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.

Spoken Language

I am needing help with explaining how an 11th grade student who is deaf with ASL as his first language and English as his second language and uses an ASL interpreter in class is struggling with learning Latin IV. He uses a CI and hearing aid.

Question from A.D., Ohio. Posted October 30, 2014.
Response from Kearsy Cormier - Deafness Cognition and Language Research Center (DCAL)

Research on deaf signers who have ASL as their first/preferred language has clearly shown that their skills in using spoken/written English vary enormously. Those who acquire ASL earliest tend to be better at English overall than those who learn ASL later, but many do struggle with English as it is for them a second language (just as learning say French would be for a native English speaker). Learning then additional spoken/written languages beyond English is even more challenging for the deaf student, particularly when they are being taught alongside hearing students via interpreters. This would be like a native English speaker who can read and write French as a foreign language trying to learn Latin as an additional language in a class full of monolingual French speakers where the class was taught exclusively in spoken French and interpreted (just for that one student) into spoken English. There has been very little research on acquisition of additional/foreign languages by deaf signers in these kinds of situations, but it is clear that such a student must be given proper support in order to achieve the same level of success as his hearing peers.

My 4 year old son has been diagnosed with severe sensorineural hearing loss in both ears. He was not born this way; we believe he lost his hearing sometime between 2.5 and now. He was just diagnosed in June and he will be getting his first pair of hearing aids at the end of July. I’ve been told by his ENT and Audiologist that we need to make a decision about cochlear implants (CIs) very soon. My son had lots of vocabulary and speech sounds; he now is a little difficult to understand but communicates with family and friends. My question is where can I find good information about CIs and also why must I rush to make a decision?

Question from M.H., New Jersey. Posted June 27, 2014.

It sounds as if your child’s loss predominantly occurred after he acquired verbal speech and auditory language, so his deafness is categorized as “post-lingual.”  This means your son’s brain has a memory of what speech sounds like, even if that memory and how to reproduce it are fading a bit. That is one reason why implantation is recommended sooner rather than later – research has demonstrated that the shorter the lag between onset of the hearing loss and input from a cochlear implant, the better the child does.  We believe that is because the auditory memory (part of that auditory path design) has had less time to “forget” the sounds of speech.  There are lots of research articles that talk about keeping that time-frame short between onset of hearing loss and use of the CI, although outcomes are more variable than they might appear.

The signal from the hearing aid is amplified speech and other sounds, so your son will hear things at a louder level with his aids.  The sounds will be distorted and some sounds may not be transmitted very well (sounds like /sssss/ and /shhhhhh/).  His brain and his ears are connected by a path of nerves (the auditory path), and the signals that the ears receive must be interpreted by the brain.  There is big difference between the signal provided by a hearing aid (loud speech) and the signal transmitted by the cochlear implant (kind of like Stephen Hawking’s electronic speech).

Without knowing more details as to the cause of the hearing loss, it is unclear whether there are specific reasons for recommending earlier implantation – some audiologists and ENTs simply believe that CIs are for almost every deaf children and the sooner the better. However, I can tell you that there are some conditions that can cause a bony growth to happen in the cochlea (which is the organ if hearing) and, if so, this growth begins after the hearing loss in a gradual and slow manner.  If this occurs, the longer one waits, the more difficult it can be to insert the electrode of the cochlear implant.

There may be other reasons your healthcare providers are wanting you to make a decision, but you need to do your homework first. One of the predictors of children’s success with CIs, literally, is how much time their parents spend getting information on the subject. Here are two links that let you compare what the signals of a hearing aid sound like and the signals of a Cochlear Implant sound like

https://www.youtube.com/watch?v=1l37lzLIgQU

http://www.etc.cmu.edu/projects/tatrc/?page_id=371

Here are some article review links:

http://www.scielo.br/scielo.php?script=sci_pdf&pid=S1808-86942012000200019&lng=en&nrm=iso&tlng=en

https://ore.exeter.ac.uk/repository/handle/10871/11533

[Ed. – For more, very objective information visit the UK’s Ear Foundation]

Our district audiologist wants to put all DHH students on personal FM and remove the class soundfields altogether. I find conflicting research on this. The DHH teachers don’t want to get rid of the class soundfield systems. Can you please confirm either the benefits or detriment of keeping the soundfield in place in addition to personal FMs?

Question from E.W., California. Posted June 12, 2014.

By class soundfield system, I assume you mean a room equipped with two or more speakers that broadcast the desired signal into the desired space.  The problem with these systems is that everyone in the room is exposed to the signal and, depending upon where the deaf or hard-of-hearing student is sitting, there could loss of signal strength over distance.  Personal FM systems have the advantage of being set up specifically for the user, whether the individual is using a hearing aid (s), a cochlear implant, or both.  The signal is clear, coming directly from the teacher to the student.  The signal does not lose strength over classroom distance, and the teacher can use one microphone to connect to several students at the same time.  Also, there is no “carry over” into adjoining classes as there might be with a sound field system (depending upon the decibel level of the signal).  In my opinion, the FM is superior though more expensive. Two additional notes:  (1) Students with milder hearing losses may do best with soundfield system while those with severe to profound losses are likely to do better with FM. (2) It is unclear why a person would remove an existing soundfield system unless maintenance is an issue.

