Social Development in Children With Early Cochlear Implants: Normative Comparisons and Predictive Factors, Including Bilateral Implantation

Objectives: There are mixed results regarding psychosocial development in children with cochlear implants (CIs) compared with children with normal hearing (NH), and the effect of bilateral CIs has not yet been investigated. This study aimed to investigate whether social development differed between NH children and those with early CIs, and to identify new predictors of psychosocial development in children with early CIs. Design: The psychosocial development, cognitive and language abilities of 159 children were measured as part of a longitudinal outcomes study of children with CIs. Parental involvement was also assessed. Results: The children in this study did not differ significantly from their peers with NH in terms of their psychosocial development, except with regard to Prosocial Behavior, with parents reporting significantly poorer development in this area. Having bilateral CIs predicted significantly fewer difficulties with psychosocial development, with earlier age at implantation increasing the effect size of the second CI for Emotional Symptoms and Peer Problems. Receptive language ability, higher parent education, later birth order, high parent involvement, and female gender predicted significantly fewer parent reports of psychosocial problems. Higher child cognitive ability and greater screen time predicted significantly greater reported psychosocial difficulties. Marginal effects modeling quantified the effects of changes in the predictive factors examined. Conclusions: Psychosocial development in these children with early CIs was found to be similar to that for peers with NH, with the exception of delayed Prosocial Behavior development. Having bilateral CIs predicted significantly better emotional outcomes. A number of new predictive factors were found for psychosocial development. The results of the marginal effects modeling should be shared with parents and professionals to increase their understanding of the impact of changes in predictive factors, particularly in terms of their own contribution to psychosocial outcomes for children with CIs. ACKNOWLEDGMENTS: The authors express their gratitude to the participating children and their families. The authors thank their collaborative partners: The Melbourne Cochlear Implant Clinic at the Royal Victorian Eye and Ear Hospital, The Shepherd Centre, The Hear and Say Centre, The Cora Barclay Centre, The Sydney Cochlear Implant Centre, The Hearing House in New Zealand and the Audiology Department at the Adelaide Women’s and Children’s Hospital. The authors thank the LOCHI study for sharing cognitive and language data for overlapping participants. This work was supported by an Australian Research Council Linkage Grant (Grant Number LP0989391), and Cochlear Ltd. All authors except Peter Busby, who is an employee of Cochlear Ltd, declare no conflict of interest. Address for correspondence: Julia Sarant, PhD, Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Victoria 3010, Australia. E-mail: jsarant@unimelb.edu.au. Received September 17, 2016; accepted October 17, 2017. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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