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![Page 1: The impact of language underperformance on social and communication functioning in children with cochlear implants Jareen Meinzen-Derr, Susan Wiley, Sandra.](https://reader036.fdocuments.net/reader036/viewer/2022062714/56649cff5503460f949d15ff/html5/thumbnails/1.jpg)
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
![Page 2: The impact of language underperformance on social and communication functioning in children with cochlear implants Jareen Meinzen-Derr, Susan Wiley, Sandra.](https://reader036.fdocuments.net/reader036/viewer/2022062714/56649cff5503460f949d15ff/html5/thumbnails/2.jpg)
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
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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?
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Eligibility
Balanced regarding degree of hearing loss and age
3-6 Years
Bilateral hearing loss
prelingual
Nonverbal IQ >40
NVIQ40-79
NVIQ>80
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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
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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
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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
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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 100+15)
• Can measure adaptive behavior in different subgroups
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Defined Language “Gap”
LANGUAGE:COGNITIVE RATIO
IQ = 100LANGUAGE =
80
80/100 or (0.80*100)=80
Language abilities relative to cognitive abilities
>50% have a language to cognitive ratio <80
Receptive Language standard scoreNonverbal IQ standard score
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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 31.1 15.7
Bilateral CI 24 58.5%
Maternal education HS/GEDSome college
CollegePost graduate
715811
17%36.5%19.5%27%
Insurance PrivatePublic
Combo
16178
39%41.5%19.5%
Income <$50,000 20 50%
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Commun. Social Daily Motor Adaptive
VABS Standard Scores
50
55
60
65
70
75
80
85
90
95
100
105
110
Self Care Mobility Social Function
PEDI Standard Score
0
5
10
15
20
25
30
35
40
45
50
55
60
65
Functional Skill OutcomesVineland Adaptive Behavior
Scales(mean of 100)
Pediatric Evaluation of Disability Inventory
(t-score of 50)
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Vineland Adaptive Behavior Scales
(mean of 100)
Comm
.
Social
Daily
Mot
or
Adapt
50
60
70
80
90
100
110
CIHA
Pediatric Evaluation of Disability Inventory
(t-score of 50)
Self-care
Mobility Social-5
5
15
25
35
45
55
65
CIHA
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Communication and Social Function among Children with CI
VABS COMMUN. β P-VALUE PARTIAL R2 TOTAL R2
NONVERBAL IQ 0.25 0.034 0.315 0.315RECEPTIVE: IQ 0.34 0.003 0.266 0.581WORKING MEMORY -0.42 0.009 0.066 0.647SES SCORE 2.31 0.002 0.106 0.753
PEDI SOCIAL β P-VALUE PARTIAL R2 TOTAL R2
NONVERBAL IQ 0.48 <.0001 0.292 0.292RECEPTIVE: IQ 0.37 0.002 0.121 0.413PREMATURE -4.16 0.046 0.056 0.469UNKNOWN ETIOLOGY -7.7 0.058 0.052 0.521
NS: receiving therapy, aided SRT/SAT, duration with implant, age of implant, mom education
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Range of Nonverbal IQ
TOTAL IQ >95 IQ 80-95 IQ <80
PE
DI S
oc
ial F
un
ctio
n S
co
re
35404550556065707580859095
100105110115
LOW LANGUAGE
COMMENSURATE LANGUAGE
Adjusted mean PEDI social function scores (adjusted to scale of 100)
p=0.007
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Range of Nonverbal IQ
TOTAL IQ >95 IQ 80-95 IQ <80
Co
mm
un
icatio
n F
un
ctio
n S
co
re
50
55
60
65
70
75
80
85
90
95
100
105
110
115
LOW LANGUAGE
COMMENSURATE LANGUAGE
Adjusted Mean Vineland Communication Scores
p=0.008
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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
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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
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0-3 year old group:Language Gap is not widening with age
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Already seeing decline in social functioning with increasing age
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Early relationship between ratio and communication functioning
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Early relationship between ratio and social functioning
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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)
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Future Directions• Participation in 6 weeks of weekly aug comm
therapy followed by 6 weeks at home and final 6 weeks of therapy
• Useage of i-pad monitored• Language changes pre- to post- intervention
measured– Syntax, grammar, MLU
6 weeks intervention
6 weeks home
practice
6 weeks intervention
Evaluation, language sample
Evaluation, language sample
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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
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Thank YouSpecial 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
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Extra slides
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Range of Nonverbal IQ
TOTAL IQ >95 IQ 80-95 IQ <80
Co
mm
un
ica
tion
Fu
nctio
n S
co
re
50
55
60
65
70
75
80
85
90
95
100
105
110
115
LOW LANGUAGE
COMMENSURATE LANGUAGE
Communication function for cohort
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Range of Nonverbal IQ
TOTAL IQ >95 IQ 80-95 IQ <80
PE
DI S
oc
ial F
un
ctio
n S
co
re
35404550556065707580859095
100105110115
LOW LANGUAGE
COMMENSURATE LANGUAGE
Social Function for cohort