Research Paper

The use of cochlear implants (CIs) in children has become increasingly controversial since they were originally designed in 1957. In Canada, candidates for CIs suffer from severe to profound sensorineural hearing loss (70dB HL or worse) in both ears (Cochlear Implants, 2018). The majority of deaf children are born into hearing families and therefore have additional barriers to overcome in their developmental journeys. Selecting a communication method is one of the most important and difficult decisions the parent of a Deaf child must make. However, professionals and community resources present opposing information about the advantages and disadvantages of various therapies and modes of communication. Cochlear implants are still relatively new technology, and amendments should be made so that treatment protocols reflect the most recent research available. Recent research has demonstrated the various benefits of the use of Sign Language in conjunction with CIs, yet many support services actively discourage or prevent its use. It would be highly beneficial for Deaf children and their families if current policies would begin to encompass the many benefits of a multi-modal approach to language. Deaf children should be required to develop some form of signed communication prior to the insertion of a cochlear implant to reduce the risk of developmental delays and provide a constantly available form of communication.

The support systems in place for the hearing families of Deaf children are partially responsible for the developmental delays displayed by CI users during childhood. Deaf children born into hearing families are particularly disadvantaged because they are born without access to their parents’ native language. The current support systems that exist in North America for families of hearing-impaired children do not adequately educate parents on the communication strategies they should or could employ (Snoddon, 2008, p. 583). Parents develop high expectations in a CIs ability to develop “normal” speech and language. As a result, only some parents prioritise using whichever communication method will be most beneficial for their child’s overall development (Hyde & Punch, 2011, p. 542). Unfortunately, even early implantation of a CI does not guarantee the development of spoken language skills (Hall, 2017, p. 962). Unless support services set realistic expectations, parents are likely to assume that whichever therapy method they utilise will develop complete speech skills that negate the need for a signed language. Hearing parents of Deaf children rely on the advice of professionals and community resources to guide their decisions (McDonald Connor, Hieber, Arts, & Zwolan, 2000, p. 1186). Ironically, “social work programs, like speech-language pathology and medical training programs, generally do not provide their students with in-depth information about deaf people or signed language” and they are likely to make recommendations based off public policies rather than scientific research (Snoddon, 2008, p. 592). Ontario’s Infant Hearing and Communication Development Program (IHP) requires children to be immersed in oral communication methods following implantation (p. 592). Research studies in Australia have also shown that many parents are actively discouraged from using any form of signed language with their deaf child (Hyde & Punch, 2011, p. 542). In contrast, Sweden requires children to learn Sign Language for them to be considered for a CI (Snoddon, 2008, p. 587). A correlation was demonstrated between signed language and spoken language abilities in Swedish children, though most children became less dependent on their use of Sign Language as language skills developed (Hyde & Punch, 2011, p. 537). There is no evidence that learning Sign Language negatively impacts the ability to learn spoken language, so it is surprising that any intervention programs would discourage using a language that is fully accessible to the child. Early intervention is fundamental to developing language skills, so misinformation by authoritative figures often leads to uninformed decisions being made which result in developmental delays.

Deaf children need to be exposed to Sign Language from they moment they are diagnosed with profound hearing loss to minimise the risk of language delays. There is a critical period of language development in all children which usually ends in early adolescence, and language deprivation during these years can drastically impact the formation of neural networks (Easterbrooks & Baker, 2002, p. 55) (Hall, 2017, p. 962). Without exposure to Sign Language, Deaf children are completely deprived of language prior to CI implantation. If deprived from language during this critical period, they may struggle to develop any formal language skills – whether signed or spoken (Mayberry, 2006, p. 38). Oral communication advocates often believe that Sign Language affects the ability to develop spoken language skills, but there is very little evidence to substantiate this belief. It is possible that the consequences of language deprivation are being confused with the impact of Sign Language on spoken language acquisition (Hall, 2017, p. 961). Although some research does suggest that children immersed in oral communication programs have higher consonant-production accuracy scores, the studies that established such conclusions are either out-dated or so affected by limitations of sample size and uncontrolled variables that their results must be taken with a grain of salt (McDonald Connor, Hieber, Arts, & Zwolan, 2000, p. 1185). Unlike speech, Sign Language is fully-accessible prior to CI implantation and allows the opportunity for Deaf children to progress at normal rates of language development. This is clearly demonstrated by Deaf children born to Deaf parents who reach language developmental milestones at the same ages as hearing children (Snoddon, 2008, p. 585). However, 90% of deaf children are born into hearing families and are not naturally exposed to this form of communication. With adequate support from their hearing families and community services, knowledge of Sign Language seems to promote rapid language development following implantation (Hyde & Punch, 2011, p. 545). Although early implantation may expose children to language within the critical period, they may struggle to associate auditory stimuli with words. Some children may be able to transfer their knowledge of “verbal skills from sign language, learned earlier on, to spoken language,” but not all of them will be so successful (Jimenez, Pino, & Herruzo, 2009, p. 113). Tim Lane, an American Sign Language (ASL) instructor at the University of Victoria, explained his experience with assistive hearing devices as having little effect on his ability to comprehend speech. Roughly translated from ASL, he said that they allowed him to understand his environment, but that speech was very hard (personal communication, November 20, 2018). This suggests that early acquisition of Sign Language can also act as a safety net for children that struggle to adapt to their CIs.

