The Real Markers of Success in cochlear implantation in young children:

Social Skills & Theory of Mind

CI 2015 SymposiumOctober, 2015

Washington, DC

Aleisha DAVIS, Katie NEAL, Yetta ABRAHAMS, Tracy HOPKINS, Alyshia HANSEN, Janna WELLER

Thursday, October 15th, 1.45-3.15pmNo Disclosures

Speech, Language and VocabularyOutcomes from Early Intervention Graduation (CA5 & 6yrs)

Age appropriate speech and language is possible by 3 years (Ching, 2011).

This trajectory can be improved and maintained at 4 & 5 years &…

Speech, Language and Vocabulary

Early EI & HA fitting (CI < 6 Months)

Early EI & HA fitting (CI 6-12 Months)

Early EI & HA fitting (CI > 12 Months)

Early EI & Late HA fitting (CI > 12 Months)

Late EI & HA fitting (CI >12 Months)

Age

Gro

up

ing

for

Inte

rven

tio

n, f

itti

ng

and

CI

Median Total Language Score n=98

What makes language and communication

successful?

Well Spoken “Language”

• But “COMMUNICATION”

= how it is used

Social Skills: Ways of dealing with others to create positive interactions; the route to creating and developing relationships,

Learnt through experience with peers/parents

Social Inclusion: The connectedness of the individual with their

social setting rather than purely their ‘presence’

Pragmatics: Context and it’s contribution to meaning.

Social Inclusion: The connectedness of the individual with their

social setting rather than purely their ‘presence’

Theory of Mind: The ability to make inferences about the beliefs and desires of other people

Mentally put ourselves in another’s shoes and have a sense of what they are thinking/feeling

A predictor of key social childhood competences: e.g., social interactional skills, and consequently interactions and peer

popularity (Wellman & Liu, 2004)

Neuro Linguistic

Linguistic/ Cognitive

Pragmatic

lexical enrichment (the child gains from

acquiring a rich mental-state vocabulary)

syntactic enrichment (the child gains from

acquiring syntactic tools for embedding one thought in another)

pragmatic enrichment (the child gains from conversations where

varying perspectives on a topic are articulated).

Morphological changes are hallmarks of sensory

deficits.What influence does this

architectural change have on ongoing development? Harnessing neuroplasticity.

Embedded structures - relationship to meaning and comprehension.

Implications for language based assessment?

lexical enrichment (the child gains from

acquiring a rich mental-state vocabulary)

syntactic enrichment (the child gains from

acquiring syntactic tools for embedding one thought in another)

pragmatic enrichment (the child gains from conversations where

varying perspectives on a topic are articulated).

Mental state language Knowledge and opportunity

What happens when social skills; pragmatics and ToM are

compromised?

When faced with threat of being stigmatized, to seemingly protect themselves, individuals disconnect from social supports, therein reducing their coping or

adaptive capacity Hogan et al. (2012)

Atypical + Delayed Acquisition

Diverse desires: people like different thingsDiverse beliefs: people think different thingsKnowledge access: seeing (or hearing!) is knowing False beliefs: people can think something that I know is not trueReal vs apparent emotion: people can pretend and hide how they feel.

Typical Acquisition

Could not conceive someone liking or believing differently to

themselves HOWEVER

Passed knowledge access & false belief (? insight into what someone

is thinking but more impersonal/ concrete).

Acquiring skills in an appropriate developmental order

BUT NOTAn appropriate number of skills for

their age

Translational research n=50

Bilateral >90dBHL Bilateral 75-89dBHL (4FA better ear)

Bilateral 55-74dBHL (4FA better ear)

Unilateral

Hearing Aid n=8

Cochlear Implant n=30

Unilateral Cochlear Implant n=5

Bone Conductor n=2

Baha n=1

No Device n=4

Age at assessment (yrs) n=50

3yrs 7.5%4yrs 38%

5years 55.5%

Symmetry n=50Unilateral Hearing Loss 26%Bilateral Hearing Loss 64%

Atypical & Delayed

Typical Hearing Average Age 5,7yrs

(Atypical 8%)

(Wellman & Liu, 2004)

Bilateral HL (Atypical = 62%

p=0.0004)

Unilateral HL(Atypical =45%p=0.0005)

Atypical/delayed acquisition

Typical acquisition

% o

f C

hild

ren

n w

ith

typ

ical

/at

ypic

al/d

elay

ed

ac

qu

isit

ion

Atypical & Delayed

Typical Hearing Average Age 5,7yrs

(Atypical 8%)

(Wellman & Liu, 2004)

Bilateral HL (Atypical = 62%

p=0.0004)

Unilateral HL(Atypical =45%p=0.0005)

Atypical/delayed acquisition

Typical acquisition

% o

f C

hild

ren

n w

ith

typ

ical

/at

ypic

al/d

elay

ed

ac

qu

isit

ion

Typical acquisition Atypical/delayed acquisition

LanguageDelayed Language

Language WNL

Does socio-economic status matter?

