To examine intelligence, language, and academic achievement through 18 years of age among children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected infants.
We used growth curve modeling to analyze trends in IQ (full-scale, verbal, and nonverbal intelligence), receptive and expressive vocabulary, and academic achievement in math and reading. Separate models were fit for each outcome, modeling the change in overall scores with increasing age for patients with normal hearing (n = 78) or with sensorineural hearing loss (SNHL) diagnosed by 2 years of age (n = 11) and controls (n = 40).
Patients with SNHL had full-scale intelligence and receptive vocabulary scores that were 7.0 and 13.1 points lower, respectively, compared with controls, but no significant differences were noted in these scores among patients with normal hearing and controls. No significant differences were noted in scores for verbal and nonverbal intelligence, expressive vocabulary, and academic achievement in math and reading among patients with normal hearing or with SNHL and controls.
Infants with asymptomatic congenital cytomegalovirus infection identified through newborn screening with normal hearing by age 2 years do not appear to have differences in IQ, vocabulary or academic achievement scores during childhood, or adolescence compared with uninfected children.
Comments
RE: Reporting Full Scale IQ scores with Children with SNHL
We read with interest Lopez et. al.’s article regarding intelligence and academic achievement in children with asymptomatic congenital CMV. We work with deaf and hard-of-hearing (D/HH) children, many of whom have SNHL secondary to prenatal CMV infection. The more published information available on this population the better we can develop appropriate mental health and educational interventions.
We do note a concern on the use of Full Scale IQ scores as an estimate of the overall cognitive functioning of children with SNHL. It is noted that these patients had FSIQ scores lower than the FSIQ scores of controls without SNHL. The appropriate assessment of cognitive potential of children with significant hearing loss has long been a challenge for those of us working with this population. Verbal and language-loaded items included in the FSIQ are designed for children who have access to spoken English from birth. As most D/HH children do not have access to ANY language from birth these measures of auditory and crystalized intelligence are of questionable validity in assessing overall intellectual functioning of these children (Miller, Thomas-Presswood, Metz, & Lukomski, 2015). Best practices in clinical and school psychology calls for the use of non-language measures in estimating the cognitive potential of children with significant hearing loss (Reesman et al., 2014). An excellent background and review of these practices is found in
Vernon, M. (2005). Fifty years of research on the intelligence of deaf and hard-of-hearing children: A review of literature and discussion of implications. Journal of Deaf Studies and Deaf Education, 10(3), 225-231. doi:10.1093/deafed/eni024
Due to the low incidence of significant hearing loss and the complicated issues regarding language development, whether signed or spoken, in these children it is common for professionals and researchers to be unfamiliar with the best practices in assessment of D/HH. We are grateful to have the chance to respond to researchers working with this population and are happy to provide additional information regarding appropriate assessment in clinical or research settings.
References:
Miller, M. S., Thomas-Presswood, T. N., Metz, K., & Lukomski, J. (2015). Psychological and psychoeducational assessment of deaf and hard of hearing children and adolescents. Gallaudet University Press.
Reesman, J. H., Day, L. A., Szymanski, C. A., Hughes-Wheatland, R., Witkin, G. A., Kalback, S. R., & Brice, P. J. (2014). Review of intellectual assessment measures for children who are deaf or hard of hearing. Rehabilitation Psychology, 59(1), 99.
RE: Ganciclovir and ANC
Previous studies and recommendations had stressed holding or stopping ganciclovir for ANC < 1500. As a hematologist, we do not consider, nor is their data, to support the idea that ANC over 500 (ie range 500 -1500) increases infection risk, especially when drug induced and therefore decreasing or stopping ganciclovir for ANC in this range is potentially dangerous without proven benefit. Also 30% of African Americans are reported to have ANC < 1000 on normal CBC without known consequence. thus we recommend continuing ganclovir for CMV infected, or possibly infected children even when the ANC drops.