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| 1. Please state your position on cochlear implants, defining any particular advantages or disadvantages you believe the devices have. |
| Nancy Bloch, The National Association of the Deaf |
| Adults considering implants largely base their decision on individual desires and medical feasibility. Also important is the fact that individuals who lose their hearing late in life, with their auditory memories intact, have a clear advantage over those who have not had the opportunity to learn spoken language prior to implantation. The childhood implantation decision is a complex process for parents, requiring knowledge as to medical feasibility as well as the full range of educational, language and psychosocial development options available. This includes opportunities for early development of visual language. Parents also need to consider commitment to many years of rehabilitation and access to adequate support services, including financial resources |
| Donna Sorkin's Rebuttal: |
| Nancy urges that children who are implanted also have opportunities for visual communication. We feel that this is a very personal decision and must be made family by family. Some families, for example, have chosen to use Cued Speech in combination with a cochlear implant. Others emphasize the auditory-verbal or auditory-oral approach. Some opt to use Signed Exact English or ASL with the cochlear implant. We don't believe there is any single right answer that applies to all families. The family should make that decision based on their own research, situation, preferences, etc. |
| Nancy Bloch, The National Association of the Deaf |
| The NAD takes no position on adult implantation for this is believed to be an individual choice. The NAD recently released a new position statement on cochlear implants, which can be found on the NAD web site. The NAD recognizes the right of parents to make fully informed decisions on behalf of their deaf children with regard to implantation. Implants are seen as the panacea for deafness, which only serves to perpetuate devaluative societal attitudes towards deafness and deaf people. Simply put, while the device provides the ability to receive auditory signals, the ability to make sense of and use these signals for meaningful dialog varies greatly from person to person. |
| Donna Sorkin's Rebuttal: |
| I disagree that cochlear implants are viewed as a panacea. AG Bell, implant centers and professionals in the field always emphasize that families that pursue this option for children must be prepared for the work that follows to make full use of the technology. Additionally, those of us familiar with cochlear implants (and I count myself amongst those, both as a cochlear implant user and as someone who has advised hundreds of families) know that the cochlear implant is a tool to communication and that it does not provide normal hearing. I don't understand why some deaf people feel that because individuals and families have pursued the cochlear implant option their choice somehow devalues others' choices for manual communication. |
| Donna Sorkin, Alexander Graham Bell Association |
| AG Bell encourages the use of technology to maximize a child or adult's ability to access the spoken word. If the individual's hearing characteristics are such that they derive minimal benefit from hearing aids and if the implant center determines that the child or adult is a good candidate for a cochlear implant, then AG Bell would urge consideration of an implant as an important opportunity to maximize development of listening and speaking skills. Cochlear implants have been shown to significantly improve a child's success with speech development and listening and hence provide them with access to the larger hearing world. Cochlear implants provide access both to spoken language and to environmental sounds. |
| Nancy Bloch's Rebuttal: |
| The NAD, too, advocates greater accessibility and a level playing field albeit in a slightly different sense. We do not place our emphasis with any one innovation, preferring instead to focus on utilization of the ever-growing array of technologies that are at our disposal, benefiting deaf and hearing alike. Increased hearing and speech capabilities do not necessarily determine successful interaction with the larger hearing world. Deaf people who use sign — some of whom do not use speech — in fact interact successfully on a daily basis with hearing persons, at work, in the community and the marketplace, and at home. Many do so with fewer impediments than deaf persons who communicate solely through oral means. Interaction with the hearing world is in no way linked exclusively to speech or signing, but, rather, depends on the deaf person's sense of identity and self-esteem, their innate understanding of communication and language, and their ability to have meaningful discourse with those with whom they come into contact — hearing and deaf alike. |
| 2. Who would you consider to be the best candidates for a cochlear implant? Is there anyone unsuited for a cochlear implant? |
| Donna Sorkin, Alexander Graham Bell Association |
| The best candidate is someone who will use English as his or her primary language and will be exposed to spoken language on a daily basis. Further, the best candidates for this procedure will have support from his or her family, friends and, where appropriate, the educational system. Families of children who are implanted must be willing to follow through on recommended rehabilitation programs as recommended by their implant center. Children who receive cochlear implants will continue to require specific services (e.g., audiology, speech language therapy), a favorable acoustical environment and possibly technology (such as a sound field amplification system or a personal FM). With children, earlier implantation has been shown to provide the greatest opportunity for success. For adults, success is most likely for those who have a good memory of sound and have regularly used their residual hearing with amplification. |
