Discussion Session

Chair:

Professor Bencie Woll, Chair in Sign Language and Deaf Studies, DCAL, UCL

Panel members:

Dr Andrew Faulkner, Head of SHaPS, PaLS, UCL

Professor Gary Morgan, Psychology, City University and Deputy Director, DCAL

Dr Rachel Rees, Lecturer, PaLS, UCL

Gwen Carr, Honorary Senior Research Associate, UCL, Education Consultant to the England Newborn Hearing Screening team

Several questions were brought forward for the panel. These questions fell (roughly) into four categories:

Speech Perception

Language,

Families & Professionals

Intervention & Monitoring Protocol (MP).

There was not enough time in the panel discussion for all of them, however they are all laid out here (with the discussion notes from the panel discussion).

1) SPEECH PERCEPTION (Andy Faulkner)

Q) Is there any evidence showing the effects of children with cochlear implants having reduced access to speech reading (i.e., is an AVT type approach detrimental to developing auditory-visual listening skills)?

A) This question has no straightforward answer. We cannot really say not to use a specific method of intervention at all because all techniques can have their time and place. It is dependent on the individual and the situation. (BW).

Q) Do AVT children perform poorer in listening in noise, for example, because they don’t link what they see (speech reading) with what they hear?

Q) In light of today’s discussions, is it ever legitimate to work on developing auditory pathway (i.e., listening without visual cues) for short, specific periods of time (on the basis that the auditory pathway has to be as ‘effective’ as possible, especially post implant)?

A) Good early input is important, for example, from using two CIs.

--There was some discussion regarding the age of implantation and the current guidelines. In general, better outcomes are reached when CIs are received at a younger age but sequential implantation at an older age in children also shows good results.

Q) What accounts for the high variability in speech perception skills of children with CI?

A) This question is difficult to answer because there are several factors that affect development of speech perception especially in individuals with CI, and there really is not a one good answer to the question. Overall, we have to remember that there are wide range of abilities also in the hearing population and no homogeneous outcomes in development.

Q) How can we get hold of the CI simulation recordings?

A) These are available in the web:

Go to TigerCIS (http://www.tigerspeech.com/tst_tigercis.html)

Q) How can we train pitch discrimination? Which resources are available?

A) We have found associations between musical skills, improved pitch perception and use of pitch cues in language processing in adults. Based on recent results it also looks like those children with better musical skills are good at various listening tasks and there is interest in the training of musical skills (‘music-based training’) also in CI users (work by Ritva Torppa & Dr Andrew Faulkner).

Q) We have learned that children with CI can have some difficulties with pitch perception.

- What impact can we expect that this might have on their ability to pick up social language/speech cues evidenced through pitch changes?

- Would using ‘motherese type’ speech be helpful in helping them to learn and understand spoken language?

- Should we be training pitch perception?

A) We can talk about ‘implicit meaning’ that is not necessarily concretely present in the language -so how to get that through to a child? Hearing children are immersed in the social language via the input but in CI users and deaf children noise-related factors will reduce the quantity and quality of overheard language. So speech and language therapy should also focus on working on various social characteristic of language (e.g., pragmatics in addition to speech sounds and vocabulary and so forth). Research has shown (e.g., by Michael Tomasello and colleagues) how complex factors involving speaker’s voice, face and so forth are picked up automatically - without instruction. These factors are also important for learning abstract concepts and unfortunately often overlooked in deaf children where the focus frequently is in learning/teaching concrete concepts. (GM)

--a discussion followed where RR also mentioned syntactic complexity and the effect of more complex syntactic frames affecting positively the vocabularies of children but, in addition, these children are also better at working out the intentions of their mothers. Regarding ‘motherese’ and child-directed speech with exaggerated intonation: motherese is culture dependent and, therefore, not always used. It seems that lack of it does not necessarily have a negative effect on development. However, in deaf children and in terms of their difficulties in pitch perception some aspects of motherese (e.g. exaggerated intonation) could be a helpful.

