ORIGINAL ARTICLE Year : 2022  |  Volume : 28  |  Issue : 3  |  Page : 228-234

Expectations on communication abilities, social skills, and academic achievements of children with cochlear implant in Indian context: Preoperative parental perspectives

S B Rathna Kumar1, Sakeena Shora2, Udit Saxena3, Vijaya Raju Bollapalli4, Mendem Bapuji5
1 Department of Audiology, Ali Yavar Jung National Institute of Speech and Hearing Disabilities (Divyangjan), Maharashtra, India
2 Department of Speech Lang Pathology, Spectrum Healthcare, Maharashtra, India
3 Department of Audiology, MAA Institute of Speech and Hearing, Hyderabad, Telangana, India
4 Composite Regional Centre for Empowerment of Persons with Disabilities (Divyangjan), Davangere, Karnataka, India
5 Centre for Applied Linguistics and Translation Studies, University of Hyderabad, Hyderabad, Telangana, India

Date of Submission27-Mar-2020Date of Acceptance12-Jun-2020Date of Web Publication21-Nov-2022

Correspondence Address:
Dr. S B Rathna Kumar
Ali Yavar Jung National Institute of Speech and Hearing Disabilities (Divyangjan), Mumbai - 400 050, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/indianjotol.INDIANJOTOL_50_20

Objective: We assessed preoperative parental expectations on communication abilities, social skills, and academic achievements of children with cochlear implant (CI). Materials and Methods: A total of 18 questions from the “Parent Expectations Questionnaire for Cochlear Implants” related to communication abilities, social skills, and academic achievements were administered on a total of 80 parents who were in the process of cochlear implantation for their children. Results: The results revealed that parents expressed high expectations (expectation score between 81% and 100%) on communication abilities (82.5%), social skills (90.8%), and academic achievements (84.1%) of their children from cochlear implantation. With respect to questions related to communication abilities, social skills, and academic achievements, 87.28%, 97.17%, and 91.80% of parents, respectively, agreed that their children show improvements in the above domains. Conclusions: Overall, parents expressed high expectations on the outcomes of children with CI. Hence, CI team must judge the actualism in the preoperative parental expectations and disseminate accurate prognostic information that is expected from cochlear implantation before surgery in order to make the whole procedure effective.

Keywords: Academic achievements, cochlear implant, communication abilities, preoperative parental expectations, social skills

How to cite this article:
Kumar S B, Shora S, Saxena U, Bollapalli VR, Bapuji M. Expectations on communication abilities, social skills, and academic achievements of children with cochlear implant in Indian context: Preoperative parental perspectives. Indian J Otol 2022;28:228-34
How to cite this URL:
Kumar S B, Shora S, Saxena U, Bollapalli VR, Bapuji M. Expectations on communication abilities, social skills, and academic achievements of children with cochlear implant in Indian context: Preoperative parental perspectives. Indian J Otol [serial online] 2022 [cited 2022 Nov 23];28:228-34. Available from: https://www.indianjotol.org/text.asp?2022/28/3/228/361641   Introduction 

Cochlear implantation is presently one of the most considerable and successful treatment options available for individuals having hearing impairment of severe degree and beyond.[1],[2] Abundant research investigations have proved the supremacy of cochlear implant (CI) over hearing aids in terms of improving speech understanding abilities in population across age.[3],[4] The last two decades have seen a tremendous increase in the number of children with hearing impairment of severe-to-profound degree undergoing cochlear implantation worldwide.[1] This can be attributed to the numerous proven benefits provided by CI in children, including overall improvement in auditory development,[5],[6] enhanced speech production,[7],[8] and greater speech intelligibility.[9],[10] In addition to the communication abilities, CI also showed significant positive effects on the psychosocial behavior and quality of life[11],[12] and academic performance in children.[13],[14]

Unlike developed countries, a developing world like India was late to wake up to the reality of cochlear implantation and to establish cochlear implantation as a treatment modality for hearing impairment. Fortunately, the situation began to change gradually, and over the years, cochlear implantation has become well-established in India.[15] Rapidly growing economy, expanded literacy, and inclusion of CI surgery under government health insurance schemes are some of the factors which have led to this change.[15] India is now approximately 20 years old since the establishment of cochlear implantation, and there are around 200 state-of-the-art CI centers in major cities of India with experienced hearing professionals and well-equipped habilitation centers for the comprehensive postimplantation management. By far, more than 25,000 cochlear implantations have been done across India.[15]

