Raising and Educating a Deaf Child

International experts answer your questions about the choices, controversies, and decisions faced by the parents and educators of deaf and hard-of-hearing children.

Language and Communication

The high school I work at as an educational sign language interpreter will soon be enrolling a young girl from a refugee camp. The student has a hearing loss, but it is not known to what degree. She has had no formal learning experiences except for a few years in the refugee camp she lived in. I would like some resources in order to help the student be as successful as possible. At this point, she will be mainstreamed because there is not a teacher of the deaf full time at this high school. Can you suggest some good resources to tap into in order to help this student with language acquisition?

Question from S.C., Colorado. Posted February 11, 2014.
Response from Barbara Gerner De Garcia - Gallaudet University

This profile of a student arriving from a refugee camp, sadly, is not uncommon.

A principle that Dr. Gilbert Delgado established in his groundbreaking book The Hispanic Deaf, published in 1984, is that above all, each student has to be dealt with on a case-by-case basis. This seems like common sense, but unfortunately, we often hope that there are solutions that we can pull off the shelf or recommend for whole categories of students.

With that principle I mind, I can recommend the following:

Where is she coming from? Are there other refugees from the same refugee camp and country in the school district? What resources exist in the community for this group of refugees. People who are providing community support for the refugees should have more information that can be relevant. It is important to network.

How does the student communicate with her family and people in her environment?

If she is hard of hearing, does she speak? What language? What language does the family speak?

Does she use gestures and home signs?

The student’s hearing loss should be determined as soon as feasible.

If the student is hard of hearing, and high school age, hearing aids are not likely to be effective without one-to-one therapy.  This may be a goal a little further down the road.

Placing a student with a hearing loss in mainstreamed classes with an interpreter is not an appropriate placement. Unless she and the interpreter share a sign language, she has no access.

If she doesn’t know English, under Federal law, including Title IV of the Civil Rights Act, her language needs must be addressed. “ELL students must be provided with alternative services until they are proficient enough in English to participate meaningfully in the regular program.” https://www2.ed.gov/about/offices/list/ocr/qa-ell.html

Regarding resources for language acquisition, all students entering special education are required to have a full educational evaluation. These professionals should, after evaluating the student, provide goals for language and literacy development. Materials used should be at a basic level, and because she is an adolescent, not designed for very young children. If there are other hearing students in the district who also lack formal schooling, what has been done for them?  Does the district have ESOL specialists? What materials does the district have for teaching English to students new to the language?

These are very broad and general suggestions for a complex issue. Without more specific details, such as how the student communicates, family language, specifics about the school district, it is difficult to be specific. Finally, a sign language interpreter should not be responsible for language development of this student. I do not believe this satisfies Federal Law requirements for alternative services to assure acquisition of English.

I work in schools in Madrid Spain. We are debating the usefulness of Cued Speech for reading in deaf children with CIs. What are the latest results on this and how generalizable to Spanish children are these results?

Question from M.P., Spain. Posted February 5, 2014.

There are reasons to believe that Cued Speech may help deaf children with cochlear implants to learn to read and write. Cochlear implants provide auditory information that may be not precise enough to develop accurate phonological representations. Consequently, the reading and spelling skills of children with implants may be delayed compared to the acquisition of these skills by hearing children (with the same instruction). Those children who receive Cued Speech combined with the audio-visual input may develop more precise phonological representations, and better phonemic awareness which is an important skill for learning to read.

There are at least two empirical studies showing better reading, spelling, and reading related skills in deaf children with cochlear implants exposed to Cued Speech compared to deaf children with implants and not exposed to Cued Speech:

Leybaert, J., Bravard, S., Sudre, S., & Cochard, N. (2009). La adquisicion de la lectura y la orthographia en ninos sordos con implante coclear : Efectos de la Palabra Complementada. In : M. Carillo & A.B. Dominguez (Eds). Dislexia Y Sordera. Lineas actuales en el estudio de la lengua escrita y sus dificultades  (pp. 201-219). Malaga: Aljibe.

Bouton, S., Bertoncini, J., Serniclaes, W. & Colé, P. (2011) Reading and reading-related skills in children using cochlear implants: Prospects for the influence of cued speech. Journal of Deaf Studies and Deaf Education, 16, 458-473. 

