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Hearing Disorders: HELP
Articles by Alexandra L. Quittner
Based on 13 articles published since 2010
(Why 13 articles?)
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Between 2010 and 2020, Alexandra L. Quittner wrote the following 13 articles about Hearing Disorders.
 
+ Citations + Abstracts
1 Article Health-Related Quality of Life Instruments for Children With Cochlear Implants: Development of Child and Parent-Proxy Measures. 2019

Hoffman, Michael F / Cejas, Ivette / Quittner, Alexandra L. ·Department of Psychology, University of Miami, Miami, Florida, USA. · University of Miami Miller School of Medicine, University of Miami, Miami, Florida, USA. · Miami Children's Research Institute, Nicklaus Children's Hospital, Miami, Florida, USA. ·Ear Hear · Pubmed #30059365.

ABSTRACT: OBJECTIVES: Severe to profound hearing loss is associated with worse health-related quality of life (HRQoL), reflecting the wide-ranging effects of deafness on spoken language, cognition, and social/behavioral development. However, there are currently no cochlear implant (CI)-specific HRQoL measures that were developed using the Food and Drug Administration Guidance on patient-reported outcomes. This study developed the first HRQoL instruments (CI-QoL) for children with CIs, ages 6 to 12, and a parent-proxy measure for this age group. DESIGN: Two phases of instrument development were conducted. Phase 1 consisted of a literature review yielding a conceptual framework and discussion guides to elicit information from stakeholder focus groups at CI clinics in Miami and Philadelphia (n = 30; e.g., physicians, speech pathologists). During phase 2, open-ended interviews were conducted with 21 parent-child dyads (M child age = 9.1 years) recruited from these two clinics. Interviews were transcribed, followed by content analysis in NVivo to identify the most frequent and difficult themes. Items were then derived from these themes to form the initial draft instruments. A multimodal approach was used to create the child-report version (i.e., pictorial representations, audio recording of items, written text above the drawings) to maximize comprehension and ease of responding. Both measures were developed to be administered electronically on a tablet device. In phase 3, a new set of parent-child dyads (n = 20; child age M = 9.2 years) completed a cognitive testing protocol to ensure clarity, ease of use, and comprehensiveness. Cognitive testing led to revisions and finalization of the instruments. RESULTS: The final self-report measure contained 33 items across eight domains: Noisy Environments, Academic Functioning, Child Acceptance, Oral Communication, Social Functioning, Fatigue, Emotional Functioning, and Device Management. The final parent-proxy measure included 42 items on nine scales: the same eight scales that appear on the child version, with the addition of Behavior Problems. Correlations between child and parent reports on each scale ranged from r = 0.08 to 0.48. CONCLUSIONS: CI-specific HRQoL instruments have now been developed for school-age children with CIs, with an accompanying parent-proxy version. After a psychometric validation, these CI-specific measures will enable us to track long-term outcomes, evaluate the efficacy of interventions to improve CI use (e.g., single versus bilateral implantation, AV therapy, maternal sensitivity training), and provide a profile of the "whole child's" functioning to facilitate care.

2 Article Comparisons of IQ in Children With and Without Cochlear Implants: Longitudinal Findings and Associations With Language. 2018

Cejas, Ivette / Mitchell, Christine M / Hoffman, Michael / Quittner, Alexandra L / Anonymous7500942. ·Department of Otolaryngology, University of Miami, Coral Gables, FL. · School of Public Health, Johns Hopkins University, Baltimore, MD. · Department of Psychology, University of Miami, Coral Gables, FL. · Miami Children's Research Institute, Miami, FL. ·Ear Hear · Pubmed #29624538.