| Nancy Bloch's Rebuttal: |
| The NAD takes a more holistic approach with its emphasis on early exposure to and usage of sign language as a vital component of the rehabilitation and support services program for implanted deaf children and their families. It is incumbent upon such centers to afford implanted children with all the tools available that can contribute to lifelong success. The reality is that childhood implantation continues to have variable outcomes. For some, it works better than for others. Either way, empirical research has shown that children who maximize use of signing at an early age score higher at a later age on reading and mathematics tests. We have long known the data on the accomplishments of deaf children of deaf parents whose abilities are comparable to and better than their hearing peers. Such children are both fluent in English and sign language. This points to the very real benefits of early signing, given appropriate support for overall language development. |
| 3. What would you say to people who are considering cochlear implants? Do you have any particular advice for parents considering the surgery for their child? |
| Nancy Bloch, The National Association of the Deaf |
| The NAD believes the adult implant decision is an individual choice, with full consideration as to risks, benefits and long-term implications. The same is true for parents, who need to know that the implant is not a magic pill for the ability to hear. Being able to hear in no way guarantees the acquisition of spoken language for meaningful discourse. This is why NAD emphasizes early sign language development during the critical period of 0–6 years. Parents who incorporate sign language would tend to be more accepting of their child as a whole regardless of auditory perception and usage. These parents and children, too, would benefit by interacting with successful deaf persons both with and without implants. |
| Donna Sorkin's Rebuttal: |
| Again, AG Bell feels that there is no one right option for all families and disagrees with the NAD recommendation that ASL is appropriate for all children with cochlear implants. This is an individual decision that should be made considering a number of factors. AG Bell promotes oral communication options — auditory-oral, auditory-verbal and Cued Speech — but recognizes that other communication options may be more appropriate for some families. |
| Donna Sorkin, Alexander Graham Bell Association |
| Cochlear implants have been shown to provide extraordinary benefits for appropriate candidates. Many individuals gain comfortable use of the voice telephone. Studies of those who have received cochlear implants have demonstrated significant quality-of-life gains. Further, for children who receive implants at an early age with appropriate follow-up therapy, language development skills after several years are similar to those of normal hearing children. Another important benefit is the access that a cochlear implant provides to the larger world. Children can communicate freely and easily with anyone. In school, workplace, and beyond this translates into greater life opportunities. |
| Nancy Bloch's Rebuttal: |
| Painting a rosy scenario for people with implants, with little or no barriers to interaction with the hearing world, carries with it a responsibility to provide balanced information. While this may be true for implanted adults who have lost their hearing at a later age, the same cannot be applied in a blanket sense to children. Children with implants, regardless of their degree of individual success, will always be deaf and will experience the same attitudinal, communication and related barriers that deaf and hard-of- hearing children face. The larger hearing world tends to see these children as being different. Even with the passage of the Americans with Disabilities Act in 1990, societal attitudes remain by far the greatest barrier to success for individuals with disabilities. It is, therefore, incumbent upon us all to equip deaf and hard-of-hearing children with all the tools available for life success. Lastly, I do not agree with Ms. Sorkin's statement, which suggests that the quality of life may be less for adults and children without implants. There is so much richness in the lives of successful persons without implants that is not appreciated by those who simply cannot look beyond the realm of hearing and speech. |
| 4. How would you describe the success rate of cochlear implants? |
| Donna Sorkin, Alexander Graham Bell Association |
| Studies of cochlear implant outcomes indicate that the majority of children and adults derive significant understanding of speech. Most gain open set discrimination (i.e., they can understand speech without seeing the speaker's face). There are important gains in children's ability to speak intelligibly, especially when they are implanted earlier (i.e., prior to age 4). Learning to speak is much easier for implanted children since they can hear and modulate their voices. Furthermore, the majority of cochlear implant recipients state that they like the sounds that they receive — both speech and environmental sounds. People often note that their cochlear implants give them a sense of being "connected" to the world. |
| Nancy Bloch's Rebuttal: |
| Again, I wish to emphasize that unbiased and independent long-term studies are needed with regard to the benefits of implant and hearing aid technologies. Current implant research outcomes emphasizing speech and auditory capabilities are so positive that one must pay attention also to the other side of the coin, so to speak. The reality is we are seeing too many children with implants who are given the benefit of sign language much later in their lives, rather than early on. And these children are fighting to catch up on basic language development. We all know that the ages of 0–6 are the most critical for language acquisition and usage.
