Education and rehabilitation of deaf children with cochlear implants: a multidisciplinary task

In the last decade the population of deaf children has changed dramatically in a lot of countries, especially in those where universal neonatal hearing screening, early multi-disciplinary support, digital hearing aids and cochlear implants are available. Most of these children can acquire intelligible spoken language and choose spoken language as their main means of communication and for access to education, because they go to mainstream schools in larger proportions, and fewer to schools for the deaf. Mainstream placement does not eliminate the need for services, which will vary depending upon the child's age, language modality, and other child specific factors. But there is also evidence that the outcomes after paediatric implantation are very heterogeneous. All this is a big change for the educational services. We must ensure that their staff have the skills to meet these challenges: to be flexible, continually updated with the technology and changing expectations (ongoing professional training), to provide an environment which will utilise the hearing while meeting the linguistic and curricular needs of the children, to meet the psycho-social needs of this group as they grow through adolescence, and to work with other professionals. Now, and looking ahead, the challenge for deaf education is also to embrace the diversity of this population and to appropriately address the specific needs of each child.     

Age differences in the use of informative/heuristic communicative functions in young children with and without hearing loss who are learning spoken language.

Previous research has suggested that the normal development of communicative functions proceeds from the directing or "instrumental" types to the informative or "heuristic" types with age. This paper describes a cross-sectional study of communicative function in children with profound hearing loss and children with normal hearing, from ages 12-54 months. The children with hearing loss were learning spoken English as their primary means of communication. The primary purpose of the study was to evaluate whether the pattern of age differences seen in the two groups of children (those with and without normal hearing) are similar patterns that occur at differing chronological ages, or whether they are dissimilar patterns altogether. A second purpose was to examine the relationship between the use of informative/heuristic functions and the acquisition of vocabulary and syntax. The data suggested a somewhat different pattern of communicative function development in children with and without hearing loss. In addition, the use of language for social purposes was closely related to the achievement of traditional language milestones. In both normally hearing children and in those with hearing loss, the correlations between the use of informative-heuristic functions and various measures of language development indicated that the more mature uses of language co-occur with increased frequency of communication, larger vocabulary, and longer utterance length. These results document that when linguistic improvements such as increasing vocabulary size and sentence length occur in deaf children learning spoken English, they are used for appropriate and informative social purposes that are commensurate with their language age.     

Creative language abilities of deaf children

The language flexibility and creativity of deaf children was investigated by having four deaf and four hearing 12-15-year-olds generate stories to experimenter-supplied themes. These were videotaped and examined for instances of nonliteral communication. Contrary to previous claims that deaf children are extremely rigid and literal in their language use, subjects here showed considerable use of creative language devices when evaluated in sign rather than vocal language. Deaf students produced traditional types of figurative contructions at a rate equal to their hearing age-mates and surpassed them in four other categories of nonliteral expression. These findings are discussed in terms of the cognitive skills required for and reflected by figurative language use and common assumptions concerning deaf children's related abilities.     

Effects of parental deafness and early exposure to manual communication on the cognitive skills, English language skill, and field independence of young deaf adults

Congenitally deaf college students with deaf parents who were native ASL signers (the ASL group) were compared to congenitally deaf college students who learned to sign between the ages of 6 and 12 years and who had hearing parents (the Delayed sign language group) on tests of cognitive skills, the cognitive style of field independence/dependence, and English language presented and produced through spoken, written, and sign modes. A control group of hearing college students was also included in the study. Differential effects of parental deafness and early exposure to manual communication, generally reported for deaf children, were not observed in the cognitive and communication performance of the experimental subjects. Furthermore, the Delayed sign language group performed significantly better than the ASL group on tests of speech perception and speech intelligibility. No differences on tests on cognitive skills were observed between the deaf and hearing subjects or between males and females. However, deaf females in both groups were more field dependent than deaf males and hearing females, while deaf males did not differ from hearing males. A test of speech reception skill was the only predictor of field independence for the ASL group while a test of cognitive skills was the only predictor of field independence for the other two groups.     

Deaf children's expression of communicative intentions

This study investigated the expression of communicative intentions by 3-year-old hearing-impaired children who were learning a system for manually coded English. Children were videotaped in their homes, interacting with their mothers. Children's communicative expressions were identified and coded according to a system modified from those developed to describe hearing children's pragmatic functioning. Between 4.5 and 5.5 communicative expressions were produced per minute. A large proportion of the expressions consisted of social or imperative intentions while a much smaller proportion were used for heuristic or informational purposes. Implications for the deaf children's future language use and development are discussed. The data presented provide some guidelines for pragmatic expectations for young deaf children and may help clinicians to identify deaf children who have developmental problems in addition to their hearing loss.     

