Communication and Cytomegalovirus (CMV) Infection

Hey Everyone!

Every so often you get a kid on your caseload or open their evaluation intake form and see a word that you never new existed.  So what do you do?  You Google it, only to find out there is precious little information on how this disease/disorder/infection/syndrome affects communication.  This is exactly the case with Cytomegalovirus (CMV).

I had to do a ton of research on CMV and rather than archive it on my computer (a.k.a. never to be seen again), I thought I would offer it up to the internet gods to be brought down into the hands of some other needy soul.  If you need this information then you probably NEED!! it.  Otherwise, bookmark this for that eventual day.

 

Communication and Cytomegalovirus

 

What is Cytomegalovirus (CMV) Infection?

CMV or cytomegalovirus (si-to-MEG-a-lo-vi-rus) is any of several viruses that are frequently involved in human infection.  Cytomegalovirus is found universally throughout all geographic locations and socioeconomic groups, and infects between 50% and 85% of adults in the United States by 40 years of age (National 1).  Often present with hearing loss and cerebral palsy, CMV can also cause [is also frequently concurrent with] low cognitive ability, poor audition skills, and weak muscle coordination (kids).

Resources on how CMV affects communication and how to serve a client with CMV are limited.  Where should I look?

 

Accessing literature to treat CMV is not as straight forward as researching topics such as Autism or Down syndrome.  A full understanding of the disease is needed along with knowledge about what disorders often accompany CMV.  A client should then be evaluated to identify which characteristics he or she possesses.  It’s upon researching the complications that are specific to a certain client that academic resources become valuable.

The Internet serves as the most explanatory and expansive source of information on Cytomegalovirus.  Resource groups, parent-support groups, and health sites provide a description of the disease and what complications can come along with it.

  • The National Center for Infectious Diseases: https://www.cdc.gov/cmv/
  • Kids Health for Parents:  http://kidshealth.org/en/parents/cytomegalovirus.html

CMV is often present with other disorders so it affects communication in a variety of ways

CMV is the virus most frequently transmitted to a developing child before birth.  It joins Fragile X Syndrome as being one of the leading causes in Mental Retardation.  Often present with hearing loss and cerebral palsy, a client with CMV can exhibit low cognitive ability, poor audition skills, and weak muscle coordination (kids).

Cytomegalovirus and Deafness

Arthur N. Schildroth of Gallaudet University offers one of the leading comprehensive studies of CMV and its relation to deafness.  It is complete with medical aspects, prevalence charts, testing procedures, and cultural considerations related to CMV.  Most importantly, detail is given to complications that accompany CMV and the effects on hearing (Schildroth 1994).  This is an important distinction between this article and similar writing on hearing.  Many seem afraid to divide CMV to show its specific effects on hearing. Instead writers more often present CMV as a grand complication and leave professional readers with few specifics to support intervention.

Cytomegalovirus and Intellectual Disabilities

Broadening research on Cytomegalovirus to access information on Intellectual Disabilities (Mental Retardation (MR) yields more results)  will definitely provide a clinician with more information.   Well-funded programs and databases continue to add to what is known about Intellectual Disabilities.  Romski et al. (1994) for example, provide empirically sound, clinically applicable information on communication interaction and intervention using augmentative communication.  Information such as this is not always (if at all often) applicable to CMV induced impairments.  Their subjects (13 males age 12) were “ambulatory [and] were reported to have vision and hearing acuity within normal limits (Romski 3).”  This is hardly representative of the CMV/MR population which often exhibits cerebral palsy, retinal weakness, and sensory-neural hearing damaged.

Cytomegalovirus and Assessment

As Schildroth (1994) stated; CMV is the cause of “a bewildering array of diseases.”  An evaluation should be performed to determine if impairments such as hearing loss, Intellectual Disabilities, or Cerebral Palsy exist.  Once identified, supporting literature can be gathered on each impairment to create a portfolio that is unique to each client.  The client can only benefit from research results that most closely resemble his or her impairments.

Important Point Here: If you see CMV in your file, make sure to check for hearing and intellectual concerns.

Cytomegalovirus and Treatment

Due to the sheer number of complications that could be involved with CMV, the biological/behavioral approach to therapy may offer a child the greatest benefit.  Compensatory behaviors as suggested by Hodge (1993) could ensure that a person with CMV has the highest quality of life that therapy could offer him.  For example, a hearing impairment could be rectified with hearing aids and the child taught to use the sounds that she has access to.  If she is not compromised by cerebral palsy than a sign/gesture system may be introduced.  If mental retardation and/or cerebral palsy are part of the impairment then augmentative communication may be the only option.  Concentration on the deficits and what is lacking is not an optimistic way to deal with someone who is compromised in a variety of different ways.  Each ability that exists should be celebrated and employed to its greatest extent (Hodge 1993).

Need of our Field: Communication and Cytomegalovirus

Anyone looking for a thesis topic?  While intervention is possible with portions of the literature that do exist, this field needs research that deals specifically with CMV and speech and language deficits.

  • Early detection is as important with CMV as it is with any disorder. A system of early detection, evaluation, or predictive measures surrounding communication disorders would quickly reduce the severity of many clients.  This is especially true with a hearing impairment.  Hearing loss in someone with CMV normally occurs after age two and is then degenerative.  A child would have already had access to sounds could be a great candidate for a cochlear implant should they maintain the sound repertoire.
  • While incidence and prevalence of the disease is common information, the types of communication difficulties that present themselves with CMV is not. A spectrum that encompasses communication difficulties specific to the combined deficits of CMV would help to show a clinician the range of severity that he or she is working in.
  • The field would benefit by a study of communication changes over the lifetime of someone with CMV. Information on adaptation, generalization, and the successfulness and pitfalls of communication would provide a direction in which therapy could head.

