University of Edinburgh

Language and Deaf Education: Into the 21st Century

March, 2006

Sue Archbold - Cochlear implants Changing Deaf Education?

Notes from presentation

The face of deaf education has had a long history of controversy: the question mark is important and thanks to the organisers and old friends.

I want to show you - this is an old photograph - in the past these group aids meant you could keep an eye on the children. Cochlear implants give better sounds now.

I was a Teacher of the Deaf of the first child with a cochlear implant in 1987. I said in 1987 that lots of people were focussing on this and wondered about the future. I asked the surgeon about what would happen after the child had the cochlear implant. He said that it was the job of Teachers of the Deaf.

Cochlear implant in context: they are fast moving and lots of changes have happened. Deaf education has a long history of controversy over the years. To sign or not to sign is the question. 1880 Milan conference discussed this and said the superiority of speech over signs - the aural method should be preferred. Oralism dominated then.

Arguments about communication have gone on over the years. We also argue about schools for the deaf or mainstream schools. Also there is an agenda for total inclusion for all children with disabilities. This is a worldwide phenomenon.

Signed bi-lingualism in the UK happened at the same time as cochlear implant in the 1990s.

In the long history of deaf education along came surgeons. One in particular Graham Clark who devised it (Australian) surgeons were ignorant of deaf education and they still are to some extent. What has a scar got to do with deaf education? Surgeons had no idea of the development of communication and language or the controversy.

Cochlear implants brought together surgeons and educators for the first time. Alys touched on the difficulties for parents of deaf children in the medical model. Cochlear implant means surgery has met the education field. The growth in paediatric implantation has grown worldwide. How many deaf children worldwide have a cochlear implant?

1990 - very few by 2002 - 30,000 by 2004 - 40,000. For 2006 it will move even higher even in developing countries. So cochlear implant children are a huge percentage of our deaf children.

UK figures: the % of profoundly deaf children with cochlear implants: in 2000 about 1/2 of profoundly deaf children had an implant. By 2003 there was a significant growth - also a big growth at the younger end as a result of newborn hearing screening. Also there is a growth at the teenage end too. In the UK the proportions of profoundly deaf children are higher now. 2,500 in the UK have a cochlear implant.

This is a huge change in a short time. In just over 10 years a huge growth in the numbers. do teachers of the deaf realise this and know the potential for education as a result? None of us do - we don't have enough children implanted early and going through the system.

The most common age to be implanted is changing - because of newborn screening.
What is the youngest age for implants?

New Speaker
six months

Sue Archbold
thanks for that

So 6 months is the youngest age - so very early. the age for fitting hearing aids has changed dramatically. As Alys remarked this is putting new pressures on parents driven by technology.

To be a parent is to be scared - to take a newborn baby home - is scary - sleeping, waking, feeding etc. It’s a huge responsibility. What about parents of deaf children - you have probably never thought about this before. Parental choices are then driven in new ways in medical and surgical contexts.

For the choices - they are being made earlier in the child/s life. To sign or not, wearing hearing aids, wearing cochlear implants. The dilemmas are driven faster than the technology. The diagnosis is in a clinical context. So early diagnosis, early hearing aids - what next - an early implant - this is very attractive if you are in a stage of great vulnerability after the initial diagnosis of deafness. Parents need time at this stage.

Parents and medical people are looking for a fix. If you are a surgeon you have to be quite gung ho - a decisive person. So thinking about cochlear implant in that setting this can lead to the impression that they are a fix for deafness.

Choices - at an early stage, but when your emotions are high is this the best time to make a decision. Is this the best time - there are important things in the 1st years - getting to know the child, communicating etc. We do know that good communication skills prior to implantation affect how good the communication is after implantation. It’s the quality of communication that counts not the type. Giving people time is important.

There remains a challenge. Early diagnosis leads to early implantation. Early implantation leads to better outcomes. So we do know we have to make decisions.

Sue Gregory introduced me to Tina - you have to make a choice - you can't change your mind at later stages.

Parents should be given time to make these decisions. The reality is that cochlear implant are being provided in the first year of life.

The number of children under 1 implanted is growing - they are being implanted in the first year of life and educators are dealing with that. The number is growing and the age is lowering.

