Recent research is indicating that poor language skills in some children with cochlear implants may be related to genetics and the environment rather than problems with the implant. In some cases, siblings of children with CI’s also demonstrated difficulties in language development, suggesting that some of the problems some children with CI’s face may be the result of hereditary or environmental factors.
The effects of other disabilities
Other disabilities in addition to deafness can be a contributing factor in poor outcomes. One center (Nottingham Cochlear Implant Programme, UK) reports that 5% of the children in its program are diagnosed with autism. Some have inherited syndromes and some have behavior disorders.
The Nottingham group evaluated records of prelingually deaf children who had used a CI for at least 3 years, who performed poorly on language tests, and for whom no reason was identified for limited progress. Results were reported in the journal Ear and Hearing (2011; 32:690.) (Access to the journal is available by subscription.) These children were compared to children with more typical development for a child with CI’s, and the two groups were matched by age, hearing loss, length of time since implantation, age of diagnosis, and non-verbal reasoning. The children in the group that was considered typical had language test scores similar to normal-hearing children with specific language disorders. In other words, they had disproportionate language delays. Siblings of the children with disproportionate language delays also were identified with language delays. Some parents also reported having auditory memory problems and other language concerns.
Hearing with a cochlear implant
Children with CI’s will certainly hear better than they did with hearing aids, but they are still listening through a damaged auditory system and not getting a clear signal – especially when there is competing noise, so some delay is to be expected.
Research on specific language impairment in normal-hearing children has been found to be highly inheritable with an estimate of 20%-40% in affected families. Environmental factors, including language use by family members and peers, and reactions of parents to their child’s deafness, are also significant contributors. So when a child is not doing well, many things are contributing factors. When a child is not doing well, all clinicians working with the family need to work together to figure out why. If a child is not doing well, working with the child alone may not be sufficient. Helping families learn to be better language models can certainly have a significant benefit in improving functioning.