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84 Parent Ratings of Everyday Social, Emotional, and Behavioral Functioning in Children with Unilateral versus Bilateral Hearing Loss
- Samantha Hasenbalg, Rachel Landsman, Matthew Fasano-McCarron, Megan Herlihy, Peter K Isquith
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 76-77
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Objective:
Reduced hearing is associated with increased risk for social, emotional, and behavioral difficulties. Studies to date have typically compared DHH children with their hearing peers without regard for unilateral hearing loss (UHL) versus bilateral hearing loss (BHL). Children with UHL are often perceived as more like their typically hearing peers than their peers with BHL. Children with UHL typically access sound and spoken language which facilitates their functioning with fewer supports (e.g., interpreters, captioning). These children, however, show cognitive, academic, and communication profiles more similar to children with BHL than typically hearing peers. They may also experience similar social, emotional, and behavioral challenges as their BHL peers. We examined social, emotional, and behavioral functioning in a clinically referred sample of children with UHL versus BHL.
Participants and Methods:Parents of 100 children aged 2 to 17 years (M=7.12) with either UHL (n=30) or BHL (n=70) completed the Behavioral Assessment System for Children, Third Edition (BASC-3) as part of neuropsychological evaluation in a Deaf and Hard of Hearing Program within a tertiary pediatric hospital. BASC-3 scores based on General Combined norms were compared to an expected distribution of typically developing hearing children using non-parametric one-sample tests. Profiles of scores for children with UHL and BHL were examined in a repeated measures MANOVA.
Results:The groups of children with UHL and BHL showed similar age, gender, race, ethnicity, and Area Deprivation Index compositions. Eighty four percent of BHL children communicated with spoken language, and 100% of UHL children communicated with spoken language (p=.02). There were similar rates of comorbid diagnoses for ADHD (20%), Anxiety/Depression (18%), Autism Spectrum Disorder (8%), and Intellectual Disability/Global Developmental Delay (9%). However, children with BHL tended to be at greater risk for Language Disorders (50%) than those with UHL (30%, = 3.41 p=.065). Together, children with hearing loss showed significantly higher scores on the BASC-3 Hyperactivity, Aggression, Attention Problems, Atypicality, and Withdrawal clinical scales than expected (One-Sample Kolmogorov-Smirnov Test; p<.01). Profile analysis showed that children with any type of hearing loss had a varied pattern of scores across scales (F(7,686)=4.33, p<.01), with highest scores on Hyperactivity and Attention Problems scales and lowest scores on Somatization. Scale profiles did not differ, however, between UHL and BHLgroups (p=.127).
Conclusions:Children with UHL have access to auditory input, typically enabling early language development more like their hearing peers compared to children with BHL. In turn, these children may be overlooked more so than their BHL peers. However, the likelihood of social, emotional, and behavioral difficulties is similar between the two groups of children with hearing loss, whether that is unilateral or bilateral. Our study showed both groups of children had similar profiles across BASC-3 scales with elevations relative to norms. Measuring these everyday functions in children with hearing loss is important for early detection of risks to promote early intervention.
4 Extending the 5P Clinical Decision Rule Predicting Concussion Recovery Using an Evidence-Based Assessment Model
- Dean R Allen, Peter K Isquith, Roger Zemek, Gerard A Gioia
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 603
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Objective:
Construction of predictive algorithms of concussion symptom recovery at 4 and 12 weeks post-injury using an evidence-based assessment (EBA) model to guide clinical decision-making, extending the 2016 5P decision rule.
Participants and Methods:Children and adolescents, ages 8-18 (n=1,551; mean age=12.78; 62% male), followed over 12 weeks in the prospective multicenter cohort study (Predicting Persistent Post-Concussive Problems in Pediatrics, 5P; Zemek et al., 2016). The age-specific PostConcussion Symptom Inventory (PCSI) (8-12, 17 items; 1318 years, 20 items) was completed at six timepoints from the ED and at 1, 2, 4, 8, and 12-weeks post-injury. Logistic regression analysis was applied to the set of key variables including the PCSI Total Retrospective-Adjusted PostInjury Difference (RAPID) scores, patient demographics and pre-injury history, and injury characteristics to predict participant recovery status (Recovered, Not Recovered) at the 4- and 12-week endpoints. The resulting recovery-predictive equations identified the significant sets of variables with symptom scores at four successive post-injury timepoints (ED, 1, 2, 4 weeks). Logistic Regression Threshold values were established at the 90th CI against which individual patient data was applied to determine recovery status. Participants with sub-threshold sums were deemed recovered at the target endpoint (4- or 12-weeks post-injury).