ABSTRACT: OBJECTIVES: To make longitudinal comparisons of intelligence quotient (IQ) in children with cochlear implants (CIs) and typical hearing peers from early in development to the school-age period. Children with additional comorbidities and CIs were also evaluated. To estimate the impact of socioeconomic status and oral language on school-age cognitive performance. DESIGN: This longitudinal study evaluated nonverbal IQ in a multicenter, national sample of 147 children with CIs and 75 typically hearing peers. IQ was evaluated at baseline, prior to cochlear implantation, using the Bayley Scales of Infant and Toddler Development and the Leiter International Performance Scale. School-age IQ was assessed using the Wechsler Intelligence Scales for Children. For the current study, only the Perceptual Reasoning and Processing Speed indices were administered. Oral language was evaluated using the Comprehensive Assessment of Spoken Language. RESULTS: Children in the CI group scored within the normal range of intelligence at both time points. However, children with additional comorbidities scored significantly worse on the Processing Speed, but not the Perceptual Reasoning Index. Maternal education and language were significantly related to school-age IQ in both groups. Importantly, language was the strongest predictor of intellectual functioning in both children with CIs and normal hearing. CONCLUSION: These results suggest that children using cochlear implants perform similarly to hearing peers on measures of intelligence, but those with severe comorbidities are at-risk for cognitive deficits. Despite the strong link between socioeconomic status and intelligence, this association was no longer significant once spoken language performance was accounted for. These results reveal the important contributions that early intervention programs, which emphasize language and parent training, contribute to cognitive functioning in school-age children with CIs. For families from economically disadvantaged backgrounds, who are at-risk for suboptimal outcomes, these early intervention programs are critical to improve overall functioning.

3 Article Symbolic Play and Novel Noun Learning in Deaf and Hearing Children: Longitudinal Effects of Access to Sound on Early Precursors of Language. 2016

Quittner, Alexandra L / Cejas, Ivette / Wang, Nae-Yuh / Niparko, John K / Barker, David H. ·Department of Psychology, University of Miami, Coral Gables, FL, United States of America. · Department of Otolaryngology, University of Miami Miller School of Medicine, Barton G. Kids Hear Now Cochlear Implant Family Resource Center, Miami, FL, United States of America. · School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America. · Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America. · Department of Child and Adolescent Psychiatry, Brown University, Providence, RI, United States of America. ·PLoS One · Pubmed #27228032.

ABSTRACT: In the largest, longitudinal study of young, deaf children before and three years after cochlear implantation, we compared symbolic play and novel noun learning to age-matched hearing peers. Participants were 180 children from six cochlear implant centers and 96 hearing children. Symbolic play was measured during five minutes of videotaped, structured solitary play. Play was coded as "symbolic" if the child used substitution (e.g., a wooden block as a bed). Novel noun learning was measured in 10 trials using a novel object and a distractor. Cochlear implant vs. normal hearing children were delayed in their use of symbolic play, however, those implanted before vs. after age two performed significantly better. Children with cochlear implants were also delayed in novel noun learning (median delay 1.54 years), with minimal evidence of catch-up growth. Quality of parent-child interactions was positively related to performance on the novel noun learning, but not symbolic play task. Early implantation was beneficial for both achievement of symbolic play and novel noun learning. Further, maternal sensitivity and linguistic stimulation by parents positively affected noun learning skills, although children with cochlear implants still lagged in comparison to hearing peers.

4 Article Comparisons of Longitudinal Trajectories of Social Competence: Parent Ratings of Children With Cochlear Implants Versus Hearing Peers. 2016

Hoffman, Michael F / Cejas, Ivette / Quittner, Alexandra L / Anonymous4330853. ·*Department of Psychology, University of Miami †Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A. ·Otol Neurotol · Pubmed #26719958.

ABSTRACT: OBJECTIVE: To evaluate the longitudinal effects of cochlear implantation (CIs) on young, deaf children's social competence over 5 years of implant use and compare their social skills to those of same-aged, hearing peers. STUDY DESIGN: Prospective, longitudinal between- and within-subjects design, with assessments completed 3 times over 5 years. SETTING: This study was conducted at 6 cochlear implant centers and two preschools that enrolled both CI and hearing children. PATIENTS: Parents of 132 children with CIs and 67 age-matched hearing controls completed the study measures. Children were between 5 and 9 years of age at the first time point. INTERVENTIONS: Cochlear implantation and speech-language therapy. MAIN OUTCOME MEASURES: Three subscales were drawn from 2 standardized measures of behavioral and social functioning, the Behavioral Assessment Scale for Children (Adaptability, Social Skills) and the Social Skills Rating System (Social Skills). A latent social competence variable was created using multiple subscales, which was modeled over time. RESULTS: Parent data indicated that children with CIs were delayed in comparison to their hearing peers on the social competence latent variable across all time points. Further, there was minimal evidence of "catch-up" growth over this 5-year period. CONCLUSION: Children with CIs continued to experience delays in social competence after several years of implant use. Despite documented gains in oral language, deficits in social competence remained. To date, no interventions for children with CIs have targeted these social and behavioral skills. Thus, interventions that address the functioning of the "whole child" following cochlear implantation are needed.

