Assessing Children For Cochlear Implants

1. Assessing Children For Cochlear Implants James H. Johnson, Ph.D. Department of Clinical and Health Psychology University of Florida

2. Overview and Objectives • The focus of this presentation is on the role of the child-oriented psychologist as consultant to the Cochlear Implant Team. • Specifically the goal is to highlight the nature of the pre-implant psychological evaluation in assessing children who are candidates for implantation and their families.

3. Objectives - Continued • The pre-implant evaluation is based on the premise that relevant information obtained from the child and his/her family can be useful in determining; • those children (and families) who are good candidates for this procedure and, • Potential issues that represent challenges to successful implantation that, if dealt with appropriately prior to receiving the implant, may increase the likelihood of optimal outcome. • In the next several minutes we will highlight the nature of this pre-implant assessment.

4. The Pre-Implant Psychological Evaluation • Knowledge Assessment • Motivation for Implant • Family Agreement/Disagreement • Appropriateness of Expectations • Challenges to Compliance • Parent-Child Communication • Family/Psychological/Behavioral Issues • Issues of Stress and Coping • Questions/Concerns Regarding the Implant Process

5. Knowledge Assessment • Do the parents (and child, if older) have reasonable knowledge of what the implant process involves? • What surgery will involve and the time necessary for healing. • The nature of post-implant activities (e.g., initial fitting/activation and mapping, auditory training, speech/language therapy, scheduled follow-ups). • The need for parental involvement in the child’s therapy? • What this will require in parental time and effort. • Have parents gone beyond “passive learning” in an attempt to obtain information (e.g., internet searches, making contacts with others who have been implanted)? • Any needed information?

6. Assessing Motivation for Implantation • Do the parents (and child, if older) indicate a desire for the implant? • Have they been active in seeking information regarding the implant? • Have they been active in moving the implant process along? • Do they show a willingness to do “whatever is necessary” to make the implant a success?

7. Family Agreement and Disagreements • Do parent and child agree on the desirability of the implant? • Do both parents agree on the desirability of an implant? • Are both willing to be active participants in the implant process? • Do other close family members support the idea of an implant?

8. Assessing Expectations • Do parents and child (if old enough) convey an understanding that children vary in response to implants? • Is there understanding that degree of success depends on parent and child being active participants in the process (e.g., auditory training, speech/language therapy, etc)? • Do they understand that the child may not “hear” the same way as a non-hearing impaired individual? • Is there implied acceptance of outcomes that may not involve; • the development of functional speech • a full understanding of speech without speechreading?

9. Challenges to Compliance • Do parents/child convey a willingness to be an active participant in the implant process? • Do they have a plan to deal with practical issues associated with implantation; • arrangements for surgery, • travel to doctor appointments, • auditory training, speech therapy, etc.? • Is there a history of keeping appointments, active participation in prescribed communication programs, complying with the use of assistive devices, and dealing with other required medical treatments?

10. Assessing Stress and Coping • Is there evidence of significant family stress? • What are the nature of existing stressors? • Do family members have adequate social supports to assist them in coping with ongoing stressors? • Do family members appear to have adequate skills to cope with existing stressors? • Considering both the level of stress and coping styles, is stress likely to compromise a successful outcome?

11. Assessing Other Psychosocial Factors • Do parents appear to show evidence of deficits that could compromise successful outcome or require special assistance? • Does the child show evidence of delays in development severe enough to compromise success? • Do either parents or child show evidence of psychological/behavioral problems that could compromise success?

12. Psychological and Behavioral Issues: Implications for Intervention • While not inclusive, listed below are examples of psychological family issues, sometimes highlighted in the pre-implant evaluation, that may represent contraindications or areas where family and/or child intervention is needed. • Significant Generalized Developmental Delay • Family Disagreement Regarding Implantation • Externalizing Problems of Childhood • Difficult Child Temperament • Oppositional Defiant Disorder • Attention Deficit Hyperactivity Disorder (ADHD) • Issues of Selective Noncompliance

13. Child and Family Issues: Implications for Implantation • While some of the issues just considered can, in some cases, represent a clear contraindication for implantation, in most instances information related to areas of concern simply lead to pre-implant intervention that followed by a successful implant.

14. That’s All Folks! Questions?