GREAT EXPECTATIONS: PERSPECTIVES ON COCHLEAR
IMPLANTATION OF DEAF CHILDREN IN NORWAY
The authors describe the use of cochlear implants with deaf children in Norway and examine how this intervention has raised new expectations and some tensions concerning the future of education for
deaf students. They report on two studies of communication within school learning environments of young children with implants in Norwegian preschools and primary/elementary schools. These studies involved observations of classroom discourse and teaching activity and interviews with teachers, administrators, parents, and pupils. Results suggested varied patterns of use of Norwegian and of Norwegian Sign Language and several modes of communication, including speech alone, sign alone, and speech with sign. Conclusions are drawn regarding the reasons for the observed variations and the future impact of cochlear implantation on educational policies and services for deaf children and their families in Norway.
People were overwhelmed with amazement. “He has done everything well,” they said. “He even makes the deaf hear and the mute speak.” MARK 7:37 (cited in Norwegian Directorate for Health and Social Affairs
[2006], p. 1)
The use of cochlear implants with young deaf children has accelerated over recent years to a point where many of these children are fitted with single or bilateral implants in their first year of life (Hyde & Power 2006). This process has been considerably aided by the widespread implementation in most developed nations of programs of universal newborn hearing screening, or UNHS (Yoshinaga-Itano, 2003).
These programs have the capacity to identify the nature and degree of hearing loss in the first few weeks after birth (Morton & Nance, 2006). Audiological and neurological processes follow diagnosis to ascertain the best possible candidates for implantation, with surgery taking place for many children with severe or profound hearing loss sometime in the first year after diagnosis. Many major benefits of earlier diagnosis and implantation have been reported (Fitzpatrick, DurieuxSmith, Eriks-Brophy, Olds, & Gaines, 2007; Yoshinaga-Itano, 2003; Yoshinaga-Itano, Sedey, Coulter, & Mehl, 1998), but other outcomes have also resulted that require major changes in how deafness in young children is accommodated by policies and service systems, including those for education (Thoutenhoofd, 2006; Young & Tattersall, 2007).
Of note is the need for families to deal with the diagnosis of their child’s hearing loss at an earlier age, when there has typically been no previous suspicion of hearing loss. The important process of relationship building
between parents and infant may be disturbed by the real or imagined consequences of a hearing loss for their
child, for them, or for their aspirations for their child. As Young and Tattersall (2007) have suggested, early identification is of little value if it is not combined with services designed to assist families in utilizing the potential time advantage that has been gained.
Much of the information that parents acquire about deafness and implantation, and about conditions for a
deaf child’s development, is received directly from health or education professionals associated with the referral process after newborn hearing screening has occurred. Parents are placed in a situation in which they are required to make early decisions about implantation and how to conduct their interactions with their child to form relationships and develop learning to enhance the child’s opportunities for communication, socialization, and cognitive development.
As well as the contexts of individual families, there are the broader political, social, cultural, and educational contexts in which decisions are made and services are provided. Decisions about the child’s development and future are made in dynamic personal, familial, and emotional contexts that are embedded in the political and policy traditions in health, social development, and education that a nation provides for its citizens. In this way, the processes of early identification of hearing loss and cochlear implantation, as well as the nature of the responses of health and education systems, may be seen as part of an inclusive approach.
Most nations aim to support access by citizens to equitable opportunities for development and learning through participation in society. In education in particular, national governments provide policies and practices that are directed toward inclusive outcomes for all children. As Hyde (2009) has noted, these policies and practices are not global, but are grounded in societal values and tempered by a nation’s political, cultural, social, and historical traditions and resources. Expectations can therefore vary considerably regarding cochlear implantation of deaf children. In some countries, the desired outcome may well be a form of equitable participation in daily life, development, and learning processes in academic and social settings. In other countries, the demand for excellence may also be a driving influence. “Excellence” may be defined in these contexts as leading toward “oral perfection,” while “equitable participation” may be less esteemed. Where both are present, tensions can simultaneously become evident among parents and professionals, and within policy and service systems. The Norwegian education system has “equity in education” as a national goal and overriding principle. Equity in education implies that positive discrimination is required, and leads to the claim that inclusive education means that the system must adapt to each individual and group. Adapted education as an educational principle, in turn, focuses on the individual needs of each child. In line with current national policy, however, establishing satisfactory bilingual educational settings for individual deaf children within inclusive educational settings in local schools remains a considerable challenge (Hyde, Ohna & Hjulstad, 2006). Classroom studies of learning environments for children
in so-called inclusive settings in Norway have revealed that students are often exposed to some exclusive
communication practices (Ohna et al., 2003). Ohna and colleagues found that gaining access to a common communication and learning environment was dependent on the classroom structures and the pedagogical practices used by teachers, and in some cases by interpreters. Consequently, patterns of interaction were created that could either create constraints on communication or enhance the use of the classroom languages, and subsequent learning. In the present article, we consider the situation of cochlear implantation of deaf children in Norway in its specific educational and policy contexts.
