Cochlear Implants: Language and Communication

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Language and Communication Planning

 "It is important to look beyond a single approach in achieving optimal outcomes in linguistic, cognitive, academic, and social competence for children who are deaf and hard of hearing, including those with cochlear implants."

~ Ed Bosso, Vice President of Laurent Clerc National Education Center, Opening Remarks of Conference Proceedings, Cochlear Implants and Sign Language: Building Foundations for Effective Educational Practices, April 2009

There is no single language and communication approach appropriate for the diverse children who are using cochlear implant technology. Effective language and communication strategies following implantation should reflect the complex interaction of characteristics specific to each child and family. While development of spoken language may be the purpose of obtaining a cochlear implant, the level of spoken language competence achieved, and the path to getting there may vary for each child and family.

Developing an Individualized Plan

As decisions are made about the language and communication strategies to use for a child with a cochlear implant, development of an individualized language and communication plan can provide a systematic framework to guide and monitor choices regarding practices to best match each child's characteristics. Developing a profile of a child's language and communication functioning can be useful in developing an individualized plan. The profile should reflect both formal and informal assessments completed as well as observation of the child's language and communication functioning in natural environments. The following receptive and expressive communication continuums can be incorporated into the child's profile to describe how he or she is using both visual and auditory information for accessing information and to communicate. This information can then be used to steer recommendations regarding language and communication approaches and strategies.

Receptive/Expressive Communication Continuum

As these continuums are incorporated into developing a language and communication plan, it is important to take the following into consideration:

  • How far each child with a cochlear implant will move along the receptive continuum toward auditory learning and along the expressive continuum toward spoken language competence is not guaranteed. The rate of movement along each continuum will also vary for each child.
  • Although a child may appear to have the characteristics to become a big A learner or a big O communicator at a future stage in his or her spoken language development, current school placement and language use decisions should look beyond future potential and take into consideration where a child is functioning at the time the plan is developed.
  • How a child functions on either continuum may differ in varied settings (e.g., social setting, large classroom, small group or one-on-one communication, noisy environment, complicated fast-paced language use). Language use decisions should reflect a child's needs in these varied settings.
  • How a child functions in receptive spoken language understanding may differ from how he or she functions in expressive spoken language use. For example, a child may be able to readily understand spoken language. However there may be other complicating factors (e.g., oral motor issues) unique to the child that may limit effective use of speech.
  • Where a child falls on either continuum will affect recommendations not only in language and communication development but also in all education and social-emotional development areas.

Adapted from Nussbaum, D., & Scott, S. (2011). The Cochlear Implant Education Center: Perspectives on effective educational practices. In R. Paludneviciene & I. Leigh, Cochlear implants: Evolving perspectives. Washington, DC: Gallaudet University Press.

As a plan is developed, language and communication choices should:

  • Be guided by individual communication goals/strengths
  • Provide accessible language regardless of modality while spoken language skills are developing
  • Provide accessible language to facilitate cognitive and academic development
  • Provide opportunities to develop spoken language skills in meaningful ways during both structured and natural activities
  • Take into consideration that language modality may change for students as they progress in their spoken language development
  • Take into consideration student skills and preferences
  • Take into consideration a child's overall educational and social needs
  • Follow the lead of the child in demonstrating communication preferences
  • Not allow the child to fall behind academically at the expense of focusing on spoken language development
  • Provide the child with efficient communication for interacting with peers

Language and Communication Choices

While it is beyond the scope of this document to describe and discuss what is included in various communication approaches used with children who are deaf or hard of hearing, the following considerations should be kept in mind as decisions are made for children with cochlear implants:

  • one-size-fits-all approach will not meet the needs of all children with cochlear implants
  • A combination of language and communication approaches may be employed and modified over time as spoken language competence evolves
  • The language and communication approaches and strategies for a young child will be different than those for a child obtaining an implant when he or she is older and at a later stage of language development
  • The language and communication approaches used should not be frustrating to the child

For more information about the varied approaches:

About the Use of Sign

Depending on a child's individual background characteristics, coupled with their language and communication profile, approaches inclusive of sign language may play an important role for children with cochlear implants. With purposeful planning and appropriate supports, spoken language can be nurtured and developed in a signing environment. The use of sign language does not imply exclusion of spoken language.

Sign may play an integral role in establishing early language foundations through a child's strong sense of vision while the auditory pathways are developing or provide an ongoing role for a child throughout his or her life. The role may vary from child to child. Some of the ways that sign may be addressed include (modified from Moeller, M. P., 2006, Use of sign with children who have cochlear implants: A diverse set of approaches. Loud & Clear! (PDF), 2(1), 6-12.):

  • Use of sign vocabulary to facilitate early language development before obtaining a cochlear implant. Children are exposed to sign vocabulary (conceptually accurate ASL signs or an English-based sign system) to jumpstart language development before cochlear implantation.
  • Use of sign as a bridge or transition to proficiency in spoken English. Sign (ASL or an English-based sign system) is used with the child before implantation and as a bridge to transitioning to the use of spoken English following implantation. Sign is slowly diminished as the child demonstrates increased proficiency in spoken English.
  • Continued use of sign as a support to spoken English. An English-based sign system is used in conjunction with spoken English (either via simultaneous communication, sequentially as a support to English, or via an interpreter).
  • Bilingual development of ASL and spoken English. Each language is developed and addressed as an independent language. Spoken English is facilitated for both social and academic purposes based on the individual characteristics and goals of each child. For more information about strategies to address development and use of both ASL and spoken English, referred to as a bimodal bilingual approach, see Odyssey, The "Why" and "How" of an ASL/English Bimodal Bilingual Program, by Debra Berlin Nussbaum, Susanne Scott, and Laurene E. Simms.