5 Article Comparisons of social competence in young children with and without hearing loss: a dynamic systems framework. 2015

Hoffman, Michael F / Quittner, Alexandra L / Cejas, Ivette. ·University of Miami and mikefhoffman@gmail.com. · University of Miami and. · University of Miami Miller School of Medicine. ·J Deaf Stud Deaf Educ · Pubmed #25583707.

ABSTRACT: This study compared levels of social competence and language development in 74 young children with hearing loss and 38 hearing peers aged 2.5-5.3 years. This study was the first to examine the relationship between oral language and social competence using a dynamic systems framework in children with and without hearing loss. We hypothesized that, due to deficits in oral language, children who were deaf would display lower levels of social competence than their hearing peers. Furthermore, language age would predict social competence scores. Social competence was measured with a general and deaf-specific measure. Results showed that children with hearing loss performed significantly worse than hearing peers on the general measure but better than the norms on the deaf-specific measure. Controlling for maternal education and income, regression analyses indicated that hearing status and language age predicted social competence in both groups. Among children with hearing loss, correlations were also found between age at diagnosis, age at amplification, and two of the general social competence measures. Results supported our hypothesis that deficits in language would have cascading negative effects on the development of social competence in young deaf children. Development of early intervention programs that target both language and social skills are needed for this population.

6 Article Development of joint engagement in young deaf and hearing children: effects of chronological age and language skills. 2014

Cejas, Ivette / Barker, David H / Quittner, Alexandra L / Niparko, John K. · ·J Speech Lang Hear Res · Pubmed #24845423.

ABSTRACT: PURPOSE: To evaluate joint engagement (JE) in age-matched children with and without hearing and its relationship to oral language skills. METHOD: Participants were 180 children with severe-to-profound hearing loss prior to cochlear implant surgery, and 96 age-matched children with normal hearing; all parents were hearing. JE was evaluated in a 10-minute videotaped free play task with parents. Engagement states ranged from the lowest (unengaged) to the highest level (symbol-infused coordinated). Standardized language measures were administered. RESULTS: Multivariate analyses were conducted between the groups, stratified by chronological and language age. Children who were deaf (Deaf) spent less time in total symbol-infused JE than children with normal hearing (NH) across all ages. The majority of the Deaf group (83%) fell in the lowest language age group, in comparison to 35% of the NH group, and spent significantly less time in symbol-infused JE than hearing children. These delays were also observed in the Deaf group, who fell into the 18-36 month language age. No children in the Deaf group had achieved a language age of > 36 months. CONCLUSIONS: Young children with and without hearing had different developmental trajectories of JE, which were related to oral language skills.

7 Article Age-dependent cost-utility of pediatric cochlear implantation. 2013

Semenov, Yevgeniy R / Yeh, Susan T / Seshamani, Meena / Wang, Nae-Yuh / Tobey, Emily A / Eisenberg, Laurie S / Quittner, Alexandra L / Frick, Kevin D / Niparko, John K / Anonymous6250754. ·Department of Otolaryngology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. ·Ear Hear · Pubmed #23558665.

ABSTRACT: OBJECTIVES: Cochlear implantation (CI) has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence of the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation-a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the present study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost utility of pediatric CI by age at intervention will be analyzed. DESIGN: Prospective, longitudinal assessment of health utility and educational placement outcomes in 175 children recruited from six U.S. centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent CI before 5 years of age, and had up to 6 years of postimplant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratified by preoperative, operative, and postoperative expenditures. Incremental costs and benefits of implantation were compared among the three age groups and relative to a nonimplantation baseline. RESULTS: Children implanted at <18 months of age gained an average of 10.7 quality-adjusted life years (QALYs) over their projected lifetime as compared with 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different among the three age groups. In addition, mean lifetime costs of implantation were similar among the three groups, at approximately $2000/child/year (77.5-year life expectancy), yielding costs of $14,996, $17,849, and $19,173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared with 57 and 63% for the middle and oldest groups, respectively (p < 0.05) after 6 years of follow-up. After incorporating lifetime educational cost savings, CI led to net societal savings of $31,252, $10,217, and $6,680 for the youngest, middle, and oldest groups at CI, respectively, over the child's projected lifetime. CONCLUSIONS: Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with CI was associated with greater and longer quality-of-life improvements, similar direct costs of implantation, and economically valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to CI at older ages.

