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120 6 THE PSYCHOSOCIAL DEVELOPMENT OF DEAF CHILDREN WITH COCHLEAR IMPLANTS Gunilla Preisler This chapter discusses the psychosocial situation for deaf children with cochlear implants from multiple perspectives: the parents’ perspective, the teachers’ perspective , and the children’s perspective. It considers results from international research and a recent Swedish longitudinal study that (a) indicate problems if communication and education for children with implants is based only on speech and (b) suggest that a cochlear implant cannot replace using sign language, but it can facilitate everyday life in hearing families. Nearly fifteen years have passed since the first deaf child in Sweden received a cochlear implant. Today, almost 90 percent of deaf children are implanted each year, many of them bilaterally. What do we now know about the effects of the implant on the life conditions of these children? Until the mid-1970s, deaf children predominantly received an oral education in most countries around the world. The implications of this practice were that being deaf was understood as being disabled and that the opportunity to obtain good school results and therefore take part in the wider society was limited (Gregory 2002). Has improved hearing ability, the case for most children receiving an implant, given them increased opportunities to use and understand speech as well as to take part in cultural and social activities with hearing people? Do they now have a better quality of life? These questions raise an important methodological issue for researchers, namely, how to measure quality of life in these children. Most deaf children who receive an implant today, receive it at an early age. Therefore, it is not possible for them either to compare what it was like to live without an implant or to imagine what it would have been like. One way of addressing this problem is to make comparisons between deaf children with implants and deaf children of similar age and in similar circumstance who do not have implants. However, it is not easy to find a group of deaf children without implants that is comparable with a group of children with cochlear implants in all relevant aspects other than the implant. A number of comparative studies between children with cochlear implants and those using other technical devices have been made with respect to the outcomes on speech perception and speech production tests (see, for example, Geers and Moog 1994; Miyamoto et al. 1995; Meyer et al. 1998; Allen, Nikolopoulos, and O’Donoghue 1998; Svirsky et al. 2000). However, it has been difficult to draw valid conclusions from these studies because baseline information (on measures of hearing status, language ability, or other related variables such as the families’ level of education or socioeconomic status) that would determine the degree of comparability between the groups before those in the implant group received their implants is seldom or never made available (Spencer and Marschark 2003). PSYCHOSOCIAL DEVELOPMENT OF DEAF CHILDREN WITH COCHLEAR IMPLANTS 121 The studies mentioned above indicated that the children made progress with the implant. However, that progress—discriminating certain target words or being able to utter single words and simple sentences—is not sufficient when one wants to take part in social activities with others. In many studies, the child’s auditory development is mistaken for language ability (Blamey et al. 2001). Blume (2002) made a review of studies on quality of life in adults and children. He found the studies indicated that there were positive effects of implantation. He also found that the children themselves were not involved in the studies. Either experts (physicians and researchers) or parents (who responded on behalf of the child) decided what important improvements were made after implantation. Measurement of quality of life with respect to cochlear implants has primarily concerned the costs and benefits of the procedure (see O’Neill et al. 2001). These studies adopted a dominant societal or hearing perspective. To date, there have been no studies from the perspective of deaf children themselves (Blume 2002). In this chapter, I intend to shed light on the children’s psychosocial situation, not only from a societal or hearing perspective (mainly represented by parents and teachers) but also from the children’s own perspective. I use the term psychosocial to mean the child’s potential and ability to initiate and comprehend communication with others. Reciprocity, mutual understanding, and shared meaning are regarded as important prerequisites for well-functioning psychosocial development. The children’s language, play, and interactions will be regarded as important markers of psychosocial developmental...

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