This presentation was first delivered at the University of Central Lancashire (Deaf Studies Seminar) in Preston, 22 February 2005___________

Updated for a seminar at Queen Margaret University College, 24 October 2005 .

The order of those things we know about deaf pupils with cochlear implants

Ernst Thoutenhoofdernst@ed.ac.ukMoray House School of EducationUniversity of Edinburgh2005

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International literature review, 1994–2002

Thoutenhoofd, E.D., Archbold, S.M., Gregory, S., Lutman, M.E., Nikolopoulos, T.P. and Sach, T.H. (2005) Paediatric cochlear implantation: Evaluating Outcomes. London, England: Whurr. ISBN 1-86156-366-3.

Project funded by Cochlear International.slide 3

Areas of interest

Language and communication(spoken and sign languages).

Family and social life.

Education, placement and attainment.

Health economics.

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Purpose

To summarise the current knowledge on this topic and identify gaps in the literature.

To make recommendations for future research in the area, identifying aspects of benefit not previously taken into account.

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Coverage (selection criteria for inclusion)

Published in English.

Research conducted after 1994, in order to exclude single-channel implants.

Sample sizes of ≥12 children or parents.

Databases were searched twice, at start and end of the project. The review covers 145 accounts, from 248 originally identified.slide 6

Journal spread

Most articles appeared in medical journals, and searches through Medline were the most productive. Other sources were BEI/ERIC, CINAHL, IBSS, PsycInfo and Web of Science.

104 key words and reported measures were listed against the collection of articles.slide 7

Key findings

Speech recognition and speech perception are the most researched outcomes.

Studies generally report wide variation in individual performance.

Demographic reporting focuses mostly on audiological, implant and placement measures.

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General finding

“Relative to the huge range of factors that may affect outcome […], there is a more general under-analysis of demographic sample characteristics and few attempts at factoring out intervening variables. Hence any number of outside factors might help to explain individual variation.” (:21)

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General conclusion

Outcomes may be divided into 3 categories:

Robust outcomes eg improved auditory performance

Inconclusive/contradictory outcomeseg language development; placement

Outcomes with little or no researcheg educational outcomes; quality of life10 of 17 slides

Selected conclusion

“… the perceptual effect of the implant is equivalent, on average, to an improvement of about 28dB in hearing thresholds.” (Blamey et al. 2001:264)

“…the average language delay will be about 4 or 5 years by the time the children enter secondary school at about age 12 years.” (ibid:283)

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Achievements of Deaf Pupils in Scotland Project (ADPS), 2000–2005

Marian Grimes, Emily Healy, Ernst Thoutenhoofd.

Data collection funded by Scottish Executive Education Department (2000–2004) and the National Deaf Children’s Society (2005)

A D P S

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Further details

http://www.education.ed.ac.uk/adps/http://www.ssc.mhie.ac.uk/

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The goal of ADPS

The ADPS project is longitudinal in intent, tracking the educational situation and performance of most deaf pupils in Scotland specifically in order to identify factors that help explain the over-time expression of adverse effect on achievement.

Questionnaire return rates for the four years are well over 95%.slide 14

The ADPS population, 2000–2005

2,030 pupils in the database6,108 year records22,724 attainment records

Details at 24 October 2005.Nb: the information on the slides that follow is ‘work in progress’, much in the spirit of this seminar/workshop. The tables have not been checked by the ADPS team, and therefore any errors that may exist are entirely my own. For data published through the project, consult the ADPS website.

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Cochlear implant details (October 2005)

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(n) Age DOB_CI CI_Census Age at CI CI experience

preschool (n) 29average 3.7 32.6 10.8 2.3 0.5median 4.0 30.0 6.0 2.1 0.1st dev 1.1 11.4 10.2 0.9 0.7

primary (n) 83average 8.4 42.1 52.3 3.0 4.0median 8.1 39.0 55.0 3.0 4.1st dev 2.1 17.3 24.2 1.5 1.9

secondary (n) 31average 15.2 102.0 67.7 8.2 5.3median 16.0 105.0 60.0 8.1 5.0st dev 2.1 53.3 35.5 4.5 3.0

Full-time placement: profound/ci (October 2005)

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2.5 3.5year 1 2 3 4 1 2 3 4

(n) 185 149 131 119 91 106 108 110

Mainstream 25.4 20.1 22.9 26.1 57.1 50.9 46.3 43.6Units 35.7 34.9 31.3 26.9 30.8 32.1 38 37.3School for deaf pupils 34.6 40.3 42 42.9 11 15.1 13.9 17.3SEN setting 3.8 4 3.8 4.2 1.1 1.9 1.9 1.8

Other settings 0.5 0.7

2.5 = deaf pupils with profound bilateral deafness, without ci.3.5 = deaf pupils with ci.

