Social participation of children and adolescents with cochlear implants: a qualitative analysis of parent, teacher, and child interviews

Psychosocial factors, including socioemotional well-being, peer relationships, and social inclusion with hearing and deaf peers, are increasingly becoming a focus of research investigating children with cochlear implants. The study reported here extends the largely quantitative findings of previous research through a qualitative analysis of interviews with parents, teachers, and pediatric cochlear implant users themselves in three eastern states of Australia. We interviewed 24 parents, 15 teachers, and 11 children and adolescents. The findings displayed commonalities across the three groups of participants, indicating positive experiences around the children's psychosocial development with their cochlear implants, but also ongoing difficulties communicating in groups of people and problems related to social skills. Some children had little contact with other deaf children (with or without cochlear implants) despite parents and teachers perceiving such contact beneficial. Children attending schools where there were other deaf children valued friendships with both deaf and hearing peers. Adolescence was a particularly difficult time for some as they struggled with feelings of self-consciousness about their deafness and external cochlear implant equipment and worries around friendships, dating, and their future place in the world. Recommendations for practice and further research are made.     

Do you see what I see? School perspectives of deaf children,hearing children and their parents☆

Perspectives on academic and social aspects of children’s school experiences were obtained from deaf and hearing children and their (deaf or hearing) parents. Possible differences between (1) the views of children and their parents and (2) those of hearing children and their parents compared to deaf children and their parents were of particular interest. Overall, parents gave their children higher school friendship ratings than the children gave themselves, and hearing children and their parents were more positive about children’s friendships than were deaf children and their parents. Both children and parents also saw deaf children as less successful in reading than hearing children. However, deaf children having deaf parents, attending a school for the deaf and using sign language at home all were associated with more positive perceptions of social success. Use of cochlear implants was not associated with perceptions of greater academic or social success. These and related findings are discussed in the context of parent and child perspectives on social and academic functioning and particular challenges confronted by deaf children in regular school settings.     

Stress and coping in families with deaf children

More than 90% of deaf children are born to hearing parents who experience stress, not only in respose to the initial diagnosis, but also in adapting to the unique needs of their deaf child. This article is a selective literature review summarizing information from three fields in order to broaden our understanding of family adaptation to deafness. Discussion includes (1) psychology's model of individual stress and coping (2) family science's model of family stress management, and (3) literature on family adjustment to disability. The last part of the article traces the development of professionals' understanding of the reciprocal influences between deaf children and their families and describes recent research indicating that the impact of deafness on families is complex and variable. The final conclusion is that adoption of a family stress and coping paradigm would inform discussion of current issues in deafness, such as cochlear implants and bilingualism/biculturalism.     

Congenitally deafblind children and cochlear implants: effects on communication

There has been much research conducted demonstrating the positive benefits of cochlear implantation (CI) in children who are deaf. Research on CI in children who are both deaf and blind, however, is lacking. The purpose of this article is to present a study of five congenitally deafblind children who received cochlear implants between 2.2 and 4.2 years of age. Ratings of video observations were used to measure the children's early communication development with and without the use of their cochlear implants. In addition, parental interviews were used to assess the benefits parents perceived regarding their children's cochlear implants. Two examples are included in this article to illustrate the parents' perspectives about CI in their deafblind children. Benefits of CI in this cohort of children included improved attention and emotional response as well as greater use of objects in interaction with adults. The best overall outcome of CI is not spoken language but better communication.     

Identification of Effective Strategies to Promote Language in Deaf Children With Cochlear Implants

Parental involvement and communication are essential for language development in young children. However, hearing parents of deaf children face challenges in providing language input to their children. This study utilized the largest national sample of deaf children receiving cochlear implants, with the aim of identifying effective facilitative language techniques. Ninety‐three deaf children (≤ 2 years) were assessed at 6 implant centers prior to and for 3 years following implantation. All parent–child interactions were videotaped, transcribed, and coded at each assessment. Analyses using bivariate latent difference score modeling indicated that higher versus lower level strategies predicted growth in expressive language and word types predicted growth in receptive language over time. These effective, higher level strategies could be used in early intervention programs.     

