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.     

Teachers' ratings of functional communication in students with cochlear implants

The study examined factors associated with teachers' ratings of functional communication skills of students with cochlear implants. Deaf students living in and around a metropolitan area were surveyed to locate 51 with cochlear implants. Teachers rated each student's functional use of the implant, given three defined ratings. Additional information regarding sex, communication option, placement, home language, rural or nonrural address, etiology, and presence or absence of an additional disability was gathered. Chi-square analyses of the data were performed. The data indicated that students with a known etiology and a rural address, and who used sign language at home or school, were less likely than others to use the implant as a primary channel for receptive communication. The authors suggest that the teacher's role in implant use warrants more attention. Speech-language pathologists, otologists, audiologists, and parents of deaf children should consider all factors related to successful implant use before advocating or choosing this financially, emotionally, and therapeutically challenging option.     

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.     

The modes of communication used by children with cochlear implants and the role of sign in their lives

In a mixed-methods study, which included surveys of 247 parents and 151 teachers, the researchers investigated the modes of communication used by children with cochlear implants and the role of signed communication in the children's lives. Findings indicated that 15%-20% of the children in the parent surveys and approximately 30% of the children in the teacher surveys were using some form of signed communication. Qualitative findings from interviews with parents, teachers, and children with cochlear implants elaborated on the quantitative findings. While the development of spoken-language communication was the main aim of their children's cochlear implantation for the large majority of parents, many valued the use of either Signed English or Australian Sign Language, which they felt supported their children's personal, social, and academic development. Young people who used sign switched comfortably between communication modes according to their communication partners, topics, and settings.     

Audiological and medical considerations for children with cochlear implants.

Recent advancements in technology have resulted in the development of implantable devices--cochlear implants--designed to maximize the sensation of hearing in the hearing-impaired population. For children who meet the numerous preselection criteria, the cochlear implant can be effective and beneficial. The implants must be inserted surgically, which involves placing an electrode array in the cochlea and attaching the receiver/stimulator to the skull. The child can usually be discharged from the hospital by the third postoperative day. The external device is fitted and initially stimulated about four to six weeks after surgery. During initial stimulation, all 22 electrodes are individually adjusted, or mapped. The electrodes are readjusted and remapped at frequent intervals during the initial months following stimulation. These follow-up visits also allow the audiologist to evaluate the child's progress in the home and educational environments.     

Theory of mind and language in children with cochlear implants

Thirty children with cochlear implants (CI children), age range 3-12 years, and 30 children with normal hearing (NH children), age range 4-6 years, were tested on theory of mind and language measures. The CI children showed little to no delay on either theory of mind, relative to the NH children, or spoken language, relative to hearing norms. The CI children showed a slightly atypical sequence of acquisition of theory of mind concepts. The CI children's theory of mind performance was associated with general syntactic proficiency more than measures of complement syntax, and with time since implantation more than age at implantation. Results suggest that cochlear implantation can benefit spoken language ability, which may then benefit theory of mind, perhaps by increasing access to mental state language.     

Motor development of deaf children with and without cochlear implants

The purpose of this study was to investigate the impact of a cochlear implant (CI) on the motor development of deaf children. The study involved 36 mainstreamed deaf children (15 boys, 21 girls; 4- to 12-years old) without any developmental problems. Of these children, 20 had been implanted. Forty-three hearing children constituted a comparison group. Motor development was assessed by three standardized tests: the Movement Assessment Battery for Children, the K?rperkoordinationstest für Kinder, and the One-leg standing test. Results showed that the hearing children performed on average significantly better than the deaf children (whether or not using a CI). Regarding the use of a CI, there was only a significant difference on one subtest between both groups, although there was a nonsignificant trend for the deaf +CI group to score somewhat worse on average than the deaf -CI group. This led to some significant differences between the hearing group and the deaf +CI group on measures requiring balance that did not hold for the hearing/deaf -CI comparison. Although this study could demonstrate neither a positive nor a negative impact of CI on balance and motor skills, the data raise the need for further, preferably longitudinal, research.     

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.     

