University of Edinburgh

Working with children with cochlear implants in sign bilingual settings

Presented on 17 January 2008


Sue Archbold

1. A child (3) is using sign language before implant and parents are advised to stop sign language immediately after implant. You are the teacher of the deaf - what do you advise?

2. A mother is using sign language without voice with her child - and feels that her child's implant isn't working and doesn't encourage the use of the implant. What would you do?

3. A teenager with an implant since 6 years old - uses sign for the curriculum - not keen on wearing the implant - what would you do and advise?

4. Parents' home language is Urdu - child implanted at 2 - going to mainstream nursery - sign language available. What do you advise about the use of sign language, Urdu and English? Would it be different at school and home? How would you advise parents to help their child?

5. How can you provide flexibility of educational provision - are there new ways to do it? How would you assess a child's changing communication needs? How can you provide for a child's needs in mainstream education?

6. What skills and expertise do schools for the deaf using sign language have for children who are using implants and who use mainly spoken language? What opportunities do schools for the deaf have for using sign supported English and pure BSL? What could be the roles before and after implantation? For different children? At different times?

A child implanted at 3 - had good sign language skills at school for the deaf - one year after implant is vocalising at home but silent at school. What are the possibilities? What do you need to know? What would you suggest?

A young person (14) with an implant is in a mainstream school using spoken language - he meets no deaf young people. What concerns would you have? Why might he want to learn sign language? How can you provide sign language input? How can you provide a peer group?

After implant what would make you think that a child had a language learning problem?

A child has implant at 3 - had implant for 2 years - is now 5 and good user of sign language at school and at home. Parents ask advice about how to move on with spoken language at home. Where and when can they use spoken language alone safely?

Does it matter that parents are using sign supported English early on or should they be using pure sign language? Can the children learn pure BSL later on in life?

Educational issues

After implantation: Priorities - how can this be provided in a sign bilingual setting?

  • Wearing it!
  • Monitoring the implant functioning
  • Developing listening skills
  • Using hearing in the development of communication and language.

What are the educational issues?

  • Flexibility
  • Monitoring progress
  • Educational decisions


  • Children's potential and needs change after implantation.
  • How can we provide flexible support which changes over time?
  • How do we assess changing needs?


  • Disagreement about typical degree of 'match' between signed and spoken representations.
    - Sensitive, fluently signing parents tend to produce sign support speech after CI? - deserves more research.
    - Parents of hearing infants learn simple signs.
  • 'Real' sign language requires other models
    - Special role for deaf teachers and other professionals
    - Sensitive/critical period for sign as well as speech

Why sign?

  • Seems to support vocabulary development - mediator (Connor et al, case studies)
  • Covering the risk in outcome - and supporting social/cognitive growth as speech develops.

Pat Spencer's work


  • Use oral or auditory verbal methods
  • Use simultaneous speech and sign
  • Use sign and speech independently (bi - bi)

NB it is not necessary to choose one approach for ever!

Sign. What do we mean? (thanks to Pat Spencer)

  • sign language
    - May be 'sandwiched' with spoken productions - but not produced simultaneously.
  • 'total communication'
    - Simultaneous communication
    - 'sign supported speech'
    - Flexible approach, differing by situation and individual child.

Total Communication assumptions

  • Child uses both vision and audition for receptive communication.
  • Usage will vary by situation and according to communication partner.
  • Usage may change or evolve over time.
  • Signed productions may follow spoken language rules.

Concerns expressed about use of total communication (with or without CI)

  • Will the two modalities compete for attention (and spoken language lose out)?
  • Who will provide the language models?
  • Will children be able to use 'artificial' sign systems to communicate with the Deaf community?

Pat Spencer's ideas

  • Deaf children with cochlear implants are still deaf although most will have access to auditory information.
  • Older ages at implantation usually require more structured listening practice.
  • Flexibility is important, sensitive to changing child and family needs.
  • Children may understand and produce spoken language and still use sign language and maintain deaf identity.
  • Research from 5 years ago is too old.

The options actually make family decisions more difficult

  • We don't really know enough yet. Need to keep open minds
  • and constantly evaluate progress
  • study the results of all the options
  • modify or change approach if child not happy or showing progress (Spencer).

Spencer's Quest for Peace

Can we find ways to help deaf children use and reach all their potential?

  • For sign and deaf identity
  • For spoken language and access to general community
  • For literacy and academic achievement

Identity and self-esteem issues

  • Still not Hearing
    - Adolescent CI groups. Signers teach oters
  • Bicultural identity relates to stronger self-esteem (Bat-Chava 2000)

Decreasing communication frustration

  • Hearing children using signs show good spoken language development (Acredolo)
  • If they hear it, they will say it.

To support bilingual-bicultural development of children with CIs

  • Provide rich, fluent spoken language experience.
  • Provide support from signs - and in different context, rich fluent sign language experience.
  • Support parents' communication intuitions.
  • Monitor individual development and be flexible.
  • Show respect for child and parent preferences - and for Deaf and hearing communities and languages.

Educational issues: what are they?

  • Testing implant systems
  • Monitoring speech production

Let me take you to a school; 14 children with implants; how many wear them? None.


  • There was no link between the implant centre and home and school.
  • The teachers did not know what to expect or how to manage the equipment.
  • The teachers did not know that the children could now hear spoken language at quiet levels ... and didn't change.

What kind of support in mainstream class?

  • Not sitting beside in class
  • Pre-class preparation of topic
  • Knowledge of new vocabulary
  • Notetaker
  • Using distant computer
  • A specialist teacher to solve problems.

Teachers - please ...

  • Talk clearly and slowly
  • not at the board
  • repeat the questions around the class
  • indicate who has asked the question or made the comment
  • don't walk around!
  • introduce topics
  • summarise the points.

Pat Spencer's Quest for Peace

Can we find ways to help deaf children use and reach all their potential?

  • For their own identity
  • for spoken language and access to general community
  • for literacy and academic achievement
  • and move on from the old arguments.

Technical Challenges

  • Electro-acoustic stimulation
  • Fully implantable devices
  • Hair cell regeneration
  • Brain stem implants

New technologies - what next?