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Children with hearing loss (HL) are at risk for a lower educational achievement. This longitudinal study compared the school career of a nationwide Dutch cohort with and without HL based on descriptive data of the governmental authority Statistics Netherlands. From 2008 to 2018, 3,367,129 children, of whom 1,193 used cochlear implants (CIs) and 8,874 used hearing aids (HAs), were attending primary and/or secondary education. Sixty-one percent of children with HL attended mainstream and 31% special primary education. Compared to mainstreamed pupils without HL, mainstreamed pupils with HL achieved lower levels for language and mathematics in primary education but eventually attended comparable types of secondary education. Children with HL attending special primary education attained lower types of secondary education compared to mainstreamed peers with and without HL. These findings suggest that future educational (and as a result professional) attainment of a child with HL depends on the type of primary educational setting., (© The Author(s) 2021. Published by Oxford University Press.)

Objectives: To compare the quality of life (QoL) of children with hearing loss (HL) and children with normal hearing (NH) and to examine how the QoL of children with HL changes over time, considering language skills, type of hearing device, degree of HL, and type of education., Methods and Materials: This longitudinal study included 62 children with HL and their parents. Developmental outcome data were collected at two time points, when the mean ages of the children were 4 and 11 years. The Pediatric Quality of Life (PedsQL™) questionnaire, which includes assessments of Physical, Emotional, Social, and School functioning, was completed by parents at both time points and by the children with HL at the second time point. Receptive and expressive language skills at 4 years were assessed by the Reynell Developmental Language Scale. Results were compared with a Dutch normative sample., Results: The QoL of children with HL was similar to that of children with NH at both time points on two of the four QoL scales, Emotional and Physical functioning. On the other two scales, Social and School functioning, children with HL who attended special education and children who switched to mainstream education showed lower scores than children with HL who were consistently in mainstream education and lower scores than children with NH. The School QoL of children with HL decreased over time, as did the School QoL of children with NH. Social QoL of children with cochlear implants decreased over time, but this was not the case in children with hearing aids. Language skills and the degree of HL did not clinically improve the QoL over time of preschool children with HL., Conclusions: The QoL of children with HL in mainstream education and the Physical and Emotional QoL of all children with HL were satisfactory. It is essential to develop specific guidance regarding school activities for children with HL in special education and for children with HL who switch to mainstream education in order to increase their social QoL., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose The aim of the study was to evaluate the application of a modified version of the Amsterdam Inventory for Auditory Disabilities and Handicap to inventory self-reported hearing difficulties pre and post hearing aid fitting in 6 dimensions: detection, speech in silence, speech in noise, localization, discrimination, and noise tolerance. Method Questionnaires pre and post hearing aid fitting were collected during regular practice of hearing aid provision. Data of 740 subjects are presented; 337 already used hearing aids, and 403 were new users. Results Group-averaged scores improved due to hearing aid fitting for all 6 dimensions. Based on a criterion previously defined for the Amsterdam Inventory for Auditory Disabilities and Handicap questionnaire, 66% of subjects had a significant individual improvement in sum score. Experienced users showed lower improvement in scores, whereas their aided prescores were, on average, not better than the (unaided) score of 1st users. Conclusions The questionnaire can be applied as a structured approach to inventory hearing problems in 6 dimensions prior to hearing aid fitting and to systematically evaluate the effects of hearing aid fitting after a trial period. The data presented here can serve as normative data for comparison of individual subjects in clinical practice.

There is lack of a systematic approach concerning how to select an adequate hearing aid and how to evaluate its efficacy with respect to the personal needs of rehabilitation. The goal of this study was to examine the applicability and added value of two widely used self-reporting questionnaires in relation to the evaluation of hearing aid fitting. We analyzed responses, pre- and postfitting, from 1,319 subjects who completed the Client Oriented Scale of Improvement (COSI) and a slightly adapted version of the Amsterdam Inventory for Auditory Disability and Handicap (in Dutch: AVAB). Most COSI responses were at or near the maximum possible score. Results show a close relation between COSI's degree of change and final ability (Spearman's rho = 0.71). Both AVAB and COSI showed a significant effect of hearing aid experience, but-in contrast to AVAB-COSI did not show a significant effect of the degree of hearing loss. In addition, a Friedman test showed significant differences between six dimensions of auditory functioning for both AVAB and COSI, although post hoc analysis revealed that for COSI, the dimension speech in quiet explained most variation between dimensions. In conclusion, the effects of hearing loss were more salient in AVAB, while both AVAB and COSI showed differences regarding hearing aid experience. Combining the advantages of both methods results in a detailed evaluation of hearing aid rehabilitation. Our results therefore suggest that both methods should be used in a complementary manner, rather than separately.

