Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas

Cochlear Implants & Education of the Deaf Child Funded by the NIDCD

Sample Characteristics 1.Between 8 and 9 years of age years of implant use 3.Implanted at 2,3 or 4 years of age 4.Normal intelligence 5.Monolingual home environment

Home States: 181 Children

Intervening Variables Family Characteristics Implant Characteristics Child Characteristics

Family Characteristics Family Size Parent’s Education Family Income

Implant Characteristics Duration of Implant Use Duration of SPEAK Use Number of Active Electrodes Dynamic Range Highest Frequency Coded Loudness Growth

Child Characteristics Age at Onset Age First Hearing Aid Age at Implant Cause of Deafness Intelligence

Independent Variables Methodology Individual Therapy Educational Setting

Rating Periods 1.Pre-Implant 2.First Year Post-Implant 3.Second Year Post-Implant 4.Third Year Post-Implant 5.Current Year

Increased Auditory Emphasis Methodology Rating Scale (Total Communication)(Oral Communication)  Mostly Sign  Speech & Sign  Speech Emphasis  Cued Speech  Auditory Oral  Auditory Verbal Increased Speech Emphasis

Outcome Variables Speech Perception Speech Production Language Reading

Multivariate Analysis Method Classroom Therapy INDEPENDENT VARIABLES

Multivariate Analysis Method Classroom Therapy Speech Perception Speech Production Language Reading INDEPENDENT VARIABLES OUTCOME VARIABLES

Multivariate Analysis Method Classroom Therapy Child Family Implant Speech Perception Speech Production Language Reading INDEPENDENT VARIABLES INTERVENING VARIABLES OUTCOME VARIABLES

Speech Intelligibility

Spontaneous Language Samples Every child had two 25-minute Interviews: Speech interview: Partner used spoken English only Only speech transcribed Speech & Sign interview Partner used speech and sign Both speech & sign transcribed

IPSyn Total Score Oral exceeds TC in both interviews

Child & Family Characteristics Speech Perception Speech Production Spoken Language Spoken&Signed Language Reading Age ** Age at Onset ** Age at Implant Performance IQ *** ***** Family Size ****** Family SES **** ** Gender ******* Explained Variance 22% 23%27%25% *p<.05, **p<.01, ***p<.001

Implant Characteristics Speech Perception Speech Production Spoken Language Spoken&Signed Language Reading Duration SPECTRA *** ******* # Active Electrodes ******* Dynamic Range *** ** *** Loudness Growth ***** Added Variance 22%20%15%14%12% *p<.05, **p<.01, ***p<.001

Rehabilitation Characteristics Speech Perception Speech Production Spoken Language Spoken&Signed Language Reading Hours of Therapy Therapist Experience Parent Participation Private/Public Schl Mainstrm/Spec Ed. **** Oral/TC Mode *** * Added Variance 12%11%9%3%6% *p<.05, **p<.01, ***p<.001

Overall Outcome (n=181) Predictor Variables Child & Family25% Implant18% Rehabilitation10% Total Explained Variance 53%

Perception Outcome

Speech Production Outcome

Language Outcome

Younger is NOT Better  Age 2 isn’t young enough  Early advantage no longer apparent at age 8-9  Implant coding is not sufficient for normal speech & language development

Is Younger Better?  Is there an advantage to implanting before 2 years of age?  Are the outcomes of younger implantation apparent earlier?  Are the effects of younger implantation apparent for newer technology users?

Effect of Very Early Cochlear Implantation on Language Johanna Nicholas, Ph.D. Washington University Ann Geers, Ph.D. U. of Texas -- Dallas Research Sponsored by NIDCD

Study Design Test Groups Age at Test/ Observation Cochlear ImplantNormal Hearing 3.5 years of ageN = 76N = years of ageSame children, 1 yr later N=12

Selection criteria  Received a CI by 38 months of age  Presumed deaf since birth  No other significant disabilities  Normal nonverbal intelligence  Enrolled in oral education  English the primary language at home  No loss of implant use > 30 days  Full insertion of the electrode array

Procedure 3.5 years of age:  30 minute language sample 4.5 years of age:  30 minute language sample  Preschool Language Scale

Age CI and CI use at each test

Parent-Child Play Sessions

Language Sample Variables  Total Number of Words  Number of Different Root Words  MLU in Words  Number of bound morphemes per word  Number of different bound morphemes

Hierarchical Linear Modeling  At any given duration of implant use, what factors significantly impact: Language level Rate of language growth

Hierarchical Linear Modeling Standardized Coefficients-Level 1 Intercept Pre-CI AidedAge at Implant Total Words-7.82***-11.93** # Root Words-1.80***- 2.07*** MLU-0.02***- 0.04*** # Bnd Morphs-0.98***- 1.58*** Diff Bnd Morphs -0.11***- 0.19*** __________ ** p <.01; ***p<.001, df=72

Hierarchical Linear Modeling Standardized Coefficients-Level 2 Slope Pre-CI AidedAge at Implant Total Words # Root Words MLU-0.01* 0.00 # Bnd Morphs-0.06*** 0.02+* Diff Bnd Morphs ** __________ ** p <.01; ***p<.001 (+ quadratic)

Number of Different Root Words

Mean Length of Utterance (MLU)

Conclusions  Language scores increased with better pre- implant aided threshold  Language scores increased with longer implant experience  Language scores increased with decreasing age at implant  At the same duration of implant use, language scores increased as age at implant decreased (AOI <2 years)

PLS – Expressive Quotient

Conclusions  AOI <2 yrs: Language closer to normal for each month younger age at implant  AOI >2 yrs: Less payoff for younger cochlear implantation

Conclusions  It is appropriate for expectations of spoken language competence to be raised for children receiving cochlear implants before 2 years of age  Children who receive the implant before 2 years of age will likely be able to make a successful transition to the mainstream educational system in time for kindergarten.