Profoundly deaf children are now hearing in a way that was not possible before. They are acquiring language by overhearing it. They acquire swear words that no-one has taught them. They are not hearing perfectly. That change has happened quickly compared to the history of deaf education.

What else do we know?

We know they should be perceiving 25-30 (?) across the frequency range. If they are not then the implant is not tuned properly. So what do they do with this hearing and what sense do they make of it? It is not normal hearing - they still have a moderate or unilateral hearing loss. In Denmark the children have bilateral implants.

Here are some figures from Nottingham cochlear implant programme: this includes all the children 4 years after implantation. In the category of common phrases like stop that, come here, stop that and come back - the next category is understanding conversation (without lip reading). The last one is using the telephone. We divided them into various age groups.

  1. Over 80% understood common phrases in the older age group but less conversation.
  2. There is a difference between those implanted young and those implanted older in their understanding of conversation without lipreading.
  3. Speech perception over 10 years: even this is changing after a long period after implantation.

What we are seeing is the children are making progress over a long time scale.

speech intelligibility
experience in deaf speech, little experience , all
Speech on all measures of articulation is speech same as hearing child of same age
under 3

Have a look at this category - none between 5 and 7 have same speech intelligibility as hearing brothers and sisters. 40% of those under 3 have intelligibility same as hearing brothers and sisters.

You go to mainstream school and sound as if you have same intelligibility as mainstream child - equates this with your language skills, etc and doesn't think this child has any issues.

Over time we see changes in speech intelligibility over time - 5-10 years following implantation. We have evidence of what is being heard, intelligibility. Where do children go to school, what communication mode should be used.

This is a study we did comparing profoundly deaf children with hearing aids throughout the UK with a group who had implants early - 5-7 years old
unit or resource base
school for the deaf

Here are the children with cochlear implanted young. More in mainstream, fewer in schools for the deaf but these children are aged 5-7. These children grow older, get into secondary provision.  Peer group issues? What bothers me is what happens at secondary provision, the challenges.

Information on placement - now evidence on communication mode - we looked at children 3 years after implant. On all measure of speech perception - those using oral communication doing better than those using sign communication. But what? (Said Sue) Lets look at the oral group 3 years after implantation and look at those always oral, those who started with sign and changed to oral. It is as if things are written in stone. Guess what? No significant difference between them.

Comparing those using sign and comparing to oral -no significant difference. Useful information for cochlear implant surgeons who say if you use sign language with your child we will not implant them.

Wanted to look further - analysed 176 children with implants 5 years
under 3
between 3 and 5
over 5
looked at choice of communication mode at each interval.

This is percentage using sign over time after implantation.

  1. Before implantation - those under 3 - 80% using sign - one year, three, five years after.
  2. Change in communication mode over time after cochlear implant.
  3. Those between 3 and 5 changed communication mode towards oral communication more slowly and not so many
  4. Those over 5 - very little change in communication mode over time in those implanted over 5.

Published by Linda Watson.

Mode of communication after implantation is related to age. Likely to use oral communication 5 years after no matter what pre-implant. Those over 5 tend not to change communication mode.

Children are changing mode following cochlear implant - do we realise this - implications for flexibility in deaf education. Do cochlear centres realise this. A surgeon would not implant child if he went to the nursery using sign communication. Signing before implantation will not hinder communication.

Pat Spencer - doing a conference at education implications of implantation in June. Marc will be there. I like Pat's way with words - her quest for peace. Not necessary to choose one communication approach forever, don't need to put parents in position of making these choices as a once and forever choice. Flexibility is important - sensitive to changing time and family needs. All the families are different with differing needs. Children may produce spoken language but still use sign language.

Technology is moving fast. Any research that is over 5 years old is too old. We need to do new research. Teachers of the Deaf need to be flexible. We have current research - funded by Deaf Children's Society - looking at why children change communication mode - if they do. Because people say they have to talk following implantation - asking teachers and children - what comes out strongly is that they want the most effective communication mode, a pragmatic approach - the world out there is mostly speaking and our children can communication with spoken language.

