A few weeks back a number of trade magazines had the following type of headline, “Some Kids With Cochlear Implants Face Cognitive Risks.”  That headline is an attention grabber; it conjures up in the mind a correlation between cochlear implantation and cognitive risks. This article cites research coming out of Indiana University looking at 73 children implanted before the age of seven in comparison to 78 children with normal hearing. They report that “Delays in executive functioning have been commonly reported by parents and others who work with children with cochlear implants.”  In the article, they go on to state that
“In this study, about one third to one half of children with cochlear implants were found to be at risk for delays in areas of parent-rated executive functioning, such as concept formation, memory, controlled attention, and planning,” he said. “This rate was two to five times greater than that seen in normal-hearing children.”
This information was widely reported on multiple CI parents’ websites and the reaction was strong. Many felt the study had no validity because it did not compare CI children to deaf non-implanted children. Still others, I believe, correctly defined the issue. The problem was not the study, it was the headline used by the authors. After reading the headline, article and reviewing the poster presentation for the study, the news article without a doubt puts forward a false correlation, one the researchers did not present in their poster. I guess that should not be a surprise, sensationalism in journalism, but I also think there is a fundamental misunderstanding about children with cochlear implants and their learning curve. To illustrate, lets explore the idea of executive functioning.
What is Executive Functioning? Executive functioning is the application and synthesis of acquired information. In education we like to call it higher order thinking or crucial thinking. Here is a commonly accepted taxonomy for learning called Bloom’s revised taxonomy. If you look at the graph, you will see the various levels of cognition as defined by Bloom. What we call lower-order thinking are simply memorization and understanding a concept. As you progress up the taxonomical triangle, you see that you move from simply acquiring information to applying, analyzing, evaluating and creating with that information.
Executive function would exist at the upper parts of the triangle. It's a learned activity. Students need to be explicitly taught to use these skills. Most speech therapy focuses on sound and the acquisition of words, but in many cases do not give the student the opportunity to apply that information in real and meaningful ways. Much of what I have observed through my own son’s speech therapy is behavioral in nature and exists at a lower taxonomical level. At first this is completely necessary. A child with a CI needs to learn how to identify sound. Their brains need a period where they can start to integrate the auditory sense. But, at some unknown point, their brains understand how to use sound, but in many cases we just keep feeding in lower order information.
What is suspect in this study and many is the idea of the control group and how we as educators go about helping children with CIs. Maybe the reason we continue to find issues with the development of CI children is because our measure and approaches to their education are all wrong. As researchers and educators, we are trained to look at a norm, see a deviation, develop a plan to address that deviation and then compare to the norm to see how the intervention worked. This concept of basic scientific method works as long as the norm you look at is the correct norm. Our math can be completely right, the method sound, the treatment and control group intact, and the conclusion can be all wrong.
Comparing CI children to normal hearing children would seem to be a very good methodology, but it is not. CI children have too many factors different from normal hearing children to ever truly meet their milestones in the compressed time one learns spoken language. The mainstreaming goal is to fast pace a CI student so they can catch up, but the problem with this approach, learning does not happen that way. We learn langue over a long period of time through a recursive process of informed trial and error. During that period a child constructs their own understanding of language through years of exploration, correction, reflection and resolution of ideas and concepts. Understanding words and sounds is a lower order thinking process, but putting together meaningful language requires us to adapt and synthesis language through meaningful social experiences. We do not learn higher order thinking from approaches that ask us to simply identify and memorize.
Finally, maybe it is time for CI researchers to identify a new control group, high performing CI children that were implanted at age one or less. Throughout the literature I continue to see studies that compare CI subjects that have a wide variation in implantation date. For instance a 2011 study that came to the same results about executive functioning risks, looked at children that had been implanted before the age of seven, but the mean implantation age was 33.7 months. So on average, for this study, the average child was functionally deaf for the first three years of their life. Then at age three, they are implanted and introduced to sound. Then over a period of time they are measured for executive functioning and we find a deficiency. That does not seem to me to be a sound method in that we know from the literature factors such as socio-economic status and age of implantation can have significant influence on results. Throughout the literature we see children implanted at a very young age performing high on most scales. We need to recognize that CI children have different developmental experiences and patterns. Those patterns need to be identified and applied to subsequent generations of research as the control.