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Original Investigation |

Neurocognitive Risk in Children With Cochlear Implants

William G. Kronenberger, PhD1; Jessica Beer, PhD2; Irina Castellanos, PhD2; David B. Pisoni, PhD2,3; Richard T. Miyamoto, MD2
[+] Author Affiliations
1Riley Child and Adolescent Psychiatry Clinic, Department of Psychiatry, Indiana University School of Medicine, Indianapolis
2DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
3Department of Psychological and Brain Sciences, Indiana University, Bloomington
JAMA Otolaryngol Head Neck Surg. 2014;140(7):608-615. doi:10.1001/jamaoto.2014.757.
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Importance  Children who receive a cochlear implant (CI) for early severe to profound sensorineural hearing loss may achieve age-appropriate spoken language skills not possible before implantation. Despite these advances, reduced access to auditory experience may have downstream effects on fundamental neurocognitive processes for some children with CIs.

Objective  To determine the relative risk (RR) of clinically significant executive functioning deficits in children with CIs compared with children with normal hearing (NH).

Design, Setting, and Participants  In this prospective, cross-sectional study, 73 children at a hospital-based clinic who received their CIs before 7 years of age and 78 children with NH, with average to above average mean nonverbal IQ scores, were recruited in 2 age groups: preschool age (age range, 3-5 years) and school age (age range, 7-17 years). No children presented with other developmental, cognitive, or neurologic diagnoses.

Interventions  Parent-reported checklist measures of executive functioning were completed during psychological testing sessions.

Main Outcomes and Measures  Estimates of the RR of clinically significant deficits in executive functioning (≥1 SDs above the mean) for children with CIs compared with children with NH were obtained based on 2 parent-reported child behavior checklists of everyday problems with executive functioning.

Results  In most domains of executive functioning, children with CIs were at 2 to 5 times greater risk of clinically significant deficits compared with children with NH. The RRs for preschoolers and school-aged children, respectively, were greatest in the areas of comprehension and conceptual learning (RR [95% CI], 3.56 [1.71-7.43] and 6.25 [2.64-14.77]), factual memory ( 4.88 [1.58-15.07] and 5.47 [2.03-14.77]), attention (3.38 [1.03-11.04] and 3.13 [1.56-6.26]), sequential processing (11.25 [1.55-81.54] and 2.44 [1.24-4.76]), working memory (4.13 [1.30-13.06] and 3.64 [1.61-8.25] for one checklist and 1.77 [0.82-3.83] and 2.78 [1.18-6.51] for another checklist), and novel problem-solving (3.93 [1.50-10.34] and 3.13 [1.46-6.67]). No difference between the CI and NH samples was found for visual-spatial organization (2.63 [0.76-9.03] and 1.04 [0.45-2.40] on one checklist and 2.86 [0.98-8.39] for school-aged children on the other checklist).

Conclusions and Relevance  A large proportion of children with CIs are at risk for clinically significant deficits across multiple domains of executive functioning, a rate averaging 2 to 5 times that of children with NH for most domains. Screening for risk of executive functioning deficits should be a routine part of the clinical evaluation of all children with deafness and CIs.

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Number of Clinically Elevated Executive Function Subscale Scores

Figure shows the percentage of children in each group (cochlear implant [CI] and normal hearing [NH]) with clinically elevated executive functioning on 1 or more subscales: Learning, Executive, and Attention Functioning Scale (LEAF) scores (A) and Behavior Rating Inventory of Executive Functioning (BRIEF) (preschool version) scores (B) in preschool-aged children (3-5 years old) and LEAF (C) and BRIEF (D) scores in school-aged children (7-17 years old).

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