An analysis of the five year outcomes of a cohort of 46 deaf children with severe (SLD) or profound and multiple learning difficulties (PMLD) and associated complex needs, including autism (ASD), tracked using the Nottingham Early Cognitive and Listening Links (Early CaLL): This framework monitors the relationship between sound processor use and listening, spoken language, cognition and communicative development, following cochlear implantation.

Objectives: In 2018, routine data of the five year outcomes from a cohort of 46 children, (18 PMLD and 28 SLD, including nine SLD children with an additional diagnosis of ASD), was analysed to investigate the type and amount of benefit provided by cochlear implantation and to examine any differences in outcome patterns across the populations.Methods: The level of functional sound processor use achieved over time was reviewed in relation to listening and spoken language outcomes, alongside social engagement, communicative and cognitive development. The extent to which children were able to close the gap between their overall development and their listening abilities was quantified. The outcomes of the children with an additional diagnosis of ASD, was compared to those of the SLD population as a whole.Results: Although equipment management presented long term challenges, after five years, 80% of children were able to attach some meaning to sound. Children with SLD acquired more auditory skills and spoken language than those with PMLD. Most of the children used a mix of augmentative and alternative communication approaches (AAC), with 7%, all SLD children, acquiring some simple spoken language. An additional diagnosis of ASD had a negative effect on outcomes.Discussion: For 80% of the patients, the provision of cochlear implants provided benefits, although changes were slow to develop and required high levels of adult persistence.Conclusion: Outcomes measures which are population specific and acknowledge challenges, alongside providing ways to recognise individual achievements, by matching them against individual capacity, are of great value to families and practitioners.

The development and implementation of the Nottingham early cognitive and listening links (Early CaLL); A framework designed to support expectation counselling and to monitor the progress, post cochlear implantation, of deaf children with severe (SLD) and profound and multiple learning difficulties (PMLD) and associated complex needs.

Objectives: Appropriate outcome measures are required for deaf children with severe (SLD) and profound and multiple learning difficulties (PMLD). This paper describes the development and structure of the Nottingham Early CaLL Framework and via a series of case-studies, demonstrates its effectiveness in tracking progress over time.Methods: The materials were developed in-house in 2011-2012 and refined through the exploration of established approaches in health and education, an inter-rater reliability study and an extended pilot of the draft materials.Results: The Framework quantifies the long term benefit of cochlear implantation by recording the amount of functional sound processor use achieved, alongside incremental changes in auditory behaviours, in the context of cognition, interaction and communication development. The case-studies demonstrate how it can provide evidence of measurable changes and help to explain some of the underlying reasons for the range of long-term outcomes.Discussion: Within this population, the key predictive, within-child factors of post cochlear implant listening and spoken language outcomes, are an individual's cognitive and physical capacities and their engagement in social communication.Conclusion: The Early CaLL Framework supports expectation counselling and decision-making in the assessment phase and post cochlear implantation provides monitoring tool, which encourages collaboration between families and professionals.