As sign-inclusive approaches are considered, it is important to keep in mind the following:

  • The importance of defining "sign"-When professionals and families consider use of "sign" for children with cochlear implants, it is important to understand the distinction between sign as a clarification of spoken language and ASL as a full visual language. Use of signed representations of English such as Manually Coded English (MCE), Conceptually Accurate Signed English (CASE), or Sign Supported Speech (SSS), will involve different strategies than use of a bilingual approach that develops and utilizes both ASL and spoken English as separate languages.
  • An ASL/English bilingual approach can be designed to meet the needs of children with cochlear implants-With purposeful planning and appropriate resources put in place, an ASL/English bilingual approach can be designed to meet the spoken language needs of children with cochlear implants. This includes providing opportunities for use of spoken language in natural environments, auditory, speech, and spoken language habilitation opportunities, and support services to monitor and maintain the technology. 
  • There is no conclusive evidence that sign impedes spoken language development-A review of research related to sign use reflects that signing in and of itself does not impede the development of spoken language on average across children (Marschark & Hauser, 2012). Instead, the quality and intensity of the spoken language used with a child has been found to have the most impact on the development of spoken language. With purposeful planning, spoken language can be effectively addressed in signing environments. There are many interwoven factors, aside from use of sign that can impact spoken language outcomes. Other impacting factors include consistent use of the device, parental involvement, non-verbal intelligence, availability of rich spoken language models and the quality and quantity of spoken language use in a child's environment. Evidence also supports that sign can facilitate a child's development of and transition to using spoken language in environments where spoken language is also effectively developed and incorporated into the child's life. (Spencer, P. [2009]. Research to practice, CIEC conference, Cochlear Implants and Sign Language: Building Foundations for Effective Educational Practices.)

Sign as a Bridge to Listening

Regardless of whether a child will transition from sign to spoken language or continue using sign, there are numerous strategies that can be incorporated that utilize sign to facilitate spoken language development. Some of these strategies include:

  • Providing a purposeful bridge between signed and spoken language. 

- Model and expand known signs into spoken language. For example, when a child signs ball, verbalize back, "Yes, that's a ball."

- Incorporate the use of sequential language use/sandwich technique (i.e., say it- sign it-say it or sign it-say it-sign it).

- When using ASL, provide a corresponding explanation and example of how a similar communication would occur in spoken language.

  • Documenting a plan of how and when to utilize sign during the day in the child's natural environment.
  • Minimizing the level of sign use to provide opportunities to develop spoken language during highly contextual and familiar communication situations.
  • Providing opportunities during the day where sign language is not used and incorporating listening strategies to promote understanding (e.g. limit choices, highlight key words, repeat the message, provide contextual cues).
  • Determining a plan for individualized auditory and speech habilitation (see Training the Ear to Listen).

For more information regarding considerations for sign use for children with cochlear implants:

Websites for Families Addressing Language and Communication Choices

My Baby's Hearing-This family education website was developed by Boystown National Research Hospital. The three main content sections include: 1) Hearing and Amplification, 2) Language and Learning, and 3) Parent to Parent. The first major section of My Baby's Hearing is available in Spanish at

Through Your Child's Eyes-This DVD was created through the California Department of Education and California State University, Northridge with funding provided by the Annenberg Foundation to share the benefits of sign language.

Raising and Educating a Deaf Child-This is a Rochester Institute of Technology/National Technical Institute for the Deaf website where experts answer questions about choices and controversies faced by families and educators of children who are deaf or hard of hearing.

Hands & Voices Communicator-The Hands & Voices Communicator is a U.S./international newspaper that has many articles that are relevant to families raising children who are deaf or hard of hearing. It includes stories of families who have "been there" and information that may be helpful to both families and professionals.

Developed by Debra Berlin Nussbaum at the Cochlear Implant Education Center, Laurent Clerc National Deaf Education Center; last revised May 2012

This site was supported by federal funding. Publication of this material shall not imply approval or acceptance by the U.S. Department of Education of the findings, conclusions, or recommendations herein. Gallaudet University is an equal opportunity employer and does not discriminate on the basis of race, color, sex, national origin, religion, age, hearing status, disability, covered veteran status, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, political affiliation, source of income, place of business or residence, pregnancy, childbirth, or any other unlawful basis.