Multidimensional Evaluation of Daily Device Use, Communication, and the Family System in Pediatric Cochlear Implant Users




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This dissertation investigates samples of children with hearing loss who use cochlear implants (CIs) through a family systems lens. The aim is to understand the impact of pediatric hearing loss on the parents and siblings of the affected child and the impact that families have on their children (by way of facilitating daily device use). A series of interconnected manuscripts centered on parents, siblings, and children with CIs combine to illuminate the multidimensional and bidirectional effects of pediatric hearing loss and the family system. Chapters 2 and 3 address the state of parents and siblings, respectively, of school-age and adolescent children with CIs, to understand the impact of hearing loss on other members of the family. Chapter 2 (Study

  1. compares general and condition-specific stress (via the Family Stress Scale) in 31 parents of CI users (8-16 years) to previously published samples of children with HL, finding similarities and differences across samples. Child temperament significantly predicted parental stress after controlling for other variables. Chapter 3 (Study 2) examines quantitative and qualitative perspectives of 36 children and adolescents with typical hearing (age 6-17 years) who have a sibling with CIs (age 7-17). Quantitative results indicated that siblings with TH express positive perspectives of their brother or sister with CIs and report having a CI user in the family does not affect them much, particularly if the CI user has good speech understanding and intelligibility. Qualitative responses diverge from quantitative data, with siblings expressing more negative feelings surrounding differential attention from parents and the CI user’s social communication skills. Chapter 4 (Study 3) considers an aspect of parental involvement - daily device use – in 65 young children with CIs (< 5 years), exploring the impact of device use on of emerging communication skills in 65 young children. Results of this retrospective chart review indicate better early auditory skills, speech recognition in quiet skills, and expressive/receptive language outcomes in children who wear their CIs more hours per day (on average). Chapter 5 provides pilot data for a prospectively examination of daily device use, family-related variables (e.g., parental involvement, socials support, family hardiness), and communication outcomes (i.e., speech recognition, spoken language) in a small group of young children who predominantly use CIs (n = 9, age < 6 years), representing the intersection of topics in Studies 1-3. These data demonstrate variability in daily device use and communication outcomes, but little difference in family variables (e.g., low parental stress, high parental involvement), revealing both feasibility and challenges of data collection moving forward. These studies collectively highlight the importance of considering the entirety of the family system in cases of pediatric hearing loss to maximize communication outcomes in children with hearing loss and to optimize well-being in all members of the family.



Health Sciences, Audiology, Health Sciences, Speech Pathology