Success, again, is a relative term that varies from individual to individual. For some who cannot benefit from hearing aids, the implant that provides environmental sound awareness brings about a sense of great satisfaction. For others, the ability to discern some speech sounds will be thrilling. This partial ability may cause considerable frustration for others. And for others who can maximize the use of their implants for barrier-free human discourse, it is a liberating experience. Being "connected" to the world is a highly individualized experience —it must also be recognized that there are quite a number of individuals without implants who have been and continue to be quite successful at making such worldly connections. |
| Nancy Bloch, The National Association of the Deaf |
| Success is a relative term. Being able to hear and speak does not necessarily mean the child or adult — with or without an implant — is successful. Independent and unbiased long-term research is clearly needed on academic achievement, cognitive abilities, language usage and psychosocial development of children both with and without implants. This includes comparative research with children for whom sign language is the primary mode of communication, taking into account academic performance and psychosocial development considerations. The benefits of the newer digital hearing aid technologies as an alternative should also be researched. |
| Donna Sorkin's Rebuttal: |
| I agree with Nancy's comment that "success" must be measured in a variety of ways. Measures of language and literacy have demonstrated that children who are the beneficiaries of early intervention, utilize cochlear implants, and have received appropriate (re)habilitation have speech and language skills that are equivalent to those of their normal hearing peers. |
| 5. Some deaf people argue that using the cochlear implant on a child impacts their psychological well-being by denying them the opportunity to be raised as a full-fledged member of either the deaf or hearing worlds. Do you believe that a cochlear implant can affect a deaf child's psychological development? If so, how? |
| Nancy Bloch, The National Association of the Deaf |
| The NAD believes that children with implants who have parallel visual language development opportunities have greater ability to interact with deaf peers and adult role models. This, in turn, leads to a healthier sense of identity and psychosocial development, for success in both the deaf and hearing communities. Without such opportunities, implanted children could well wonder where and with whom they feel most at ease when they reach adulthood. |
| Donna Sorkin's Rebuttal: |
| AG Bell believes that deaf and hard-of-hearing children can be psychologically and socially well-adjusted regardless of the mode of communication or technology utilized. It is not the technology that determines social adjustment; rather, there are a host of other factors that come into play. |
| Donna Sorkin, Alexander Graham Bell Association |
| A child who receives a cochlear implant does not have normal hearing, just as a child who is hard-of- hearing and uses hearing aids does not have normal hearing. Both children are, in fact, functionally hard-of-hearing. Parents in America and elsewhere still have the final say in how they wish to have their children brought up. Whether parents decide to have their child brought up as part of deaf culture or as part of the larger world is, ultimately, a decision that parents should make with full knowledge of the decision-making and its consequences. As with most things, there is no one right or wrong answer in this debate. AG Bell has seen no evidence that children who are brought up to be part of deaf culture are somehow "psychologically better off" than deaf children who are brought up in the larger world. While we at AG Bell are confident that children can thrive in either environment, the access to spoken language offered by cochlear implants provides individuals with the ability to function with greater independence and maximize their life opportunities. Ultimately, this is a choice that parents make for their children. |
| Nancy Bloch's Rebuttal: |
| Ms. Sorkin and I are in agreement with regard to parents' having the right to decide what is best for their children. However, I wish to clarify the fact that the NAD does not expect parents to choose between the deaf and hearing worlds. Learning sign does not relegate a child to the deaf world, as is commonly thought. Conversely, learning speech does not automatically admit a child to the hearing world. Many deaf signers have fully developed speech capabilities and function equally successfully in both the deaf and hearing worlds, which are by no means distinct and independent of each other. The crux of this question focuses on psychosocial, cognitive and linguistic development. We all have a responsibility to provide children with unrestricted access to all the tools available for optimal growth and lifelong success. The NAD does not believe in restricting such opportunities in any way. |
| 6. How would you define deaf culture? |
| Donna Sorkin, Alexander Graham Bell Association |
| I would defer to my colleagues from NAD to define deaf culture. |
| Nancy Bloch's Rebuttal: |
| I want to emphasize that deaf culture is by no means closed to those who do not know sign language. The arts, even music, and other forms of expression are an important part of deaf culture, as is true for other world cultures. The degree of identification with deaf culture varies with the individual, ranging from those who are native signers and hearing children of deaf parents to those who learn sign later in life. All in all, those who see and appreciate various world cultures are more receptive to the richness that the deaf cultural experience has to offer. |
