Improving behavior using child-directed interaction skills: A case study determining cochlear implant candidacy

Objective and importance Children with hearing loss (HL) are at increased risk of developing externalizing behavior problems (e.g., hyperactivity, attention problems). These problems can lead to cascading effects on children's overall development. However, few studies have identified evidence-based interventions for this population. Clinical presentation A 6-year-old boy with bilateral HL presented to the clinic with significant behavioral challenges. These challenges (e.g., fatigued quickly, poor attention, and hyperactivity) were affecting the reliability of audiological testing to determine cochlear implant candidacy. Thus, the child was referred for Parent-Child Interaction Therapy (PCIT) to address these behavioral challenges. Intervention and technique PCIT is an evidence-based intervention that has been shown to significantly improve externalizing behavior problems. This study describes how the Child-Directed Interaction phase of PCIT was tailored for a child with bilateral HL. The goal of the intervention was to reduce externalizing behaviors in order to reliably complete a cochlear implant evaluation. Post-intervention, significant improvements were noted in behavior, including a decrease in disruptive behavior to normal levels. This led to completion of previously unsuccessful audiological testing and determination of cochlear implant candidacy. Conclusion This study illustrates how PCIT was successfully tailored to one child with an HL. This is critical as children with HL are at risk for behavior problems, and effective interventions for disruptive behaviors in children with HL may lead to significant improvements in medical and psychosocial outcomes for children with HL and their families