The Case for Oral Programming for Children with Cochlear Implants:
It is Not The Traditional Oral/Total Communication Controversy
Position Paper on Cochlear Implants
“The goal is for the hearing-impaired child to grow up in a typical learning and living environment and to become an independent, participating citizen in mainstream society.” Dimity Dornan, Let’s Hear and Say: A Current Overview of Auditory-Verbal Therapy, The Auricle 16-23 (Fall/Winter 1999). “Cochlear implantation accompanied by aural habilitation (emphasis added) increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services.” Howard W. Francis et al., Trends in Educational Placement and Cost-Benefit Considerations in Children with Cochlear Implants, Arch Otolaryngol Head Neck Surg. 125, 499-505 (1999).
Several studies show the benefits of intensive oral habilitation in young children who have received cochlear implants. These children, who were once thought to be permanent additions to special education services in the school systems, and to the so-called deaf culture, are now able to be completely mainstreamed. The key to making this happen is intensive, oral based education which enables full use of their implants. These children must be placed in the appropriate setting as early as possible so that they can make a successful transition from a special education to a regular education setting.
“Educational Management of Children with Cochlear Implants” outlines some procedures for increasing the benefits that profoundly deaf children can achieve with cochlear implants. J. Moog, A. Geers, American Annals of the Deaf, 136 (2), 69-76 (1991). The Central Institute of the Deaf (“CID”) uses an exclusively oral communication program for children with cochlear implants. Although most programs use “total communication” approaches, the CID believes that the more speech the child hears, the easier it is for the child to learn to understand and produce it. When in oral programs, very profoundly deaf children rely exclusively on lipreading and skilled, specially trained teachers to learn to talk. Those in total communication programs, however, rely primarily on sign language to communicate.
“Studies show that over 90% of parents with normal hearing do not use sign language beyond a basic preschool level of competence.” Let’s Hear and Say: A Current Overview of Auditory-Verbal Therapy at 16. This means that most hearing-impaired children cannot adequately communicate with their parents when their primary mode of communication is sign language. Moreover, ASL is closer to a foreign language than it is to standard English. Children need to receive direct, intensive oral training to develop auditory and speech skills. In most oral programs, this training is an integral part of the entire school day. However, in total communication programs, it is necessary to plan for periods each day when children will work on auditory skills and no signs will be used. This is a far cry from complete immersion in an oral environment.
A study entitled “Speech Intelligibility of Children with Cochlear Implants” explored the relationship between communication mode and speech intelligibility in children who used oral or total communication programs. Mary J. Osberger et al., The Volta Review, 95 (5), 169-180 (1994). The results revealed that the speech of children placed in the oral communication program was roughly twice as intelligible as the speech of the children who were in the total communication program. Therefore, children who use total communication programs do not reach their potential in terms of speech development because of problems inherent in their method of communication.
The primary goal of the oral communication program is to eventually mainstream hearing-impaired children so that special education services will not be needed. “Let’s Hear and Say: A Current Overview of Auditory-Verbal Therapy” gives an overview of the current philosophy and teaching methods of Auditory-Verbal Therapy, which teaches hearing-impaired children to become independent of special services and ultimately completely mainstreamed. One of the main differences between the various programs for hearing-impaired children is not what the child can do but what is expected for that child. The aim for hearing-impaired children taught with the Auditory-Verbal approach is for mainstream education and the elimination or near-elimination of the need for special education services or accommodations.
According to “Trends in Educational Placement and Cost-Benefit Considerations in Children with Cochlear Implant” a cost-benefit analysis based on conservative estimates of educational expenses show a cost savings with cochlear implantation and appropriate auditory habilitation that ranges from $30,000 to $200,000. Id. at 499. This savings only occurs if these children are given the proper placement in an exclusively oral communication program that teaches children with implants how to be independent of nontraditional forms of communication, as well as the deaf culture, such as sign language, and mainstreamed instead with the speaking society.
Additional support of this position may be found in an OSEP Letter to Cohen found at 25 IDELR 516 (1996). In this letter, it states, “It is especially important that a full continuum of alternative placements is made available to meet the unique communications and related needs of deaf and hard-of-hearing students.” A full continuum would include providing both total and oral communication programs to meet the individual needs of all students, including implanted students. And as the technology advances, the needs of implanted students will be increasingly different from the needs of non-implanted deaf and hearing impaired students.
A recent due process decision in Illinois changed the former belief that oral communication for Cochlear implanted children was a methodology issue. In W.F. v Flossmoor School District No. 161 (IL 2002) (38 IDELR 50), the school district for a four-year-old boy who was implanted at the age of 18 months attempted to place him in a total communication classroom rather than a totally oral/aural program. The parents had unilaterally placed this child at a private oral/aural day school one year prior to the due process hearing, and requested retroactive and prospective placement at the day school. The hearing officer ruled in favor of the parents on all counts and specifically rebutted the dispute as methodology issue. He stated, instead, that oral programming for children with Cochlear implants was “not a methodology issue, but rather what the child needs to satisfy the goal of talking.” He further found that “If the goal for this Student is to use his cochlear implant to learn to talk, he needs a highly intensive oral/aural approach to reach this goal. The Parents sought a cochlear implant for him because they wanted their son to be able to utilize oral language as his sole means of communicating with society. For him, to be placed in a different program, would be potentially harmful in that it consumes valuable time in a narrow window of opportunity.” Therefore, the parents were entitled to reimbursement for the past year’s tuition, reimbursement for transportation to the private school and prospective placement at the private school for at least one year.
