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

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

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?

Eligibility

Balanced regarding degree of hearing loss and age

3-6 Years

Bilateral hearing loss

prelingual

Nonverbal IQ >40

NVIQ40-79

NVIQ>80

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

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

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

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

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

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%

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)

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

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

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

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

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

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

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

Already seeing decline in social functioning with increasing age

Early relationship between ratio and communication functioning

Early relationship between ratio and social functioning

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)

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

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

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

Extra slides

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

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