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Objective: To investigate the relationship between prelinguistic communication behaviors and subsequent language development after cochlear implantation in deaf children. Evaluative tools with predictive validity for language potential in very young deaf children remain elusive., Setting: A tertiary care cochlear implant center and a preschool setting of spoken language immersion in which oral language development is emphasized through auditory and oral motor subskill practice., Subjects: Eighteen prelingually deaf children who underwent unilateral implantation at an average age of 15 months also underwent testing with the Communication and Symbolic Behavior Scales (CSBS) before device activation and with the Reynell Developmental Language Scales (RDLS) at an average of 20 months after cochlear implantation., Methods: A prospective study correlated preoperative communication behavior assessments of 18 children who were candidates for cochlear implantation. We examined the value of prelinguistic behavioral testing with the CSBS in predicting later language level after cochlear implantation as reflected in RDLS scores., Results: We found positive, though weak, correlations between prelinguistic communication skills (CSBS scores) and language learning after cochlear implantation (RDLS scores). Linear correlation between test results failed to reach statistical significance (receptive comparisons, P =.17; expressive comparisons, P =.13)., Conclusions: Evaluating the quality of prelinguistic communication behaviors potentially adds important predictive information to profiles of children who are candidates for cochlear implantation. Correlative analysis suggests that early CSBS testing may provide useful clinical information. Poor CSBS scores may serve as a precaution: if children lack an appropriate prelinguistic behavioral repertoire, the emergence of age-appropriate formal language may be at risk. Observations suggest that symbolic prelinguistic behaviors are necessary, but not sufficient, for the development of strong linguistic skills. The variability of behavioral measures in very young deaf children poses challenges in designing objective measures with predictive value for later language level.

Context: Barriers to the use of cochlear implants in children with profound deafness include device costs, difficulty assessing benefit, and lack of data to compare the implant with other medical interventions., Objective: To determine the quality of life and cost consequences for deaf children who receive a cochlear implant., Design: Cost-utility analysis using preintervention, postintervention, and cross-sectional surveys conducted from July 1998 to May 2000., Setting: Hearing clinic at a US academic medical center., Participants: Parents of 78 profoundly deaf children (average age, 7.5 years) who received cochlear implants., Main Outcome Measures: Direct and total cost to society per quality-adjusted life-year (QALY) using the time-trade-off (TTO), visual analog scale (VAS), and Health Utilities Index-Mark III (HUI), discounting costs and benefits 3% annually. Parents rated their child's health state at the time of the survey and immediately before and 1 year before implantation., Results: Recipients had an average of 1.9 years of implant use. Mean VAS scores increased by 0. 27, from 0.59 before implantation to 0.86 at survey. In a subset of participants, TTO scores increased by 0.22, from 0.75 to 0.97 (n = 40) and HUI scores increased by 0.39, from 0.25 to 0.64 (n = 22). Quality-of-life scores were no different 1 year before and immediately before implantation. Discounted direct costs were $60,228, yielding $9,029 per QALY using the TTO, $7,500 per QALY using the VAS, and $5,197 per QALY using the HUI. Including indirect costs such as reduced educational expenses, the cochlear implant provided a savings of $53,198 per child., Conclusions: Cochlear implants in profoundly deaf children have a positive effect on quality of life at reasonable direct costs and appear to result in a net savings to society. JAMA. 2000;284:850-856