Monday, April 14, 2008

The Biggest Myths

The following discussion is specifically about profoundly deaf children. Earlier, on Jodi’s blog there was a discussion about myths and inaccuracies. One anonymous commenter chimed in with a comment about how much they disapprove of implanting babies. I know this blog is aimed at families who are already past this discussion, and are more interested in providing both spoken language and ASL for their implanted kids, so I am probably preaching to the choir. However, sometimes we need to go back and visit other issues. Like myths. A common belief that I have encountered is that babies should not be implanted, that the child deserves to make this decision for him/herself. The myth then is that the implant will work as well for older kids and teens as it does for babies. An associated myth is that there is no way to estimate how successful the implant will be with a given individual, or that there is not enough information available to make an informed decision on the best age to implant your child. WRONG. On all counts. While it is true that you cannot guarantee results prior to implantation, there is plenty of information now to get a very good idea of how well the implant will work. The implant does not work the same for everyone, and to determine how well it may work for you, you need to take into account how much residual hearing you have had, how good your verbal speech is, what your hearing history is, how old you are and how determined you are to make it work, among other things.

Last week, my family attended a seminar on early language acquisition, put on by Cochlear Corp. Heather Whitestone McCallum was one of the speakers, and my daughter was invited to be part of her presentation. My daughter was invited because of her early implantation and subsequent success with her implant and verbal language abilities. We really enjoyed the seminar, and got some good information. Some of that information is relevant to this discussion. Dianne Hammes, with the Carle Clinic and Foundation presented a study regarding the outcomes of four groups of children, grouped by age of implantation. The results of her study showed that children implanted by 18 months of age had near normal speech and language ability as they got older, while those implanted after 19 months of age got farther and farther from hearing average the older they got. And the older they were at implantation, the more they deviated from the norm. Please note that this is a study of verbal skills only, and did not take sign language into it.

There has been quite a bit of research regarding age of implant versus level of acquisition of verbal language that supports that study: see here and here and here. These are just a few of the many results I came up with when I Googled “Effects of early implantation on speech and language”. All of them agree that earlier is better, and that children who are implanted by 18 months of age have a very good chance of achieving speech and language abilities in the same range as their hearing peers. This does not make them hearing. It means that their brains can understand verbal language at the same level.

The important point here is that the brain is an integral part of the success of the cochlear implant. How well the brain can integrate sound is directly connected to the age at which the brain is introduced to sound. By the time a child is old enough to decide for him or herself, they are well beyond the age when the brain can easily integrate sound into meaningful understanding. So the parents who choose to wait and let the child decide, are actually choosing against getting the implant. One way or the other, the parents DO decide. It is far better for them to be intentional in their decision making. I know parents who are now very angry at the Deaf Community because they were led to believe that they could wait, and it would not impact the success of the implant. When they found out otherwise, they felt that they had been lied to by the Deaf Community. This serves nobody. It is more important to keep the lines of communication open, and keep the relationship intact than it is to have the parents follow the “ASL only” ideology without full understanding of all of the options.

The children who will have the highest success with both American Sign Language and the verbal English Language are the ones who are implanted prior to 18 months of age and who are instructed in both English and ASL from birth. This will take dedicated parents and a supportive community working together.



Anonymous said...

Wait, now you are answering back with a myth also. There is no such thing as "ASL only". Nobody is promoting that. Everyone agrees that bilingualism is the way to go. Whether the goal should be written English or spoken English is a different issue.

Anonymous said...

Anonymous, I think KL was talking about the birth to age 3 years period. When a child is born profoundly deaf, it really is "ASL only" because the child has no access to spoken English, unless she/he has hearing aids that give enough gain to detect speech sounds. The child has no academic skills yet either, therefore no reading and writing to access written English.

Anonymous said...


Bilingualism will have to cover both written AND spoken English for those children implanted early in infancy. The infant's brain is at its most plastic in acquiring language, both sign and spoken, so that written English will eventually be readily understood in toddler years.

Many AVT programs, not all, are averse to employing a visual language along with spoken language. ASL and spoken English cannot be taught at the same time together because of syntax and other differences. But this doesn't mean that the CI child cannot acquire another language, far from it, it's just that ASL and spoken language will have to be taught separately at different times during the day, in order for the child to understand that two languages are being taught. The toddler will have at least another language to rely on for communication at all times.

The trick part is to get AVT programs to allow ASL to be taught separately, if the parents wish it and if the child inclines to a bilingual approach. AVT programs shouldn't dictate to parents that ASL or another sign language is a no-no.

As for "Everyone agrees that bilingualism is the way to go", well, not "everyone" does. There are some in the CI community who will disagree with that statement.


Dianrez said...

Common sense should be the rule of thumb. I don't believe there are many parents who are angry at the Deaf community for misleading them that they could wait until the child was old enough to decide, because historically, most parents never ask input from Deaf adults.

Even though there may be a few who felt they received bad advice, we have seen throughout the years bad advice from different sources starting with the pure oralist theory in the 50's. Advice has always evolved and will continue to evolve.

Your last paragraph:

"The children who will have the highest success with both American Sign Language and the verbal English Language are the ones who are implanted prior to 18 months of age and who are instructed in both English and ASL from birth. This will take dedicated parents and a supportive community working together."

--is the best statement of common sense I have seen yet. With all bases covered, one can't go wrong.

