Many CI clinics believe that if a child uses sign language, they will never talk. Newer programs, like Koch's, integrate sign language with spoken language.
"We encourage sign language because the basic principle is, we're looking at a whole child and its very important that we develop their cognitive skills. but we're not holding everything off waiting for speech," she says.
"We want to make sure that they understand 'empty' and 'full' and the names of the people in their environment and names for emotions that they have."
Dr. John Niparko
Deaf children and adults tend to have a lower level of reading comprehension than their hearing counterparts. The average deaf adult has a 5th-grade reading level, says Dr. John Niparko, a surgeon and cochlear implant specialist at Johns Hopkins University.
He says that the reason is partly because American Sign Language is a simple language as compared with spoken or written English.
"In spoken English, a person can say, 'I'm doing something continuously.' But in sign language, a person says 'I'm doing something over and over again.'"
The slight, but significant, difference is difficult to translate from English to sign language.
Harlane Lane, an advocate for the deaf community, argues that there is no hard evidence that the primary benefit sought - mainly acquisition of spoken language - can be achieved with a cochlear implant
Other critics of the implant say more research needs to be done to prove that CIs benefit deaf children enough to allow them to function with spoken language as well as their hearing counterparts.
Sandy Harvey, the Executive Director of the American Society for Deaf Children, says the main problem is a lack of clear guidelines.
Although hospitals generally screen children with physical and psychological tests before approving them, Harvey says the National Institutes For Health has not pinpointed which children are less likely to benefit from a CI.
Harvey says there are children with CIs who are not "star" patients, and go on to abandon their implants, opting instead to communicate entirely with American Sign Language.
"Nobody wants to address that issue," she said. "When parents call us and are trying to find out, they've been told that some children are more successful than others."
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