Comparisons of visual attention in school-age children with cochlear implants versus hearing peers and normative data

Objective: Previous research has found that preschoolers with hearing loss have worse visual attention and elevated rates of behavior problems when compared to typically hearing peers (Barker et al., 2009). However, little is known about these deficits in school-age children with cochlear implants (CIs). We evaluated visual selective attention in school-age children with CIs and hearing peers and examined the link between visual attention and behavior problems. Method: Data were drawn from the Childhood Development after Cochlear Implantation (CDaCI) study, the largest longitudinal, multi-site study of children with CIs. Visual attention was measured using d prime (d′) on a continuous performance test (The Gordon CPT), which requires participants to watch a stream of digits and hit a button after seeing a certain target (a 9 following a 1). The CPT captures the probability of a hit (pressing button for a target) vs a false alarm (pressing the button for a non-target) while accounting for chance responding. In addition, predictors of visual attention, including IQ (using Processing Speed and Perceptional Reasoning on the WISC-IV), age at implantation, gender, and device management were examined. Externalizing problems were assessed using parent-report on the BASC-2. Data were drawn from 60 months post-implantation. Results: Children with CIs (n = 106) showed significantly worse visual selective attention than hearing peers. The difference in d′ was driven by higher rates of false alarms. In the CI group, the Processing Speed Index on the WISC was correlated with total omissions, total commissions and d′. Within the CI group, d′ significantly predicted parent-reported externalizing behavior problems. This finding was primarily driven by elevated Hyperactivity in the CI group. Conclusion: Children with CIs continue to display deficits in visual attention when compared to their hearing peers. Despite improvements in oral language, these problems have critical implications for academic performance and social competence. Currently, cochlear implant teams do not focus on these other dimensions of development and thus, may not be positioned to address them. Assessment of attention and behavior should be incorporated into routine, annual visits soon after implant surgery, and remediation of these deficits should be included in early intervention programs.