Social development in Chinese children with cochlear implants and hearing peers: a propensity score matching study

Cochlear implantation (CI) is a critical intervention for restoring auditory function in individuals with severe to profound hearing impairment; however, the relationship between CIs and social development in hearing-impaired children has not been fully elucidated. This study examined disparities in child-parent relationship, teacher-student relationship and peer relationship between hearing-impaired children with CIs and their typically hearing (TH) peers in China, focusing on the dimensions of social relationships in social development.

Samples were selected from one primary special school and two primary mainstream schools in Xi'an, Shaanxi Province, China, in August 2024. According to the inclusion criteria, 35 CI recipients and 209 TH children in grades 3-5 were enrolled in the experimental and control groups, respectively. Self-reported data were used. Propensity score matching was employed to control demographic covariates, and the Hodges-Lehmann aligned rank test was used for the postmatching analysis.

This study revealed that CI recipients reported higher teacher-student closeness (ATE=2.55, d=0.61, p<0.05) yet experienced more teacher-student conflict (ATE=5.25, d=1.78, p<0.001). CI recipients exhibited significantly elevated peer-related loneliness (ATE=18.03, d=1.62, p<0.001). The two groups have no significant differences in child-parent closeness, teacher-student dependency and teacher-student satisfaction.

These multifaceted outcomes highlight that while hearing-impaired children with CIs achieved positive relationships with peers and adults comparable to their normal-hearing peers in specific domains, the auditory restoration provided by CIs does not automatically ensure social ease. This underscores the need for targeted language rehabilitation and inclusive educational environments to enhance their socioemotional well-being.