- Cochlear Failures
Recently, I have been doing some reading and a fair amount of thinking about cochlear implants, a common activity in our field at present. In the interest of full disclosure, I should begin by stating that I am on record as having reservations about both the relative efficacy and advisability of cochlear implants with very young children. My reasoning is somewhat nuanced and I will provide some background on it and then raise what I perceive to be an important issue that, if not addressed, may be of potential harm to an unknown number of deaf children. I would be gratified to receive responses from colleagues with a range of perspectives.
Much of my personal philosophy has been influenced by the work of others and by applied research, in some of which I was a participant. I am in accord with the Total Communication approach (TC) as promulgated by Roy Holcomb more than 30 years ago. He advocated the use of all forms of language and communication—ASL, speech, auditory training, English-based signing, the manual alphabet, print, gestures, etc.—according to the needs of an individual child. Unfortunately, this approach was watered down in practice in most programs. First, ASL was seldom, if at all, used. Secondly, Total Communication came to be equated solely with the combined use of use of spoken English and English-based signing, also known as Simultaneous Communication (SimCom), thus detracting from the inclusive nature of Holcomb’s model.
Around the same time that the TC/SimCom concept was gaining favor, I was involved in a longitudinal study of early intervention programs across the United States that included auditory-only, oral-aural, Rochester Method and simultaneous communication approaches. The simultaneous communication programs did not officially use ASL. The results in general indicated that by early elementary years children who had been taught through some form of manual communication had superior academic achievement and English skills to those with no exposure to manual communication. However, using what has been termed a characteristics by treatment interaction model, the effect was pronounced for children with profound hearing losses, but was not evident for those with less than profound losses, suggesting the logical conclusion that the greater the hearing loss the more imperative that some form of manual communication be employed. However, the extent of hearing loss is only one factor in making a decision that should be tailored to the individual child.
A second question that was of importance to us addressed the concern of many parents, educators, and other professionals; does the introduction of manual communication impede the development of oral-aural skills in young deaf children? For generations prior to the 1970s the field was dominated by the belief that any form of manual communication, especially ASL, which was a different language, was detrimental to the development of expressive and receptive spoken language skills and, by extension, print literacy. With the exception only of children classified as multiply disabled, all instruction in schools and programs for deaf children up to age 12 was oral-only. After that age some programs continued as exclusively oral, others used signs either in coordination with speech or sign alone, and others split into oral and manual sections, with the “oral failures” consigned to manual instruction. The idea was that deaf children should be allowed to succeed or fail orally and that at some time around puberty or entrance into junior high school the “failures” be singled out and assigned to signing classrooms.
In our analysis we found that children in two programs had superior test scores for expressive and receptive oral aural communication; one was auditory based and one was simultaneous communication. After observations and analyzing curricula, we concluded that manual communication had no influence, per se, on the development of oral aural skills, the key factor was the level of speech and auditory training. If a program using sign and/or the manual alphabet had a well developed system for speech and auditory training, the results would be similar to those for auditory or oral aural programs. [End Page 423]
The study was conducted before the wide-spread introduction of ASL into classrooms, the...