| 2021 |
Jenks |
PBK; CNC; MAIS |
Thirty-three percent evidenced open-set auditory recognition after 4 or 5 months using the CI; 13.33% achieved speech recognition of monosyllables in a closed-set format, while 40% did not evidence any score changes in the MAIS scale, even improving their hearing thresholds by making use of the CI. |
Thirty per cent used oral language after the CI; 13.33% spoke being helped by signs, and 13.33% use Sign Language; 13.33% used AAC, and 26.66% did not use any formal ways of communication. |
Language development is significantly affected by the ASD and, consequently, few children achieve the use of oral language and school inclusion. However, the use of CI is supported for its potential to improve hearing and language skills, and in the interaction, at least in part of that population. |
| 2021 |
Mancini |
CAP; CL; MAIS; IT-MAIS; MacArthur Bates; CDI; PPVT; Common Protocol of Evaluation in Rehabilitation Audiology; TROG-2 |
13.6% did not evidence any benefits making use of the CI, in terms of auditory recognition; 31.8% were able to recognize environmental sounds or words; and 22.5% achieved the ability of speech understanding. |
45.5% did not evidence any benefits regarding oral language; 72.7% did not achieve oral language or only spoke isolated words, and 18.2% could articulate simple phrases. |
CI can benefit deaf children with ASD, although their results regarding speech perception and language development are worse than the findings among implanted children with hearing loss, but no comorbidities. Limited improvement in language skills was found in most children with more severe ASD. |
| 2018 |
Mesallam |
MAIS; MUSS |
Average scoring in MAIS: 18.88%; the group with ASD had worse result of speech perception than the other children with assessed comorbidities. |
Average scoring in MUSS: 7.33%; 8 out of 9 assessed children did not use the oral language to communicate after the CI. |
The benefits of the CI in deaf children with ASD are limited and cannot be compared to the results in children without additional disabilities. |
| 2019 |
Scarabello |
MUSS; ABFW (vocabulary); PPVT; MacArthur; OCC; DDST I; Language Categories |
Not assessed |
Performance worse than expected in the expressive vocabulary of the ABFW test, with a minimum of 0% in the verbal designation of words until 5 years of age, when there was average scoring of 9% in the “means of transport” category. All participants scored 0 in the receptive vocabulary. Most of them (n=8) remained in the Language Category 1 - absence of speech. No participants achieved over 3 element sentence building. Mean of 18.7% in the MUSS. |
Communicative performance of children with hearing loss and ASD below the expected, despite discrete improvement. There is worse performance in this population than in the population user of CI without additional disabilities. |
| 2018 |
Motegi |
Enjoji Scale of Infant Analytical Development |
Not assessed |
Children with ASD, HI and ID showed significant delay in language development and greater delay in development of emotional and social behavior when compared with children of groups with ID only. |
There is development delay characteristic in children with additional comorbidities, users of CI. |
| 2016 |
Lachowska |
Response to music; Ling 6 Sound Check; Response to own name; Test of onomatopoeic words; Parents’ questionnaire with questions on hearing behavior |
Three out of 6 children showed speech recognition of their own names, according to their parents. There was no hyperacusis using the CI. Parents did not observe any improvement in the children’s visual contact or anxiety. Only one child, the oldest, could undergo the free-field audiometric test. |
Only one out of 6 assessed children, the oldest one, used isolated words to communicate. The other children only uttered screams. |
Traditional methods for skill assessment of children without comorbidities, who make use of CI, are insufficient to assess children with ASD, users of CI. |
| 2016 |
Valero |
CAP; CL |
Fifty-nine percent of the children rejected the CI, resulting in its discontinued use at some moments, and 27.2% quit using the CI. Complete rejection of the device was reported at a mean age of seven, ranging from 2 months to 10 years after the CI surgery. Among those, 2% reported hyperacusia. |
Most of the children communicated by means of more than one method (e.g.: speech, signs and/or AAC); 27.2% made exclusive use of non-verbal communication; 18% used speech as their main way of communication; 41% were able to utter some phrases or words to communicate. |
Further research is required to develop and/or change ASD assessment in children who make use of CI. Moreover, longitudinal studies of speech expression/perception in children with ASD before and after the implantation are required. |
| 2016 |
Mikic |
CAP; SIR |
In children diagnosed with ASD later, auditory skills developed slowly. Depending on their individual skills, at 6 years of age, some children were able to identify environmental sounds or discriminate speech sounds. |
The speech intelligibility in children with ASD was classified as category 2 at best, with none or very little progress until age 6, despite intensive speech-language therapy. |
Communication skills were strongly affected by a degree of expression of autism characteristics. Accurate and valid triage instruments for babies and toddlers are further necessary to reduce the detection age of ASD in children with congenital deafness, and they must be included in the pre-surgical procedures of CI. |