8 Article Influence of implantation age on school-age language performance in pediatric cochlear implant users. 2013

Tobey, Emily A / Thal, Donna / Niparko, John K / Eisenberg, Laurie S / Quittner, Alexandra L / Wang, Nae-Yuh / Anonymous4710751. ·Dallas Cochlear Implant Program, University of Texas at Dallas, Dallas, Texas, USA. etobey@utdallas.edu ·Int J Audiol · Pubmed #23448124.

ABSTRACT: OBJECTIVE: This study examined specific spoken language abilities of 160 children with severe-to-profound sensorineural hearing loss followed prospectively 4, 5, or 6 years after cochlear implantation. STUDY SAMPLE: Ninety-eight children received implants before 2.5 years, and 62 children received implants between 2.5 and 5 years of age. DESIGN: Language was assessed using four subtests of the Comprehensive Assessment of Spoken Language (CASL). Standard scores were evaluated by contrasting age of implantation and follow-up test time. RESULTS: Children implanted under 2.5 years of age achieved higher standard scores than children with older ages of implantation for expressive vocabulary, expressive syntax, and pragmatic judgments. However, in both groups, some children performed more than two standard deviations below the standardization group mean, while some scored at or well above the mean. CONCLUSIONS: Younger ages of implantation are associated with higher levels of performance, while later ages of implantation are associated with higher probabilities of continued language delays, particularly within subdomains of grammar and pragmatics. Longitudinal data from this cohort study demonstrate that after 6 years of implant experience, there is large variability in language outcomes associated with modifiers of rates of language learning that differ as children with implants age.

9 Article Identification of effective strategies to promote language in deaf children with cochlear implants. 2013

Cruz, Ivette / Quittner, Alexandra L / Marker, Craig / DesJardin, Jean L / Anonymous5010737. ·Department of Otolaryngology, University of Miami, Miami, FL 33136, USA. icruz@med.miami.edu ·Child Dev · Pubmed #23002910.

ABSTRACT: Parental involvement and communication are essential for language development in young children. However, hearing parents of deaf children face challenges in providing language input to their children. This study utilized the largest national sample of deaf children receiving cochlear implants, with the aim of identifying effective facilitative language techniques. Ninety-three deaf children (≤ 2 years) were assessed at 6 implant centers prior to and for 3 years following implantation. All parent-child interactions were videotaped, transcribed, and coded at each assessment. Analyses using bivariate latent difference score modeling indicated that higher versus lower level strategies predicted growth in expressive language and word types predicted growth in receptive language over time. These effective, higher level strategies could be used in early intervention programs.

10 Article Effects of maternal sensitivity and cognitive and linguistic stimulation on cochlear implant users' language development over four years. 2013

Quittner, Alexandra L / Cruz, Ivette / Barker, David H / Tobey, Emily / Eisenberg, Laurie S / Niparko, John K / Anonymous870737. ·Department of Psychology, University of Miami, Miami, FL, USA. aquittner@miami.edu ·J Pediatr · Pubmed #22985723.

ABSTRACT: OBJECTIVES: To examine the effects of observed maternal sensitivity (MS), cognitive stimulation (CS), and linguistic stimulation on the 4-year growth of oral language in young, deaf children receiving a cochlear implant. Previous studies of cochlear implants have not considered the effects of parental behaviors on language outcomes. STUDY DESIGN: In this prospective, multisite study, we evaluated parent-child interactions during structured and unstructured play tasks and their effects on oral language development in 188 deaf children receiving a cochlear implant and 97 normal-hearing children as controls. Parent-child interactions were rated on a 7-point scale using the National Institute of Child Health and Human Development's Early Childcare Study codes, which have well-established psychometric properties. Language was assessed using the MacArthur Bates Communicative Development Inventories, the Reynell Developmental Language Scales, and the Comprehensive Assessment of Spoken Language. RESULTS: We used mixed longitudinal modeling to test our hypotheses. After accounting for early hearing experience and child and family demographics, MS and CS predicted significant increases in the growth of oral language. Linguistic stimulation was related to language growth only in the context of high MS. CONCLUSION: The magnitude of effects of MS and CS on the growth of language was similar to that found for age at cochlear implantation, suggesting that addressing parenting behaviors is a critical target for early language learning after implantation.

11 Article Language and behavioral outcomes in children with developmental disabilities using cochlear implants. 2012

Cruz, Ivette / Vicaria, Ishabel / Wang, Nae-Yuh / Niparko, John / Quittner, Alexandra L / Anonymous9510728. ·Department of Otolaryngology, University of Miami, Miami, Florida 33136, USA. icruz@med.miami.edu ·Otol Neurotol · Pubmed #22699986.

