Project Title: The Impact of Social Functioning on Behavior in Young Children Who Are Deaf or Hard of Hearing
Student: Madeline Bonfield ’18
Mentor: Dr. Shala Hankison
The impact of social functioning on behavior in young children who are deaf or hard of hearing
Authors: Bonfield M1, Wiley S2, Grether S2, Smith L1, Choo D3, Meinzen-Derr J1
Divisions of: 1Biostatistics and Epidemiology, 2Developmental and Behavioral Pediatrics, 3Otolaryngology
Children who are deaf or hard of hearing (DHH) are at risk for communication and social function delays which may have cascading effects on behavior. The objective of this study was to determine the relationship between social functioning and behavior in young children who are DHH.
Analysis included children with mild to profound permanent bilateral sensorineural hearing loss (mean age mos 57.1±13.8) enrolled in a language-functional outcomes study. Children completed standardized assessments of language and cognitive development. Functional skills were assessed with the Pediatric Evaluation of Disability Inventory (PEDI), behavioral skills were assessed with the Child Behavior Checklist (CBCL). PEDI social function scores were correlated with CBCL behavior domains and specific social function items were evaluated as they related to behavior.
Of the 90 children, 56.7% were male, 46% had a cochlear implant, the median identification age was 6 months. The mean nonverbal intelligence quotient was 94.3 (SD ± 19.5), the mean receptive language score was 80.6 (± 8.5), the mean PEDI social function score was significantly lower than the population mean (38.3 vs. 50, p<.0001).
Children, as a group, had relatively low CBCL scores; only 5% had clinically significant internalizing or externalizing behavior scores suggesting low rates of behavior problems. However, 12.5% had clinically significant attention problem domain scores; ~18% of children<5 had attention problems compared to 3% of older children. Poorer social functioning was significantly associated (p<0.01) with worsening internalizing (r=-0.27) and externalizing (r=-0.39) behaviors. Specifically, poorer social functioning was associated with worse scores on the attention problems subdomain (r=-0.42). Specific PEDI items that were associated with attention problems included difficulty asking questions, describing feelings, taking turns, and understanding time concepts.
Most young children who are D/HH did not have clinically significant behavioral concerns on standardized measures; there was an association with poorer abstract functioning and executive functioning with higher ratings on behavioral measures, (domain of attention). Early language deficits (language under-performance) may contribute to perceived attention issues in children who are D/HH.