Results:A total of 19 predictive equations were generated for the two age groups across the recovery timeline. Four sets of equations were developed to predict symptom recovery status at 4-weeks post-injury for the two age groups (8-12 AUC=0.679-0.884; 13-18 AUC=0.752-0.909). Prediction of symptom recovery status at 12-weeks post-injury yielded six equations for the 8-12 age group (AUC=0.723-0.825), and five equations for the 13-18 age group (AUC=0.724-0.887). Total PCSI RAPID score was identified as a significant variable in each of these 19 equations. Participant sex was identified as significant in 18 of the 19 constructed equations. Other variables that were identified as significant at varying timepoints included age, pre-injury history of learning disability and migraines, and an early post-injury sign in the ED (answering questions more slowly than usual). Examples of the equations include: Week 1 predicting symptom recovery status at 4-weeks: 8-12 yr group-(Sex*.802)+(week 1 Total RAPID Score*.142)+(Age2* .053)+(-3.851) with AUC=0.808; 13-18 yr group-(Sex*.980)+(Week 1 Total RAPID Score*.071)+(-3.261) with AUC=0.861.
Conclusions:Clinicians’ management of the concussion recovery of children and adolescents can benefit from EBA guidance. The 5P dataset (Zemek et al., 2016) provides an important window into “typical” and “atypical” recovery trajectories, establishing an initial predictive decision rule for a 4-week recovery endpoint, at the ED timepoint only, reporting AUC=0.69. The current study extends the prediction modeling using successive post-injury timepoints reflecting a typical management timeline. Symptom reports from both 1- and 2-weeks post injury with patient demographics/ history predicted symptom recovery status at 4- and 12-weeks post-injury, significantly improve predictive accuracy over the ED timepoint alone. These predictive equations, when applied to the individual patient, can serve to assist the clinician’s understanding of the patients’ recovery trajectory, i.e., on track for a typical or atypical recovery, further informing the intervention strategy.
70 Uncovering Comorbid Neuropsychological Disorders in Children with Unilateral Hearing Loss Under Consideration for Cochlear Implantation
- Rachel Landsman, Amanda Griffin, Matthew Fasano-McCarron, David Faller, Margaret Kenna, Greg Licameli, Peter Isquith
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 745-746
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Objective:
Children with unilateral hearing loss (UHL) have difficulty hearing in noisy environments and localizing sounds, impacting learning and social opportunities across contexts. Using a visible device like a cochlear implant (CI) may improve functioning but can also create psychological risk. Audiological measures alone are insufficient for predicting social, emotional, educational, adaptive, and quality-of-life post-operative outcomes, which are highly variable in this population and can also be impacted by a secondary diagnosis. Extending beyond audition to consider the “whole child” through neuropsychological evaluation may produce a sharper picture of potential outcomes, with or without surgical/audiological intervention. Given recent FDA approval for CI in children with UHL, more are receiving this elective surgery despite difficulties predicting who will experience significant benefit. Here we describe neuropsychological profiles of children with UHL who underwent CI candidacy evaluation at a tertiary pediatric hospital.
Participants and Methods:During pre-operative clinical care, CI candidates completed targeted neuropsychological evaluation to identify patient- and family-level factors that could impact CI use and outcomes from surgery. Cognitive, language, attention/executive, visuoperceptual/visuomotor, academic, adaptive, and emotional/behavioral functioning were assessed. Evaluations integrated history, observations, caregiver report forms, and performance-based test data.
Results:18 individuals were evaluated (age 7-months to 16-years). Most had left-sided UHL (67%) and were male (61%). Known hearing loss etiologies were congenital cytomegalovirus (n=5), enlarged vestibular aqueduct (n=1), traumatic brain injury (n=1), meningitis (n=1), cholesteatoma (n=1), neurofibromatosis type 1 (n=1), and Waardenburg syndrome (n=1). Indices of general cognitive ability were generally low average to average. Patterns of cognitive impairment were not restricted to language-based tasks (e.g., Beery VMI-6 range 56-109, M=89.42, SD=16.27). Standardized parent ratings of everyday executive functioning, social/emotional/behavioral functioning, and adaptive skills were collected. Eight (44%) had a behavioral health diagnosis: Attention Deficit Hyperactivity Disorder (n=2), Global Developmental Delay (n=2), Unspecified Neurodevelopmental Disorder (n=2), Autism Spectrum Disorder (n=1), and Depression (n=1). Thirteen (72%) received or will receive a CI, of whom 38% had a behavioral health diagnosis. Average Area Deprivation Index (a marker of socio-economic status) was lower for individuals who ultimately received CIs (M=18%tile) compared to those who did not (M=25%tile).
Conclusions:There may be increased rates of neurodevelopmental/psychological conditions among children with UHL, especially when the etiology involves the central nervous system. Albeit preliminary, results align with findings from bilateral hearing loss samples. Findings highlight the importance of routine neuropsychological screening in children with UHL and close interdisciplinary collaboration for optimal outcomes. Socio-economic disparities among those who do and do not receive CI need further exploration as those who did not receive CIs tended to be from less resourced neighborhoods. Additional research is warranted to understand the full range of risk and protective factors for children with UHL and how these relate to outcomes for those who opt for cochlear implantation.
