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 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.
Response from Deborah Chen Pichler - Gallaudet University

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.

What is the role of a speech therapist in communication development of a 7-year-old deaf child using sign language?

Question from Z.D., South Africa. Posted October 27, 2011.

The role of a speech therapist or the speech-language pathologist (SLP) in the case of a 7 year-old deaf child using sign language  is intrinsic and multi-faceted.  The clinician must be aware of the implications of the type of sign-language being used.  If the child is using American Sign Language (ASL) then there will be bilingual issues to be addressed when it comes to teaching reading, because the child must learn English to read.  The SLP can facilitate learning English Grammar forms in preparation for reading and writing in English whether the sign system used is a contrived system such as Signed English, or ASL.

There are also many things that can be done with both spoken phonology (sounds of the language) that can contribute to the ability to decode printed words (phonological awareness and phonological processing).  In fact, just because a child is using sign language, this does not rule out that using voice to communicate might be a goal.  The child may want to target high use words and phrases for speaking.   Children who are deaf also may need to target “pragmatics” or the practical use of language in social contexts. It is the proverbial “knowing what to say, how to say it, and when to say it – and how to “be” with other people.”  Because deaf children do not always “overhear” social niceties, they may need to be taught these things directly (e.g., we don’t typically ask grown-ups their age, or even if you do not care for a particuar gift you get it would be impolite to say “I don’t like this!” ).

Other areas the SLP may target is helping the child to increase vocabulary, (especially multiple meaning words), learning idiomatic language “put the lights out.” In summary one of the key elements to your question is the word “language. ”  The role of the SLP is to facilitate speech and language learning in all contexts and modalities appropriate for the individual.

I became totally deaf at the age of 34, and am now 47. I am a full-time student working towards my Bachelors in Social Work. Having been on both sides (hearing and deaf), and through my education, I know the importance of communication regardless of what mode a parent uses to teach a child.

My question is this, in my internship I am working with a client whose parents want me to teach their child phonics. Their child has never heard a sound what-so-ever. I honestly don’t see the point in it, as how do you describe a “hard C” vs. a “soft C” to someone who has never heard. I do understand wanting to teach them the correct endings to words, such as when to add “ed” (as in worked). In ASL one would sign “finish” + “work” or vice versa. I can see how that would benefit a deaf child in knowing how ASL and English connect for reading, writing, and comprehension.

What are your thoughts on the parts of the phonic’s lessons that rely on having some auditory hearing to use as a base for teaching it? What does one say to hearing parents who want their deaf child to know how each letter is pronounced with phonics, when the child is completely deaf? For me, I still have use of my voice, I just don’t hear anything at all, but knowing phonics has helped my interpreters and friends in teaching me how to voice a new vocabulary word or someone’s name correctly. I just can’t imagine the benefits of this information to someone who has never heard. Am I wrong in my thinking? Or should I focus on helping this child make the connection between ASL and English?

This child’s ASL understanding is wonderful, and they can communicate and articulate very well, but lacks in English comprehension skills. I have noticed this when I ask if they understood the paragraph they just read, and they reply yes. Then when I pick out a word and ask them to tell me the meaning, they say they don’t know. When I then show them the ASL sign for the word, their face lights up and they fully understand then.

Question from T.S., Michigan. Posted June 20, 2011.

My first thought was to refer this question to a speech therapist… or language person of some kind. However, that’s not what this is about. First of all, you really do not have much choice in this matter; it’s the parent’s decision. Yes, you can and should educate the parents to the greatest extent possible (and appropriate), but their desires are not surprising, and you have to respect their wishes if you were going to continue working with the child. But, you raise an excellent second point. There is no evidence that fluency in a signed language is sufficient to provide a deaf child with the underpinnings necessary for English literacy. Research and theory both point to the need for some kind of a bridge. For some deaf individuals the bridge is speechreading, for others it is cochlear implants or an English-based signing system. Supporting this child’s ASL skills will help to provide a fluent first language on which to build literacy. Phonics will help to bridge the child’s language skills to English literacy. You are an outstanding model for both the child and the child’s parents. Hopefully, you can help to educate all of them at the same time.

I am the mother of a 7 year old deaf child. My daughter passed her newborn hearing screen and a follow up ABR at 6 months old (she was high risk due to being in the NICU). But she began losing her hearing by 15 months old and was dx’ed with a moderately severe loss by 18 months and fitted with hearing aids.

We began to speak and sign but she never “caught on” to spoken language. At 3, she was placed at a Deaf school. We continued to do therapy, but she didn’t gain any spoken language. She quickly became pretty fluent in ASL.

In kindergarten her hearing loss progressed and she received a CI. She suddenly was able to process spoken language. She has made tremendous gains in her spoken language in the two years since she was implanted. She understands and discriminates running spoken language and has gained nearly 5 years worth of language. She is now in a well respected oral school.

So, my question is this….can she actually catch up? She hears very well, but can she reach age appropriate with her spoken language? Or do we eventually de-emphasis it and go back to ASL?

Question from A Mom, Confusion USA. Posted March 21, 2011.

It sounds as if your daughter had a very solid language base (ASL) in those first years of her life, which tells us that her language-learning skills seem to be intact, thus she is a “language learner.” You also say that she has made 5 years of gain in her language skills (I am assuming English skills) over the past few years, which again provides evidence that she had a strong language system in place to “map” the spoken English language onto. From what we know about second language learning and from deaf children learning spoken language with CIs, I would say she has an excellent prognosis.  A study published by Nichols and Geers (2007, see below), also provides us with evidence that would suggest your daughter is on the road to success.  That study found that the smaller language delay a child has when they receive a CI, the better the chances are that the child will, indeed catch up. Given that your daughter seems to have been performing at a very high level with regard to language (ASL) at the time she received a CI in the first place, we can be very optimistic about her future language abilities.  It will be very important in the next few years to target her ability to learn to read and write.  Once she is reading, she will continue to acquire the higher levels of language she will need to become a competent language learner.

Further reading:

Nichols, J. & Geers, A. (2007). Will they catch up ?  The role of age at cochlear implantation in the spoken language development of children with severe to profound hearing loss.  Journal of Speech, Language, and Hearing Research, 50, 1048–1062.