| Nancy Bloch, The National Association of the Deaf |
| Deaf culture should be viewed in the same sense as other world cultures; that is, sharing a defined language, heritage and norms. Sign language discourse and shared experiences are vitally important to those who ascribe to deaf culture. Such persons also function equally as successfully in the mainstream hearing culture — contrary to popular belief that the deaf and hearing worlds are totally separate. |
| Donna Sorkin's Rebuttal: |
| I agree with Nancy's comments. |
| 7. What long-term effect, if any, will cochlear implants have on deaf culture? |
| Nancy Bloch, The National Association of the Deaf |
| Cochlear implants have clearly had an impact, given the general publics focus on spoken language development. Deaf culture, with its rich visual language and heritage, will nonetheless continue to endure through the ages, even with new and emerging technologies. Sign language is increasingly being used by hearing parents of hearing children to stimulate cognitive development, by high school and college students seeking foreign language credits, and by those whose daily lives involve interaction with signers, and so on. The bottom line is that every one of us needs to respect every child and adult, including language usage and communication preferences. |
| Donna Sorkin's Rebuttal: |
| I agree entirely with Nancy's comments with regard to the need for all of us to respect others' choices. But I wish I could agree with the comment that the public understands the needs of people who are deaf and hard-of-hearing who have chosen to use their residual hearing. In fact, we find the opposite is true. Too often, children and adults are offered access that consists of an ASL interpreter, when, in fact, they don't know ASL. Such lack of understanding occurs throughout the public school system, at places of entertainment and in the workplace. We don't find that there has been any improvement at all in the publics understanding of the needs to provide captioning, assistance listening devices, or oral or Cued Speech interpreters. |
| Donna Sorkin, Alexander Graham Bell Association |
| I don't know for certain what the long-term impact on deaf culture will be, though, clearly, a greater proportion of children with severe to profound hearing loss now have access to sound that allows them to listen and speak. At this time, approximately 20 percent of eligible children are receiving cochlear implants and this percentage is expected to increase over time. |
| Nancy Bloch's Rebuttal: |
| Hearing aids have, in fact, been with us for quite a long time, and have had no significant impact on the deaf culture, with its rich heritage and language. The same would be true for cochlear implant technologies. |
| 8. Who is part of deaf culture? |
| Donna Sorkin, Alexander Graham Bell Association |
| I think that whether or not a person is part of deaf culture depends on that person's perspective. If a child or adult identifies with deaf culture — whether or not they have a cochlear implant — then they could be considered part of deaf culture. It is the sense of identification rather than the mere fact of having the technology that matters. There are many individuals who are deaf and oral who do not have cochlear implants (such as the adult members of AG Bell) who most decidedly do not identify with deaf culture despite the fact that they are deaf and do not have cochlear implants. |
| Nancy Bloch's Rebuttal: |
| Very well said. Ms. Sorkin and I are in agreement on an individual's sense of identification with various groups and cultures. Yes, indeed, those who do not know sign often do not identify themselves with deaf culture. It is interesting to note that many of the deaf members of AG Bell are quite fluent signers, even though these abilities were developed much later in their lives. Conversely, the NAD has members who do not even know sign, yet seek to take part in the NAD heritage of protecting the civil and advocacy rights of deaf and hard-of-hearing people. |
| Nancy Bloch, The National Association of the Deaf |
| If such individuals already consider themselves as being part of the deaf culture, even with an implant they will continue to perceive themselves in the same way. Those with and without implants who seek to interact largely with hearing persons are making that individual choice for themselves. The reality is that most seek out and interact with others like themselves when it comes to marriage, community involvement and socialization. |
| Donna Sorkin's Rebuttal: |
| I agree that one's identification with deaf culture has to do with personal perspective, not the technology one uses to communicate. |
| 9. What effect, if any, will cochlear implants have on American Sign Language? |
| Nancy Bloch, The National Association of the Deaf |
| None at all. However, the fact remains that children who are denied the opportunity for early development of sign language skills will likely find themselves at a crucial juncture in their lives where they are not able to connect with and identify with others who are also deaf. This is why the NAD emphasizes the importance of parallel visual language development for children with implants, in addition to acquisition of auditory and speech skills. This would enable various communication options, especially for those for whom spoken language development remains a challenge. |
| Donna Sorkin's Rebuttal: |
