In 1996, when Anne Marie Tharpe and I were designing a training program for students in speech language pathology, audiology, and deaf education to work together to support children with cochlear implants, we conducted a survey of the top 20 graduate programs in communication sciences and disorders to determine how other universities included this information in their curriculum. At that time only one program had a class that focused on cochlear implants, and this was targeted to audiologists only. Three other programs indicated that they included information on cochlear implants as part of a course on auditory rehabilitation. Our survey of all training programs listed in the 1996 American Annals of the Deaf resulted in 21 respondents, none of whom included specific coursework in cochlear implants. In most clinics and classrooms around the country (with the exception of those associated with the few major cochlear implant and oral deaf research centers), children with cochlear implants were something we had only heard about.

Since that time things have changed. The number of children receiving cochlear implants has risen sharply each year and gives every indication of continuing. The age of implantation candidacy has continued to drop: currently the Food and Drug Administration approves children as young as 12 months for cochlear implants-and in other countries, the age is even lower. The popular media has showcased "miracle success stories" (e.g., "60 Minutes). A recent documentary film, Sound and Fury (2000), has explored the cultural clash that cochlear implant technology has precipitated with individuals who identify with Deaf culture. And increasingly, children with cochlear implants are showing up in classrooms and on caseloads. Frequently, especially in rural areas where there are few educational personnel with training or experience with oral deaf children, the speech language pathologist is given the responsibility for following these children and assuring that they are receiving appropriate educational support (Carver, 2003; Harris & Schery, 1999).

A random, stratified survey of 600 parents of children who had received Nucleus implants (Cochlear Corporation, Englewood, CO) was conducted by Cochlear Corporation in 2002. Results indicated that the number one concern of parents was finding an appropriate educational program for their child where personnel were knowledgeable about the implant and how to maximize auditory learning/speech and language development for the child (Sorkin, 2002).

This volume of TLD presents an overview of the current state of the art in pediatric cochlear implants for speech-language clinicians, educators of the deaf, educational audiologists, and early-intervention personnel who now are working with children with implants or who anticipate doing so in the near future. The articles cover topics and information that students in our training program, professionals who have attended our workshops, or those who have requested that student teams come to school districts to present information have found helpful. (The training program at Vanderbilt has been supported by the U.S. Department of Education, Grants for Pre-Service Personnel Training, Mary McDermott, Project Officer. Components include a multidisciplinary problem-based learning seminar, followed by individualized practicum experiences with children with cochlear implants. In the final training component, student teams follow children who have received cochlear implants into school settings to share information and support with educational personnel. Most recently, interactive videoteleconferencing has allowed interaction with more rural and remote schools.)

The first article, by Schery and Peters, reviews current research on the efficacy of cochlear implants in children for improving speech perception, speech production, and general language skills. It then presents an example of an auditory training and language building program that is based on the commonly indexed four levels of auditory skill development. Activities for use with both individuals and in groups are suggested, along with ways in which auditory input can be varied systematically to increase task difficulty.

McConkey-Robbins next provides a practical guide for providing communication intervention for infants and toddlers with cochlear implants, a group that is increasing rapidly as a result, in part, of recently enacted legislation on newborn infant hearing screening. She uses the IT-MAIS, a parent interview/observational instrument, to assess the young child's meaningful use of auditory information and to suggest language facilitation activities that are both developmentally appropriate and based in the family context.

The third article is a review of the surgical aspects of cochlear implantation with children. Doctors Cohen and Haynes provide readers with an overview of the surgery itself and discuss considerations for candidacy as well as complications that might occur.

Hedley-Williams, Sladen, and Tharpe, in their article, Programming, Care and Troubleshooting of Cochlear Implants for Children, provide practical information on cochlear implant devices that are being fitted on children and explain how these devices are programmed or "mapped." They present guidelines for intervention/education professionals to follow to troubleshoot the cochlear implant device in the educational environment. They also discuss how a classroom can be modified to maximize the auditory information a child receives for language and speech learning.

In the final article, Chute and Nevins remind readers that children with cochlear implants must function in a total environment when they are in their educational settings. The challenges that children with cochlear implants face-even those children who are highly successful implant users-are important for educators and clinicians to keep in mind to help these youngsters succeed in their social and academic milieu.

The rapid advances in pediatric cochlear implant device development and in surgery have led to a generation of deaf children, some of whom are only toddlers, who now are able to access auditory information that was previously unavailable. Projecting technical improvements into the future, some day it may be possible for these children to learn language incidentally in the manner in which children without hearing loss do. For the time being, however, children with cochlear implants need dedicated educators, audiologists, and communication specialists who understand how the implant device works, how to keep it functioning, and who work conscientiously on a daily basis to maximize the auditory and language learning for each and every child with a cochlear implant. As issue editor, I join the contributing authors in hoping that this issue of TLD helps inform professionals who are undertaking this challenge.

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