Middle Ear Effusion, Attention, and the Development of Child Behavior Problems
ABSTRACT
Objective: Much interest centers on whether middle ear effusion (MEE) early in life has lasting developmental conse-quences. It was hypothesized that episodic loss of hearing acuity associated with MEE results in a deficit in attention, a core factor in the development of child behavior problems, and that impaired attention is related to behavior prob-lems during the early years of childhood. Method: This was a prospective study of a large sample of children (n = 698) that was representative of the local population in terms of socioeconomic and ethnic characteristics. The children were recruited at birth and were monitored with regular home visits for 3 years to check for the presence of MEE. Assessment of attention occurred at 2, 3, 5, and 7 years. Behavior problems were assessed at 3, 5, and 7 years. Results: The results did not support the hypothesis that children with greater duration of MEE experience greater attention deficits and more behavior problems than children with a shorter duration of MEE. Structural Equation Modeling parameter estimates resulted in no support for the primary hypothesis. Correlational analyses also did not support the hypothesis. Attention and behavior problems were related significantly. Conclusions: Our negative findings call into question the results of previous studies relating MEE to behavior and attention problems, studies that may have been biased by small, non-representative samples and retrospective designs that lacked careful documentation of MEE.
Objective: Much interest centers on whether middle ear effusion (MEE) early in life has lasting developmental conse-quences. It was hypothesized that episodic loss of hearing acuity associated with MEE results in a deficit in attention, a core factor in the development of child behavior problems, and that impaired attention is related to behavior prob-lems during the early years of childhood. Method: This was a prospective study of a large sample of children (n = 698) that was representative of the local population in terms of socioeconomic and ethnic characteristics. The children were recruited at birth and were monitored with regular home visits for 3 years to check for the presence of MEE. Assessment of attention occurred at 2, 3, 5, and 7 years. Behavior problems were assessed at 3, 5, and 7 years. Results: The results did not support the hypothesis that children with greater duration of MEE experience greater attention deficits and more behavior problems than children with a shorter duration of MEE. Structural Equation Modeling parameter estimates resulted in no support for the primary hypothesis. Correlational analyses also did not support the hypothesis. Attention and behavior problems were related significantly. Conclusions: Our negative findings call into question the results of previous studies relating MEE to behavior and attention problems, studies that may have been biased by small, non-representative samples and retrospective designs that lacked careful documentation of MEE.
Cite this paper
Cross, J. , Johnson, D. , Swank, P. , Baldwin, C. & McCormick, D. (2010). Middle Ear Effusion, Attention, and the Development of Child Behavior Problems. Psychology, 1, 220-228. doi: 10.4236/psych.2010.13029.
Cross, J. , Johnson, D. , Swank, P. , Baldwin, C. & McCormick, D. (2010). Middle Ear Effusion, Attention, and the Development of Child Behavior Problems. Psychology, 1, 220-228. doi: 10.4236/psych.2010.13029.
References
