Wraparound support for learners with cochlear implants

By Education Gazette editors

Issue: Volume 100, Number 15

Posted: 24 November 2021

Reference #: 1HARWW

Tamariki and rangatahi who have cochlear implants from an early age can learn to communicate like their typically hearing peers, and many of them function highly at school, but they still face challenges.

Olivia, who is 12, has had cochlear implants since she was two years old.

A cochlear implant (CI) allows children and young people with severe and profound hearing loss to access sound – but it doesn’t restore normal hearing. The CI bypasses the normal acoustic hearing process and replaces it with electric signals which directly stimulate the auditory nerve. The devices are government funded and there are a range of support services throughout Aotearoa to help children and their whānau.

“In New Zealand, the devices can be implanted from six months old, which maximises the window from 0-3 years that is the critical age for speech development. Children and people who lose hearing later can still benefit from CIs – they often have clear spoken language if they have heard before, but they need more support to learn how to ‘hear’ with a CI,” explains Robyn Moriarty, paediatric audiology manager at The Hearing House in Tāmaki Makaurau Auckland.

“The babies who receive implants at six months and wear the devices all the time go on to develop speech and language skills like children with typical hearing. If they receive their implants a bit later, they can catch up, but if they haven’t got established listening skills by age five, they may need to rely on visual communication in addition to hearing – there are always grey areas and exceptions.

“But if your brain has never had sound and then has access suddenly through a cochlear implant, it can take time, support and therapy to learn to use it meaningfully, especially for communication,” she says.

Collaboration and choices

Robyn says that when parents get a diagnosis that their child is deaf, they are often in a state of shock, as the majority of parents are from a listening world and may not have had any experience with deafness or the Deaf community.

Acquiring good language skills – spoken and signed – requires early intervention tailored to each child and family.

“In the past it has been the perception that there was an either/or choice between, ‘do you want to listen and talk, or do you want to use New Zealand Sign Language?’

“In reality, you can do both. You can use the CI to develop speech and spoken language and you can also develop language through the use of sign language. Collaborative decisions can be made with parents and their health and education partners; as professionals we should be offering all choices to families so they can choose what they want for their children,” she says.

The Hearing House has a caseload of approximately 280 children with CIs from Taupō to Northland. A small percentage are in schools where NZSL is used, but the majority are in mainstream schools where some use sign and spoken language; most only use spoken language because that is what their whānau use.

Unless ākonga have other learning difficulties, they don’t always access funding for support, but Robyn says they do have to work harder than their hearing peers. Many use a ‘Roger’, a wireless Bluetooth microphone worn by the teacher and the child, which can be used to help other children in the class as well.

“Children with hearing loss of any degree can benefit from special technology in schools to make sure they can hear the teacher – that’s really well funded in New Zealand.

“The Resource Teachers of the Deaf (RTD) who Ko Taku Reo provide, and advisers on deaf children from Ministry of Education Learning Support do a great service regarding setting up technology for the classroom, but they also consider the curriculum and make sure the child is in an environment that’s fostering good hearing. They help classroom teachers be aware that children with hearing loss are getting a bit of extra support to catch up if they need it,” says Robyn.

Hearing fatigue

Grace Morton is a speech and language therapist with The Hearing House and responsible for 120 young people with CIs aged 8-19. Part of her role is to monitor their speech and language development, then liaise with teachers and whānau to provide advice on how a child can access learning more easily and what can be offered to further support their learning.

“There’s a bit of a misnomer that somebody wearing a CI can hear normally because they’re able to talk and communicate and go to a mainstream school. But I am in awe of what these kids have to navigate on a daily basis – things they have to think about all the time that typical hearing people might take for granted.

“I talked to kids about what strategies they use, and they talk about how they sit in a certain place in the classroom. It’s really helpful to sit on the side of the classroom, so they can not only see the teacher, but they can see any child who puts their hand up to ask a question. This just comes naturally to these kids because it has to – that’s how they cope in a hearing world.

