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School failure in students who are normal-hearing or deaf: with or without cochlear implants

School failure in students who are normal-hearing or deaf: with or without cochlear implants To evaluate the impact of cochlear implants on the school failure of deaf who attend mainstream classes by compar- ing them to their normal-hearing peers as well as deaf without cochlear implants. This case–control study included participants aged 8–18 years. The number of school years failed was obtained from school records. The greatest differences in achievement levels were found between hearing students and those who were deaf without cochlear implants. Cochlear implants provide educational opportunities for hearing-impaired students, yet those without cochlear implants remain at a great disadvantage. These findings suggest that measures promoting greater equity and quality for all deaf students allow achievement levels closer to those of the not impaired. Keywords: Cochlear implant, Children, Adolescent, Deafness, Hearing loss, Normal hearing, School, School failure In this sense, and as each society in the various regions Background of the world face political, economic, social, and cultural The education of deaf children is a complex problem that challenges, there is an increase in international concern manifests itself at different levels. There is not always a regarding the objectives and content of education. The clear distinction among the methodological aspects, pur- implementation of extended educational opportunities poses of action and philosophical, sociological, and polit- in effective development for the individual or society ical options. Today, the right to public education for all depends ultimately on people actually learning, that is, students is not justified simply because it is effective but acquiring useful knowledge, reasoning skills and values. because it distributes the costs of special schools, reflects the desires of parents, and most of all defends the child´s Consequently, basic education should focus on the acqui- dignity as a free human being with equal rights. sition of actual learning outcomes rather than exclusively u Th s, education should contribute to the full devel on enrolment, established programs, and fulfilment of graduation requirements. For deaf people, as for other opment of the human being, and each person should citizens, education is critical for employment and social become capable of independent and critical thinking, participation in general. forging his or her own judgment as he or she consid- When we consider education, we inevitably also think ers the available options in life. Today, more than ever of educational success, which can be measured in many before, education provides humans with the freedom of ways. As is true in many other countries, the success of thought, judgment, emotions, and imagination required to develop talent and remain, as much as possible, auton the Portuguese education system is measured by the out- come of student assessments. The results obtained by omous and participative citizens. this appraisal system can be affected by several factors that interfere, either directly or indirectly, with the final outcome. *Correspondence: iduarte@med.up.pt Portuguese students are subjected to two evaluation Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, processes, internal summative assessment and external Portugal summative assessment. Internal summative assessment Full list of author information is available at the end of the article © 2016 Duarte et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Duarte et al. SpringerPlus (2016) 5:237 Page 2 of 8 occurs in the 1st, 2nd and 3rd grades, and the teach- school but ultimately achieve educational and employ- ers and school management bodies are responsible for ment levels similar to their normal-hearing peers. the assessment. External summative assessment occurs They submit that in order to minimize these delays in the 4th, 6th and 9th grades and is intended to assess and improve academic success in mainstream educa- the student’s level of achievement through the use of tion, early oral education and cochlear implantation are national evaluation criteria. Summative assessment important. Other studies have indicated that the educa- determines whether a student progresses or is retained. tional level of young people with cochlear implants does Students with permanent special educational needs can not differ from that of the normal-hearing population have curricular adaptations on their educational back- (Huber et  al. 2008). Another study involving 41 partici- ground, and although they take the same external sum- pants with cochlear implants found that these individu- mative assessment tests as the other students, current als reached high levels of educational achievement and legislation provides for special assessment allowances, reported very high levels of satisfaction with life, com- such as extra time for the exam and alternative means of parable to those of adults with normal hearing (Spencer communication, that may benefit such children. Further - et al. 2012). more, children and young people with permanent special One of the final objectives of a pediatric cochlear educational needs may attend the school with the most implant program is to provide access for those with appropriate resources (i.e., reference school) regardless severe and profound deafness to an education similar to of their area of residence and can choose the subjects in that of their normal-hearing peers through mainstream which they enroll from 4th grade and on. Deaf children education. Many studies report that while there is a trend also have the right to bilingual education (Decree-Law toward mainstream education for students with cochlear No. 3/2008; Legislative Order No. 24-A/2012). implants, the majority of these students are rated poorly Failure in school can have many lifelong consequences. in the area of communication by their teachers and per- Grade retention reduces self-esteem and alters peer form below average overall (Nevins and Chute 1995; group formation. It has a negative impact on measures Mukari et al. 2007). of social adjustment, behavior, self-competence, and atti- In this paper, we compared children and adolescents tudes toward school and can cause considerable stress for with cochlear implants with their normal-hearing peers students. When a grade must be repeated, students per- as well as deaf students without cochlear implants with ceive it as failure, and some students who fail a grade are respect to the percentage of repeated school years. more likely to engage in health-impairing behaviors, such as alcohol and drug abuse. Failing students move from Methods classes with their peers to ones with younger students. Study design The causes of school failure are numerous and usu - This case–control study included 24 deaf children and ally not the result of a single factor. Social, psychologi- adolescents with cochlear implants, 24 deaf children and cal, behavioral, and academic difficulties and school adolescents without cochlear implants, and 24 normal- and health conditions are among the factors that impair hearing children and adolescents aged 8–18  years who academic performance. One in five children who repeat attended school in Portugal. The students were matched a grade in school has a disability (Byrd 2005; Kamal and by gender and school year. Bener 2009). Failure in school is also related to the degree of parental involvement, which plays a vital role in aca- Setting demic performance, as well as the drop-out rate and the The setting was Northern Portugal, where deaf students amount of money spent on resources (i.e., a failing stu- were attending the same schools as normal-hearing stu- dent costs extra money). dents. The Ministry of Education authorized the study As reported in several studies, children with profound under Order no. 15847/2007. The data were collected and severe deafness benefit considerably from cochlear during the 2010–2011 school year. implants (Peixoto et  al. 2013), and most of these chil- The data characterizing the sample, such as etiology dren integrate into mainstream schools (Archbold et  al. and age at deafness diagnosis, were collected through 2002; Clark 2003). Although the cochlear implant does semi-structured interviews with the parents. The data not transform a deaf child into a normal-hearing child, regarding the number of failures (repeated school years) it helps deaf students make gains despite their remain- were obtained from school records. ing educational needs and challenges (Chute and Nevins 