Educational inclusion in children with cochlear implants: strengths and dificulties.: History Edit
Subjects: Others

Olga M. Alegre de la Rosa y Luis M. Villar Angulo.

This study aims to investigate whether emotional problems and difficulties differ between children with cochlear implants (CIs) or hearing aids (HAs), according to multi-informant ratings. A battery of psychological instruments, e.g., Strengths and Difficulties Questionnaire (SDQ), Illinois Test of Psycholinguistic Abilities (ITPA), Peabody. Image Vocabulary Test (PPVT) and Raven Progressive Matrices Test (RPM), was administered to children with CIs or HAs. The study involved 187 children with CIs, 113 children with HAs, 176 fathers and mothers, and 300 school teachers. Perception disagreements were found between children, families, and school teachers in terms of their SDQ ratings. Total SDQ score lowly correlated with other outcomes, e.g., total ITPA, final PPVT, and final Raven. Regression linear analyses demonstrated 6 socio-demographic and linguistic covariates that significantly predicted children’s total SDQ score. Numerous independent variables were found to be associated with children’s total strengths and difficulties results. The findings highlight the importance of providing tailored, flexible support for a heterogeneous population of children with varied strengths and needs, e.g., developing and implementing instructional systems for school aptitude-treatment.

  • Cochlear implant
  • hearing aid
  • family
  • teacher
  • SDQ
  • Educational inclusion

This study tries to detect psychological differences between children with two types of hearing devices -children who use cochlear implants (CIs) or hearing aids (HAs)-. Children with hearing loss have psychological difficulties related to their speech perception (Henner et al., 2018). The sensory information perceived by children with hearing devices is essential to overcome the delay they exhibit in the quality of spoken language. From an educational perspective, the application of psychological tests concerns researchers because children with insufficient linguistic development thoroughly need to understand test instructions. Class teachers and speech-language pathologists are not the only educational agents that remedy the linguistic weaknesses of children with hearing devices. Families are de facto interventionists in the development of language. They provide fluency in the primary oral communication, which sustains the basic perceptual scheme of the child’s future cognitive development.

The patterns of agreement among teachers, parents, and students across the person-environment interaction are a fundamental problem in predicting individual differences in social behavior and learning from instruction. It is clear that the routine use of the Strengths and Difficulties Questionnaire (SDQ) is unique in that it derives essential understandings of students’ interpersonal relations. The SDQ is conceived as an instrument to perform the screening of positive socialization behavior and the psychopathology of 3–16-year-old children. As such, SDQ measures are useful for investigators to demonstrate, scientifically, the impact of problems and challenges of children with hearing difficulties on their instructional needs. Many researchers’ first goal to employ SDQ with deaf or hard of hearing children is methodological. The structure and reliability of SDQ have been studied in many countries (Rodríguez-Hernández et al., 2014).

Parents and school teachers of children with CIs or HAs deal with many challenges in making decisions regarding diagnostic teaching, creating informed opinions about children’s abstract reasoning, and promoting the development of spoken or sign language in children with hearing difficulties (Isarin et al., 2015; Wong et al., 2018). The following are the primary purposes of this study: Firstly, this study aims to investigate multiple inter-rater concordance correlation coefficients for SDQ data. Authors calculate agreement reports between children, family, and teachers on problems and difficulties of children with CIs or HAs to give homogeneity and consistency to scores (Gresham et al., 2017). Secondly, it also attempts to uncover the functional relationships of problems and difficulties of children with hearing devices and their total scores in tests of psycholinguistic abilities, image vocabulary, and abstract reasoning (Durkin & Conti-Ramsden, 2007). The last goal is to discover the causal effect relationships between variables, therefore, to predict the implanted children’s total SDQ score (target variable) using the implanted children’s psychological variables, e.g., ITPA, PPVT and RPM (predictors). Furthermore, it aims to calculate the implanted children’s total SDQ score (target variable) by influences from other aggregated multi-informants’ socio-demographic covariates (predictors): Student-level covariates, e.g., Gender; Hearing device; Individualized Curriculum Adaptation (ICA) program; Chronological and Implantation age; School-level covariates—e.g., Grade, School Speech Therapy (number of hours), Tutor, and Speech-language pathologist Experience (number of years); Family-level covariates—e.g., Gender, Studies, Parents’ age (father and mother) and Home communication; and Geographical location-level covariate—e.g., Administrative province of residence (Sarchet et al., 2014).

