title: Assessing joint attention and symbolic play in children with cochlear implants and multiple disabilities: two case studies.
abstract: OBJECTIVE
  The presence of disabilities in addition to deafness poses unique challenges for evaluating outcomes in young children who receive cochlear implants. We describe two cases in which measures of joint attention and symbolic play contributed to our understanding of progress in language acquisition following implantation for children with additional developmental disabilities.
  
  
  METHODS
  Prospective case study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Case 1, identified with global developmental delays and implanted at age of 2 years 8 months; Case 2, diagnosed with autism spectrum disorder and implanted at age of 4 years 4 months.
  
  
  METHODS
  Cochlear implant.
  
  
  METHODS
  Communication assessments were conducted using the Reynell Developmental Language Scales and the MacArthur-Bates Communicative Development Inventories before implantation (baseline) and at 12 months postimplant. Children were also videotaped during a 10-minute free play with their mothers (Joint Attention task) and 5-minute solitary play (Symbolic Play task) at baseline, 6 months, and 12 months postimplant. Videotapes were coded for child attention and play states.
  
  
  RESULTS
  The MacArthur-Bates Communicative Development Inventories provided important information regarding both children's emerging joint attention and symbolic play skills that are typically not assessed by direct measures of early child language. Videotaped parent-child interaction revealed qualitative differences in the nature of these children's attention and play, which has important implications for intervention.
  
  
  CONCLUSIONS
  For these two children, obtaining developmental information from various sources, including precursor skills to the development of oral language, provided a more complete picture of each child than conventional clinician-elicited language assessments alone.
authors.affiliation: House Ear Institute, Los Angeles, California 90057, USA. kjohnson@hei.org
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.forename: Jean L
authors.initials: JL
authors.lastname: DesJardin
authors.forename: David H
authors.initials: DH
authors.lastname: Barker
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Quittner
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Winter
mesh_terms: D000015:Abnormalities, Multiple / Q000523:psychology*; D001288:Attention / Q000502:physiology*; D002675:Child, Preschool; D003054:Cochlear Implants; D003142:Communication; D003638:Deafness / Q000150:complications / Q000523:psychology*; D006801:Humans; D007804:Language Development; D008297:Male; D009483:Neuropsychological Tests; D010988:Play and Playthings / Q000523:psychology*; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology; D012813:Sign Language; D014743:Videotape Recording