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 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.
Response from Marc Marschark - NTID

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.

My daughter recently had a baby who was born deaf. We are all trying to come to grips with this, but we are getting conflicting information. I have been reading everything that I can find about deaf children and a lot of it recommends using sign language. The audiologist we spoke to said that if we use sign language with her it will retard her ability to speak. Can you help?

Question from S. A., Texas. Posted February 22, 2011.

This is one of the most common dilemmas facing parents (and grandparents) of deaf children – and perhaps the one for  which they are most frequently given advice driven by philosophy rather than evidence. Simply put, there is no evidence that learning to sign interferes with learning to speak. In fact, the research points to early sign language either supporting spoken language or having no effect, while it generally leads to better social-emotional functioning and early academic achievement. That said, all of this is much more complex than such a simple answer implies. Let me suggest an excellent video on the topic available in English and Spanish (captioned in both). “Through Your Child’s Eyes” is objective and informative…and should answer many of your questions.

Importantly, though, there is no need for an “either/or” decision.  Providing your granddaughter with access to and support for both sign language and spoken language offers more opportunities for learning. And, no, the two will not interfere with each other any more than two languages do for bilingual children around the world. In fact, hearing children raised in bilingual environments show cognitive advantages as early as seven months of age (even before they are using those languages), although parallel research has not been done with deaf children.

My sister is hard of hearing and has been so since childhood. My parents (in India) tried their best at educating her with the limited resources at their disposal but they gave up when they saw that she was not making significant progress. As a result my sis who is 20 now, can read / write/ understand words in her limited vocab but has difficultly learning new words. She has difficulty in reading or understanding new words. She is good at computer graphics and animation but cannot move ahead to learn things as she cannot read the english language textbooks. She easily picks up things which can be demonstrated practically but stumbles when she has to learn theory. Is it too late for her to learn English (which is needed to work with computers)? Is there a viable path that she can follow to get her education and make a career out of it? Would the English language course at ELI, Gallaudet help her? Any there courses to learning english for people like her at NTID or elsewhere? I somehow he feels that she is falling through the cracks in the system where he is not totally deaf but her hard-of-hearing creates learning disabilities which we cannot overcome.

Question from R.A., India. Posted April 30, 2010.

Can she learn English? Yes, however, she will always be very delayed in her English abilities and it is very unlikely that she will develop sufficient English to be successful in a work environment based on her age and description of early language exposure.

From a neurolinguistic development perspective, there is a short critical window of time for deaf children to learn English language and be efficient and age appropriate. This window is approximately from 0 to 6-years-old. Current research indicates that deaf children who learn English after the age of six demonstrate a life long delay in the language. The later English is taught the greater the delay. Her sister’s brain simply does not have the neural networks in the language centers of her brain developed related to English language. At her age, her sister would need to utilize her most native language (if that be sign language) and use any accommodations necessary to support her limited English skills.

In terms of references I would check these out and anything by Dr. Laura Ann Petitto

Kuhl, P. (2004) Early Language Acquisition: Cracking The Speech Code, Nature Reviews/Neuroscience, Vol 5.

Mayberry, R. (2002) Cognitive Development in Deaf Children: The Interface of Language and Perception in Neuropsychology, Handbook of Neuropsychology, 2nd Edition, Vol 8, Part II

McSweeney, M. (2007) Language in The Deaf Brain, Science Interviews, www.thenakedscientists.com

Spencer, P. & Harris, M. (2006) Patterns and Effects of Language Input to Deaf Infants and Toddlers From Deaf and Hearing Mothers, In M. Marshark & P. Spencer (Eds.) Advances in the Sign Language Development of Deaf Children (pp. 71-101).

[Although NTID and Gallaudet do not have any programs that would be helpful, you might want to contact a local speech-language apologist for advice.]