Participants. All eligible children in the Canary Islands were recruited to the study. The study cohort consisted of children with CIs (n= 187) and HAs (n= 113). They had access to the same hearing service provider (Canary Health Service) before 3 years of age. One hundred and thirty-seven children were recruited from the island of Tenerife and 163 from the island of Gran Canary. The chronological ages of the children were between 6–9 years (n = 104), 10–12 years (n = 88), and 13–16 years (n = 108). They attended inclusive school centers. One hundred and nineteen followed an ICA program, while 181 enrolled in the regular curriculum of their typical peers. Etiology causes were excluded from the study because of lacking information. All parents and proxy families provided informed written consent for administering questionnaires and tests to each child with CIs or HAs. Besides, ethical and legal disposition approval for the present study was attained from the Clinical Research Ethics Committee (C.E.I.C.) of the Canary Insular Maternal and Child University Hospital. The role of family-center care was essential for children’s communication (Ching et al., 2018). Therefore, authors included parental education and family labor status, as latent variables that might predict children’s strengths and psycho-educational problems (Porter et al., 2003). Thus, fathers (n = 87) and mothers (n = 89) had primary education degrees, and they were working (parents n = 230, mothers n = 213). Fathers contributed data in the cycle of 41–50 years old (n = 143), between 31–40 years old (n = 95), more than 50 years (n = 55), and between 20–30 years (n = 7). Mothers’ age contributed data between 41–50 years old (n = 143), between 31–40 years old (n = 95), more than 50 years old (n = 55), and between 20–30 years old (n = 15). On one hand, authors substantiated fathers’ active role in oral communication with their children, noting parents who utilized verbal communication (n = 215), compared to those who employed only signs (n = 28) or were bilingual (n = 57). On the other hand, there was ambivalent data about the role played by school professionals who had been in contact with children with CIs or HAs. While class teachers display adequate attitudes towards the inclusion of children with hearing loss in regular school classrooms, school professionals need to prepare the teachers to deal with cochlear implant technology and other auditory issues (Compton et al., 2009; Eriks-Brophy & Whittingham, 2013). There was a greater number of female teachers [speech-language pathologists (n = 249) and class teachers (n = 227)] compared to male teachers [speech-language pathologists (n = 51) and class teachers (n = 73)]. The average age of speech-language pathologists was 50–59 years (n = 171), and that of the class teachers was 60 or more (n = 150). On average, both types of school educators had professional experience of 10 years or more: speech-language pathologists (n = 193) and class teachers (n = 185).

Materials. Strengths and Difficulties Questionnaire (SDQ). Goodman (2001) designed the SDQ consisting of 25 items grouped into five scales: Emotional problems, Behavioral problems, Problems with peers, Hyperactivity, and Prosocial behavior. The SDQ is an instrument to perform the screening of the positive behavior of socialization and the psychopathology of 3–16-year-old children and adolescents.  Illinois Test of Psycholinguistic Abilities (ITPA). Before the translated version of the ITPA into Spanish, 68 studies had adopted this instrument between 1968 and 1974 to investigate children’s abilities (Kirk & Elkins, 1974; Kirk et al., 2001). It is composed of 10 subtests, for each of the following functions: listening comprehension, visual comprehension, visual-motor sequential memory, auditory association, auditory sequential memory, visual association, visual integration, verbal expression, and grammatical integration. It allows the detection, prediction, and diagnosis of possible errors or difficulties in the child’s communication process.  Peabody. Image Vocabulary Test (PPVT). This interactive test (Dunn and Dunn, 2007) has two alternative forms (A and B) of a receptive vocabulary assessment. Each type includes 228 elements, equally distributed across 19 item-sets. Each item-set contains 12 elements of increasing difficulty. The administration time is limited to 10—15-minute by applying the sets according to the child’s age or skill level. Children point to one out of four images that best represents the meaning of a verbally presented stimulus word.  Raven Progressive Matrices Test (RPM). This instrument (Raven, 1989, 2000) has been distributed to deaf or hard of hearing children for the last 50 years (Henner et al., 2018). It comprises 60 items that measure abstract reasoning, in which children are required to select the missing fragment from an incomplete plan.