ABSTRACT: OBJECTIVE: Over the past decade, the number of deaf children with developmental disabilities receiving cochlear implants has increased dramatically. However, little is known about the developmental outcomes of these children post-implantation. The current study evaluated oral language and behavioral outcomes over 3 years after implantation in a sample of typically developing deaf children and children with developmental disabilities. STUDY DESIGN: A three year longitudinal study of the effects of cochlear implantation on language and behavioral outcomes in children with and without additional disabilities. SETTING: Six cochlear implant centers in the United States. PATIENTS: The study cohort consisted of 188 deaf children. Eighty-five percent of the sample (n = 157) had a single diagnosis of severe to profound hearing loss and 15% (n = 31) had an additional disability. MAIN OUTCOME MEASURES: Oral language was assessed using the Reynell Developmental Language Scales, and behavioral outcomes were assessed using the Child Behavior Checklist. RESULTS: Results using multilevel modeling indicated that deaf children with and without additional disabilities improved significantly in oral language skills post-implantation. However, children with additional disabilities made slower progress. In terms of specific diagnoses, children with developmental disorders, such as autism, made the slowest progress over time. In addition, behavior problems increased significantly in this group, whereas behavior problems decreased over 3 years in the typically developing deaf sample. CONCLUSION: Overall, given the improvements in expressive and receptive language skills documented over 3 years, these findings support the use of cochlear implants for deaf children with developmental disabilities.

12 Article Timing of cochlear implantation and parents' global ratings of children's health and development. 2012

Clark, James H / Wang, Nae-Yuh / Riley, Anne W / Carson, Christine M / Meserole, Rachel L / Lin, Frank R / Eisenberg, Laurie S / Tobey, Emily A / Quittner, Alexandra L / Francis, Howard W / Anonymous1690726 / Niparko, John K. ·Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·Otol Neurotol · Pubmed #22588232.

ABSTRACT: OBJECTIVE: To assess children's health-related quality of life (HRQL) and development after cochlear implant (CI) surgery and compare improvements between different age of implantation categories. STUDY DESIGN: Prospective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls. SETTING: Six US CI centers. PATIENTS: Deaf children who received CI (n = 188) and hearing children of comparable ages (n = 97). INTERVENTION: CI before 5 years of age. MAIN OUTCOME MEASURE: Parental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children's growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning. RESULTS: Baseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by 4 years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after 4 years. Cognition and speech recognition were positively associated with both HRQL and development. CONCLUSION: Parental perspectives on quality of their child's life and development provide practical insight into the optimal timing of interventions for early-onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.

13 Article Spoken language development in children following cochlear implantation. 2010

Niparko, John K / Tobey, Emily A / Thal, Donna J / Eisenberg, Laurie S / Wang, Nae-Yuh / Quittner, Alexandra L / Fink, Nancy E / Anonymous5180658. ·Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jnipark1@jhmi.edu ·JAMA · Pubmed #20407059.

ABSTRACT: CONTEXT: Cochlear implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL). OBJECTIVE: To prospectively assess spoken language acquisition following cochlear implantation in young children. DESIGN, SETTING, AND PARTICIPANTS: Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent cochlear implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004. Follow-up completed between November 2005 and May 2008. MAIN OUTCOME MEASURES: Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales). RESULTS: Children undergoing cochlear implantation showed greater improvement in spoken language performance (10.4; 95% confidence interval [CI], 9.6-11.2 points per year in comprehension; 8.4; 95% CI, 7.8-9.0 in expression) than would be predicted by their preimplantation baseline scores (5.4; 95% CI, 4.1-6.7, comprehension; 5.8; 95% CI, 4.6-7.0, expression), although mean scores were not restored to age-appropriate levels after 3 years. Younger age at cochlear implantation was associated with significantly steeper rate increases in comprehension (1.1; 95% CI, 0.5-1.7 points per year younger) and expression (1.0; 95% CI, 0.6-1.5 points per year younger). Similarly, each 1-year shorter history of hearing deficit was associated with steeper rate increases in comprehension (0.8; 95% CI, 0.2-1.2 points per year shorter) and expression (0.6; 95% CI, 0.2-1.0 points per year shorter). In multivariable analyses, greater residual hearing prior to cochlear implantation, higher ratings of parent-child interactions, and higher socioeconomic status were associated with greater rates of improvement in comprehension and expression. CONCLUSION: The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.