Selected cohort yrs 1–3: hearing loss and ci N= 124 (yr1); 137 (yr2); 116 (yr3)

2000-2001 N= A+ C+UL 1 2 3 4 5 CI UL 1 2 3 4 5 CI

P6N= 118 3 2 21 39 24 14 9 3 2 21 39 24 14 9Reading 112 3 2 19 35 20 8 9 3 1 15 24 12 1 4Writing 106 3 2 18 34 18 5 9 2 0 13 22 10 1 2Maths 119 2 2 21 36 21 11 9 2 0 10 21 13 2 4% average 89 100 92 90 82 57 100 78 17 60 57 49 9.5 37

2001-2002 A+ D+UL 1 2 3 4 5 CI UL 1 2 3 4 5 CI

P7N= 127 5 5 24 41 24 12 9 4 5 24 41 24 21 9Reading 121 5 5 22 41 22 10 9 1 1 11 14 11 3 3Writing 107 4 5 21 38 19 6 9 1 1 9 9 9 1 1Maths 119 4 5 24 40 21 9 9 1 1 7 14 7 1 3% average 87 100 93 97 86 69 100 25 20 38 30 38 7.9 26

2002-2003 A+ D+UL 1 2 3 4 5 CI UL 1 2 3 4 5 CI

S1N= 112 7 4 21 37 18 8 7 7 4 21 37 18 8 7Reading 110 5 4 19 33 18 6 7 3 0 11 17 10 1 4Writing 108 4 4 18 32 16 5 7 3 0 10 13 8 1 3Maths 112 5 4 19 32 18 6 7 3 0 9 15 5 1 5% average 67 100 89 87 96 71 100 43 0 48 41 43 13 57

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Notes to slide 18

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Details as at 22 February 2005. ‘Year 1’ is school year 2000–01. The hearing loss descriptors represent: UL (all unilateral hearing loss), 1 (within normal limits), 2 (mild hearing loss), 3 (moderate hearing loss), 4 (severe hearing loss), 5 (profound hearing loss), CI (cochlear implanted pupils). The dataset was since recoded for hearing loss, so that these details have now been replaced with a different ordinal scale.

The table does not offer the number of pupils within each category, but the “% average” gives the percentage of those who have achied at the given level for any of the three subjects, against the total number of pupils within that category of hearing loss. Level ‘A’ is the threshold (base) level of attainment targeted at the start of Primary. Progression towards Level F is assumed to be continuous from P2 to S2. Figures exclude pupils in SEN settings, but include those pupils in deaf schools for whom their year group is known (ie sufficient basis exists for those pupils to progress). Figures also exclude those for whom outcomes were not reported or not known.

Reading age yr 1: chronological age (all pupils & ci disaggregated) N=792 (ci=69)

N= 69 12 14622 18020 1368 1325 100 2 29

>2 1 1 1 3above 1–2 10 1 3 8 2 2

0–1 192 20 3 25 4 111 121 6 2

0 2 1 1 1 4 3 1 5 1 3

0–1 315 30 7 315 25 1 18 20 5below 1–2 123 50 4 49 6 24 1 211 7 2

2–3 2 24 5 313 162 10 1 5 13–4 1 1 10 1 20 2 18 3 131 9 34–5 1 15 141 8 10 25–6 11 11 5 36–7 1 4 191 11 17–8 1 7 7 18–9 6 11 1

9–10 1 1 2>10 1 4

2

13–15 15–17 17+

(unexplained)

5–7 7–9 9–11 11–13

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Notes to slide 20

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Details as at 22 February 2005. ‘Year 1’ is school year 2000–01. Figures include all pupils for whom reading age assessments were reported, regardless of placement or SEN.

The column headings list chronological (actual) age, in bands -- there may be a skewing effect on the data due to banding, which is not investigated. The vertical rows list the reported reading age, expressed in years above or below chronological age.

The ‘all pupil’ figures (in black) include those of the ci pupils (in red). Note that the figures report the number of reading age test instances, not the number of pupils -- ie, in some instances, more than one reading age assessment may have been reported for a pupil, and all have been included.