The age at which children receive their cochlear implant(s) varies according to individual circumstances and geographical factors. Ideally, children with hearing loss are diagnosed very soon after birth or after losing their hearing. However, this is not always the case.

While we know the provision of the best technology immediately following early diagnosis results in the best outcomes, children implanted later also often demonstrate significant benefit following the provision of high-quality technology. Sharma, S. D., Cushing, S. L., Papsin, B. C., & Gordon, K. A. (2020). Hearing and speech benefits of cochlear implantation in children: A review of the literature. International Journal of Pediatric Otorhinolaryngology, 133, 109984. https://doi.org/10.1016/j.ijporl.2020.109984[1]

When a child is implanted later, there is often a significant gap between the child’s language development and what would be considered typical for their age. This language gap can result in a child starting school with a lower language level than their peers. For instance, a child entering school might have a language level equivalent to that of a three-year-old, while their classmates may have the language skills typical of six-year-olds. Geers, A. E., Nicholas, J., Tobey, E., & Davidson, L. (2016). Persistent Language Delay Versus Late Language Emergence in Children With Early Cochlear Implantation. Journal of Speech, Language, and Hearing Research, 59(1), 155–170. https://doi.org/10.1044/2015_jslhr-h-14-0173[2]

Challenges Faced by Late Pediatric Recipients of Cochlear Implants

The language gap poses several challenges in the school environment:

1. Learning Vocabulary as They Go

Children with typical hearing and language come to school with a well-developed vocabulary, giving them a head start. In contrast, children who receive cochlear implants later may have limited vocabulary.

In the classroom, this can lead to having to learn new vocabulary at the same time as learning new concepts. For example, a teacher might read a book about polar bears to the class. The book includes words such as ‘claws’ and ‘hibernate.’

Many of the children in the class will already understand those words and can map the meaning onto the example they see. Children with less vocabulary will need to learn the meaning of those words at the same time as they learn about polar bears.

2. Limited Knowledge and Development of Sounds in Words

When learning to read, it is helpful if children have a well-established speech sound repertoire. Typically developing children use all the sounds in their language by the age of six.

Children implanted later may not yet be able to make all the sounds, and there may be errors in the sounds they use in words. This can make learning to read difficult. For example, learning the sound the letter ‘k’ makes is difficult if the child cannot yet say that sound.

Again, this learning takes place simultaneously with learning to read, making the process more effortful and difficult.

3. Limited Phonemic and Phonological Awareness

Phonemic and phonological awareness refers to the ability to notice, think about, and manipulate sounds in words and sentences. This includes skills like rhyming.

Children with typical language development have some understanding of these processes when they enter school. This understanding often comes much later for children who were implanted later, which affects their ability to learn to read.

4. Less Experience With Social Connections

Children who received their implants later have had less time to learn how to make friends and how to interact with their peers.

Additionally, if they have lower language levels, they may find that their peers play games and have discussions they can’t understand.

Children with hearing loss, particularly those who are implanted later, can have later-than-typical development of Theory of Mind skills. These skills are important to help make and maintain friendships.

Ideas for Supporting Late-Implanted Children at School

There are many ways to help children who face the challenges above in school settings. These include:

• Ensuring each child receives the best technology, including latest-generation audio processors, such as SONNET 3 or RONDO 3.
• Using assistive listening technology, such as AudioLink XT, in the classroom
• Ensuring the classroom environment supports the child. The resources below have been developed specifically to help you achieve this.
• Where possible, providing the child with additional support from teacher aides or shadow teachers. For children who are ‘learning as they go,’ extra time to learn vocabulary and language can be invaluable. At times, it may be helpful for the teacher aide or shadow teacher to work with the child in a one-on-one setting.
• Pre-teaching and post-teaching: If the child has access to a teacher aide or shadow teacher, new concepts and vocabulary can be taught either before or after they are introduced in the class.

Although children who receive cochlear implants face unique challenges, by ensuring access to the best auditory technology, providing additional classroom support, and implementing targeted teaching strategies, we can help these children thrive in the school environment.

Resources for Teachers

In addition to the free resources below, we also recommend checking out our article, What Teachers of Children With Cochlear Implants Need to Know.