Running Head: Cochlear Implantation
Literacy Achievement and Early Cochlear
Implantation in Deaf Children
Lawrence W. Sherman and Teri L. Cruse
Department of Educational Psychology
Miami University
Available on the web at:
http://www.users.muohio.edu/shermalw/cruse_mwera2004.html
Abstract. Interest in the effect of cochlear implantation
devices in deaf children has focused on their influence on literacy
achievement. Early learning and
developmental theorists have suggested that the earlier this surgical procedure
is done, the more positive the influence will be on children’s literacy
learning. Demographic data were
obtained for 11 children attending a private school for the deaf. These children had all received testing
using the Woodcock/Johnson Letter Recognition Scale. The children had received this surgical procedure at various
developmental points in time ranging from 27 to 60 months. The duration of use of the cochlear
implant ranged from 27 to 70 months.
Pearson-Product-Moment correlations between age in months when the
device was implanted and their total reading scores (r = -.89), as well as two
subscales (letter/word recognition, r = -.91, and reading comprehension, r =
-.93) were statistically significant (p < .01). Likewise, the duration of time in months the device was in
effect and their total reading scores (r = .79), as well as two subscales
(letter/word recognition, r = .91, and reading comprehension, r = .88) were
statistically significant (p < .01). Considering the small sample size of
our study, we were especially impressed with the robust magnitudes of these relationships. While acknowledging that there is some
controversy among the deaf culture regarding the use of this surgical
procedure, our data strongly suggest early use of the cochlear implant device
enhances children’s literacy achievement.
Literacy
Achievement and Early Cochlear Implantation in Deaf Children
Introduction
Many studies have been
conducted on the benefits of cochlear implants. There have been over 25,000 children fitted with cochlear
implants in the last 20 years.
Rubinstein (2002) states that children fewer than 24 months of age were at one stage excluded as candidates for
this procedure. There were
concerns about misdiagnosis, safety of the procedures and long-term reliability
of the device. In recent years,
this view has shifted. Children
are being implanted earlier and the results are supporting the change in
policy. Research conducted by
Ruben (1997) suggests there are critical periods for
language development. Pinker
(1994) theories regarding the “Language Instinct,” would support
the importance of early critical periods for language development. Findings from Bollard et al. (1999) and
Conner et al. (2000) describe age as a key variable for vocabulary development.
Although the use of
cochlear implant technology has opened doors for many deaf people, controversy
regarding the technology remains. In 2001, the National Association of the Deaf
(NAD) created a position paper addressing the Cochlear Implant Debate (Bloch,
2001). Throughout the deaf community, an outcry was heard stating the loss of a
culture due to the new cochlear implant technology. This objection is similar
to the fear present in the 1950's, when hearing aids were made available to
younger children and technology had made them more useful (Pollard, 2001). The Deaf community in the 1950’s
feared the loss of its culture and its language, American Sign Language, just as it does now with
the rise of cochlear implants. The
focus of the 2001 NAD position statement on cochlear implants was on preserving
and promoting the psychosocial integrity of deaf and hard of hearing children
and adults (Bloch, 2001). Many, outside the deaf community, believe deafness is
a handicap that needs to be to be fixed. The cochlear implant is seen as the
device that "fixes" the deaf person. One important aspect detailing the popularity of implantation
and oral language training is the notion that being deaf has "perceived
burdens" in a hearing society. (Mayhill, 2001). NAD has now shifted their position against cochlear
implantation to one of accepting the rights of all individuals and individual
differences. The organization
maintains the view of cultural diversity and the need for candidates and
parents considering a cochlear implant to have as much information as possible
on the advantages and disadvantages of this device. One conceivable advantage for deaf children is the
possibility of early implantation.
Due to a change in the
minimum age for implantation, the possibility for a longitudinal study on early
implantation could be carried out.
