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Parents' Views on Changing Communication After Cochlear Implantation
  • Dr. Linda M. Watson/University of Birmingham WAS available from 5/19/08 until 6/08/08 to to answer questions and share ideas concerning her research and its implications for parents of children who are deaf/hard of hearing, their teachers and other professionals who work with them.
  • You are encouraged to read the research summary below and review the attached discussion.

Abstract: We sent questionnaires to families of all 288 children who had received cochlear implants at one center in the United Kingdom at least 5 years previously. Thus, it was a large, unselected group. We received 142 replies and 119 indicated that the child and family had changed their communication approach following cochlear implantation. In 113 cases the change was toward spoken language and in 6 cases the change was toward signed communication. Parents were asked to respond to statements about communication with their deaf child, and their responses indicated that parents wanted the most effective means of communication and one that their child would find most useful in the future. Findings that emerged from parents' comments indicated that the change toward greater use of spoken language was child-led and driven by increased audition. Parents also valued the contribution of signed communication.

Section 1: Introduction
Cochlear implants are an accepted option for profoundly deaf children and their use has become widespread over the past 20 years. They provide deaf children with access to spoken language via hearing and hence facilitate the development of spoken language (Svirsky et al., 2000). An important question for parents is whether children continue to use the same communication approach following cochlear implantation as they did before they received the implant. In much research, there is an underlying assumption that the child’s communication approach remains static and does not change after cochlear implantation, although Yoshinaga-Itano (2006) reported three cases of profoundly deaf children who received cochlear implants prior to three years of age and who changed from use of signed communication to use of spoken language.

This paper reports on three phases of a project that we carried out based on one cochlear implant centre in the UK. We wanted to investigate whether these children did change their communication approach after cochlear implantation and, if so, whether it changed towards greater use of spoken language or greater use of sign (either signs used in conjunction with spoken language as in Total Communication or SimCom or use of a signed language, in this case BSL). Where there was evidence of a change, we investigated the nature of the change further and then sought parents’ views on the reasons for the change, first by using a questionnaire and then by interviewing a sample of parents at length.

Section 2: Phase 1
We considered the data on 175 children who had received a cochlear implant at this one centre at least 5 years previously. This represented the whole cohort of children who had received an implant at least 5 years previously and for whom we had data available, so it included children with any cause of deafness (including children with disabilities). The children came from across the UK and used the whole range of communication approaches. Since staff at this centre routinely collect data on all children who have received a cochlear implant annually, we had the data to hand. When we investigated the whole cohort, we found that there was a trend towards using spoken language, which was statistically significant. By 5 years after implantation, 106/175 children (61%) were using spoken language for communication. We divided the cohort of 175 into 3 groups by age at implant: Group 1: under 3 years of age; Group 2: between 3 and 5 years of age at implant and Group 3: aged 5 or over at implant. We found that the younger children were more likely to change. The data for group 1 (29 children) showed that prior to implant 3/29 were using spoken language and by 5 years after implant this had risen to 24/29 (83%). Group 2 (85 children) also showed a trend towards spoken language, with 23/85 using spoken language prior to implant and 54/85 (64%) by 5 years later. The older group were less likely to change, with only 6/61 changing to using spoken language, although this group was more complex and more children (24/61) were using spoken language prior to implant. We also found that the younger children changed more quickly than the older children. From the 21 children who changed in group 1, a few (4) changed during the first year post-implant and the majority (14) changed between 1 and 3 years post –implant. Group 2 tended to take longer to change, with some changing between 3 and 5 years post-implant. The full results are available in Watson, Archbld and Nikolopolous (2006).