I am a teacher of the deaf in the school for the deaf in Scotland. I have recently begun working with a family whose son, aged 2 1/2 years, has just been diagnosed with a severe/profound loss. He is currently undergoing cochlear implant assessment. The family are very keen to develop both sign and speech as they acknowledge they do not know what the future holds and they understand the need to establish language. It is at this point my question arises. The family home language is Arabic and they have asked about using Arabic sign and speech at home and BSL/English of the home. The boy in question has a hearing sibling who is already bilingual. I am finding it challenging locating any information about the development of 2 sign languages at the same time. Is this an area any research has ever been done in? Is there any advice I can take to the family? The family used the approach of Arabic at home and English outside the home with their hearing son. Can this approach be applied to the development of 2 sign languages? I don’t think this is beyond the family as Mum is a linguist and can speak 5 languages. Her enthusiasm and interest is immense! My concern is whether this too much for the child?

Question from J.R., Scotland. Posted March 7, 2014.

I have been on the lookout for publications on the acquisition of two sign languages simultaneously, but I have not found any. However, there is an increasing number of Deaf couples marrying across nationalities, and raising their children with more than one sign language, so there is anecdotal evidence of children growing up sign bilingual, and from what I hear, the situation is not so different from bilingualism in two spoken languages, or one spoken and one sign language. The biggest challenge to raising functionally bilingual children, however, is not with the children, it’s with the adults. It is very difficult to provide adequate input in both languages, especially if one of the languages is a minority language. Bilingualism researchers estimate that children need much more input in a minority language than is required for a majority language to successfully learn and maintain it at conversational levels. It also helps a lot of the input is from varied sources, including peers; simply depending on the parents to provide input is often not enough. These input challenges are compounded when the goal is to raise the child with 3 or 4 languages.

That said, I am raising my children trilingually, including two very small minority languages, and so far the results are encouraging. My strategy was to greatly prioritize the minority languages in the years before my children entered English-speaking preschool. Until the age of two, we only spoke Taiwanese and Croatian to our children, and they didn’t have much working knowledge of English at all. This made the start of preschool frustrating for them, admittedly, but they learned English so quickly that it wasn’t a problem for long. And it gave them a foundation in Croatian and Taiwanese that we built relentlessly on once they entered school. We invest in multi-week trips to Croatia and Taiwan every year to give them a wider context for using those languages, and to strengthen their relationships with family there. Now, at the ages of 10 and 4, they are both able to use all three languages, although English will undoubtedly become their dominant language.

Finally, as a professor at Gallaudet University, I also signed very extensively with my children when they were young, often in conjunction with spoken Taiwanese. I signed ASL with Taiwanese rather than Taiwan Sign Language, since I don’t know the latter. This actually worked fantastically well for lexical learning and my children quickly amassed a large vocabulary of ASL signs and the corresponding Taiwanese words. On trips to Croatia, the ASL signs also turned out to provide an effective bridge to Croatian: I could speak Croatian and sign key words in ASL, and the children were able to very quickly map the new Croatian word to the familiar sign without having to ask what the Croatian word meant in Taiwanese. I would say that it almost seemed like magic, except that this doesn’t sound very scientific… Of course, as a linguist, I should stress that what I taught my children was not ASL. I mostly taught them just lexical signs, accompanying spoken Taiwanese or Croatian, something akin to what is known as “signed supported English.” This is not a very effective form of sign input for a Deaf child to learn sign language, but my children are hearing, and my goal was not to teach them full ASL.

All this to say that I think learning BSL, spoken English and spoken Arabic should be well within the abilities of this family. The chances of success should be higher than usual, given the parents’ linguistic experience/motivation and the fact that they are willing to give their child early and intense exposure to sign language (something I think is one of the best things parents can do to to ensure the success of a cochlear implant). I would advise against trying to learn Arabic SL and focus on BSL instead. Sign language vocabulary is very easy to learn, but the grammar and phonology can be challenging for hearing learners, so one sign language at a time is probably plenty. Since this family will be trying to teach BSL as a full language to their child, it will be *very* important to find native signing BSL models and peers for the child, and to not limit their BSL use to lexical signs accompanying spoken Arabic sentences (feel free to use Arabic words with BSL signs for vocabulary learning, but my point is that there needs to also be times when BSL is used on its own). There will be plenty of time for the child to pursue Arabic SL (there are actually multiple, distinct sign languages used in Arabic-speaking countries) later once he or she is a bit older and has established BSL and spoken Arabic.

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 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.

I have a son who was born deaf but has a cochlear implant. he doesn’t want to pick up on spoken language so im introducing sign language to him. He also has many developmental delays and was wondering what would be the best way to go about teaching how to sign.

Question from P.T., California. Posted September 19, 2012.

This is a tricky question, not one that can be addressed fully on this site. There are so many questions that need to be asked! Crucially, I would want to know things like: How old is the child? How long since he had his implant, and has he been wearing it consistently? Are you sure the technology is working correctly and that your son was mapped correctly? What do we know about these other developmental delays?

