2. Assessing Children For Cochlear Implants Assessing Children For Cochlear Implants James H. Johnson, Ph.D. Department of Clinical and Health Psychology University of Florida

3. Overview and Objectives The focus of this presentation is on the role of the child-oriented psychologist as consultant to the Cochlear Implant Team. Specifically the goal is to highlight the nature of the pre-implant psychological evaluation in assessing children who are candidates for implantation and their families.

4. Objectives - Continued The pre-implant evaluation is based on the premise that relevant information obtained from the child and his/her family can be useful in determining; – those children (and families) who are good candidates for this procedure and, – Potential issues that represent challenges to successful implantation that, if dealt with appropriately prior to receiving the implant, may increase the likelihood of optimal outcome. In the next several minutes we will highlight the nature of this pre-implant assessment.

5. The Pre-Implant Psychological Evaluation Knowledge Assessment Motivation for Implant Family Agreement/Disagreement Appropriateness of Expectations Challenges to Compliance Parent-Child Communication Family/Psychological/Behavioral Issues Issues of Stress and Coping Questions/Concerns Regarding the Implant Process

6. Knowledge Assessment Do the parents ( and child, if older ) have reasonable knowledge of what the implant process involves? – What surgery will involve and the time necessary for healing. – The nature of post-implant activities (e.g., initial fitting/activation and mapping, auditory training, speech/language therapy, scheduled follow-ups). – The need for parental involvement in the child’s therapy? – What this will require in parental time and effort. Have parents gone beyond “passive learning” in an attempt to obtain information (e.g., internet searches, making contacts with others who have been implanted)? Any needed information?

7. Assessing Motivation for Implantation Do the parents (and child, if older) indicate a desire for the implant? Have they been active in seeking information regarding the implant? Have they been active in moving the implant process along? Do they show a willingness to do “whatever is necessary” to make the implant a success?

8. Family Agreement and Disagreements Do parent and child agree on the desirability of the implant? Do both parents agree on the desirability of an implant? Are both willing to be active participants in the implant process? Do other close family members support the idea of an implant?

9. Assessing Expectations Do parents and child (if old enough) convey an understanding that children vary in response to implants? Is there understanding that degree of success depends on parent and child being active participants in the process (e.g., auditory training, speech/language therapy, etc)? Do they understand that the child may not “hear” the same way as a non-hearing impaired individual? Is there implied acceptance of outcomes that may not involve; – the development of functional speech – a full understanding of speech without speechreading?

10. Challenges to Compliance Do parents/child convey a willingness to be an active participant in the implant process? Do they have a plan to deal with practical issues associated with implantation; – arrangements for surgery, – travel to doctor appointments, – auditory training, speech therapy, etc.? Is there a history of keeping appointments, active participation in prescribed communication programs, complying with the use of assistive devices, and dealing with other required medical treatments?

11. Assessing Stress and Coping Is there evidence of significant family stress? What are the nature of existing stressors? Do family members have adequate social supports to assist them in coping with ongoing stressors? Do family members appear to have adequate skills to cope with existing stressors? Considering both the level of stress and coping styles, is stress likely to compromise a successful outcome?

12. Assessing Other Psychosocial Factors Do parents appear to show evidence of deficits that could compromise successful outcome or require special assistance? Does the child show evidence of delays in development severe enough to compromise success? Do either parents or child show evidence of psychological/behavioral problems that could compromise success?

13. Psychological and Behavioral Issues: Implications for Intervention While not inclusive, listed below are examples of psychological family issues, sometimes highlighted in the pre-implant evaluation, that may represent contraindications or areas where family and/or child intervention is needed. – Significant Generalized Developmental Delay – Family Disagreement Regarding Implantation – Externalizing Problems of Childhood Difficult Child Temperament Oppositional Defiant Disorder Attention Deficit Hyperactivity Disorder (ADHD) – Issues of Selective Noncompliance

14. Child and Family Issues: Implications for Implantation While some of the issues just considered can, in some cases, represent a clear contraindication for implantation, in most instances information related to areas of concern simply lead to pre-implant intervention that followed by a successful implant.

15. That’s All Folks! Questions?