K.L.s Wondering Mind

Location: Des Moines, Washington, United States

Friday, April 11, 2008

The Biggest Myths

The following discussion is specifically about profoundly deaf children. Yesterday on Jodi’s blog there was a discussion about myths and inaccuracies. One anonymous commenter chimed in with a comment about how much they disapprove of implanting babies. I know this blog is aimed at families who are already past this discussion, and are more interested in providing both spoken language and ASL for their implanted kids. However, sometimes we need to go back and visit other issues. Like myths. A common belief that I have encountered is that babies should not be implanted, that the child deserves to make this decision for him/herself. The myth then is that the implant will work as well for older kids and teens as it does for babies. An associated myth is that there is no way to estimate how successful the implant will be with a given individual, or that there is not enough information available to make an informed decision on the best age to implant your child. WRONG. On all counts. While it is true that you cannot guarantee results prior to implantation, there is plenty of information now to get a very good idea of how well the implant will work. It is not the same for everyone, and takes into account how much residual hearing you have had, how good your verbal speech is, what your history is, how old you are and how determined you are, among other things.

Last week, my family attended a seminar on early language acquisition, put on by Cochlear Corp. Heather Whitestone McCallum was there, and my daughter was invited to be part of her presentation. My daughter was invited because of her early implantation and subsequent success with her implant and verbal language abilities. We really enjoyed the seminar, and got some good information. Some of that information is relevant to this discussion. Dianne Hammes, with the Carle Clinic and Foundation presented a study regarding the outcomes of four groups of children, grouped by age of implantation. The results of her study showed that children implanted by 18 months of age had near normal speech and language ability, while those implanted after 19 months of age got farther and farther from hearing average the older they got. And the older they were at implantation, the more they deviated from the norm.

There has been quite a bit of research regarding age of implant versus level of acquisition of verbal language that supports that study: see here and here and here. These are just a couple of the many results I came up with when I Googled “Effects of early implantation on speech and language. All of them agree that earlier is better, and that children who are implanted by 18 months of age have a very good chance of achieving speech and language abilities in the same range as their hearing peers. This does not make them hearing. It means that their brains can understand verbal language at the same level.

The important point here is that the brain is an integral part of the success of the cochlear implant. How well the brain can integrate sound is directly connected to the age at which the brain is introduced to sound. By the time a child is old enough to decide for him or herself, they are well beyond the age when the brain can easily integrate sound into meaningful understanding. So the parents who choose to wait and let the child decide, are actually choosing against getting the implant. One way or the other, the parents DO decide. It is far better for them to be intentional in their decision making. I know parents who are now very angry at the Deaf Community because they were led to believe that they could wait, and it would not impact the success of the implant. When they found out otherwise, they felt that they had been lied to by the Deaf Community. This serves nobody. It is more important to keep the lines of communication open, and keep the relationship intact than it is to have the parents follow the “ASL only” ideology without full understanding of all of the options.

The children who will have the highest success with both American Sign Language and the verbal English Language are the ones who are implanted prior to 18 months of age and who are instructed in both English and ASL from birth. This will take dedicated parents and a supportive community.


Tuesday, April 01, 2008

testing a methodology blog


As many of you know, while I support bilingualism, I myself do not know ASL at all. My daughter, who is almost 10 now, lost her hearing at 7 months of age, and was implanted just after her first birthday. We looked at all the early intervention programs, methodologies and school age programs, and went with Total Communication with Signing Exact English (TC-SEE). NorthWest-School. We started signing as soon as her hearing loss was diagnosed, even before she was implanted. And she picked up signing quickly. She also picked up spoken English after her implantation, and became primarily oral by the time her second birthday came around. We continued with TC and she entered a private TC school at age three. By age four, her receptive and expressive verbal language was above age level average for hearing kids. And her signing was just as good. Eventually she was mainstreamed, and the signing was dropped, because she simply didn’t need it. Her implant really does work that well for her. However, she is good at signing and we don’t want her to loose that. So she will be learning ASL starting this summer. All that having been said, the question remains, why didn’t we just start out with bilingual ASL and English?

There are primarily two reasons we went with a TC program using SEE instead of ASL. The biggest reason is that there were absolutely no ASL programs that included speech. Sure, if you wanted some speech therapy included, they would bring in a speech-language pathologist (SLP) once a week for a one hour session. But the TC program with SEE had all teachers and kids say and sign everything. All the time. It was a huge difference. And it had more than 20 years of test scores of the students showing that academically, it had high standards and results. The other reason was parental support. The TC program had tons of parental support for both the signing and the verbal aspects of the program. The ASL programs had plenty of ASL support, but absolutely none for the verbal aspects. That is one thing the TC program has in common with AVT. Parental support.

There is a general question floating around the blogosphere. “Why don’t the parents just add ASL to their Auditory Verbal Therapy (AVT) lessons, and make their children bilingual?” It would seem to be a simple and economical solution. It isn’t. To understand the problem, you need to understand AVT. Auditory Verbal Therapy. It is exactly what it sounds like. Hearing and speaking. No signing. It is not only how they teach AVT, it is a basic philosophy. They believe that to maximize the auditory pathway growth in the brain, they spend a great deal of time teaching the child to listen and speak. To add sign, means the child might get the information visually rather than aurally. That would not strengthen the auditory portion of the brain. There are plusses and minuses to this method. A big plus is that for early implanted children, it is exceptionally effective. The minus is that it doesn’t work for all children, and it really has problems with older implanted kids. And it leaves those children without nearly enough language. And those children have no ability to communicate with ASL folks in the Deaf Community.

So why do parents use this method? Parental support is a big reason. Proven results is another. So how do we promote bilingual ASL and spoken English for those families who have chosen cochlear implants? It isn’t enough to simply say “Add ASL to whatever methodology you are currently using”. Most methodologies either already incorporate a different form of sign, or are philosophically against sign altogether. And it is horribly unfair to ask parents to choose a methodology and then have them go against what they have chosen to crib in ASL on top of it. Since most parents are hearing, and generally new to Deaf Culture and such, they are understandably overwhelmed. They need to find a single methodology that supports them, and shows proven results. They need to visit the program, see the kids and talk to the other parents. What they need is an ASL English bilingual program that does everything in one program. One that provides ASL classes, speech and verbal language support and an understanding and acceptance of cochlear implants.

There are lots of ASL programs around the country. How many of them have successful verbal language incorporated into the program? If there are any, those programs need to be emulated by other ASL programs around the country. If there aren’t any, then a model needs to be created that can then be incorporated by other ASL programs. A national support system needs to be put into place so each of these programs can support each other. And continuing education can be implemented.

If we want parents to teach their children ASL and English, then we need to give them the programs to do just that. Do you know of a successful program that does this? We’d like to hear about it.