Peer-reviewed article

Domains of Psychosocial Risk in School-Aged Cochlear Implant Users.

Castellanos I, Beer J, Pisoni DB, Kronenberger WG · 14 Jul 2026

Abstract

Purpose The purpose of this study was to identify domains of psychosocial risk specific to school-aged cochlear implant (CI) users and to explain individual differences in psychosocial risk within the CI sample. Method The parent-completed Behavior Assessment System for Children was used to measure psychosocial functioning behaviors in 59 children with CIs and 52 children with hearing 7-19 years of age. Item-level differences between the CI and hearing samples were identified, and a principal components analysis (PCA) was conducted on differentiating items to identify at-risk psychosocial behavioral constructs specific to CI users. Associations between CI-specific risk constructs and audiological, speech-language, and neurocognitive functioning were investigated. Results CI users showed significantly greater psychosocial difficulties compared to their hearing peers on 14 items of the Behavior Assessment System for Children-Second Edition. A PCA on those items identified three domains that represent CI-specific psychosocial risks: communication deficit, social popularity, and executive functioning. Better receptive vocabulary and verbal comprehension were associated with better functioning in all three CI psychosocial risk domains. Better verbal short-term memory was associated with fewer risks related to communication deficit and social popularity, whereas better verbal working memory was associated with stronger executive functioning. Participants with stronger sentence recognition had fewer risks related to communication deficit. Conclusions Children and adolescents with CIs show specific elevated psychosocial risks for problems in social communication and executive functioning. Language abilities broadly influenced all psychosocial risk domains, while other cognitive abilities were more specifically associated with some psychosocial outcomes. Development of measures tailored to assess CI-specific domains of psychosocial risk is needed to inform targeted clinical intervention. Supplemental material https://doi.org/10.23641/asha.32913569.