2006; Nevins and Chute 1995). Participants Venail et al. (2010) concluded that children with coch- Of the 72 children and adolescents invited to partici- lear implants were more likely to fail early grades in pate, 61 (84.7  %) consented. Twenty of the children/ Duarte et al. SpringerPlus (2016) 5:237 Page 3 of 8 adolescents with profound hearing loss had an cochlear sign language, preschool enrolment, deferred enrolment, implant (unilateral), and twenty-four of the children/ado- and school reference. lescents with profound/severe hearing loss had conven- tional hearing aids and/or no implants. Both groups had Study size sensorineural bilateral hearing loss. Seventeen individu- By contacting the Ministry of Education, a list of 10 als with normal hearing also participated in the study. schools that integrated children and adolescents with Among those with implants, the age of implantation severe or profound deafness, with and without cochlear ranged from 2 to 5 years. All of the children who received implants, was obtained. All of the schools were con- implants before beginning school had used them for 3 tacted, and a total of 7 schools agreed to participate in the or more years. All of the deaf children had hearing par- study; however, only 5 met the inclusion criteria (i.e., the ents. All of the participants had normal intellectual school was attend by both implanted and non-implanted development, were between the ages of 8 and 18  years, deaf students as well as normal-hearing students). In and attended school in Portugal. The participants were the schools, 24 implanted and 24 non-implanted deaf matched by gender and school year. Any children with students were identified as well as 24 normal-hearing other disabilities, such as cerebral palsy, auditory neu- students. ropathy, syndromes, hypoplasia of the auditory nerve, or Informed consent was obtained from the school direc- bilateral implant, were excluded. tors and the students’ parents. All of the children with cochlear implants who were mainstreamed, and the deaf children without coch- Data sources lear implants were placed in schools in which they were The data on the number of school years failed were col - taught using sign language. lected by the teachers based on the students’ school records. In addition, a questionnaire that included three National database questions regarding the level of a family’s participation in To compare sample parameters with the Portuguese the student’s school life using a Likert scale was adminis- population, we accessed a hospital admissions database, tered to the teachers. courtesy of the Central Administration of the Health Sys- While asking for parental consent, a semi-structured tem. The national database contains information such interview was administered to collect clinical histories as anonymized patient identification, episode, process and socio-demographic data. The Graffar Scale was used number, age, sex, admission date, discharge date, ward(s), to determine socioeconomic status. hospital attended (tertiary vs. university), district, out- Access to the student records was conducted uni- come (death, discharge, or transfer), and payment data formly by teachers who followed a prescribed grid to (diagnosis related groups). It also contains ICD-9-CM minimize biases. In addition, a pilot study was con- codes for principal and secondary diagnoses (up to 19), ducted with 10 teachers to improve the questionnaire procedures (up to 20), and external causes (up to 20). regarding family participation in the school life of the The patient population included all patients hospital - student. ized in all acute care public hospitals in Portugal. The data were collected from 1992 to 2002 on children aged Ethics committee 8–18 years at the time of evaluation for cochlear implant This study was approved by the São João Health Cen - placement. In this database, all implanted subjects were tre Ethics Committee. All of the data collection was in included because it was not possible to isolate prelingual accordance with the Helsinki Declaration of 1964, as deaf subjects. Therefore, we compared our sample with revised in 2013. only those patients in the database who were hospitalized for implant placement at or before 5 years of age (i.e., the Statistical analysis maximum age at the time of implant in the sample). Kruskal–Wallis tests were used to determine if there was a different in the percentage of repeated school Variable years among normal-hearing, implanted deaf, and non- School failure is measured with the percentage of implanted deaf students. The differences between the repeated school years, i.e. the percentage of school years three groups were analyzed using Mann–Whitney tests repeated calculated for each student. The sample popu - and Bonferroni-adjusted p values. Chi square tests or lation was characterized with respect to sex, age, socio- Fisher exact tests were used to compare family participa- demographic status, hearing ability, etiology of deafness, tion in school life in the three groups. A statistical signifi - age at diagnosis, cochlear implant, early intervention, cance of 0.05 was used. Duarte et al. SpringerPlus (2016) 5:237 Page 4 of 8 Table 1 Cochlear implants in  children (5  years old or less) Results between 1992 and 2002: population and our sample char- Seventeen of the 24 normal-hearing participants and 20 acteristics of the 24 selected participants with cochlear implants were included in the study. All others either chose not to Sample Population p n = 20 n = 196 participate or were excluded based on the exclusion crite- ria. Of 24 selected participants without cochlear implants Female gender n (%) 10 (50) 88 (45) 0.662 all were included. Of the 61 participants, 35 (57 %) were Hospital female. Sixty-eight percent (n = 11) of the normal-hear- Covões (Coimbra) 20 (100) 192 (98) 1.000 ing sample, 50 % (n = 10) of the cochlear-implanted deaf, Sta Maria (Lisboa) 0 4 (2) and 58 % (n = 14) of the non-implanted deaf were female. Age of implant 0.416 There was no significant difference in the percentage of 1 0 4 (2) females among the three groups (p  =  0.661). The mean 2 6 (30) 95 (48) (SD) age was 10 (3) years in the normal-hearing group, 11 3 10 (50) 66 (34) (4) years in the implanted deaf group, and 13 (4) years in 4 3 (15) 23 (12) the non-implanted deaf group; these differences were not 5 1 (5) 8 (4) significant (p  =  0.078). There were no significant differ District <0.001 ences between the 2 deaf groups regarding the etiology Porto 20 (100) 32 (16) of the hearing disability. There were no significant differ - Aveiro 0 27 (14) ences observed between the three groups with respect Lisboa 0 22 (11) to the socioeconomic status (p  =  0.421). From the 61 Braga 0 20 (10) participants, 7  % belong to the socioeconomic status I, Coimbra 0 16 (8) 18  % belong to the socioeconomic status II, 57  % to the Outros 0 79 (40) socioeconomic status III, 15 % to the socioeconomic sta- p values <0.05 is presented in italic tus IV and 3 % belong to the socioeconomic status V. All of the participants were children of hearing parents and attended public school. Of the participants, 39  % were without implants used sign language. In either group, in the fourth grade, 25  % in the seventh grade, 18  % in only 25  % of the students had at least one parent who the ninth grade, and 18 % in the twelfth grade. The group used sign language. No significant differences were found with cochlear implants was homogenous with respect to between these two groups with respect to enrolment where the implant surgeries and post-implantation reha adjustments or adjustments in the evaluation process. bilitations took place. We found significant differences in the median per - We compared the implanted study participants with centage of school years repeated among the deaf deaf people in the Portuguese population who received implanted children, deaf children without implants and implants between 1992 and 2002 and who were aged the normal-hearing children (p  =  0.039). The median 8–18  years at the time of evaluation and 5  years old or percentages were 0 % (range 0–20 %), 0 % (0–40 %), and less at the time of implant and found, no significant dif - 11  % (0–50  %) in the normal-hearing, deaf implanted, ferences in sex (p  =  0.662), age at implant (p  =  0.345), and deaf non-implanted groups, respectively (see Fig. 1). or type of hospital where the implant was performed With respect to the median percentage of repeated (p  >  0.999). The only significant difference we found school years, a significant difference was found between between these two groups was with respect to the district the normal-hearing and non-implanted deaf partici- of