Sign language iconicity and its influence on the ability to describe the function of objects

We examined the influence of sign language iconicity on children’s ability to describe the function of objects. Forty-eight hearing preschoolers were divided into three groups and asked to describe the function of 15 high and 15 low iconic signs. We questioned the Hearing/Verbal (H/V) group verbally, Hearing/Verbal+Sign (H/V+S) group verbally with objects simultaneously signed, and the Hearing/Sign (H/S) group with objects signed without voice. Ten deaf children (D/S) were also tested using sign language. H/S and D/S performed significantly better on high than low iconic items. Nine signs were sufficiently iconic to aid function identification by sign naïve hearing children. Results suggest that certain highly iconic signs may contribute to performance on tests administered in sign language.

Learning outcomes

The reader will learn about sign language iconicity and its influence on the ability of hearing and deaf children to perform on object function questions.     

Effects of parental style of interaction on language development in very young severe and profound deaf children

AIMS: (1) To study the influence of different styles of parent-child interaction in the language development of very young deaf children. (2) To find out if there are differences in parent-child interaction between two groups of very young deaf children following an Aural/Oral or a Bilingual approach to education. METHODS: Subjects were selected from all deaf children in the County of Avon who were under 3 years of age at the time of first assessment, had severe or profound, bilateral, sensorineural hearing loss and no associated medical problems. There were 16 children and families at the start of the project but only 13 completed all the assessments. The Bristol Language Developmental Scales (BLADES) was used to assess both sign and spoken language development. Interaction was studied through analysis of contingency and book-reading applied to selected periods of 3 min from four videorecorded sessions, taken at 3 months intervals for a period of 1 year. RESULTS: From the 13 children studied, only seven presented with some degree of expressive language measurable by the BLADES. Analysis of contingency showed that parents present with higher percentage of both Direct Related Acts and ON then their children Acts (On Acts: where both individuals are involved in the same task). Regarding bookreading, it was observed that parents often attend to child initiatives and acknowledge most of them but they make little effort to expand or use the child's message as topic for further conversation. In the reduced sample of seven children with expressive language, those with better language development had parents with: (a) higher percentage of DR acts; (b) higher percentage of ON acts; (c) higher percentage of appropriate responses to child communicative initiatives. CONCLUSIONS: In this small group language development seems to be facilitated by encouraging child participation and using a more contingent and child centred interaction. No significant differences were found between oral and bilingual families in terms of quality of interaction.     

Prelinguistic communication and subsequent language acquisition in children with cochlear implants

OBJECTIVE: To investigate the relationship between prelinguistic communication behaviors and subsequent language development after cochlear implantation in deaf children. Evaluative tools with predictive validity for language potential in very young deaf children remain elusive. SETTING: A tertiary care cochlear implant center and a preschool setting of spoken language immersion in which oral language development is emphasized through auditory and oral motor subskill practice. SUBJECTS: Eighteen prelingually deaf children who underwent unilateral implantation at an average age of 15 months also underwent testing with the Communication and Symbolic Behavior Scales (CSBS) before device activation and with the Reynell Developmental Language Scales (RDLS) at an average of 20 months after cochlear implantation. METHODS: A prospective study correlated preoperative communication behavior assessments of 18 children who were candidates for cochlear implantation. We examined the value of prelinguistic behavioral testing with the CSBS in predicting later language level after cochlear implantation as reflected in RDLS scores. RESULTS: We found positive, though weak, correlations between prelinguistic communication skills (CSBS scores) and language learning after cochlear implantation (RDLS scores). Linear correlation between test results failed to reach statistical significance (receptive comparisons, P =.17; expressive comparisons, P =.13). CONCLUSIONS: Evaluating the quality of prelinguistic communication behaviors potentially adds important predictive information to profiles of children who are candidates for cochlear implantation. Correlative analysis suggests that early CSBS testing may provide useful clinical information. Poor CSBS scores may serve as a precaution: if children lack an appropriate prelinguistic behavioral repertoire, the emergence of age-appropriate formal language may be at risk. Observations suggest that symbolic prelinguistic behaviors are necessary, but not sufficient, for the development of strong linguistic skills. The variability of behavioral measures in very young deaf children poses challenges in designing objective measures with predictive value for later language level.     