| Nancy has not really answered the question. But to respond to her comment, parents do have the right to make choices for their children with regard to communication options (and most things). Whether children use hearing aids or cochlear implants, and their choice of identity when they grow up, remains the parents' choice. |
| Donna Sorkin, Alexander Graham Bell Association |
| Families clearly have more options for their deaf children than at any other time, both because of improved hearing aid technology and cochlear implants. Since we are now able to provide young children with excellent speech sounds at an early age, they are able to access spoken language and, thus, learn to listen and speak. Indeed, the technology is now so different and dynamic that old presumptions fall away and each child will have the opportunity to determine what is best for him or her. I don't know what the implications are for use of ASL; I think decisions on its use will vary depending upon the individual family and child's own preferences, needs and comfort level. Public school systems are just learning to accommodate these children in mainstream settings. Some are doing a good job at this, while others clearly have a long way to go to meet these children's needs. AG Bell and our members are working with states and local school districts to improve educators' understanding of the needs of children with cochlear implants in public school settings. It is important that appropriate services and accommodations are made in mainstream settings where the majority of these children will go to school. |
| Nancy Bloch's Rebuttal: |
| Hearing technologies have improved, yes, and educational options have not changed. We have had the Individuals with Disabilities Education Act (IDEA) on the books since the 1960's. What has indeed changed is that cochlear implants are seen by the public as the proverbial solution that will enable deaf children to "hear" in the same way as their hearing counterparts. It is of paramount importance that all of us advocate for attention to the specialized educational and support needs of deaf children, both with and without implants. Also important is that we do not deny deaf children the opportunity to learn and use sign language, even if they are immersed in an environment that relies largely on hearing and speech. We at the NAD are working hard to ensure that the individualized needs of all deaf and hard-of-hearing children in all educational settings are addressed under the IDEA and the Americans with Disabilities Act (ADA). |
| 10. Researchers at Johns Hopkins University have found that children with cochlear implants can be mainstreamed into public schools at three or four times the rate of children without implants. As the number of deaf children with cochlear implants increases, what effect will this have on the deaf education system? |
| Donna Sorkin, Alexander Graham Bell Association |
| Public school systems are just learning to accommodate these children in mainstream settings. Some are doing well; some have a long way to go. However, the Individuals with Disabilities Education Act (IDEA) requires that public schools provide children with disabilities what they need to excel. AG Bell and its members are currently working with states and local school districts to improve educators' understanding of the needs of children with cochlear implants in public school settings. It is likely that few of these implanted children will be placed in state schools for the deaf, which have traditionally used ASL as the primary language. |
| Nancy Bloch's Rebuttal: |
| We at the NAD are doing likewise on the education front. Our focus is more holistic, taking into consideration the individualized needs of deaf and hard-of-hearing children, including full access to educational settings with appropriate support services. As I said earlier, mainstream educational placements are not a new phenomenon, and are at an all-time high even for deaf children without implants. ASL usage, contrary to my esteemed colleague's statement, is very much a part of the mainstream education setting. So, too, is English usage within the private or residential education setting. In a nutshell, cochlear implants do not in themselves guarantee success in mainstream settings. |
| Nancy Bloch, The National Association of the Deaf |
| The NAD has long advocated the provision of educational services appropriate to the individualized needs of deaf and hard-of-hearing children — across the full continuum of educational placement options. Our concern is that these children in mainstream placements, including those with implants, frequently do not receive the benefit of direct communication and support services that are so critical to academic and extracurricular success. Mainstreaming is the current trend for implanted children, and often without assessment of specialized educational and support service needs. Such efforts merit closer scrutiny, especially to ensure that children both with and without implants do not fall through the cracks. |
| Donna Sorkin's Rebuttal: |
| I agree wholeheartedly that children with hearing loss are often denied their rights in the educational system. Indeed, this is all too often the case, regardless of the level of hearing loss or the technology utilized. Children who are oral and use their residual hearing will need assistance technology, acoustical improvements, periodic speech and audiological services, and more. I concur with Nancy that public school systems need to be made more aware of the needs of all children with hearing loss. |
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