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October 10, 2014 - ASL bilingual cochlear implant deafhood language development sign
Last week I wrote about a very specific notion, deafhood, which I thought would help clarify the debate that exists over cochlear implants. Since then I’ve realized from talking with people that many aren’t familiar with the debate itself. Rather than restate objective information that is published, or attempt to characterize information I don’t believe is helpful, I’m going to re-thread the debate with a practical example using a much more agreeable notion: the importance of language development.
If you’re choosing implants for your deaf infant, it becomes a matter of addressing how you’re going to make sure your child maintains a healthy language development trajectory.
Babies are highly sensitive to the language in their environment. With enough exposure they have no problem learning multiple languages simultaneously. My niece Ella is about 18 months (in this video) and her spoken English is developing normally, but she’s babbling in sign to communicate with her grandpa who is deaf.
Before we get in the water, some basics: Cochlear implants represent a breakthrough in biomedical technology, in that they offer the perception of sound through the surgical implantation of a sophisticated hearing aid. Surgical implantation near the ear for those eligible, can in the long run improve existing hearing or in some cases offer hearing where there was none. There are hard constraints in attempting to offer a solution without complications, but on many fronts it is reasonable to assume the technology will improve. This is not unique to the implants, it’s a reality for most biomedical solutions: therapy, recovery, and possibly adjustments to lifestyle choices. However, it is also clear that neuroscientific, psychological, and technical insights will only improve. In that these implants are the first of their kind in many regards, there are a few complications which may escape casual observation. Part of the “debate” where it unfolds, is over the proper discussion of these complications (and as my previous post elaborated, the inclusion of an alternative, pro-deafhood perspective). Ok, we can dive in (we’ll mostly skip over limitations of hardware and surgery. Language development and cochlear implants
90% of deaf infants are born from hearing parents. So what do hearing parents do if their child is born deaf? The overwhelming intuition is to see how to adapt the child as hearing. Cochlear implants are the clearest, most promising contribution to that intuition. But regardless of how quickly a newborn is identified as deaf, the earliest allowable age for implantation is 12 months. Meanwhile, most children are developing precursors to a fluent language from day one. Obvious milestones for infant language development are measurable as early as 4 and 5 months. Infants are already predicting where to look in response to verbal cues, and recognizing their name, “mom” and “dad”. By 9 months they’re able to rapidly learn and recognize novel objects from paired sounds. For hearing children they’re already organizing a world of sounds with meanings. And in the past few decades careful research has shown the same trajectory on these milestones for deaf children, too. They notice hand gestures, and they babble with their hands. Meanwhile, what are infant candidates for the cochlear implant learning? If your goal is the greater well-being of the child, then it seems obvious to immerse your child in signing environments, at least during the first 12 months. This can only benefit the eventually hearing child. Bilingual children match their monolingual peers on early language development milestones. But I couldn’t find this suggestion on any of the above-mentioned sites claiming to provide impartial advice for the well-being of an infant. The bottom line is meaningfully addressing what is best for the child. Regardless of implantation or not, the road to a fulfilling development takes a serious dedication that is very trying for anyone involved. The reality is that a child with a bionic ear can be “normal” just a deaf kid can. They both will face difficulties in accommodation. But those difficulties can be reduced to two things: what others think (partially addressed in my last post), and how much language they get. Choosing with respect to the former is a personal. For the latter, the key to a successful life lies in providing an immediate and immersive language environment. I side-stepped mechanical limitations of the implant earlier, but I want to keep our splash in the debate brief. If you want to stay in the pool, here’s a balanced page from yet another perspective, the NIDCD. With respect to staying in a literal pool, the newest implants still require a separate upgrade and special batteries, and you’re limited to 2 hours. FAQ of relevant info (most taken from the sources linked in the first question):
- For those who are eligible, how much is their hearing improved?
The answer from publicly accessible authorities ([American Speech-Language Hearing Association](http://www.asha.org/public/hearing/Cochlear-Implant-Frequently-Asked-Questions/]), [Hearing Loss Association](http://www.hearingloss.org/content/cochlear-implants), [FDA](http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/CochlearImplants/ucm062866.htm)) is vague: it depends, and can't be adequately estimated until after the implantation.
What determines improvement?
- For kids and adults older than two, having prior hearing. For all, extensive therapy.
For those that benefit, what is the time-course for improvement?
- Most improvements are near-term, and after months it plateaus.
What limits are imposed on the lifestyles of those with electronics in their head?
- The external component can't be near metal detectors, can't get wet or hit. The internal component's technology may not be updatable.
What is the [financial commitment](http://www.asha.org/public/hearing/Cochlear-Implant-Frequently-Asked-Questions/)?
- $53,000 for the surgery and an estimated $1 million lifetime cost. (Many insurance plans cover aspects of this.)