The development of language and communication may play an important role in the emergence of behavioral problems in young children, but they are rarely included in predictive models of behavioral development. In this study, cross-sectional relationships between language, attention, and behavior problems were examined using parent report, videotaped observations, and performance measures in a sample of 116 severely and profoundly deaf and 69 normally hearing children ages 1.5 to 5 years. Secondary analyses were performed on data collected as part of the Childhood Development After Cochlear Implantation Study, funded by the National Institutes of Health. Hearing-impaired children showed more language, attention, and behavioral difficulties, and spent less time communicating with their parents than normally hearing children. Structural equation modeling indicated there were significant relationships between language, attention, and child behavior problems. Language was associated with behavior problems both directly and indirectly through effects on attention. Amount of parent–child communication was not related to behavior problems.

the CDaCI Investigative Team abstract BACKGROUND: Most children with hearing loss who receive cochlear implants (CI) learn spoken language, and parents must choose early on whether to use sign language to accompany speech at home. We address whether parents' use of sign language before and after CI positively influences auditory-only speech recognition, speech intelligibility, spoken language, and reading outcomes.

Objective-To examine the results of health-related quality of life questionnaire scores from profoundly deaf children fitted with at least one cochlear implant and compare responses to normal hearing age mates and to their parents.Study design-Cross sectional study utilizing a generic quality of life questionnaire designed to be completed by both parents and children independently of each other. Setting-Questionnaires completed at various summer camps designed for children with cochlear implants in Texas and Colorado.Subjects and Methods-Eighty-eight families from 16 states were divided in to two subgroups by age of cochlear implantation: an 8-11 year old group and one 12-16 year old group. The KINDL R Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents was distributed and participants completed the questionnaire independently from their participating family member.Results-CI users in both age groups scored similarly to their normal hearing peers and their parents. Younger CI users scored their family domain lower than their normal hearing peers. Teen CI users scored the school domain lower than their parents. Among CI participants, earlier implantation and longer cochlear implant use resulted in higher Quality of Life scores.Conclusion-Children with cochlear implants experience similar quality of life as normal hearing peers. Parents are reliable reporters on the status of their child's overall quality of life.

Objective-Children with hearing loss who use cochlear implants have lower quality of life (QoL) in social situations and lower self-esteem than hearing peers. The child's QoL has been assessed primarily by asking the parent rather than asking the child. This poses a problem because parents have difficulty judging less observable aspects like self-esteem and socio-emotional functioning, the domains most affected by hearing loss.Methods-This case-control study evaluated QoL in 50 preschoolers using a cochlear implant and their parents with the Kiddy KINDL R , an established QoL measure. Children's responses were compared to a hearing control group and correlated with demographic variables. We used a questionnaire for parents and a face-to-face interview with children. T-tests were used to compare (a) paired parent-child ratings and (b) children with cochlear implants versus normal hearing. Spearman rank correlations were used to compare QoL with demographic variables.Results-Children using cochlear implants rated overall QoL significantly more positively than their parents (M D = 4.22, p=.03). Child rating of QoL did not differ significantly by auditory status (cochlear implant (82.8) vs. hearing (80.8), p=0.42). Overall QoL correlated inversely with cochlear implant experience and chronologic age, but did not correlate with implantation age.Conclusions-Preschool children using cochlear implants can assess adequately their own QoL, but parents afford valuable complementary perspective on the child's socio-emotional and physical well-being. Preschool children using cochlear implants rate overall QoL measures similar to hearing peers. A constellation of QoL measures should be collected to yield a better understanding of general QoL as well as specific domains centered on hearing loss.

Parents of children and adolescents with CIs rate overall HRQoL positively across psychosocial domains. Significantly less positive ratings of education and effects of implantation may result from limited access to CI-related accommodations and varying parent expectations, warranting further exploration to maximize psychosocial and performance outcomes in pediatric CI users.

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Implementation of the PMSTB in clinical practice and dissemination of associated data are both critical for achieving the next level of success for children with hearing loss and for elevating pediatric hearing health care ensuring evidence-based practice for (re)habilitative audiology.

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