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Language Development in Hearing Impaired Children with Cochlear Implants: Case Studies in Bilingualism

Explore language development in hearing impaired children with cochlear implants, focusing on bilingualism and the impact of second language learning. Two case studies provide insights into factors affecting language acquisition in multilingual environments.

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Language Development in Hearing Impaired Children with Cochlear Implants: Case Studies in Bilingualism

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  1. Advances in Deafness ManagementSecond Language Learning in Cochlear Implant UsersOctober 9, 2005 Ripley K. WONG Speech Therapist In-charge Queen Mary Hospital Hong Kong

  2. Hong Kong Scenario • Multilingual society • Two formal languages: English & Chinese • Return of sovereignty to PRC in 1997 • Immigrants from Mainland China • Maids needs for learning different languages

  3. Language Development in HI Children • HI children develop language at slower rate (Davis et al, 1986) • Profoundly HI children develop language at half the rate of normal hearing children (Carney & Moeller 1998) • Increasing gap between language age and chronological age (Miyamoto et al, 1997)

  4. Language Development

  5. Language Development in HI Children with CI • Language delay compared to NH peers, but rate of language development similar (Miyamoto et al, 1997; Vermeulen et al, 1999) • Rate of language development exceeded that of unimplanted HI children (Svirsky et al, 2000) • Different rate of development for different language skills (Ertmer et al, 2003, Young & Killen, 2002)

  6. Second Language Learning in Hearing Impaired Children • Interference between languages • Reduced exposure to phonemic patterns / sound systems of spoken languages • Difficulty in picking up different phonemic patterns of different languages • Lack of natural ambient language input • Language delay resulting from hearing impairment

  7. Bilingual CI Users • Age-appropriate language skills in primary language and competent in second spoken language (Waltzman et al, 2003) • CI users can achieve oral proficiency in more than one language (Robbins et al, 2004) • A CI user acquired Cantonese, Mandarin and English to a degree comparable to NH peers (Francis & Ho, 2003)

  8. Case 1 • KC • 10 years old • Fitted with bilateral HA at 2;02 y.o. • No spoken language before implantation • CI done at 2 years 10 months (Clarion, S-Series) • Moved to an English-speaking country after implantation • 1st language: English

  9. Case 1 • Returned to HK in 2003 (8;03) • studying in international school • Had Mandarin class in school • Started ST training on Cantonese in February 2004, aged 8;07 (totally attended 15 sessions from 2/04 to 12/04) • Re-started ST training in 4/05 (attended 5 sessions from 4/05 to 9/05)

  10. Case 1: Language Assessment (English) • Peabody Picture Vocabulary Test (PPVT) • At high end of normal range • Clinical Evaluation of Language Fundamentals (CELF) • Receptive language: WNL • Expressive language: above average • 85-115: WNL, average of NH children: 100

  11. Case 1: Language Development

  12. 2nd Language Performance

  13. Case 1: Language Assessment (Cantonese) • Cantonese Receptive Vocabulary Test (CRVT) • At the beginning of treatment: <1;10 (score:22) • One year after treatment: 2;06 (score: 30) • Raynell Developmental Language Scales (RDLS) • After one year of treatment: • VC: 2;01 • VE: 1;09

  14. Case 1: Conclusion • Slow in acquiring 2nd language (Cantonese) • No interference with 1st language (English) development • Factors leading to slow acquisition: • Environmental factor: school, family • Interference from Mandarin • Personality factor

  15. Interference from Mandarin

  16. Case 2 • YC • 12 years 2 months old • Fitted with bilateral HA at 2;06 • Lived in Mainland China and spoke Mandarin before implantation • Studied in school for the deaf with total communication in Mainland • CI done at 6 years 10 months and 7 years 6 months (bilateral implantation, MedEl combi 40+ ) • Moved to HK in early 2001 (7;07)

  17. Case 2 • Started ST training in Cantonese since February 2001 (7;08) • Enrolled in normal KG and primary school • Average academic performance • Uses mainly Cantonese to communicate

  18. Case 2: Language Assessment (Mandarin) • Informal observation (pre-implant, CA: 6;09) • Short sentences (mainly 3-4 elements), no complex/compound sentences • Vocabulary: inadequate in view of his CA • Different speech acts noted (asking questions, making clarification, greetings, labelling, etc) • Not able to understand abstract concept e.g. conditional sentences

  19. Case 2: Language Assessment (Cantonese) • RDLS • Delay in both verbal comprehension and verbal expression • Delay in verbal comprehension > verbal expression

  20. Case 2: Speech Perception Assessment (Cantonese) • Paediatric Speech Perception Test • Vowel identification: 85% • Consonant identification: 65% • Tone identification: 64% • Sentence recognition: 80% • Connected speech comprehension: 70% • Performance comparable to same aged peers with Cantonese as 1st language

  21. CASE 2: Language Development (Cantonese)

  22. Case 2: Conclusion • Delayed development in 2nd language (Cantonese) acquisition • Possible explanation for the delay • Age at implantation • Delay in 1st language development • Constant gap between CA and speech perception ability but increasing gap with language age

  23. Case 2: Conclusion • Speech Perception ability comparable to other implantees with Cantonese as 1st language • Development in 1st language slow down because of complete switch from 1st language to 2nd language

  24. Case 3 • KK • 7 years 4 months old • Fitted with bilateral HA at 2;04 • No verbal language before implantation • CI at 3;04 (MedEl Combi 40+) • Lived in Mainland China • Studied in normal KG in Mainland • Speaks Mandarin

  25. Case 3 • 1 year post-implant assessment (1st language, Mandarin) • RDLS (based on Cantonese Version): • CA:4;04 • VC: 2;10 • VE: 2;05 • Informal observation: • Speaking mainly 2-3 element sentences • Developed various word classes: verbs, nouns, adjectives • Rate of development exceeds increase in age

  26. Case 3 • Had two months training in Cantonese (July to August 2004, age:6;04, 3 years post implant) • Showed significant improvement in vocabulary learning by CRVT: • Before treatment: raw score-3; AE-<1;10 • After treatment: raw score-27; AE-2;02 • Rate of acquisition exceeded age increase • Above-average academic achievement in 1st language • Treatment suspended because of family problem

  27. Conclusion • CI users can acquire 2nd spoken language • Able to perceive the phonemic patterns of 2nd language • Functional use of the 2nd language • Delay in 2nd language development • 1st language development continues as long as it was continuously used in daily life

  28. Conclusion • Possible factors affecting 2nd language acquisition • Age at implantation • Language ability in 1st language • Environmental stimulation for 2nd language • Language similarity, especially phonemic patterns

  29. Thank You

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