I’ve seen and heard Marc Marschark say repeatedly that there is no evidence showing Cued Speech supports reading skills. He also writes “.In its more than 60 years of existence, it has never been found to facilitate the acquisition of reading skills by deaf children who are learning English.”

My question is has anyone ever bothered to do a proper unbiased research study on using cued speech with D/HH students to learn literacy?

Question from C.T., Washington. Posted December 27, 2013.

You’re almost correct. What he says is that there is no evidence to support cued speech facilitating the acquisition of literacy skills in deaf or hard-of-hearing children learning English. He readily acknowledges that there is a wealth of supportive evidence from children learning French. The difference appears to be that French (and Spanish and Italian) have very regular sound-to-spelling correspondence whereas English does not (see Alegria & Lechat, 2005).

Even if he can’t do the math (cued speech was developed in 1965-1966), Marschark explains that if, after more than 40 years,  there are no published studies supporting cued speech for English, the alternatives are that either (a) the research has not been done or (b) there has not been positive evidence. In fact, there has been a number of studies conducted aimed at supporting cued speech for deaf children in the United States, but apparently none have yielded sufficiently positive results and been “unbiased” enough to have been published in a peer-reviewed journal.

Cued English clearly facilitates speech reception and may support literacy subskills for some deaf or hard-of-hearing children, but English is simply too irregular for it to be of benefit more generally.

Recommended reading:  Alegria, J., & Lechat, J. (2005).  Phonological processing in deaf children: When lipreading and cues are incongruent.  Journal of Deaf Studies and Deaf Education, 10, 122-133.

Which reading curriculum(la) do you recommend using with deaf/hh students? Do you support using cued speech with English speaking deaf/hh students?

Question from D.D., Arkansas. Posted December 9, 2013.

Thank you for providing the opportunity to remind visitors that this site tries to provide people with evidence-based information about raising and educating deaf children. Only in rare circumstances does the site offer opinions or preferences, and then we ensure that the person writing the response is clear about that.

I do not recommend any particular reading curriculum for deaf and hard-of-hearing students. I know of different schools and programsusing different curricula, and I’m not aware of any evidence that suggests that one is any better than the other. The issue is the extent to which the curriculum is appropriate for the student and matches their strengths and needs (and is delivered in a corresponding manner).

With regard to cued speech, I used to be a stronger proponent than I am now. Cued speech clearly supports the reception of spoken language by deaf and hard-of-hearing individuals. I infer, however, that your question relates to reading. There has never been any evidence that cued speech supports deaf children learning to read English.  The evidence demonstrating cued speech to support reading subskills comes from work involving French or Spanish, which are far more regular in their sound-to-spelling correspondence. Clearly, cued speech has its proponents, and some children succeed well with it. But the evidence for supporting the the reading of English is lacking, and has been for the more than 40 years since cued speech was created.

What is the difference between American Sign Language and Signed English? Is there another name that people refer to Signed English? Is it preferable to teach kids Signed English?

Question from S.T, Kentucky. Posted October 31, 2013.

Sign (or signed) languages are not universal languages, nor are they invented ones. They are, like spoken languages, natural languages, grown and transmitted in communities of language users. In the case of sign languages, the cores of these communities are deaf people and their deaf or hearing relatives. Languages constitute one of the most important characteristics of the cultural and psychological identities of various peoples. This process of cultural identification explains why deaf people in the United States use American Sign Language (ASL), deaf people in France use French Sign Language (la Language des Signes Francais), and deaf people in the Netherlands use Sign Language of the Netherlands (Nederlandse Gebarentaal). The structure of sign languages resembles that of spoken languages with their own vocabulary, phonology (albeit in manual form), morphology, syntax, and pragmatics; so ASL is not a form of English.

There are also systems that combine speech and sign according to different rules, and Signed English is one of these (as are Signed Dutch and Signed Polish). These systems differ in the extent to which they represent the lexical and grammatical properties of the spoken language in the sign channel. Some systems are strict, designed to represent the elements of a spoken language 100% in manual components. They manually encode English or Dutch fully, or at least that is the intention.

