Cochlear Implant in Autistic Children - Coursework Example

Running Head: COCHLEAR IMPLANT IN AUTISTIC CHILDREN Cochlear Implant in Autistic Children XXX XXX In this paper we shall examine the affectsof Cochlear Implants (CI) on the development of children suffering from Autism Spectrum Disorder. We shall first examine the criteria for determining candidacy for a cochlear implant and development in deaf children post implant. Next we shall study the special case of children who have additional disabilities such as autism. We shall also examine the benefits of a cochlear implant in autistic children. Finally we shall try to understand if Cochlear Implants in autistic children has the desired affect or not. Cochlear Implant in Autistic Children Cochlear Implants were first developed by Graeme Clark, a researcher at the University of Melbourne, in 1978. A Cochlear Implant is an electronic device which is implanted in the cochlea of the ear and is connected to a microphone on the outside through a speech processor and a transmitter. It works by converting sound vibrations into electrical stimuli, which provides a sensation of sound. Cochlear Implants are primarily recommended for those with a severe to profound hearing disorder. Among children and infants, a Cochlear Implant can help develop speech and communication skills. However, due to the long period of therapy required, its candidacy has to be determined on an individual basis and there is disagreement over its suitability for autistic children. Cochlear Implant Candidacy Most cases of hearing impairment are due to loss of hair cell receptors in the inner ear, which limits the cochlea’s ability to transduce sound information from the environment to neural transmissions that can be interpreted by the central nervous system as auditory sensations (Copeland & Pillsbury, 2004). Since in such cases the nervous elements that transmit information from the cochlea to the brain remain intact, a Cochlear Implant is a viable option. The actual surgery to implant a cochlear implant is performed on an outpatient basis and requires about two to three hours of general anesthesia. However, once the prosthesis is implanted in the cochlea, there is an extensive process requiring aural habilitation with inputs from experienced audiologists and speech and language experts. Also, since the entire circuitry remains permanently attached to the patients, patients are required to take a number of precautions to avoid damage to the delicate device. The FDA-approved minimum age of implantation is one year. It is difficult to implant the device in younger children due to difficulty in properly testing the hearing in such young patients. Another concern is with patients suffering from multiple handicaps. Since these children suffer from numerous other challenges, implants are often difficult to program reliably (Copeland & Pillsbury, 2004). Candidates also need to “have the psychological makeup, motivation, and motivated support system to learn to use the device consistently to optimize their performance.” (Niparko & Blankenhorn, 2003). Considering all these factors, every patient needs to be carefully evaluated for candidacy for a cochlear implant. Another issue to be addressed while deciding candidacy is parental expectations. Unfortunately, there are no clearly defined criteria for “realistic expectations” in parents (Zaidman-Zait & Most, 2005). It is almost impossible to predict the outcome of the implant for an individual child even after a thorough investigation and this can lead to unrealistic parental expectation. The problem could be further compounded in parents of autistic children. Benefits of Implant in Deaf Children The primary goal of Cochlear Implant in children is to help them acquire language and communication skills. How much a child will benefit from a cochlear implant depends on a number of pre-implant factors. These factors include “Age; onset, etiology, and progression of deafness; cognitive and educational level; communication mode; language competence; family and environment; sensory and motor skills; and personal motivation” (Niparko & Blankenhorn, 2003). Benefits also increase with increased duration of the use of device. However, in children suffering from multiple disabilities, the benefits can be limited and require a much longer habilitation process. The second most important benefit of a cochlear implant is development of socialization and daily living skills of the children. Based on a research conducted by Bat-Chava, Martin & Kosciw (2005), cochlear implants may be better than hearing aids in helping deaf children improve their social skills over time. However, according to Peterson (2004), there is a delay in theory of mind development of deaf children with no significant differences between children using and hearing aids and those with cochlear implant. All the above mentioned researches point to the fact that while there is considerable improvement in speech development, communication and social skills of deaf children following a cochlear implant, it is a slow process and requires years of habilitation. Autism and Hearing Deficit Before moving any further, let us examine the incidence of hearing disability among the autistic children. According to a study conducted by Rosenhall, Nordin, Sandström, Ahlsén, & Gillberg (1999), pronounced to profound bilateral hearing loss or deafness was reported in 3.5% of autistic children. According to them, this is significantly higher than the general population. Of the 475 children who received cochlear implant in the University of Michigan, 8 were diagnosed with autism. Thus the prevalence of autism in this population was 1.7% (Donaldson, Heavner, & Zwolan, 2004). Even this is significantly higher than the incidence of autism in the general population. Considering such high incidence of deafness among the autistic children, it is worthwhile to explore the ability of autistic children to benefit from cochlear implants despite the challenges associated with the implants in these patients. Unfortunately, there is very limited research on the co-existence hearing loss and autism. And even less literature exists on children with Cochlear Implants who suffer from multiple disabilities. As Edwards (2007) has pointed out, this is primarily because in the earlier years, children with multiple disorders were not considered suitable candidates for the implant. And even when it became more common to implant such children, they were excluded from studies to make the study group more homogenous. In the following pages we shall refer the little literature available on autistic and children with cochlear implant to study the benefits of the implant in these children. Children