The Incidence of Permanent Hearing Loss and the Use of Cochlear Implants in Children in Norway
Norway is a country of about 4.7 million people, with its population spread across a large geographical area. In Norway, approximately 0.1% of newborn children have some form of hearing loss, and since 2008 all hospitals have participated in newborn hearing screening (Helse og omsorgsdepartementet [Ministry of health and care services], 2007). The incidence of permanent hearing loss is similar to rates observed in other developed countries (see, e.g., Mehl & Thomson, 2002), that is, typically 1 per 1,000 with a permanent bilateral hearing loss of 40 dB or greater. Of this population, at least 30% may be predicted to have a severe sensorineural hearing loss and 10% a profound loss ( Johnston, 2004; Yoshinaga-Itano, Coulter & Thomson, 2000), accompanied in some cases by detected or undetected retrocochlear complications. The profoundly deaf group comprises the most likely candidates for cochlear implantation.
It is anticipated that the recent full implementation of UNHS in Norway will significantly lower the age of diagnosis of hearing loss and increase the potential for earlier fitting of hearing aids or implants and the commencement of forms of parent/family support at earlier stages. In other countries that have implemented UNHS, age of confirmed diagnosis has been reduced from an average of 24–30 months to 2–3 months (Morton & Nance, 2006; Young & Tattersall, 2007). With the implementation of UNHS in Norway there is already evidence of an earlier detection process unfolding, with 4 children under 12 months of age and 15 between ages 1 and 2 years implanted in 2005, and, in 2007, the implantation of 17 children less than 12 months old and 29 between ages 1 and 2 years. (Figure 1 shows implantation data by year from 1988 to 2007.)
The use of cochlear implantation for persons with a hearing loss in Norway also reflects the process in other developed countries. The first person to receive a cochlear implant in Norway was an adult fitted in the city of Trondheim in 1985. Nineteen other adults received implants from 1985 to 1989. The first postlingually deaf child was implanted in 1988 at 6.5 years of age at the Rikshospitalet (the National University Hospital) in Oslo. This individual was believed to be the first child implanted in Europe with the Nucleus 22 prosthesis. The following year, the first prelingually deaf child was implanted, at 8 years of age. Subsequently, the child did not benefit from the implant and became a nonuser. In 1992, a 3-year-old prelingual deaf child was implanted, then educated in a bilingual program, as was the standard practice at the time. The child remains a consistent user of the device. To date, the youngest child implanted in Norway was 5-1⁄2 months old. Between March 1988 and December 2006, more than 300 children were implanted, and by December 2007 a total of 364 children had received an implant. In contrast to the situation in some countries, all implant surgery on children is done at one hospital, the Rikshospitalet. Other hospitals in Norway, in Bergen and Trondheim, perform implantations, but only on adults. Children assessed for implantation at the Rikshospitalet include individuals with severe as well as profound hearing loss, and some with additional disabilities. Bilateral implantation is available if considered anatomically and audiologically feasible. Parents have a choice of either the MED-EL or the Nucleus device. The process of implantation (including assessment, surgical procedures, acquisition of the prosthesis, and postimplant mapping and therapy) involves no cost to parents.
Figure 1 shows a pattern of slow increases in child fittings from 1988 to 1998, with acceleration beyond 1999. The annual data for 2003 and 2004 (the latter reported in January 2005) reflect little change in the ages of fitting, with 33% of children being implanted between ages 2 and 3 years in 2004 and 35% in 2003, and in 2006 and 2007 a majority under the age of 1 year. As indicated, the national implementation of UNHS continues to influence this pattern toward younger ages of fitting.The Education System for Deaf Children and Their Families in Norway The French pedagogical system for educating deaf children was imported into Norway via Denmark around the start of the 19th century. In 1825, the first school for the deaf, based on the use of sign language and employing both deaf and hearing teachers, was established in Trondheim, in central Norway.
In 1848, the “German method based on oral training, was introduced at a new private school for the deaf in the Norwegian capital, Christiania (later Oslo). The well-known rivalry between manual and oral educational methods took its specific turn in Norway after 1850. Both the manual and oral schools were regarded as successful, which led to some satisfaction but also to further aspirations among politicians, the public, and professionals.