residence (p  <  0.001). Our participants were all from pants (p = 0.048), but no significant difference was found the same district (Porto), whereas those in the compara- between the implanted deaf participants and those with tor population were from Porto (16  %), Aveiro (14  %), normal-hearing (p  =  0.675) or the non-implanted deaf Lisbon (11  %), Braga (10  %), or other districts (48  %) participants (p = 0.423). (Table 1). Table  3 shows that among the three groups, there was Table  2 displays characteristics of the deaf partici- no significant difference in the frequency with which the pants based on the responses to the parent and teacher guardian contacted the school or was concerned with the questionnaires. No significant differences were found students’ progress as reported by the teachers. In con- between the deaf children who received implants and trast, teachers reported that guardians of non-implanted those who did not with respect to the areas studied. We deaf students helped students with school work less found that 95 % of the implanted participants used both often than guardians of non-hearing impaired or deaf sign language and speech to communicate, whereas 5  % implanted students. used speech only to communicate. All of the participants Duarte et al. SpringerPlus (2016) 5:237 Page 5 of 8 Table 2 Characteristics of  the deaf children and  adoles- There were no significant differences between the cents with and without implants non-implanted and implanted deaf study participants regarding enrolment adjustments or adjustments in the Deaf with  Deaf without  p implants implants evaluation process. Both groups benefited from these n = 20 n = 24 special measures that aim to promote access, educational success, and equal opportunities. Parents questionnaire: Failure usually results from a combination of factors Etiology of hearing loss n (%) 0.325 and can have lifelong consequences. Byrd (2005) stated Genetic disorders 6 (30) 8 (33) that health conditions can impair academic performance, Premature birth 0 1 (4) and one in five children who repeat a grade in school has Meningitis 3 (15) 0 some identifiable disability. Rubella 1 (5) 2 (8) Deaf students without cochlear implants appear to fail Toxoplasmosis 1 (5) 0 more than deaf students with cochlear implants. Experi- Unknown 9 (45) 13 (54) ence shows that worldwide, the non-implanted deaf are Diagnosis age (months) median 21 (6, 36) 24 (0, 48) 0.866 largely excluded from tertiary education (Ruben 2000). (min, max) Lang (2002) stated that teachers need to be better pre- Sign language use n (%) pared to teach deaf students, providing these students Participants 19 (95) 24 (100) 0.455 with quality elementary and secondary educational At least one parent 5 (25) 6 (25) 0.540 opportunities so that they have equal access to higher Teachers questionnaire: education. School reference n (%) 11 (55) 10 (42) 0.378 Once science demonstrates that the learning capa- Was enrolled in preschool n (%) 18 (90) 22 (92) 1.000 bilities of an individual are not determined at birth but Had an early intervention n (%) 8 (40) 8 (33) 0.647 rather are the result of life history, experience, and the Delay in enrolment n (%) 1 (5) 3 (12) 0.614 wealth of stimuli offered by the environment, new per - Special conditions of matriculation 18 (95) 19 (83) 0.363 n (%) spectives and duties emerge. Thus, it is no longer only Special assessment conditions 15 (79) 22 (96) 0.153 a question of equal access to school but one of equal n (%) knowledge (i.e., the necessary opportunities as well as the p < 0.05 is considered significant means should be given to all so that learning is possible A network of reference schools for bilingual education of deaf students was for all). established in 2008 to define the requirements needed to provide quality Therefore, we believe that schools and society in gen - education for these students. The students in these schools benefit from teachers with specialized training in deafness and competence in sign language, eral must tailor resources in a way that ensures that the deaf sign language teachers, sign language interpreters and speech therapists right conditions exist to allow deaf children to develop personalities and skills. Unequal results are inevita- ble, but they are acceptable if these children have been Discussion afforded learning conditions of equivalent quality as their The finding that the median percentages of repeated normal-hearing counter-parts. school years of the normal-hearing, cochlear-implanted u Th s, the equality of opportunity reflects the need to deaf students were similar and lower than that of deaf ensure the normal performance, not necessarily the students without implants suggest that cochlear implants equal performance, of each individual. Every individual reduce the number of school failures, although the differ - must have the necessary means to make a choice. Equal- ence in between the deaf with implants and deaf without ity comprises, in this way, the concept of individual implants was not statistically significant. self-realization. The group of implanted deaf students in this study did Allowing deaf people to become part of the commu- not appear to be biased because of the studied characteris- nity is only an initial step because being part of the com- tics, the only statistically significant difference between the munity means being part of the structure and playing a selected participants and the deaf implanted Portuguese social role. The real challenge is for deaf people to per - population was their district of residence; no significant dif - form social functions that are valid and valued. ference in sex, age, or place of cochlear implantation was Moreover, cochlear implantation appears to favor the found. We believe that the district of residence is not a fac- perception of a good quality of life in deaf children and tor that biases the data from our sample. Although 11 cases adolescent compared with deaf peers without cochlear were lost after the participants were age- and sex-matched, implant (Duarte et al. 2014). This finding reflects the sat - this did not bias our results because the groups remained isfaction of the children and adolescents with their own comparable in sex, age, and socio-demographic status. competence and academic performance. Duarte et al. SpringerPlus (2016) 5:237 Page 6 of 8 Fig. 1 Median, interquartile range, minimum and maximum percentage of repeated school years per group (hearing, implanted deaf and no implanted deaf groups) Table 3 Family participation in the school life of the students as characterized by the teachers Describe family participation in the school life of the student: Total Normal Deaf with  Deaf without  p hearing Implants Implants The guardian contacts the school n (%) 0.636 Always/almost always 39 (70) 11 (79) 12 (63) 16 (70) Sometimes/rarely/never 17 (30) 3 (21) 7 (37) 7 (30) The guardian is concerned with the student’s progress n (%) 0.630 Always/almost always 42 (75) 12 (86) 14 (74) 16 (70) Sometimes/rarely/never 14 (25) 2 (14) 5 (26) 7 (30) The guardian helps the student with school work n (%) 0.023* Always/almost always 24 (43) 9 (64) 10 (53) 5 (22) Sometimes/rarely/never 32 (57) 5 (36) 9 (47) 18 (78) * p < 0.05 Here, the role of technicians and teachers may be rel- We were also able to investigate the effect of family evant. Several authors have observed that schools are in participation on school life, although they were evalu- the best position to take the initiative of approaching the ated in an indirect way through the perspective of the family and community (Harry 1992; Shen et  al. 1994). teachers. It was found a significant difference between When parents are aware of what their children are learn- the three groups in respect to the support given by their ing, they are more likely to help or become involved in guardians regarding homework. The teachers believed their child’s learning activities at home when requested that the normal hearing children are the ones receiving by teachers to do so. more support, followed by the implanted children and Duarte et al. SpringerPlus (2016) 5:237 Page 7 of 8 lately the hearing impaired children with less support. are paramount in a child’s functional recovery. u Th s, it This may be due to a lack of competence concerning sign is critical that deafness screening be promoted and con- language as well as a distrust of their capacities to help, ducted in an equitable manner on all newborns with the we found that only 25  % of the deaf students with and aim of identifying hearing loss so that rehabilitation can without cochlear implants had at least one parent able proceed in global and multidisciplinary terms as