Pediatrics Flashcards
What is the most frequency psychological diagnosis for deaf children?
- Behavioral disorder
- Deaf children often exhibit impulsivity, immaturity, egocentricity, lack of empathy, lack of inner control, and self-awareness
Why might deaf children develop behavioral disorders?
- Learned behaviors vs. poor parent-child communication?
- When communication deficits are present, poor relational skills develop, therefore the child displays a lack of empathy or awareness of others at an older age and these behaviors are deemed “deviant”
- Hearing parents of deaf children generally experience greater frustration in child rearing which may cause a lack of awareness for affective cues from their child
What are the consequences of physical punishment between hearing parents and deaf children?
- Leads to poor self-monitoring by the child
- Little information provided to help understand broken rules
Describe language ability of deaf children.
- Language ability not modality is the best predictor of interpersonal communication in children
- Hearing parents who are adept in ASL can avoid developmental risks of inadequate communication (however, reliance on sign is significantly limiting the child’s options for communication partners)
- CI and oral education can add to the child’s experiential input by improving auditory access
- Additional encouragement to proceed to a CI from HAs?
What are the effects of deafness on motor function?
-Reaction time and speed of movement
What are the 4 categories of motor function affected by deafness?
1) Organic factors
2) Sensory deprivation
3) Language (verbal) deprivation
4) Emotional factors
Describe the effects of deafness on motor function: organic factors.
- Vestibular deficits
- EX: hand-eye coordination, balance, body coordination
Describe the effects of deafness on motor function: sensory deprivation.
- Vocal play and babbling are the infant’s way of practicing movement and motor control
- They learn that an action they initiate results in a target behavior
Describe the effects of deafness on motor function: language (verbal) deprivation.
-Deaf children lack the ability to internally rehearse/plan language before the activities become automatized
Describe the effects of deafness on motor function: emotional factors.
- Poor parent-child communication can result in overprotection or neglectful parenting behaviors which affects the child’s self-concept
- Ultimately, the deaf child may become shy, withdrawn, and have poor self-confidence
What are the effects of deafness on motor speech production?
- Motor learning for speech production relies on intact sensory receptor mechanisms and the subsequent integration of acoustic info with visual, proprioceptive, and kinesthetic feedback
- EX: praxis
- Connections of auditory and motor events develop between 3 and 12 months of age
- Acoustic patterns of speech contain cues for the motor actions required to generate these patterns
What are the effects of deafness on the acquisition of acoustic patterns of speech?
- Children with HL (even with CI) have access to a limited portion of these patterns
- Children with HL learn patterns for individual words but show difficulty breaking the patterns down into the syllable or phoneme level
- Implications for including more emphasis on motor skill and sensory-motor integration
What are the goals of the S/L evaluation?
- Provide a baseline of speech and language skills
- Uncover other obstacles to S/L acquisition
- Contribute to child’s overall profile to assist with candidacy
What are some measures of receptive/expressive language?
- PPVT
- CELF
What are some measures of articulation/intelligibility language?
- CID Phonetic Inventory
- Goldman-Fristoe
What are some measures of auditory/listening skills language?
- MAIS/IT-MAIS
- Functional Auditory Performance Indicators (FAPI)
What are some measures for screening for neurodevelopmental disorders (i.e., ASD)?
- Modified Checklist for Autism in Toddlers (M-CHAT) for children 16-30 months
- Clinical “red flags”: joint attention/eye contact, pointing gesture, pretend play
- Learning disabilities in older children
What are some subareas of the S/L evaluation?
- Receptive/expressive language
- Articulation/intelligibility
- Auditory/listening skills
- Voice
- Fluency
- School environment/modality
- Family support
- Counseling re: realistic expectations
What are ways to classify voice?
- Vocal quality: breathy, hoarse, clear, aphonic?
- Resonance- hypo/hypernasal, alternate between?
- Breath support- adequate for connected speech?
What are the 5 levels of the auditory skills pyramid?
- Level 1: Awareness
- Level 2: Suprasegmental discrimination and association
- Level 3: Segmental association and identification
- Level 4: Identification
- Level 5: Processing and comprehension
Describe Level 1 of the auditory pyramid: Awareness.
