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Parental perspectives on changing communication skills after implantation

This information is based on the results of questionnaires and face-to-face interviews with parents and their implanted children.

Over the years there has been a lot of discussion about which communication method to use with deaf children. This has continued with the arrival of cochlear implants which many see as an aid to the development of language through speech and hearing. There has also been a lot of controversy about how best to support children before and after implantation and we felt it was helpful to look at this area in more depth.

We asked parents about how they communicated with their child before and after implantation and why they chose to use a particular communication method. Here we use the results of our questionnaire and quotations from the interviews to describe parents’ responses, highlighting the issues that they felt were important.Do children change their communication method after cochlear implantation?

Do children change their communication method after cochlear implantation?

The first part of this project found that the majority of children who receive a cochlear implant at the Nottingham Cochlear Implant Programme change from using more sign language to using more speech within five years.

Children who are implanted at a young age (under three years) are even more likely to choose to use mainly speech (83%) than those who had an implant when they are older (over five years at implant, 43%).

Communication mode one, three and five years after implantation

This graph shows the communication mode that children are using at different stages – under one, one, three and five years after implantation. They have been divided up into children who were implanted under three years of age, between three and five years of age and over five years of age. This shows that when children are implanted over five years of age (purple bars) there is little or no change from sign language to speech even five years after implantation. In contrast the children implanted under three years (green bars) show a big change to using speech after five years.

Communication mode for children implanted under three years of age

Looking more closely at the children who were implanted below the age of three, you can see from the following figure that as children use more oral communication, they use less signed communication.

This graph shows the percentages, for children implanted under three, of those using signed communication (in red) and those using oral communication (in orange) before and over five years after implantation.

In order to look at the trends in more detail, and the reasons for changes in communication choices, this was followed up in two further studies, using a questionnaire to parents and then interviews.

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Communication before cochlear implantation

Most of the parents who were interviewed said that they used sign language or a mixture of sign and speech before their child had a cochlear implant.

“We found out that she was deaf at four months and started signing then... I couldn’t have gone through three or four years with no communication.”

“We muddled through using speech, sign and gesture. The most important thing was being able to communicate as a family.”

Communication choice

How did parents choose a communication method to use?
In their responses to the questionnaire about communication after implantation:

  • 93% of parents said they wanted the most effective means of communication
  • 91% of parents agreed that they wanted a method that their child would find most useful in the future

Parents had different ideas about the use of signed support. Some parents saw it as a useful tool or bridge whilst other parents were keen to focus on the development of spoken language as soon as possible. Other parents hoped that their child would continue to use sign alongside speech.

“Basically everyone would say that it was better to use sign language and speech. We didn’t agree with sign. We would agree (to use sign) for the transitional period until his speech developed.”

“I was gesturing – learnt basic (sign) names for animals, colours –  one key word. He did need this – but I would always speak it – and probably for a few months after implant. We had to use it to get some language. Also used photos to show him. Signing really helped us with concepts e.g. yesterday, tomorrow, three sleeps.”

Many parents remain positive about the use of sign language.

“We had to get his sign language going which aided his speech in the years to come.”

“We were hoping that she would be more oral - if she hadn’t been we would have been disappointed but we always wanted her to be bi-lingual.”

“I want her to feel confident in using sign in her mid to late teens. One of the main reasons we went for a cochlear implant was to give her a choice - there are two sides to this – recognise the fact that she is deaf but give her the option of spoken language."

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Communication after cochlear implantation

Parents’ comments suggested that they found sign language useful but that the change towards greater use of speech was their child’s choice. As their child could hear more, so they chose to use more speech.

Did communication change?

  • 120 parents said that that their child and family had changed their communication method following cochlear implantation.
  • 113 parents said that they now used more spoken language and  7 parents said they used more signed communication.

Which communication method did parents think their child preferred?

  • 70% of parents felt that their child preferred speech.
  • 18% of parents felt that their child preferred to use sign language.

For many parents, communication changes were driven by the child’s changing needs:

“It was a very natural and child-driven change to spoken language. He prefers spoken language both receptively and productively.”

“He dropped the signing before I did, entirely through his choice. Our communication mode has always been motivated by her request.”

“In choosing an implant we were wanting to give him a choice. He now, at 17, definitely has that choice – he chooses his implant, he loves to hear and he chooses to speak.”

Does the use of sign language interfere with the development of speech?

  • 50% of parents did not feel that using sign language stopped their child from learning to speak.

“I don’t think that signing as well as talking is going to prevent speech – if you can’t talk you won’t develop – you run the risk of depriving them of communication.”

  • 23% disagreed and felt that the use of sign language did appear to be slowing down their child’s development of speech.

Does the use of speech interfere with the development of sign language?

  • 9% of parents felt that using speech slowed down their child’s sign language development

Parents spend a lot of time talking to teachers of deaf children about their child’s communication but they usually decide for themselves which communication method they want to use.

Although many young people develop speech through their cochlear implant this does not mean that they do not want to use sign.

One young person said: “I sign to all my friends. Saw a lot of people signing so I picked it up. “
Interviewer: “Do you use sign only or sign and voice?”
Young person: “If someone is a good signer I sign without my voice.”

Interviewer: “Which do you like to do best? Do you like to sign or talk or do both? “
Young person: “Do both because if I sign it makes me feel kind of good when you do two languages. Sometimes I miss talking but when I am talking with my family I miss signing.”

Interviewer: “Which will you use when you leave school? “
Young person: “Talk but I will still keep in touch with deaf friends.”

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Parental reflections on cochlear implantation

Many parents are very grateful that their child had a cochlear implant.