soon as to communicate in sign language (25  %). This effectively possible. reduces or limits communication between these parents and their children, especially if this is the only method of Conclusion communication. The results of the cochlear implanted children and ado - Although there is no consensus in the literature on the lescents are closer to the normal hearing children in subject, Lyness et  al. (2013) found no convincing evi- respect to the percentage of school years repeated, com- dence that the use of sign language was detrimental to pared to the hearing impaired children and adolescents the success of the cochlear implant. On the contrary, the with no implant. The teachers perceived that the parents success of the cochlear implant seems to depend on audi- of the normal hearing and of the implanted children and ovisual integration skills. Early placement of a cochlear adolescents give more support regarding homework, in implant is an amazing contributor to the acquisition of comparison to the parents of the hearing impaired chil- functional hearing for congenitally deaf children. How- dren and adolescents with no implant. ever, language skills and cognitive development should Thus, the responsibility of parents, health profession - not be overlooked when considering the effectiveness als, teachers, and society as a whole should be propor- of a cochlear implant (Lyness et  al. 2013). In this study, tional to their power, expressing a duty that is never 95  % of the implanted deaf used both sign language and merely individual but rather requires a broad politi- speech to communicate; 5 % used speech only. cal organization that follows and enforces it. Based on Horacek et  al. (1987) demonstrated that educational these results and the results of other more in-depth intervention reduced the incidence of grade failure most studies, in the future, it will be possible to identify with successfully (15 % reduction) when delivered both as pre- greater accuracy and precision the specific character - school and school-age programs, and that achievement istics and factors influencing grade retention so that test scores in reading and mathematics showed a paral- intervention programs can be tailored to the needs of lel beneficial effect from intervention. These data support deaf children and everyone can have an equal oppor- the use of early intervention programs that target high- tunity to fully achieve their potential within the same risk children as a mean of reducing their rate of school time period. failure. Authors’ contributions Undoubtedly, one of the current challenges of the edu- ID contributed to the conception of the manuscript, acquisition, analysis cational community is the ability to facilitate successful and interpretation of the data and revising the manuscript critically. CCS contributed in the statistical analysis and interpretation of data. RN and GR learning in all students, regardless of their socioeconomic contributed to the design and conception of the manuscript, its critical revi- status, cultural or family situation, personality character- sion and gave final approval of the published version. All authors gave their istics, abilities, or any type of deficit. final consent of the published version and agreed to be accountable for all aspects of the work. All authors read and approved the final manuscript. In this sense, every child or young person requires a proper analysis of their situation. Attention to individual Author details differences requires the delivery of a personalized educa - Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Depart- tion to each student. Thus, it is the responsibility of the ment of Health Information and Decision Sciences, Centre for Research education system to fit into reality or rather to put into in Health Technologies and Information Systems (CINTESIS), Faculty of Medi- practice what is laid out in the various legal documents cine, University of Porto, Porto, Portugal. focused on the matter. Acknowledgements u Th s, in a general sense, we can say that to achieve edu - This research was supported by the National Institute for Rehabilitation cational success, particularly of a deaf child, we should (Portugal). We gratefully thank the children, adolescents, families, schools, and teachers who participated in this study. We also wish to thank the Central take into account from an early age the characteristics Administration of the Health System (Portugal) for providing access to their and particular needs of each student, realizing that the database. needs of an implanted deaf child will be different from Competing interests those of a normal-hearing child or a deaf child without The authors declare that they have no competing interests. implants. On the other hand, the age of deafness onset, the time lag between diagnosis and initiating the reha- Received: 29 September 2015 Accepted: 23 February 2016 bilitation process, and the home environment of a child Duarte et al. SpringerPlus (2016) 5:237 Page 8 of 8 References Lyness CR, Woll B, Campbell R, Cardin V (2013) How does visual language affect Archbold SM, Nikolopoulos TP, Lutman ME, O’Donoghue GM (2002) The edu- crossmodal plasticity and cochlear implant success? Neurosci Biobehav cational settings of profoundly deaf children with cochlear implants com- Rev 37(10, Pt. 2):2621–2630. doi:10.1016/j.neubiorev.2013.08.011 pared with age-matched peers with hearing aids: implications for man- Mukari SZ, Ling LN, Ghani HA (2007) Educational performance of pediatric agement. Int J Audiol 41(3):157–161. doi:10.3109/14992020209077179 cochlear implant recipients in mainstream classes. Int J Pediatr Otorhi- Byrd RS (2005) School failure: assessment, intervention, and prevention in pri- nolaryngol 71(2):231–240. doi:10.1016/j.ijporl.2006.10.005 mary pediatric care. Pediatr Rev 26(7):233–243. doi:10.1542/pir.26-7-233 Nevins ME, Chute PM (1995) Success of children with cochlear implants in Chute PM, Nevins ME (2006) School professionals working with children with mainstream educational settings. Ann Otol Rhinol Laryngol 104(Suppl. cochlear implants. Plural Publishing, San Diego, CA 166):100–102 Clark G (2003) Cochlear implants: fundamentals and applications. Springer, Peixoto MC, Spratley J, Oliveira G, Martins J, Bastos J, Ribeiro C (2013) Eec ff tive - New York, NY ness of cochlear implants in children: long term results. Int J Pediatr Duarte I, Santos C, Rego G, Nunes R (2014) Health-related quality of life in Otorhinolaryngol 77(4):462–468. doi:10.1016/j.ijporl.2012.12.005 children and adolescents with cochlear implants: self and proxy reports. Ruben RJ (2000) Redefining the survival of the fittest: communication Acta Oto-Laryngol. doi:10.3109/00016489.2014.930968 disorders in the 21st century. Laryngoscope 110(2, Pt. 1):241–245. Harry B (1992) An ethnographic study of cross-cultural communication with doi:10.1097/00005537-200002010-00010 Puerto Rican-American families in the special education system. Am Educ Shen S, Pang I, Tsoi S, Yip P, Yung K (1994) Home-school co-operation research Res J 29(3):471–494. doi:10.3102/00028312029003471 report. Education Department, Committee on Home-School Coopera- Horacek HJ, Ramey CT, Campbell FA, Hoffmann KP, Fletcher RH (1987) tion, Hong Kong Predicting school failure and assessing early intervention with high- Spencer LJ, Tomblin JB, Gantz BJ (2012) Growing up with a cochlear implant: risk children. J Am Acad Child Adolesc Psychiatry 26(5):758–763. education, vocation, and affiliation. J Deaf Stud Deaf Educ 17(4):483–498. doi:10.1097/00004583-198709000-00024 doi:10.1093/deafed/ens024 Huber M, Wolfgang H, Klaus A (2008) Education and training of young people Venail F, Vieu A, Artieres F, Mondain M, Uziel A (2010) Educational and employ- who grew up with cochlear implants. Int J Pediatr Otorhinolaryngol ment achievements in prelingually deaf children who receive cochlear 72(9):1393–1403. doi:10.1016/j.ijporl.2008.06.002 implants. Arch Otolaryngol Head Neck Surg 136(4):366–372. doi:10.1001/ Kamal M, Bener A (2009) Factors contributing to school failure among school archoto.2010.31 children in very fast developing Arabian society. Oman Med J 24(3):212– 217. doi:10.5001/omj.2009.42 Lang HG (2002) Higher education for deaf students: research priorities in the new millennium. J Deaf Stud Deaf Educ 7(4):267–280. doi:10.1093/ deafed/7.4.267 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png SpringerPlus Springer Journals

School failure in students who are normal-hearing or deaf: with or without cochlear implants

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Springer Journals
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Copyright © 2016 by Duarte et al.