The process of cochlear implantation provokes many anticipations and expectations in parents on postoperative outcomes of their children.[16] Better communication abilities, high social skills, greater academic achievements, positive change in their future life, less rehabilitation demand, overall satisfaction, and stress-free life are some of the common expectations of parents from their children who are in the process of cochlear implantation.[16],[17] Although some studies reported that parental expectations have largely been met after cochlear implantation,[18],[19] others suggested that cochlear implantation and subsequent rehabilitation requirements might affect parental dynamics. Parents in such cases tend to have unreasonably high expectations from their children,[20],[21] accompanied with considerable anxiety and fear.[21],[22] In the later stages, facing the subsequent demanding rehabilitation requirements, the family's level of stress increases,[23],[24] especially if their preoperative high expectations are not encountered.[21],[25]

Kumar et al.[17] investigated parental expectations on outcomes of children with CI in Indian scenario, but postoperative, and reported high expectations in terms of communication abilities, social skills, academic achievement, and change in their future life among parents. However, the assessment of preoperative parental expectations on outcomes of children should be considered as one of the important variables while evaluating children for cochlear implantation.[16],[25] Assessing preoperative parental expectations help the CI team to comprehend the dynamics involved in parental expectations on outcomes of children from cochlear implantation. This will enable the CI team to help parents come on genuine and realistic understanding about expected outcomes before cochlear implantation in order to make the whole procedure effective. There is a paucity of studies on preoperative parental expectations in Indian scenario. Hence, the present study aimed to investigate preoperative parental expectations on communication abilities, social skills, and academic achievements of children who were in the process of cochlear implantation.

  Materials and Methods 

The research design of the present study was survey, and the sampling technique was purposive sampling. The present study included 80 parents who were in the process of cochlear implantation for their children. The participants recruited for the study were those who visit special schools, institutes, hospitals, and private(re) habilitation centers in and around the city of Mumbai, India. Thirty-seven of them were mothers and 43 of them were fathers of children. A total of 18 questions related to three subscales such as communication abilities (10 questions), social skills (3 questions), and academic achievements (5 questions) were selected from the Parent Expectations Questionnaire for CIs developed by Nemours Children's Clinic, Florida, USA. These questions were validated for suitability in the Indian context by five audiologists experienced in the field of CI. These questions were then translated in Marathi and Hindi by native speakers and then back translated in order to ensure that the meaning of the content remains the same. Then, native speakers with knowledge of English as well proofread these translated questions in order to ensure that the translated questions were closest to the original version.

These questions were administered on parents for assessing the parental expectations on outcomes from children with CI. The parents were explained in detail about the purpose of the study, and the informed consent was taken from all the parents. A five-point rating scale was used for rating the responses, i.e., strongly disagree, disagree, neutral (neither disagree nor agree), agree, and strongly agree. The responses rated as strongly disagree, disagree, neutral, agree, and strongly agree were assigned a score of 5, 4, 3, 2 and 1, respectively. The percentage of parents in terms of ratings for each question was calculated from each subscale, i.e., communication abilities, social skills, and academic achievements. Similarly, the percentage of parents in terms of ratings for combined questions of each subscale and combined subscales was calculated. In addition, a question-wise total score was calculated and converted into percentage to obtain expectation score (%) for each question from each subscale. Similarly, a subscale-wise total score was calculated and converted into a percentage to obtain each subscale expectation score (%). Finally, the combined subscales' total score was calculated and converted into a percentage to obtain a combined expectation score (%). Based on the percentage of expectation scores, the expectation levels were categorized into four levels, i.e., almost no expectations, low expectations, medium expectations, and high expectations. The expectation levels were as follows: 40% and below = almost no expectations, 41%–60% = low expectations, 61%–80% = medium expectations, and 81% and above high expectations.

Ethical clearance

This is a behavioural study in which data is collected using non-invasive methods. Further, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and it's later amendments or comparable ethical standards.

