The Real Markers of Success in cochlear implantation in young … · 2018-04-03 · The Real...
Transcript of The Real Markers of Success in cochlear implantation in young … · 2018-04-03 · The Real...
The Real Markers of Success in cochlear implantation in young children:
Social Skills & Theory of Mind
CI 2015 SymposiumOctober, 2015
Washington, DC
Aleisha DAVIS, Katie NEAL, Yetta ABRAHAMS, Tracy HOPKINS, Alyshia HANSEN, Janna WELLER
Thursday, October 15th, 1.45-3.15pmNo Disclosures
Speech, Language and VocabularyOutcomes from Early Intervention Graduation (CA5 & 6yrs)
Age appropriate speech and language is possible by 3 years (Ching, 2011).
This trajectory can be improved and maintained at 4 & 5 years &…
Speech, Language and Vocabulary
Early EI & HA fitting (CI < 6 Months)
Early EI & HA fitting (CI 6-12 Months)
Early EI & HA fitting (CI > 12 Months)
Early EI & Late HA fitting (CI > 12 Months)
Late EI & HA fitting (CI >12 Months)
Age
Gro
up
ing
for
Inte
rven
tio
n, f
itti
ng
and
CI
Median Total Language Score n=98
What makes language and communication
successful?
Well Spoken “Language”
• But “COMMUNICATION”
= how it is used
Social Skills: Ways of dealing with others to create positive interactions; the route to creating and developing relationships,
Learnt through experience with peers/parents
Social Inclusion: The connectedness of the individual with their
social setting rather than purely their ‘presence’
Pragmatics: Context and it’s contribution to meaning.
Social Inclusion: The connectedness of the individual with their
social setting rather than purely their ‘presence’
Theory of Mind: The ability to make inferences about the beliefs and desires of other people
Mentally put ourselves in another’s shoes and have a sense of what they are thinking/feeling
A predictor of key social childhood competences: e.g., social interactional skills, and consequently interactions and peer
popularity (Wellman & Liu, 2004)
Neuro Linguistic
Linguistic/ Cognitive
Pragmatic
lexical enrichment (the child gains from
acquiring a rich mental-state vocabulary)
syntactic enrichment (the child gains from
acquiring syntactic tools for embedding one thought in another)
pragmatic enrichment (the child gains from conversations where
varying perspectives on a topic are articulated).
Morphological changes are hallmarks of sensory
deficits.What influence does this
architectural change have on ongoing development? Harnessing neuroplasticity.
Embedded structures - relationship to meaning and comprehension.
Implications for language based assessment?
lexical enrichment (the child gains from
acquiring a rich mental-state vocabulary)
syntactic enrichment (the child gains from
acquiring syntactic tools for embedding one thought in another)
pragmatic enrichment (the child gains from conversations where
varying perspectives on a topic are articulated).
Mental state language Knowledge and opportunity
What happens when social skills; pragmatics and ToM are
compromised?
When faced with threat of being stigmatized, to seemingly protect themselves, individuals disconnect from social supports, therein reducing their coping or
adaptive capacity Hogan et al. (2012)
Atypical + Delayed Acquisition
Diverse desires: people like different thingsDiverse beliefs: people think different thingsKnowledge access: seeing (or hearing!) is knowing False beliefs: people can think something that I know is not trueReal vs apparent emotion: people can pretend and hide how they feel.
Typical Acquisition
Could not conceive someone liking or believing differently to
themselves HOWEVER
Passed knowledge access & false belief (? insight into what someone
is thinking but more impersonal/ concrete).
