We know that getting a cochlear implant is not an instant fix. Speech, language, and listening skills do not magically appear after activation, and progress is on everyone’s minds. How does progress happen? How much is enough? How fast? What should we do if things aren’t working out as planned?
How does progress happen?
Making progress toward speech, language, and listening skills is an incredibly complex interaction between the ears, the mouth, the brain, the environment — it’s amazing, really. As an adult who is a fluent user of language, it’s hard to remember how you actually learned to talk. Most people don’t remember being taught language. When everything goes right, it just… happens. But peek behind the scenes, and there’s really so much to it.
Sometimes progress seems to plateau then shoot up, then plateau again, like walking up a set of stairs. The “jump ups” are thrilling and the “no movement” times are frustrating, but this is very normal. Sometimes plateaus occur when a child is busy achieving other developmental milestones (for example, some babies temporarily babble less once they become really good crawlers). Think about that little brain having only so many resources, so children tend to put all of their energy in one “bucket” (gross motor, fine motor, language, etc.) when they’re working hard to learn a new skill. Other times, a plateau is a time for a child to take in new information and process it. Remember that receptive knowledge (understanding) has to come before expressive use (saying the word, sound, or sentence structure).
Other children make progress that seems to consistently move in an upward direction, like a mountain. Whether at a fast or slow rate, they’re always on the move. This is pretty straightforward and simple.
What about children who don’t seem to make progress, or even those who regress or seem to lose skills they had previously mastered?
What we don’t want to see is a plain (no progress) or a valley (regression). People may try to comfort you with the maxim that, “Children learn at different rates,” and yes, that’s true. Children learn at different rates, but they all should be moving forward. If you’re not seeing progress, it’s time to run through a troubleshooting checklist. See this article for more information: Help! My Child Isn’t Making Progress with a CI.
When is a little regression normal?
We may see a little regression (in listening, speech, and language skills as well as other skills, like potty training or academics or emotional development) when a child experiences a big life change, like moving to a new house or the addition of a new sibling to a family. This is very developmentally appropriate and normal, as long as it resolves over time. A change in hearing technology (moving from hearing aids to a cochlear implant) can have a similar effect as children sort out all of the new input that their brain is receiving. Regression can also be an indicator that there’s a problem with hearing technology (for example, the child needs a new map, or the hearing loss has progressed).
When children learn their first words, it’s not uncommon to hear a word once and then not again for a few days or even a week or so. This is also okay. Remember that it’s one thing to perform a skill once (it may even be a fluke or a lucky guess), and another thing entirely to have mastered it so well that it’s a consistent, easy part of your repertoire. However, if you’ve heard words and now they’re completely gone, this could be a sign of other developmental issues. Your Listening and Spoken Language Specialist can help you sort our the difference, and may make referrals to other professionals (like a developmental neuropsychologist) when necessary.
How do we measure progress?
We all want progress, so we need data to stay on top of it and make sure it’s actually happening. Regular assessments, whether standardized tests or criterion-referenced checklists, should be administered regularly to ensure that children are keeping pace. Our general rule is more than one month’s progress in one month’s time (or one year’s progress in one year’s time, etc. etc. etc.). Children with hearing loss start off at risk, and, even if they receive amplification within the first month of life, they still have less auditory experience than their hearing peers (who begin to hear about 20 weeks before they’re even born). We cannot be content with slower progress, because it means that we will never close the gap and achieve age-appropriate skills. If this isn’t happening, see HERE for how to troubleshoot.
What is our end goal? What about special cases?
Our end goal is a child who has speech, language, listening, cognitive, and social skills on par with his or her hearing peers. Sounds too good to be true? Studies show that with committed parents and the guidance of a Listening and Spoken Language Specialist, Auditory Verbal graduates CAN and DO achieve this.
Of course, there are exceptions to every rule. In the case of a child with multiple, severe additional disabilities or intellectual delays, it may not be realistic to expect age-appropriate skill. However, progress is still possible. For these children, my goal is that their skills would be equal to that of a peer with their same conditions. A child who has Down syndrome and hearing loss (which do commonly occur together) may not achieve grade-level reading skills, but I want her reading skills to be to her fullest potential when compared to other children with DS but without hearing loss. A child with cerebral palsy may not have the motor ability to produce intelligible speech, but I still aim to have his receptive (listening) communication skills as high as possible. Whatever the child’s conditions, I want to work hard to achieve communication that is both optimal (up to his full potential) and functional (practical for the child’s everyday learning and social needs).
Children whose hearing loss is identified late (which, in today’s world of newborn hearing screening, really means any time after that first year of life, if that), may also face challenges with progress. For these children, a greater than month-for-month rate of progress is even more crucial than usual, because we are working to close an even larger gap. For special considerations when working with children in this situation, see The Catch-Up Game.
What about progress for teens and adults who are learning (or re-learning) to hear?
Teens and adults aren’t excluded from progress, either! Just like children, they may face plateaus, valleys, plains, and mountains. It’s important to have a comprehensive rehabilitation plan in place to help older listeners get the most out of their hearing devices. While teens and adults may already have a language system in place, the new “listening system” they received with their cochlear implant will be an adjustment that requires patience and practice. Expect that hearing can — and should — get better with time and auditory training.
Elizabeth A. Rosenzweig 