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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 6-9

Intellectual disability in young children with hearing impairment: Study from a tertiary care center in Bangladesh


1 Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
2 Institute of Pediatric Neurodisorder and Autism, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Date of Submission26-Oct-2021
Date of Acceptance16-Feb-2022
Date of Web Publication31-May-2022

Correspondence Address:
Dr. Kanij Fatema
Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/pnjb.pnjb_20_21

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  Abstract 

Background: Hearing impairment (HI) is an important disability hampering the overall development, particularly cognitive domain in children. Coexistence of HI with intellectual disability (ID) affects adversely the overall prognosis of a child. To highlight this underdetermined issue, this study has been done to determine the proportion of ID in children of HI. Materials and Methods: This cross-sectional study is held in children with HI of 0–42 months. In the study subjects, psychological assessment was done by Baily Scale of Infant Development III (BSID III). Detailed history was taken; physical examination was done in each patient after taking informed written consent. Hearing assessment was done by an audiologist and was leveled as mild, moderate, severe, and profound. Results: The study subject was 203, and mean age was 27.2 ± 8.7 (3–42) months. There was a slight male predominance. Majority of children mode of birth was lower uterine segment cesarean section. Neonatal seizure was significantly associated with intellectual impairment in the study subject (P <0.001). No significant association of the HI was found in different levels of intellectual status of the children; however, 35% of the study subject had borderline intellectual status and most of them belonged to the profound HI. Conclusion: A significant proportion of the study subjects had borderline intellectual status, although very limited numbers had ID. Moreover, children with profound hearing loss were most affected.

Keywords: Children, hearing impairment, intellectual disability


How to cite this article:
Ferdousy SM, Rahman MM, Fatema K, Akhter S. Intellectual disability in young children with hearing impairment: Study from a tertiary care center in Bangladesh. Paediatr Nephrol J Bangladesh 2022;7:6-9

How to cite this URL:
Ferdousy SM, Rahman MM, Fatema K, Akhter S. Intellectual disability in young children with hearing impairment: Study from a tertiary care center in Bangladesh. Paediatr Nephrol J Bangladesh [serial online] 2022 [cited 2022 Jun 30];7:6-9. Available from: http://www.pnjb-online.org/text.asp?2022/7/1/6/346345




  Introduction Top


Hearing impairment (HI) is an important morbidity which hampers the early development, particularly cognition and learning. Children with HI have various comorbid conditions such as intellectual disability (ID), autism spectrum disorder, specific learning disabilities, attention deficit disorder, attention deficit hyperactive disorder, orthopedic impairments, emotional disabilities, speech and language impairments, traumatic brain injury, health impairments, low vision, etc.[1],[2],[3]

ID is an important but undetermined and under-addressed comorbid condition in children with HI. Yet, both these disabilities have some common etiology and co-occur often. Such etiologies include hereditary syndromes (e.g., Usher, CHARGE, Goldenhar, and Down syndromes), maternal infections (e.g., congenital rubella, cytomegalovirus, toxoplasmosis), prematurity, meningitis, anoxia, trauma, etc.[3]

Children with significant ID and HI face a set of obstacles as this hinders the communication. Thus the literacy and language outcome are guarded in these children. Hence, this combined condition is mentioned as complication rather than additive.[4] It is pertinent to improve the knowledge of this comorbid condition to provide appropriate service to maximize the outcome of communication, language, and literacy.

The management pattern of HI with ID is different and needs multidisciplinary approach. Moreover, there is shortage of skilled manpower to provide appropriate service to these groups of children.[4],[5]

There are a limited number of studies in developing counties such as Bangladesh on this aspect. With this view, this study was done to elucidate the pattern of ID in children with HI in a tertiary care center in Bangladesh.


  Materials and Methods Top


It was a cross-sectional observational study among children aged 0–42 months who had HI and came to the center for developmental evaluation. It was conducted in a tertiary care referral center, Institute of Pediatric Neurodisorder and Autism (IPNA), Bangabandhu Sheikh Mujib Medical University from January 2016 to January 2020. During this period, about 521 children of 0–42 months were reported with HI, out of them, 203 children’s psychological assessment was done by Baily Scale of Infant Development III (BSID III).

In each patient, details regarding birth history, developmental history, family history, and risk factors of HI were taken and noted. An expert child psychologist had done the psychological assessment by BSID III. The Bayley-III assesses infant and toddler development across five domains: cognitive, language (receptive and expressive), motor (gross and fine), social-emotional, and adaptive. Assessment of the former three scales was conducted using items administered to the child. Assessment of the latter two scales relied on primary caregiver responses to a questionnaire. The categories of intellectual status were as follows: average (85–115), borderline (70–84), mild (69–50), moderate (49–35), severe (20–34), and profound (<20). For convenience, here we put categories of average, borderline, and impaired (mild, moderate, severe, and profound).