In consequence, in 1881 Norwegian lawmakers enacted specific, ambitious, and progressive legislation on education for all deaf children. Embedded in this law (the Abnormskolelov, “legislation concerning the education of abnormal children”) was the conviction that the “abnormality” of deaf children or deaf people in general was primarily related to the exceptional educational methods required in their development and education. According to the Abnormskolelov,
both the manual and oral communication methods were to be applied in schools, with the restriction that each school was not to use more than one method (Simonsen, 2000).
The progress of the system of schools for the deaf in Norway through the 19th and 20th centuries can be characterized as following international trends, with severe limitations on the use of manual methods and sign language following the Milan Congress of 1880 and a “new” rise of oralism in the mid-1900s under the influence of members of a British family of scholars, the Ewings (I. R. Ewing & A. W. Ewing, 1954, 1958; A. G. W. Ewing & E. C. Ewing, 1964), and, in the Netherlands, of Henk Huizing’s “acoupedics” (Power & Hyde, 1997). Oralism remained dominant until the decade between 1970 and 1980, during which national law and policy were reformed (Simonsen, 2005).
Following this period, optimism developed regarding the value of bilingual education of deaf children,
and efforts to develop specific curricula adjusted to the needs of deaf children followed. By the end of the 1990s, bilingual education and the schools for the deaf using this approach were flourishing, supported by legal protection of children’ right to access to bilingual education by means of Norwegian Sign Language, or NSL, per Section 2-6 of the Norwegian Education Act of 1998. An increasing number of deaf children divided their learning time between their local school and a school for the deaf. A free 40-week educational program for teaching parents and families basic sign language and knowledge about deafness, Se mitt språk (See my language), has been offered since 1995. The political, legislative, and educational structures used in Norway for deaf children and their families are different from those in other countries and even have specific differences from the systems used in other Nordic countries.
A national state support system for children with special educational needs was established in 1992, with its main objective being to assist families, local schools, and municipal authorities in their efforts toward inclusion of children with special needs in local schools. The national support system consists of 15 resource centers
funded by the state and 25 associated centers funded independently or by other means. Among these are six resource centers for deaf and hard of hearing children, each with a school for the deaf and itinerant advisory services.
These centers offer supervision and guidance for individual children and their families as well as programs for municipalities, local schools, and child guidance services. One of the centers, the Skådalen Resource Center, has a specific research unit. Both the Skådalen Center and some of the other centers conduct research on
deaf education in close collaboration with universities in Norway and abroad, with the intention of monitoring the national system of education for deaf students and promoting effective change. The research reported in the present article is one such outcome.
Over the last decade, two principal discourses on the education of deaf children with a cochlear implant have emerged in Norway, as they have in many other Western countries: a cultural- bilingual discourse and a medical– cochlear implant discourse. Both leave limited scope for an arguably more salient discourse on distinct educational issues (Simonsen & Ohna, 2003). The assumed dichotomy between these two reigning discourses leaves education in a somewhat restricted position at a critical time when issues of pedagogy and curriculum should be primary focuses for researchers and practitioners (Hyde & Høie, 2007).
According to Section 2-6 of the Norwegian Education Act of 1998, parents may decide whether or not their deaf child should be in a program of bilingual education with NSL added as a language of instruction and communication.
Specific syllabuses for educating students in such programs were developed during the 1990s. As such, Section 2-6 may be implemented in special classes or in local schools across the districts of Norway.
In 2008, Section 2-6 was revised. Under this revision, a strictly defined bilingual educational program was no longer required for access to sign language in deaf children’s education. Any child with an educational need to learn and be taught through sign language will now be entitled to have that need met, regardless of how his or her educational program or school is categorized.
The choice of educational approach,
communication mode, and
language (or languages) used is dependent
on the parents’ judgments
about the educational needs of their
child, particularly their wishes in relation
to the preferred modes of communication
applied in classrooms.
Their decision is usually made in a
context of counseling and support by
an interdisciplinary professional team.
What is unusual in an international
context is that the right to bilingual
education for a deaf child is not dependent
on audiological criteria, but
on the assessment of communicative
and educational needs. It remains to
be seen how long this context of decision
making based on communicative
and educational evaluations will last.
The new potentials, both real and
perceived, presented by the earlier
detection of hearing loss and the impact
of greater levels of implantation
of infants with severe and profound
hearing loss are creating challenges to
current educational policies and practices
directed at achieving inclusion in
a context of bilingualism. Tensions are
evident among practitioners, parents,
and associations of deaf and hard of
hearing people. Using two national
projects conducted over the last
decade by the Skådalen Resource
Center as a focus, we attempt in the
present article to update the situation
of Norway in respect to the implications
of cochlear implantation for policy
and practice.
