Language Performance in Children With Cochlear Implants and Additional Disabilities

Objectives/Hypothesis: Quantify post-cochlear implant (Cl) language among children with disabilities and determine the role of nonverbal cognitive quotients (NVCQ) in predicting language. Study Design: Small cohort study in pediatric tertiary care center. Methods: Children (n = 20) with CIs and developmental disabilities were enrolled. Receptive and expressive language was reported as language quotients (LQs). Pre- and post-CI LQs were compared using the signed-rank test. Multiple regression models analyzed language while controlling for possible confounders. Results: Five subjects had symptomatic cytomegalovirus, and four subjects had CHARGE syndrome with hearing loss etiology. Seventy-five percent had cognitive deficits, and 55% had motor delays. Median age of CT was 24 months; median CI duration was 27.7 months. The range of NVCQs for the study cohort was 27 to 115. Fifteen subjects had NVCQs <80. Age at implantation, income, and number of siblings were not correlated with language. Although children had significant increases in language age pre- to post-Cl, median LQs did not significantly change after implantation. NVCQ, age at hearing loss diagnosis, implant duration, and number of different therapies attended were significant in models. NVCQ contributed the most unique variance (67%; P = .0003). Pre-CI language performance did not predict post-CI performance. Conclusions: This study is the first step in addressing the effects of CIs on language among children with disabilities. Progress in language skills occurred for all participants, although rates of progress were slow and highly variable. NVCQ was the strongest predictor of language, although cognition is not always sufficient for good language development. Adapting therapeutic strategies may be essential to impact greater language progress in these complex children.