Objectives: (1) To examine behavior

Objectives: (1) To examine behavior problems in Mandarin-speaking children with cochlear implants
(CIs); (2) to investigate the associated factors of problem behaviors; (3) to understand the relationships
between behavior problems and parenting stress.
Methods and materials: Sixty patients (25 boys, 35 girls) aged 6–18 years (mean = 12.2 3.2) who used
CIs for a mean duration of eight years participated in the study. Behavior problems were assessed by
Achenbach’s child behavior checklist (CBCL). Categorical auditory performance (CAP) and speech
intelligibility rating (SIR) scales were utilized to investigate auditory performance and speech production
intelligibility. Parenting stress index (PSI) was filled out by parents to measure parenting stress level.
Results: Significantly more CI subjects had problems with ‘Withdrawn/Depressed’ (p = 0.010), ‘Social
Problems’ (p < 0.001), ‘Thought Problems’ (p < 0.001), ‘Attention Problems’ (p < 0.001), ‘Aggressive
Behavior’ (p = 0.010) and ‘Overall Behavior’ (p = 0.001) than the normative sample did. ‘Social Problems’
was the most common problem and could be independently associated with gender, socioeconomic
status and CAP (R2 = 0.361). CAP score was also associated with Overall Behaviors (R2 = 0.081). The
results of PSI had a significant positive correlation with almost all CBCL subscales (p < 0.05).
Conclusion: The CI subjects still exhibit social and attention problems, which may in turn increase
parenting stress. Good family support as well as aural–verbal rehabilitation are of particular importance
in determining behavioral outcomes in CI children.