GRAND FINALE – Communication and Cytomegalovirus

Cytomegalovirus is a common cause of mental retardation, cerebral palsy, and hearing loss.  Individually these impairments are already a difficult portion of a speech-language pathologist’s caseload.  When combined to affect one child, the need for speech and language intervention is monumental.  Only a small amount of academic literature would be needed to explain how CMV affects communication, and how to serve a client with CMV or a related population.

References and More Resources

Boppana, S. B., Fowler, K.B., Britt, W.J., Stagno, S., Pass, R.F. (1999). Symptomatic Congenital Cytomegalovirus Infection in Infants Born to Mothers With Preexisting Immunity to Cytomegalovirus.  Pediatrics, 104 (55).
Hodge. M., (1993).   Assessment and Treatment of a Child with a Developmental Speech Disorder: A Biological-Behavioral Perspective.  Seminars in Speech and Language, 14 (2).
Romski et al. (1994).   Adult-Directed Communications of Youth with Mental Retardation Using the System for Augmenting Language.  Journal of Speech and Language Research, 37 (3).
Schildroth, A.N., (1994).  Congenital Cytomegalovirus and Deafness.  American Journal of Audiology. Jul94.  27-37.

Internet Citations

Kids Health for Parents: http://kidshealth.org/parent/infections/bacterial_viral/cytomegalovirus.html
National Center for Infectious Diseases: http://www.cdc.gov/ncidod/diseases/cmv.htm
Transplantation and Donation: http://www.transweb.org/qa/qa_txp/faq_cmv.html
The Influence of Latent Viral Infection on Rate of Cognitive Decline over 4 Years.  Aiello, Allison E.; Haan, Mary N.; Blythe, Lynn; Journal of the American Geriatrics Society, Vol 54(7), Jul 2006. pp. 1046-1054. [Journal Article]
Brief Report: Autistic Disorder in Three Children with Cytomegalovirus Infection.  Sweeten, Thayne L.; Posey, David J.; McDougle, Christopher J.; Journal of Autism and Developmental Disorders, Vol 34(5), Oct 2004. pp. 583-586. [Journal Article]
 Intellectual assessment of children with asymptomatic congenital cytomegalovirus infection.  Kashden, Jody; Frison, Sonja; Fowler, Karen; Journal of Developmental & Behavioral Pediatrics, Vol 19(4), Aug 1998. pp. 254-259. [Journal Article]
Cytomegalovirus.  Santos de Barona, Maryann; In: Health-related disorders in children and adolescents: A guidebook for understanding and educating. Phelps, LeAdelle; Washington, DC, US: American Psychological Association, 1998. pp. 213-218. [Chapter]

 ERIC

Congenital Cytomegalovirus Infection: A Significant Cause of Deafness and Mental Deficiency. . By: Eichhorn, Sarah K.. American Annals of the Deaf, v127 n7 p838-43 Dec 1982. (EJ276481)
Hearing Loss and Cytomegalovirus. . By: Strauss, Melvin. Volta Review, v99 n5 p71-74 1997. (EJ603406)
Health Update: CMV and Child Care Prgrams. . By: Aronson, Susan S.. Child Care Information Exchange, n59 p25-28 Jan 1988. (EJ366484)
Autism in a Child with Congenital Cytomegalovirus Infection. . By: Markowitz, Phillip I.. Journal of Autism and Developmental Disorders, v13 n3 p249-53 Sep 1983. (EJ293188)
Progressive Hearing Impairment in Children with Congenital Cytomegalovirus Infection. . By: Dahle, Arthur J.; And Others. Journal of Speech and Hearing Disorders, v44 n2 p220-29 May 1979. (EJ206474)
Autistic Symptoms in a Child with Congenital Cytomegalovirus Infection . By: Stubbs, E. Gene. Journal of Autism and Childhood Schizophrenia, 8, 1, 37-43, Mar 78. (EJ184841)
Subclinical Congenital Cytomegalovirus Infection and Hearing Impairment . By: Dahle, Arthur J.; And Others. Journal of Speech and Hearing Disorders, 39, 3, 320-9, Aug 74. (EJ104322)
Viral infection and cognitive decline.  Itzhaki, Ruth F.; Wozniak, Matthew A.; Journal of the American Geriatrics Society, Vol 55(1), Jan 2007. pp. 131. [Comment/Reply]

 

Written by: Scott Prath

3 Comments on “Communication and Cytomegalovirus (CMV) Infection”

  1. September 19, 2017 at 10:49 am #

    Question: Is the statistic, “infects between 50-85% of adults in the U.S.” accurate, that number seems high?

    • September 19, 2017 at 11:08 am #

      Really hard to believe, right? Here are several sources (taken 09/2017). I believe that it can be asymptomatic and therefore the rate of incidence seems large.

      Center for Disease Control
      “In the United States, nearly one in three children are already infected with CMV by age 5 years. Over half of adults by age 40 have been infected with CMV. Once CMV is in a person’s body, it stays there for life and can reactivate. A person can also be reinfected with a different strain (variety) of the virus.”https://www.cdc.gov/cmv/index.html

      “Experts estimate that more than half of the adult population in the United States has been infected with CMV, and 80% of adults have had the infection by the time they are 40 years old. About one in 150 children is born with CMV infection.” http://www.medicinenet.com

      “Blood tests show that 60 to 90% of adults have had a CMV infection at some time.”
      http://www.merckmanuals.com/home/infections/viral-infections/cytomegalovirus-cmv-infection

  2. September 21, 2017 at 9:34 am #

    Thank you for your response, Scott. I’m amazed at those numbers! Thank you for sharing information on how to best serve this population.

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