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E. Roberts, S. R. Hooper, et al., “Early Childhood Otitis Media in Relation to Children’s Atten- tion-Related Behavior in the First Six Years of Life,” Pe- diatrics, Vol. 107, No. 5, 2001, pp. 1037-1042. [16] J. Roberts, M. R. Burchinal and S. M. Clarke-Klein, “Oti- tis Media in Early Childhood and Cognitive, Academic, and Behavior Outcomes at 12 Years of Age,” Journal of Pediatric Psychology, Vol. 20, No. 5, 1995, pp. 645-660. [17] K. E. Bennett, M. P. Haggard, P. A. Silva, et al., “Behav- iour and Developmental Effects of Otitis Media with Ef- fusion into the Teens,” Archives of Disease in Childhood, Vol. 85, No. 2, 2001, pp. 91-95. [18] J. L. Paradise, C. A. Dollaghan, T. F. Campbetll, et al., “Otitis Media and Tympanostomy Tube Insertion during the First Three Years of Life: Developmental Outcomes at the Age of Four Years,” Pediatrics, 2003, Vol. 112, No 2, pp. 265-277. [19] M. K. Rothbart, M. L. Posner and K. L. Hershey, “Tem- perament, Attention and Developmental Psychopathology,” In: D. Cicchetti and D. J. Cohen, Ed., Developmental Psychopathology, Theory and Methods, John Wiley, New York, Vol. 1, 1995, pp. 315-340. [20] R. A. Barkley, G. J. DuPaul and M. McMurray, “Com- prehensive Evaluation of Attention Deficit Disorder with and without Hyperactivity as Defined by Research Crite- ria,” Journal of Consulting and Clinical Psychology, Vol. 58, No. 6, 1990, pp. 775-789. [21] NJ Roizen, TA Blondis, M Irwin, et al., “Adaptive Func- tioning in Children with Attention-Deficit Hyperactivity Disorder,” Archives of Pediatrics & Adolescent Medicine, Vol. 148, No. 11, 1994, pp. 1137-1142. [22] R. J. McGowan, D. L. Johnson and S. E. Maxwell, “Rela- tions between Infant Behavior Ratings and Concurrent and Subsequent Mental Test Scores,” Developmental Psy- chology, Vol. 17, No. 5, 1981, pp. 542-533. [23] H. Ruff, K. Lawson, R. Parrinello, et al., “Long-Term Stability of Individual Differences in Sustained Attention in the Early Years,” Child Development, Vol. 61, No. 1, 1990, pp. 60-75. [24] C. M. Heinicke, S. D. Diskin, D. M. Ramsey-Klee, et al., “Pre- and Post-Birth Antecedents of 2-Year-Old Attention, Capacity for Relationships and Verbal Expressiveness,” Developmental Psychology, Vol. 22, No. 6, 1986, pp. 777- 787. [25] A. F. Mirsky, “Behavioral and Psychophysiological Mark- ers of Disordered Attention,” Environmental Health Per- spectives, Vol. 74, 1987, pp. 191-199. [26] S. B. Campbell, “Longitudinal Studies of Active and Ag- gressive Preschoolers: Individual Differences in Early Behavior and in Outcome,” In: D. Cicchetti and S. L. Toth, Ed., Rochester Symposium on Developmental Psy- chopathology: Internalizing and Externalizing Expressions of Dysfunction, Erlbaum Group, Hillside, Vol. 2, 1991. [27] M. J. Eliason and L. C. 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Rapoport, “Reaction Time Indices of Attention Deficits in Boys with Disrup- tive Behavior Disorders,” Journal of Abnormal Child Psy- chology, Vol. 19, No. 2, 1991, pp. 233-252. [32] M. J. Owen, C. D. Baldwin and V. M. Howie, “Incidence and Duration of Otitis Media with Effusion during the First Two Years of Life,” Paper Presented at: Southern Society for Pediatric Research, New Orleans, 4-5 Febru- ary 1988. [33] R. M. Lerner, M. Palermo, A. Spiro, et al., “Assessing the Dimensions of Temperamental Individuality across the Life Span: The Dimensions of Temperament Survey (DOTS),” Child Development, Vol. 53, No. 1, 1982, pp. 149-159. [34] R. L. Thorndike, E. P. Hagen and J. M. Sattler, “Stanford- Binet Intelligence Scale,” 4th Edition, Riverside Publish- ing, Chicago, 1986. [35] T. M. Achenbach, “Manual for the Child Behavior Check- list/2-3 and 1992 Profile,” University of Vermont De- partment of Psychiatry, Burlington, 1992. [36] T. M. Achenbach, “Manual for the Child Behavior Check- list/4-18 and 1991 Profile,” University of Vermont De- partment of Psychiatry, Burlington, 1991. [37] T. M. Achenbach, “Manual for the Teacher’s Report Form and 1991 Profile,” University of