Interviews with deaf children about their experiences using cochlear implants

Within the framework of a longitudinal study of deaf children with cochlear implants, 11 children with implants were interviewed. The objective was to shed light on what it is like for a child to use a cochlear implant, based on these children's own experience with implants, which ranged from 5.0 to 7.5 years. Six of the children were in schools for the deaf, five in regular classes. All but one used an implant daily. The children appreciated that an implant enabled them to perceive sounds in the environment. Some of the children in regular classes could take part in one-to-one conversations with teachers but had difficulty following teaching and discussions. This observation was consistent with what the children's parents and teachers had maintained. Peer interaction was said to be best when other children had the use of at least some signs.     

Development of implanted deaf children’s conversational skills

Previous studies of preverbal development have highlighted the recurrent difficulties experienced by deaf children in acquiring knowledge of the social rules and social skills pertaining to discourse. We expected cochlear implants in children with bilateral profound deafness to improve their use of verbal language, so that their communication skill profile resembled that of younger, hearing children. Using conversation samples taken from videos recorded every 6 months over a 2-year period, we monitored the development of communication skills in a group of 18 prelingually profoundly deaf children (mean implantation age, 3 years and 5 months). Results corroborated our hypothesis that the overall communication performances of children with cochlear implants improve, both quantitatively and qualitatively, as early as the first year post-implantation.     

Parents of deaf children seeking hearing loss-related information on the internet: the Australian experience

Parents whose children are diagnosed in an infant screening program are required to make some difficult choices about the management of the hearing loss at a time when they are emotionally vulnerable. They are required to evaluate information and outcomes regarding issues such as technology for hearing impairment, communication options, education, and rehabilitation. The World Wide Web has become an important resource of health information for both health consumers and practitioners. The ability to obtain accurate health information online quickly, conveniently, and privately provides opportunity to make informed decisions. However, little is known about the level of the use of the Internet to acquire health information, particularly in the case of parents of deaf children seeking information. This study confirms that searches for health information on the Internet are conducted primarily by mothers. In the Australian context, there is minimal online information available to families beyond early intervention. Information on education issues, mental health, and deafness or the day-to-day management of a child or adolescent with a hearing loss are neglected topics on Web sites. This study also revealed that the majority of respondents had never visited HealthInsite or Medline Plus, two gateway sites for reliable consumer health information, although the information on these sites is more generic in nature and unlikely to assist parents to make informed choices on complex issues such as communication options or education. However, the study suggested that half the parents have talked to their doctor or hearing professional about information they found on the Internet, which is an encouraging tendency.     

Some ethical dimensions of cochlear implantation for deaf children and their families

A major source of controversy between Deaf people and those who support a "social/cultural" view of Deafness as "a life to be lived" and those who see deafness within a "medical model" as a "condition to be cured" has been over the cochlear implantation of young deaf children. Recent research has shown that there are noticeable inequities in access to such procedures in western countries; inequities that give rise to the need for informed public policy discussions. It has also found that parents of newly diagnosed deaf children are not provided with access to all the possibilities for their children-including that of a "Deaf life." How this information can be provided to parents and the public via widespread discussions in the media and elsewhere and involving Deaf people in the implantation counseling process is an issue that needs to be addressed by those responsible for implantation programs.     

Ethics, deafness, and new medical technologies

In the last 50 years, several new technologies have become enormously important within the Deaf community and have helped significantly to improve deaf people's lives in a hearing world. Current public attention and admiration, however, seems unduly focused on medical technologies that promise to solve "the problem" of being deaf. One reason for this interest, we argue, is the public's preoccupation with deafness as a disability and promises that technological breakthroughs such as the cochlear implant will "cure" deafness. Pressure on parents to make quick and early decisions and lack of adequate information about alternatives often leave them unprepared for the consequences of these decisions. To allow deaf individuals and their families to make better informed decisions about their lives and their futures, we argue finally that professionals who interact with these families adopt inclusive and individualizing ethics.     