Perception of suprasegmental features of speech by children with cochlear implants and children with hearing AIDS

This study assessed perception of suprasegmental features of speech by 30 prelingual children with sensorineural hearing loss. Ten children had cochlear implants (CIs), and 20 children wore hearing aids (HA): 10 with severe hearing loss and 10 with profound hearing loss. Perception of intonation, syllable stress, word emphasis, and word pattern was assessed. Results revealed that the two HA groups significantly outperformed the CI group in perceiving both intonation and stress. Within each group, word pattern was perceived best, and then intonation and emphasis, with syllable stress perceived poorest. No significant correlation emerged between age at implantation and perception of the various suprasegmental features, possibly due to participants' relatively late age at implantation. Results indicated that CI use did not show an advantage over HA use in the perception of suprasegmental features of speech. Future research should continue to explore variables that might improve this perception.     

Long-term predictors of narrative skill in children with early bilateral cochlear implants

Narratives require the integration of many different linguistic skills and can be used as an ecologically valid measure of child language development. This study investigated the narrative skills of 18 six- to seven-year-old prelingually deaf children who received simultaneous bilateral cochlear implants (CI) between 5 and 18 months of age. No significant differences were found on any of the narrative measures between this group and a matched group of normal-hearing children. Measures taken of the children at 3, 6, 9, 12, 24, 36 and 48 months post-implantation, and measures from their parents were examined as possible predictors of narrative skills 72 months post-implantation. Child auditory skills, expressive language and receptive language were significant predictors of later narrative skills. A greater use of auditory-verbal language relative to visually supported language by parents and educators was associated with increased language complexity in child narratives. These results strongly suggest that early bilateral CI is associated with improved language outcomes for children with severe congenital hearing loss.     

Reading and reading-related skills in children using cochlear implants: prospects for the influence of cued speech

We assessed the reading and reading-related skills (phonemic awareness and phonological short-term memory) of deaf children fitted with cochlear implants (CI), either exposed to cued speech early (before 2 years old) (CS+) or never (CS-). Their performance was compared to that of 2 hearing control groups, 1 matched for reading level (RL), and 1 matched for chronological age (CA). Phonemic awareness and phonological short-term memory were assessed respectively through a phonemic similarity judgment task and through a word span task measuring phonological similarity effects. To assess the use of sublexical and lexical reading procedures, children read pseudowords and irregular words aloud. Results showed that cued speech improved performance on both the phonemic awareness and the reading tasks but not on the phonological short-term memory task. In phonemic awareness and reading, CS+ children obtained accuracy and rapidity scores similar to CA controls, whereas CS- children obtained lower scores than hearing controls. Nevertheless, in phonological short-term memory task, the phonological similarity effect of both CI groups was similar. Overall, these results support the use of cued speech to improve phonemic awareness and reading skills in CI children.     

Evaluating phonological processing skills in children with prelingual deafness who use cochlear implants

This study investigated the phonological processing skills of 29 children with prelingual, profound hearing loss with 4 years of cochlear implant experience. Results were group matched with regard to word-reading ability and mother's educational level with the performance of 29 hearing children. Results revealed that it is possible to obtain a valid measure of phonological processing (PP) skills in children using CIs. They could complete rhyming tasks and were able to complete sound-based tasks using standard test materials provided by a commercial test distributor. The CI children completed tasks measuring PP, but there were performance differences between the CI users and the hearing children. The process of learning phonological awareness (PA) for the children with CIs was characterized by a longer, more protracted learning phase than their counterparts with hearing. Tests of phonological memory skills indicated that when the tasks were controlled for presentation method and response modality, there were no differences between the performance of children with CIs and their counterparts with hearing. Tests of rapid naming revealed that there were no differences between rapid letter and number naming between the two groups. Results yielded a possible PP test battery for children with CI experience.     