“Every child is different, but they have to work so hard to piece together what they’re hearing – it’s not normal hearing and even if they’re used to it, it doesn’t mean that it’s easy. It can be really, really tiring – hearing fatigue is a very real issue and when you’re in noisy environments, it’s pretty exhausting,” explains Grace.

Grace Morton has helped Olivia feel more confident as she heads to high school next year.  

Empowering ākonga

As well as working alongside children to support their speech and language development, Grace is passionate about empowering agency, independence and the development of self-advocacy skills.

Grace focuses on children when they are turning eight and turning 12, ages when a comprehensive speech and language assessment is done. She offers them five sessions of one-to-one therapy on confidence and advocacy as they transition to new schools – intermediate, or high school.

“Not everyone has an RTD, Adviser on Deaf Children (AoDC), or teacher aide with them all day every day and I think it’s our responsibility as clinicians to make sure these kids are accessing the curriculum in a fair way.”

Grace explains that the only way that can really be achieved is by empowering the child to have the skills and knowledge of knowing what to do, “because we can’t expect all teachers to be experts on this topic, which is quite specialised”.

“For most of these kids it’s so normal for them to have CIs and their whānau and friends are completely used to it.

“But then the kids are being thrown into high school, which is a completely different environment because you have many different teachers and all these new peers and a whole new learning environment and they’re not used to people not knowing how to communicate with them. Most of these kids have such amazing families and support systems, but what happens when she goes to a new school and she’s got six teachers, not just the one teacher to train up on how to use the Roger [microphone]?” asks Grace.  

Helpful strategies

Auckland 12-year-old Olivia is one of the ākonga who has benefitted from one of Grace’s confidence courses, which included talking about Olivia’s strengths and developing some more coping strategies.

“Grace has been helping me with trying to be confident about my ears. A big issue is that I will be going to college next year and whenever I come to a new group, every single time, there’s one person who is staring at my ears and that can get very uncomfortable for me.

“The most helpful strategy is to take three deep breaths in and out if you’re in a big situation where you might feel a bit uncomfortable and try and make what you say ‘short’ because I like to make things very long!” says Olivia.

Alice and husband Richard worry how Olivia will navigate the turbulent teenage years. She says the five-session course was validating for Olivia.

“It was awesome and perfectly timed. That was such a gift from The Hearing House just before Olivia is heading off to college. There’s a real mental health aspect to it – I think it’s really boosted her confidence,” says Alice.

“Grace tells me that if I’m not that confident, or that you feel different to everybody else, you should practise your responses with your family or friends and that helps a lot,” adds Olivia.

Many children with cochlear implants like Olivia have strong family support. From left Alice, Olivia, Hannah and Richard; older sister Sophie was away when the photo was taken.

Olivia’s story

Olivia likes art, swimming and graphic novels – and she has had cochlear implants since she was two.

“What I like about them is that I can hear everybody, I can hear my dog’s voice, I get to hear all the unique sounds and all the things that I would not get to hear. Another good thing about CIs is I can actually socialise and access more people because if I didn’t have the CI, I would be signing right now,” she says.

Education Gazette spoke to the 12-year-old and her mum, Alice Henry, via Zoom when they had been in lockdown for 11 weeks. Olivia is bubbly, confident and delightful, but she’s the first to admit that it takes a lot of work to be growing up in a mainstream environment.

“When I have my ears off, I can’t hear anything. It’s like there’s nobody there, you’re all alone. There’s not a single sound, you can only feel vibrations so much more – I can feel my sisters stomping down the hallway,” explains Olivia.

Small things make a difference

Olivia’s family moved to Auckland when Olivia was a pre-schooler, where they could access services provided by The Hearing House.

“She could access face to face weekly therapy here – that was a great year to get her ready for school – she went to the pre-school at The Hearing House,” says Alice.

