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

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.
Response from Marc Marschark - NTID

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.

My grandaughter is aged four, has deaf parents, and high level BSL which is her first language. Her levels have been assessed as being approximately two years above her age in terms of her language acquisition.We are currently requesting that she is taught in a mainstream class with a high level interpreter in a bilingual setting but have been offered CSW’s with BSL level 2/3. Where can we find research/evidence to back up our request that she needs a highly skilled interpreter to go from one language to the other and therefore help her to acquire English as her second language, rather than a low level communication support worker which we have been told is all that a primary aged child needs?

Question from A.R., London. Posted August 21, 2013.

I am not aware of research that evaluates the merits of a Communication Support Worker (CSW) compared with a Sign Language Interpreter. Although the titles and job descriptions of each of these speak for themselves, and in theory at least, a CSW is appropriate for some deaf children, in practice, there are very few CSWs with sufficiently high levels of sign language to meet the needs of children such as your granddaughter. Then again, there are few high-level interpreters who work in school settings.

The difference between the two roles is that a CSW is there to support communication, which is particularly necessary for deaf children with less well developed language. In these cases, the CSW may simplify the language used in class as needed in order to help the deaf child’s learning and language development. The CSW often goes beyond translation to provide additional explanations so that the child knows what to do or understands what s/he is meant to learn in class. In contrast, a sign language interpreter is there to translate directly from one language to another, normally without simplifying or modifying the language in any way. With an interpreter translating exactly what is said in class by the teacher and the other pupils, the deaf child has exactly the same access to information as any other child in the classroom. Importantly, the SLI will expose your granddaughter to all the complexities of classroom language that she needs to further develop her own language and this will also help her when she comes to learning to read English. A CSW with inadequate signing skills may oversimplify classroom language which can then limit language development. A final point of difference is that a CSW typically sits alongside the deaf child in class to support them whereas the interpreter stands next to the teacher. The advantage of the interpreter being positioned next to the teacher is that a deaf child has the possibility of watching both, thereby developing speechreading skills for improved understanding of spoken English.

There certainly is research to indicate that exposure to higher levels of language leads to better language development (e.g. Wood et al 1986) and also that higher language levels are associated with better literacy levels among deaf children – this is true for deaf children who communicate using spoken language (e.g. Daneman et al, 1995; Gravenstede & Roy, 2009) and those who use sign language (e.g. Strong & Prinz, 2000). Finally, there is also research that shows that better speechreading, particularly at a young age, is an important predictor of reading in deaf children (e.g. Harris & Moreno, 2006; Kyle & Harris 2010).

I am a mother of two profoundly Deaf children who have unilateral cochlear implants and have full access to NZSL as I am an interpreter and my husband is Deaf. My daughter, who is 3, has very strong spoken language skills and reasonably good sign language skills. I see her tendency is to use spoken language more dominantly. I want to know if there is any experience and research of educating children in both languages fluently and in what ways have been successful. I often use a form of sign-supported English when reading, but lately I notice she is not watching my signing. I have switched to separating the language and only using English or only using NZSL but when I just use NZSL she complains and wants me to use spoken English. I would love to have access to any literature in this area to help me navigate and teach 2 languages to my children.

Question from E.K., New Zealand. Posted August 16, 2013.

Unfortunately, there does not appear to be any research literature about this issue. What we know from observations and teacher reports concerning students in our bilingual programs is that this situation is not at all unusual among deaf 5- and 6-year-olds with cochlear implants. At first, they seem to start using fewer signs productively themselves, and later they ask hearing and Deaf teachers to switch on their voices when communicating with them. Why? We don’t know. Our speculation is that this reflects some kind of an evolutionarily-determined drive for multimodal perception. However, we also don’t know whether this is a temporary situation or whether the children “grow out of it.” There clearly is a need to collect more observations by parents and teachers as well as to conduct systematic research on the issue which may have long-term implications for academic outcomes, social-emotional functioning, and cognitive development.

Recommended reading:

Knoors, H. & Marschark, M. (in press). Teaching deaf learners: Psychological and developmental foundations. New York: Oxford University Press.

Watson, L., Hardie, T., Archbold, S., & Wheeler, A. (2008). Parents’ views on changing  communication after cochlear implantation. Journal of Deaf Studies and Deaf Education,   13, 104-116.

