Cochlear Implantation Can Improve Auditory Skills, Language and Social Engagement of Children With Autism Spectrum Disorder

Abstract

Objective: To review outcomes of cochlear implantation (CI) in children diagnosed with autism spectrum disorder (ASD). Study Design: Retrospective case review and parent survey. Setting: Tertiary care children's hospital. Patients: Thirty children with ASD who underwent CI between 1991 and 2018. Mean age at CI ¼ 3.5 years (0.8-11.8), mean age at diagnosis of ASD ¼ 5.1 years (2.0-15.0) (22/30 diagnosed after CI), mean follow-up ¼ 10.5 years (1.4-21.6). Parents of 7 children returned a survey. Intervention: Unilateral or bilateral cochlear implantation. Main Outcome Measures: Speech perception; expressive communication mode; educational placement; social engagement; consistency of CI use; parent survey of child behavior change. Results: Thirty-three percent of all and 45% of the 22 consistent device users developed measurable open-set speech perception by an average of 4.5 years of device use.Educational placement at last follow-up included 13% mainstreamed without interpreter, 50% Special Education programs, 10% therapeutic residential or day programs, 23% total communication programs, and one home schooled. Spoken language alone was used by 31% and spoken plus sign by 14%, with the remainder using sign alone, augmentative communication devices or no mode of communication. By parent report, 86% showed improvement in social engagement compared to pre-CI. Survey results showed the behaviors most frequently ranked as most affected by CI were communication and attention, while awareness of environment had the lowest (most affected) mean ranking. Conclusions: Findings support a growing body of literature that cochlear implantation has the potential to improve auditory skills, language, and enhance social engagement in some deaf children with autism spectrum disorder.

Evaluation and results of children with Autism Spectrum Disorder using cochlear implants: an integrative literature review

“…The CI can benefit hearing-impaired children also diagnosed with ASD, although all studies included in this review reported worse results for that population than those observed in children without additional disabilities 7,9,10,[18][19][20][21][22][23][24][25][26][27][28][29][30] . There is a series of reasons for such differences in the results between different populations, and they include the presence of learning and communicative disorders, associated motor impairment, sensory sensitivity, among other disorders observed in children with ASD, regardless of the presence of hearing impairment 23 .…”

“…From the 16 included studies, most of them were conducted in the United States of America (USA) (n=4) 7,18,25,28 . Only one study 21 The results after the CI in children with ASD may vary, and it is possible to beneft from the device with time and proper support.…”

“…Many times, researchers 7,18,28,30 claimed that it was not possible to apply standardized measures to assess the development of hearing and language skills among children diagnosed with ASD, who make use of CI, due to the severity of their development delay. In a study 18 published in 2021, the authors reported that MAIS was the only protocol of speech perception capable of being applied. In another study, only two of seven assessed children were able to respond the Glendonald Auditory Screening Procedure (GASP) 7 .…”

“…In order to evaluate the hearing skills, most studies used the Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS), and the Meaningful Auditory Integration Scale (MAIS) [18][19][20]27 , the classification in Hearing Loss Categories 19,23,24 , and/or speech perception testing, conducted with the child, such as the Phonetically Balanced Kindergarden Test (PBK) 18,25 . Regarding the evaluation of language development, the Peabody Picture Vocabulary Test (PPVT) 19,21 , classification in Language Ability Categories 19,21,23,24,26 , and the Meaningful Use of Speech Scale (MUSS) 20,21 were used.…”

“…Most researchers 7,10,[18][19][20][21]27 included scales and/or questionnaires applied by means of an interview with the parents. That can be justified due to the difficulty in obtaining reliable results in standardized tests with that attention and symbolic playful behaviors recorded in an individual playful situation, and with their parents, may add complementary information to the one from clinical measures 28 .…”