“Communication within the family is perfectly normal. I dread to think where he would be without a cochlear implant. I just don’t see how he could have developed language skills.”

“We are very happy. We were warned to have realistic expectations but this is 100% more than we could have hoped for – couldn’t hope for more. He has local friends, goes to local school, catches the bus home with his friends, goes to local discos. I never worry about him. It is very easy to forget that he is hearing-impaired. Although his speech might not be perfect, people generally understand what he is saying.”

One parent of a child who lost his hearing following meningitis saw the cochlear implant as the only way of giving him back some hearing.

“At the end of the day the cochlear implant was his only hope of being able to learn to listen and speak again – for us that was our goal. If it had not been possible we would have gone headlong into sign but we wanted to give him every opportunity to listen and speak again.”

One mother talked about the reasons why she wanted a cochlear implant for her child who has other special needs in addition to her deafness and the need to be realistic.

“We hoped that she would want to wear her cochlear implant all the time, that she would learn to talk in such a way that someone who did not know her would understand. But we understood that it might not be the case. We said that if it gave her access to environmental sound it would be worth it.”

Some parents commented on the fact that children now receive implants at a very young age:

“I would have liked him to have a cochlear implant sooner. If he was a baby now and deaf we would want an implant straight away.”

The communication journey

In their interviews, parents appeared to be describing a “Communication Journey”, in which their child’s communication needs may change over time.

Communication journey

After diagnosis of profound deafness and before the cochlear implant operation, parents choose the most effective way of communicating with their child. This is often a mixture of sign and speech.  If a child receives a cochlear implant when they are young or quickly after hearing is lost, spoken language is likely to develop, with a corresponding reduction in the use of signed communication.  For children implanted young, this happens relatively quickly, and parents report that they follow the child’s changing needs, as the quotations show. They also report that they need to ensure there is a consistent focus on developing speech following implantation.

Even so, they and many of the children and young people remain flexible in their attitude towards communication. Sign continues to be useful in certain situations especially where the speech processor cannot be worn for example when swimming or in the bath. 

Parents and their children often show an increased interest in the use of sign in adolescence, when good levels of spoken language have been established and sign language may be learnt as a second language. 


These studies show that after implantation, the majority of children develop the use of spoken language, whether they have used some signed communication or not prior to implantation. However, although parents are keen for their children to learn to use and understand spoken language many also feel that signed communication is important too, especially in the early days. Those implanted young are more likely to use spoken language and to develop its use quickly. Parents also recognise the flexibility it gives children and young people when amongst deaf friends and when the cochlear implant cannot be used for any reason. Results from these and other studies carried out by the Ear Foundation have found that young people are often interested in using sign language as they grow older, even though they can also speak intelligibly and understand spoken communication.

More research is needed to investigate the optimal support for children after implantation.

Details of the Study

Who contributed to this project?
This information was collected in a three part study carried out by Sue Archbold and Alexandra Wheeler at the Ear Foundation in conjunction with Linda Watson from Birmingham University and Tim Hardie, parent of a deaf child with a cochlear implant.

The families had all received cochlear implants from the Nottingham Cochlear Implant Programme (UK). The project was funded by a grant from the National Deaf Children’s Society.

Part 1: The data
Information on 176 children on the Nottingham Cochlear Implant Programme was collected and analysed. The communication method used by the children before implantation was compared with the method they used at five years after implantation.

Part 2: The questionnaire
The questionnaire was returned by 142 parents of children who were all profoundly deaf and had been implanted for 5 years or more.

Parents were asked:

  • which communication method they used before implant and now, using a five point scale: entirely sign, mainly sign, about equal, mainly speech, entirely speech.
  • if they changed their communication method after implantation,  to tell us whether they agreed with ten statements:
  1. I want to use the most effective way of communicating with my child.
  2. I want to use the easiest method (for me) of communicating with my child. 
  3. I want to use the method of communication in which I am most skilled. 
  4. Using sign language appeared to be impeding my child’s speech development. 
  5. Using speech appeared to be impeding my child’s sign language development. 
  6. I want to use the language which is most likely to be useful to my child in the future. 
  7. I want my child to know British Sign Language because she or he is part of the Deaf community. 
  8. My child preferred to use sign language. 
  9. My children preferred to use spoken language. 
  10. I was following the advice of my teacher of deaf children.

Part 3: The interviews
In the final part of the study, we looked at the three groups of children in the data - those who had shown no change in communication method following implantation, those who had shown some change and those who had shown great change. We interviewed 12 families, parents and their children.

The interviews were carried out by a researcher, a teacher of deaf children who had no connection with Nottingham Cochlear Implant Programme.

We would like to thank all the families and staff on the Nottingham Cochlear Implant Programme for taking part in this project.


Watson LM, Archbold SM, Nikolopoulos TP(2006) C hildren’s communication mode five years after cochlear implantation: changes over time according to age at implant.  Cochlear Implants International Vol 7, Issue 2, Pages 77-91, June 2006.

Watson LM, Hardie T, Archbold S, Wheeler A (2007) Parents’ views on changing communication after cochlear implantation.  Journal Deaf Studies and Deaf Education. 12:3 Summer 2007.

Wheeler A, Archbold S, Gregory S, Skipp A, (2007) Cochlear Implants: The  young people’s perspective. Journal Deaf Studies and Deaf Education. 12:3 Summer 2007.

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Information supplied by The National Deaf Children's Society. Reproduced with permission.
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Disclaimer: The information contained on this website is not intended as a substitute for independent professional advice.

15-Nov-2015 1:48 PM (AEST)