2) LANGUAGE (Gary Morgan)

Q) Having been trained to aim for language development in children which is commensurate with non-verbal cognitive ability, I feel we need to discuss:

- How much language delay is acceptable whilst we await oral language development which is in line with non-verbal cognitive ability?

- At what point do we progressively add sign to the child’s programme including full BSL if necessary?

- Are we united in a desire to NOT produce frustrated, cognitively underdeveloped casualties as a result of our interventions? Do we talk enough about that?

- I am not anti-cochlear implant but I feel we need more consensus on when and how we react when progress is slow and sign could help.

A) Any amount of delay is difficult to gain back and generally waiting is not recommended. We need to think what the child is telling you what they need. Unfortunately, cognitive delays can snowball and we know little how language and cognition relate to one another. These factors make predicting the consequences difficult. Overall, we cannot just wait for language to develop, because if language is not developing it can also have long lasting cognitive effects.

RR/AF: CI children are missing many important cues. There is evidence in the deaf community using BSL that shows that parents naturally adjust the amount of signing, that is, parents automatically adapt themselves. Sign language can be seen as an “an insurance policy” for the parents.

Q) Is there a minimum amount of acoustic information necessary for the development of spoken language? Is this a useful consideration when planning intervention with deaf children?

A) This issue is frequently raised (and studied) in bilingual development but less so in deafness. Focus should not necessarily be on the amount but on the quality and variety of acoustic information (e.g., variety of speakers, genres etc). If the child is involved and engaged in the process they will acquire and grasp the concepts faster but if the child is not engaged no amount of repetition will necessarily do.

3) FAMILIES AND PROFESSIONALS (Rachel Rees)

Q) Does the panel have any suggestions for improving the situation where families receive conflicting strategies from different professionals?

A) Hopefully the CIPDEC project will begin to address this problem by identifying the range of strategies suggested by different professionals and having a dialogue about their evidence base and efficacy. (RR).

Q) I am really pleased that the research questionnaire is looking at approaches advised by CI teams and those used by local teams. Is there a real problem when the advice given to families is different and conflicting?

A) Biggest complaint from families is about receiving conflicting advice. However, parents are happy to have several viewpoints available to them. So difference in opinion is fine but conflict is not. We have to bear in mind that different families have different values and cultures, and also that there is evidence backing all available methods. So what to recommend? In the end, it is about the manner how knowledge is shared. If some method is working for you and your child, then good but this might not work well in another setting. We could try and share the evidence-base with parents and bring families in as well. (GC)

--There was discussion about knowledge exchange between researchers, professionals and families and agreement that this should be improved by, for example, arranging similar symposiums (and possibly bringing in the families as well).

4) INTERVENTION AND MONITORING PROTOCOL (Gwen Carr)

Q) Can monitoring protocol data be used as research data? E.g., for longitudinal studies

A) The use of Monitoring Protocol in research does not work largely because MP is not designed for that and there are better measures available to use in longitudinal contexts.

Q) How do services support families/Early Years Centres (nurseries) transfer (understand) the information from the Monitoring Protocol to the Early Years Foundation Stage Curriculum?

A) At times we are too formal. But you can write informal reports based on the MP and use it to inform the relevant people what you know of that child’s development compared, for example, against the age norms. You can tell them what they need to know in that particular setting. We need to say what these children can do (and not always what they cannot do).

Q) Has there been a systematic evaluation of the Early Monitoring protocol’s operation?

Q) How do you manage the difficulties of demanding siblings when using the Monitoring Protocol with families (i.e., families with constant divided attention)?

Q) Are you concerned about the impact the SEN Green Paper may have on the role of ToDs/ resources?

--At the end there was discussion about children and families in the research literature (with reference to MM’s talk): how well they represent the general population out there? There are issues such as language background and non-English families (i.e., children who are usually not included in the research studies), and the effects of socioeconomic status (often ignored and not reported in research literature). Moreover, those children and families who are willing to take part in research projects do not necessarily reflect the variability that is out there. Following this, the question also is how well do the services relate to the population out there?