Hoffman Michael, Tiddens Elena, Quittner Alexandra L
University of Miami, Flipse Building, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146 United States.
Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
Hear Res. 2018 Mar;359:91-100. doi: 10.1016/j.heares.2018.01.002. Epub 2018 Jan 9.
Previous research has found that preschoolers with hearing loss have worse visual attention and elevated rates of behavior problems when compared to typically hearing peers (Barker et al., 2009). However, little is known about these deficits in school-age children with cochlear implants (CIs). We evaluated visual selective attention in school-age children with CIs and hearing peers and examined the link between visual attention and behavior problems.
Data were drawn from the Childhood Development after Cochlear Implantation (CDaCI) study, the largest longitudinal, multi-site study of children with CIs. Visual attention was measured using d prime (d') on a continuous performance test (The Gordon CPT), which requires participants to watch a stream of digits and hit a button after seeing a certain target (a 9 following a 1). The CPT captures the probability of a hit (pressing button for a target) vs a false alarm (pressing the button for a non-target) while accounting for chance responding. In addition, predictors of visual attention, including IQ (using Processing Speed and Perceptional Reasoning on the WISC-IV), age at implantation, gender, and device management were examined. Externalizing problems were assessed using parent-report on the BASC-2. Data were drawn from 60 months post-implantation.
Children with CIs (n = 106) showed significantly worse visual selective attention than hearing peers. The difference in d' was driven by higher rates of false alarms. In the CI group, the Processing Speed Index on the WISC was correlated with total omissions, total commissions and d'. Within the CI group, d' significantly predicted parent-reported externalizing behavior problems. This finding was primarily driven by elevated Hyperactivity in the CI group.
Children with CIs continue to display deficits in visual attention when compared to their hearing peers. Despite improvements in oral language, these problems have critical implications for academic performance and social competence. Currently, cochlear implant teams do not focus on these other dimensions of development and thus, may not be positioned to address them. Assessment of attention and behavior should be incorporated into routine, annual visits soon after implant surgery, and remediation of these deficits should be included in early intervention programs.
先前的研究发现，与听力正常的同龄人相比，听力损失的学龄前儿童视觉注意力较差，行为问题发生率较高（Barker等人，2009年）。然而，对于接受人工耳蜗植入（CI）的学龄儿童的这些缺陷知之甚少。我们评估了接受人工耳蜗植入的学龄儿童和听力正常的同龄人的视觉选择性注意力，并研究了视觉注意力与行为问题之间的联系。
数据来自人工耳蜗植入后儿童发育（CDaCI）研究，这是对接受人工耳蜗植入的儿童进行的最大规模的纵向、多地点研究。使用连续性能测试（The Gordon CPT）中的d'来测量视觉注意力，该测试要求参与者观看一串数字，并在看到特定目标（1后面跟着9）后按下按钮。CPT在考虑随机反应的同时，捕捉命中（按下目标按钮）与误报（按下非目标按钮）的概率。此外，还研究了视觉注意力的预测因素，包括智商（使用韦氏儿童智力量表第四版中的处理速度和知觉推理）、植入年龄、性别和设备管理情况。使用BASC-2上的家长报告来评估外化问题。数据来自植入后60个月。
接受人工耳蜗植入的儿童（n = 106）的视觉选择性注意力明显低于听力正常的同龄人。d'的差异是由较高的误报率导致的。在人工耳蜗植入组中，韦氏儿童智力量表的处理速度指数与总遗漏、总错误和d'相关。在人工耳蜗植入组中，d'显著预测了家长报告的外化行为问题。这一发现主要是由人工耳蜗植入组中多动症状的增加所驱动的。
与听力正常的同龄人相比，接受人工耳蜗植入的儿童在视觉注意力方面仍然存在缺陷。尽管口语能力有所提高，但这些问题对学业成绩和社交能力具有关键影响。目前，人工耳蜗植入团队并不关注这些其他发展维度，因此可能无法解决这些问题。注意力和行为评估应纳入植入手术后不久的常规年度检查中，这些缺陷应在早期干预项目中得到补救。