Research on Inclusive
Education of Children
With a Cochlear Implant
in Norway
The first of the two national studies,
“Children With Cochlear Implants”
(conducted from 1999 to 2001), examined
the communication conditions in
the learning environments of 43 deaf
children in kindergartens and primary
and upper secondary schools (Christophersen,
2001; Hjulstad, Kristoffersen,
& Simonsen, 2002; Landsvik 2001; Simonsen
& Kristoffersen 2001; Strand,
2002). The children in kindergartens
varied in age from 3 years to 5 years 6
months. The age at which the children
received their implants varied from 2
years 6 months to 5 years 1 month,
with an average age of implantation of
3 years 2 months. According to
parental reports and school records
(based on information provided by
parents), 20 children were considered
prelingually deaf and 4 postlingually
deaf. The 19 children attending school
ranged in age from 6 to 19 years.
This qualitative study included interviews
with children with a cochlear
implant, their parents, and their teachers;
videotapes of interaction patterns
in classrooms and kindergartens; and
related field notes. Analyses of the
recordings of children’s access to
classroom communication showed
major variations among the kindergartens,
schools, programs, and professionals
participating in the study
(Hjulstad et al., 2002). Assessment of
interaction and participation patterns
demonstrated correspondence with
the modes of communication that
were applied, in the sense that educational
settings that offered a range
of cultural tools, including both sign
language and spoken language and
an array of flexible and adapted approaches
to communication, represented
beneficial environments for
attaining higher levels of student inclusion
and participation in classroom
activities (Hjulstad et al., 2002). In
educational settings where spoken
Norwegian was used, access to communication
and interaction was restricted
in many cases, including
collective learning processes in groups
and participation in classroom instruction
and associated peer interaction.
Parents’ responses demonstrated expectations
more in line with their children
achieving an appropriate level of
“participation,” primarily in school
and family life, rather than expectations
of “excellence,” particularly with
the use of spoken language (Strand,
2002). As for the children themselves,
the nine primary school children who
were interviewed were able to convey
an impressive metacomprehension of
their communicative situation and the
strategies that they used to participate
(Christoffersen, 2001).
The second study of educational
settings for children with a cochlear
implant, “Inclusive Education of Children
With Cochlear Implants: A Follow-
up Study,” was undertaken from
2004 to 2007. This was a study of the
same 24 children with a cochlear -
implant in kindergarten included
in the earlier national study (“Children
With Cochlear Implants,”
1999–2001). These former preschool
children were tracked in their lower
primary-school settings (Simonsen,
Kristoffersen, & Hjulstad, 2008). A
majority of the 24 children had been
placed in their local schools, while
some had been placed in special
units or special schools for the deaf.
School placement, however, was not
representative of educational programming
in Norway, as bilingual
programs can be identified in all of
these settings. However, programs
using spoken Norwegian as the single
communicative tool are only to
be found in local schools. The main
purpose of the follow-up study was
to generate knowledge from the educational
practices that were observed
and reported. There were three research
questions:
• What kinds of linguistic resources
are available and in
use in the interactions between
teachers and children in the activities
in classrooms?
• What are the opportunities and
constraints in regard to learning
and participation within the different
educational practices that
are observed?
• How do schools regard the
learning environment for students
with a cochlear implant?
Sample and Procedures
The children in the 2004–2007 followup
study are now generally regarded as
cochlear implant “pioneers” in Norway.
Recipients of implants in the period
1996–1999, they represent about 70%
of the total population (35) of preschool
children implanted up to 1999.
The follow-up study included 10 girls
and 14 boys from both rural and urban
areas in Norway. In addition to the diversity
within the group in terms of
age, school type, education program,
degree of hearing loss, and curriculum
category chosen, there was also considerable
diversity with respect to how
classroom communication and participation
were organized, regulated, and
maintained. This involved variations
among the modalities (speech, sign,
and speech with sign) that were used
and between the two languages in use:
Norwegian and NSL.
Data were collected during the
2004–2005 academic year. The children
then ranged in age from 7 to 11
years, attended school grades 1–5,
and varied in regard to duration of implant
use from 5 to 8 years. The educational
placements of the students
included local schools (15), schools
for students who are deaf or hard of
hearing (7), and local schools with
separate units for deaf children (2).
The curriculum categories chosen by
parents were bilingual education (as
defined in Section 2-6 of the Education
Act of 1998), special needs education
(per Section 5-1 of the Education
Act), and local schools using only spoken
Norwegian. We report some findings
from the initial study and the follow-
up study in the present article to
demonstrate the patterns of communication
and language use that
emerged.
The data from both the initial study
(1999–2001) and the follow-up study
(2004–2007) consist of field notes of
classroom activities and interactions,
the products of children’ activities
(mostly written materials), and classroom
organization and teaching materials.
The observations were based on
multiple audiovisual recordings of different
forms of classroom talk and the
interactive events and contexts in
which they occurred. Two cameras on
tripods were used with an external microphone.
