The Childhood Development after Cochlear Implantation (CDaCI) Study is a multisite, prospective investigation of a large and diverse cohort of US children with cochlear implants. Our primary objective is to evaluate the effect of variables that influence language learning after implantation. Success in spoken language depends on complex interactions between multiple domains of development. Thus, our aims are driven by hypotheses that relate variability in post-implant language outcome to environmental, social, interventional, and biological influences. A major challenge in childhood research relates to the reliable elicitation of communication and linguistic data. We address this task with hierarchical measures and videoanalytic techniques, recorded at fixed intervals, which allow us to track communicative skills as they emerge. We continue to build on this research experience to examine how language skills unfold in children participating in the study, evaluating their: 1) expressive and receptive language and academic achievement, 2) speech production, 3) speech recognition, 4) cognitive skills, 5) social interaction and behavior, 6) relationships with family members, and 7) health-related quality of life and related economic outcomes. CDaCI Study participants consist of children who received a cochlear implant (CI) before the age of 5 years (n=188) and a control group (n=97) of normal hearing (NH) age-mates. Average ages at enrollment were 2.2 years (CI) and 2.3 years (NH). Retention rates for ongoing data accrual are 85% for CI children and 84% for NH children, although all data collected over the past 8+ years have been included in published analyses. So, as CDaCI participants entered the study as preschoolers, they now embark on their middle school experience, entering high school over the next five years at current average ages of 11.0 (CI) and 10.8 (NH) years old. Despite wide recognition of the benefits of early cochlear implantation, there remains equipoise with respect to clinical, rehabilitative, and educational strategies that enable cochlear implant technology to be used to its fullest potential for language acquisition. Modifiers of linguistic outcome become even more compelling as children with cochlear implants face the communication and social demands of their early teens. This prospective, multidimensional study with concurrent controls offers prospects for novel, generalizable insights into the sources of variation in language learning and social and behavioral development after cochlear implantation, offering clinical guidelines to reduce low performance and variation in outcome.

Public Health Relevance

Young children with severe-to-profound hearing loss are candidates for a cochlear implant, and it is essential to understand how cochlear implants can produce consistent, optimized results with objective studies of performance outcomes. The longitudinal multisite study of Childhood Development after Cochlear Implantation measures the ability of US participants to learn to listen and speak after cochlear implantation, to interact wih their environment and with others, and to attain the experiences that contribute to quality of life In the continuation of this study we propose to investigate the factors in our participants'school experience and daily lives that affect their capacity to listen to others and to express themselves, identifying targets for further therapy to take implant technology to its fullest potential.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Research Project (R01)
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Special Emphasis Panel (ZDC1-SRB-Y (60))
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Donahue, Amy
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University of Southern California
Schools of Medicine
Los Angeles
United States
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Cejas, Ivette; Barker, David H; Quittner, Alexandra L et al. (2014) Development of joint engagement in young deaf and hearing children: effects of chronological age and language skills. J Speech Lang Hear Res 57:1831-41
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Tobey, Emily A; Thal, Donna; Niparko, John K et al. (2013) Influence of implantation age on school-age language performance in pediatric cochlear implant users. Int J Audiol 52:219-29
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Niparko, John K; Tobey, Emily A; Thal, Donna J et al. (2010) Spoken language development in children following cochlear implantation. JAMA 303:1498-506
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Lin, Frank R; Wang, Nae-Yuh; Fink, Nancy E et al. (2008) Assessing the use of speech and language measures in relation to parental perceptions of development after early cochlear implantation. Otol Neurotol 29:208-13
Francis, Howard W; Buchman, Craig A; Visaya, Jiovani M et al. (2008) Surgical factors in pediatric cochlear implantation and their early effects on electrode activation and functional outcomes. Otol Neurotol 29:502-8

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