Cochlear Implants: Considerations for Families (and the Professionals Who Work Alongside Them)

The issue


The number of children now obtaining cochlear implants is growing quickly and, as a result, so is the diversity in the characteristics of the children using them. It would therefore seem logical that recommendations for language and communication approaches, habilitation supports, and educational placements also be varied and tailored to match the individual profile of each child using the technology. This is not always the case. Recommendations are often centered on listening and spoken language (as this is the intended purpose of the device), with sometimes inequitable attention on other critical areas of development. It is important that families of children with cochlear implants, and the professionals working alongside them, consider thoroughly not only decisions involved in the surgical and spoken language habilitation aspects of this technology but also decisions impacting the full range of a child’s language, communication, learning, and social development.

What we know

We know that “accessible language” (language provided in a manner in which a child has the likelihood of being able to learn and interact with it) from the earliest age possible is essential to establishing language foundations and preventing language delay in children who are deaf. Evidence indicates that some children using cochlear implants will be an appropriate match for approaches exclusive to spoken language and will develop competence in listening and spoken language at a level to fully access learning. For reasons known and unknown, not all children using cochlear implants will equally benefit from these approaches and achieve this level of spoken language competence. Some children are observed to benefit from approaches that also include visual strategies (i.e., sign support, American Sign Language, cueing systems) to establish early language foundations, transition to spoken language after implantation, and/or support learning throughout their education. What constitutes as accessible language has been shown to vary from child to child, to change for some children prior to implantation and as spoken language skills emerge (or not emerge as expected), and to vary in different environments (i.e., home, school, social). In addition, evidence indicates that children with cochlear implants, as children who are deaf, can benefit from exposure to and interaction with other children and adults who are deaf to support social-emotional and identity development. We also know that families may receive conflicting advice as to which approaches and supports to consider. When visual supports may be warranted for their child, some families are cautioned that to use anything but spoken language will compromise spoken language outcomes. There is no evidence, however, indicating that signing impedes spoken language development; in fact, evidence actually suggests that the use of sign language can support spoken language development.

What we don’t know

The characteristics of children obtaining cochlear implants, as well as the technology itself, continue to change. It has therefore been a challenge to study the complex and interconnected factors that impact practices and outcomes. Research is just beginning to scratch the surface in looking beyond speech perception and production at language, literacy, cognitive growth, learning, and social-emotional development as well as at factors such as neural reorganization and its impact on memory and learning of children with cochlear implants. As there is still so much unknown about the relationship between practices and outcomes, it is difficult to be certain of how to promote balanced practices that facilitate listening and spoken language with practices that focus on and safeguard all areas of a child’s development.


Not knowing what constitutes “effective practices” collectively for all children using cochlear implant technology should compel professionals and families to work collaboratively to implement an individualized planning process. Each child’s plan should reflect both the potential and the limitations of the technology and take into consideration all areas of development and education. Having an individualized language and communication plan, that can be built into a child’s Individualized Family Service Plan (IFSP), Individualized Education Program (IEP), 504 plan, or other educational planning document, should be considered integral to designing and monitoring appropriate strategies and services to ensure access to learning for each child with a cochlear implant. One such resource to consider in guiding this collaborative planning is Students with Cochlear Implants: Guidelines for Educational Program Planning. These guidelines, available at, were developed by a team of more than 40 professionals convened by the Boston Children’s Hospital Deaf and Hard of Hearing Program and designed and published in 2015 in collaboration with the Laurent Clerc National Deaf Education Center.

Posted on Oct 20, 2015 by
Debra Nussbaum
Laurent Clerc National Deaf Education Center
Debra.Nussbaum {at}

Further reading

Huttunen, K., & Välimaa, T. (2010). Parents’ views on changes in their child’s communication and linguistic and socioemotional development after cochlear implantation. Journal of Deaf Studies and Deaf Education, 15, 383. view details

Hyde, M., Punch, R., & Komesaroff, L. (2010). Coming to a decision about cochlear implantation: Parents making choices for their deaf children. Journal of Deaf Studies and Deaf Education, 15, 162-178. view details

Pisoni, D. B., Conway, C. M., Kronenberger, D. L., Horn, J. K., & Hennings, S. C. (2008). Efficacy and effectiveness of cochlear implants in deaf children. In M. Marschark & P.C. Hauser (Eds.), Deaf cognition: Foundations and outcomes (pp. 52-101). New York: Oxford University Press. view details

Spencer, P. E., Marschark, M., & Spencer, L. J. (2011). Cochlear implants: Advances, issues and implications. In M. Marschark & P. E. Spencer (Eds.), The Oxford handbook of deaf studies, language, and education (Vol. 1, 2nd ed., pp. 452-471). New York: Oxford University Press. view details

Walker, E. A., & Tomblin, J. B. (2014). The influence of communication mode on language development in children with cochlear implants. In M. M. Marschark, G. Tang, & H. Knoors, Bilingualism and bilingual deaf education (pp. 134-149). New York: Oxford University Press. view details