Transcripts were made of
the recorded classroom activities,
with note being made of lesson or activity
type, the participants involved,
the classroom organizations, the nature
of the discourses that occurred,
and the communication modes and
language forms that were used. Interviews
with teachers and principals
were audiorecorded and transcribed.
The audiovisual data consisted of approximately
60 hours of recordings,
and the audiorecorded interviews
approximately 50 hours. Additionally,
we rated each student on the
Categories of Auditory Performance
and the Speech Intelligibility Ratings
(O’Donoghue, Nikolopoulos, & Archbold,
2000). These data are presented
in Tables 1 and 2.
The two tables show increasing rates of auditory perception and speech intelligibility for most of the children across the study period.
Some Characteristics of the Use of Modalities in Classrooms The 2004–2007 follow-up study involved two methods and related analyses. The first method entailed an examination of interaction patterns based on a conversation analysis focused on understanding the nature of situated learning in local school and special classrooms in which the deaf students with a cochlear implant were enrolled (Hjulstad & Kristoffersen, 2007). The second method entailed interpretations of the statements of the experiences, pedagogical principles, and practices reported by education staff, including teachers, sign language interpreters, teacher assistants, and principals (Simonsen et al., 2008).
To describe a “typical” classroom in our study is complex. When categorizing the classrooms according to their use of a particular communication modality during classroom activities, we identified five different patterns (see Table 3).
While the various patterns of use were not employed in all activities in the particular schools involved, they do offer evidence of the diversity of ways in which communication and language issues were operating. There was no common causal explanation, and the observed diversity is seen to be an outcome of the various interpretations that are possible under national legislation and policy in Norway concerning deaf children; the choices that parents, schools, and teachers make; and the devolution of many of these decisions to local school districts serving the needs of deaf children within their existing resource base. Thus, there may be considerable diversity within schools even though a particular pattern of communication is in apparent use at any specific time.
Any expectations that classroom practices would be in accordance with the conventional labels assigned to the education of deaf students were not found in the two national studies.
On the contrary, the analyses show that local classroom practices with local and pedagogical adjustments to the perceived needs of individual children were the pattern. In this Norwegian context, the notion of fixed educational programs in conventional terms of “oral education,” “bilingual education,” or “Total Communication” makes little sense. This finding suggests that other national or comparative studies of the classroom experiences of deaf students with a cochlear implant may prove productive in revealing what diversity exists among the comunication and curricular practices used in schools and associated local interpretations of national policies (see also Knorrs, 2007).
Educational or Instructional Patterns
In examining the local schools, in which a student with a cochlear implant will usually find himself or herself the only such student in a class of hearing children, we found indications that some teachers’ choices of communication mode and language were guided by their perspective that all children should be able to participate in the classroom discourse.
Other teachers, however, seemed to be led more by directions from medical advisers or by parents regarding which communication mode to apply. Here, differences between mixed-modality classrooms may, to some extent, be influenced by the child’s degree of hearing loss and perceived competence in a particular language. An interesting and perhaps more important finding is that different instructional activities appear to
create different challenges with respect to participation by the child with a cochlear implant, but the availability of different communication modalities offers potential for enhanced participation.
For example, the use of sign and speech at the same time is more common in teacher-directed plenary lessons, in which a teacher who is bilingual addresses both the bilingual
deaf student and the hearing students at the same time.
Whole-class conversation was less teacher directed, and all children were communicatively more active. This often created a more demanding discourse for children with a cochlear implant; further, the teachers more frequently used sign and speech at the same time in their contributions, and interpreted peers’ speech-alone contributions into sign-alone form for the deaf student. We termed this kind of mode and language mixing participation- related modality alternation.
Other kinds of activity were less demanding for the participant with a cochlear implant, for example, seat work, when teachers often used speech alone in communication. Even here, teachers mixed languages and modes in different ways in different situations, for example, during the explanation of certain concepts, clarifications, or other situations occurring in a specific context.
At the study sites there were also instructional activities that were interpreter mediated rather than teacher mediated, and classes in which most hearing students were reasonably proficient in NSL. These activities further demonstrated the variety of communication modes and mixing of language forms according to the perceived needs of the child with a cochlear implant, the other participants, and the activity in question.
In the bilingual classrooms (those for which students’ parents had chosen to adhere to Section 2-6 of the Education Act of 1998 and its provisions), we observed that the goals and purposes of the teaching of children with a cochlear implant were not necessarily about maintaining NSL as their first language, as it was possible that the language learned first was no longer a student’s most frequently used language in school or at home. This was the case for many of the children we studied, in instances in which Norwegian in spoken and written forms remained in active use in classrooms.