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Science; Science, general
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10.1186/s40064-016-1927-9
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Abstract

To evaluate the impact of cochlear implants on the school failure of deaf who attend mainstream classes by compar- ing them to their normal-hearing peers as well as deaf without cochlear implants. This case–control study included participants aged 8–18 years. The number of school years failed was obtained from school records. The greatest differences in achievement levels were found between hearing students and those who were deaf without cochlear implants. Cochlear implants provide educational opportunities for hearing-impaired students, yet those without cochlear implants remain at a great disadvantage. These findings suggest that measures promoting greater equity and quality for all deaf students allow achievement levels closer to those of the not impaired. Keywords: Cochlear implant, Children, Adolescent, Deafness, Hearing loss, Normal hearing, School, School failure In this sense, and as each society in the various regions Background of the world face political, economic, social, and cultural The education of deaf children is a complex problem that challenges, there is an increase in international concern manifests itself at different levels. There is not always a regarding the objectives and content of education. The clear distinction among the methodological aspects, pur- implementation of extended educational opportunities poses of action and philosophical, sociological, and polit- in effective development for the individual or society ical options. Today, the right to public education for all depends ultimately on people actually learning, that is, students is not justified simply because it is effective but acquiring useful knowledge, reasoning skills and values. because it distributes the costs of special schools, reflects the desires of parents, and most of all defends the child´s Consequently, basic education should focus on the acqui- dignity as a free human being with equal rights. sition of actual learning outcomes rather than exclusively u Th s, education should contribute to the full devel on enrolment, established programs, and fulfilment of graduation requirements. For deaf people, as for other opment of the human being, and each person should citizens, education is critical for employment and social become capable of independent and critical thinking, participation in general. forging his or her own judgment as he or she consid- When we consider education, we inevitably also think ers the available options in life. Today, more than ever of educational success, which can be measured in many before, education provides humans with the freedom of ways. As is true in many other countries, the success of thought, judgment, emotions, and imagination required to develop talent and remain, as much as possible, auton the Portuguese education system is measured by the out- come of student assessments. The results obtained by omous and participative citizens. this appraisal system can be affected by several factors that interfere, either directly or indirectly, with the final outcome. *Correspondence: iduarte@med.up.pt Portuguese students are subjected to two evaluation Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, processes, internal summative assessment and external Portugal summative assessment. Internal summative assessment Full list of author information is available at the end of the article © 2016 Duarte et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Duarte et al. SpringerPlus (2016) 5:237 Page 2 of 8 occurs in the 1st, 2nd and 3rd grades, and the teach- school but ultimately achieve educational and employ- ers and school management bodies are responsible for ment levels similar to their normal-hearing peers. the assessment. External summative assessment occurs They submit that in order to minimize these delays in the 4th, 6th and 9th grades and is intended to assess and improve academic success in mainstream educa- the student’s level of achievement through the use of tion, early oral education and cochlear implantation are national evaluation criteria. Summative assessment important. Other studies have indicated that the educa- determines whether a student progresses or is retained. tional level of young people with cochlear implants does Students with permanent special educational needs can not differ from that of the normal-hearing population have curricular adaptations on their educational back- (Huber et  al. 2008). Another study involving 41 partici- ground, and although they take the same external sum- pants with cochlear implants found that these individu- mative assessment tests as the other students, current als reached high levels of educational achievement and legislation provides for special assessment allowances, reported very high levels of satisfaction with life, com- such as extra time for the exam and alternative means of parable to those of adults with normal hearing (Spencer communication, that may benefit such children. Further - et al. 2012). more, children and young people with permanent special One of the final objectives of a pediatric cochlear educational needs may attend the school with the most implant program is to provide access for those with appropriate resources (i.e., reference school) regardless severe and profound deafness to an education similar to of their area of residence and can choose the subjects in that of their normal-hearing peers through mainstream which they enroll from 4th grade and on. Deaf children education. Many studies report that while there is a trend also have the right to bilingual education (Decree-Law toward mainstream education for students with cochlear No. 3/2008; Legislative Order No. 24-A/2012). implants, the majority of these students are rated poorly Failure in school can have many lifelong consequences. in the area of communication by their teachers and per- Grade retention reduces self-esteem and alters peer form below average overall (Nevins and Chute 1995; group formation. It has a negative impact on measures Mukari et al. 2007). of social adjustment, behavior, self-competence, and atti- In this paper, we compared children and adolescents tudes toward school and can cause considerable stress for with cochlear implants with their normal-hearing peers students. When a grade must be repeated, students per- as well as deaf students without cochlear implants with ceive it as failure, and some students who fail a grade are respect to the percentage of repeated school years. more likely to engage in health-impairing behaviors, such as alcohol and drug abuse. Failing students move from Methods classes with their peers to ones with younger students. Study design The causes of school failure are numerous and usu - This case–control study included 24 deaf children and ally not the result of a single factor. Social, psychologi- adolescents with cochlear implants, 24 deaf children and cal, behavioral, and academic difficulties and school adolescents without cochlear implants, and 24 normal- and health conditions are among the factors that impair hearing children and adolescents aged 8–18  years who academic performance. One in five children who repeat attended school in Portugal. The students were matched a grade in school has a disability (Byrd 2005; Kamal and by gender and school year. Bener 2009). Failure in school is also related to the degree of parental involvement, which plays a vital role in aca- Setting demic performance, as well as the drop-out rate and the The setting was Northern Portugal, where deaf students amount of money spent on resources (i.e., a failing stu- were attending the same schools as normal-hearing stu- dent costs extra money). dents. The Ministry of Education authorized the study As reported in several studies, children with profound under Order no. 15847/2007. The data were collected and severe deafness benefit considerably from cochlear during the 2010–2011 school year. implants (Peixoto et  al. 2013), and most of these chil- The data characterizing the sample, such as etiology dren integrate into mainstream schools (Archbold et  al. and age at deafness diagnosis, were collected through 2002; Clark 2003). Although the cochlear implant does semi-structured interviews with the parents. The data not transform a deaf child into a normal-hearing child, regarding the number of failures (repeated school years) it helps deaf students make gains despite their remain- were obtained from school records. ing educational needs