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Communication Skills and Cognitive Development
of Implanted Children: a longitunal Study
Abstract
Cochlear implants imply improvement and qualitative
changes in acoustic perception, these changes progressively allow
language acquisition. Scientific evidence concerning verbal progress
is very strong as far as comprehension and production measures
are concerned. However, there is no such evidence for communication
performances, taking into account both the representative (cognitive
development) and the communicative |
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(communication development) side of language. It appears
necessary to devise a new procedure for observing language improvement
in children with cochlear implants.
A scale for assessing communicative progress in implanted children has been used:
The Vineland Social Maturity Scale, which was used before implantation and one
year following the activation of the implant.
Cognitive competencies of implanted children will be assessed with the French
version of a performance intelligence scale (i.e. non-verbal), which can be used
from 2.6 to 7.0 years old (preschooler S.O.N., Snidgers-Oomen). The scale is
composed of five sub-tests which require non-verbal responses. It enables calculation
of mental age and IQ for individuals without language or with low linguistic
skills, and the scale is standardised both for hearing and deaf children. The
S.O.N. is used before implantation and one year after the first activation.
7 children (aged from 2 to 7 years old) who received a MED-EL cochlear implant
have been tested (Vineland and S.O.N.). Preliminary results indicate that having
access to language allows for an increase of intellectual skills; It is also
noticeable that there is a clear effect on the social adaptation level.
Aim
As increasing numbers of children receive cochlear implants,
and with age of implantation decreasing, there is a need for varying methods
to assess progress. The majortiy of studies so far have been investigating
the perceptive skills/abilities of children post-operatively (Uziel et al.,
1992; Truy, Jonas et Morgan, 1995; Lenarz, 1997). Following these studies,
work has been done within the field of expressive language skills and articulation
(Ouellet et Cohen, 1999). Currently, the differential perspective is gaining
more and more interest. Researchers have been looking at the individual differences
and the impact of specific variables on the degree and fastness/speed of the
language acquisition. Different factors such as educational system (integration
in normal hearing environment), aetiology, age at implantation, communication
mode before the implantation, and the level and degree of oral stimulation
within the family, are considered as being significant for further language
development (Miyamoto, Kirk, Svirsky, Seghal, 2000, Uziel, 2000). Several authors
(Tait et Lutman, 1994, 2000) have published studies in which they looked into
the necessary prerequisites for the development of oral language. Within our
study, we studied the following two hypotheses:
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Access to oral language will
result in an increase of social adaptation and integration
in their social environment. |
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Access to oral language
and by this, access to new possibilities for mental representations
and new levels of abstraction, will
influence the cocgnitive development. |
Methods
One group of 7 children (2;2 years to 7;9 months) implanted
at Rennes, who received a MED-EL cochlear implant have been tested. Cognitive
development and adapatative behaviour were examined before implantation; one
year after implantation (for 7 children) and 2 years after implantation (for
5 children)
In order to evaluate cognitive development we used the age-dependant SON-R 21/2
- 7 (Snijders-Oomen non-verbal intelligence test) translated and validated in
French for normal hearing and deaf children (Deleau, Rouault-Richard et Perrin,
1989). It offers to children the possibility of a test which is not influenced
by the language. It comprises of 5 subtests which measure memory, abstraction,
categorisation, spatial concept, and calculation of the intelligence quotient.
In table 1, we present the evolution over time for all the children after implantation.
In order to evaluate adaptative development
we used the Vineland Scale (Sparrow, Balla et Cicchetti, 1984 et
Fombonne, Achard et Truffeau, 1995). This instrument provides a
measure of adaptative behaviour for children, adolescents, and
for mentally retarded adults. It permits to explore three domains:
communication, daily living skills and socialisation. For each
domain children obtained raw scores corresponding to a standards
scores whichs permits to evaluate children progress.
Results Cognitive development
The results show an increase of the intellectual level after the implantation.
