Your Child Has a Cochlear Implant: Why Include Sign Language?

This article was published in the Spring 2008 edition of The Endeavor, the magazine of the American Society for Deaf Children (www.deafchildren.org). It is reprinted here with permission.

Debra Nussbaum is an audiologist and coordinator of the Cochlear Implant Education Center at the Laurent Clerc National Deaf Education Center at Gallaudet University.

Over the past 10 years of my 30-year career in deaf education, I have focused on children with cochlear implants. I've worked directly with hundreds of children and their families, attended countless workshops and conferences, and networked with thousands of professionals on this topic. I have witnessed the potential of this technology to provide quality sound to children who are deaf. I also have observed that just getting a cochlear implant is no guarantee that a child will be able to learn to listen so well that he or she can use only listening to learn.

Each child with a cochlear implant is unique, and there does not appear to be a single approach that is the one right approach to develop language and communication for all children with cochlear implants. For this reason, the Cochlear Implant Education Center (CIEC) at the Laurent Clerc National Deaf Education Center at Gallaudet University is focusing on examining a variety of ideas and strategies for children with cochlear implants that value and develop spoken language while also valuing and developing sign language and Deaf identity.

Maybe you've heard the frequently expressed opinion associated with cochlear implants within some parts of the medical and deaf education community that "the use of sign language will limit the outcomes for spoken language development through the cochlear implant." We continue to find that families are counseled to either never sign with their child (even prior to a young child's getting a cochlear implant) or to stop signing with their child (even older children who have used sign language for quite a while) once they get their cochlear implant. When this notion is conveyed to families of children getting cochlear implants, it is difficult for families to provide evidence and support for why sign language should be included. As there is not yet enough research, why should the use of sign language be considered for a child with a cochlear implant?

Here are a few things to think about:
-For young children, cochlear implant surgery does not typically occur until approximately 12 months of age. By the time the speech processor of the implant is turned on and the child has even a brief opportunity to access quality sound, at least 14-15 months of prime language learning time has passed. Recognizing the crucial importance of establishing language foundations early in a child's life, it makes sense that sign language should at least be considered as a foundation of early language for a child until the auditory sense has time to develop and the child has opportunities to listen.

-For older children (beyond the early language acquisition years) who are established, successful sign language users and who then get a cochlear implant, the transition to becoming an auditory-only learner may not be realistic. The cochlear implant may offer the child awareness and enjoyment of sound and the ability to develop some important skills in communicating via spoken language and developing literacy. However, spoken language may not become the child's primary way to communicate.

-Some children, even with a cochlear implant, may struggle to develop listening and speaking skills. They are wired to learn more visually. It is often not clear what a child's learning style will be with a cochlear implant and whether sign language could and should be an integral part of the language and communication practices. If a child with a cochlear implant does acquire a greater competence and a preference for using sign language and does not develop equal competence in spoken English, it is important that the child's proficiency in sign language be valued and the child not seen as a failure with his or her cochlear implant.

-A cochlear implant is a physical device. It can break, the batteries can die, it can get lost, children may refuse to wear it, the internal device can fail, and nobody wears it 24 hours a day (contact sports, bathing, etc.). A child's competence in sign language offers language and communication abilities that are beneficial when the cochlear implant may not be available.

-Bilingual development and the use of both American Sign Language (ASL) and spoken English as separate languages should be strongly considered as a "first choice" option for children with cochlear implants. If both ASL and spoken English are developed and used before and after a child receives a cochlear implant, this approach can promote competence in two languages which can benefit the child in his or her learning, social interactions, and identity as a deaf individual.

-If an oral environment is being considered for a child with a cochlear implant who also uses sign language, it is beneficial to consider using guidelines to confirm whether the child is ready for such a transition. For an example of such guidelines, see: Children with Cochlear Implants Who Sign: Guidelines for Transitioning to Oral Education or a Mainstream Setting (PDF) from Children's Hospital. These guidelines also can be used to document the functioning of a child in an oral environment to determine whether he or she could be better served in an environment that includes sign language.

At Kendall Demonstration Elementary School at the Clerc Center, we have designed a bilingual ASL/spoken English model to meet the needs of children with cochlear implants and are evaluating its effectiveness. We are finding that with appropriate planning and supports in place, many children with cochlear implants are developing language foundations in both ASL and spoken English, and that sign language is not limiting their spoken language development. In fact, we are finding that the use of sign language is beneficial in helping children build their skills in spoken English.

Use of cochlear implants and a bilingual ASL/spoken English model is gaining momentum with both hearing families, deaf families and the greater Deaf community. We are observing a recent trend with deaf families beginning to consider cochlear implants for their young deaf children. In addition, we are seeing emerging discussion within the Deaf community regarding the benefits of using both ASL and cochlear implants. For more information about issues surrounding ASL and cochlear implants, refer to the ASL-Cochlear Implant Community website, http://aslci.blogspot.com. (K.L. comment - Yes I know this is referring to us. It was in the article)

Making choices about the best way to approach language and communication development for a child with a cochlear implant is not always clear. While the goal of obtaining a cochlear implant is to increase a child's potential to access sound for the purpose of developing spoken language, it is important to keep this goal in perspective with all of a child's needs and look at how sign language can be included. Yes, spoken language must be addressed and valued in the child's environment, but sign language also can play an important role.