and challenges (Chute and Nevins 2006; Nevins and Chute 1995). Participants Venail et al. (2010) concluded that children with coch- Of the 72 children and adolescents invited to partici- lear implants were more likely to fail early grades in pate, 61 (84.7  %) consented. Twenty of the children/ Duarte et al. SpringerPlus (2016) 5:237 Page 3 of 8 adolescents with profound hearing loss had an cochlear sign language, preschool enrolment, deferred enrolment, implant (unilateral), and twenty-four of the children/ado- and school reference. lescents with profound/severe hearing loss had conven- tional hearing aids and/or no implants. Both groups had Study size sensorineural bilateral hearing loss. Seventeen individu- By contacting the Ministry of Education, a list of 10 als with normal hearing also participated in the study. schools that integrated children and adolescents with Among those with implants, the age of implantation severe or profound deafness, with and without cochlear ranged from 2 to 5 years. All of the children who received implants, was obtained. All of the schools were con- implants before beginning school had used them for 3 tacted, and a total of 7 schools agreed to participate in the or more years. All of the deaf children had hearing par- study; however, only 5 met the inclusion criteria (i.e., the ents. All of the participants had normal intellectual school was attend by both implanted and non-implanted development, were between the ages of 8 and 18  years, deaf students as well as normal-hearing students). In and attended school in Portugal. The participants were the schools, 24 implanted and 24 non-implanted deaf matched by gender and school year. Any children with students were identified as well as 24 normal-hearing other disabilities, such as cerebral palsy, auditory neu- students. ropathy, syndromes, hypoplasia of the auditory nerve, or Informed consent was obtained from the school direc- bilateral implant, were excluded. tors and the students’ parents. All of the children with cochlear implants who were mainstreamed, and the deaf children without coch- Data sources lear implants were placed in schools in which they were The data on the number of school years failed were col - taught using sign language. lected by the teachers based on the students’ school records. In addition, a questionnaire that included three National database questions regarding the level of a family’s participation in To compare sample parameters with the Portuguese the student’s school life using a Likert scale was adminis- population, we accessed a hospital admissions database, tered to the teachers. courtesy of the Central Administration of the Health Sys- While asking for parental consent, a semi-structured tem. The national database contains information such interview was administered to collect clinical histories as anonymized patient identification, episode, process and socio-demographic data. The Graffar Scale was used number, age, sex, admission date, discharge date, ward(s), to determine socioeconomic status. hospital attended (tertiary vs. university), district, out- Access to the student records was conducted uni- come (death, discharge, or transfer), and payment data formly by teachers who followed a prescribed grid to (diagnosis related groups). It also contains ICD-9-CM minimize biases. In addition, a pilot study was con- codes for principal and secondary diagnoses (up to 19), ducted with 10 teachers to improve the questionnaire procedures (up to 20), and external causes (up to 20). regarding family participation in the school life of the The patient population included all patients hospital - student. ized in all acute care public hospitals in Portugal. The data were collected from 1992 to 2002 on children aged Ethics committee 8–18 years at the time of evaluation for cochlear implant This study was approved by the São João Health Cen - placement. In this database, all implanted subjects were tre Ethics Committee. All of the data collection was in included because it was not possible to isolate prelingual accordance with the Helsinki Declaration of 1964, as deaf subjects. Therefore, we compared our sample with revised in 2013. only those patients in the database who were hospitalized for implant placement at or before 5 years of age (i.e., the Statistical analysis maximum age at the time of implant in the sample). Kruskal–Wallis tests were used to determine if there was a different in the percentage of repeated school Variable years among normal-hearing, implanted deaf, and non- School failure is measured with the percentage of implanted deaf students. The differences between the repeated school years, i.e. the percentage of school years three groups were analyzed using Mann–Whitney tests repeated calculated for each student. The sample popu - and Bonferroni-adjusted p values. Chi square tests or lation was characterized with respect to sex, age, socio- Fisher exact tests were used to compare family participa- demographic status, hearing ability, etiology of deafness, tion in school life in the three groups. A statistical signifi - age at diagnosis, cochlear implant, early intervention, cance of 0.05 was used. Duarte et al. SpringerPlus (2016) 5:237 Page 4 of 8 Table 1 Cochlear implants in  children (5  years old or less) Results between 1992 and 2002: population and our sample char- Seventeen of the 24 normal-hearing participants and 20 acteristics of the 24 selected participants with cochlear implants were included in the study. All others either chose not to Sample Population p n = 20 n = 196 participate or were excluded based on the exclusion crite- ria. Of 24 selected participants without cochlear implants Female gender n (%) 10 (50) 88 (45) 0.662 all were included. Of the 61 participants, 35 (57 %) were Hospital female. Sixty-eight percent (n = 11) of the normal-hear- Covões (Coimbra) 20 (100) 192 (98) 1.000 ing sample, 50 % (n = 10) of the cochlear-implanted deaf, Sta Maria (Lisboa) 0 4 (2) and 58 % (n = 14) of the non-implanted deaf were female. Age of implant 0.416 There was no significant difference in the percentage of 1 0 4 (2) females among the three groups (p  =  0.661). The mean 2 6 (30) 95 (48) (SD) age was 10 (3) years in the normal-hearing group, 11 3 10 (50) 66 (34) (4) years in the implanted deaf group, and 13 (4) years in 4 3 (15) 23 (12) the non-implanted deaf group; these differences were not 5 1 (5) 8 (4) significant (p  =  0.078). There were no significant differ District <0.001 ences between the 2 deaf groups regarding the etiology Porto 20 (100) 32 (16) of the hearing disability. There were no significant differ - Aveiro 0 27 (14) ences observed between the three groups with respect Lisboa 0 22 (11) to the socioeconomic status (p  =  0.421). From the 61 Braga 0 20 (10) participants, 7  % belong to the socioeconomic status I, Coimbra 0 16 (8) 18  % belong to the socioeconomic status II, 57  % to the Outros 0 79 (40) socioeconomic status III, 15 % to the socioeconomic sta- p values <0.05 is presented in italic tus IV and 3 % belong to the socioeconomic status V. All of the participants were children of hearing parents and attended public school. Of the participants, 39  % were without implants used sign language. In either group, in the fourth grade, 25  % in the seventh grade, 18  % in only 25  % of the students had at least one parent who the ninth grade, and 18 % in the twelfth grade. The group used sign language. No significant differences were found with cochlear implants was homogenous with respect to between these two groups with respect to enrolment where the implant surgeries and post-implantation reha adjustments or adjustments in the evaluation process. bilitations took place. We found significant differences in the median per - We compared the implanted study participants with centage of school years repeated among the deaf deaf people in the Portuguese population who received implanted children, deaf children without implants and implants between 1992 and 2002 and who were aged the normal-hearing children (p  =  0.039). The median 8–18  years at the time of evaluation and 5  years old or percentages were 0 % (range 0–20 %), 0 % (0–40 %), and less at the time of implant and found, no significant dif - 11  % (0–50  %) in the normal-hearing, deaf implanted, ferences in sex (p  =  0.662), age at implant (p  =  0.345), and deaf non-implanted groups, respectively (see Fig. 1). or type of hospital where the implant was performed With respect to the median percentage of repeated (p  >  0.999). The only significant difference we found school years, a significant difference was found between between these two