Factors that affect the social well-being of children with cochlear implants

The aim of the study was to identify factors associated with the level of social well-being for cochlear implanted children and to estimate effect-related odds ratios for the children's well-being. Another aim was to analyse associations between speech and language level and the level of social well-being. Data relate to 167 children with cochlear implants. In structural interviews, parents rated their children's level of social well-being regarding the degree of their child's personal-social adjustment. Five different factors were considered. Logistic regression models and proportional odds models were used to analyse the relationship between the considered factors and the assessments. The analyses showed that the communication mode at home was the most highly associated factor. A statistically significant association was found between the level of social well-being and speech understanding, speech production and vocabulary. Children who were exposed to a spoken language had considerably better odds of having a high level of social well-being compared to children with a mixture of spoken language and sign support or sign language.     

Multisign combinations by children with intellectual impairments: an analysis of language skills.

Research suggests that people with intellectual impairments who use manual signs to augment or substitute for speech rarely progress beyond the stage of single signs and that word order is particularly problematic. However, the majority of studies have focused on experimental tasks, and relatively little is known about spontaneous sign production in naturalistic settings. The present study explored the linguistic development in sign and speech of 10 children who relied on manual signs (the Makaton vocabulary) as their main means of communication. Mean utterance length in sign ranged from 1.0 to 2.5, and analysis of semantic relations, lexical development, and word order suggested that the children had not developed their language beyond MLU Stage I. Examination of their abilities within the modality of sign indicated that some children were able to manipulate features of sign at a sublexical level. The results are discussed in relation to the language input by teachers, and inferences are drawn regarding the underlying modality of linguistic representation in children who use manual signs.     

Pragmatic and semantic development in young children with impaired hearing

The purpose of the study was to characterize the early pragmatic-semantic communicative development of young hearing-impaired children learning spoken English as a first language. Twelve children with impaired hearing, ranging in age from 22 months to 60 months, were videotaped. Approximately 13 hours of videotaped data from four different communicative settings were analyzed. The pragmatic and semantic categories used by these children varied across age groups. Results are discussed with regard to age, expressive modality, mean length of utterance (MLU), and hearing loss. There was much variation among these parameters in communicative development across children.     

The effects of early manual instruction on the oral language development of two deaf children]

The speech and language training for deaf children at our clinic is performed using a multisensory method, which consists of reception and expression training for sign language and fingerspelling as well as auditory training, lip reading, and written language training (the Kanazawa Method). We have already reported that acquisition of written language is not dependent on oral language, and that written language is easier to learn than oral language for deaf children. In the present investigation, we analyzed the acquisition of comprehensible and expressive vocabulary in sign language and fingerspelling. The subjects were two children congenitally deaf at levels higher than 105dB. Recorded language samples by the age of 48 months were analyzed. Acquisition of sign language was found to be significantly easier than acquisition of oral language. The development of expressive noun words, function words, and Wh-question words in sign language at the early period was almost equivalent to that of hearing peers, and then the sign language appeared transfer to the oral language. These results suggest that early presentation of sign language with written and oral language is effective in the acquisition of communicative attitudes, function words and interrogative sentences which are most difficult for the hearing-impaired. It was shown that early presentation of sign language with written and oral language serves to promote acquisition of oral language.     

Parental perceptions of children's communicative development at stuttering onset.

There has been clinical speculation that parents of young stuttering children have expectations of their children's communication abilities that are not well-matched to the children's actual skills. We appraised the language abilities of 15 children close to the onset of stuttering symptoms and 15 age-, sex-, and SES-matched fluent children using an array of standardized tests and spontaneous language sample measures. Parents concurrently completed two parent-report measures of the children's communicative development. Results indicated generally depressed performance on all child speech and language measures by the children who stutter. Parent report was closely attuned to child performance for the stuttering children; parents of nonstuttering children were less accurate in their predictions of children's communicative performance. Implications for clinical advisement to parents of stuttering children are discussed.     