Oral communication advocates are often concerned that children will become dependent on visual communication if Sign Language is developed before speech. However, exposure to Sign Language develops the same inherent properties of language as speech and, in fact, facilitates the learning of spoken English as a second language. The lexical and grammatical components of Sign Language provide a foundation for learning a spoken language (Snoddon, 2008, p. 591). Evidence also suggests that “bilinguals are associated with better cognitive outcomes when compared with monolinguals” (Hall, 2017, p. 961). As their communication skills continue to develop, many children become less reliant on signed communication. Additionally, they find it easy to swap between communication modes depending on their environment (Hyde & Punch, 2011, p. 545). These findings suggest that most children are only “dependent” on signed communication when they are speaking with another member of the Deaf community or are unable to use their CI. Furthermore, delayed development of a signed language may cause the visual information to be processed in a less efficient manner (Hall, 2017, p. 962). Sign Language is frequently used as a remedial therapy once a child reaches school age, but it is not as practical a rehabilitation option if it requires active processing in the brain due to delayed acquisition. New developments in childhood hearing assessments have resulted in an upward trend of early CI implantation. Cochlear implants are proven to be more successful when implanted before the age of 5, but it may not be possible to diagnose other learning deficits at such an early age (Hyde & Punch, 2011, p. 547). Some research suggests that learning two languages is too demanding for children with specific language impairment and therefore does not support the early development of Sign Language (Snoddon, 2008, p. 588). Contrastingly, new research suggests that children with special needs are likely to benefit the most from the additional support of signed communication (Bosco, D'Agosta, Traisci, Nicastri, & Filipo, 2010). In short, it is advantageous to expose children to whichever form of communication is fully accessible to them and will be acquired easily.

Language deprivation contributes to the social and emotional delays frequently exhibited by Deaf children, but exposure to signed communication in early adolescence facilitates the development of social skills and emotional resilience. Hall (2017) argues that some of the negative consequences of language deprivation include “cognitive delays, mental health difficulties, lower quality of life, higher trauma and limited health literacy”. Difficulties communicating with family and peers result in fewer conversational opportunities (Snoddon, 2008, p. 594). As fewer opportunities present themselves, children have fewer chances to practice social skills and form relationships. Learning Sign Language as early as possible is fundamental for the development of an accessible language that allows communication prior to the use of a CI. Language abilities foster a child’s understanding of appropriate social interactions. Some family members will have great difficulty developing Sign Language skills themselves, and the problems that arise from fractured communication with their child may increase anxiety and lead to emotional deficits (Marschark, 2007, p. 220). As a result, it is important that all family members actively participate in communicative strategies. As delays in social skills develop, so do emotional deficits. Frustration and anxiety conveyed as temper tantrums may be a direct result of difficulties communicating and understanding social cues. As children continue to develop, depression may be attributed to feelings of isolation and struggles with identity. Deaf children born into hearing families are not naturally involved in the Deaf community. The use of a CI adds to the disparity between their hearing and Deaf identity, and so Deaf children may find it difficult to recognise themselves as part of either community (Hyde & Punch, 2011, p. 545). Though some CI users will discover Sign Language independently to form a relationship with the Deaf community, it becomes significantly more difficult to learn any language after adolescence. An established understanding of Sign Language allows a CI user to readily engage with the Deaf community and develop a social network that understands the obstacles they face on an everyday basis. A feeling of identity and support is essential for developing emotional resilience.