For further discussion about using both sign language and spoken language as an option for children with cochlear implants, see the following resources:

Nussbaum, D. Cochlear Implants: Navigating a Forest of Information: One Tree at a Time
Children with Cochlear Implants Who Sign: Guidelines for Transitioning to Oral Education or a Mainstream Setting (PDF)

Sign of the (Changing) Times. Loud and Clear, A Cochlear Implant Rehabilitation Newsletter, Issue 2, 2006. (PDF)

Chute, P., & Nevins, M. E. (2002). The Parents' Guide to Cochlear Implants. Washington, DC: Available from Gallaudet University Press

Christiansen, J., & Leigh, I. (2002). Cochlear implants in children: Ethics and choices. Washington, DC: Available from Gallaudet University Press

ESOL/Bilingual Programs Don’t Apply to ASL/Spoken English Students at Public Schools

-written by Anonymous Deaf mother of Deaf ASL CI User

I just visited a public school in our neighborhood to consider enrolling my son for Kindergarten next fall and my son's current speech therapist joined us for the visit to provide support. We met with the school’s speech therapist and she was very excited to work with my son who has a CI as she has never worked with one but has heard a lot about CI. She usually works with hearing children who have language delays, some of them due to learning disabilities or autism but not with bilingual students who participate in ESOL (English for Speakers of Other Languages) program.

My son is still learning to improve his English grammar because he is fluent in ASL at home with his Deaf parents. So, we consider him being bilingual in ASL and spoken English and it may take him a little longer to become completely proficient in both languages like many other bilingual children (Spanish-English, Chinese-English, etc). Our speech therapist told us that the ESOL/Bilingual program doesn’t apply to my son but he would still need speech therapy although he doesn’t have significant delay in spoken language. Is it because ASL isn’t considered a language in their school system? That sort of bothers me.

There are so many bilingual children at the school that need ESOL/Bilingual services and they don’t include ASL users. I also have heard that some of KODAs (hearing Kids of Deaf Adults) are delayed in English at an early age since they use ASL at home as their first language and I think that the ESOL may be beneficial for them, too. Should we request for an ASL/English specialist to participate in those programs for deaf/hard of hearing children and KODAs at public schools? Does ESOL only apply to spoken foreign languages but not ASL because it is a visual language? The philosophy at their school system is as follows.

The goal of the ESOL program is to help the English Language Learners (ELLs) enrolled in the ESOL program to learn enough English to function linguistically and culturally in the County Public Schools and in the mainstream of American society. The education of the ELLs is a collaborative responsibility shared by the ESOL teacher, the classroom teacher, all other appropriate school staff, as well as the ELL student.

Anonymous Author

Survey for CI users using ASL as primary/secondary language

An audiology student at Gallaudet University sent us an email asking us to share with the rest of the community the link to her research project with the hopes to get more survey responses.

Survey participants must:

1. be 18 or older,
2. Must have had cochlear implant(s) at one time...either currently using or discontinued use accepted, and
3. must use ASL as a primary or secondary language.
   

The survey should take 15-20 minutes, and your help would be very much appreciated. This research project has been approved by the Gallaudet Institutional Review Board.

Below is an short bio of the researcher, an explanation of this research and why this survey is useful:

I am the survey administrator and my name is Kristine Moore. I am a 3rd year Doctorate of Audiology Graduate Student at Gallaudet University. Gallaudet is a university in Washington, D.C. exclusively for deaf and hard of hearing individuals. Gallaudet accepts some hearing people each year, but it is designed and run with deafness as the primary and most influential factor. It's an incredible place. The discussion of ASL and cochlear implants and how the two can coincide successfully is a pertinent topic for the campus and for culture as a whole. For my research project I hope to study this area further by researching the factors influencing the decision to obtain cochlear implant(s) in individuals who use American Sign Language as a primary or secondary language. PLEASE click on the link to take the COMPLETELY CONFIDENTIAL survey to further the understanding of this topic. THANK YOU for generous gift of your time and survey responses.

PLEASE click on the link below to take a CONFIDENTIAL survey about Cochlear Implants and American Sign Language:

https://www.surveymonkey.com/s/ASLandCochlearImplantUsersPLEASETakeThisGallaudetUniversityResearchSurvey

Study finds Toddlers with Implants Process Language Slower than Hearing Peers

I came across a very interesting article that falls right in line with what I have observed with my daughter. Here is the link to the study:
http://www.niu.edu/northerntoday/2010/feb22/grieco-calub.shtml
Briefly, it states that of the two year olds in the study, the ones with implants processed language slower than their hearing peers. I fully agree with that, and the recommendations in the article about how to help the kids with implants overcome the obstacle.

One thing I did not see was whether or not the kids with implants had one or two implants. I have seen my daughter's language processing time get better since she got her second implant. I am curious if having two implants would make a difference in the speech processing time in a study.

If you or your child has bilateral implants, have you noticed a difference in the speed at which understanding of speech takes place, compared to only having one implant?