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Spoken Language Scores of Children Using Cochlear Implants Compared to Hearing Age-Mates at School Entry.

Dr. Ann Geers was available from 3/30/09 until 4/12/09 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 This study investigated three questions: Is it realistic to expect age-appropriate spoken language skills in children with cochlear implants (CIs) who received auditory–oral intervention during the preschool years? What characteristics predict successful spoken language development in this population? Are children with CIs more proficient in some areas of language than others? We analyzed language skills of 153 children with CIs as measured by standardized tests. These children (mean age = 5 years and 10 months) attended programs in the United States (N = 39) that used an auditory–oral educational approach. Age-appropriate scores were observed in 50% of the children on measures of receptive vocabulary, 58% on expressive vocabulary, 46% on verbal intelligence, 47% on receptive language, and 39% on expressive language. Regression analysis indicated that, after controlling for the effects of nonverbal intelligence and parent education level, children who received their implants at young ages had higher scores on all language tests than children who were older at implantation. On average, children with CIs performed better on certain language measures than others, indicating that some areas of language may be more difficult for these children to master than others. Implications for educators of deaf children with CIs are discussed. (Geers, Moog, Biedenstein, Brenner, & Hayes, 2009)

Summary Early cochlear implantation has affected how quickly children with severe-profound hearing loss can catch up with their hearing age mates in spoken language and the age at which these children enter the mainstream. However, age-appropriate language skills are not being attained by all children when they reach school age which results in reduced ability to compete successfully in a mainstream classroom. We sought to identify reasons for this variability in spoken language outcomes by testing a large group of 5- and 6-year old children across North America with cochlear implants. This age is an important milestone because it marks the point of transition from preschool to elementary school in the US. All of the children were enrolled in Listening and Spoken Language (LSL) education programs. A goal of LSL programs is to develop age-appropriate spoken English to allow mainstreaming with hearing peers in kindergarten or first grade. The goals of this study were to determine whether children implanted at very young ages could achieve spoken language skills commensurate with their hearing peers, to investigate factors that contribute to successful spoken language learning, and to identify whether children demonstrate differing levels of success depending on the spoken language domain measured. Thirty-nine LSL education programs located in 20 different states across the US were invited to contribute test scores to this study. Language test results were recorded for all children enrolled between 2003 and 2006. A total of 153 children met the sample selection criteria, which included:1) 5;0 to 6;11 years of age; 2) age at onset of profound deafness 24 months or younger; 3) age at cochlear implant surgery before 5 years; 4) duration of cochlear implant use 12 months or greater. All participants were enrolled in early intervention programs which used auditory approaches to teach spoken language and which emphasized parent support and follow-through. Participating programs either provided the requested test results from their records or obtained parent consent for our research staff to travel to their facility to test all children who met the sample selection criteria. The skill areas evaluated were: Vocabulary (receptive and expressive), Language (receptive and expressive) and Intelligence (Performance and Verbal). The group achieved their highest average scores on the receptive and expressive vocabulary tests, where at least half of the children scored within the average range for hearing age-mates. Significantly lower scores were obtained on global language tasks, such as verbal intelligence and aspects of connected language and syntax, where fewer than half of the sample achieved age-appropriate scores. The highest correlations with language outcomes were obtained from four predictor variables: PIQ (higher IQ was associated with higher language scores), Parent Education (families with a more highly educated parent had children with better language), gender (girls scored higher than boys), age at implant stimulation (younger was better). We determined the language quotient score that could be expected as a function of age at implant when the other predictors (PIQ, parent education and gender) were held constant. This analysis allowed us to focus on the performance of 5- and 6- year old children in oral programs based on how young they were when they received a cochlear implant, without the influence of variance in intelligence, parent education or gender. The latest implant age associated with age-appropriate expected language scores varied with the skill measured, ranging from 4 years of age for expressive vocabulary to 1 year of age for global expressive language skills, including sentence structure and syntax. Our results indicated that children who received an implant at younger ages were more likely to achieve age-appropriate spoken language levels in time for kindergarten. Furthermore, the age by which cochlear implant use was associated with this goal varied depending upon the language skill measured. Age-appropriate development of complex language skills seemed to require earlier cochlear implantation and longer experience with the implant than the development of vocabulary skills. In addition to supporting the decision to provide cochlear implants to children with profound deafness at the youngest age feasible, these results have important implications for clinicians conducting assessment and intervention in LSL education settings. These results support the use of a battery of language measures to assess where intervention might be needed. Assessment of only vocabulary is insufficient when considering the amount of support that a child requires and/or the need for continued special education. It is also important to take into account verbal intelligence, connected language, and complex syntax as these skills develop more slowly and have an impact on the child’s development of reading skills. Furthermore, these data suggest that cochlear implanted children with at least average nonverbal intelligence and good family support who have the benefit of early spoken language intervention can be expected to achieve spoken language levels that closely approach those of their hearing age-mates by the early elementary school years.

Reference List Geers, A. E., Moog, J. S., Biedenstein, J., Brenner, C., & Hayes, H. (2009). Spoken Language Scores of Children Using Cochlear Implants Compared to Hearing Age-Mates at School Entry. The Journal of Deaf Studies and Deaf Education, enn046.