A method to break the cognitive barrier between a deaf child and a hearing parent

A deaf child actively uses about 1000 concepts in common with the hearing world. The rest of his up to 10,000 concepts belong to sign language and cannot be accurately translated into written language. This makes it difficult for the deaf to understand a normal written text, especially its abstractions. We have developed a new communication system in order to break the barrier between the hearing and the deaf. In this system a deaf child speaks with a writing hand-piece terminal through an FM route to a small unlimited text-to-speech synthesizer carried by the parent. The parent answers similarly to a 48-grapheme alphanumerical display carried by the child on a rack in front of him. The parent's unit with a speech synthesizer weighs about 2 kg and its size is about 7 X 20 X 25 cm; the size of the child's unit is one half of that and it weighs, with the display, 2 kg. Even a 4-year-old child carries the apparatus easily; nevertheless a still lighter unit is under construction. The system takes the learning process to everyday situations and makes it possible for a deaf child to converse in the normal written and spoken language. Thus, his concept capacity in the spoken language can be increased.     

Semantic categorization: A comparison between deaf and hearing children

Learning to read is a major obstacle for children who are deaf. The otherwise significant role of phonology is often limited as a result of hearing loss. However, semantic knowledge may facilitate reading comprehension. One important aspect of semantic knowledge concerns semantic categorization. In the present study, the quality of the semantic categorization of both deaf and hearing children was examined for written words and pictures at two categorization levels. The deaf children performed better at the picture condition compared to the written word condition, while the hearing children performed similarly at pictures and written words. The hearing children outperformed the deaf children, in particular for written words. In addition, the results of the deaf children for the written words correlated to their sign vocabulary and sign language comprehension. The increase in semantic categorization was limited across elementary school grade levels.Learning outcomes: Readers will be able to: (1) understand several semantic categorization differences between groups of deaf and hearing children; (2) describe factors that may affect the development of semantic categorization, in particular the relationship between sign language skills and semantic categorization for deaf children.     

Use of audiovisual information in speech perception by prelingually deaf children with cochlear implants: a first report.

OBJECTIVE: Although there has been a great deal of recent empirical work and new theoretical interest in audiovisual speech perception in both normal-hearing and hearing-impaired adults, relatively little is known about the development of these abilities and skills in deaf children with cochlear implants. This study examined how prelingually deafened children combine visual information available in the talker's face with auditory speech cues provided by their cochlear implants to enhance spoken language comprehension. DESIGN: Twenty-seven hearing-impaired children who use cochlear implants identified spoken sentences presented under auditory-alone and audiovisual conditions. Five additional measures of spoken word recognition performance were used to assess auditory-alone speech perception skills. A measure of speech intelligibility was also obtained to assess the speech production abilities of these children. RESULTS: A measure of audiovisual gain, "Ra," was computed using sentence recognition scores in auditory-alone and audiovisual conditions. Another measure of audiovisual gain, "Rv," was computed using scores in visual-alone and audiovisual conditions. The results indicated that children who were better at recognizing isolated spoken words through listening alone were also better at combining the complementary sensory information about speech articulation available under audiovisual stimulation. In addition, we found that children who received more benefit from audiovisual presentation also produced more intelligible speech, suggesting a close link between speech perception and production and a common underlying linguistic basis for audiovisual enhancement effects. Finally, an examination of the distribution of children enrolled in Oral Communication (OC) and Total Communication (TC) indicated that OC children tended to score higher on measures of audiovisual gain, spoken word recognition, and speech intelligibility. CONCLUSIONS: The relationships observed between auditory-alone speech perception, audiovisual benefit, and speech intelligibility indicate that these abilities are not based on independent language skills, but instead reflect a common source of linguistic knowledge, used in both perception and production, that is based on the dynamic, articulatory motions of the vocal tract. The effects of communication mode demonstrate the important contribution of early sensory experience to perceptual development, specifically, language acquisition and the use of phonological processing skills. Intervention and treatment programs that aim to increase receptive and productive spoken language skills, therefore, may wish to emphasize the inherent cross-correlations that exist between auditory and visual sources of information in speech perception.     

Neurolinguistic development in deaf children: the effect of early language experience

Recent investigations have indicated a relationship between the development of cerebral lateralization for processing language and the level of development of linguistic skills in hearing children. The research on cerebral lateralization for language processing in deaf persons is compatible with this view. We have argued that the absence of appropriate input during a critical time window creates a risk for deaf children that the initial bias for left-hemisphere specialization will be distorted or disappear. Two experiments were conducted to test this hypothesis The results of these investigations showed that children educated early and intensively with cued speech or with sign language display more evidence of left-hemisphere specialization for the processing of their native language than do those who have been exposed later and less intensively to those languages.     