groups was with respect to the district the normal-hearing and non-implanted deaf partici- of residence (p  <  0.001). Our participants were all from pants (p = 0.048), but no significant difference was found the same district (Porto), whereas those in the compara- between the implanted deaf participants and those with tor population were from Porto (16  %), Aveiro (14  %), normal-hearing (p  =  0.675) or the non-implanted deaf Lisbon (11  %), Braga (10  %), or other districts (48  %) participants (p = 0.423). (Table 1). Table  3 shows that among the three groups, there was Table  2 displays characteristics of the deaf partici- no significant difference in the frequency with which the pants based on the responses to the parent and teacher guardian contacted the school or was concerned with the questionnaires. No significant differences were found students’ progress as reported by the teachers. In con- between the deaf children who received implants and trast, teachers reported that guardians of non-implanted those who did not with respect to the areas studied. We deaf students helped students with school work less found that 95 % of the implanted participants used both often than guardians of non-hearing impaired or deaf sign language and speech to communicate, whereas 5  % implanted students. used speech only to communicate. All of the participants Duarte et al. SpringerPlus (2016) 5:237 Page 5 of 8 Table 2 Characteristics of  the deaf children and  adoles- There were no significant differences between the cents with and without implants non-implanted and implanted deaf study participants regarding enrolment adjustments or adjustments in the Deaf with  Deaf without  p implants implants evaluation process. Both groups benefited from these n = 20 n = 24 special measures that aim to promote access, educational success, and equal opportunities. Parents questionnaire: Failure usually results from a combination of factors Etiology of hearing loss n (%) 0.325 and can have lifelong consequences. Byrd (2005) stated Genetic disorders 6 (30) 8 (33) that health conditions can impair academic performance, Premature birth 0 1 (4) and one in five children who repeat a grade in school has Meningitis 3 (15) 0 some identifiable disability. Rubella 1 (5) 2 (8) Deaf students without cochlear implants appear to fail Toxoplasmosis 1 (5) 0 more than deaf students with cochlear implants. Experi- Unknown 9 (45) 13 (54) ence shows that worldwide, the non-implanted deaf are Diagnosis age (months) median 21 (6, 36) 24 (0, 48) 0.866 largely excluded from tertiary education (Ruben 2000). (min, max) Lang (2002) stated that teachers need to be better pre- Sign language use n (%) pared to teach deaf students, providing these students Participants 19 (95) 24 (100) 0.455 with quality elementary and secondary educational At least one parent 5 (25) 6 (25) 0.540 opportunities so that they have equal access to higher Teachers questionnaire: education. School reference n (%) 11 (55) 10 (42) 0.378 Once science demonstrates that the learning capa- Was enrolled in preschool n (%) 18 (90) 22 (92) 1.000 bilities of an individual are not determined at birth but Had an early intervention n (%) 8 (40) 8 (33) 0.647 rather are the result of life history, experience, and the Delay in enrolment n (%) 1 (5) 3 (12) 0.614 wealth of stimuli offered by the environment, new per - Special conditions of matriculation 18 (95) 19 (83) 0.363 n (%) spectives and duties emerge. Thus, it is no longer only Special assessment conditions 15 (79) 22 (96) 0.153 a question of equal access to school but one of equal n (%) knowledge (i.e., the necessary opportunities as well as the p < 0.05 is considered significant means should be given to all so that learning is possible A network of reference schools for bilingual education of deaf students was for all). established in 2008 to define the requirements needed to provide quality Therefore, we believe that schools and society in gen - education for these students. The students in these schools benefit from teachers with specialized training in deafness and competence in sign language, eral must tailor resources in a way that ensures that the deaf sign language teachers, sign language interpreters and speech therapists right conditions exist to allow deaf children to develop personalities and skills. Unequal results are inevita- ble, but they are acceptable if these children have been Discussion afforded learning conditions of equivalent quality as their The finding that the median percentages of repeated normal-hearing counter-parts. school years of the normal-hearing, cochlear-implanted u Th s, the equality of opportunity reflects the need to deaf students were similar and lower than that of deaf ensure the normal performance, not necessarily the students without implants suggest that cochlear implants equal performance, of each individual. Every individual reduce the number of school failures, although the differ - must have the necessary means to make a choice. Equal- ence in between the deaf with implants and deaf without ity comprises, in this way, the concept of individual implants was not statistically significant. self-realization. The group of implanted deaf students in this study did Allowing deaf people to become part of the commu- not appear to be biased because of the studied characteris- nity is only an initial step because being part of the com- tics, the only statistically significant difference between the munity means being part of the structure and playing a selected participants and the deaf implanted Portuguese social role. The real challenge is for deaf people to per - population was their district of residence; no significant dif - form social functions that are valid and valued. ference in sex, age, or place of cochlear implantation was Moreover, cochlear implantation appears to favor the found. We believe that the district of residence is not a fac- perception of a good quality of life in deaf children and tor that biases the data from our sample. Although 11 cases adolescent compared with deaf peers without cochlear were lost after the participants were age- and sex-matched, implant (Duarte et al. 2014). This finding reflects the sat - this did not bias our results because the groups remained isfaction of the children and adolescents with their own comparable in sex, age, and socio-demographic status. competence and academic performance. Duarte et al. SpringerPlus (2016) 5:237 Page 6 of 8 Fig. 1 Median, interquartile range, minimum and maximum percentage of repeated school years per group (hearing, implanted deaf and no implanted deaf groups) Table 3 Family participation in the school life of the students as characterized by the teachers Describe family participation in the school life of the student: Total Normal Deaf with  Deaf without  p hearing Implants Implants The guardian contacts the school n (%) 0.636 Always/almost always 39 (70) 11 (79) 12 (63) 16 (70) Sometimes/rarely/never 17 (30) 3 (21) 7 (37) 7 (30) The guardian is concerned with the student’s progress n (%) 0.630 Always/almost always 42 (75) 12 (86) 14 (74) 16 (70) Sometimes/rarely/never 14 (25) 2 (14) 5 (26) 7 (30) The guardian helps the student with school work n (%) 0.023* Always/almost always 24 (43) 9 (64) 10 (53) 5 (22) Sometimes/rarely/never 32 (57) 5 (36) 9 (47) 18 (78) * p < 0.05 Here, the role of technicians and teachers may be rel- We were also able to investigate the effect of family evant. Several authors have observed that schools are in participation on school life, although they were evalu- the best position to take the initiative of approaching the ated in an indirect way through the perspective of the family and community (Harry 1992; Shen et  al. 1994). teachers. It was found a significant difference between When parents are aware of what their children are learn- the three groups in respect to the support given by their ing, they are more likely to help or become involved in guardians regarding homework. The teachers believed their child’s learning activities at home when requested that the normal hearing children are the ones receiving by teachers to do so. more support, followed by the implanted children and Duarte et al. SpringerPlus (2016) 5:237 Page 7 of 8 lately the hearing impaired children with less support. are paramount in a child’s functional recovery. u Th s, it This may be due to a lack of competence concerning sign is critical that deafness screening be promoted and con- language as well as a distrust of their capacities to help, ducted in an equitable manner on all newborns with the we found that only 25  % of the deaf students with and aim of