A cochlear implant (CI) allows children and young people with severe and profound hearing loss to access sound – but it doesn’t restore normal hearing. The CI bypasses the normal acoustic hearing process and replaces it with electric signals which directly stimulate the auditory nerve. The devices are government funded and there are a range of support services throughout Aotearoa to help children and their whānau.
“In New Zealand, the devices can be implanted from six months old, which maximises the window from 0-3 years that is the critical age for speech development. Children and people who lose hearing later can still benefit from CIs – they often have clear spoken language if they have heard before, but they need more support to learn how to ‘hear’ with a CI,” explains Robyn Moriarty, paediatric audiology manager at The Hearing House in Tāmaki Makaurau Auckland.
“The babies who receive implants at six months and wear the devices all the time go on to develop speech and language skills like typical hearing children. If they receive their implants a bit later, they can catch up, but if they haven’t got established listening skills by age five, they may need to rely on visual communication in addition to hearing – there are always grey areas and exceptions.
“But if your brain has never had sound and then has access suddenly through a cochlear implant, it can take time, support and therapy to learn to use it meaningfully, especially for communication,” she says.
Collaboration and choices
Robyn says that when parents get a diagnosis that their child is deaf, they are often in a state of shock, as the majority of parents are from a listening world and may not have had any experience with deafness or the Deaf community.
“In the past it has been the perception that here was an either/or choice between, ‘do you want to listen and talk, or do you want to use New Zealand Sign Language?’
“In reality, you can do both. You can use the CI to develop speech and spoken language and you can also develop language through the use of sign language. Collaborative decisions can be made with parents and their health and education partners; as professionals we should be offering all choices to families so they can choose what they want for their children,” she says.
The Hearing House has a caseload of approximately 280 children with CIs from Taupo to Northland. A small percentage are in schools where NZSL is used, but the majority are in mainstream schools where some use sign and spoken language; most only use spoken language because that is what their whānau use.
Unless ākonga have other learning difficulties, they don’t always access funding for support, but Robyn says they do have to work harder than their hearing peers. Many use a ‘Roger’, a wireless Bluetooth microphone worn by the teacher and the child, which can be used by other children in the class as well to help the CI user fully participate.
“Children with hearing loss of any degree can benefit from special technology in schools to make sure they can hear the teacher – that’s really well funded in New Zealand,” says Robyn.
“The Resource Teachers of the Deaf (RTD) who Ko Taku Reo provide, and advisers on deaf children from Ministry of Education Learning Support do a great service regarding setting up technology for the classroom, but they also consider the curriculum and make sure the child is in an environment that’s fostering good hearing. They help classroom teachers be aware that children with hearing loss are getting a bit of extra support to catch up if they need it,” she says.
Grace Morton is a speech and language therapist with The Hearing House and responsible for 120 young people with CIs aged 8-19. Part of her role is to monitor their speech and language development, then liaise with teachers and whānau to provide advice on how a child can access learning more easily and what can be offered to further support their learning.
“There’s a bit of a misnomer that somebody wearing a CI can hear normally because they’re able to talk and communicate and go to a mainstream school. But I am in awe of what these kids have to navigate on a daily basis – things they have to think about all the time that typical hearing people might take for granted.
“I talked to kids about what strategies they use, and they talk about how they sit in a certain place in the classroom. For example, it’s really helpful to sit on the side of the classroom, so they can not only see the teacher, but they can see any child who puts their hand up to ask a question. This just comes naturally to these kids because it has to – that’s how they cope in a hearing world.
“Every child is different, but they have to work so hard to piece together what they’re hearing – it’s not normal hearing and even if they’re used to it, it doesn’t mean that it’s easy. It can be really, really tiring – hearing fatigue is a very real issue and when you’re in noisy environments, it’s pretty exhausting,” explains Grace.
As well as working alongside children to support their speech and language development, Grace is passionate about empowering agency, independence and the development of self-advocacy skills.
Grace focuses on children when they are turning eight and turning 12, ages when a comprehensive speech and language assessment is done. She offers them five sessions of one-to-one therapy on confidence and advocacy as they transition to new schools – intermediate, or high school.
“Not everyone has an RTD, AoDC or teacher aide with them all day every day and I think it’s our responsibility as clinicians to make sure these kids are accessing the curriculum in a fair way.”
Grace explains that the only way that can really be achieved is by empowering the child to have the skills and knowledge of knowing what to do – with their equipment, in the classroom and in social situations.
“I’m not saying they’re miraculously confident after five sessions with me and everything is sorted, but I think that for most of these kids it’s so normal for them to have CIs and their whānau and friends are completely used to it.
“But then the kids are being thrown into high school, which is a completely different environment because you have many different teachers and all these new peers and a whole new learning environment and they’re not used to people not knowing how to communicate with them. Most of these kids have such amazing families and support systems, but what happens when she goes to a new school and she’s got six teachers, not just the one teacher to train up on how to use the Roger [microphone]?” asks Grace.
Auckland 12-year-old Olivia is one of the ākonga who has benefitted from one of Grace’s confidence courses, which included talking about Olivia’s strengths and developing some more coping strategies.
“Grace has been helping me with trying to be confident about my ears. A big issue is that I will be going to college next year and whenever I come to a new group, every single time, there’s one person who is staring at my ears and that can get very uncomfortable for me.
“The most helpful strategy is to take three deep breaths in and out if you’re in a big situation where you might feel a bit uncomfortable and try and make what you say ‘short’ because I like to make things very long!” says Olivia.
Alice and husband Richard worry how Olivia will navigate the turbulent teenage years. She says the five-session course was validating for Olivia.
“It was awesome and perfectly timed. That was such a gift from The Hearing House just before Olivia is heading off to college. There’s a real mental health aspect to it – I think it’s really boosted her confidence,” says Alice.
“Grace tells me that if I’m not feeling that confident, or if you feel different to everybody else, you should practice your responses with your family or friends and that helps a lot,” adds Olivia.
This article is reproduced with the permission of the Ministry of Education.