A comparison of the anticipated benefits and received outcomes of pediatric cochlear implantation: parental perspectives

Findings of a study that investigated parents' expectations and experiences of their children's outcomes with cochlear implants are presented. A survey completed by 247 parents whose children had received implants in eastern Australia compared parents' reports of their preimplant expectations with their experiences of postimplant outcomes on several items related to communication, academic, and psychosocial domains. Quantitative findings derived from the survey data were extended and elaborated on by qualitative findings from interviews with 27 of the parents. The findings indicated that parents' relatively high expectations of their children's outcomes largely had been met, although a tenth of survey respondents reported that their expectations had not been met. It appeared that professionals generally provided parents with realistic expectations. The qualitative findings revealed a complex interaction among parents' expectations, hopes, and determination that their children would do well with the implant. Implications for professionals are discussed.     

Cochlear implants for younger children: a preliminary description of the parental decision process and outcomes

The authors conducted a preliminary telephone interview study of a random sample of 35 parents whose children had received cochlear implants through a large-scale implant program. Parents were asked about their child's preimplant and postimplant communications skills, how they learned about implants, and how they arrived at the decision to have their child receive an implant. Results of the interviews suggest, a least for this program, that two types of decision sequences are followed. One type of parent has initial and primary contact through a medical practitioner, uses that source of information exclusively, and is motivated by a desire for a "normal" communication situation. The second type of parent learns about implants from another parent, family member, or teacher. This individual will seek other sources of information and is most often motivated by the child's lack of communication skill. Generally, from parents' perspective, language and speech rather than improved social skills or social contact are the primary benefits of the implant.     

Spelling of Deaf Children Who Use Cochlear Implants

The spellings of 39 profoundly deaf users of cochlear implants, aged 6 to 12 years, were compared with those of 39 hearing peers. When controlled for age and reading ability, the error rates of the 2 groups were not significantly different. Both groups evinced phonological spelling strategies, performing better on words with more typical sound–spelling correspondences and often making misspellings that were phonologically plausible. However, the magnitude of these phonological effects was smaller for the deaf children than for hearing children of comparable reading and spelling ability. Deaf children with cochlear implants made the same low proportion of transposition errors as hearing children. The findings indicate that deaf children do not rely primarily on visual memorization strategies, as suggested by previous studies. However, deaf children with cochlear implants use phonological spelling strategies to a lesser degree than hearing peers.     

Cochlear implanted pupils in Scottish schools: 4-year school attainment data (2000-2004)

The Achievements of Deaf Pupils in Scotland (ADPS) project has been tracking the educational attainment of deaf pupils in Scotland's schools since 2000. At the time of writing, the database contains records for 1,752 deaf pupils (2000-2005). Here 4-year aggregate educational attainment data are reported for a subset of 152 school-aged deaf pupils with cochlear implants notified to the ADPS database between June 2000 and June 2004. The data describe primary and secondary school results in reading, writing, and math for this subgroup, as well as placement and communication characteristics. The educational attainment of the group of deaf pupils with cochlear implants is clearly marked when the deaf pupil population is disaggregated for hearing loss, achieving comparatively higher average attainment in both 5-14 Curriculum National Tests (Mathematics in particular) and Standard Grades. Therefore the gap in performance relative to the national population data is reduced for those deaf pupils, although it still widens at higher levels of achievement for the National Tests. Although most pupils with cochlear implants are placed in the mainstream, there is no pattern of migration toward mainstream schools. Some deaf pupils with cochlear implants moved out of mainstream to other types of placement, and this has implications for health-economic cost-utility assessments of cochlear implantation that favor mainstream education by drawing upon the relative cost of different placement types. These findings suggest that the ADPS program of research can contribute school outcome data as valuable real-life outcome measures in wider assessments of the benefit of cochlear implants to deaf children and deaf young people.     

