The development of language and communication may play an important role in the emergence of behavioral problems in young children, but they are rarely included in predictive models of behavioral development. In this study, cross-sectional relationships between language, attention, and behavior problems were examined using parent report, videotaped observations, and performance measures in a sample of 116 severely and profoundly deaf and 69 normally hearing children ages 1.5 to 5 years. Secondary analyses were performed on data collected as part of the Childhood Development After Cochlear Implantation Study, funded by the National Institutes of Health. Hearing-impaired children showed more language, attention, and behavioral difficulties, and spent less time communicating with their parents than normally hearing children. Structural equation modeling indicated there were significant relationships between language, attention, and child behavior problems. Language was associated with behavior problems both directly and indirectly through effects on attention. Amount of parent–child communication was not related to behavior problems.

Cochlear implants in profoundly deaf children have a positive effect on quality of life at reasonable direct costs and appear to result in a net savings to society. JAMA. 2000;284:850-856

Every year, 10 000 infants are born in the United States with sensorineural deafness. Deaf children of hearing (and nonsigning) parents are unique among all children in the world in that they cannot easily or naturally learn the language that their parents speak. These parents face tough choices. Should they seek a cochlear implant for their child? If so, should they also learn to sign? As pediatricians, we need to help parents understand the risks and benefits of different approaches to parent–child communication when the child is deaf.

SRI-Q allows tracking of global development of speech recognition over time as children progress through a hierarchy of speech perception measures and complements the more detailed assessments obtained from individual tests within the hierarchy.

Children with hearing loss, with early and appropriate amplification and intervention, demonstrate gains in speech, language, and literacy skills. Despite these improvements many children continue to exhibit disturbances in cognitive, behavioral, and emotional control, self-regulation, and aspects of executive function. Given the complexity of developmental learning, educational settings should provide services that foster the growth of skills across multiple dimensions. Transdisciplinary intervention services that target the domains of language, communication, psychosocial functioning, motor, and cognitive development can promote academic and social success. Educational programs must provide children with access to the full range of basic skills necessary for academic and social achievement. In addition to an integrated curriculum that nurtures speech, language, and literacy development, innovations in the areas of auditory perception, social emotional learning, motor development, and vestibular function can enhance student outcomes. Through ongoing evaluation and modification, clearly articulated curricular approaches can serve as a model for early intervention and special education programs. The purpose of this article is to propose an intervention model that combines best practices from a variety of disciplines that affect developmental outcomes for young children with hearing loss, along with specific strategies and approaches that may help to promote optimal development across domains. Access to typically developing peers who model age-appropriate skills in language and behavior, small class sizes, a co-teaching model, and a social constructivist perspective of teaching and learning, are among the key elements of the model. Keywords cochlear implants, children, educational settings The ProblemDespite appropriate amplification and early and intensive intervention, many children with hearing loss continue to lag behind their peers in some aspects of speech and language development, socioemotional and behavioral development, specific areas of cognitive development, and sensory-motor development. Pisoni et al. (2008) assert that significant cortical reorganization has likely already taken place in the brains of young children with hearing loss prior to cochlear implantation because of sensory deprivation. They contend that neural reorganization, particularly in the frontal cortex, affects aspects of speech and language development, other cognitive processes, such as executive function and cognitive control processes, and neural systems. These can explain variance in performance outcomes among children following implantation. Children with cochlear implants have been found to have slower verbal rehearsal speeds, scanning rates, and shorter digit spans when compared with hearing peers despite intelligence in the normal range (Burkholder & Pisoni, 2003), differences the authors attribute to sensory deprivation. Some children with hearing loss now compare favorably with hearing peers in some domains, but r...