Objectives: The first aim of this study was to examine various aspects of Theory of Mind (ToM) development in young children with moderate hearing loss (MHL) compared with hearing peers. The second aim was to examine the relation between language abilities and ToM in both groups. The third aim was to compare the sequence of ToM development between children with MHL and hearing peers., Design: Forty-four children between 3 and 5 years old with MHL (35 to 70 dB HL) who preferred to use spoken language were identified from a nationwide study on hearing loss in young children. These children were compared with 101 hearing peers. Children were observed during several tasks to measure intention understanding, the acknowledgement of the other's desires, and belief understanding. Parents completed two scales of the child development inventory to assess expressive language and language comprehension in all participants. Objective language test scores were available from the medical files of children with MHL., Results: Children with MHL showed comparable levels of intention understanding but lower levels of both desire and belief understanding than hearing peers. Parents reported lower language abilities in children with MHL compared with hearing peers. Yet, the language levels of children with MHL were within the average range compared with test normative samples. A stronger relation between language and ToM was found in the hearing children than in children with MHL. The expected developmental sequence of ToM skills was divergent in approximately one-fourth of children with MHL, when compared with hearing children., Conclusion: Children with MHL have more difficulty in their ToM reasoning than hearing peers, despite the fact that their language abilities lie within the average range compared with test normative samples.

Objective: Permanent childhood hearing impairment often results in speech and language problems that are already apparent in early childhood. Past studies show a clear link between language skills and the child's social-emotional functioning. The aim of this study was to examine the level of language and communication skills after the introduction of early identification services and their relation with social functioning and behavioral problems in deaf and hard of hearing children., Study Design: Nationwide cross-sectional observation of a cohort of 85 early identified deaf and hard of hearing preschool children (aged 30-66 months)., Methods: Parents reported on their child's communicative abilities (MacArthur-Bates Communicative Development Inventory III), social functioning and appearance of behavioral problems (Strengths and Difficulties Questionnaire). Receptive and expressive language skills were measured using the Reynell Developmental Language Scale and the Schlichting Expressive Language Test, derived from the child's medical records., Results: Language and communicative abilities of early identified deaf and hard of hearing children are not on a par with hearing peers. Compared to normative scores from hearing children, parents of deaf and hard of hearing children reported lower social functioning and more behavioral problems. Higher communicative abilities were related to better social functioning and less behavioral problems. No relation was found between the degree of hearing loss, age at amplification, uni- or bilateral amplification, mode of communication and social functioning and behavioral problems., Conclusion: These results suggest that improving the communicative abilities of deaf and hard of hearing children could improve their social-emotional functioning., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Children with hearing loss are at risk of developing psychopathology, which has detrimental consequences for academic and psychosocial functioning later in life. Yet, the causes of the extensive variability in outcomes are not fully understood. Therefore, the authors wanted to objectify symptoms of psychopathology in children with cochlear implants or hearing aids, and in normally hearing peers, and to identify various risk and protective factors., Design: The large sample (mean age = 11.8 years) included three subgroups with comparable age, gender, socioeconomic status, and nonverbal intelligence: 57 with cochlear implants, 75 with conventional hearing aids, and 129 children who were normally hearing. Psychopathology was assessed by means of self- and parent-report measures., Results: Children with cochlear implants showed similar levels of symptoms of psychopathology when compared with their normally hearing peers, but children with hearing aids had significantly higher levels of psychopathological symptoms, while their hearing losses were approximately 43 dB lower than those of children with implants. Type of device was related with internalizing symptoms but not with externalizing symptoms. Furthermore, lower age and sufficient language and communication skills predicted less psychopathological symptoms., Conclusions: Children who are deaf or profoundly hearing impaired and have cochlear implants have lower levels of psychopathological symptoms than children with moderate or severe hearing loss who have hearing aids. Most likely, it is not the type of hearing device but rather the intensity of the rehabilitation program that can account for this difference. This outcome has major consequences for the next generation of children with hearing loss because children with profound hearing impairment still have the potential to have levels of psychopathology that are comparable to children who are normally hearing.

