What Factors Are Associated with Good Performance in Children with Cochlear Implants? From the Outcome of Various Language Development Tests, Research on Sensory and Communicative Disorders Project in Japan: Nagasaki Experience

OBJECTIVES: We conducted multi-directional language development tests as a part of the Research on Sensory and Communicative Disorders (RSVD) in Japan. This report discusses findings as well as factors that led to better results in children with severe-profound hearing loss. METHODS: We evaluated multiple language development tests in 33 Japanese children with cochlear implants (32 patients) and hearing aid (1 patient), including 1) Test for question and answer interaction development, 2) Word fluency test, 3) Japanese version of the Peabody picture vocabulary test-revised, 4) The standardized comprehension test of abstract words, 5) The screening test of reading and writing for Japanese primary school children, 6) The syntactic processing test of aphasia, 7) Criterion-referenced testing (CRT) for Japanese language and mathematics, 8) Pervasive development disorders ASJ rating scales, and 9) Raven's colored progressive matrices. Furthermore, we investigated the factors believed to account for the better performances in these tests. The first group, group A, consisted of 14 children with higher scores in all tests than the national average for children with hearing difficulty. The second group, group B, included 19 children that scored below the national average in any of the tests. RESULTS: Overall, the results show that 76.2% of the scores obtained by the children in these tests exceeded the national average scores of children with hearing difficulty. The children who finished above average on all tests had undergone a longer period of regular habilitation in our rehabilitation center, had their implants earlier in life, were exposed to more auditory verbal/oral communication in their education at affiliated institutions, and were more likely to have been integrated in a regular kindergarten before moving on to elementary school. CONCLUSION: In this study, we suggest that taking the above four factors into consideration will have an affect on the language development of children with severe-profound hearing loss.

Mainstreaming Mental Health into the Development Priorities in the United Nations

Mental health represents a critical indicator of human development, serving as a key determinant of well-being, quality of life, and hope. As such, mental health has an impact on a range of development outcomes. There is growing recognition within the international community that mental health is one of the most neglected yet essential development issues. The adoption of the Convention on the Rights of Persons with Disabilities in 2006 by the United Nations General Assembly provided momentum to highlight the importance of the nexus between disabilities and mental health in the context of human rights, peace and security, humanitarian activities and in development work including response to AIDS. In addition, the Ministerial Declaration on Implementing the Internationally Agreed Goals and Commitments in Regard to Global Public Health, in the high-level segment of the substantive session of the Economic and Social Council in July 2009, highlighted the importance of integrating mental health into the implementation of the MDGs and other internationally agreed development goals and commitments, in order to achieve development outcomes. Based on these new developments, the Department of Economic and Social Affairs (DESA) of the Untied Nations and the World Health Organisation (WHO) issued the “United Nations-WHO Policy Analysis: Mental Health and Development: Integrating Mental Health into All Development Efforts including MDGs” in 2010. This document serves as a foundation for further mainstreaming of mental health into the development agenda including response to AIDS in the United Nations system and the broader international community. In the area of HIV, the United Nations Population Fund (UNFPA) integrated mental health into one of three goals and an outcome of its Strategic Plan: Universal access to reproductive health and comprehensive HIV prevention for improved quality of life. Based on this, UNFPA started to integrate mental health into its fund-wide policies and guidelines, and programmes at regional and country levels. In addition, the United Nations Children‟s Fund held a round table on adolescent mental health with partners in April 2011, and placed an emphasis on mental health and AIDS among adolescents. Poor mental health is both a cause and a consequence of ill-health including issues related to HIV, poverty, compromised education, gender inequality, violence and other global challenges. It impedes the individual's capacity to realize their potential and make a contribution to their community. On the other hand, positive mental health is linked to a range of development outcomes. Dialogue and consultations on a post-MDGs framework will present critical opportunities to ensure the explicit inclusion of mental health in any emerging development framework for 2015 and beyond. In addition, utilizing best practices from UNFPA and others, it is also important to continue efforts to integrate mental health into strategic plans and other policies and programmes of the United Nations implementing entities. Now is the time to include mental health as an integral part of development through increased recognition of the link between development and mental/emotional well-being, as well as the inclusion of persons with mental and intellectual disabilities, to achieve development for all.

Bilateral Cochlear Implantation for Children in Nagasaki, Japan

OBJECTIVES: The number of patients with bilateral cochlear implant (CI) has gradually increased as patients and/or parents recognize its effectiveness. The purpose of this report is to evaluate the efficacy of 29 bilateral CI out of 169 pediatric CI users, who received auditory-verbal/oral habilitation at our hearing center. METHODS: We evaluated the audiological abilities 29 Japanese children with bilateral CIs including wearing threshold, word recognition score, speech discrimination score at 1 m from front speaker (SP), 1 m from second CI side SP, speech discrimination score under the noise (S/N ratio=80 dB sound pressure level [SPL]/70 dB SPL, 10 dB) at 1 m from front SP, word recognition score under the noise (S/N ratio=80 dB SPL/70 dB SPL, 10 dB) at 1 m from front SP. RESULTS: Binaural hearing using bilateral CI is better than first CI in all speech understanding tests. Especially, there were significant differences between the results of first CI and bilateral CI on SDS at 70 dB SPL (P=0.02), SDS at 1 m from second CI side SP at 60 dB SPL (P=0.02), word recognition score (WRS) at 1 m from second CI side SP at 60 dB SPL (P=0.02), speech discrimination score (SDS) at 1 m from front SP under the noise (S/N=80/70; P=0.01) and WRS at 1 m from front SP under the noise (S/N=80/70; P=0.002). At every age, a second CI is very effective. However, the results of under 9 years old were better than of over 9 years old on the mean SDS under the noise (S/N=80/70) on second CI (P=0.04). About use of a hearing aid (HA) in their opposite side of first CI, on the WRS and SDS under the noise, there were significant differences between the group of over 3 years and the group of under 10 months of HA non user before second CI. CONCLUSION: These results may show important binaural effectiveness such as binaural summation and head shadow effect. Bilateral CI is very useful medical intervention for many children with severe-to-profound hearing loss in Japan as well as elsewhere.