Brain metabolism of children with profound deafness: a visual language activation study by 18F-fluorodeoxyglucose positron emission tomography

CONCLUSION: The use of fluorodeoxyglucose positron emission tomography (FDG-PET) with a visual language task provided objective information on the development and plasticity of cortical language networks. This approach could help individuals involved in the habilitation and education of prelingually deafened children to decide upon the appropriate mode of communication. OBJECTIVES: To investigate the cortical processing of the visual component of language and the effect of deafness upon this activity. SUBJECTS AND METHODS: Six prelingually deafened children participated in this study. The subjects were numbered 1-6 in the order of their spoken communication skills. In the time period between an intravenous injection of 370 MBq 18F-FDG and PET scanning of the brain, each subject was instructed to watch a video of the face of a speaking person. The cortical radioactivity of each deaf child was compared with that of a group of normal- hearing adults using a t test in a basic SPM2 model. RESULTS: The widest bilaterally activated cortical area was detected in subject 1, who was the worst user of spoken language. By contrast, there was no significant difference between subject 6, who was the best user of spoken language with a hearing aid, and the normal hearing group.     

Autism spectrum disorders in 24 children who are deaf or hard of hearing

Objectives

Approximately 4% of children who are deaf or hard of hearing have co-occurring autism spectrum disorder (ASD). Making an additional diagnosis of ASD in this population can be challenging, given the complexities of determining whether speech/language and social delays can be accounted for by their hearing loss, or whether these delays might be indicative of a comorbid ASD diagnosis. This exploratory study described a population of 24 children with the dual diagnosis of ASD and hearing loss.

Methods

Children completed a comprehensive ASD evaluation using standardized autism diagnostic instruments (Autism Diagnostic Observation Schedule, language and psychological testing). Children with permanent hearing loss who had a developmental evaluation between 2001 and 2011 and were diagnosed with an ASD based on the results of that evaluation were included. Information on communication modality, language and cognitive abilities was collected.

Results

The median age of diagnosis was 14 months (range 1–71) for hearing loss and 66.5 months (range 33–106) for ASD. Only 25% (n = 6) children were diagnosed with ASD ≤48 months of age and 46% by ≤6 years. Twelve (50%) children were diagnosed with ASD, 11 were diagnosed with pervasive developmental disorder not otherwise specified and 1 child had Asperger's. Most (67%) had profound degree of hearing loss. Fourteen (58%) children had received a cochlear implant, while 3 children had no amplification for hearing loss. Nine (38%) of the 24 children used speech as their mode of communication (oral communicators).

Conclusions

Communication delays in children who are deaf or hard of hearing are a serious matter and should not be assumed to be a direct consequence of the hearing loss. Children who received cochlear implants completed a multidisciplinary evaluation including a developmental pediatrician, which may have provided closer monitoring of speech and language progression and subsequently an earlier ASD diagnosis. Because children who are deaf or hard of hearing with ASD are challenging to evaluate, they may receive a diagnosis of ASD at older ages.     

Language development in children after receiving bilateral cochlear implants between 5 and 18 months

Objective

The objective of this study was to examine receptive and expressive language development in children who received simultaneous bilateral cochlear implants (CIs) between 5 and 18 months of age and to compare the results with language development in chronologically age-matched children with normal hearing.

Methods

The study used a prospective, longitudinal matched-group design. Data were collected in a clinical setting at postoperative cochlear implant check-ups after 3, 6, 9, 12, 18, 24, 36, and 48 months of implant use. The sample included 42 children: 21 cochlear implant users and 21 with normal hearing, matched pairwise according to gender and chronological age. Communication assessments included the LittlEARS questionnaire, the Mullen Scale of Early Learning, and the Minnesota Child Development Inventory.

Results

The cochlear implant users’ hearing function according to LittlEARS was comparable to that of normal-hearing children within 9 months post-implantation. The mean scores after 9 and 12 months were 31 and 33, respectively in the prelingually deaf versus 31 and 34 in the normal-hearing children. The children's receptive and expressive language scores showed that after 12-48 months with cochlear implants, 81% had receptive language skills within the normative range and 57% had expressive language skills within the normative range. The number of children who scored within the normal range increased with increasing CI experience.

Conclusions

The present study showed that prelingually deaf children's ability to develop complex expressive and receptive spoken language after early bilateral implantation appears promising.The majority of the children developed language skills at a faster pace than their hearing ages would suggest and over time achieved expressive and receptive language skills within the normative range.