Although cochlear implants improve the ability of profoundly deaf children to understand speech, critics claim that the published literature does not document even a single case of a child who has developed a linguistic system based on input from an implant. Thus, it is of clinical and scientific importance to determine whether cochlear implants facilitate the development of English language skills. The English language skills of prelingually deaf children with cochlear implants were measured before and after implantation. We found that the rate of language development after implantation exceeded that expected from unimplanted deaf children (p < .001) and was similar to that of children with normal hearing. Despite a large amount of individual variability, the best performers in the implanted group seem to be developing an oral linguistic system based largely on auditory input obtained from a cochlear implant.Most children who are born profoundly deaf or who become deaf before the age of 3 fall significantly behind their normal-hearing peers in their mastery of the surrounding oral language in its written, read, spoken, and signed forms. Studies of English achievement in this population document significant delays in all language domains (Davis, 1974;Geers, Kuehn, & Moog, 1981;Levitt, McGarr, & Geffner, 1987;Osberger, Moeller, Eccarius, Robbins, & Johnson, 1986). Lexical-semantic and syntactic-morphological abilities have been shown to be severely delayed regardless of whether the profoundly deaf children used oral communication (OC, which excludes the use of manual signs) or total communication (TC, the simultaneous use of oral and manual language). Numerous studies have found that profoundly prelingually deaf children lag in their English language abilities with respect to normal-hearing children. For example, a group of children was tested before and after a 3-year experimental instructional program designed to provide maximum academic achievement under ideal conditions (Moog & Geers, 1985). These children were deaf at birth or before their first birthday, received early amplification and instruction, and had at least average nonverbal intelligence. After training, despite a mean age of 9.92 years, their receptive and expressive language abilities (as tested with the Northwestern Syntax Screening Test, which samples a variety of syntactic English skills; Lee, 1971) were at the level of normal-hearing 4.5-to 6.3-year-olds. Delays in language development were also found in a large-scale study of Stanford Achievement Test Reading Comprehension scores in 8-to 18-year-old hearing-impaired students who received special services in schools throughout the United States. The study showed that by the time these students finished high school, their median reading comprehension levels were below those of average normal-hearing third graders (Allen, 1986 Until the early 1980s, there was no treatment that would allow profoundly deaf persons to improve their hearing so they could understand speech again. With the a...

These results demonstrate that pediatric cochlear implant users are sensitive to the acoustic-phonetic similarities among words, that they organize words into similarity neighborhoods in long-term memory, and they use this structural information in recognizing isolated words. The results further suggest that the PB-K underestimates these subjects' spoken words recognition.

This study examined the effects of age at implantation on the development of communication abilities in children with early implantation. The 73 participants were prelingually deafened, received a cochlear implant before 5 years of age, and used current cochlear implant technology. The children were administered a battery of speech and language outcome measures before implantation and again at successive 6-month postimplant intervals. A mixed model analysis was used to examine the rate of growth in word recognition and language skills as a function of age at time of implantation. The results revealed significant improvements in communication skills over time. Spoken word recognition improved at a faster rate in the oral children with early implantation. However, the children who underwent implantation before 3 years of age had significantly faster rates of language development than did the children with later implantation. The oral children demonstrated more rapid gains in communication abilities than did the children who used total communication.

SummaryObjective-We adapted a behavioral procedure that has been used extensively with normalhearing (NH) infants, the visual habituation (VH) procedure, to assess deaf infants' discrimination and attention to speech.Methods-Twenty-four NH 6-month-olds, 24 NH 9-month-olds, and 16 deaf infants at various ages before and following cochlear implantation (CI) were tested in a sound booth on their caregiver's lap in front of a TV monitor. During the habituation phase, each infant was presented with a repeating speech sound (e.g. 'hop hop hop') paired with a visual display of a checkerboard pattern on half of the trials ('sound trials') and only the visual display on the other half ('silent trials'). When the infant's looking time decreased and reached a habituation criterion, a test phase began. This consisted of two trials: an 'old trial' that was identical to the 'sound trials' and a 'novel trial' that consisted of a different repeating speech sound (e.g. 'ahhh') paired with the same checkerboard pattern.Results-During the habituation phase, NH infants looked significantly longer during the sound trials than during the silent trials. However, deaf infants who had received cochlear implants (CIs) displayed a much weaker preference for the sound trials. On the other hand, both NH infants and deaf infants with CIs attended significantly longer to the visual display during the novel trial than during the old trial, suggesting that they were able to discriminate the speech patterns. Before receiving CIs, deaf infants did not show any preferences.Conclusions-Taken together, the findings suggest that deaf infants who receive CIs are able to detect and discriminate some speech patterns. However, their overall attention to speech sounds may be less than NH infants'. Attention to speech may impact other aspects of speech perception and spoken language development, such as segmenting words from fluent speech and learning novel words. Implications of the effects of early auditory deprivation and age at CI on speech perception and language development are discussed.

Objectives Few studies have examined the long-term effect of age at implantation on outcomes using multiple data points in children with cochlear implants. The goal of this study was to determine if age at implantation has a significant, lasting impact on speech perception, language, and reading performance for children with prelingual hearing loss. Design A linear mixed model framework was utilized to determine the effect of age at implantation on speech perception, language, and reading abilities in 83 children with prelingual hearing loss who received cochlear implants by age 4. The children were divided into two groups based on their age at implantation: 1) under 2 years of age and 2) between 2 and 3.9 years of age. Differences in model specified mean scores between groups were compared at annual intervals from 5 to 13 years of age for speech perception, and 7 to 11 years of age for language and reading. Results After controlling for communication mode, device configuration, and pre-operative pure-tone average, there was no significant effect of age at implantation for receptive language by 8 years of age, expressive language by 10 years of age, reading by 7 years of age. In terms of speech perception outcomes, significance varied between 7 and 13 years of age, with no significant difference in speech perception scores between groups at ages 7, 11 and 13 years. Children who utilized oral communication (OC) demonstrated significantly higher speech perception scores than children who used total communication (TC). OC users tended to have higher expressive language scores than TC users, although this did not reach significance. There was no significant difference between OC and TC users for receptive language or reading scores. Conclusions Speech perception, language, and reading performance continue to improve over time for children implanted before 4 years of age. The current results indicate that the effect of age at implantation diminishes with time, particularly for higher-order skills such as language and reading. Some children who receive CIs after the age of 2 years have the capacity to approximate the language and reading skills of their earlier-implanted peers, suggesting that additional factors may moderate the influence of age at implantation on outcomes over time.