Executive Functions, Pragmatic Skills, and Mental Health in Children With Congenital Cytomegalovirus (CMV) Infection With Cochlear Implants: A Pilot Study

Abstract

Congenital cytomegalovirus (cCMV) infection is the most common cause of progressive hearing impairment. In our previous study around 90% of children with a cCMV infection and CI had severely damaged balance functions (Karltorp et al., 2014). Around 20% had vision impairment, 15% were diagnosed with Autism-Spectrum-Disorder, and 20% with ADHD. One clinical observation was that children with cCMV infection had problems with executive functioning (EF), while controls with a genetic cause of deafness (Connexin 26 mutations; Cx26) did not have similar difficulties. A follow-up study was therefore initiated with the main objective to examine EF and pragmatic skills in relation to mental health in children with a cCMV infection and to draw a comparison with matched controls with Cx26 mutations (age, sex, hearing, non-verbal cognitive ability, vocabulary, and socioeconomic status level). Ten children with a cCMV infection and CI (4.8-12:9 years) and seven children with CI (4:8-12:8 years) participated in the study, which had a multidisciplinary approach. Executive functioning was assessed both with formal tests targeting working memory and attention, parent and teacher questionnaires, and a systematic observation by a blinded psychologist during one test situation. Pragmatics and mental health were investigated with parent and teacher reports. In addition, the early language outcome was considered in non-parametric correlation analyses examining the possible relationships between later EF skills, pragmatics, and mental health. Children with cCMV had a statistically significant worse pragmatic outcome and phonological working memory than controls despite their groups having similar non-verbal cognitive ability and vocabulary. However, there were no statistical differences between the groups regarding their EF skills in everyday settings and mental health. There were associations between early language outcomes and later EF skills and pragmatics in the whole sample. Conclusion: Children with a cCMV infection are at risk of developing learning difficulties in school due to difficulties with phonological working memory and pragmatic skills in social interactions.

Executive Functions and Deafness: Results in a Group of Cochlear Implanted Children

“…They had better results in all EF domains studied. These results were similar to the data in previous literature [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The absence of auditory stimuli in the newborn and the slowdown in language development and brain plasticity resulting from the hearing deprivation period could be therefore considered potential alterations at the basis of the EF deficits in children with CIs.…”

Long-term results of cochlear implantation in children with congenital single-sided deafness

“…SSD children should receive special monitoring of their NH ear as up to 75% (6/8) may develop delayed-onset contralateral SNHL [ 32 ]. Children with cCMV, in particular, bear the risk of developing learning difficulties in school due to difficulties with phonological working memory, pragmatic skills in social interactions and balance disorders [ 33 ]. The auditory reserve of the NH ear is relevant not only in children with cCMV etiology, but in all children with SSD: adult SSD CI patients showed significantly poorer hearing in the NH ear compared to an age-correlated group of NH subjects [ 34 ].…”

Cognitive Assessment of Children Who Are Deafblind: Perspectives and Suggestions for Assessments

“…Hence, it is important to evaluate the child’s physiological and psychological states during the assessment in this regard. For example, an observational and qualitative analysis scale has been developed to evaluate a child’s behavior emotional, behavioral and attention abilities during the testing session (see Löfkvist et al, 2020 ).…”