Anonymous said...

The last paragraph that Dianrez is referring to...are you able to provide research materials that support this statement for deaf babies?

Jodi Cutler Del Dottore said...

Oooh, I can post without a gmail account? You...Go...Girl. That was the myth that bothered me the most on the comments from that post. Thank you for addressing it with research to back it up.
That is so cool that your daughter was part of the presentation, it must have been a special moment for your family and...well-deserved. Blog on, MOM. Jodi

K.L. said...

The researchers have not caught up with us as of yet. Research can easily show that language, both verbal and visual is learned best when presented at birth. But there is not much out there that shows the success of the combination of ASL and verbal English presented to CI kids when they have been implanted early.

K.L. said...

Thanks Jodi,
It was pretty cool to see our not-quite-10 year old standing up there with the microphone in her hand as poised as could be, with all those professionals sitting in the audience. She did a great job.

raychelle said...

There are quite a bit of studies listed here at Gallaudet's Cochlear Implant Education Center website. Small, but growing!

Click here to go to their site: Studies of ASL with CI

Anonymous said...

I dont think it is impossible to have a bilingual child (ASL/Spoken English/Written English) - i'm a living testimonial to that! However, the poster above is absolutely correct about one thing - it has to be taught seperately.

In my case, since i got my CI at 7, I was 'late' so my ASL skills were firmly established (so was my written English skills). From the age 9 to 13, i barely signed - why? My parents wanted to encourage me to speak and use my hearing, so they stopped signing. I adapted.

It worked out really well - now I'm fluent in both languages.

I'll also point out another fact. It is indeed possible for a child who is implanted after 5 to be successful. However, I think it depends on the child's intelligence - if it's a smart child, s/he will learn both languages just fine. However, an 'average' child might have more difficulties with late implantation. Who wants to gamble? I know everyone thinks that their child is the smartest child in the world, but you just never know.

CICDA member said...

Dianrez, I personally know of many deaf parents who hestiated in implanting their deaf children because of this very same myth- that it is ok to wait until the child is old enough to decide for him/herself and that it won't have an adverse impact on speech development. Some of them decided later on to do it anyway despite pressure from the deaf community and they now feel angry for listening to some in the deaf community and for waiting too long.

I also know of many other deaf parents who decided against implanting their children because they still believe that it is ok to wait until the child gets older. They think that the CI is same as hearing aids, and that they provide roughly the same benefit. So they use hearing aids with their deaf children until they are old enough to decide whether they want a CI or not. The pressure from the deaf community can be so much that many deaf parents simply decide not to do it at all so that they don't have to deal with the backlash from the deaf community, especially from those deaf people who think that it is best to wait until the child is old enough to decide for him/herself.

Deaf parent of a deaf child with a CI

K.L. said...

I have seen many success stories from older implanted children. However, many of them had a progressive loss, and did get some useable hearing from hearing aids prior to implantation. As I said at the top of the post, it is the profoundly deaf child who cannot get useable hearing from hearing aids that needs to be implanted as quickly as possible to get the most out of the implant.

There are so many variables involved, that the only way to know is to get evaluated by a qualified implant center.

Anonymous said...

I will never forget about my hard of hearing sister who was doing something like high inspiration. To tell you my sister is story, my sister who is adopted from another country, came to Michigan when she was at the age of seven. She had never attended school in her country. My adopted parents handed her hearing aids to wear as a child. She learned fast and picked up sound environment through auditory and learned fast to grain oral language skill without lip-read training. My sister was more able to catch spoken words, but not always. She can sign language. I watched her develop her had habit of reading and she listened and watched captioned TV all the time.

I am, in fact, Deaf. Both ears are 70 db. I am adopted from another country as well. My sister and I were the exact same 20 db with hearing aids. I could hear the sound of environment only, but I couldn’t even catch some words by listening to speaking. It was because I could pick up different types of sounds phone, knocks and etc, but I didn’t understand spoken words. Nobody believed I could hear the sound of a frog and the sound of dripped water with hearing aids. I knew how to whistle without hearing aids.

It brother me if cochlear implant has the most common measure 20 db and does not recognize a variety of auditory measure in comparison with the hearing aids. I suspect that oral language is the only measure and they measure auditory only.

I had experienced bilingual- Spanish language sign and oral Spanish as a child. I existed between Deaf world and hearing world. It seems to me that t Deaf and hearing people are the same humans and have the same intelligence level. I remember that when I was a deaf child in the deaf school, I could speak Spanish orally and could represent Spanish in sign language. I didn’t know what bilingual meant. I thought I used to use Total communication that belonged to oral and sign language. Total communication doesn’t fit in language to be identified. For this reason, I realize that I was, in fact, bilingual between Spanish sign language and oral language as a child, and I accessed oral for hearing people and accessed signing language for deaf communication. I admitted that I preferred Spanish sign language over oral Spanish because it gave me access to structure language through in a national language. In my country, the Deaf community has the most common national sign language “one-size-fits-all” like the Maya (Indian) community owns their nationally spoken language not Spanish. Deaf children do not use one-size fits- all for reading, writing and oral language at the deaf school.

PS. To tell you the truth, oral language was only an accessory.


Tiffani said...

Great job of myth-busting and including support studies. I hope you won't mind if I link to it sometime later.

Also thanks for linking to my blog.