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

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

3. Sample Characteristics 1.Between 8 and 9 years of age 2.4-6 years of implant use 3.Implanted at 2,3 or 4 years of age 4.Normal intelligence 5.Monolingual home environment

4. Home States: 181 Children

5. Intervening Variables Family Characteristics Implant Characteristics Child Characteristics

6. Family Characteristics Family Size Parent’s Education Family Income

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

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

9. Independent Variables Methodology Individual Therapy Educational Setting

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

11. 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

13. Outcome Variables Speech Perception Speech Production Language Reading

14. Multivariate Analysis Method Classroom Therapy INDEPENDENT VARIABLES

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

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

18. Speech Intelligibility

19. 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

20. IPSyn Total Score Oral exceeds TC in both interviews

21. 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

22. 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

23. 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

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

25. Perception Outcome

26. Speech Production Outcome

27. Language Outcome

28. 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

29. 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?

30. 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

31. Study Design Test Groups Age at Test/ Observation Cochlear ImplantNormal Hearing 3.5 years of ageN = 76N = 12 4.5 years of ageSame children, 1 yr later N=12

32. 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

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

34. Age CI and CI use at each test

35. Parent-Child Play Sessions

36. 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

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

38. 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

39. Hierarchical Linear Modeling Standardized Coefficients-Level 2 Slope Pre-CI AidedAge at Implant Total Words-0.08 0.22 # Root Words 0.00 0.02 MLU-0.01* 0.00 # Bnd Morphs-0.06*** 0.02+* Diff Bnd Morphs -0.01 0.00** __________ ** p <.01; ***p<.001 (+ quadratic)

40. Number of Different Root Words

41. Mean Length of Utterance (MLU)

42. 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)

43. PLS – Expressive Quotient 424140393837363534333231302928272625242322212019181716

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

45. 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.