Ertmer’s et al. (2003) study noted that children who were
implanted during the preschool years tended to outperform those implanted
later. Bollard (1999) found
that children implanted at a younger age (approximately 3:7 years) achieved an
increase of 42 months in vocabulary age after 18 months of implant experience.
When hearing children
begin to read, most are competent language users (Geers, 2003). Vocabulary and
oral language skills have been strongly associated with reading and academic
skills for children with normal hearing. The reading task for a deaf child is
an extremely different type of language experience. Often, low literacy levels are reported among students with
hearing impairments and it is believed to be due in part to the difference
between their incomplete spoken language system and the demands of reading a
speech based system (Perfetti & Sandak, 2000). It has been suggested that early implantation increases
speech perception in young children (Baumgartner, 2002). It has also been studied that children
who receive a cochlear implant before three years of age exhibit higher
vocabulary and word reading scores than children fitted after 5 years of
age. Early implantation, in turn,
would assist in the acquisition of beginning reading skills (Geers, 2003). The
goal of this study is to explore the effect of age of implantation, duration of
experience with the device and academic success.
In our sample of
children their educational setting invites active participants in intense auditory
training. American Sign Language
is not used as a form of communication.
They are taught to listen and understand what they hear. Speech training is an integral part of
the program. This school services
children ranging in age from two to nine years of age. The question in need of answering is
when the child is mainstreamed, what is their level of achievement. Does early implantation offer a
significant influence when addressing academic achievement? Are these children ready to be
integrated into the regular class?
It is important to keep
in mind children develop at different rates and there are outside factors that
could influence the variables which we are examining. These unexplored variables, for example, family support and
quality of programs, may affect the results of the study.
Method
Sample
The 11 participants in
our study received their cochlear implant at various times between the ages of
27 to 60 months and had an average duration of implant use of 49 months. The children were in an auditory-oral
educational setting. Most of the children were reportedly deaf from birth, but
two children had a known etiology of deafness after birth. All the children
were deafened under two years of age and all were implanted by the age of five years.
The children had at least two annual testing
records detailing their reading achievement. Achievement testing occurred during the month of September
2003. The average
Intelligence Quotient was obtained from the Wechsler Intelligence Scale III (Wechsler,
1991). Ages were recorded in months for statistical purposes. All data was
obtained anonymously with written permission from the school's director. Approval for this study was
granted from the Miami University Human Subject's Institutional Review Board.
Instruments
To obtain reading
achievement scores two sub-tests were selected from diagnostic reading
assessment batteries standardized on hearing children. Scores are expressed as grade
equivalents based on the normative sample. General issues of reliability and validity are detailed in
Burros (2001).
Woodcock Johnson III
Letter-Word. This instrument
identifies an aspect of reading decoding.
It requires identifying and pronouncing isolated letters and words. It is constructed so students are only
tested on those items within their operating range. All the students began with test question one and the test
was complete as soon as the student gave six incorrect responses. The results of this test could be
influenced by the children’s special production ability, because accurate
articulation of each letter is required.
Continuous interval-like data was collected and used as grade equivalent
scores. For example, a 0.5 score
would be equivalent to a Kindergarten child in his fifth month.
Woodcock Johnson III
Reading comprehension. This
sub-test measures reading comprehension of contextual information. It requires reading a short passage and
supplying a key missing word.
There are 47 questions.
There is no speech required for this test. This will be used as a continuous interval-like value. The scores were used as a grade
equivalent values in a similar fashion as the “letter-word” score
described above.
Wechsler Intelligence Scales for
Children III. The WISC III is
used as a tool in school placement for determining the presence of a learning
disability or a developmental delay and in tracking intellectual
development. All of the scales are
divided into six verbal and five performance sub-tests. A composite full-scale IQ score is computed
with a mean of 100 and a standard deviation of 15. The predictive validity shows a correlation with achievement
for hearing-impaired-deaf categories.
Again, Burros (2001) report acceptable reliability and validity for this
instrument.