She says The Hearing House services are well tailored to support children in mainstream schools with CIs and she’s fully supportive of the new system which will now see these services provided seamlessly throughout a child’s schooling.

She gets quite emotional when describing Olivia: “We call her our summer child because she’s always smiling. She has a hard road in life; not only does she have profound hearing loss, but she also has learning disabilities. But she just keeps on trying.”

And small things make a difference. During Auckland’s lockdown, Olivia’s teacher at Glendowie Primary School, Liz Keyser, emailed that it was time to do individual reading assessments via Zoom. When it became apparent that this wasn’t so easy for Olivia, Liz drove to her house with a hard copy and conducted the test.

“She came, wearing a mask, and they sat at the outside picnic table. She did the test with Olivia and gave me the thumbs up through the window as she headed back to her car. Olivia came in beaming and she said ‘Mum, I was reading at 10-11 years old but today I came out at 12-13!’ Just the look of delight on her face that she’s hit that age-appropriate stage!” shares Alice.

Pros and cons

Olivia explains the benefits and frustrations of CIs, and what she would like people to know about them.

“I want to let people know that it’s quite amazing to have these things because I can actually be in the conversation, which can be quite hard if you’re deaf or have your ears off.”

However, she’s often tired by the end of the school day.

“In big groups having a lot of people talking at the same time is a lot because I’m putting so much energy out trying to listen to what everybody is saying. When my friends are talking, I might miss something because I’m trying to concentrate on something else and they come back to you and I’ll say ‘oh my goodness, what were you guys saying?’ and they get frustrated and say ‘never mind’ and that can get very frustrating to me and a bit annoying because I get left out of the conversation,” says Olivia.

“The biggest skill to have is communication. All my teachers communicate with me – they constantly ask me if we need to change something. Like I was talking to my teacher the other day about masks and if we’re back in class and the face will be covered up and they can’t talk normally, it will be hard for me to lip read or hear them.

“Another thing that teachers should all know is that if somebody did not hear what you are saying, don’t go loud or slow, just keep calm and repeat what you’re saying. Because talking too loud or coming up close can be very disturbing!” she laughs.

Universal design for learning

Liz Keyser says that having Olivia in her Year 8 class has changed the way she teaches.

“At the beginning of the year, I found it a little bit intimidating at times just because I would forget to ask her for her microphone, and I could see she was anxiously looking for the support she needed. It took some time to get our routine in place.

“But I feel that my teaching style has changed, which I have really appreciated. I’ve learnt a lot from Olivia – just repeating things, making sure she understands what I am saying and making it as visual as possible. Now whenever I present anything, I always make sure that it’s visible, as well as clear and short. It definitely benefits some of the other children in my class as well,” says Liz.

After doing a course on Universal Design for Learning, Liz realised that everything she does for Olivia can benefit every child in the class.

“I feel that everything you do for a child with CIs, you should be doing for everyone in your class – repeating instructions and making sure that you are writing the instructions as well. I have Google slides with instructions on the board as well as saying them. I make sure I’m facing her so she can read my lips if she needs to at times.”

Liz says that in general, Olivia’s classmates are very supportive.

“They’re very quick to take the microphone when they need to. It’s very normal because she’s been at the school for eight years, so I think the kids are used to being able to handle it – I think it’s good for them too.”

Network of support

In July 2020 two Deaf Education Centres – van Asch in Christchurch and Kelston in Auckland – merged into a new national school, Ko Taku Reo Deaf Education New Zealand. They had previously provided support services for children with cochlear implants.

Following this merger and a review, The Hearing House and Southern Cochlear Implant Programme (SCIP) began to directly provide habilitationists to support children and people with cochlear implants.

Ko Taku Reo’s internal support of students with cochlear implants will continue as it has and the relationship between Ko Taku Reo and the two Cochlear Implant Programmes remains focused on working together in new ways for the best outcomes for ākonga and whānau.