Acquiring skills in an appropriate developmental order
BUT NOTAn appropriate number of skills for
their age
Translational research n=50
Bilateral >90dBHL Bilateral 75-89dBHL (4FA better ear)
Bilateral 55-74dBHL (4FA better ear)
Unilateral
Hearing Aid n=8
Cochlear Implant n=30
Unilateral Cochlear Implant n=5
Bone Conductor n=2
Baha n=1
No Device n=4
Age at assessment (yrs) n=50
3yrs 7.5%4yrs 38%
5years 55.5%
Symmetry n=50Unilateral Hearing Loss 26%Bilateral Hearing Loss 64%
Atypical & Delayed
Typical Hearing Average Age 5,7yrs
(Atypical 8%)
(Wellman & Liu, 2004)
Bilateral HL (Atypical = 62%
p=0.0004)
Unilateral HL(Atypical =45%p=0.0005)
Atypical/delayed acquisition
Typical acquisition
% o
f C
hild
ren
n w
ith
typ
ical
/at
ypic
al/d
elay
ed
ac
qu
isit
ion
Atypical & Delayed
Typical Hearing Average Age 5,7yrs
(Atypical 8%)
(Wellman & Liu, 2004)
Bilateral HL (Atypical = 62%
p=0.0004)
Unilateral HL(Atypical =45%p=0.0005)
Atypical/delayed acquisition
Typical acquisition
% o
f C
hild
ren
n w
ith
typ
ical
/at
ypic
al/d
elay
ed
ac
qu
isit
ion
Typical acquisition Atypical/delayed acquisition
LanguageDelayed Language
Language WNL
Does socio-economic status matter?
Atypical/delayed acquisition
Typical acquisition
Lowest SES Highest SES
Socio-economic Indexes for Areas (SEIFA) Ranking
Cultural & Linguistic diversity
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
English Only
Atypical/delayed acquisition
Typical acquisition
Bilingual Exposure ESL/Majority other than English
% o
f ch
ildre
n w
ith
typ
ical
or
atyp
ical
/d
elay
ed a
cqu
isit
ion
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FLI not in range of concern FLI in range of concern
Listening Skills
Hearing levels & Device Type
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Typical Hearing Average Age 5,7yrs
(Atypical 8%)
(Wellman & Liu, 2004)
Bilateral CI >90dbHL Bilateral CI 55-89dbHL Bilateral HA 55-89dBHL Unilateral
% Typical acquisition
% Atypical/ Delayed acquisition
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All children with additional needs that impact learning had Atpical/delayed acquisition
The influence of Age
10
25
40
55
70
85
100
115
130
145
>90dBHL CI< 6 months
>90dBHL CI 6-12 months
>90dBHL CI > 13 months
75-85dBHL CI <12 months
75-85dBHL CI >13 months
55-74dBHL CI <12 months
55-74dBHL CI >13months
55-74dBHL HA<12 months
55-74dBHL HA >13months
Tota
l Lan
guag
e Sc
ore
n=9
8
CI for profound bilateral HL CI for 74-89dBHL 4FA CI 55-74dBHL 4FA HA 55-74dBHL 4FA
Best standard language scores are for children implanted <12 months, irrespective of residual hearing, and some children with moderate SNHL using HA fitted < 12 months
Timing important
Bilateral >90dbHL CI < 12 Months
Bilateral >90dbHL CI < 12 Months
Bilateral 55-89dBHL CI <12 Months
Bilateral 55-89dBHL CI > 12 Months
Typical Hearing Average Age 5,7yrs
(Atypical 8%)
(Wellman & Liu, 2004)
% Typical acquisition
% Atypical/Delayed acquisition
Considerations for development in children with hearing loss
• Age of Implant• Unilateral vs
Bilateral (more typical
acquisition for unilateral)
• Additional needs that impact learning (all children had atypical/delayed pattern)
No effect Observed Impact Possible Impact
• CI under 12 months
• Listening Skill (69% with Atypical/delayed acquisition are in the range of concern)
• Hearing level (linked to age of optimal access and device compliance)
• Language exposure
• SES • Birth Order • Languages
other than English
Considerations for development in children with hearing loss
• Age of Implant• Unilateral vs
Bilateral (more typical
acquisition for unilateral)
• Additional needs that impact learning (all children had atypical/delayed pattern)
No effect Observed Impact Possible Impact
• CI under 12 months
• Listening Skill (69% with Atypical/delayed acquisition are in the range of concern)
• Hearing level (linked to age of optimal access and device compliance)
• Language exposure
• SES • Birth Order • Languages
other than English
Overhearing Optimising access
Distance /BGNTonal Detection
Focusing of specific language
structures Assistive listening
devices
Intervention Parental input
Opportunity to failService delivery
Direct and indirect learning
Use of mental state language
Concrete vs abstract
Identification Amplification Intervention
Language levelDegree of hearing
loss Changed sensory
pathways
Practical Translation: Confident Kids
pragmatic enrichment (the child gains from conversations where varying perspectives on
a topic are articulated).