My niece is 27 years old. She graduated from her high school’s deaf and hard-of-hearing program at 21. She is profoundly deaf. She learned ASL when she came to live with us at 14. Prior to learning ASL she didn’t have a language base. She would like to attend RIT’s program for the deaf but we are a concerned with the requirements. It will be very difficult for her to take the SATs. As far as we understand the SAT is required. Any advice or suggestions that could be provided would be greatly appreciated.

Question from C.P., New York. Posted August 7, 2013.

There are several degree pathways at RIT (associate, associate + bachelor, bachelor at the undergraduate level), and admission criteria varies for each of RIT’s nine colleges.  NTID Admissions looks at many variables in facilitating an admission decision (SAT/ACT test scores, high school GPA, courses taken in high school, letter of recommendation, etc.).  In the test score sense, at minimum, the average accepted student into an associate degree program has a score of 15-16 on the ACT.  We accept students with lower and higher ACT scores into some of the associate degree program choices.  This link tells you what it will take to be admitted to a program of choice at all degree pathways: http://www.ntid.rit.edu/sites/default/files/colleges_admissions_requirements.pdf.

It is recommended, given your niece’s specific circumstances, to connect with Rick Postl, admissions counselor for New York, at Rick.Postl@rit.edu to begin a dialogue of options.  Admissions counselors for other states can be found at http://www.ntid.rit.edu/admissions/counselors.

I have my son’s IEP meeting coming up soon and I’m not sure if I’m going the right track. My son will be 3 soon. He has moderate sensorineural hearing loss in both ears. When he was born, he had mild/moderate hearing losses. I would really like for him to learn ASL and I feel the earlier the better. I have been doing research and it seems like it would benefit him. However, the class I am looking into has no children who use spoken language, so that would be coming entirely from teachers. I am really excited, but whenever I’ve had the chance to speak to audiologist, speech therapist, or teachers about this, I receive a questioning look, and they tell me that he should go into an oral-only program. What should I do?

Question from L.L., California. Posted August 1, 2013.

First of all, you are definitely on the right track!  Children who are deaf or hard of hearing should have the opportunity to acquire American Sign Language and spoken language (to the maximum extent possible).  You have both the right and responsibility to advocate for what is in your child’s best interest. The challenge is ensuring that your child’s educational program provides him with the resources to make this possible. On your side is the legislation (IDEA Part C) that supports parents as equal members of the IFSP team. There are also best practice principles such as those included in Supplement to the 2007 Joint Committee on Infant Hearing Position Statement. See: http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2013-0008.full.pdf

Your expertise and knowledge of your child’s strengths, abilities and needs are invaluable. In addition, according to IDEA, your goals and priorities for your child must be recognized. Your child will be transitioning into preschool and educational programming will soon be covered under IDEA Part B. My suggestion is that you request that a Communication Plan be developed for your child and included in your child’s IFSP/IEP as he transitions to preschool.  Some states have included a communication plan as part of the IDEA process. There are several examples of communication plans available online. You might want to look at http://pattan.net-website.s3.amazonaws.com/files/materials/forms/Comm-Plan120210.pdf  as an example.

It’s important that you continue to work closely with your child’s IFSP/IEP team as you develop a communication plan that will ensure that your child has the opportunities to acquire language and communication through the modalities (hearing, seeing) that are most accessible to him. This would include opportunities to communicate with peers and adults who use ASL and also those who use spoken language.

