and communication functioning Language gap significantly impacts this functioning negatively The gap does not mean below average It is easy to become complacent regarding normal language scores Current study includes 0-3y population to determine a developmental profile of children who may need early support

18 0-3 year old group: Language Gap is not widening with age

19 Already seeing decline in social functioning with increasing age

20 Early relationship between ratio and communication functioning

21 Early relationship between ratio and social functioning

22 Future Directions Pilot augmentative technology intervention trial Children enrolled in the study with a language gap (irrespective of technology use) are eligible for an assistive technology intervention Receive i-pad with Word Power software (locked down for other app use during intervention period)

23 Future Directions Participation in 6 weeks of weekly aug comm therapy followed by 6 weeks at home and final 6 weeks of therapy Evaluation, language sample 6 weeks intervention 6 weeks home practice 6 weeks intervention Evaluation, language sample Useage of i-pad monitored Language changes pre- to post- intervention measured Syntax, grammar, MLU

24 Early Qualitative Findings 2 children enrolled: 1 with average non-verbal IQ 1 with below average non-verbal IQ Quick learning noted by both Increased speech production within one session of therapy by child with non-verbal IQ Increased sentence length with better grammar in child with average IQ

25 Thank You Special thanks to Sandi Bechtol, RN Meredith Tabangin, MPH CCHMC Audiology Boys Town National Research Hospital (Mary Pat Moeller & Barbara Peterson) Participating Families HRSA MCHB R40MC21513, March of Dimes #12-FY14-178

26 Extra slides

27 Communication function for cohort Communication Function Score COMMENSURATE LANGUAGE LOW LANGUAGE TOTAL IQ >95 IQ IQ <80 Range of Nonverbal IQ

28 Social Function for cohort PEDI Social Function Score COMMENSURATE LANGUAGE LOW LANGUAGE TOTAL IQ >95 IQ IQ <80 Range of Nonverbal IQ