Vermont Department of Psychiatry, Burlington, 1991. [38] T. R. Dupuy, D. McCarney and L. M. Greenberg, “T.O.V.A. Manual: Tests of Variables of Attention Computer Pro- gram. Version 6.0 for the IBM PC or IBM Compatible,” Lawrence M. Greenberg, Minneapolis, 1990. [39] A. B. Hollingshead, “Hollingshead Four-Factor Index of Social Status,” Department of Sociology, Yale University, New Haven, 1975. [40] B. M. Caldwell and R. H. Bradley, “Home Observation for Measurement of the Environment (Revised Edition),” University of Arkansas, Little Rock, 1984. [41] K. G. Joreskog and D. Sorbom, “LISREL 7: Estimation of Linear Structural Equation Systems by Maximum Like- lihood Methods,” National Educational Resources, Chi- cago, 1988. [42] D. Francis, “An Introduction to Structural Equation Mod- els,” Journal of Clinical and Experimental Neuropsychol- ogy, Vol. 10, No. 5, 1988, pp. 623-639. [43] T. Hubbard, J. L. Paradise, B. J. McWilliams, et al., “Con- sequences of Unremitting Middle Ear Disease in Early Life: Otologic, Audiologic and Developmental Findings of Children with Cleft Palate,” New England Journal of Medicine, Vol. 312, No. 24, 1985, pp. 1529-1534. [44] A. R. Adesman, L. A. Altshuler, P. H. Lipkin, et al., “Oti- tis Media in Children with Learning Disabilities and in Children with Attention Deficit Disorder with Hyperac- tivity,” Pediatrics, Vol. 85, No. 3, 1990, pp. 442-446. [45] K. Hoffman-Lawless, R. W. Keith and R. T. Cotton, “Audi- tory Processing Abilities in Children with Previous Mid- dle Ear Effusion,” Annals of Otology, Rhinology and Laryn- gology, Vol. 90, No. 5, 1981, pp. 543-545. [46] P. A. Silva, D. Chalmers and I. Stewart, “Some Audiologi- cal, Psychological, Educational and Behavioral Charac- teristics of Children with Bilateral Otitis Media with Ef- fusion: A Longitudinal Study,” Journal of Learning Dis- abilities, Vol. 19, No. 3, 1986, pp. 165-169.
[1] K. A. Daly, “Definition and Epidemiology of Otitis Me- dia,” In: J. E. Roberts, I. F. Wallace and F. W. Henderson, Ed., Otitis Media in Young Children: Medical, Develop- mental, and Educational Considerations, Brookes Pub- lishing, Baltimore, 1997. [2] G. A. Zielhuis, G. H. Rach, A. van den Bosch, et al., “The Prevalence of Otitis Media with Effusion: A Critical Re- view of the Literature,” Clinical Otolaryngology, Vol. 15, No. 3, 1990, pp. 283-288. [3] M. Owen, C. D. Baldwin, D. Luttman, et al., “The Uni- versality of Otitis Media with Effusion Detected by Tym- panometry on Frequent Home Visits in Galveston, Texas,” Proceedings of the 5th International Symposium on Re- cent Advances in Otitis Media, Fort Lauderdale, 1993. [4] P. D. Eimas and J. F. Kavanagh, “Otitis Media, Hearing Loss, and Child Development: A NICHD Conference Sum- mary,” Public Health Reports, Vol. 101, No. 3, 1986, pp. 289-293. [5] D. P. McCormick, C. D. Baldwin, J. S. Klecan-Aker, et al., “Association of Early Bilateral Middle Ear Effusion with Language at Age 5 Years,” Ambulatory Pediatrics, Vol. 1, No. 2, 2001, pp. 87-90. [6] D. J. Lim, C. R. Bluestone, J. O. Klein, et al., “Recent Advances in Otitis Media,” Decker Periodicals, Philadel- phia, 1993. [7] J. S. Gravel and I. F. Wallace, “Listening and Language at 4 Years of Age: Effects of Early Otitis Media,” Journal of Speech and Hearing Research, Vol. 35, 1992, pp. 588- 595. [8] L. V. Feagans, E. Kipp and I. Blood, “The Effects of Otitis Media on the Attention Skills of Day-Care-At- tending Toddlers,” Developmental Psychology, Vol. 30, No. 5, 1994, pp. 701-708. [9] L. V. Feagans, M. Sanyal, F. Henderson, et al., “Rela- tionship of Middle Ear Disease in Early Childhood to Later Narrative and Attention Skills,” Journal of Pediat- ric Psychology, Vol. 12, No. 4, 1987, pp. 581-594. [10] J. E. Roberts, M. R. Burchinal and F. Campbell, “Otitis Media in Early