Tuesday, April 20, 2010

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


Rhowena said...

My child was implanted at one year of age, and while her verbal growth was improving, we continued using ASL. She was later bilaterally implanted, and after mulitple explants and reimplantation, we still used ASL. Her verbal language did improve, however it wasn't where we all wanted it to be, but it was comfortable for her to still communicate with us using ASL. Since then, we have learned that she has Speech of Apraxia, which explains a lot. We were very fortunate to have all learned and used ASL with her, and while she is still vocal and expressive, ASL is primary in her life.

kim said...

I haven't raised deaf kids, but my philosophy as a parent was to be encourage them to be who they were, not who I wanted them to be. The only way to find out who your kid is, is to give them many opportunities to explore. With a deaf child it seems a no-brainer to explore ASL, ESPECIALLY since that child will have no language for the first 12 month of life without it. That's a lot of lost time during the prime language development period.

I have to agree with the other points in the article as well. As a "late-deafened" person with many, many friends who use CI's, I'm aware that malfunctioning isn't unusual at all. And of course there are those times you don't have them on.

Tessa Lou said...

I have rarely been this confused. We are implanting my son in less than a month, bilateraly. We currently use ASL and have all plans to continue with ASL, but everyone we consult with for the implants discourages us strongly against our plan. I can not see taking away a solid form of communication on the hopes that all is perfect with the implant. This puts us at a place where the two local schools will not take him in the preschool programs unless we pick. I need more information. Please help.

Starrynight said...
This comment has been removed by the author.
Starrynight said...

Tessa Lou,
What are your goals for your son? Do you want him to speak English and use ASL? If that is the case, it is challenging to find a school that offers both languages. My child speaks at school and uses ASL with his deaf parents at home. It works out well for us but sometimes I wish he could use both languages at school. Our CI surgeon even encouraged us to continue ASL with our child as long as we give him an opportunity to learn to speak and hear outside home. I guess because we are deaf parents, they can't stop my child from signing. ASL is really beneficial for deaf children and my child does very well in both languages. Good luck on your decision!

AliciaD said...


There are some (or maybe even many) audiologists and implant centers that will discourage the use of ASL. I think this is because they are focused on the idea that in order for a deaf child to succeed with an implant, they must speak/listen and using ASL will be detrimental for that.

That, of course, is not true. But I still see a lot of people who say that, especially by those who support the auditory-verbal route which by default, tends to include those who are involved with CIs.

There are bilingual bicultural schools for the deaf offer services for children with CIs and encourage those children to be bilingual in both ASL and spoken/written English. However, others do not. It depends where you are. Both Maryland School for the Deaf and Kendall offer services to accommodate children with CIs.

I've heard of some schools which will not do that however, which is too bad. Some families have resolved this by using ASL at home, with Deaf friends, with their nearby Deaf community and sending their child to a mainstreamed or oral school. Or, vice versa: sending their child to a school for the deaf and finding opportunities for them to use spoken English elsewhere (ie: in AV therapy, with hearing friends and family, etc). There really is no perfect solution if the schools are not accepting, unfortunately, but you can find a way to make it work and bridge and build both languages.

Ann said...

I want to Thank you for this article. My daughter is two and wearing aides, she seems to benifit from them, of course I wish she would keep them on!-) It is becoming apparent that her hearing is dipping more and I'm so very confused. We sign as much as possible, I need to actually kick into high gear with that, but I am worried about if implanting becomes an issue with ASL, I want her to have every possible communication mode available to her. Our other concern is losing what residual hearing she does have, I would probably only be hard pressed to accept unilateral CI, she is also legally blind, which is the only reason I think I am willing to consider CI without her being profoundly deaf. So, I guess what I'm trying to figure out is the best option for her that will still allow her to be her. If her vision goes, ASL will mean nothing except tactually, which can be difficult, losing the rest of her hearing, will put pause on her vision also. I am one very torn mother, but thank you for definitely letting me know I'm not crazy for wanting her to still acquire ASL and language.