Redefining cochlear implant benefits to appropriately include children with additional disabilities

Approximately 40?% of children who otherwise meet audiological candidacy criteria for a cochlear implant (CI) have co-occurring conditions likely to impact their progress, including learning disability, intellectual disability, developmental delay, language and communication disorders, disorders of attention, blindness/low vision, cerebral palsy, or other medical, sensory, and motor problems. It is not in keeping with current thinking about improving the lives of individuals with disabilities to exclude such children from an accepted treatment for deafness such as a cochlear implant. In this chapter, we review the types of additional disabilities that co-occur with hearing loss, and the research literature which shows CI benefit for children with additional disabilities, including improvements in speech perception, speech production, language and communication, adaptive behavior, and parental reports of quality of life, and discuss other areas of assessment to redefine benefit in such children. Improvement is often slower than for a normally developing CI child and may vary depending on the nature and severity of the additional disabilities. However, we must start to broaden our concept of CI candidacy and explore new definitions of benefit for children who may not acquire spoken language but who may still derive significant benefit from hearing. The potential for CIs to improve communication, cognition, psychosocial, emotional functioning, and family relationships and/or quality of life is an important consideration. We propose that a young deaf child severely affected by additional disabilities who responds meaningfully to sensory stimulation and/or exhibits evidence of social responsiveness and has good parental support may benefit from an implant.