Heading This text box uses 24 point Arial, while the heading above is 36 point Arial Bold. The margins are set to 0.5cm and the box will expand to fit the text. Subsequent paragraphs have an additional 0.5 line spacing, so there is no need to type a ‘blank line’ between each paragraph. This is set using the Line Spacing command on the Format menu. You can edit this box by right-clicking on its border and choosing Format Autoshape, then selecting the fill colour, line colour that you want to use. You can also select the text and set the font and size you require. Finally, you can copy-and-paste the box as required, ensuring that they are all consistent and avoiding repetitive work. Recognising Additional Disabilities in Children Implanted Under Two Years of Age This study reviewed data on children implanted under 2 years to determine how accurately additional disabilities were recognised pre implant. All subjects were assessed at one year post implant to evaluate the impact of disabilities on outcomes Research indicates that 30 – 40% of children who are deaf have other disabilities. The presence of an additional disability does not preclude a cochlear implant, but it is likely to affect outcomes and rate of progress. It has become common for children under the age of 2 years to be implanted. It is more difficult to diagnose some additional disabilities in infancy. Recognising additional disabilities and their potential impact on outcomes is important for counselling parents. Method Retrospective study of data on children implanted under 2 at the South of England Cochlear Implant Centre Children’s Implant Profile (CHIP) ratings used to ascertain concerns regarding additional disabilities pre implant Medical and speech language therapy reports used to ascertain diagnoses post implant Outcomes assessed at 1 year post implant using the Meaningful Auditory Integration Scale (MAIS) and Categories of Auditory Performance (CAP) Subjects 38 children fitted criteria 30 families consented to use of data (17 girls, 13 boys) Disabilities identified in this study were: global developmental delay (n=3) (identified in all 3 cases pre-implant) autistic spectrum disorders (ASD) (n=3) (identified in 1 case of 3 pre-implant) speech and language disorders (n=4) (none identified pre-implant) Outcome scores at one year post implant on MAIS and CAP showed significantly lower rates of progress for children with disabilities than for the group with no disability In this study 60% of disabilities were not identified pre implant As the age of implant reduces identification of additional disabilities pre implant is likely to be increasingly difficult Further investigation into more sensitive assessments pre implant is indicated Poor outcomes at one year post implant may indicate the need for further investigation and/or referral to other agencies Expectations counselling needs to be ongoing in response to progress Discussion Global developmental delay may be the most easily recognised in infancy because there are indicators unrelated to hearing and communication (eg motor milestones) ASD may be more difficult to diagnose under 2 years. Donaldson, Heavner and Zwolan (2004)* note the average age of confirmed diagnosis of ASD in hearing children is 3.4 years, compared with that in children with cochlear implants of 4.7 years Speech and language disorders were not identifiable pre implant but were evident by one year post implant Results Introduction Outcomes 1 year post Margie Harriott Jill Mustard South of England Cochlear Implant Centre The difference in the means was significant (2-tailed t=6.30, dƒ=28, p=0.000) *Reference J.Arch Otolaryngol Head Neck Surg May;130(5): Donaldson, AI Heavner, KS Zwolan TA Measuring progress in children with autism spectrum disorder who have cochlear implants Conclusions Identifying Additional Disabilities The difference in the means was significant (2-tailed t=7.16, dƒ=28, p=0.000)