University of Edinburgh

Working with children with cochlear implants in sign bilingual settings

Presented on 17 January 2008

Recent research

Sue Archbold

Perception: Categories of auditory performance (CAP)

  • No perception of environmental sounds
  • Perception of environmental sounds
  • Response to speech sounds
  • Discrimination of environmental sounds
  • Discrimination of speech sounds
  • Understanding of common phrases (no lipreading)
  • Understanding of conversation (no lipreading)
  • Using the telephone

Speech perception in implanted prelingually deaf children 4 years after implantation

Age Common phrases Conversation Telephone
5-7 years 80% 30% <10%
3-5 years >95% >70% >30%
<3 years 100% 85% 45%

Speech perception over 10 years (Beadle 2005)

Time Understanding conversation Using telephone
Before 0 CAP rating 0 CAP rating
5 years 6 CAP rating
10 years 7 CAP rating

Speech intelligibility rating

  • No speech
  • Unintelligible speech
  • Speech intelligible to experienced listener
  • Speech intelligible to inexperienced listener
  • Intelligible speech

Speech intelligibility in implanted prelingually deaf children 4 years after implantation

Age experienced listener little experience all
5-7 years 60% <10% 0%
3-5 years >90% <30% >10%
<3 years 100% 80% 40%

Speech intelligibility rating over 10 years (Beadle, 2005)

Time no spoken language experienced listener inexperienced listener
Before SIR rating 1
5 years   SIR rating 3
10 years SIR rating 4

What about those parental decisions about education?

Is cochlear implantation influencing the educational decisions of where children go to school and what communication mode is used?

Educational placement

Children implanted young, before the age of five, are showing a similar pattern of educational placement as the severely deaf with hearing aids of the same age in the UK, 3 years after implant.

Children with cochlear implants in mainstream schools are younger at implantation than those in units or schools for the deaf (p<0.05). (Archbold et al 2002).

Communication approach

Three years after implantation, on measures of speech perception and production, the children using oral communication out-performed those using sign communication.

However, when those who had used signed communication and changed to oral communication by three years after implantation were compared to those who had always used oral communication, there was no significant difference between the two groups. (Archbold et al, BJA, 2000)

Literature review (Spencer and Marschark, 2003)

  • "Overwhelmingly majority of reports indicate that ... those in oral or auditory verbal programming make faster progress"
  • For speech intelligibility, perception, receptive and expressive language
  • However ... "children generally increase their speech and language skills after implantation regardless of type of programme ... if sufficient spoken language exposure and/or intervention is provided."
  • "... no language modality has yet resolved deaf children's continuing delays after implantation"

L Spender et al (1998)

Children with implants tended to produce boung grammatical morphemes more than those with hearing aids and to express them vocally even when producing signs for content words.

Geers et al (Ear & Hearing 2003)

Children educated without use of sign exhibited a significant advantage in their use of bound morphemes, in the length of their utterances and in the complexity of the syntax used in their spontaneous language.

Svirsky et al, Psychological Science, 2000

No difference in overall language levels between a group of children - signing and oral programmes - but oral programme children better skills when only spoken language considered.

Work in progress ... here

  • Children divided into <3 at implant, 3-5, over 5 years
  • Communication mode chosen - before imlant, 1 year, 3 years and 5 years after
  • Investigating the changes in communication mode - why they happen - funded by NDCS

NLVT results one year after

  • 3+: NLVT mean: 15.4%; median 5%
  • 2+: NLVT mean: 19.5%; median 20%
  • 1+: NLVT mean: 66.3%; median 71%

Children implanted at 1+ scored significantly higher after 12 months than children implanted at 2+ or 3+.

Statistical significance: p<0.0001 between 1+ and 2+ or 3+; NS between @+ and 3+.

Management decisions: what about communication mode?

In Margaret's group before implantation:

  • 3+: sign 85%, oral 15%
  • 2+: sign 79%, oral 21%
  • 1+: sign 76%, oral 24%

No significant difference between any groups.

Communication changes in early implanted children

12 months after implantation:

  • 3+: sign 82%, oral 18%
  • 2+: sign 70%, oral 30%
  • 1+: sign 15%, oral 85%: p<0.0001

1+ 6 months after implantation: oral 61%

Why are they changing communication mode? Research funded by NDCS

  • Parents want most effective means of communicating
  • The child preferred spoken language
  • Change led by the change in hearing

"It was a very natural and child-driven change to spoken language.
He prefers spoken language both receptively and productively."

The communication journey

  • Further research by NDCS
  • Parents talk about a 'communication journey'
  • The old arguments?
  • What are they?

Before implantation - most effective communication (oral or sign, gesture)

After implantation - development of spoken language supported by audition / reduction of sign/SSE - Spoken language established - increased interest in use of SSC or BSL.

NDCS/TEF study of young people with cochlear implants

  • To explore the issues which are important to young people with cochlear implants, producing information, papers and other publications.
  • These will inform parents making a decision about a cochlear implant, the young people themselves and the professionals working with them.


Deaf or hearing?

  • 15/29 'Deaf'
  • 7/29 'Hearing and Deaf'
  • 6/29 'Hearing'


  • 7 wanted to be treated 'normally'
  • speech is 'normal'

"I'm a normal teenage boy"
"I know I'm deaf ... without your cochlear implant you are always going to be deaf, it's hard to cope with, I always want to be normal"
(male, spoken language, post meningitic)

"I'm a bit of both - when I'm at the airport and there's all these announcements I think I'm deaf and weird! I do! When I'm at the deaf club I think I'm deaf but here with my family I'm in the middle"
(female, spoken language, congenital/genetic)

"To be honest inside me I'd say I'm hearing because I can hear what everyone else is saying"
(male, spoken language, congenital)

  • "With my deaf friends I sign - with the others I talk"
  • "Some days deaf and some days hearing"

Overall they seem positive and to have a flexible view of themselves ... it's a new world!

So what are the implications?

  • For parents
  • For teachers
  • How can we help this communication journey?
  • A quest for peace