Childhood and Patterns of Intellectual Development and Later Academic Performance,” Journal of Pediatric Psychology, Vol. 19, No. 3, 1994, pp. 347-367. [11] P. A. Silva, C. Kirkland, A. Simpson, et al., “Some De- velopmental and Behavioral Problems Associated with Bilateral Otitis Media with Effusion,” Journal of Learn- ing Disabilities, Vol. 15, No. 7, 1982, pp. 417-421. [12] S. M. Sperduti, “A Structural Model for Otitis Media and Pain Effects on Attention and Difficult/Fussiness Factors of Temperament,” Unpublished Masters Thesis, Univer- sity of Houston, Houston, 1996. [13] E. Arcia and J. E. Roberts, “Otitis Media in Early Child- hood and its Association with Sustained Attention in Struc- tured Situations,” Behavioral Pediatrics, Vol. 14, No. 3, 1993, pp. 181-183. [14] J. Kindig, “Otitis Media: Its Relationship with Delayed Reading and Attention Deficit Disorder,” Dissertation Abstracts International, Vol. 56, 1996, p. 3520. [15] K. R. Minter, J. E. Roberts, S. R. Hooper, et al., “Early Childhood Otitis Media in Relation to Children’s Atten- tion-Related Behavior in the First Six Years of Life,” Pe- diatrics, Vol. 107, No. 5, 2001, pp. 1037-1042. [16] J. Roberts, M. R. Burchinal and S. M. Clarke-Klein, “Oti- tis Media in Early Childhood and Cognitive, Academic, and Behavior Outcomes at 12 Years of Age,” Journal of Pediatric Psychology, Vol. 20, No. 5, 1995, pp. 645-660. [17] K. E. Bennett, M. P. Haggard, P. A. Silva, et al., “Behav- iour and Developmental Effects of Otitis Media with Ef- fusion into the Teens,” Archives of Disease in Childhood, Vol. 85, No. 2, 2001, pp. 91-95. [18] J. L. Paradise, C. A. Dollaghan, T. F. Campbetll, et al., “Otitis Media and Tympanostomy Tube Insertion during the First Three Years of Life: Developmental Outcomes at the Age of Four Years,” Pediatrics, 2003, Vol. 112, No 2, pp. 265-277. [19] M. K. Rothbart, M. L. Posner and K. L. Hershey, “Tem- perament, Attention and Developmental Psychopathology,” In: D. Cicchetti and D. J. Cohen, Ed., Developmental Psychopathology, Theory and Methods, John Wiley, New York, Vol. 1, 1995, pp. 315-340. [20] R. A. Barkley, G. J. DuPaul and M. McMurray, “Com- prehensive Evaluation of Attention Deficit Disorder with and without Hyperactivity as Defined by Research Crite- ria,” Journal of Consulting and Clinical Psychology, Vol. 58, No. 6, 1990, pp. 775-789. [21] NJ Roizen, TA Blondis, M Irwin, et al., “Adaptive Func- tioning in Children with Attention-Deficit Hyperactivity Disorder,” Archives of Pediatrics & Adolescent Medicine, Vol. 148, No. 11, 1994, pp. 1137-1142. [22] R. J. McGowan, D. L. Johnson and S. E. Maxwell, “Rela- tions between Infant Behavior Ratings and Concurrent and Subsequent Mental Test Scores,” Developmental Psy- chology, Vol. 17, No. 5, 1981, pp. 542-533. [23] H. Ruff, K. Lawson, R. Parrinello, et al., “Long-Term Stability of Individual Differences in Sustained Attention in the Early Years,” Child Development, Vol. 61, No. 1, 1990, pp. 60-75. [24] C. M. Heinicke, S. D. Diskin, D. M. Ramsey-Klee, et al., “Pre- and Post-Birth Antecedents of 2-Year-Old Attention, Capacity for Relationships and Verbal Expressiveness,” Developmental Psychology, Vol. 22, No. 6, 1986, pp. 777- 787. [25] A. F. Mirsky, “Behavioral and Psychophysiological Mark- ers of Disordered Attention,” Environmental Health Per- spectives, Vol. 74, 1987, pp. 191-199. [26] S. B. Campbell, “Longitudinal Studies of Active and Ag- gressive Preschoolers: Individual Differences in Early Behavior and in Outcome,” In: D. Cicchetti and S. L. Toth, Ed., Rochester Symposium on Developmental Psy- chopathology: Internalizing and Externalizing Expressions of Dysfunction, Erlbaum Group, Hillside, Vol. 2, 1991. [27] M. J. Eliason and L. C. Richman, “Behavior and Atten- tion in LD Children,” Learning Disability