In each child, hearing assessment was done in different centers. The otoacoustic emissions test was done. During the test, the audiologist or other provider placed a small probe that looks like an earphone inside the ear canal. Sound was sent to the probe. The probe records and measures the inner ear’s response to the sounds. Pure-tone audiometry was also done. During this test, the audiologist or other providers changed the pitch and loudness of the tones at different points during the test. The test helps find the quietest sounds your child can hear at different pitches. Each child was categorized as mild (26–40 dB), moderate (41–60 dB), severe (61–80 dB), and profound (81 or more dB) deafness. Threshold tracing was done in the descending order. All frequencies were tested individually. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS), version 22.


  Results Top


In this study, the data of 203 children were analyzed. The mean age of the study subject was 27.2 ± 8.7 (3–42) months: most (37.9%) of them belonged to 21–30 months [Table 1]. The mean age of detection of HI was 13.9 ± 8.27, and most of the patients were diagnosed in less than 10 months of age (48.3%) [Table 2]. The male–female ratio was almost similar with a slight dominance of male (52.2%) [Table 3].
Table 1: Age distribution of the study patients (n = 203)

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Table 2: Age of detection of hearing impairment of the study patients (n = 203)

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Table 3: Gender distribution of the study patients (n = 203)

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More than half of the study subjects were born by lower uterine segment cesarean section (LUCS); although there was a slight predominance of mild intellectual impairment in LUCS subjects, there was no statistically significant difference in psychological status in study subjects in mode of delivery [Table 4]. Regarding the risk factors at birth, the most common risk factor was delayed cry. Neonatal seizure was significantly associated with intellectual impairment in the study subject (P <0.001) [Table 5].
Table 4: Association of psychological assessment with mode of delivery (n = 203)

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Table 5: Association of psychological assessment with birth history (n = 203)

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On developmental status, motor delay was significantly found in subjects with mild psychological impairment in comparison with other groups [Table 6]. Family history of consanguinity, hearing disorder, and affected sib were not significantly associated with psychological grading of the study patients (P > 0.05) [Table 7]. The hearing levels in the study subjects were moderate, severe, and profound. No significant association of hearing loss was found with different psychological gradings of the study patients (P > 0.05) [Table 8].
Table 6: Association of psychological assessment with development history (n = 203)

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Table 7: Association of psychological assessment with family history (n = 203)

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Table 8: Association of psychological assessment with level of hearing loss (n = 203)

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  Discussion Top


Childhood HI is an important cause of developmental disability.[6] Among the other disabilities such as speech delay, behavioral disorder, etc., cognitive impairment is an issue to deal with as it is often under-addressed. In this study, about 4.43% of the children with HI had ID. Among them, most of the subjects had mild impairment (seven), whereas one had moderate and one had severe impairment. Although the number of children is less, these children should be addressed appropriately with a multidisciplinary team.

This study was done in the pediatric age group. Among the 203 children, the mean age was 27.2 ± 8.7 (3–42) months. Most of the patients were diagnosed below 10 months of age, whereas the mean age of detection was 13.9 ± 8.27 months. In related study done in the pediatric age group, most children were below the 3-year group.[7] A slight male dominance was found in this study like most of the previous studies.[8],[9]

HI and ID are integrally related as many of the etiologies are common in both the disorders. Common causes of hearing loss are genetic disorders, environmental factors, congenital infection, perinatal insult, neonatal hyperbilirubinemia, etc. These etiologies are responsible for cognitive delay also.[10],[11] In this study, the etiologies behind hearing loss were delayed cry, neonatal seizure, hyperbilirubinemia, neonatal intensive care unit stay, and maternal drug ingestion. The etiologies have similarities with related studies.[12]

A family history of permanent childhood hearing loss is considered a risk factor for pediatric hearing loss. In previous studies, it has been seen that positive family history was a risk factor for congenital cases in 7.29% of the cases and for postnatal cases in 36.84% of the cases of pediatric hearing loss subjects.[13] However, in this study, consanguinity was present in 55 subjects and positive family history was present in 14 subjects. Among them, most of the cases had normal or borderline intellectual development and only four cases had ID.

HI impacts greatly on the other domains of development. These children suffer deficit in receptive and expressive language, social interactions, academic achievement, cognition, etc.[14] In this study, a maximum of 184 (80.64%) cases had speech delay. In the speech delay group, 18 cases had ID. Another four children had motor delay, out of which three had ID. Visual impairment was present in two cases here.