Objective: Sufficient self-esteem is extremely important for psychosocial functioning. It is hypothesized that hearing-impaired (HI) children have lower levels of self-esteem, because, among other things, they frequently experience lower language and communication skills. Therefore, the aim of this study was to compare HI children's self-esteem across different domains with those of normal hearing (NH) children and to investigate the influence of communication, type of education, and audiological characteristics., Methods: This large (N = 252) retrospective, multicenter study consisted of two age- and gender-matched groups: 123 HI children and 129 NH controls (mean age  = 11.8 years). Self-reports were used to measure self-esteem across four domains: perceived social acceptance by peers, perceived parental attention, perceived physical appearance, and global self-esteem., Results: HI children experienced lower levels of self-esteem regarding peers and parents than NH controls. Particularly HI children who attended special education for the deaf were at risk, even after correcting for their language development and intelligence. Yet, levels of global self-esteem and self-esteem involving physical appearance in HI children equalled those of NH controls. Furthermore, younger age at implantation and longer duration of having cochlear implants (CIs) were related to higher levels of self-esteem., Conclusion: HI children experience lower levels of self-esteem in the social domains. Yet, due to the heterogeneity of the HI population, there is high variability in levels of self-esteem., Discussion: Clinicians must always be aware of the risk and protective factors related to self-esteem in order to help individual patients reach their full potential.

The purpose of this study was to examine several behavioral problems in school-aged hearing-impaired children with hearing aids or cochlear implants, compared to normally hearing children. Additionally, we wanted to investigate which sociodemographic, linguistic, and medical factors contributed to the level of behavioral problems, to pinpoint where targeted interventions can take place. This large, retrospective study included a sample of 261 school-aged children (mean age = 11.8 years, SD = 1.6), that consisted of three age- and gender-matched subgroups: 75 with hearing aids, 57 with cochlear implants, and 129 normally hearing controls. Self- and parent-reports concerning reactive and proactive aggression, delinquency, and symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder were used. In addition, several language and intelligence tests were administered. Hearing-impaired children showed significantly more proactive aggression, symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder than their normally hearing peers. More behavioral problems were associated with special schools for the deaf, sign (-supported) language, hearing aids (in contrast to cochlear implants), higher age, male gender, lower socioeconomic status, lower intelligence, and delayed language development. Hearing-impaired children face multiple problems regarding their behavior. The outcomes implicate that professionals should be aware of the higher risk of developing behavioral problems, in order to screen, detect, and treat in time. Furthermore, the associated risk and protective factors emphasize that clinicians must always consider the heterogeneity of the group of hearing-impaired children, in order to help and support the individual patient.

Objectives/hypothesis: The objectives of this study were to examine the levels of anxiety in hearing-impaired children with hearing aids or cochlear implants compared to normally hearing children, and to identify individual variables that were associated with differences in the level of anxiety., Study Design: Large retrospective cohort study., Methods: Self-reports and parent-reports concerning general anxiety, social anxiety, and generalized anxiety disorder were used. The study group (mean age, 11.8 years) consisted of three age-matched subgroups: 32 children with cochlear implants, 51 children with conventional hearing aids, and 127 children without hearing loss., Results: Levels of anxiety in children with cochlear implants and normally hearing children were similar. Early implantation was associated with lower levels of general and social anxiety. Remarkably, children with conventional hearing aids had higher levels of social anxiety, and their parents also reported more generalized anxiety disorder., Conclusions: The outcomes demonstrate that in their level of anxiety, children with cochlear implants might be more comparable to normally hearing children than to children with hearing aids. This positive finding can be the consequence of audiological factors or other aspects of the cochlear implant rehabilitation program., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Objective: The purpose of this study was to examine the levels of depressive symptoms and the unique contribution of two aspects of emotion regulation (coping and mood states) to the development of depression in hearing-impaired children and a control group., Methods: In order to compare the groups, self-report questionnaires concerning symptoms of depression, coping strategies, and mood states were used. The study group consisted of 27 children with cochlear implants, 56 children with conventional hearing aids, and 117 normally hearing children., Results: Hearing-impaired children reliably reported more symptoms of depression than their normally hearing peers. Degree of hearing loss, socioeconomic status, gender, and age were unrelated to the level of depressive symptoms. But attending mainstream schools or using exclusively speech for communication were related to fewer depressive symptoms. The associations with depressive symptoms differed between the groups. For hearing-impaired children, the cognitive aspects (coping) and the affective aspects (mood states) of emotional functioning contributed separately to the prediction of depressive symptoms. For normally hearing children an integration of cognitive and affective aspects was detected: adequate coping skills prevented the development of negative mood states and in turn depressive symptoms., Conclusions: Hearing-impaired children reported more depressive symptoms than normally hearing children. Prevention and treatment of depression in hearing-impaired children could focus on the use of coping strategies adequately, because these strategies have a direct relation with the level of depression., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)