Mikic B, Jotic A, Miric D, Nikolic M, Jankovic N, Arsovic N
Clinical Center of Serbia, clinic for otorhinolaryngology and maxillofacial surgery, Belgrade, Serbia.
Clinical Center of Serbia, clinic for otorhinolaryngology and maxillofacial surgery, Belgrade, Serbia; University of Belgrade, Medical faculty, Belgrade, Serbia.
Eur Ann Otorhinolaryngol Head Neck Dis. 2016 Jun;133 Suppl 1:S36-9. doi: 10.1016/j.anorl.2016.01.012. Epub 2016 May 27.
Incidence of children with autism spectrum disorder (ASD) is rising through the years with estimated 1 in 68 in the US in 2014. This incidence is also rising in the population of congenitally deaf children. Favorable outcome after early cochlear implantation is expected due to plasticity and reorganization capacity of brain in infants and toddlers, but outcomes could be significantly modified in children with diagnosed ASD. Current methods of screening for autism have difficulties in establishing diagnosis in children who have both autism and other developmental delays, especially at such an early age. The aim of the study was to assess the development of auditory perception and speech intelligibility in implanted children with profound congenital hearing loss who were diagnosed with ASD comparing to those who were typically developing.
Fourteen children underwent cochlear implantation; four were later diagnosed with ASD and ten were typically developing. All children underwent intensive postoperative speech and hearing therapy. The development of auditory perception and speech intelligibility was assessed using the Categories of Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) during the 5-years follow-up.
In children later diagnosed with ASD, auditory processing developed slowly. Depending on the individual capabilities, by the age of six they could identify environmental sounds or discriminate speech sounds. Speech Intelligibility in children with ASD was at best rated as category 2, with very little or no progress up to the age of six, despite extensive speech and language therapy. Communication skills were strongly affected by a degree of autistic features expression.
Preoperative psychological assessment in congenitally deaf infants should be expanded by the use of validated instruments for early detection of autism. The possibility of developing ASD should be kept in mind by all professionals involved in programs for cochlear implantation.
多年来，自闭症谱系障碍（ASD）儿童的发病率一直在上升，2014年美国估计每68名儿童中就有1名患病。先天性失聪儿童群体中的发病率也在上升。由于婴幼儿大脑的可塑性和重组能力，早期人工耳蜗植入有望取得良好效果，但已确诊患有ASD的儿童的治疗效果可能会受到显著影响。目前的自闭症筛查方法在诊断同时患有自闭症和其他发育迟缓的儿童时存在困难，尤其是在如此年幼的阶段。本研究的目的是评估被诊断患有ASD的先天性重度听力损失植入儿童与正常发育儿童相比的听觉感知和言语清晰度的发展情况。
14名儿童接受了人工耳蜗植入；其中4名后来被诊断患有ASD，10名发育正常。所有儿童术后均接受了强化言语和听力治疗。在5年的随访期间，使用听觉表现类别（CAP）和言语清晰度评分（SIR）评估听觉感知和言语清晰度的发展情况。
在后来被诊断患有ASD的儿童中，听觉处理能力发展缓慢。根据个体能力，到6岁时他们能够识别环境声音或辨别语音。患有ASD的儿童的言语清晰度最高被评为2级，尽管接受了广泛的言语和语言治疗，但直到6岁几乎没有或没有进展。沟通能力受到自闭症特征表达程度的强烈影响。
先天性失聪婴儿的术前心理评估应通过使用经过验证的工具来扩大，以早期发现自闭症。参与人工耳蜗植入项目的所有专业人员都应牢记儿童患ASD的可能性。