There are claims that deaf children will learn to read better if they learn a manually-coded form of the spoken/written language (like English), but there is little evidence to support that claim. Although systems like Signed English have the advantage of being more English-like, they do not “hold together” structurally the way natural languages like ASL do. Different children will find different modes of communication easier to master, and one could probably argue either way. ASL is a true language and at the heart of the Deaf community, however, while Signed English is an artificial sign system intended as an educational tool and is not often used in conversation.

Recommended Reading:

Holcomb, T. K. (2013). An introduction to American deaf culture. New York: Oxford University Press.

Marschark, M. (2007). Raising and educating a deaf child, Second edition. New York: Oxford University Press.

I am living in India and fostering a 6 year old boy who has 95% hearing loss. He used to live in an orphanage and came into my foster care in July. Prior to this no one noticed that he was deaf. I want to look into getting cochlear implants for him, but have been told that because of his age and that he has gone 6 years having no auditory input, the CIs won’t work. Thoughts?”

Question from N.C., India. Posted October 30, 2013.

Amazing that this child went six years until his hearing loss was discovered. This used to happen more than we would like to admit here in the United States, but thanks to newborn hearing screening we are usually able to diagnose hearing loss much earlier now.

Several things that make me curious relate to whether or not to pursue the option of cochlear implantation. I am curious as to whether this little guy has any vocalizations and how he makes his needs known. Do you have a sense whether he is bright and learns quickly? The reason I ask this is that sometimes children who are quick learners are able to slide under the radar and perform well in many arenas and their hearing loss gets over-looked. Alternatively, children who have multiple developmental delays in motor skills, learning, self-care, and if they have a lot of health issues as well, their hearing loss goes undetected as other health issues are the focus of intervention. I am also curious as to whether he ever had some hearing. If he does have the ability to vocalize he may have had hearing at one point in time.

First of all, I think you need to assure that this boy has access to language. As a child with profound hearing loss without amplification/implants he will need to have access to a signed language so that he can learn to communicate with the world. At this point, access to language (sign) is a main priority. In addition, I would also encourage you to advocate for a cochlear implant evaluation. He may indeed be a wonderful candidate. We know that children who learn quickly, who have had hearing, who have support to learn to listen and who are exposed to speech consistently will learn to produce the sounds of their language and within 4 years of CI listening experience, they may be able to produce a majority of the sounds, even if they get a relatively late start.

I have a 7 month old son, and although his hearing is fine, my wife and I would like to teach him sign language. We have seen a lot of books out there but I thought I would ask you and get your advise as to which book(s) you would recommend.

Question from S.J., Rochester, NY. Posted October 28, 2013.

One thing I think you would want to avoid are “baby sign” books that offer artificially-created signs (designed to make money for the authors). If you’re going to sign with your hearing child, you might as well use a natural sign language – in our case American Sign Language. Many schools now accept ASL as satisfying their foreign language requirement.

Folks in the NTID Department of American Sign Language and Interpreter Education have offered three recommendations:

The Gallaudet Dictionary of American Sign Language 

 The Gallaudet Survival Guide to Signing

Basic Course in American Sign Language

They are available from Amazon and other retailers.

My 11 year old son has only become deaf over the last two years, the result of a neurological condition. He has good vocabulary, great speech and rounded communication skills following 10 years of growing up in the hearing world. His reception method is primarily speechreading, supported by some residual hearing. (His deafness is Auditory Neuropathy Spectrum Disorder – which for him particularly impacts speech perception).

Some professionals are recommending that he fully embraces Total Communication, becomes more integrated with Deaf peers and in particular learns British Sign Language. I am not sure. He has no experience of signing (other than basic alphabet), and has a preferred an oral/aural approach. I want to help him learn more about Deaf culture, but I’m keen that we take advantage of his 10 years of open communication to make sure that he doesn’t lose the ‘advantage’ he’s had.

Is anyone aware of any research on “late” presenting deafness in children, and the pluses and minuses of investing in BSL at this age.

Question from S.M., London. Posted October 21, 2013.

It might be useful to separate out the two issues in this questions, that of diversity of language support and Deaf culture.