Teacher Statements
The findings reported in the present article do not constitute the entire set of findings from the two studies (Hjulstad et al., 2002, Simonsen et al., 2008); however, we present them to demonstrate the contextualizing influences of national legislation and policy, local school practices, teacher knowledge, and parental choices about the educational experiences of children with a cochlear implant.
The teachers generally reported a pragmatic approach to the use of linguistic forms in the classroom. Choices were based on the nature of the learning situation and the relational aspects involved. The legal framework of the education of each student, whether it was bilingual education per Section 2-6, special needs education per Section 5-1, or simply ordinary adjusted education, was not a precise indicator of the actual educational practices of any classroom, as noted earlier in the present article. This outcome was explained by teachers as resulting from practicalities such as access to specific language competencies and resources and associated economic resources, as well as being a consequence of the pedagogical freedom and sovereignty of the local school and the individual teacher.
The educational practices reported by the teachers in the follow-up study seem to indicate one of two different profiles among the teachers, reflecting their professional position in regard to the children with a cochlear implant: a sense of either independence or dependence.
The first group of teachers reported that they encouraged the children to speak and communicate in whichever language and mode was most functional and could be comprehended by the participants in the particular activity. None of these teachers were dissatisfied if, for example, the child with a cochlear implant used speech more than sign or sign more than speech. This was simply regarded as part of the process of becoming capable of participating and communicating within different communities of language users and a consequence of being a bimodal, bilingual learner. Further, it did not necessarily suggest the primacy of either language, or indeed the child’s progression away from bilingualism and toward spoken language.
These teachers viewed the emerging bimodal bilingualism as a characteristic of these young cochlear implant pioneers, many of whom were introduced to sign language before receiving their implants.
The second group of teachers, who may be identified as more dependent on external authorities in regard to their responsibilities toward the child with a cochlear implant, reported strong external influences and expectations at work, including those of parents, providers of educational and psychological services, resource centers, and the cochlear implant team at the national hospital. While these external agents might agree, often they did not, placing these teachers in a difficult position.
The main disagreement that was reported was over the language mode to be applied in the school. When both visual and auditory languages were allowed, the tension levels were reported as being low and allowing for diversity in instruction and adapted education.
In the cases in which spoken Norwegian was the only language permitted, tension levels were reported to be higher. Some of the teachers in this latter situation described feeling squeezed between expectations and reality, and said they had difficulty meeting the demands of their classrooms: “We try not to use sign language in class—but it is hard”; or, “I realize when he does not understand what is being said. Then we have to use our hands.” The increasing complexity of the subjects taught in primary and secondary schools, combined with the demand for higher levels of literacy, with the resultant increase in problems providing access to communication in classrooms, was creating anxiety for several of these teachers.
The gap reported by these teachers between governmental, parental, and societal expectations of cochlear implantations and their own perceived realities of the education of these children may be interpreted as a problem of bridging between, on the one hand, bilingualism, special needs education, and adjusted education as legal and political concepts in Norway, and, on the other hand, the complex and diverse communicative and educational needs of deaf children with implants. It may be said that one outcome of the 2004–2007 study was the strong conviction among teacher participants that a need exists for more studies of students with a cochlear implant in various school and classroom contexts that may reveal the complexities of communication patterns and language mixing across a range of curricular activities. Such studies could lead to a better understanding that effective communication may enhance participation as a part of the learning processes of the classroom, and counter the perception that participation should be viewed as an end in itself.
Conclusion
Norway is a country with a relatively small population but strong historical and social traditions directed toward national independence and inclusion of all its citizens in education. The trends noted for the early detection and incidence of hearing loss among young children and the early use of cochlear implants largely parallel those observed in other developed nations. An exception, to date, has been that the child’s degree of hearing loss has not been a critical factor in the determination of school placement, the right to bilingualism, or curriculum choice.
What is demonstrated in the findings reported in the present article and in the description of the Norwegian system for the education of deaf children is that specific national legislation, local responses to policy implementation, traditions about the recognition of languages, and the use of teacher judgment in classrooms can all significantly influence the everyday experiences of deaf children with a cochlear implant. In particular, a diversity of communication practices and outcomes is revealed that may be seen as participatory and inclusive in the relevant educational settings and learning contexts. In terms of communication, these practices and outcomes involve the use of spoken Norwegian and NSL as well as the discriminating use of various language forms and modality mixing in classroom learning activities.
Although Norway has strong and well-articulated legislation, traditions, and policies in the area of bilingualism for deaf children in inclusive education contexts, these contexts are now being challenged, and pressures for reform of service systems are evident.
There are tensions and pressures associated with changing expectations on the part of some parents and professional and community groups about the implications of earlier detection of hearing loss through UNHS and earlier cochlear implementation of deaf children.