Analysis
The results of this
study are divided into two parts. The affect of early implantation and the
duration of implant use are both hypothesized to be related to reading
achievement. Our null hypothesis states that there will be no relationship
between age of cochlear implantation and reading achievement ( Ho: r
= 0). This null hypothesis was
tested using an alpha risk level of .01 with a one-tail test. A series of simple linear regression
analyses were used to assess these correlations. Statview (1999) software was used to analyze the
data. Again, our research
hypotheses predicted that age of implantation would be negatively correlated
with achievement, and duration of implant would be positively related to achievement.
Results
Our results are
presented in Table 1 and Figures 1 to 6.
[Table 1 and the six figures are not presented here, but will be shown
and distributed during the presentation.]
As can be seen in the inter-correlation matrix of Table 1, Age of
Implant was significantly (p<.01) and inversely related to reading
achievement on both Woodcock/Johnson subscales (Letter/word recognition, r =
-.91,; Reading Comprehension, r = -.93), as well as on the total reading score
(r = -.89). The duration of use of
the cochlear implant was likewise significantly (p<.01)and positively
correlated to reading achievement on both Woodcock/Johnson subscales
(Letter/word recognition, r = .91,; Reading Comprehension, r = .88)as well as
on the total score (r = -.89). The
magnitude of these relationships is particularly impressive given that our
sample was only 11 children.
Figure 1,2 and 3 show a
high negative correlation regression line plots between Age of implantation and
reading achievement scores. A correlation for the data revealed that age of
implantation and reading achievement scores were significantly related. There is a significant negative
correlation, thus the null hypothesis is rejected and the research hypotheses
predicting an inverse relationship between age of implantation and achievement
was supported. The earlier the
implantation the higher the achievement.
Figures 4,5,and 6 show a positive correlation. Duration of implant use and reading achievement are also
significantly (p<.01) related.
With this significant positive correlation, the null hypothesis was
rejected. The longer the cochlear
implant is in use the higher is the achievement. The WISC III Performance IQ was not a significant variable
in these relationships. However it
should be noted that these children do fall well within the range of
“normal” intelligence (Mean Performance IG = 107, SD = 7.9, with
I.Q’s ranging from a low of 92 to a high of 118).
Discussion/Conclusions
While
the data suggests an advantage for using the technology of a cochlear implant
at any age, the obtained levels of achievement show a significant benefit for
early implantation. Given this
small sample our correlations are particularly impressive and robust. These advances in cochlear implant
technology have far exceeded the expectations of just a decade ago. Ten years ago, the results were
less significant and deaf children did not achieve the feats written about
today. The age of implantation has
a correlation with Reading scores.
Children in this sample implanted at an early age were at the average
grade equivalent of 2.1. The
normed grade equivalent average was 2.2.
These results suggest children can have possible normal literacy
development when given an implant early in their lives. No one could have
predicted the outcomes of children reading at grade level or better.
It is important to keep
in mind that the development of abilities in children depend on many
variables. In an ideal world,
children would be educated in the educational setting that best fits their
learning style. Recent data demonstrate the possibilities for deaf children who
have a cochlear implant with early intervention in an ideal school
program. Our sample came from a
private school where the children’s teachers as well as their parents are
highly motivated. Future research
should attempt to confirm our findings in public school settings, especially
with a larger sample. For deaf
children, achieving levels of achievement performance such as we obtained in
our study may affect everything about their future lives.
Figure 1. Age at
implantation in months predicting Letter/Word identification Grade Equivalent
Score.
Figure 2. Age at
implantation in months predicting Reading Comprehension Grade Equivalent Score
Figure 3. Age at
implantation in months predicting Total Reading Grade Equivalent Scores.
Figure 4. Duration of Implant use in months
predicting Letter/Word Identification Grade Equivalent Score.
Figure 5. Duration of Implant Use in months
predicting Reading Comprehension Grade Equivalent Score.
Figure 6.Duration of
Implant use in months predicting Total Reading Grade Equivalent Score.
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