This increase can be explained by the fact that the child has access to oral
language. This situation changed cognition and allowed them to have access to
another mental representation mode. This change could explain partially the higher
performance in the subtests, requiring conceptual thinking and the ability to
think abstractly. These results are similar to previous research (Dauman et al.,
1998). Apart from this, we want to emphasise another aspect. It seems that the
implanted children improve in other areas such as attention and concentration.
Social adaptation
* A noticeable increase in socialisation is observed. This includes the capabilities
of the child to integrate by getting familiar with the norms and it´s
cultural values. Moreover, the child also learns to establish stable relationships
with social partners.
**All subjects show an increase in communication skills after the cochlear
implantation. This is demonstrated by the increase of verbal productions of
the child and by appetence to interact with it 's social environment.
***First year after implantation the domain of daily living skills don 't increase.
It would be explained by the fact that implanted children retain relative dependance
on parents. However, we observed a real augmentation in independence after
the second year of implantation.
Discussion
Preliminary results obtained from a limited
sample, motivate us to continue our research. The number of
study subjects need to increase before any general conclusions
can be made. A more homogeneous sample will also allow us to
look into the interindividual variability.
Our hypotheses seems to be correct, implanting a child with a cochlear implant
has a significant effect on the overall development of the child and not only
on the language development. These results show that having access to language
allows for an increase of intellectual skills already within the first year
after implantation. It is also noticeable that there is a clear effect on the
social adaptation level, which is more effective in the second year after implantation.
References
Dauman R, Carbonnière B, Soriano
V, Berger-Lautissier S, Bouyé J, Debruge E; Coriat G,
Bébéar JP.
Implants cochléaires chez l 'adulte et l 'enfant. Encycl Méd
Chir (Elsevier, Paris), Oto-Rhino-Laryngologie, 20-185-194, 1998, 12p.
Fombonne E, Achard S, Truffeau R. L 'évaluation du comportement adaptatif
: L 'échelle de Vineland. Handicaps et inadaptations. Les cahiers du
CTNERHI - N° 67-68, 1995.
Lenarz T. Cochlear Implant in Children Under the Age of Two Years, in Honjo
I, Takahashi H (Eds) : Cochlear Implant and Related Sciences Update. Adv Otorhinolaryngol.,
Basel, Karger, 52, 204-210,1997.
Miyamoto R.T, Kirk K.I, Svirsky MA, Seghal S. Longitudinal Communication Skill
Acquisition in Paediatric Cochlear Implant Recipient, in Kim C.S, Chang SO,
Lim D, (Eds) : Updates in Cochlear Implantation. Adv Otorhinolaryngol. Basel,
Karger, 57, 212-214, 2000.
Ouellet C, Cohen H. Speech and Language Development following Cochlear Implantation.
Journal of Neurolinguistics, 12,271-288,1999.
Sparrow S, Balla D, Cicchetti D. Vineland Adaptative Behaviour Scales (Survey
Form) American Guidance Service, Circle Pines Minnesota, 1984.
Tait M, Luttman ME. Comparison of early communicative behaviour in young children
with cochlear implants and with hearing aids. Ear Hear, 15(5), 352-61.
Tait M, Luttman ME, Robinson K. Preimplant measures of preverbal communicative
behaviour as predictors of cochlear implant outcomes in children. Ear Hear,
21 (1), 18-24, 2000.
Truy E, Jonas AM, Morgon A. Apport de l 'implant cochléaire chez dix
enfants sourds congnitaux. Bulletin d 'audiophonologie, Ann.Sc. Univ.Fr.C.,
11,489-503, 1995.
Uziel A., Dejean Y, Reuillard-Artières F, Mondain M, Sillon M, Vieu
A, Piron JP, Broche M. Implantation cochléaire chez l 'enfant sourd.
Bulletin d 'audiophonologie, Ann Sc. Univ. Fr.C., 9, 401-412, 1992.
Corresponding author:
Gaid Le Maner-Idrissi
Laboratoire de Psychologie du développement et de l'Education
6, avenue Gaston Berger
35043 Rennes cedex.
France
Mail to:Gaid.lemaner-idrissi@uhb.fr
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