Reading comprehension of deaf children with cochlear implants

The reading comprehension and visual word recognition in 50 deaf children and adolescents with at least 3 years of cochlear implant (CI) use were evaluated. Their skills were contrasted with reference data of 500 deaf children without CIs. The reading comprehension level in children with CIs was expected to surpass that in deaf children without implants, partly via improved visual word recognition. Reading comprehension scores of children with implants were significantly better than those of deaf children without implants, although the performance in implant users was substantially lagging behind that in hearing children. Visual word recognition was better in children with CIs than in children without implants, in secondary education only. No difference in visual word recognition was found between the children with CIs and the hearing children, whereas the deaf children without implants showed a slightly poorer performance. The difference in reading comprehension performance of the deaf children with and without CIs remained present when visual word recognition was controlled for. This indicates that other reading-related skills were also contributing to the improved reading comprehension skills of deaf children with CIs.     

Word-learning abilities in deaf and hard-of-hearing preschoolers: effect of lexicon size and language modality

Deaf and hard-of-hearing (DHH) children's ability to rapidly learn novel words through direct reference and through novel mapping (i.e., inferring that a novel word refers to a novel object) was examined. Ninety-eight DHH children, ranging from 27 to 82 months old, drawn from 12 schools in five states participated. In two tasks that differed in how reference was established, word-learning abilities were measured by children's ability to learn novel words after only three exposures. Three levels of word-learning abilities were identified. Twelve children did not rapidly learn novel words. Thirty-six children learned novel words rapidly but only in the direct reference task. Forty-nine children learned novel words rapidly in both direct reference and novel mapping tasks. These levels of word-learning abilities were evident in children who were in oral-only and in signing environments, in children with cochlear implants, and in deaf children of deaf parents. Children's word-learning abilities were more strongly correlated to lexicon size than age, and this relation was similar for children in these different language-learning environments. Acquisition of these word-learning abilities seems based on linguistic mechanisms that are available to children in a wide range of linguistic environments. In addition, the word-learning tasks offer a promising dynamic assessment tool.     

Peer relationships of children with cochlear implants

Previous research on children with cochlear implants has focused mostly on their speech perception and production. With the growing numbers of children who use the implant, it is important to assess other aspects of these children's functioning. This article offers a qualitative and quantitative analysis of interviews with parents who described their children's communication skills and peer relationships before they had the implant and afterward. Results show that the implant has the potential to improve deaf children's relationships with hearing peers. Nonetheless, children with implants still face communication obstacles, which impede their social relationships with hearing peers. Results are discussed in light of the different points of view of various "stake holders" regarding cochlear implants in children.     

Family supports and resources for parents of children who are deaf or hard of hearing

The study examined family supports after identification of children's hearing loss. On a questionnaire, 456 respondents rated the importance of different aspects of family support, the quality of supports they experienced, and their preferences about informational resources. They verified the importance of informational resources, social-emotional support, and educational advocacy. Families expressed a preference for discussion with other parents of children with hearing loss over discussion with parents of children without hearing loss. The quality of support was rated higher by parents of children with cochlear implants than by parents of children with hearing aids. Top-ranked sources of support included individual professionals and service providers, other parents of children with hearing loss, family support organizations, and grandparents and extended-family members. Open-ended written responses indicated that parents desired additional opportunities to connect with mentors, role models, and other parents.     

Executive function and language in deaf children

The relationship between language and executive function (EF) and their development in children have been the focus of recent debate and are of theoretical and clinical importance. Exploration of these functions in children with a peripheral hearing loss has the potential to be informative from both perspectives. This study compared the EF and language skills of 8- to 12-year-old children with cochlear implants (n = 22) and nonimplanted deaf children (n = 25) with those of age-matched hearing controls (n = 22). Implanted and nonimplanted deaf children performed below the level of hearing children on tests assessing oral receptive language, as well as on a number of EF tests, but no significant differences emerged between the implanted and nonimplanted deaf groups. Language ability was significantly positively associated with EF in both hearing and deaf children. Possible interpretations of these findings are suggested and the theoretical and clinical implications considered.