Assessment of behavioral problems in children with hearing loss

Objective: To compare the prevalence of disruptive behavior problems between preschool-aged children with hearing loss and normal hearing. Study Design: Cross-sectional study. Setting: Tertiary academic center. Patients: Caregivers of children (2-5 yr old) with normal hearing (NH) (n=39), hearing loss using hearing aid(s) (HA) (n=29), or cochlear implant(s) (CI) (n=21). Intervention(s): Demographic information and a mental health history were obtained. Child behavior and language development were assessed. Main Outcome Measure(s): The Young Child-Diagnostic Interview Schedule for Children-IV and the MacArthur-Bates Communication Development Inventory III. Results: Distributions of race, socioeconomic status, insurance status, and parental home situation (single versus two parent family) were similar across all groups. Parents of children with hearing loss were significantly more likely to report behavior problems (HA=41%, CI=38%) than parents of NH children (10%; p=0.002). Children with hearing loss were significantly more likely to meet diagnostic criteria for oppositional defiant disorder (HA=48%, CI=48%) than NH children (23%; p=0.02). More NH children (8%) than hearing impaired children (0%) had accessed mental health services ( p=0.08). NH children were found to have more advanced language development than hearing-impaired children ( p<0.01), but controlling for Communication Development Inventory III percentiles, the observed behavioral differences remained. Conclusion: Controlling for language development, children with hearing loss have higher prevalence of and impairment from disruptive behaviors than their NH peers. These children are less likely to receive appropriate behavioral interventions. Further research is warranted to investigate the impact of disruptive behaviors on speech and hearing rehabilitation. Methods to improve access to effective behavioral interventions in this population are needed.