71 Profiles of Parent Ratings on the Behavior Assessment System for Children-Third Edition in Children with Autism Spectrum Disorder who are Deaf and Hard of Hearing
- Megan Herlihy, Rachel Landsman, Matthew Fasano-McCarron, Arielle Spellun, Samantha Hasenbalg, Peter Isquith
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 746-747
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Objective:
Standardized assessment measures can provide data to inform a diagnosis of Autism Spectrum Disorder (ASD). Most measures assessing ASD characteristics rely on some degree of behavioral response to sound (e.g., responding to name, demonstrating listening response), and are often not appropriate for use with children who are Deaf and Hard of Hearing (DHH), especially with individuals who use signed languages. Few studies have reported on the Behavioral Assessment System for Children, Third Edition (BASC-3) for DHH children, and we aim to describe BASC-3 profiles in children with ASD who are DHH.
Participants and Methods:Participants include eight DHH patients diagnosed with ASD through interdisciplinary team evaluations by developmental-behavioral pediatricians, speech-language pathologists, and neuropsychologists with expertise in DHH child development. Demographics include a mean age of 6.17 years, and 62.5% were Male. Self-reported racial distribution was 75% White, 12.5% Black and 12.5% declined to answer. Average Area Deprivation Index (marker of socioeconomic status) was 32.13%tile. As a part of the evaluation, parents rated their children using the BASC-3. Languages include spoken English (75%) and American Sign Language (25%). Relevant co-occurring
neurodevelopmental/psychological diagnoses include Global Developmental Delay (n=1), Moderate Intellectual Disability (n=1), and Depression (n=1). Types of hearing loss include sensorineural (75%), conductive (12.5%), and mixed (12.5%). Three participants had different degrees of bilateral hearing loss in each ear: mild sloping-severe, moderate rising-mild (n=1), profound, moderate rising-normal level (n=1), and profound, moderate (n=1). Four participants had the same level of hearing loss in both ears: moderate-moderately severe (n=1), moderately severe-severe (n=1), severe-profound (n=1), and profound (n=1). One child had a unilateral moderate hearing loss. Technology utilized: unilateral hearing aid (n=2), bilateral hearing aids (n=2), unilateral cochlear implant (n=1), bilateral cochlear implants (n=2), and bimodal technology (n=1). BASC-3 scales of interest in this study were the developmental social disorders scale (DSD), Autism probability index (AUI), clinical scales, and adaptive scales. BASC-3 scores were standardized using General Combined norms and means were plotted.
Results:BASC-3 mean scores on clinical scales were elevated (T>60) on Atypicality (M=71), Hyperactivity (M=63), Withdrawal (M=63), and Attention Problems (M=65) in children with ASD who are DHH in this sample. BASC-3 mean scores on adaptive scales were below threshold (T<40) on Social Skills (M=37), Functional Communication (M=39), and overall Adaptive Skills (M=39). DSD scores were in the at-risk (T>60<70) range for 2 out of 8 cases and clinically significant (T>70) for 5 out of 8 cases.
The AUI was clinically significant for 2 out of the 3 cases within the age range for reporting AUI data.
Conclusions:In this preliminary sample of DHH children with a confirmed diagnosis of ASD by comprehensive specialized interdisciplinary clinical evaluations, parent ratings on the BASC-3 were consistent with what is known about BASC-3 profiles in hearing children diagnosed with ASD. Our findings suggest it may be helpful to review the DSD, AUI, clinical scales, and adaptive skills scales profiles when assessing DHH children at risk for ASD. Further research, including a larger sample size and assessment of language differences among participants, is necessary.
10a - Hearing loss across the lifespan: neuropsychological perspectives
- from Section II - Disorders
- Edited by Jacobus Donders, Scott J. Hunter, University of Chicago
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- Book:
- Principles and Practice of Lifespan Developmental Neuropsychology
- Published online:
- 07 May 2010
- Print publication:
- 14 January 2010, pp 257-276
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Summary
Introduction
Unlike many conditions described in this volume, having a hearing loss or being deaf does not necessarily result in specific deficits in functioning. Functional outcomes depend on a complex interplay of physiological, developmental and environmental factors. We start with the premise that hearing loss by itself will often have an impact on cognitive organization but not necessarily or consistently on intellectual, neuropsychological, emotional, social or behavioral functioning. Disruption of these functions depends heavily on other factors that may be associated with etiology of the hearing loss or the interaction between individuals and their environment, including communication, family, educational, emotional and sociolinguistic environments. At the same time, effects related to a hearing loss can have significant negative impact in each of these areas, particularly without comprehensive and appropriate supports.
Hearing loss cannot be viewed as a single disorder or characteristic. A child with a congenital hearing loss secondary to prenatal infection is quite different from an older adult with hearing loss associated with the cumulative effects of aging, even if the mechanical aspects are similar. The child is likely to have had limited early access to language, potentially altering the child's educational, social and familial environments, whereas the adult has probably had typical developmental experiences. Even two children born with the same etiology and mechanics of hearing loss can develop along quite different trajectories depending on environmental variables.