My husband and I adopted our fourth child at age 3.5 from Eastern Europe. He had virtually NO language other than pointing, and indicating if he was happy or sad. The orphanage that we adopted him from reported that they did not realize he was profoundly deaf until he was 3 years old. He had never had any speech therapy, preschool, or early Intervention. Once he was part of our family, through much testing, we confirmed that he was profoundly deaf in both ears. He was fitted with hearing hearing aids, and at age 6, due to concerns for safety, he received a cochlear implant, and continues to wear one hearing aid. Our son is an absolute joy, and makes our family complete. He is now 7 years old, and has learned SO much. We use Total Communication both at home and at school. He is in a first grade class, with most academics taught in a self-contained HOH classroom, and spends part of the day in the “regular education class.” Socially, he is mostly like other 7 year old boys: fun-loving, action-packed, into sports and playing outside. Academically, he is still at a pre-school/kindergarten-ish level, and his receptive and expressive language is severely delayed. He talks and signs, but the majority of his words are not understandable. He mostly uses ASL/Signed English to communicate. Our major concern for our little guy, is, that his school is VERY focused on how behind he is language-wise, and academically (which he is). However, it is very difficult for them to see how far he HAS come in the four years we have had him. We don’t know any other families that have Deaf Children, that had NO Early Intervention, that were adopted internationally, and have the extreme language delay that our son has. We feel like we don’t know how to advocate for him at school, have high/yet acheivable expectations for him. All the literature that we find talks about how very important early Intervention is….but our child was not given that, and it was not in our control until he came to us. How do we provide him the most support possible, and help to increase his global language. His language delay is obviously impacting how much he is able to take in/learn at school. But we don’t know how to “hurry language along” for him. He gets “speech/language” 5 days a week at school…and we constantly talk and sign at home. It just doesn’t seem to be enough. Does he need some type of intensive therapy?

Question from R.B., Somewhere, USA. Posted April 26, 2013.

From what you have written, it really looks as if your son is thriving being in a loving home and has developed a way to communicate in a social way.  You are correct about him getting a “late start” with regard to his exposure to consistent language, listening, and speech.  When we, as professionals, begin working with children who are “budding roses,” I like to think that we all look at “potential” for blooming, and it is fairly common and appropriate to look at how much progress he makes over time, now that he is in a consistent educational environment.  We hope to see one year of progress from where he is, for each year of experience.

He is currently in the mainstream classroom, and in a HOH classroom.  What I cannot get a real feel for is how consistent his language input is within each modality.  If he is getting a “total communication” philosophy, I worry that he may not be getting immersed in language consistently.  It looks as if that is a concern from his educators.  I typically am an enthusiastic advocate for total communication, but given his late start with language exposure, combined with the question of how much he was able to hear even after he had hearing aids, I feel more compelled to be sure he gets immersed in a consistent, accessible language system.  Given this, I wonder whether you have considered a school for the deaf?  Is there one close to you? Is there an intensive summer program that uses American Sign Language?  I am asking this because I would be really curious to see how fast he picks up on a completely accessible language system when he is immersed in it.

While I am not abandoning speech and listening, I do think that we need to temper expectations a bit with regard to his potential to be an auditory learner given we can only verify that from age 6 on he is getting consistent access to sound via his CI.

As a first step, try contacting Hands & Voices (www.handsandvoices.org) or the American Society for Deaf Children (www.deafchildren.org) to find other families with deaf children in your area. Talking with other parents who have had similar experiences will be immensely helpful.

I am wondering if you have any information about testing Deaf and hard-of-hearing students who come from non-English backgrounds to determine English proficiency? State laws require all students who have any other language spoken at home be tested when the enter preschool, before they leave preschool, and every year in school thereafter. The tests used by the district in preschool (Pre-IPT and WIDA-MODEL) do not allow sign language to be used, though they are spoken language and listening tests. Besides the obvious concern that students may score low because of a language delay due to their hearing loss and not just the second language at home, there is also the concern of testing students without sign when Total Communication is their mode of communication documented on their IEP. The problem is two laws colliding. The result from a low test score is a letter to parents saying their child qualifies for a bilingual or ESL classroom, though the team is recommending the DHH classroom. Do you have any information or ideas of other ways DHH students are tested to comply with state mandated ELL testing?

Question from S.H., Illinois. Posted April 9, 2013.

Let me share my experience in Colorado: As stated in this request for information, the primary area that language proficiency becomes an issue is with regards to eligibility for special education as there is a question on the eligibility form that asks if the learning problems are a result of lack of proficiency in English. In Colorado, the legal interpretation at the Department of Education is that the hearing loss trumps primary language, so that children would be eligible for special education even if they come from a family that es ASL or a language other than English in the home.

Regarding assessment, I think it would be discriminatory to provide the language assessment without the accommodation of sign when a child uses sign. The child’s primary language should also be assessed and when sign is used by the child, the assessment should be conducted by an individual fluent in the sign language of the child (ASL, Spanish, Chinese, etc.) to compare competency in the child’s primary language and in English.