Background to this study In their study, Watson and colleagues sent questionnaires to

U.K. families of all 288 children who had received a CI in the past 5 years. They received 142 replies (49%), of whom119 (83.8%) indicated that the child and family had changed their communication approach following cochlearimplantation. In 113 cases the change was toward spoken language and in 6 cases the change was toward signedcommunication (Watson et al., 2007). This shift toward the use of spoken language and parent’s reports of satisfactionafter five years of device use were largely related to the achievements in speech and language made by their child.

The current study Questionnaires investigating communication choices were posted to parents of

all 640 children who received the cochlear implant at the Eye & Ear Hospital, Melbourne, Australia. Specifically thisquestionnaire [replicating Watson's (2007) study in the UK] investigated the factors that influence parents to chooseeither a visual/manual based approach (sign, sign language, total communication) or an auditory/oral based approach(oral-aural, auditory verbal) with their children, and whether the child's preferred communication approach had shiftedover time.

Methods & Materials A new form of the questionnaire was developed with 4 themes;

1. Child’s actual communication mode now and in the pastAfter completing some basic demographic information such as who completed the questionnaire and level of education,Parents were asked to select which communication mode best described the child’s communication before and afterimplant, one, two, three, five and 10 years post implant, and currently. Codes 1-6 were derived from definitions providedby Geers and Brenner (2003).

2. Statements regarding communication choicesParents were asked to indicate their level of agreement with 12 statements by circling a Likert-like scale (e.g. agreestrongly -- agree somewhat -- neither agree/nor disagree -- disagree somewhat -- disagree strongly). These statementswere derived from Watson’s study (see examples in Table 1).

3. Sources of Information about CommunicationParents were asked to nominate who/what was the primary source of information used to make decisions about thechild’s communication.

4. Open ended responsesParents were invited to write anything they felt the researchers should know about their communication choices.

creating sound value

www.hearingcrc.org

Table 1. Examples of statements • I want to use most effective way of

communicating with my child• I want the easiest method (for me) of

communicating with my child• I want to use the communication method in

which I am most skilled• I want to use the communication method

which is more likely to be useful to my childin the future

• Using sign language appeared to beimpeding my child’s speech development /Using sign language appeared to beimpeding my child’s speech development.

• My child preferred to use spoken language• I think my child can communicate very well

now• I think my child is still delayed in his/her

communication• Overall, I am satisfied with the decisions I

made regarding my child’s communication

Conclusions 47% of parents reported that their child used spoken language and listening, and did not require visualcommunication. For 25% an Oral Aural approach was used. For 29% of parents, the role of Sign communication was important. Theresults suggested a flexible approach, in fact, a more parent-centred approach to communication choices may be warranted,particularly when children have significant additional special needs. Although clinicians may wish to counsel using the latest researchevidence, we also need to listen to parents needs and aspirations.Acknowledgements to the children, parents, speech pathologists, audiologists, surgeons & administrative staff at the Cochlear Implant Clinic, RVEEH, Melbourne, Australia.

dettmans@unimelb.edu.au

Communication before and after cochlear implants

Shani Dettman1,2 and Rita Lonski11 The University of Melbourne, Department of Audiology & Speech Pathology, 2 The HEARing Cooperative Research Centre, 3 Royal Victorian Eye & Ear Hospital

Results Statistical testing of the 168 returned vs. non-returned questionnaires indicated the groups were not

significantly different for gender, and duration post-implant, but were significantly different for age at implant; thereturned questionnaires being from current families with younger children. Over 83% of returned questionnaires werecompleted by the mother (Figure 1.) with 90% finishing high school or higher education (Figure 2.). Over 54% of thechildren had shifted towards a more auditory/oral mode of communication, 40% had stayed the same and 6% hadshifted towards a more sign based approach post-implant and overtime (Figure 3.). The majority of parents (47%)reported that their child currently used a mode of communication that used audition and speech with no reliance onvisual cues (Figure 4.).

With regard to the statements, over 93% of parents chose the "most effective" mode of communicating with their childand 82% wanted it to be "useful to my child in the future". Over 81% of parents agreed that their child could"communicate very well now" and 97% were satisfied with their decisions.

30% of parents reported that they used a combination of persons to assist them with making a decision regardingcommunication mode for the child. 17% reported the teacher-of-the-deaf was the primary source of information, and16% reported that it varied over time. 11% considered the direction provided by family to be most important and 11%reported that the audiologist they first met at the diagnosis of hearing loss was the key person assisting them to make adecision about communication. The speech pathologist, audiologist, or ENT surgeon at the cochlear implant clinic wereeach regarded as the key person used to make communication decisions by 5 % of families.

When invited to make their own open-ended comments, some parents expressed strong views. These could besummarised into three main themes; 1). sign was important, and conversely 2). a preference for emphasis onspoken language, and 3). requests for clear communication from professionals (Table 2.).

85

312

Figure 1. Who completed the questionnaire %

mother

grandparent

father

10

18

29

22

21

Figure 2. Education level completed %

did not complete high school

completed high school

completed TAFE/other

completed university

completed post‐grad

5440

6

Figure 3. Shift in communication over time %

shift toward oral / aural communication

stayed the same

shift toward sign / visual communication

0

7

22

0

25

47

Figure 4. What communication is used currently %

1. Sign only = 0

2. Sign with some speech

3. Sign and Speech

4. Cued Speech = 0

5. Oral / Aural

6. Oral / Aural no visual cues

Table 2. Parents comments “I believe using both Auslan and oral

language has helped my daughter greatly. She canfit into both worlds, hearing and deaf, which hashelped her greatly with friendships and education. Ibelieve that doing sign language does not delayspeech; if you give your child all the tools, they thencan decide later in life which forms of communicationthey choose.” Mother A

“not signing with my child (after the implant)was a good decision, I think, to make. It forced us touse hearing and speech which was to my son’sadvantage” Mother B

“every specialist had a different opinion andsometimes I felt (and sometimes I still do) like I wasdoing it wrong or that my views/ opinions/ideas werenot seen as valid to some professionals. I am themost experienced person at dealing with mydaughter but they seemed not to care about that andit can be disheartening to feel that way about whatyou have tried so hard to achieve” Mother C of 2children with cochlear implants at 2.5 and 2.17 years

Visual and Sign Auditory and SpeechEmphasis Emphasis

1 2 3 4 5 6