Neurological enrichment (harnessing neuroplasticity
providing opportunity).
lexical enrichment (the child gains from acquiring a rich mental-state vocabulary)
syntactic enrichment (the child gains from acquiring syntactic
tools for embedding one thought in another).
• Informing parents about the development of social interaction and providing opportunity for exposure for children has a positive effect for both in the development of social skills
• While ToM is strongly correlated to the development of social & pragmatic skills further analysis is required to understand the links between atypical/delayed acquisition and what this means for social and pragmatic skill development.
The Shepherd Centre team
Thank you to the children and families that share their
journey with us.
We’d also like to acknowledge past TSC staff members who have contributed to the design and
implementation of our Theory of Mind research
ReferencesAstington JW, Jenkins JM. Theory of mind development and social understanding. Cognition and Emotion. 1995; 9:151-165.
Hughes C, Jaffe SR, Happe F, Taylor A, Caspi A, Moffitt TE. Origins of individual differences in Theory of Mind: From nature to nurture? Child Development. 2005; 76:356-370.
Ching, T. Y. C., Crowe, K., Martin, V., Day, J., Mahler, N., Youn, S., . . . . Orsini, J. (2010). Language development and everyday functioning of children with hearing loss assessed at 3 years of age. International Journal of Speech-Language Pathology, 12(2), 124-131.
Fitzpatrick, E. M., Crawford, L., Ni, A., & Durieux-Smith, A. (2011). A Descriptive Analysis of Language and Speech Skills in 4-to 5-Yr-Old Children With Hearing Loss. Ear and Hearing, 32(5), 605-616.
Fulcher, A., Purcell, A. A., Baker, E., & Munro, N. (2012). Listen up: Children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age. International Journal of Pediatric Otorhinolaryngology, 76(12), 1785-1794
Geers, A. E., & Sedey, A. L. (2011). Language and Verbal Reasoning Skills in Adolescents With 10 or More Years of Cochlear Implant Experience. Ear & Hearing, 32(1) Supplement, Long-Term Outcomes of Cochlear Implantation in Early(Childhood), 39S-48S.
Olson S, Lopez-Duran N, Lunkenheimer E, Chang H, Sameroff A. Individual differences in the development of early peer aggression: Integrating contributions of self-regulation, theory of mind, and parenting. Development and Psychopathology. 2011; 23:253-266.
Ruffman T, Slade L, Crowe E. The relation between children’s and mother’s mental state language and theory-of-mind understanding. Child Development. 2002; 73:734-751.
Santiesteban I, Sarah White S, Cook, Gilbert S, Heyes C, Bird G. Training social cognition: From imitation to Theory of Mind. Cognition. 2012; 122:228-235.
Schick B, de Villiers P, de Villiers J, Hoffmeister R. Language and theory of mind: A study of deaf children. Child Development. 2007; 78: 376-396.
Wellman H, Fuxi F, Peterson C. Sequential progressions in a theory of mind scale: Longitudinal perspectives. Child Development. 2011; 82(3):780-792.
Wellman H, Liu D. Scaling of theory of mind tasks. Child Development. 2004; 75:523-541.
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