Speech production in deaf implanted children with additional disabilities and comparison with age-equivalent implanted children without such disorders.

OBJECTIVE: To assess the long-term speech intelligibility in implanted children with additional disorders and compare them with age-equivalent implanted children without such disorders. PATIENTS: 175 profoundly deaf children 5 years following cochlear implantation; 67 children with additional difficulties and 108 children without such difficulties. All children were implanted under 5-year-old. MAIN OUTCOME MEASURE: Speech intelligibility rating (SIR) scale that can be readily applied to young deaf children irrespective of their performance and is reliable between observers. RESULTS: Five years following implantation, 47 (70%) children with additional difficulties developed connected intelligible speech versus 104 (96%) in the control group. However, the quality of speech was quite different between the two groups, as only 11 (16%) children with additional difficulties achieved the two higher categories (intelligible to all or to people with little experience), whereas 66 (61%) children in the control group did (P<0.000001). The total number of additional disorders had the strongest correlation with the outcome. Language and communication disorders were the most important contributing factor, followed by physical, cognitive, and autistic spectrum disorders. CONCLUSION: The majority of deaf children with additional disorders develop connected intelligible speech 5 years following implantation; however, a significant proportion do not develop any speech at all. Thus a third of this group did not realise one of the most important objectives for parents of implantation. Benefit from implantation should not be restricted to speech production alone in this specific population.

Using SNAP Dragons to monitor narrative abilities in young deaf children following cochlear implantation.

OBJECTIVE: To assess the narrative abilities of young deaf children before cochlear implantation and 1 and 2 years following implantation, and to explore possible changes in the implanted children's preferred mode of communication in the narrative abilities task. STUDY DESIGN: Prospective longitudinal study assessing the narrative abilities of young deaf children before and after cochlear implantation. SETTING: Pediatric tertiary referral center for cochlear implantation. PATIENTS AND METHODS: The narrative abilities of 35 young profoundly deaf children were assessed before implantation and 1 and 2 years following implantation using the Stories/Narratives Assessment Procedure. Children with age at implantation less than 6 years were included in the study (mean age at implantation was 3.5 years; range 1.4-5.9 years). All children were filled with the Nucleus multichannel cochlear implant system. With respect to their communication modes, they came from a wide range of backgrounds and all children were encouraged to use their preferred mode of communication during the narrative task. RESULTS: The data showed that there was a statistically significant increase in narrative abilities across the three data points (P<0.001). Before receiving the implant, children were mostly in the pre-structural, receptive stages and could at most label or comment on the pictures (median narrative stage 2). By the 2-year interval, children were mostly using one or two categories or one complete episode with spontaneous retelling (median narrative stage 4). Although children were not pressured to use any particular communication mode, a shift to speech was found following implantation and this was statistically significant (P<0.001). CONCLUSION: Young implanted deaf children showed a significant progress in their narrative abilities through time and a significant shift in the predominant mode of communication towards more speech orientated communication modes following cochlear implantation.