Supplementary Material for: Social Life and Communication Skills of School-Age Children with Congenital Hearing Loss Who Received Cochlear Implants at an Advanced Age

Introduction: Despite improved hearing, children who receive cochlear implants (CIs) at a later age encounter difficulties in adapting to society, exposing them to psychological and social risks. This study contributes to the conceptualisation of preventive interventions in schools to address potential issues so that these children can play a more active role in society.
Methods: A total of 52 children (aged 3–12 years) who received CIs at 30 months of age were assessed using the Asahide-Shiki Social Adaptive skills test, which evaluates children’s social skills on four domains: (A) language, (B) everyday life, (C) social life, (D) communication.
Results: Overall, the average score of children who receive CIs at a later age was lower than that of their hearing peers. Pre-school children obtained statistically lower scores in all skills. While this general lag in skill development was no longer observed in the lower grades of elementary school, the upper-grade school children presented lower scores than their hearing peers, although only those pertaining to everyday and social life skills were statistically significant. Accordingly, the average scores were distributed in an inverted V shape among age groups.
Conclusion: These results suggest that children who receive CIs at a later age develop their social skills later than their peers with normal hearing in preschool, catch up to their peers in the 1st to 3rd grades, and then lag in the 4th to 6th grades. Accordingly, acquiring age-appropriate social skills in the upper grades remains a challenge for children who obtained CIs at the age of approximately 3, suggesting the need for intervention programs for school-age children even when they do not show significant language acquisition delays.

Introduction: 尽管听力有所改善，但较晚植入人工耳蜗（cochlear implants, CIs）的儿童在社会适应方面仍面临困难，使他们暴露于心理和社会风险之中。本研究有助于学校预防性干预措施的概念化，以应对潜在问题，从而帮助这些儿童更积极地参与社会生活。
Methods: 共纳入52名在30月龄时植入CIs的儿童（年龄3–12岁），采用朝日-式社会适应技能测试（Asahide-Shiki Social Adaptive Skills Test）进行评估，该测试从四个维度评价儿童的社会技能：（A）语言、（B）日常生活、（C）社会生活、（D）沟通。
Results: 总体而言，较晚植入CIs儿童的平均得分低于听力正常的同龄人。学龄前儿童在所有技能维度上的得分均具有统计学意义的降低。尽管在小学低年级阶段未观察到这种普遍的技能发展滞后，但小学高年级儿童的得分仍低于听力正常同龄人，其中仅日常生活和社会生活技能维度的差异具有统计学意义。因此，各年龄组的平均得分呈倒V形分布。
Conclusion: 这些结果表明，较晚植入CIs的儿童在学龄前阶段的社会技能发展晚于听力正常同龄人，在小学1–3年级时追上同龄人，但在4–6年级时再次落后。因此，对于约3岁时植入CIs的儿童而言，在高年级阶段获得适龄社会技能仍是一项挑战，这提示即使儿童未表现出明显的语言习得延迟，也需为学龄儿童提供干预方案。