  Results 

The percentage of parents in terms of ratings for each question of three subscales, i.e., communication abilities, social skills, and academic achievements, was calculated and tabulated from [Table 1],[Table 2],[Table 3]. The percentage of parents in terms of ratings for combined questions of each subscale, i.e., communication abilities, social skills, and academic achievements, and combined subscales was calculated and tabulated in [Table 4]. The mean expectation score (%), standard deviation, and level of expectation for each question related to three subscales, i.e., communication abilities, social skills, and academic achievements, were calculated and tabulated from [Table 5],[Table 6],[Table 7]. The mean expectation score (%), standard deviation, and level of expectation for each subscale, i.e., communication abilities, social skills, and academic achievements, and combined subscales were calculated and tabulated in [Table 8].

Table 1: Percentages of parents in terms of ratings for each question related to communication abilities

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Table 2: Percentages of parents in terms of ratings for each question related to social skills

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Table 3: Percentages of parents in terms of ratings for each question related to academic achievements

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Table 4: The percentage of parents in terms of ratings for combined questions of each subscale, i.e., communication abilities, social skills, and academic achievements, and combined subscales

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Table 5: Expectation score (%), standard deviation score (%), and expectation level of parents for each question related to communication abilities

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Table 6: Expectation score (%), standard deviation score (%), and expectation level of parents for each question related to social skills

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Table 7: Expectation score (%), standard deviation score (%), and expectation level of parents for each question related to academic achievements

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Table 8: Expectation score (%), standard deviation score (%), and level of expectation for each subscale and combined subscales

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  Discussion 

We investigated preoperative parental expectations on communication abilities, social skills, and academic achievements of children who were in the process of cochlear implantation. With respect to questions related to communication abilities, more than 90% of parents agreed that their child will be able to use the telephone (93.8%), develop intelligible speech (91.3%), follow conversation with a group of people (91.3%), communicate without sign language (91.3%), improve communication skills (language and speech) tremendously (95%), and produce a variety of speech sounds (100%). Around 80%–90% of parents agreed that their child be able to easily detect even very quiet sounds in his/her environment (88.3%) and understand speech without relying completely on lipreading (86.3%). The present study also indicated that 77.5% of parents agreed that their child's speech will be intelligible even for people who are unfamiliar with him/her, whereas only 57.5% agreed that their child will be able to easily understand others without having them repeat themselves several times, and 40% of parents remained neutral for this question. On average, 87.28% of parents showed positive expectations on communication abilities.

Parents' responses to questions related to social skills revealed that more than 90% of parents agreed that their child will easily make friends with hearing peers (98.5%), will be accepted by his classroom hearing peers (92.6%), and will improve social skills tremendously (100%). Similarly, with respect to questions related to educational achievements, more than 90% of parents agreed that their child will improve tremendously in his/her academic achievements (91.3%), achieve high standards in reading and writing (93.8%), participate easily in a regular classroom setting (90.1%), and improve learning abilities tremendously, whereas 83.8% of parents agreed that their child will achieve high standards in mathematics. On average, 97% and 91.8% of parents showed positive expectations on social skills and educational achievements, respectively.

With respect to communication abilities, parents expressed high expectation levels for questions such as child will be able to use the telephone (82.5%), easily detect even very quiet sounds in his/her environment (83.5%), develop intelligible speech (80.5%), able to communicate without the use of sign language (87.5%), improve his/her communication skills tremendously (88.3%), and produce a variety of speech sounds (91.3%), whereas parents express medium expectation levels for questions such as child will be able to understand speech without relying completely on lipreading (79%), develop intelligible speech even for people who are unfamiliar with him/her (76.3%), follow a conversation with a group of people (79.5%), and easily understand others without having them repeat themselves several times (72%).

With respect to social skills, parents expressed high expectation levels for questions such as child will easily make friends with hearing peers (90.7%), will be accepted by his classroom hearing peers (89.8%), and will improve social skills tremendously (91.8%). Similarly, with respect to educational achievements, parents expressed high expectation levels for questions such as child will improve tremendously in his/her academic achievements (85%), achieve high standards in reading and writing (83.3%), participate easily in a regular classroom setting (81%), improve learning abilities tremendously (82.8%), and achieve high standards in mathematics (88.5%). On average, it was noticed that parents had high expectation levels on all the three domains, i.e., communication abilities, social skills, and academic achievements.