Contrary to what parents may want to believe, children with cochlear implants are “still deaf” and there will always be moments where Sign Language is the most viable form of communication. Cochlear implants are relatively new technology and are very susceptible to damage – particularly in the hands of children. One study demonstrated replacement rates in children as high as 25% (Marschark, 2007, p. 47). Furthermore, maintenance and repair of a CI may not always be financially feasible. In the face of a technological malfunction, a child may be left without access to language for extended periods of time. There are also children who outright refuse to wear their implant and are vulnerable to the same language deprivation. Children impacted by this lack of technology may have had the opportunity to develop speech skills but are limited by their abilities to converse back and forth without sound or signed communication. Lip reading and communication through written messages is ineffective and exhausting. A knowledge of some signed communication can support families, teachers and peers through these difficult times. It can also be beneficial for activities such a swimming where a CI cannot be used; “It’s partly safety, and it’s partly to keep in communication” (Hyde & Punch, 2011, p. 543). It is not essential that families use Sign Language as their primary means of communication, but it is beneficial for all family members to understand the basics to prevent breakdowns in communication and support difficult conversations.

Advances in technology and research are yet to diminish the presentation of developmental delays in Deaf children. Consequently, it is appropriate to consider the inadequacies of support systems in successfully promoting the development of language, social and emotional skills. The support systems that exist in many parts of the world do not adequately educate parents, and follow policies that are not congruous with current research and developments in CI technology. As a result, many children are vulnerable to delays due to language deprivation during the critical development window of adolescence. Despite the arguments against the early acquisition of Sign Language, many parents find it beneficial to use signed communication in conjunction with other communication strategies. Strict policies about therapeutic communication methods prevent families from being able to create a flexible regime that is ideal for their family logistics and child’s development. Families that were supported in exploring multiple paths held more favourable opinions of their support services and their outcomes. That being said, most families that follow strict treatment protocols are usually dissuaded from using signed communication. The idea of this research is not to refute the benefits of cochlear implants or oral communication, but to show the advantages of supporting oral communication with Sign Language during early adolescence. Although it is incredibly difficult for adults to learn the Sign Language skills necessary to interact with their Deaf child, changes to policies should make support services more readily available to families and develop programs that cater specifically to communicating with children. Regardless of which mode of communication a family decides to employ, a Deaf child’s success will ultimately be determined by their family’s dedication and commitment to their ongoing development.

SUMMARY COMMENTS

I commented on the rough drafts, so I will not add much here. You generally did a great job of presenting all of the relevant issues around sign language and cochlear implants. You made a good argument, although, as you point out in your self-assessment, there’s not a substantial movement to not have children learn sign language as well. It’s not as much of a controversial topic as it might have been. That being said, you did bring in more counterargument for this draft, so we do get a better sense that that there is some form of controversy at least. You make good use of secondary sources, and the paper is very well-written in terms of prose writing. The organization is fairly clear too.