These major changes and the opportunities that they present are placing current policies and practices in a critical perspective. Expectations by some parents and professionals of outcomes that are not clearly associated with children’s development of bilingual competence and identity are a source of tension and debate among stakeholders.
While the early detection of hearing loss and the implantation of younger deaf children are of major significance and benefit for all concerned, the need to consider the diverse outcomes that these developments may have for individual children in classrooms across the country and in their postschool life remains paramount. In this context, the experiences reported with cochlear implants in Norway may be described as complex but not necessarily confusing. Many teachers of these deaf students seem able to focus on classroom learning, using a variety of tools of communication and learning. This capacity makes the flexibility that is provided for in current legislation and policy a major asset of this national system.
In any reformation of policy and practice, it is essential that the perspectives of teachers, the pedagogies they use, and the realities they face continue to be a focus in studies of learning by deaf children in classrooms.
Teachers and other classroom practitioners represent a unique source of knowledge for research on the educational needs of children with a cochlear implant (Thoutenhoofd et al., 2006). In particular, there is an urgent need for school achievement data on students with an implant using, for example, some of the methods employed in the study of the educational achievements of deaf students in Scotland by Thoutenhoofd (2006). Tapping this pool of knowledge and combining quantitative data on demography and large-scale educational attainment data with ethnographic approaches and classroom studies on the micro level may lead to increased understanding and reveal the subtleties and complexities involved in cochlear implantation in early childhood and in education. The object of such research would be the intrinsic and dynamic ways deaf students make use of languages for interaction with their environment in the learning processes.
What the current situation in Norway— as exemplified by the two national studies discussed in the present article—seems to imply is the possibility of a unified rather than a dualistic or divided perspective on the national future of deaf education, provided that both visual and auditory modes of communication and the languages they may form are perceived not as oppositional but as complementary.
In this sense, “excellence,” as we note in the opening section of the present article, would be a marker of the quality of the learning environment and an indicator of the degree of access to communication for all students— not a referent to any single language form or communication mode.
References
Christophersen, A.-B. (2001). Barn med cochlea
implantat: Hvordan opplever de sink -
ommunikasjonssituasjon [Children with
cochlear implants: Their communicative
strategies and experiences] (Skådalen Publication
Series Report No. 11). Oslo, Norway:
Skådalen Resource Center.
Ewing, A. G. W., & Ewing, E. C. (1964). Teaching
deaf children to talk. Washington, DC: Volta
Bureau.
Ewing, I. R., & Ewing, A. W. (1954). Speech and
the deaf child. Manchester, England: Manchester
University Press.
Ewing, I. R., & Ewing, A. W. (1958). New opportunities
for deaf children. London: University
of London Press.
Fitzpatrick, E., Durieux-Smith, A., Eriks-Brophy,
A., Olds, J., & Gaines, R. (2007). The impact
of newborn hearing screening on communication
development. Journal of Medical
Screening, 14(3), 123–131.
Helse og omsorgsdepartementet [Ministry of
health and care services]. (2007). Innst. S. nr.
101 (2007–2008). Retrieved July 29, 2009,
from http://www.helse-midt.no/templates/
StandardMaster_93548.aspx
Hjulstad, O., & Kristoffersen, A.-E. (2007).
Pupils with a cochlear implant in Norway:
Perspectives on learning and participation
in research and practice. In M. Hyde & G.
Hoie (Eds.), To be or to become: Language
and learning in the lives of young deaf children
(Skådalen Publication Series Report
No. 25, pp. 67–91). Oslo, Norway: Skådalen
Resource Center.
Hjulstad, O, Kristoffersen, A.-E., & Simonsen, E.
(2002). Barn med cochlea implantat:
Kommunikative praksiser i barnehagen
[Children with cochlear implants: Communication
practices in kindergartens] (Skådalen
Publication Series Report No. 17).
Oslo, Norway: Skådalen Resource Center.
Hyde, M. B. (2009). Inclusion in an international
context. In D. Moores & M. Miller
(Eds.), Deaf people around the world:
Developmental, educational, and cultural
issues (pp. 352–367). Washington,
DC: Gallaudet University Press.
Hyde, M. B., & Høie, G. (2007). (Eds.). Constructing
educational discourses on deafness
(Skådalen Publication Series Report
No. 26). Oslo, Norway: Skådalen Resource
Center.
Hyde, M. B., Ohna, S.-E., & Hjulstad, O. (2006).
A comparison of the definitions, policies,
and practices associated with the educational
inclusion of deaf students in Australia
and Norway. American Annals of the Deaf,
150(5), 415–426.