identifying hearing loss so that rehabilitation can without cochlear implants had at least one parent able proceed in global and multidisciplinary terms as soon as to communicate in sign language (25  %). This effectively possible. reduces or limits communication between these parents and their children, especially if this is the only method of Conclusion communication. The results of the cochlear implanted children and ado - Although there is no consensus in the literature on the lescents are closer to the normal hearing children in subject, Lyness et  al. (2013) found no convincing evi- respect to the percentage of school years repeated, com- dence that the use of sign language was detrimental to pared to the hearing impaired children and adolescents the success of the cochlear implant. On the contrary, the with no implant. The teachers perceived that the parents success of the cochlear implant seems to depend on audi- of the normal hearing and of the implanted children and ovisual integration skills. Early placement of a cochlear adolescents give more support regarding homework, in implant is an amazing contributor to the acquisition of comparison to the parents of the hearing impaired chil- functional hearing for congenitally deaf children. How- dren and adolescents with no implant. ever, language skills and cognitive development should Thus, the responsibility of parents, health profession - not be overlooked when considering the effectiveness als, teachers, and society as a whole should be propor- of a cochlear implant (Lyness et  al. 2013). In this study, tional to their power, expressing a duty that is never 95  % of the implanted deaf used both sign language and merely individual but rather requires a broad politi- speech to communicate; 5 % used speech only. cal organization that follows and enforces it. Based on Horacek et  al. (1987) demonstrated that educational these results and the results of other more in-depth intervention reduced the incidence of grade failure most studies, in the future, it will be possible to identify with successfully (15 % reduction) when delivered both as pre- greater accuracy and precision the specific character - school and school-age programs, and that achievement istics and factors influencing grade retention so that test scores in reading and mathematics showed a paral- intervention programs can be tailored to the needs of lel beneficial effect from intervention. These data support deaf children and everyone can have an equal oppor- the use of early intervention programs that target high- tunity to fully achieve their potential within the same risk children as a mean of reducing their rate of school time period. failure. Authors’ contributions Undoubtedly, one of the current challenges of the edu- ID contributed to the conception of the manuscript, acquisition, analysis cational community is the ability to facilitate successful and interpretation of the data and revising the manuscript critically. CCS contributed in the statistical analysis and interpretation of data. RN and GR learning in all students, regardless of their socioeconomic contributed to the design and conception of the manuscript, its critical revi- status, cultural or family situation, personality character- sion and gave final approval of the published version. All authors gave their istics, abilities, or any type of deficit. final consent of the published version and agreed to be accountable for all aspects of the work. All authors read and approved the final manuscript. In this sense, every child or young person requires a proper analysis of their situation. Attention to individual Author details differences requires the delivery of a personalized educa - Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Depart- tion to each student. Thus, it is the responsibility of the ment of Health Information and Decision Sciences, Centre for Research education system to fit into reality or rather to put into in Health Technologies and Information Systems (CINTESIS), Faculty of Medi- practice what is laid out in the various legal documents cine, University of Porto, Porto, Portugal. focused on the matter. Acknowledgements u Th s, in a general sense, we can say that to achieve edu - This research was supported by the National Institute for Rehabilitation cational success, particularly of a deaf child, we should (Portugal). We gratefully thank the children, adolescents, families, schools, and teachers who participated in this study. We also wish to thank the Central take into account from an early age the characteristics Administration of the Health System (Portugal) for providing access to their and particular needs of each student, realizing that the database. needs of an implanted deaf child will be different from Competing interests those of a normal-hearing child or a deaf child without The authors declare that they have no competing interests. implants. On the other hand, the age of deafness onset, the time lag between diagnosis and initiating the reha- Received: 29 September 2015 Accepted: 23 February 2016 bilitation process, and the home environment of a child Duarte et al. SpringerPlus (2016) 5:237 Page 8 of 8 References Lyness CR, Woll B, Campbell R, Cardin V (2013) How does visual language affect Archbold SM, Nikolopoulos TP, Lutman ME, O’Donoghue GM (2002) The edu- crossmodal plasticity and cochlear implant success? Neurosci Biobehav cational settings of profoundly deaf children with cochlear implants com- Rev 37(10, Pt. 2):2621–2630. doi:10.1016/j.neubiorev.2013.08.011 pared with age-matched peers with hearing aids: implications for man- Mukari SZ, Ling LN, Ghani HA (2007) Educational performance of pediatric agement. Int J Audiol 41(3):157–161. doi:10.3109/14992020209077179 cochlear implant recipients in mainstream classes. Int J Pediatr Otorhi- Byrd RS (2005) School failure: assessment, intervention, and prevention in pri- nolaryngol 71(2):231–240. doi:10.1016/j.ijporl.2006.10.005 mary pediatric care. Pediatr Rev 26(7):233–243. doi:10.1542/pir.26-7-233 Nevins ME, Chute PM (1995) Success of children with cochlear implants in Chute PM, Nevins ME (2006) School professionals working with children with mainstream educational settings. Ann Otol Rhinol Laryngol 104(Suppl. cochlear implants. Plural Publishing, San Diego, CA 166):100–102 Clark G (2003) Cochlear implants: fundamentals and applications. Springer, Peixoto MC, Spratley J, Oliveira G, Martins J, Bastos J, Ribeiro C (2013) Eec ff tive - New York, NY ness of cochlear implants in children: long term results. Int J Pediatr Duarte I, Santos C, Rego G, Nunes R (2014) Health-related quality of life in Otorhinolaryngol 77(4):462–468. doi:10.1016/j.ijporl.2012.12.005 children and adolescents with cochlear implants: self and proxy reports. Ruben RJ (2000) Redefining the survival of the fittest: communication Acta Oto-Laryngol. doi:10.3109/00016489.2014.930968 disorders in the 21st century. Laryngoscope 110(2, Pt. 1):241–245. Harry B (1992) An ethnographic study of cross-cultural communication with doi:10.1097/00005537-200002010-00010 Puerto Rican-American families in the special education system. Am Educ Shen S, Pang I, Tsoi S, Yip P, Yung K (1994) Home-school co-operation research Res J 29(3):471–494. doi:10.3102/00028312029003471 report. Education Department, Committee on Home-School Coopera- Horacek HJ, Ramey CT, Campbell FA, Hoffmann KP, Fletcher RH (1987) tion, Hong Kong Predicting school failure and assessing early intervention with high- Spencer LJ, Tomblin JB, Gantz BJ (2012) Growing up with a cochlear implant: risk children. J Am Acad Child Adolesc Psychiatry 26(5):758–763. education, vocation, and affiliation. J Deaf Stud Deaf Educ 17(4):483–498. doi:10.1097/00004583-198709000-00024 doi:10.1093/deafed/ens024 Huber M, Wolfgang H, Klaus A (2008) Education and training of young people Venail F, Vieu A, Artieres F, Mondain M, Uziel A (2010) Educational and employ- who grew up with cochlear implants. Int J Pediatr Otorhinolaryngol ment achievements in prelingually deaf children who receive cochlear 72(9):1393–1403. doi:10.1016/j.ijporl.2008.06.002 implants. Arch Otolaryngol Head Neck Surg 136(4):366–372. doi:10.1001/ Kamal M, Bener A (2009) Factors contributing to school failure among school archoto.2010.31 children in very fast developing Arabian society. Oman Med J 24(3):212– 217. doi:10.5001/omj.2009.42 Lang HG (2002) Higher education for deaf students: research priorities in the new millennium. J Deaf Stud Deaf Educ 7(4):267–280. doi:10.1093/ deafed/7.4.267

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Published: Feb 29, 2016

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