The Parents' Guide to Cochlear Implants

9. Cochlear Implants and the Whole Child: Implications for Performance

109 COCHLEAR IMPLANTS AND THE WHOLE CHILD Cochlear Implants and the Whole Child: Implications for Performance Chapter 9 Children with cochlear implants demonstrate abilities that often astound parents,teachers,and the children themselves. But not every child with an implant performs in the same manner . What may be success for one child might be viewed as failure for another. Parents should understand that their child’s performance with the implant is often linked to the skills and abilities the child had when he or she entered the implant process . The more children bring to the process, the more they will gain from it. Generally speaking, children with implants demonstrate a range of performance in speech perception and speech production . Auditorily,children with implants can be grouped into three main categories. At the extreme low end are those children who can only detect or recognize sound patterns. For these children, implantation only provides an awareness of sound; they cannot understand spoken language through listening alone. The next level of performance includes children who are able to understand some speech through their implants but still need visual or manual cues to participate in conversations. The highest performing group is made up of those children who can understand speech through listening alone. Despite this good auditory success , these children may still need speechreading cues to comprehend speech, especially in noise. Just how intelligible a child’s speech becomes after implantation also varies. At the extreme low end,there is a group of children whose speech will remain unintelligible. This is followed by a group of children whose speech is understandable as long 110 CHAPTER 9 as the listener knows the topic of the conversation. Finally,there is a group of implant users whose speech is completely understandable ,even to strangers. More often than not, it is likely that a child’s speaking success is related to listening ability. In the chapter that discussed the pre-implant evaluation, we identified a number of factors that shape performance. These were outlined using the tool known as the ChIP (see chapter 2). Beyond the factors identified by the ChIP are additional issues that contribute to any one child’s implant benefit. To begin with, parents should remember that no two children,whether hearing or deaf, are the same. Each one brings a personality, level of motivation ,and general outlook about the world to the process.These traits affect how a child approaches every experience and can also influence the auditory gains achieved after implantation. Videotapes distributed by manufacturers or organizations and schools that champion implantation often show children who are the better performers. Parents considering the implant cannot use these films as the only resource to make predictions about their own child’s performance. This may lead to disappointment for everyone involved. The numerous factors that affect implant performance make it virtually impossible to determine the exact outcome any particular child will achieve. Thus,it is important for parents to understand implant performance considering the“whole child” and not just the“ears.” Factors Contributing to Implant Performance As we noted in the discussion on candidacy, age at the time of implantation and duration of deafness are two critical factors that can affect performance with an implant. When children receive an implant after a short duration of deafness,then achievement tends to reach the high end of the scale. This does not mean that children with a longer duration of deafness cannot 111 COCHLEAR IMPLANTS AND THE WHOLE CHILD receive implants. It just means that the results may not be as great or achieved as quickly as a child who had a shorter duration of deafness. It is obvious that children who are implanted earlier in life will, by definition,have a shorter duration of deafness. Recall ,the U.S.Food and DrugAdministration has approved implantation in profoundly deaf children as early as twelve months of age. Some children have received implants in infancy due to special medical circumstances (e.g.,severe cochlear ossification secondary to early meningitis), thereby exploring the potential for even earlier implantation. The implantation of this younger group is recent and,therefore, analysis of follow-up data is not yet possible . Preliminary results indicate that these deaf infants develop auditory skills in a manner that is more similar to hearing children their own age. The ultimate effect this will have on the development of speech and language skills is being studied...