Hyde, M. B., & Power, D. (2006). Some ethical
dimensions of cochlear implantation for
deaf students and their families, Journal
of Deaf Studies and Deaf Education, 11,
102–111.
Knorrs, H. ( 2007). Educational responses to
varying objectives of parents of deaf children:
A Dutch perspective. Journal of Deaf
Studies and Deaf Education, 12, 243–253.
Johnston, R. (2004). W(h)ither the Deaf community?
Population, genetics, and the future
of Australian Sign Language. Sign Language
Studies, 6(2), 137–173.
Landsvik, B. (2001). Barn med cochlea implantat:
Kommunikasjon og samspill i barnehagen
[Children with cochlear implants:
Communication and interaction in kindergarten]
(Skådalen Publication Series Report
No. 12). Oslo, Norway: Skådalen Resource
Center.
Mehl, A. L., & Thomson, V. (2002). The Colorado
newborn hearing screening project,
1992–1999: On the threshold of effective
population-based universal newborn hearing
screening. Pediatrics, 109(1), E7.
Morton, C. C., & Nance, W. E. (2006). Newborn
hearing screening: A silent revolution.
New England Journal of Medicine, 354,
2151–2164.
Norwegian Directorate for Health and Social
Affairs. (2006). Cochlea-implantat (CI):
Hjelp til et hørende liv [Cochlear implant
(CI): Help for a hearing life]. Oslo, Norway:
Author.
O’Donoghue, G. M., Nikolopoulos, T. P., & Archbold,
S. (2000). Determinants of speech
perception in children after cochlear implantation.
The Lancet, 356(9228), 466–468.
Ohna, S.-E., Hjulstad, O., Vonen, A. M, Grønlie,
S., Hjelmervik, E., & Høie, G. (2003). På vei
mot en ny grunnskoleopplæring for døve
elever [Toward a new primary education for
deaf students] (Skådalen Publication Series
Report No. 20). Oslo, Norway: Skådalen
Resource Center. Power, D. J., & Hyde, M. B. (1997). Multisensory
and unisensory approaches to communicating
with deaf children. European
Journal of Psychology and Education, 12,
449–464.
Simonsen, E. (2000). Vitenskap og profesjonskamp:
Opplæring av døve og åndssvake i
Norge 1881–1963 [Science and professional
struggle: Education of the deaf and of the
mentally retarded in Norway 1881–1963].
Oslo, Norway: Unipub.
Simonsen, E. (2005). Disability history in Scandinavia:
Part of an international research
field. Scandinavian Journal of Disability
Research, 7(3–4), 137–154.
Simonsen, E., Kristoffersen, A.-L., & Hjulstad, O.
(2009). Hva skjer i klasserommet? Rapport
fra prosjektet Inkluderende opplæring av
barn med cochlearimplantat. [What goes on
in the classroom? Inclusive education of children
with cochlear implants] Skådalen Publication
Series No. 28.
Simonsen, E., & Ohna, S. E. (2003). Behovet for
kvalitetsreform i audiopedagogikken [The
need for reform in teacher training for education
of the deaf]. Spesialpedagogikk, 68(1),
14–21.
Strand, L. (2002). Å høre til: Samtaler med
foreldre [Belonging: Talks with parents]
(Skådalen Publication Series Report No.
19). Oslo, Norway: Skådalen Resource
Center.
Thoutenhoofd, E. (2006). Cochlear implanted
children in Scottish schools: Four-year
school attainment data (2000–2004). Journal
of Deaf Studies and Deaf Education,
11(2), 171–188.
Yoshinaga-Itano, C. (2003). From screening to
early identification and intervention: Discovering
predictors of successful outcomes
for children with significant hearing loss.
Journal of Deaf Studies and Deaf Education,
8(1), 11–30.
Yoshinaga-Itano, C. (2004). Earlier identification
for earlier intervention. In D. Power & Gregory
R. Leigh (Eds.), Educating deaf students:
Global perspectives (pp. 69–84).
Washington, DC: Gallaudet University
Press.
Yoshinaga-Itano, C., Coulter, D., & Thomson, V.
(2000). The Colorado newborn hearing
screening project: Effects on speech and
language development for children with
hearing loss. Journal of Perinatology, 20(8),
S132–S137.
Yoshinaga-Itano, C., Sedey, A. L., Coulter, D. K., &
Mehl, A. L. (1998). The language of early- and
later-identified children with hearing loss. Pediatrics,
102, 1161–1171.
Young, A., & Tattersall, H. (2007). Universal
newborn hearing screening and early identification
of deafness: Parents’ responses to
knowing early and their expectations of
child communication development. Journal
of Deaf Studies and Deaf Education,
12(2), 209–220. VOLUME 154, NO. 3, 2009 AMERICAN ANNALS OF THE DEAF
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