References Bosco, E., D'Agosta, L., Traisci, G., Nicastri, M., & Filipo, F. (2010). Use of sign language in paediatric cochlear implant users: Whys and wherefores. Cochlear Implants International, 11, 249-253. doi:10.1179/146701010X12671177988959 Cochlear Implants. (2018). Retrieved November 27, 2018, from Canadian Hard of Hearing Association: https://www.chha.ca/hearing-education/cochlear-implants/#Candidate Easterbrooks, S. R., & Baker, S. K. (2002). Language learning in children who are deaf and hard of hearing: Multiple pathways. Boston, MA: Allyn & Bacon. Hall, W. C. (2017). What you don’t know can hurt you: The risk of language deprivation by impairing Sign Language development in Deaf children. Maternal and Child Health Journal, 21(5), 961-965. doi:10.1007/s10995-017-2287-y Hyde, M., & Punch, R. (2011). The Modes of communication used by children with cochlear implants and role of sign in their lives. American Annals of the Deaf, 155(5), 535-549. doi:10.1353/aad.2011.0006 Jimenez, M. S., Pino, M. J., & Herruzo, J. (2009). A comparative study of speech development between deaf children with cochlear implants who have been educated with spoken or spoken + sign language. International Journal or Pediatric Otorhinolaryngology, 73, 109-114. doi:10.1016/j.ijporl.2008.10.007 Marschark, M. (2007). Raising and educating a Deaf child: A comprehensive guide to the choices, controversies, and decisions faced by parents and educators (2nd ed.). New York, NY: Oxford University Press. Retrieved from https://ebookcentral.proquest.com/lib/uvic/detail.action?docID=415689# Mayberry, R. I. (2006). Learning Sign Language as a second language. In K. Brown (Ed.), Encyclopedia of Language & Linguistics (2nd ed., pp. 743-746). Elsevier. doi:10.1016/B0-08-044854-2/05260-3 McDonald Connor, C., Hieber, S., Arts, H. A., & Zwolan, T. A. (2000). Speech, vocabulary, and the education of children using cochlear implants: Oral or total communication. Journal of Speech, Language and Hearing Research, 43, 1185-1204. Snoddon, K. (2008). American Sign Language and early intervention. The Canadian Modern Language Review, 64(4), 581-604. Retrieved from muse.jhu.edu/article/241545

Audience Analysis:

This essay is written with an academic audience in mind. One target audience would be the professionals and community workers who support families and advise on Deaf therapies. As mentioned in my essay, there are many professionals who may provide advice on therapy options for Deaf children who are not sufficiently equipped to do so. Additionally, it targets the people who make decisions about the government-funded support systems that are available to Deaf families. The purpose of the essay is to encourage the target audience to act on current research to make changes and amend early intervention protocols by adjusting the requirements necessary to qualify for a cochlear implant.

Although they are not part of an academic audience, parents of Deaf children would benefit from reviewing the information presented in this essay. The information presented also acts as a valuable source of information for parents on the benefits of Sign Language development.

Lastly, researchers are a target audience for this essay. Some of the “recent” research in this field is from as early as 2002. Put in to perspective, such research is a quarter of the age of cochlear implant technology itself. This essay presents some of the holes that exist in research and areas that should be explored in further depth.

Self-assessment:

1st draft:

As is abundantly obvious from the lack of introduction and conclusion, my essay is still a work in progress. I read so much information in the planning stage of this assignment that I struggled to decide which research would be most relevant. I tweaked my thesis a little bit from what I had originally proposed so that it would be supported more by existing research in the field. My first paragraph originally contained so much information that it now represented by two paragraphs. However, I am worried that these paragraphs are still quite long.

I have used strictly authoritative sources except for one direct quote from my ASL lecture. I emailed him to verify whether it would be OK to include in my assignment and am still waiting for a response, so it may not be included in my final draft. I think that the authoritative sources are essential for the essay to fulfil its purpose.

I enjoyed researching this topic but was inundated with information that focused on the benefits of early CI implantation. The benefits of early implantation are widely reported and agreed upon, whereas the use of Sign Language and remedial therapies are significantly more controversial. I chose to focus on this aspect of Deaf language development because I think it deserves considerable attention and further research.

2nd draft:

This draft of my essay not finally has an introduction and conclusion. I made a few slight changes to the body of the essay, but most of the ideas remain the same. I took in to consideration your point about making a break in my last paragraph. Instead of separating it, I have bridged my ideas a little bit more clearly so that they form a more cohesive paragraph. I thought that the social and emotional skills were closely intertwined so didn’t want to separate them unnecessarily. If you still think that they form separate ideas, then I will form two paragraphs.

Final draft:

I got the go-ahead from my ASL lecturer to keep a quote from him in the body of my essay. I thought I may have had to cut it out at the last minute, but now get to keep that paragraph the way it is. I had to do a little bit of digging to check how to cite it originally and found some conflicting information when searching for how to cite lecture material that wasn’t presented in written form.

I added a couple of small counter argument comments, but there is very little current research that actually suggests that learning Sign Language is damaging to speech/language development. Instead, I’ve broached the idea that research is not keeping-up with the developments in CI technology. I also adjusted my conclusion to give a slight run-down of what was covered in the body of my essay in more direct terms.