I am doing research on the effects of teaching a deaf child to speak and how it plays into their personal lives and on to the deaf community. As an interpreter I have noticed that my oral clients tend add new signs that are not ASL. I feel like all people should have the choice to be involved in the Deaf and/or hearing community. How do you think speech effects their identity and the identity of the deaf community?

Question from Abigale, Boston. Posted April 12, 2010.

With regard to the creation of new signs and, I suspect, your concern about the use of initialized signs, you might want to take a look at linguistics resources. Contrary to claims, there does not appear to be any negative evidence concerning the use of initialized signs. “Signs that are not ASL” are used by deaf people all the time; that is part of the ongoing evolution of language.

Concerning the relation of speech and identity, a variety of books have been written on the subject, usually by deaf people more invested in being part of the hearing community than the Deaf community. With regard to the evidence base, let me offer two suggestions: Most generally, you might look at Irene Leigh’s new book A Lens on Deaf Identities, Oxford, (2009).  Specifically with regard to children, try Most, T. (2007).  Speech Intelligibility, Loneliness, and Sense of Coherence Among Deaf and Hard-of-Hearing Children in Individual Inclusion and Group Inclusion. Journal of Deaf Studies and Deaf Education, 12, 495-503.

How does a child who is born with a hearing impairment acquire a spoken language during the critical stage of language acquisition?

Question from Safoora M., Johannesburg, South Africa. Posted March 2, 2010.

There is considerable evidence that auditory input and spoken language stimulation for deaf children who are to learn spoken language are important to initiate as early as possible (hence, we often talk about “critical periods” for language development). However, such programs Tust be individualized to the particular child, taking into account their audiological, developmental and family needs.  Dr. Patricia Spencer suggests looking into either the John Tracy Clinic (http://www.jtc.org/services/distance-education/index.html) or Boystown National Research Hospital (http://Cathy.carotta@boystown.org) for distance programs for parents of deaf children.  Dr. Ann Geers also suggests that the AG Bell association (see our Partners page) is an excellent resource for finding helpful professionals in their area, and they have a variety of materials specifically geared to parents. If you are interested in research supporting early spoken language intervention, she suggests looking at chapters in Spencer, P. E. & Marschark, M., Editors (2006). Advances in the spoken language development of deaf and hard-of-hearing children. New York: Oxford University Press.

Dr. Geers also pointed out that “there is ample evidence that the brain is most ‘plastic’ or accepting of new information when the child is young (3 or under) and children who receive auditory stimulation (through a CI or HA) during this time period usually demonstrate normal central auditory maturation within about 6 months of stimulation. Spoken language progress will be affected by additional diagnoses or disorders that can affect learning or communication development independent of hearing loss. Such children can be expected to progress at a slower rate even if stimulation occurs early. Certain nonverbal communication skills (e.g. eye contact, turn taking) are also predictive of spoken language development. Oral motor skills are also considered in the prognosis. Difficulty with oral motor skills like moving the lips, teeth or tongue appropriately will influence a child’s speech production. Taking all of this into account, research has shown that children who are in environments where speech is used and that focus on listening have better speech perception and spoken language outcomes overall.

Dr. Jean-Pierre Gagné emphasized that language does not develop normally nor naturally in most children with hearing loss, so direct/specific intervention programs must be sought. He suggested that (re)habilitation will focus on four or five aspects:

  1. Make sure the child has appropriate amplification and that he/she uses it all the time (including assistive devices such as an FM system when appropriate, for example, if going to a day care centre or preschool program).
  2. The child will need speech-language-pathologist (or other professional) services to help in the development of speech and Language
  3. The parents will need SLP (or other professional) services to learn how to stimulate their child in order to optimize the opportunities to develop speech/language as well as cognitive and social communication skills, beyond the therapy sessions
  4. The child should be provided with as much opportunity to interact with other children (including this with normal hearing) i.e., attend day care center or preschool program.
  5. Parents may want to join a support group for parents who have children with hearing loss (see the John Tracy suggestion, above).