with Autism There are three main characteristic of autism: impairment in social interaction, impairments in verbal and non-verbal communication and restricted and repetitive patterns of behavior (Donaldson, Heavner, & Zwolan, 2004). According to Edwards (2007), about 30%-40% of deaf children are found to have additional disabilities. These disabilities “include cognitive or learning difficulties, global developmental delay, visual impairment, language and communication disorders (autistic spectrum disorders [ASDs]), and other medical, physical, or motor problems.” Since many of these impairments range in severity it is difficult to decide when such children need additional attention. As a result of this ambiguity, for many years, children with multiple disabilities were considered unsuitable for a cochlear implant. The problem is even more acute in children suffering from autism. Autistic children without any hearing disability are hard pressed to communicate effectively. They also have difficulty in developing spoken language skills. As a result, autistic children are generally not considered good candidates for cochlear implant. However, with the age at which cochlear implants are recommended having gone down, increasingly children with cochlear implants are later diagnosed with autism (Edwards, 2007). It is often years before professionals realize that a child is suffering from autism. As stated earlier, it takes years before children with cochlear implant start showing improvements, and even than there is a wide range of improvements shown. Under the circumstances, it is not easy, even for professionals to be able to tell if a child is making the desired progress. But once it is identified that a child is not making the anticipated progress, “the next challenge is to identify the reason for this” (Edwards, 2007). Edwards further points out that once it has been established that a child suffers from an additional disability like autism, the next challenge is to overcome the parental resistance. Since such children require highly specialized care, there is also a lack of trained professionals in this field. Follow up of Children with Cochlear Implant Hamzavi (2000) was one of the first to study the affect of cochlear implant in children suffering from multiple disorders. He did a follow up analysis of ten children with multiple disabilities. One of the ten children suffered from “autism with mild intellectual deficit and moderate sensory-motor integration disturbances.” Within three months of the implant, the child started using voice to communicate and the severity of the autism was also reduced. In three years he had developed spontaneous speech. This was an extremely positive benefit of the implant in an autistic child. However, since only one child with autism was studied, the results were inconclusive. Donaldson, Heavner, & Zwolan (2004) carried out a more comprehensive survey to review seven children, ages 3 to 16, which were diagnosed with autism spectrum disorder and had received cochlear implant. The objective of this study was to quantify progress in speech and language perception after the implant. Due to several limitations, the study could only test the patients on a few parameters. Yet, the study revealed improvement for all subjects post operatively. The lack of standardized measures of progress was acutely felt by Donaldson et al. The study conducted by Donaldson et al., clearly showed that a cochlear implant in autistic children helped improve several behaviors. The survey showed improvements in vocalization, eye contact, use of sign language, reaction to sound and response to requests. One limitation of the survey was that the children were not examined before the implant. Hence, the survey team had to rely on parental perception to arrive at the conclusions. Conclusion As seen above, cochlear implant in deaf and autistic children not only helps them improve there auditory perception but also helps reduce the severity of their autism. Hence cochlear implant is such patient is a very viable option. However, very limited research has been done in this area and there is need for a much more extensive study to further establish the benefits of a cochlear implant in autistic children. Also, future studies need to check the level of development before implant and compare it would post-operative development. Even in the absence of a more comprehensive study, it is clear that cochlear implants can hugely benefit children with autistic spectrum disorder. Reference Bat-Chava, Y., Martin, D., & Kosciw, J. (2005, December). Longitudinal improvements in communication and socialization of deaf children with cochlear implants and hearing aids: Evidence from parental reports. Journal of Child Psychology and Psychiatry, 46(12), 1287-1296. Retrieved December 23, 2007, from PsycINFO database. Copeland, B., & Pillsbury, H. (2004). Cochlear implantation for the treatment of deafness. Annual Review Of Medicine, 55, 157-167. Retrieved December 27, 2007, from MEDLINE database. Donaldson, A., Heavner, K., & Zwolan, T. (2004, May). Measuring progress in children with autism spectrum disorder who have cochlear implants. Archives Of Otolaryngology--Head & Neck Surgery, 130(5), 666-671. Retrieved December 22, 2007, from MEDLINE database. Edwards, L. (2007, 2007 Summer). Children with cochlear implants and complex needs: a review of outcome research and psychological practice. Journal Of Deaf Studies And Deaf Education, 12(3), 258-268. Retrieved December 28, 2007, from MEDLINE database. Hamzavi, J., Baumgartner, W., Egelierler, B., Franz, P., Schenk, B., & Gstoettner, W. (2000, December 22). Follow up of cochlear implanted handicapped children. International Journal Of Pediatric Otorhinolaryngology, 56(3), 169-174. Retrieved December 22, 2007, from MEDLINE database Niparko, J., & Blankenhorn, R. (2003). Cochlear implants in young children. Mental Retardation And Developmental Disabilities Research Reviews, 9(4), 267-275. Retrieved December 23, 2007, from MEDLINE database. Peterson, C. (2004, September). Theory-of-mind development in oral deaf children with cochlear implants or conventional hearing aids. Journal of Child Psychology and Psychiatry, 45(6), 1096-1106. Retrieved December 21, 2007, from PsycINFO database. Rosenhall, U., Nordin, V., Sandström, M., Ahlsén, G., & Gillberg, C. (1999, October). Autism and hearing loss. Journal of Autism and Developmental Disorders, 29(5), 349-357. Retrieved December 21, 2007, from PsycINFO database. Zaidman-Zait, A., & Most, T. (2005, September). Cochlear Implants in Children with Hearing Loss: Maternal Expectations and Impact on the Family. Volta Review, 105(2), 129-150. Retrieved December 23, 2007, from PsycINFO database. Read More