Although CI recipients were initially happy to receive even modest gains in terms of speech perception, the expectations are now much higher.[26],[27] The high expectations might be partly because of the extended candidacy criteria for cochlear implantation by the Food and Drug Administration.[26] There has been a rapid and continuous evolution in the field of CI technology, particularly in speech coding strategies as well as surgical procedures to implant electrodes.[28],[29],[30] This has not only resulted in positive outcomes in children in terms of improved auditory development[28],[31] but also enhanced speech production,[32],[33] greater speech intelligibility,[34],[35] positive effects on the psychosocial behavior and quality of life,[6],[36] and better academic performance.[13],[36]

Thus, significant advances in CI technology and increasingly positive outcomes from CI have resulted in relaxation in candidacy criteria to consider subjects as young as 12 months with pre- or postlingual onset of hearing loss, significant residual hearing, and some degree of preimplant speech recognition scores.[26],[29],[30] Over the years, cochlear implantation has become a standard treatment paradigm worldwide for the management of children with prelingual severe-to-profound hearing impairment.[18],[37] Even in a developing world like India, cochlear implantation has now become well-established due to rapidly growing economy, expanded literacy, and inclusion of CI surgery under government-supported schemes.[15] Hence, it is not surprising that parents express high hopes and expectations on outcomes of their children from CI that is evident in the present study.

Nikolopoulos et al.[38] investigated parental views on outcomes of children from CI and reported that parents met their preoperative expectations and, in some cases, surpassed at each of the follow-up intervals. Zaidman-Zait and Most[16] examined maternal expectations on outcomes of children with CI and reported that maternal satisfaction correlated positively with their preoperative expectations on communication abilities and social skills. Archbold et al.[39] explored the parents' perceptions on outcomes of children with CI and revealed that the majority of parents agreed that their expectations had been exceeded, although few disagreed. Piazza, Kandathil, and Carron[18] investigated parental expectations and satisfaction on outcomes of children with CI and reported that parents were satisfied with the performance of their children after cochlear implantation. Hassuji[19] measured parental expectations and actual outcomes 1-year postcochlear implantation and demonstrated the ability of CIs to meet the parental expectations subject to the time frame postimplantation.

Quittner et al.[23] reported high psychological stress among parents due to unrealistic expectations, the need of parental involvement in posthabilitation, and restrictions in parents' pursuit of their own personal activities. Perold[21] investigated mothers' expectations and satisfaction with the outcomes of their children with CI and reported that parents expressed increased anxiety during the switch-on period as well as experienced disappointment in the period following the switch-on of their children's implant as they had unrealistic expectations of seeing immediate improvement in their children's communication abilities. Weisel et al.[25] studied the mothers' stress and expectations from their children with CI and reported that the attitudes and expectations of mothers were very high. They concluded that if expectations from and attitudes toward the cochlear implantation are so high, perhaps unrealistically high, then the effects of the CI, good as they are, will likely fail to meet them.

On average, parents expressed high levels of expectations on outcomes in domains such as communication abilities, social skills, and academic achievements of children from cochlear implantation in the present study. However, from the above review of literature, there has been nonalignment on whether parents meet their preoperative expectations, especially if their preoperative expectations are unrealistically high.[21],[25] Hence, CI team must be watchful on the parental expectations on outcomes of their children from CI before surgery. In addition, the CI team should judge the expected outcomes and disseminate accurate prognostic information to parents. This will help the parents come to realistic understanding on postimplantation outcomes in order to make the whole procedure effective.

Beadle et al.[24] reported that although parents expressed unrealistically high expectations preoperatively, parents may change their expectations and come to realistic understanding over postimplant rehabilitation period. In addition, the researchers reported that parents received more social support from formal sources like CI team than from informal social supports such as family, friends, and neighbors. Hence, CI team should continue their support to parents at different stages of cochlear implantation program. The provision of information, guidance, and support provided by CI team should empower parents in establishing long-term and intensive collaborative intervention program that is very much needed after cochlear implantation.

  Conclusions 

We assessed preoperative parental expectations on outcomes of children from cochlear implantation. Parents expressed high expectations on communication abilities, social skills, and academic achievements from cochlear implantation. Hence, CI team must be watchful on the parental expectations and disseminate accurate prognostic information in order to ensure that parents come to realistic understanding on postoperative outcomes. Further, CI team should continue their support at different stages of cochlear implantation to empower parents in establishing long-term and intensive collaborative intervention program in order to enable parents to meet their preoperative expectations. India is a developing country with vast diversity. Hence, similar studies should be carried out as a function of age of implantation, socioeconomic status, financial assistance for CI, educational status of parents, geographical background, etc., as these variables might influence the parental expectations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]