Research shows how sign language exposure affects young cochlear implant recipients

In a new, multisite study of deaf children with cochlear implants, UT Dallas researchers have found that children with either no exposure or limited exposure to sign language end up with better auditory, speaking and reading skills later. The paper is one of the first nationwide longitudinal studies of how sign language exposure affects young cochlear implant recipients.

The topic of whether children with cochlear implants should begin their communication experience with sign language has been controversial. However, Dr. Andrea Warner-Czyz, assistant professor in the School of Behavioral and Brain Sciences (BBS) and co-author of the study, said the research clarifies outcomes for such decisions.

"If you want your deaf child to be an oral communicator and have reading and language measures on par with their normal hearing peers, then signing to them may not provide the easiest route to that outcome," she said.

The study recently was published in the journal Pediatrics.

A cochlear implant is a biomedical device surgically implanted in the cochlea to replace the function of the damaged inner ear. The Food and Drug Administration has approved cochlear implantation for children with severe to profound hearing loss as young as 1-year-old.

Dr. Ann Geers, a BBS research scientist who was the lead author of the study, said a major question for normal hearing parents and the professionals who work with pediatric cochlear implant users is whether spoken language skills are best developed by focusing on the auditory speech signal or whether early exposure to an unambiguous visual language provides an important foundation for learning a spoken language.

To determine the answer, Geers, Warner-Czyz and researchers from six cochlear implant centers across the U.S. studied about 100 elementary-age children who had cochlear implants. The children, like 95 percent of all children born with hearing loss, had parents with normal hearing. The children either had early exposure to sign language that continued more than two years after the implantation, early sign language exposure that stopped before two years post-implant, or had no sign language exposure.

Each year, the researchers looked at how the children performed in the areas of speech perception, speech intelligibility, language and reading. The study showed that the children who continued to sign after two years of having a cochlear implant had poorer outcomes across all communication domains, particularly compared to those who didn't sign at all.

"This study provides the most compelling support yet available for the benefits of listening and spoken language input for promoting verbal development in children implanted by 3 years of age," Geers said. "Contrary to earlier published assertions, there was no advantage to parents' use of sign language. This result affirms the decision of many hearing parents who choose not to use sign language when their child receives a cochlear implant."

The researchers said the study's findings should be a powerful counseling tool for families, especially those whose native language is spoken rather than signed.

"A lot of these families think that once their child receives a cochlear implant, then that's it. But there's a lot of work that goes into getting these kids with the successful outcomes -- some of which has to do with how you use spoken language gt vto communicate with your child," Warner-Czyz said.

New review examines link between pain and opioid abuse

The drug overdose epidemic is largely driven by opioids, which continue to be prescribed for chronic pain despite recommendations to use non-opioids for most cases. A new review published in the British Journal of Pharmacology examines the interaction between pain and the abuse of opioids, and investigates the circuits in the brain that may be behind this link. The review is part of a special theme issue on Emergent Areas of Opioid Pharmacology.

"We have shown that the brain's natural opioid system is drastically changed by the presence of pain, and these changes may very well contribute to the difficulty of treating chronic pain with opioids," said first author Adrianne Wilson-Poe, PhD of the Washington University in Saint Louis School of Medicine. "We have just glimpsed the tip of the iceberg when it comes to pain's effect on the brain, however, and we need a lot more research and grant funding to get to the bottom of the extremely complex interaction between drug abuse and pain."

She and senior author Jose Moron-Concepcion, PhD, Associate Professor in the Department of Anesthesiology at Washington University, note that without a fundamental understanding of pain-induced changes in the brain and how these adaptations interact with subsequent drug exposure, investigators are merely fishing for solutions to the opioid crisis. "Our work is attacking this problem head-on by diligently characterizing the mechanisms involved in pain, addiction, and the interaction between them," said Dr. Wilson-Poe. "We envision a future where chronic pain is considered a disease in its own right, not merely a symptom of some other biological process."

The review stresses that opioids are the most powerful analgesics known to man, and their continued use in the treatment of severe pain is inevitable; however, opioid therapy of the future must look very different from how it does today. Efforts to address this issue include a 2016 guideline by the Centers for Disease Control and Prevention that recommends using non-opioids for most cases of chronic pain, using the lowest effective dose when prescribing opioids, and ensuring that patients who are treated with opioids are closely monitored.

The review is part of a larger themed issue, 'Emergent Areas of Opioid Pharmacology,' that will publish at a later time.

The National Institute on Drug Abuse notes that the emergence of illicitly manufactured synthetic opioids including fentanyl, carfentanil, and their analogs represents an escalation of the ongoing opioid overdose epidemic. Also, prescription opioid misuse is a significant risk factor for heroin use, and 80% of heroin users first misuse prescription opioids.