The presence of disabilities in addition to deafness
poses unique challenges for evaluating outcomes in young children who receive cochlear implants
. We describe two cases in which measures of joint attention
and symbolic play
contributed to our understanding of progress in language
acquisition following implantation for children with additional developmental disabilities.
Prospective case study.
Tertiary referral center.
Case 1, identified with global developmental delays
and implanted at age of 2 years 8 months; Case 2, diagnosed with autism spectrum disorder and implanted at age of 4 years 4 months.
Main Outcome Measure(s):
Communication assessments were conducted using the Reynell Developmental Language
Scales and the MacArthur-Bates Communicative Development Inventories before implantation (baseline) and at 12 months postimplant. Children were also videotaped during a 10-minute free play with their mothers (Joint Attention
task) and 5-minute solitary play (Symbolic Play
task) at baseline, 6 months, and 12 months postimplant. Videotapes were coded for child attention and play states.
The MacArthur-Bates Communicative Development Inventories provided important information regarding both children's emerging joint attention
and symbolic play
skills that are typically not assessed by direct measures of early child language
. Videotaped parent-child interaction revealed qualitative differences in the nature of these children's attention and play, which has important implications for intervention.
For these two children, obtaining developmental information from various sources, including precursor skills to the development of oral language
, provided a more complete picture of each child than conventional clinician-elicited language