Importantly, we need to know what is meant by “doesn’t want to pick up on spoken language.”  This is an interesting and unusual way of phrasing this, and I would need to know how you have reached this conclusion? It is only with this sort of information that we can give you any clear advice. Plus, assessments describing the child’s progress or lack of progress from the pre-implant stage to now would be very useful indeed.

The next step would be to think about what you mean by sign language. To professionals this may be very clear, but to parents it can mean many different things. Are you looking to use signs to support spoken language? Or, are you looking at a whole new language? Using simple signs to support spoken English would be a great place to start. Learning a language like American Sign Language would require a big commitment from you and other family members. And, she would need to explore at length whether your child’s developmental delays might act as a barrier to language learning – sign languages are not an easy option!

I think you really need to talk to your local professionals, so the whole family can all think about what you are trying to achieve with your child and refocus on the goals. Importantly, if they tell you either that you must not sign with your son or that he will never achieve spoken language, you should look for another opinion. There is no “black and white” here, you are asking about a complex situation that likely does not have any simple answer.

I had an audiologist tell me that 99% of the time when you add sign support to an implanted student the language level/development drops. I respectfully disagreed – Your thoughts?

Question from R.S., California. Posted May 17, 2012.

Thoughts aside, there is no published evidence we know of to indicate that this is the case. You might recommend the following to the audiologist: Spencer, L. J., Gantz, B. J. & Knutson, J. F. (2004). Outcomes and achievement of students who grew up with access to cochlear implants. Laryngoscope, 114, 1576 –1581. They found that high school students with implants who also had sign language interpreters in the classroom were performing at a level comparable to their hearing peers, a result normally not obtained with longer-term use of implants by students without sign language support.

I have a kindergarten who is in a mainstream school. We are currently getting a TOD for a hour a day, interpreter all day ans speech 3 days a week. She is testing above all of her hearing peers and are hopes are to keep it that way. We are currently using total communication and just recently had another hearing test. During this test the audiologist worked on her repeating her words which she is only getting 30% accurate. So are there any studies or research that say how we can help her. To us we know that she is using all of her skills and we are extremely proud of her.

Question from G.R., New Jersey. Posted April 6, 2012.

From your question, I am not sure what type (if any) listening device your child is using.  Hearing aids?  Cochlear Implant?  The other question I have is when was her hearing loss first suspected and/or confirmed.  The exciting things are that she is performing as well as (and it looks like even better than) her peers.  This index should bring you comfort that you are on the right path.  I am reading between the lines a bit, but your information that she is repeating words at 30% accuracy indicates that she working hard to derive information from the listening-only condition.  Again, I am assuming that the 30% number is representing that the test condition is “listening only.”  I wonder how she does with “auditory- plus vision” condition, that is, does her score improve when she can listen and speech-read?  If she has 50% accuracy when she is able to speech-read, we can assume she is using both vision and audition to understand speech that is spoken.  Without more information it is hard to give advice, but here is what I know.  We have research that indicates that there is a relationship between how well a deaf child uses sound cues and their eventual speech and reading scores.  Having said that, in looking at one study, I can tell you that for 72 children who had four years of Cochlear Implant listening experience, guess what their average score on a word repetition task was?  35%.  This tells us that your daughter is within the average range of deaf children for listening. My advice would be to target her ability to increase her word discrimination skills.  Work on her ability to listen to and identify a closed set of words (vocabulary lists from her school units).  Play listening games where you pronounce a word from a list and have her guess which word you said.  Do this  where she first watches you say the word, then when she is pretty accurate, stand behind her so she cannot see you and see if can understand the word.  Another task is to have her tell you if two words “sound alike”.  Let her watch you as you say two words that either rhyme (pick, kick)  or do not rhyme (walk, doctor).  When she is accurate at this task you can again make it harder by standing behind her as you pronounce the words.  As her listening skills improve, you can then have her listen to a word and repeat it.  Say “pink”  when she is accurate with that do a “switch up” Now say “pink” without the /p/ sound  (target:  ink).  These types of listening practice games will increase her phoneme (individual sound) awareness and ultimately yield a payoff for developing reading skills.

I have a daughter who is deaf and has a cochlear implant. She is an oral student in 7th grade and mainstreamed in the public school. The Speech Language Pathologist at the school who gives her speech therapy has never worked with a child with a cochlear implant and has very little experience working with deaf children. What are my rights to have a qualified SLP work with my daughter and not this district appointed SLP?

Question from K.T., California. Posted February 9, 2012.

A very good question! In California, the School District (LEA) is required to provide the appropriate Designated Instructional Services (DIS) for special education students who reside in their school district.  Appropriate Related Services are an IEP decision, and one that you will need to discuss with your school district and your daughter’s school. This is a common experience for students that are mainstreamed in their neighborhood schools. Typically, the Speech and Language Pathologist (SLP) is not specifically trained in working with students with cochlear implants. Students who attend Regional Deaf Programs have SLP staff that are trained in working with deaf students with cochlear implants. So, the next step would be looking into the modification of your daughter’s IEP.