Download Diverse Outcomes - National Center for Hearing Assessment and

Cochlear Implants and
Early Communication
Planning
Debra Nussbaum, MA CCC-A
Susanne Scott, MS CCC-A
Coordinator
Outreach Specialist
Cochlear Implant Education Center
Laurent Clerc National Deaf Education Center
Gallaudet University
What we will discuss today
The complex issues for consideration in
communication planning
The varied profiles and outcomes of children
with cochlear implants
A philosophical framework to support diverse
communication, language, educational, and
psycho-social planning for children with
cochlear implants
Complex Issues
The impact of
deafness on
language,
communication &
psychosocial
development
 Early language
acquisition regardless of
modality, is critical to
timely development in all
areas
 Language delay is
difficult to overcome
Complex Issues
 Viewing the implant within the
context of the “whole child”
Keeping the
Cochlear
Implant In
Perspective
 Having sufficient information to
develop “realistic expectations”
 Understanding the road to
“success” with a cochlear implant
 Understanding that the implant is
only a “technology”
 Understanding that a child with an
implant is “still deaf”
Complex Issues
Uniting
medical and
educational
professionals
 Referral to educational
professionals as well as
medical professionals
 Collaboration between
hospital implant centers
and educational programs
 Collaboration between
multiple educational
programs and/or support
service providers
Varied Profiles and Outcomes
Diverse Children…Diverse Outcomes
Student characteristics
Age
Family support
Type of early intervention
Developmental history
Home language use
Pre-implant language level (spoken/sign)
Diverse Children…Diverse Outcomes
Hearing History
 Age of onset
 Age of identification
 Age of intervention
 Degree of hearing loss
 Cause of hearing loss
 Amplification history
 Auditory experiences
 Age at implantation
 Consistency of use
 Mapping
 Habilitation
Diverse Children…Diverse Outcomes
Realities




Desire of family
Outside pressures
Additional learning issues (may be uknown)
Third language use
Diverse Children…Diverse Outcomes
Children’s Hospital Oakland
Research Study
 80 children implanted between ages 2-5
 Pre-lingually deaf, profound hearing loss, minimal
benefit from hearing aids
 Progress documented for three years
AuSpLan (Auditory Speech and Language), McClatchie and
Therres, 2003
Diverse Children…Diverse Outcomes
 Predicted: 25% would become primarily “Auditory” communicators
 Outcome: 3yrs post CI
 87% Auditory Only
 13% needed some visual support
 Predicted: 46% “Both”- Auditory communicators with some visual support
 Outcome: 3yrs Post CI
 85% “Both”
 5% “Auditory”
 15% “Primarily visual”
 Predicted: 29% “Combination”- Mostly Visual with some auditory support
 Outcome: 3 yrs. Post CI
 70% “Combination”
 15% “ Became low “Both”
 15% “became poor users/non-users”
Children’s Hospital Oakland- summary of findings
Diverse Children…Diverse Outcomes
Auditory-Verbal/Oral Communicators
Combined: Auditory + Visual Communicators
Building a case for diverse
planning
Building A Case for Diverse Planning
Fully
Visual
Mostly
Visual
Mostly
Auditory
Fully
Auditory
Communicator
Communicator
Communicator
Communicator
Building A Case for Diverse Planning
Importance
of Early
Visual
Support
Support for signing with hearing babies:
 Signing is an easier motor skill to develop
than speaking
 Signing babies tend to talk earlier
 Symbolic gestures support spoken
vocabulary development
 Parents noted decreased frustration,
increased communication, and enriched
parent-infant bonding
 More sophisticated play occurred in signing
babies and an increased interest in books.
Sign With Your Baby: http://www.sign2me.com/default6.htm
Building A Case for Diverse Planning
Question: Does signing with hearing babies delay
their speech development?
Answer:
Research indicates that babies who sign tend to
have a stronger command of verbal language and
also begin speaking at an earlier age than babies
who don't sign.
Sign With Your Baby
Building A Case for Diverse Planning
The Question Remains……
If sign language is a positive support for
early language development for hearing
babies…Why not deaf babies????
Building A Case for Diverse Planning
What is some research suggesting?
“ Early sign language use, coupled with implantation at an
early age, appears to promote stronger vocabulary
development and thinking skills which in turn appears to
be positively related to increased spoken language
communication potential and to improved reading
comprehension.”
The Effect of Age at Implantation and Communication Method on the
Vocabulary and Reading Comprehension Skills of children Who Use
Cochlear Implants, McDonald Connor, C. and Zwolan, T. University of
Michigan, Draft presented, Nov. 2002)
Building A Case for Diverse Planning
Sign
language use
may play a
range of
roles and
may change
over time
 Foundational User-Bridge to oral
development (for early identified
infant)
 Transitional User-Sign has been part
of child’s life, yet goal is to transition
to oral environment
 Strategic User-Child continues to rely
on the combination of spoken and
signed language
 Dominant Sign User-ASL user who
receives implant at a later age. Will
develop useful listening skills, yet
progress may be slow
Moeller, Boys Town National Medical Center, 2002
Diverse Programming
Visual
Auditory
A finely choreographed dance
In Summary
Children with cochlear implants are diverse…
It should therefore follow that communication and
educational approaches be flexible and
individualized to meet the diverse needs of these
children and families.
So keep in mind
If you’ve met one child with a cochlear
implant and their family …
Then you’ve met ONE child with a cochlear
implant and their family…
For Further Information
Visit our website at:
http://clerccenter.gallaudet.edu/CIEC/index.html
For Further information
http://clerccenter2.gallaudet.edu/KidsWorldDeafNet/e-docs/CI/index.html
For Further Information
http://clerccenter.gallaudet.edu/Products/Sharing-Ideas/CI/index.html
For further information:
Contact:
[email protected]
or
[email protected]