Section 3: Phase 2
Since the first phase showed that many children from this implant centre did change their communication approach following cochlear implantation, we decided to ask the parents’ views on the reasons for the change. We sent questionnaires to 288 families where the child had received a cochlear implant at least 5 years previously. In the questionnaire, parents were asked to indicate whether their child had changed communication approach, and if so to respond to 10 possible reasons that we had provided by stating whether they agreed strongly with the statement; agreed somewhat; neither agreed not disagreed; disagreed somewhat; disagreed strongly. All parents were then invited to make any further comments that they wished. We received 142 responses, so we checked whether there were any statistically significant differences between those who responded and those who did not respond (in relation to gender; age at implant or score on the Categories of Auditory Performance scale, which is an indication of the child’s access to sound) and did not find any. From the 142 responses, 119 indicated that their child had changed communication approach following cochlear implantation, with 113 changing towards spoken language and 6 changing towards use of sign.

The statements that we provided related to the parents’ wishes for themselves or their child, which they felt had influenced the change in communication approach, or to their perception of their child’s preference or the effect that communication approach appeared to be having on their child (whether one communication approach appeared to be impeding the development of the other). The final statement related to whether they thought the change in communication approach was influenced by the advice of professionals.

Parents agreed most strongly with 3 statements, 2 of which related to their wishes and 1 to their child’s preference. The 3 statements were:
1. I want to use the most effective way of communicating with my child.
2. I want to use the language which is most likely to be useful to my child in the future.
3. My child preferred to use spoken language.

When we analyzed the free comments from parents, we found that parents said they were following the child’s preference and that the change was actually child-led and appeared to be driven by the increased access to sound. Whilst these parents had a preference for their child to develop spoken language, they were not opposed to the use of sign (usually signs in conjunction with spoken language) and some stressed the importance of this use of sign in the early stages post-implant. The full results are available in Watson, Hardie, Archbold and Wheeler (2007).

Section 4: Phase 3
Finally, we decided to interview some of the families who had responded to the questionnaire to seek their views in greater depth. We selected 12 families for interview. They were chosen proportionally from those who indicated that their child had not changed communication approach; those where the child had changed towards spoken language (the largest group) and those where the child had changed towards sign language.

The interviews showed that the families retained their goal that their deaf child should develop spoken language, but the communication approach changed at different stages of the child’s development, according to the child’s needs and preferences. So families talked about using Total Communication (spoken language with signs used simultaneously) prior to implant and in the early stages post-implant. Then, following the child’s preference, there was a change to using spoken language without the use of signs. However, as these deaf children grew up some of them became more interested in exploring their identity as a deaf young person with a cochlear implant and decided to learn BSL. We referred to these changes in communication approach as the ‘communication journey’. The full report is available in Wheeler, Archbold, Hardie and Watson (in press).

Section 5: Implications for parents
Our work suggests some points for parents to consider:
· From the children we studied, the majority (although not all) were using spoken language by 5 years post-implant. More children who were implanted younger were using spoken language
· Some had always used spoken language
· Others changed towards use of spoken language
· Many parents favoured the use of Total Communication prior to implant and in the early stages after implantation
· If parents’ aim is for their child to use spoken language, they may choose to use solely spoken language from the outset, but they may follow the practice favoured by parents in this study of using Total Communication at first and then changing (but not all children will change)
· Children’s communication approach is not fixed and changes as their needs and preferences change

Svirsky M, Robbins A, Kirk K, Pisoni D, Miyamoto R (2000) Language development in profoundly deaf children with cochlear implants. Psychological Science 11:153-158.

Watson LM, Archbold SM, Nikolopoous TP (2006) Children’s communication mode five years after cochlear implantation: Changes over time according to age at implant. Cochlear Implants International. 7(2) 77-91

Watson LM, Hardie T, Archbold SM, Wheeler A (2007) Parents’ views on changing communication after cochlear implantation. Journal of Deaf Studies and Deaf Education. 13:1; 104-116.

Wheeler A, Archbold SM, Hardie T, Watson LM (in press) Children with cochlear implants: The communication journey. Cochlear Implants International.

Yoshinaga-Itano C (2006) Early identification, communication modality, and the development of speech and spoken language skills: Patterns and considerations.

In PE Spencer & M Marschard (Eds.) Advances in the Spoken Language Development of Deaf and Hard-of-Hearing Children. (pp 298-327) Oxford: Oxford University Press.