| 2015 |
Eshraghi |
Early Speech Perception Test; Multisyllabic Lexical Neighborhood Test; PBK; Questionnaire to parents |
Sixty-seven percent of the children advanced for the recognition of simple phrases or hearing understanding, while 33% progressed to speech detection. |
Sixty percent of the children were able to communicate using simple phrases and some sentences, while 33% remained in category 1 (utterances). |
The use of the CI may favor expressive and receptive language in children with hearing impairment and ASD, even if those children do not develop their skills as the others without comorbidities. |
| 2014 |
Meinzen-Derr |
Revised Gesell Developmental Schedules; PLS-4; CELF; VABS |
Barely a third of the children were considered oral communicators. |
The scores of receptive language ranged from 19 to 22%; the children did not show the same development as users of CI without comorbidities. |
It is fundamental to consider language and communication delays in children who make use of the CI, and not assume that they are simply results of hearing loss in all situations. With the commonly observed disorders in children with deafness and ASD, focusing on a single approach (e.g.: oral language) is not enough to help communicative development among that population. |
| 2013 |
Robertson |
CAP; SIR |
Six out of 10 assessed children made consistent use of the CI, 2 made inconsistent use, and 2 of them discontinued its use. One child achieved simple /familiar phrase understanding after seven years of CI use. |
Six out of 10 children remained non-verbal after the CI. Only one became user of the oral language. |
The results after the CI in children with ASD may vary, and it is possible to benefit from the device with time and proper support. Some may reject it completely. In case of ASD suspicion or confirmation before the CI, it is important adequate counselling to parents regarding their expectations. |
| 2013 |
Ozdemir |
MAIS; LiP |
Three out of four children with autism evidenced limited use of the CI, while one did not use the device. Progress was observed in auditory test results after 24 months of its implantation, with similar performance among children with limited use of the device, and lower score for the child who did not use the CI. |
Not assessed |
Factors like ASD may result in limited or no use of the CI. In such cases, it is essential the joint work of therapist, family and school in order to achieve more effective results on the development of hearing, language and quality of life. |
| 2008 |
Johnson |
RDLS, MacArthur-Bates; CDI;10-minute recording in free playful situation with mother and 5 minutes by themselves |
Not assessed. |
The child already presented utterances before the CI, with the support of communicative signs. At 5 years and 4 months of chronological age, after 12 months using CI, scores of receptive and expressive language equivalent to age 23 months were observed, in addition to greater involvement in symbolic playful activities. |
Children with multiple disabilities feature unique challenges for result assessment after the CI. Interactive parent-child tasks are a valid representation of the interaction skills in children with hearing loss and other comorbidities. |
| 2006 |
Daneshi |
Persian auditory perception test for the hearingimpaired |
Limited improvement and not statistically significant differences in speech perception were identified in the group of children with CI before and after the use of the CI. |
Not assessed |
The idiosyncrasies involving the prognosis of children with varied disabilities associated to deafness are expressive, and point to limitation in their speech development, posing challenges in the aspects of evaluation, planning and implementation of rehabilitation. |
| 2004 |
Donaldson |
MAIS, MacArthur; CDI; PPVT, GASP, Questionnaire with parents |
The greatest difference observed by parents was their children’s pleasure for music. It was reported that all 7 children uttered, responded to the sound and showed satisfaction with music, at least some times after the CI. Only 2 out of seven could answer the GASP, and one of the children achieved 100% of word recognition in the test after 2 years using the CI. MAIS score increased 30% after the CI. |
Only one child used oral language. It was possible to assess expressive vocabulary in only 3 children of the 7 participants, and one of them improved after 2 years of CI use. |
The gains after the use of the CI were small. However, when compared these children before and after the intervention, they showed some progress. Improvement in behaviors and interaction points to benefit in their quality of life after the CI, although it is difficult to quantify that. |
| 2000 |
Hamzavi |
EARS |
After 1 year, they could understand “hot”, “come”, “no”, “go”, “shoe”, “mom” and “dad”. Three years after the surgery, one of the children achieved scores of 83.3% in the word recognition and vocabulary of 30 words. |
Three months after activating the CI, one of the children started using their voice to communicate. Another child with ASD started uttering. |
Children with additional diagnoses are not unfit for the CI, but not all of them are considered good candidates. Parents and children’s lives can be positively changed after the CI. However, parents must have realistic expectations. |
Thumbnail
Captions: n=number of studies; CI=cochlear implant; ASD=autism spectrum disorder Source: www.prisma-statement.org