Cochlear Implants: Making Sure Families Are Aware of the Full Picture

The issue

When a child is identified as being deaf, a cochlear implant may be recommended early in the intervention process. For hearing families, this recommendation often comes with relief that there is a “medical fix” to providing their child with the ability to hear.  While a cochlear implant provides significant benefit to many children, spoken language outcomes are extremely varied. This means that there should be a standard procedure, involving both medical and educational professionals, to provide families with the full spectrum of “what-ifs”  and “what’s involved,” from surgery, to activation and monitoring of the device,  to listening and spoken language training, to linguistic, educational, and social-emotional considerations.  It is essential that families are provided with the full range of possible outcomes, opportunities, and needed services so they can make informed decisions about choosing a cochlear implant within the context of their “whole deaf child.”

What we know

Most children who are candidates for a cochlear implant get one (or two) early in life.  We know that depending on the early intervention service providers who happen to be paired with a family, or where a family happens to live, they may or may not be informed of all they need to know.
It is important that families understand what is known about obtaining a cochlear implant including:
  • The varied listening and spoken language outcomes. While a cochlear implant provides sound awareness, this is only the first step. Development of listening and spoken language takes time, involves training, and children have varied learning curves and outcomes (the reasons for which may not be apparent early on).
  • The ongoing family role in maintaining the technology.  After surgery, successful outcomes depend on assuring that the implant is functioning optimally and used consistently.  This involves family commitment to a) ongoing visits to the implant center to program the speech processor of the device, b) daily troubleshooting, and c) out-of- pocket expenses related to items such as batteries, repairs, and device upgrades.
  • The importance of promoting language access and avoiding language delay. It is important that families understand the urgent need for children to have accessible language both pre-implantation (before having access to sound) and post- implantation (when spoken language outcomes are in question). While  optimal spoken language outcomes depend on a rich spoken language environment, evidence indicates the importance of strategies to support a child’s full  language  access via multiple pathways (i.e. visual, auditory, tactile), so language acquisition, learning, and social-emotional development are not compromised.

What we don’t know

We still don’t know enough about long-term outcomes for children who grow up with a cochlear implant from early childhood. Emerging evidence suggests that language growth may possibly plateau, or that challenges in pragmatic language may emerge that could cause a child to fall behind in school, as linguistic and learning demands become greater. We also do not yet know enough about outcomes for children with multiple disabilities or children with residual hearing, who are now being considered as candidates for implantation.  In addition, we do not know enough about relevant choices of adolescents as they proceed through school. At the Model Secondary School for the Deaf on the campus of Gallaudet University, for example, there are approximately 40 students with cochlear implants.  Some of them excel in spoken language and were academically successful in a general education setting, but decided to attend a school with the opportunity to experience being a part of the Deaf Community. We need to take a closer look at what students are informing us about their identities, how and where they learn best, and their social-emotional development.

Implications

When professionals share information with families about cochlear implants, it is important that they discuss the full range of possible outcomes as well as the ongoing familial commitment involved. Families must be aware, not only of the possibility of their child’s achieving listening and spoken language similar to hearing peers, but the varying levels of possible outcomes. It is critical that medical, audiological, and educational professionals collaborate to collectively provide families with all of the information needed to develop expectations that align with the characteristics of their child and a full understanding of all that is involved in planning appropriate supports—not ending with the surgery, but starting with the surgery.

Posted on April 4, 2017 by
Debra Berlin Nussbaum
Laurent Clerc National Deaf Education Center
Debra.Nussbaum {at} gallaudet.edu

 

Further reading

Davidson, K., Lillo-Martin, D., & Chen Pichler, D. (2014). Spoken English language development in native signing children with cochlear implants. Journal of Deaf Studies and Deaf Education, 19, 238-250. 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

Mitchiner, J. C., (2015). Deaf parents of cochlear-implanted children: Beliefs on bimodal bilingualism. Journal of Deaf Studies and Deaf Education, 20, 51-66. view details

Sarant, J. & Garrard, P. (2014). Parenting stress in parents of children with cochlear implants: Relationships among parent stress, child language, and unilateral versus bilateral implants. Journal of Deaf Studies and Deaf Education, 19, 85-106. view details