Behavioral and socio-emotional profiles in early-school-age children with cochlear implants versus normal-hearing...

To compare teacher-reported socio-emotional and behavioral functioning in early-school-age children with cochlear implants (CI) versus normal-hearing (NH) peers using the Child Behavior Assessment Scale (CBAS), and to test whether group differences persist after adjustment for socioeconomic factors.

In this cross-sectional study, 80 children aged 5-6 years were enrolled (CI = 40; NH = 40). Teachers completed CBAS subscales (Adjustment, Social Anxiety, Rule-breaking Behaviors) and total score. Between-group comparisons used Mann-Whitney U tests. ANCOVA on CBAS total adjusted for maternal education, paternal education, and household income. Exploratory correlations within the CI group examined age and clinical durations.

Compared with NH peers, the CI group showed lower Adjustment (mean ± SD: 61.45 ± 15.46 vs 80.95 ± 6.56; p < .001) and higher Social Anxiety (64.20 ± 13.27 vs 34.28 ± 7.02; p < .001) and Rule-breaking Behaviors (113.33 ± 26.77 vs 61.08 ± 15.98; p < .001). CBAS total was higher in the CI group (238.98 ± 48.22) than NH (176.30 ± 17.10; p < .001). In ANCOVA, the CI versus NH effect on CBAS total remained significant (F(1,75) = 33.846, p < .001; partial η² = 0.311), while socioeconomic covariates were not significant. Within the CI group, child age correlated positively with Rule-breaking Behaviors (r = 0.331, p = .037).

At school entry children with CI showed higher levels of socio-emotional and behavioral difficulties compared to NH peers; however, these findings should be interpreted with caution given the sample size and cross-sectional design. The results support routine psychosocial surveillance and targeted supports within CI follow-up and school settings.