Cochlear Implants in Children: Ethics and Choices

CHAPTER 4. Language Development and the Decision to Get a Cochlear Implant

99 CHAPTER 4 Language Development and the Decision to Get a Cochlear Implant Language development is probably the most contentious issue among those involved in the discussion concerning pediatric implant effectiveness, and we devote an entire chapter (chapter 9) to this issue later in the book. One of the major reasons why the parents we talked with wanted to get a cochlear implant for their child was because this would presumably provide the child with the auditory information needed to more effectively develop spoken language. Since this is a primary issue for most parents, we asked them how important their perception of their child’s language deficiency was in the decision to get an implant. We discussed this issue with 45 of the families we interviewed (who had a total of 49 children). Table 4.1 summarizes various preimplant spoken and signed language development categories as articulated by the parents; obviously, some parents described their child’s pre-implant language development in more than one way. For example, some parents reported that their child had a good amount of pre-implant sign language development and, at the same time, had little if any pre-implant spoken language development even with hearing aids. 99 It is important to keep in mind that table 4.1 summarizes the language development categories as identified by the parents we talked with, not by us.When issues related to pre-implant language development were raised, we wanted to allow the parents to describe the type of language or method of communication their child had acquired and was using before implantation.We did not want to ask parents to choose from a predefined list of options. This approach, while allowing parents to expand on the nature of their child’s pre-implant language development, does make it difficult to neatly categorize their responses.Moreover, because of the relatively unstructured nature of our interviews, we cannot say that 100 PEDIATRIC COCHLEAR IMPLANTS TABLE 4.1 Parent-Identified Pre-Implant Language Development Categories Language Development as Number of Children as Identified Identified by Parents by Parents in Each Category* Little if any spoken or signed language development 4 before hearing aids were used Little if any spoken language development before an implant 21 even with hearing aids Speech delayed or absent pre-implant 12 Language delayed vis-a-vis peers pre-implant 15 Some to good sign language development pre-implant 19 Some to good spoken language development before hearing loss 5 Some to good pre-implant spoken language development with 6 hearing aids pre-implant * The total number of children referred to in terms of language development is 49.Many children are included in more than one category. because a given parent did not mention some aspect of pre-implant language development (speech, for example) that it was not important to them. It is also important to remember that we asked parents to talk about something that, for many, happened several years ago in the context of a wide-ranging discussion that also touched on many other issues. Perhaps the most appropriate way to interpret table 4.1 is to see it as a“group photograph”of pre-implant language acquisition in which the following images seem to be most salient for the parents we talked with: Spoken language was delayed, in terms of actual achievement and in comparative terms with similar-age children, sign language (or, more broadly, some variant of manual communication) was generally valued and encouraged by many parents, and hearing aids often did not provide enough amplification for oral language development. One of the major reasons why parents were concerned about pre-implant language development was because of a perceived “window of opportunity” that they felt they needed to take advantage of.Many parents thought that if their child did not develop language at an early age, generally within the first 3 years, then subsequent language acquisition would be truncated. (See chapter 9 for a detailed discussion of this issue and other issues related to language development;suffice it to say here that parent perceptions are not always consistent with research findings.) The mother of a young boy who was implanted shortly before his second birthday said: We were told from the beginning that children only have a certain window of time to get spoken language or to get any language. Mother of a 4-year-old boy implanted in 1996...