Abstract
Children with cochlear implants are seen in classrooms and on caseloads in rapidly increasing numbers. Speech-language pathologists, educational audiologists, early childhood special educators, and other communication specialists are being charged with providing clinical and educational programs that will maximize auditory learning for these children. In most cases, this involves both direct service to the child and working with other educational personnel to build an auditory emphasis into the child's curriculum and daily social interaction. This article reviews research studies on the efficacy of cochlear implants for children's auditory communication skills, including speech perception, speech production and language, and it presents suggestions for building auditory skill development in children with cochlear implants based on teaching principles that have been identified as effective. Four classic levels of auditory skill development (awareness, discrimination, identification, and comprehension) are discussed, along with suggested activities that reflect each of the categories. Parameters that influence auditory task difficulty are presented. Both individual and group instructions are considered.
IN THE MORE than a decade since the first cochlear implant device was approved for children with severe to profound hearing loss in the United States, more than 8,000 infants and children have been implanted (Archbold, 2000), with the number of implants increasing by about 25% each year (Niparko, 2001). Increasingly, these children are being seen in classrooms and on caseloads throughout our educational system: a child with a cochlear implant is more likely to end up in mainstream education than is a child with comparable hearing levels who wears hearing aids (Archbold, Nikolopoulos, Lutman, & O'Donoghue, 2002; Francis, Koch, Wyatt & Niparko, 2000; Teagle & Moore, 2002). Research on the effi cacy of this new technology began during clinical trials, well before the auditory prosthesis was approved for children by the Food and Drug Administration in June 1990, and has expanded rapidly, shadowing technological advances and changes in candidacy. During this period, it sometimes has been diffi cult for the clinician/educator who does not work in an implant center to stay current with research-based developments that would inform our practice. Recently, several reviews of the research literature have presented some synthesis for professionals who are providing communication training for this group of children. The largest number of studies investigating children's performance with implants has focused on speech perception capabilities (Dowell, Dettman, Blamey, Barker & Clark, 2002; Waltzman, 2000). Increasingly, however, studies have examined the effects of cochlear implantation on the speech production and the language development of young children with hearing loss (Geers, 2002; Geers, Spehar, & Sedey, 2002; Miyamoto, Svirsky & Robbins, 1997; Tomblin, Spencer, Flock, Tyler & Gantz, 1999).
This article will summarize current research on the auditory, speech, and language skill development of children with cochlear implants and then outline a program for training auditory communication skills in children with cochlear implants that is consistent with current understanding of effective practices. Although neither inclusive nor prescriptive, this outline uses the traditional levels of auditory skill development as a framework to suggest sample activities that can be adapted to teach speech perception, speech intelligibility and language targets simultaneously. The final section expands on these strategies for use in groups, including inclusive classroom settings.