Another one - it is the child's choice - utilising new hearing - it is the child's choice over time. We are just following our child's needs. Understanding spoken language very easily. They are pragmatic about communication choices, not seeing them set in stone. Saying: we want both. Spoken language to be able to participate fully in a hearing world, but they also want sign language too. We need to think carefully through these. Next study funded by National Deaf Children's Society is looking at the views of young people. Great quotations from this study. Majority choosing spoken language as means of communication - they want to be able to use sign language too and recognise their deafness.

Children more sensible than the professionals? They are the ones living the lives and moving forward with both. You either have to have implant or sign - maybe we can now instead move forward with our thinking. So not providing these choices with parents at such an early stage.

Pat and Marc review of oral communication - overwhelming majority - those in oral or auditory verbal programming make faster progress.

But they generally increase their speech and language skills after implantation regardless of type of programme. No language modality has yet resolved continuing language delays after implantation

Cochlear implantation is set in a surgical context - inevitable it involves surgery. Surgeons see major goal is to provide hearing. I feel a bit like a split personality - seen at a conference as if promoting cochlear implants - going to a conference where surgeons will say I can give better than normal hearing. I will say excuse me - and putting the case for sign language - to take balanced approach forward.

For surgeons - major goal is to provide hearing. Job done. For teachers, there are other priorities. For parents - differing agendas, goals. Other things equally important. Language, reading education attainments - concerned that 40% of our children have additional difficulties.

Educational attainments - literacy - some work done in the UK looking at all deaf children with hearing aids and with implants - a measure of education achievement on left, hearing loss on bottom - as hearing loss increased education achievement decreased. With implants a different pattern. With implants the education attainments were more stable. What about reading? Another but . . . some of the early results in reading scores, have been encouraging. Still in comparatively early stages. One problem - some reading results look encouraging - measuring 8 year old levels. Pulling out a lot of data for children as life goes on and language gets more complex - be cautious about collected evidence.

Is cochlear implantation changing?

I will take you to a school. 14 in the school with cochlear implants - how many are using them? None. This is unethical. Why? No link at all between cochlear implant centre and school. Parents thought, medical model fed in, implant fed in and all would be well. But no link. Teachers did not know how to manage technology and had no expectation from implantation. An unethical measure of practice. I went to a school recently - not too far away - child had processor in bag, took it out for two half hour sessions twice a week - why bother. Teacher did not see that the support of the implant system was anything to do with her. What surgeons start, teachers have to finish. Sorry to parents in the audience but I have been asked to speak about education. How to manage the technology in the classroom. If implants can give access to useful information, need to ensure they're working. Not managing technology in the classroom - what Teachers of the Deaf need to know.

Researchers did a survey around Europe - asked Teachers of the Deaf what they needed to know - troubleshooting devices - how to work this thing. It can be obscure working processor for implant. They wanted course in their local community.

What do parents want? They also in a study said main priority was liaison between implant centre, home and school. Who did it, who was responsible for it in the long-term. This will haunt me. This parent said problem – over-expectation of family and friends expecting child to come home talking following implant. Unde-expectation of teachers who did not change their expectations following implant. Now the child had useful hearing. We need to make technology work and at Ear Foundation we are providing many courses.

To finish - implants might work too well. If you have a child speaking wholly intelligibility no-one might think they need support - this is not the same as linguistic ability.

Some children don't do as well as predicted. Many children - 3 years after implant can hear well but language is not developing. Identify a specific language difficulty we could not do before. Do we know how to educate them - deafness may no longer be main difficulty.

Challenging - do we know how to support children when teenagers - at secondary level.

Working in sign bilingual settings - started at Foundation with a consortium. Looking at challenges in this - two languages. Sue Gregory re-writing policy documents incorporating challenges children with implants bring. Ruth Swanwick's research into practice. Need to think of new ways of looking at it - cochlear implants have brought us new possibilities.

Change by implantation - changing educational decisions but our children are still deaf. Implications of even moderate losses - most have unilateral loss - still have effects of deafness - still deaf children. Teenagers with cochlear implants who need support in various ways. I think cochlear implants might provide us with a way to move forward from the belief you have to have a cochlear implant or you have to sign and look at flexible ways of moving forward - and take on the challenges and opportunities brought. They were unknown not long ago. As Teacher of the Deaf said - I would not have believed what could be achieved with bilateral implants. We do not know what the future of this little one will be - we need an open mind about it.