Two other due process hearing decisions support the theory of oral communication programs are the minimally appropriate education for children with cochlear implants. In Eureka Union School District, 28 IDELR 513 (CA, 1998), the school district attempted to place a three-year-old with aided hearing almost equal to the hearing of a nonhearing-impaired child in a total communication class for deaf/hard-of-hearing students. The parents objected, enrolled the child in an auditory/oral program at a private school and requested a due process hearing for reimbursement tuition costs. “The hearing officer examined the proposed district program for the student and concluded that it was inappropriate. The district program was not designed to address the student’s need for improvement of his listening and auditory skills and would have required him to learn a new form of communication.” (emphasis added.) The district program emphasized sign language, which the student did not need to communicate and would possibly have resulted in regression of the student’s listening and speaking skills. The private program, however, provided the student with a free and appropriate public education, since it addressed his listening and auditory skills. Accordingly, the parents were entitled to reimbursement for the costs of the private program.
In Duarte Unified School District, 26 IDELR 351 (CA, 1997), the school district recommended placing an 11-year-old with a cochlear implant in a total communication program. Despite recommendations that the student required extensive therapy to learn how to use the Cochlear implant, the district only increased the amount of therapy by an insignificant amount. The parents objected to this placement and requested a more inclusive placement in an oral class and more speech/language services. The hearing officer agreed that the proposed placement for the student was not appropriate. He concluded that the student required placement in a class that was primarily oral, in order to increase the student’s oral communication abilities and to increase the use of the cochlear implant. The school district was ordered to design a new IEP for the student which specified a more inclusive placement and at least three 60-minute sessions a week of speech/language therapy.
The technology of cochlear implants is advancing rapidly in the medical field. As it advances, the needs of implanted children will be increasingly distinguishable from the needs of non-implanted deaf and hard of hearing children. There is no question that an implanted child who, early on, is provided with a “full immersion, high expectation” 100% oral program is far more likely to succeed in school and in hearing society. The “up front” investment in oral education for implanted children is small when compared to a lifetime of special services and accommodations. And the complete or near-complete elimination of the need for special education services “with full mainstreaming” is not only a worthy goal, but one mandated, where appropriate, by IDEA. In the case of implanted children, “success” could not be better defined.
There are cases in which the district prevailed, but each of these is distinguishable. In Brougham v. Town of Yarmouth, 20 IDELR 12 (U.S. District Court, Maine, 1993), although the court held for the district, the distinct difference in the fact pattern explains the judgment. The parents removed their hearing-impaired 13-year-old son from the public school in Maine after he had been mainstreamed since he first entered public school in 1984. They unilaterally sent him to an out-of-state school for the deaf in Massachusetts and then expected full reimbursement. He had a hearing aid, instead of a cochlear implant. Also, this case dates back to 1993, which seems to be particularly outdated due to recent advancements in hearing technology.
In Bonnie Ann F. v. Calallen Independent School District, 20 IDELR 736 (U.S. District Court, Southern District, Texas, 1993), the district agreed to incorporate an oral approach and committed to discontinuing the use of all sign language techniques with the child. The parents disagreed with the placement. The district then agreed to place the child in an oral environment in the district. The parents rejected all of the options and pulled their daughter out of the school in the middle of the school year. They transferred her to a private school 300 miles away and asked for reimbursement from the district for the cost. The district prevailed due to the unreasonableness of the parents.
In Nicholas R. Petersen v. Hastings Public School, 20 IDELR 252 (U.S. District Court, Nebraska, 1993), a dispute arose from three hearing-impaired children who were taught modified sign language instead of exact sign language, which was what the parents wanted. The court held that the district had complied with the requirements of the IDEA providing an overall program designed to confer an educational benefit on each of the children. This, again, is an outdated case (1993) which contained nothing concerning cochlear implants or oral v. total communication programs.
In Unified School District 512, 22 IDELR 912 (KS 1995), the district proposed to place the child in a total communication program and the parents disagreed. Although the school district offered more pull-out time for speech and language services, more auditory training, and more mainstream time, the parents, who lived in Kansas, instead placed their child at the Central Institute for the Deaf in St. Louis, Missouri. The court held for the district denying the parent’s request for reimbursement.
Our primary goal is for hearing-impaired children to no longer be excluded from mainstream society. Cochlear implantation has made this goal achievable so long as the implanted children get the appropriate educational services. Oral communication programs give hearing-impaired children the skills they need to function in mainstream society.