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					  Assessing Children For
    Cochlear Implants




         James H. Johnson, Ph.D.
Department of Clinical and Health Psychology
           University of Florida
    Overview and Objectives
 The focus of this presentation is on the
  role of the child-oriented psychologist
  as consultant to the Cochlear Implant
  Team.
 Specifically the goal is to highlight the
  nature of the pre-implant
  psychological evaluation in assessing
  children who are candidates for
  implantation and their families.
        Objectives - Continued
   The pre-implant evaluation is based on the
    premise that relevant information obtained
    from the child and his/her family can be useful
    in determining;
    – those children (and families) who are good
      candidates for this procedure and,
    – Potential issues that represent challenges to
      successful implantation that, if dealt with
      appropriately prior to receiving the implant, may
      increase the likelihood of optimal outcome.
   In the next several minutes we will highlight
    the nature of this pre-implant assessment.
    The Pre-Implant Psychological
             Evaluation
 Knowledge Assessment
 Motivation for Implant
 Family Agreement/Disagreement
 Appropriateness of Expectations
 Challenges to Compliance
 Parent-Child Communication
 Family/Psychological/Behavioral
  Issues
 Issues of Stress and Coping
 Questions/Concerns Regarding the
  Implant Process
            Knowledge Assessment
   Do the parents (and child, if older) have reasonable
    knowledge of what the implant process involves?
    – What surgery will involve and the time necessary for
      healing.
    – The nature of post-implant activities (e.g., initial
      fitting/activation and mapping, auditory training,
      speech/language therapy, scheduled follow-ups).
    – The need for parental involvement in the child’s therapy?
    – What this will require in parental time and effort.
 Have parents gone beyond “passive learning” in an
  attempt to obtain information (e.g., internet
  searches, making contacts with others who have been
  implanted)?
 Any needed information?
       Assessing Motivation for
            Implantation
 Do the parents (and child, if older) indicate a
  desire for the implant?
 Have they been active in seeking information
  regarding the implant?
 Have they been active in moving the implant
  process along?
 Do they show a willingness to do “whatever
  is necessary” to make the implant a success?
Family Agreement and
   Disagreements
     Do parent and child agree on the
      desirability of the implant?
     Do both parents agree on the
      desirability of an implant?
     Are both willing to be active
      participants in the implant
      process?
     Do other close family members
      support the idea of an implant?
           Assessing Expectations
 Do parents and child (if old enough) convey an
  understanding that children vary in response to
  implants?
 Is there understanding that degree of success depends
  on parent and child being active participants in the
  process (e.g., auditory training, speech/language
  therapy, etc)?
 Do they understand that the child may not “hear” the
  same way as a non-hearing impaired individual?
 Is there implied acceptance of outcomes that may not
  involve;
    – the development of functional speech
    – a full understanding of speech without speechreading?
        Challenges to Compliance
 Do parents/child convey a willingness to be an active
  participant in the implant process?
 Do they have a plan to deal with practical issues
  associated with implantation;
    – arrangements for surgery,
    – travel to doctor appointments,
    – auditory training, speech therapy, etc.?
   Is there a history of keeping appointments, active
    participation in prescribed communication
    programs, complying with the use of assistive
    devices, and dealing with other required medical
    treatments?
    Assessing Stress and Coping
 Is there evidence of significant family stress?
 What are the nature of existing stressors?
 Do family members have adequate social
  supports to assist them in coping with ongoing
  stressors?
 Do family members appear to have adequate
  skills to cope with existing stressors?
 Considering both the level of stress and
  coping styles, is stress likely to compromise a
  successful outcome?
    Assessing Other Psychosocial
              Factors
 Do parents appear to show evidence of deficits
  that could compromise successful outcome or
  require special assistance?
 Does the child show evidence of delays in
  development severe enough to compromise
  success?
 Do either parents or child show evidence of
  psychological/behavioral problems that could
  compromise success?
    Psychological and Behavioral Issues:
       Implications for Intervention
   While not inclusive, listed below are examples of
    psychological family issues, sometimes highlighted in
    the pre-implant evaluation, that may represent
    contraindications or areas where family and/or child
    intervention is needed.
     – Significant Generalized Developmental Delay
     – Family Disagreement Regarding Implantation
     – Externalizing Problems of Childhood
          Difficult Child Temperament
          Oppositional Defiant Disorder
          Attention Deficit Hyperactivity Disorder (ADHD)
    – Issues of Selective Noncompliance
      Child and Family Issues:
    Implications for Implantation
   While some of the issues just considered
    can, in some cases, represent a clear
    contraindication for implantation, in most
    instances information related to areas of
    concern simply lead to pre-implant
    intervention that followed by a successful
    implant.
That’s All Folks!   Questions?

				
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posted:10/14/2011
language:English
pages:14