Atypical/delayed acquisition

Typical acquisition

Lowest SES Highest SES

Socio-economic Indexes for Areas (SEIFA) Ranking

Cultural & Linguistic diversity

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

English Only

Atypical/delayed acquisition

Typical acquisition

Bilingual Exposure ESL/Majority other than English

% o

f ch

ildre

n w

ith

typ

ical

or

atyp

ical

/d

elay

ed a

cqu

isit

ion

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FLI not in range of concern FLI in range of concern

Listening Skills

Hearing levels & Device Type

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Typical Hearing Average Age 5,7yrs

(Atypical 8%)

(Wellman & Liu, 2004)

Bilateral CI >90dbHL Bilateral CI 55-89dbHL Bilateral HA 55-89dBHL Unilateral

% Typical acquisition

% Atypical/ Delayed acquisition

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All children with additional needs that impact learning had Atpical/delayed acquisition

The influence of Age

10

25

40

55

70

85

100

115

130

145

>90dBHL CI< 6 months

>90dBHL CI 6-12 months

>90dBHL CI > 13 months

75-85dBHL CI <12 months

75-85dBHL CI >13 months

55-74dBHL CI <12 months

55-74dBHL CI >13months

55-74dBHL HA<12 months

55-74dBHL HA >13months

Tota

l Lan

guag

e Sc

ore

n=9

8

CI for profound bilateral HL CI for 74-89dBHL 4FA CI 55-74dBHL 4FA HA 55-74dBHL 4FA

Best standard language scores are for children implanted <12 months, irrespective of residual hearing, and some children with moderate SNHL using HA fitted < 12 months

Timing important

Bilateral >90dbHL CI < 12 Months

Bilateral >90dbHL CI < 12 Months

Bilateral 55-89dBHL CI <12 Months

Bilateral 55-89dBHL CI > 12 Months

Typical Hearing Average Age 5,7yrs

(Atypical 8%)

(Wellman & Liu, 2004)

% Typical acquisition

% Atypical/Delayed acquisition

Considerations for development in children with hearing loss

• Age of Implant• Unilateral vs

Bilateral (more typical

acquisition for unilateral)

• Additional needs that impact learning (all children had atypical/delayed pattern)

No effect Observed Impact Possible Impact

• CI under 12 months

• Listening Skill (69% with Atypical/delayed acquisition are in the range of concern)

• Hearing level (linked to age of optimal access and device compliance)

• Language exposure

• SES • Birth Order • Languages

other than English

Considerations for development in children with hearing loss

• Age of Implant• Unilateral vs

Bilateral (more typical

acquisition for unilateral)

• Additional needs that impact learning (all children had atypical/delayed pattern)

No effect Observed Impact Possible Impact

• CI under 12 months

• Listening Skill (69% with Atypical/delayed acquisition are in the range of concern)

• Hearing level (linked to age of optimal access and device compliance)

• Language exposure

• SES • Birth Order • Languages

other than English

Overhearing Optimising access

Distance /BGNTonal Detection

Focusing of specific language

structures Assistive listening

devices

Intervention Parental input

Opportunity to failService delivery

Direct and indirect learning

Use of mental state language

Concrete vs abstract

Identification Amplification Intervention

Language levelDegree of hearing

loss Changed sensory

pathways

Practical Translation: Confident Kids

pragmatic enrichment (the child gains from conversations where varying perspectives on

a topic are articulated).

Neurological enrichment (harnessing neuroplasticity

providing opportunity).

lexical enrichment (the child gains from acquiring a rich mental-state vocabulary)

syntactic enrichment (the child gains from acquiring syntactic

tools for embedding one thought in another).

• Informing parents about the development of social interaction and providing opportunity for exposure for children has a positive effect for both in the development of social skills

• While ToM is strongly correlated to the development of social & pragmatic skills further analysis is required to understand the links between atypical/delayed acquisition and what this means for social and pragmatic skill development.

The Shepherd Centre team

Research@shepherdcentre.org.au

Thank you to the children and families that share their

journey with us.

We’d also like to acknowledge past TSC staff members who have contributed to the design and

implementation of our Theory of Mind research

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Hughes C, Jaffe SR, Happe F, Taylor A, Caspi A, Moffitt TE. Origins of individual differences in Theory of Mind: From nature to nurture? Child Development. 2005; 76:356-370.

Ching, T. Y. C., Crowe, K., Martin, V., Day, J., Mahler, N., Youn, S., . . . . Orsini, J. (2010). Language development and everyday functioning of children with hearing loss assessed at 3 years of age. International Journal of Speech-Language Pathology, 12(2), 124-131.

Fitzpatrick, E. M., Crawford, L., Ni, A., & Durieux-Smith, A. (2011). A Descriptive Analysis of Language and Speech Skills in 4-to 5-Yr-Old Children With Hearing Loss. Ear and Hearing, 32(5), 605-616.

Fulcher, A., Purcell, A. A., Baker, E., & Munro, N. (2012). Listen up: Children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3&#xa0;years-of-age. International Journal of Pediatric Otorhinolaryngology, 76(12), 1785-1794

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