Quarterly, Vol. 11, 1988, pp. 360-369. [28] G. W. Rebok, W. E. Hawkins, P. Krener, et al., “Effect of Concentration Problems on the Malleability of Children’s Aggressive and Shy Behaviors,” Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 35, No. 2, 1996, pp. 193-203. [29] K. S. Lassiter, R. C. D’Amato, D. J. Raggio, et al., “The Construct Specificity of the Continuous Performance Test: Does Inattention Relate to Behavior and Attachment?” Developmental Neuropsychology, Vol. 10, 1994, pp. 179- 188. [30] M. A. Stein, E. Szumowski, T. A. Blondis, et al., “Adap- tive Skills Dysfunction in ADD and ADHD Children,” Journal of Child Psychology and Psychiatry, Vol. 36, No. 4, 1995, pp. 663-670. [31] T. P. Zahn, M. Kruess and J. L. Rapoport, “Reaction Time Indices of Attention Deficits in Boys with Disrup- tive Behavior Disorders,” Journal of Abnormal Child Psy- chology, Vol. 19, No. 2, 1991, pp. 233-252. [32] M. J. Owen, C. D. Baldwin and V. M. Howie, “Incidence and Duration of Otitis Media with Effusion during the First Two Years of Life,” Paper Presented at: Southern Society for Pediatric Research, New Orleans, 4-5 Febru- ary 1988. [33] R. M. Lerner, M. Palermo, A. Spiro, et al., “Assessing the Dimensions of Temperamental Individuality across the Life Span: The Dimensions of Temperament Survey (DOTS),” Child Development, Vol. 53, No. 1, 1982, pp. 149-159. [34] R. L. Thorndike, E. P. Hagen and J. M. Sattler, “Stanford- Binet Intelligence Scale,” 4th Edition, Riverside Publish- ing, Chicago, 1986. [35] T. M. Achenbach, “Manual for the Child Behavior Check- list/2-3 and 1992 Profile,” University of Vermont De- partment of Psychiatry, Burlington, 1992. [36] T. M. Achenbach, “Manual for the Child Behavior Check- list/4-18 and 1991 Profile,” University of Vermont De- partment of Psychiatry, Burlington, 1991. [37] T. M. Achenbach, “Manual for the Teacher’s Report Form and 1991 Profile,” University of Vermont Department of Psychiatry, Burlington, 1991. [38] T. R. Dupuy, D. McCarney and L. M. Greenberg, “T.O.V.A. Manual: Tests of Variables of Attention Computer Pro- gram. Version 6.0 for the IBM PC or IBM Compatible,” Lawrence M. Greenberg, Minneapolis, 1990. [39] A. B. Hollingshead, “Hollingshead Four-Factor Index of Social Status,” Department of Sociology, Yale University, New Haven, 1975. [40] B. M. Caldwell and R. H. Bradley, “Home Observation for Measurement of the Environment (Revised Edition),” University of Arkansas, Little Rock, 1984. [41] K. G. Joreskog and D. Sorbom, “LISREL 7: Estimation of Linear Structural Equation Systems by Maximum Like- lihood Methods,” National Educational Resources, Chi- cago, 1988. [42] D. Francis, “An Introduction to Structural Equation Mod- els,” Journal of Clinical and Experimental Neuropsychol- ogy, Vol. 10, No. 5, 1988, pp. 623-639. [43] T. Hubbard, J. L. Paradise, B. J. McWilliams, et al., “Con- sequences of Unremitting Middle Ear Disease in Early Life: Otologic, Audiologic and Developmental Findings of Children with Cleft Palate,” New England Journal of Medicine, Vol. 312, No. 24, 1985, pp. 1529-1534. [44] A. R. Adesman, L. A. Altshuler, P. H. Lipkin, et al., “Oti- tis Media in Children with Learning Disabilities and in Children with Attention Deficit Disorder with Hyperac- tivity,” Pediatrics, Vol. 85, No. 3, 1990, pp. 442-446. [45] K. Hoffman-Lawless, R. W. Keith and R. T. Cotton, “Audi- tory Processing Abilities in Children with Previous Mid- dle Ear Effusion,” Annals of Otology, Rhinology and Laryn- gology, Vol. 90, No. 5, 1981, pp. 543-545. [46] P. A. Silva, D. Chalmers and I. Stewart, “Some Audiologi- cal, Psychological, Educational and Behavioral Charac- teristics of Children with Bilateral Otitis Media with Ef- fusion: A Longitudinal Study,” Journal of Learning Dis- abilities, Vol. 19, No. 3, 1986, pp. 165-169.