ID or impairment is an important comorbid condition in children with HI which affects the prognosis and needs special attention during the management. In this study, very limited number of subjects (9) had ID and most of them were in the mild ID category. However, a significant number (35%) of the subjects had borderline intellectual capacity. This is a very important finding of this study and 60 (83.3%) subjects of this group were from the profound HI group. In previous studies, its prevalence of psychosocial difficulties among deaf children was about 20–50%.[15] This dual disability creates a need for caregivers and schools to develop programming that will meet the needs of even their most challenging students.


  Conclusion Top


Although the number of children with ID was minimal in this study, borderline intellectual status was found in more than one-third of the children with HI in this study. This creates the need for addressing these children with a comprehensive and multidisciplinary approach. However, further large-scale study is needed in this sector.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bruce SM, Borders C Communication and language in learners who are deaf and hard of hearing with disabilities: Theories, research, and practice. Am Ann Deaf 2015;160:368-84.  Back to cited text no. 1
    
2.
Chilosi AM, Comparini A, Scusa MF, Berrettini S, Forli F, Battini R, et al. Neurodevelopmental disorders in children with severe to profound sensorineural hearing loss: A clinical study. Dev Med Child Neurol 2010;52:856-62.  Back to cited text no. 2
    
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Guardino C, Cannon J Theory, research and practice for students who are deaf and hard of hearing with disabilities: Addressing the challenges from birth to postsecondary education. Am Ann Deaf 2015;160:347-55.  Back to cited text no. 3
    
4.
Wiley S, Moeller MP Red flags for disabilities in children who are deaf/hard of hearing. ASHA Lead 2007;12:8-29. doi:10.1044/leader.FTR3.12012007.8  Back to cited text no. 4
    
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Office of Research Support and International Affairs. Regional and National Summary Report of Data from the 2013–2014 Annual Survey of Deaf and Hard of Hearing Children and Youth. Washington, DC, USA: Office of Research Support and International Affairs; 2014.  Back to cited text no. 5
    
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Vohr B Overview: Infants and children with hearing loss—Part I. Ment Retard Dev Disabil Res Rev 2003;9:62-4.  Back to cited text no. 6
    
7.
Ibekwe UM, Oghenekaro EN Hearing loss in the pediatric age group. Sahel Med J 2020;23:116.  Back to cited text no. 7
    
8.
Billings KR, Kenna MA Causes of pediatric sensorineural hearing loss: Yesterday and today. Arch Otolaryngol Head Neck Surg 1999;125:517-21.  Back to cited text no. 8
    
9.
Dhingra PL Disorders of middle ear. In: Dhingra PL , editor. Diseases of Ear, Nose and Throat Diseases. 4th ed. New Delhi: Elsevier; 2007; p. 80-112.  Back to cited text no. 9
    
10.
Shearer AE, Hildebrand MS, Smith RJH Hereditary hearing loss and deafness overview. February 14, 1999 [Updated July 27, 2017]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle, WA: University of Washington, Seattle; 1993–2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1434/.  Back to cited text no. 10
    
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Alford RL, Arnos KS, Fox M, Lin JW, Palmer CG, Pandya A, et al; ACMG Working Group on Update of Genetics Evaluation Guidelines for the Etiologic Diagnosis of Congenital Hearing Loss; Professional Practice and Guidelines Committee. American College of Medical Genetics and Genomics Guideline for the Clinical Evaluation and Etiologic Diagnosis of Hearing Loss. Genet Med 2014;16:347-55.  Back to cited text no. 11
    
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Centers for Disease Control and Prevention. Cytomegalovirus (CMV) and Congenital CMV Infection. 2011. Retrieved January 1, 2013. Available from: www.cdc.gov/cmv/testing-diagnosis.html. [Last accessed on 2020 Aug 18].  Back to cited text no. 12
    
13.
Driscoll C, Beswick R, Doherty E, D’Silva R, Cross A The validity of family history as a risk factor in pediatric hearing loss. Int J Pediatr Otorhinolaryngol 2015;79:654-9.  Back to cited text no. 13
    
14.
Tierney CD, Brown PJ, Serwint JR Development of children who have hearing impairment. Pediatr Rev 2008;29:e72-3; discussion e73.  Back to cited text no. 14
    
15.
Dammeyer J Psychosocial development in a Danish population of children with cochlear implants and deaf and hard-of-hearing children. J Deaf Stud Deaf Educ 2010;15:50-8.  Back to cited text no. 15
    



 
 
    Tables

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



 

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