Effects of cochlear implants on children's reading and academic achievement

This article presents a critical analysis of empirical studies assessing literacy and other domains of academic achievement among children with cochlear implants. A variety of recent studies have demonstrated benefits to hearing, language, and speech from implants, leading to assumptions that early implantation and longer periods of implant should be associated with higher reading and academic achievement. This review, however, reveals that although there are clear benefits of cochlear implantation to achievement in young deaf children, empirical results have been somewhat variable. Examination of the literature with regard to reading achievement suggests that the lack of consistent findings might be the result of frequent failures to control potentially confounding variables such as age of implantation, language skills prior to implantation, reading ability prior to implantation, and consistency of implant use. Studies of academic achievement beyond reading are relatively rare, and the extent to which performance in such domains is mediated by reading abilities or directly influenced by hearing, language, and speech remains unclear. Considerations of methodological shortcomings in existing research as well as theoretical and practical questions yet to be addressed provide direction for future research.     

Phonological awareness, reading skills, and vocabulary knowledge in children who use cochlear implants

In hearing children, reading skills have been found to be closely related to phonological awareness. We used several standardized tests to investigate the reading and phonological awareness skills of 27 deaf school-age children who were experienced cochlear implant users. Approximately two-thirds of the children performed at or above the level of their hearing peers on the phonological awareness and reading tasks. Reading scores were found to be strongly correlated with measures of phonological awareness. These correlations remained the same when we statistically controlled for potentially confounding demographic variables such as age at testing and speech perception skills. However, these correlations decreased even after we statistically controlled for vocabulary size. This finding suggests that lexicon size is a mediating factor in the relationship between the children's phonological awareness and reading skills, a finding that has also been reported for typically developing hearing children.     

Literacy skills in children with cochlear implants: the importance of early oral language and joint storybook reading

The goal of this study was to longitudinally examine relationships between early factors (child and mother) that may influence children's phonological awareness and reading skills 3 years later in a group of young children with cochlear implants (N = 16). Mothers and children were videotaped during two storybook interactions, and children's oral language skills were assessed using the "Reynell Developmental Language Scales, third edition." Three years later, phonological awareness, reading skills, and language skills were assessed using the "Phonological Awareness Test," the "Woodcock-Johnson-III Diagnostic Reading Battery," and the "Oral Written Language Scales." Variables included in the data analyses were child (age, age at implant, and language skills) and mother factors (facilitative language techniques) and children's phonological awareness and reading standard scores. Results indicate that children's early expressive oral language skills and mothers' use of a higher level facilitative language technique (open-ended question) during storybook reading, although related, each contributed uniquely to children's literacy skills. Individual analyses revealed that the children with expressive standard scores below 70 at Time 1 also performed below average (<85) on phonological awareness and total reading tasks 3 years later. Guidelines for professionals are provided to support literacy skills in young children with cochlear implants.     

Neuropsychological correlates of vocabulary, reading, and working memory in deaf children with cochlear implants

The performance of deaf children with cochlear implants was assessed using measures standardized on hearing children. To investigate nonverbal cognitive and sensorimotor processes associated with postimplant variability, five selected sensorimotor and visuospatial subtests from A Developmental Neuropsychological Assessment (NEPSY) were compared with standardized vocabulary, reading, and digit span measures. Participants were 26 deaf children, ages 6-14 years, who received a cochlear implant between ages 1 and 6 years; duration of implant use ranged from 3 to 11 years. Results indicated significant correlations between standard scores on the Design Copying subtest of the NEPSY and standard scores on vocabulary comprehension, reading, and digit span measures. The results contribute to our understanding of the benefits of cochlear implantation and cognitive processes that may support postimplant language and academic functioning.     

Parents' views on changing communication after cochlear implantation

We sent questionnaires to families of all 288 children who had received cochlear implants at one center in the United Kingdom at least 5 years previously. Thus, it was a large, unselected group. We received 142 replies and 119 indicated that the child and family had changed their communication approach following cochlear implantation. In 113 cases the change was toward spoken language and in 6 cases the change was toward signed communication. Parents were asked to respond to statements about communication with their deaf child, and their responses indicated that parents wanted the most effective means of communication and one that their child would find most useful in the future. Findings that emerged from parents' comments indicated that the change toward greater use of spoken language was child-led and driven by increased audition. Parents also valued the contribution of signed communication.     

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.