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Terrible Twos or Early Signs of Psychopathology? Developmental Patterns in Early Identified Preschoolers With Cochlear Implants Compared With Hearing Controls

Netten, Anouk, P.1; Rieffe, Carolien2,3; Ketelaar, Lizet3; Soede, Wim1; Gadow, Kenneth, D.4; Frijns, Johan H., M.1,5

doi: 10.1097/AUD.0000000000000500
Research Article

Objective: Cochlear implants (CIs) have dramatically improved the lives of children who are deaf or hard of hearing; however, little is known about its implications for preventing the development of psychiatric symptoms in this at-risk population. This is the first longitudinal study to examine the early manifestation of emotional and behavioral disorders and associated risk and protective factors in early identified preschoolers with CIs compared with hearing peers.

Design: Participants were 74 children with CIs and 190 hearing controls between ages 1 and 5 years (mean age, 3.8 years). Hearing loss was detected using the Newborn Hearing Screening in The Netherlands and Flanders. Parents completed the Early Childhood Inventory-4, a well-validated measure, to evaluate the symptoms of DSM-IV–defined psychiatric disorders, during three consecutive years. Language scores were derived from each child’s medical notes.

Results: Children with CIs and hearing controls evidenced comparable levels of disruptive behavior and anxiety/depression (which increased with age in both groups). Greater proficiency in language skills was associated with lower levels of psychopathology. Early CI and longer duration of CI use resulted in better language development. In turn, higher early language skills served as a protective factor against the development of disruptive behavior symptoms.

Conclusions: This longitudinal study uniquely shows that improvement in language skills mitigates the development of early signs of psychopathology. Early identification of hearing loss and CIs help children improve their language skills.

1Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands

2Department of Developmental Psychology, Leiden University, Leiden, The Netherlands

3Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, The Netherlands

4Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA

5Leiden Institute for Brain and Cognition, Leiden, The Netherlands.

Supported by the Care for the Young: Innovation and Development program by ZonMw (grant number 80-82430-98-8025) and Stichting het Heinsius-Houbolt Fonds.

The authors have no conflicts of interest to disclose.

Received May 25, 2016; accepted August 9, 2017.

Address for correspondence: Anouk P Netten, Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail:

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