Assessing Children For
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
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
– 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
Motivation for Implant
Appropriateness of Expectations
Challenges to Compliance
Issues of Stress and Coping
Questions/Concerns Regarding the
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
– 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
Any needed information?
Assessing Motivation for
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
Do they show a willingness to do “whatever
is necessary” to make the implant a success?
Family Agreement and
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
Do other close family members
support the idea of an implant?
Do parents and child (if old enough) convey an
understanding that children vary in response to
Is there understanding that degree of success depends
on parent and child being active participants in the
process (e.g., auditory training, speech/language
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
– 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
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
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
Assessing Other Psychosocial
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
Do either parents or child show evidence of
psychological/behavioral problems that could
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
That’s All Folks! Questions?