- Detection
- Occurs 1-4 weeks post-activation
Describe Level 2 of the auditory pyramid: Suprasegmental Discrimination and Association.
- EX: /bopbop/ vs. /buzz/
- Occurs 2-5 months post-actviation
Describe Level 3 of the auditory pyramid: Segmental Association and Identification.
- Consonants vs. vowels
- Word pair contrasts
- Occurs 6-9 months post-activation
Describe Level 4 of the auditory pyramid: Identification.
- Recognize 1-4+ words in a sentence
- Occurs 9-18 months post-activation
Describe Level 5 of the auditory pyramid: Processing and Comprehension.
- Vocabulary
- Unfamiliar talkers
- Occurs 18+ months post-activation
What is the language skills pyramid?
- Level 1: word approximation
- Level 2: word production
- Level 3: connected utterances
- Level 4: simple sentences
- Level 5: expanded sentences
- Level 6: complex sentences
What listening exercises should parents do at home?
- Model a “hearing response” (i.e., saying “I hear that” while pointing to your ear)
- Engage in vocal play
- Communicate face-to-face and at the child’s level whenever possible (<3 ft)
- Use consistent labels for items until the child understands or produces the words
- Describe the ongoing action for items until the child understands or produces the word
- Provide words for your child’s wants, feelings, and intended messages
What is the ABC Model?
-Way to classify outcomes:
A = Auditory Oral/Verbal Communicator
B = Both, Auditory/Oral Communicator with Visual Assist
C = Complimentary, Auditory/Verbal Skills Assist Primary Visual Communication
D = Child doesn’t benefit from implant/auditory stimulation
Describe the ABC Model: A.
- Auditory Oral/Verbal Communicator
- Commensurate
- On track with typically developing peers, expected to be mainstreamed with minimal/moderate support
- Factors: deafness is only Dx, good use of current amplification, language ability is good (based on exposure), appropriate family support & expectation, appropriate school services, early implantation
Describe the ABC Model: B.
- Both: Auditory/Oral Communicator with Visual Assist
- Capable
- Can learn auditory and oral skills, but slower process and need intensive support; may enter mainstream, may have specialized classes
- Factors: fair use of current amplification, limited language use based on exposure, later implanted, do not catch up to hearing peers
Describe the ABC Model: C.
- Complimentary: Auditory/Verbal Skills Assist Primary Visual Communication
- Challenged
- Poor access of auditory signal from CI, require multi-modality communication strategies, in self-contained classroom
- Factors: deafness is not primary disability, other severe Dx, poor use of current amplification, language use poor/not developed based on exposure
Describe the checklist for annual mapping.
- Equipment check
- Usage problems/environment
- Any concerns from parents/patients?
- Mapping
- Testing
- HA adjustments
- Unaided testing?
- Recommendations
Describe the checklist for follow-up assessment.
- Verify map setting
- Record of progress/lack of
- LING 6 sounds
- Basic audio
- CI audio (note CI program/volume/sensitivity, CI configuration, stimuli)
- Open-set speech testing
- IT-MAIS/MAIS
What factors affect speech perception?
- Implant technology
- Surviving neural population
- Auditory (sensory) deprivation
- Auditory pathway development
- Plasticity of the auditory system
- Length of deafness
- Age at implantation
- Etiology of deafness
- Pre-op selection criteria
- Pre-op hearing levels
- Pre-op auditory speech perception
- Measures of speech perception
- Pre-op linguistic level
- Other handicaps
- Surgical issues
- Device programming
- Device/equipment malfunction
- Mode of communication
- Auditory input
- Frequency/type of training
- Pre/school environment/educational setting
- Parental/family motivation/social issues
What is the focus of improvements in implant design?
- Least traumatic to insert
- May be sufficiently atraumatic to preserve residual hearing
- Can get close to neural elements to reduce power need
- Can stimulate a more selective cell population
- Can deliver lubricants, anti-inflammatories, and neurotrophic growth factors
What are some patient resources?
- Equipment help
- AR in a box
- Remote assistant assistance
- Social support