In terms of the language issue, the first thing to stress is that  there are no ‘minuses’ of learning some BSL or Sign-Supported English (SSE)  at any age. Nothing will be lost; there can only be gains if you opt for this type of environment.  Your son may find BSL useful for learning or for socialising at some point (or a bit of both)  or, more likely, find that  SSE is a useful mediating  tool for mixed deaf and hearing interactions and some support for listening and also literacy development (now or in the future). In either case, learning BSL and meeting and learning with other deaf children will be supportive and will not  change his spoken language trajectory, only add  a layer of support.  Most children that he meets will probably also be using a mix of sign and spoken language for different purposes at  different times and you will find in any TC setting that this flexibility  is normal and  expected and managed by the hearing and deaf adults.

With regard to the other question, about Deaf culture,  entering into some sort of TC environment  will immediately offer your son  access to diverse deaf children and adults. In itself this will extend his understanding  of deafness  as he sees other ways of being and interacting in an environment where deaf and hearing  children and adult rub along together. This is perhaps a more natural way to  engage with Deaf community and culture which is entirely contextualised and nowhere near as overwhelming as seeing Deaf culture as a very separate land.

Given, as you say,  the advantage that your son has had, I would suggest that keeping his communication options open would be linguistically and culturally positive and enriching if this would sit comfortably with family routines, practices and  preferences.

Is research on Cued Speech being taken into account when evaluating and recommending a communication mode that promotes literacy in deaf children?

Question from R.M., Colorado. Posted October 13, 2013.

The wording of your question makes it a difficult, or perhaps sensitive one to answer (especially for someone who has been an advocate of cued speech). For those know unfamiliar with it, cued speech involves the use of handshapes and locations around the mouth to distinguish speech sounds that look the same. It thus supports the visual perception of speech (i.e., speechreading or lipreading). A recent study involving a large nationally-representative sample of deaf high school students indicated that over 50% of their parents thought they were using cued speech in school. The true figure is less than 5%, suggesting that many parents (and perhaps students themselves) are not familiar with the terminology used in educating deaf students.

Because you are writing from the United States an honest answer to your question would be “if research on cued speech is taken into account when evaluating and recommending a communication mode that promotes literacy in deaf children, it should not be used.” Cued speech has been shown to support the acquisition of reading-related subskills, when used both at school and at home, among deaf children who are learning French and Spanish as their first language. In its more than 60 years of existence, it has never been found to facilitate the acquisition of reading skills by deaf children who are learning English. According to Leybaert, Aparicio,  and Alegria (2011), well-respected proponents of cued speech, this likely is because relative to French and Spanish, the sound-to-spelling correspondences of English are highly irregular.

Recommended reading: Leybaert, J., Aparicio, M., & Alegria, J. (2011). The role of cued speech and language development of deaf children. In M. Marschark and P. Spencer (Eds.) The The Oxford handbook of deaf studies, language, and education, volume 1, 2nd edition (pp. 276-289). New York: Oxford University Press.

I just found out that all of the children in our son’s deaf and hard of hearing Total Communication program are only receiving approximately 18 minutes per week each of speech therapy. Is there any research that we can use to request more SLP time?

Question from N.P., Alberta. Posted October 7, 2013.

This is a really important question.  I don’t know that there has been any research that specifically relates to the question of amount of speech therapy time.  The question is also difficult because the ages of the children are not indicated.  Optimally, programs would determine intensity of service based upon a child’s needs, the child’s current functioning including current speech-language delay, the history of service, and the progress over time.  Individual therapy with a speech/language pathologist (SLP), which appears to be the question posed, or individual therapy with a professional trained to provide speech, auditory skills, or what is referred to as listening and spoken language services differs in programs across the United States.  If we have been following a child from early childhood and we can document growth over time from having individual services, which may include home intervention or clinic-based therapy, we would use this data to justify services for individual children.  I believe that there is a study conducted by Ann Geers and Jean Moog that found that amount of individual intervention was related to spoken language outcomes of children with cochlear implants.  However, I don’t know if the information was ever published.

This particular question, while an important one, is a difficult one to research because the needs of the child determine the intensity of service that each individual child might require.  Because most programs, unfortunately, are not evidence-based, that is, withdecisions about service provision are determined by data collected by the program, we are left without evidence that could help families.  In Colorado, we have used the Colorado Individual Performance Profile to determine the intensity of service and time per week of special services.  However, we have not specified how that service would be delivered, for exmaple, in individual instruction in speech therapy versus in group intervention, specialized classroom.