Language and academic outcomes of children with cochlear implants in an inclusive setting: Evidence from 18 years of data.

OBJECTIVE: This study examined outcomes in core and pragmatic language, receptive vocabulary, and academic skills in children with cochlear implants (CIs) enrolled in an inclusive educational setting. METHODS: Eighty-eight children with CIs were included in the analyses. Data was collected over an 18-year period, at six-month intervals for core language, vocabulary, and pragmatic skills and in kindergarten and second grade for academic skills. Kaplan-Meier analyses were used to estimate the median time to achieve age-appropriate scores. RESULTS: Results indicated the median time to obtain age-appropriate skills for children with CIs enrolled in our program was less than three years for core language and pragmatic skills and less than two years for vocabulary. Over 90% of the sample had academic skills in the average range in both kindergarten and second grade. DISCUSSION: This study shares outcomes of children with CIs who received consistent and intensive transdisciplinary intervention in an inclusive educational setting, revealing the trajectory required to obtain age-appropriate skills, when compared to normative data. CONCLUSION: Results were favorable, indicating that children with CIs in an inclusive program, with intensive intervention and strong language and social models, can develop skills commensurate with typically developing peers across a variety of core skills.

Psychosocial Aspects of Hearing Loss in Children.

Pediatric hearing loss changed more in the past two decades than it had in the prior 100 years with children now identified in the first weeks of life and fit early with amplification. Dramatic improvements in hearing technology allow children the opportunity to listen, speak and read on par with typically hearing peers. National laws mandate that public and private schools, workplaces, and anywhere people go must be accessible to individuals with disabilities. In 2015, most children with hearing loss attended mainstream schools with typically hearing peers. Psychosocial skills still present challenges for some children with hearing loss.

Should All Deaf Children Learn Sign Language?

Every year, 10,000 infants are born in the United States with sensorineural deafness. Deaf children of hearing (and nonsigning) parents are unique among all children in the world in that they cannot easily or naturally learn the language that their parents speak. These parents face tough choices. Should they seek a cochlear implant for their child? If so, should they also learn to sign? As pediatricians, we need to help parents understand the risks and benefits of different approaches to parent-child communication when the child is deaf [corrected].

Prelinguistic communication and subsequent language acquisition in children with cochlear implants.

OBJECTIVE: To investigate the relationship between prelinguistic communication behaviors and subsequent language development after cochlear implantation in deaf children. Evaluative tools with predictive validity for language potential in very young deaf children remain elusive. SETTING: A tertiary care cochlear implant center and a preschool setting of spoken language immersion in which oral language development is emphasized through auditory and oral motor subskill practice. SUBJECTS: Eighteen prelingually deaf children who underwent unilateral implantation at an average age of 15 months also underwent testing with the Communication and Symbolic Behavior Scales (CSBS) before device activation and with the Reynell Developmental Language Scales (RDLS) at an average of 20 months after cochlear implantation. METHODS: A prospective study correlated preoperative communication behavior assessments of 18 children who were candidates for cochlear implantation. We examined the value of prelinguistic behavioral testing with the CSBS in predicting later language level after cochlear implantation as reflected in RDLS scores. RESULTS: We found positive, though weak, correlations between prelinguistic communication skills (CSBS scores) and language learning after cochlear implantation (RDLS scores). Linear correlation between test results failed to reach statistical significance (receptive comparisons, P =.17; expressive comparisons, P =.13). CONCLUSIONS: Evaluating the quality of prelinguistic communication behaviors potentially adds important predictive information to profiles of children who are candidates for cochlear implantation. Correlative analysis suggests that early CSBS testing may provide useful clinical information. Poor CSBS scores may serve as a precaution: if children lack an appropriate prelinguistic behavioral repertoire, the emergence of age-appropriate formal language may be at risk. Observations suggest that symbolic prelinguistic behaviors are necessary, but not sufficient, for the development of strong linguistic skills. The variability of behavioral measures in very young deaf children poses challenges in designing objective measures with predictive value for later language level.

Correlation of neurocognitive processing subtypes with language performance in young children with cochlear implants.

OBJECTIVES: Test data were used to explore the neurocognitive processing of a group of children with cochlear implants (CIs) whose language development is below expectations. METHODS: This cross-sectional study examines the relationship between neurocognitive processing, as assessed by the Kaufman Assessment Battery for Children-Second Edition, and verbal language standard scores, assessed using either the Comprehensive Assessment of Spoken Language or the Clinical Evaluation of Language Fundamentals in 22 school-age children with CIs. Processing scores of CI recipients with language scores below expectations were compared to those of children meeting or exceeding language expectations. Multiple linear regression estimated the associations of simultaneous and sequential processing with language scores. RESULTS: Though simultaneous processing scores between the two groups were similar, the mean sequential processing score (91.2) in the below expectations group (n = 13) was significantly lower (P = 0.002) than that of children (n = 9) meeting expectations (110.8). After adjusting for age at implantation, a 10-point higher sequential processing score was associated with a 7.4 higher language score (P = 0.027). DISCUSSION: Simultaneous processing capacity was at least within the average range of cognitive performance, and was not associated with language performance in children with CIs. Conversely, reduced sequential processing capacity was significantly associated with lower language scores. CONCLUSION: Neurocognitive skills, specifically cognitive sequencing, serial ordering, and auditory-verbal memory may be targets for therapeutic intervention. Intensive cognitive and educational habilitation and in milieu intervention may improve language learning in children with CIs.

Achieving developmental synchrony in young children with hearing loss.

Children with hearing loss, with early and appropriate amplification and intervention, demonstrate gains in speech, language, and literacy skills. Despite these improvements many children continue to exhibit disturbances in cognitive, behavioral, and emotional control, self-regulation, and aspects of executive function. Given the complexity of developmental learning, educational settings should provide services that foster the growth of skills across multiple dimensions. Transdisciplinary intervention services that target the domains of language, communication, psychosocial functioning, motor, and cognitive development can promote academic and social success. Educational programs must provide children with access to the full range of basic skills necessary for academic and social achievement. In addition to an integrated curriculum that nurtures speech, language, and literacy development, innovations in the areas of auditory perception, social emotional learning, motor development, and vestibular function can enhance student outcomes. Through ongoing evaluation and modification, clearly articulated curricular approaches can serve as a model for early intervention and special education programs. The purpose of this article is to propose an intervention model that combines best practices from a variety of disciplines that affect developmental outcomes for young children with hearing loss, along with specific strategies and approaches that may help to promote optimal development across domains. Access to typically developing peers who model age-appropriate skills in language and behavior, small class sizes, a co-teaching model, and a social constructivist perspective of teaching and learning, are among the key elements of the model.