Language acquisition for deaf children: Reducing the harms of zero tolerance to the use of alternative approaches

Medical harm can be due to errors or complications of treatment, but it can also be due to failure to properly inform patients of the information they need to protect their overall health now and in the future. Inappropriate care of the latter type lies usually in unawareness on the part of medical personnel and on lack of coordination among the various medical professionals. Here we discuss medical harm related to the use of cochlear implants with deaf children. Because of lack of training and lack of coordination among professionals, there is a great deal of misinformation about the use of speech and sign language with deaf children who undergo cochlear implantation. Specifically, many medical professionals do not fully understand the ramifications of promoting speech-exclusive approaches and denying sign language exposure to a deaf child before and after implantation.We describe several harms from the surgery itself, and argue that, ethically speaking, a standard for success should be cochlear implants measured against hearing aids which are less invasive and do not cause permanent damage to the cochlea. In particular, we need studies that show success provided by cochlear implants justifies excluding hearing aids as treatment. We also need more studies that identify predictors of successful implant use as well as which children will benefit from a cochlear implant.Whether or not to give a child a cochlear implant has been a point of controversy since cochlear implants were first introduced. The debate is often presented as revolving around the question of whether or not cochlear implants would remove a child from Deaf communities and eventually threaten Deaf communities with extinction [1]. (In writing deaf, it is common convention to use a capital "D" when talking about communities that use a sign language as their major language, and "d" when talking about auditory status.)We don't enter into this debate here. Nor do we enter into a discussion of the ethical q