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

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.
Response from J.-P. Gagne, Ann Geers, Patricia Spencer

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).

Can you tell me what the story is on sign-supported English?

Question from Anne H., Oslo Norway. Posted February 18, 2010.

I know, I know, everyone says that sign-supported English (SSE) and simultaneous communication (SimCom) – both involving speech and sign at the same time – are bad. On the theoretical/political side, people point out that neither is truly a language unto itself, and argue that they therefore are “inappropriate.” Empirically, people point to two studies, both done over 20 years ago, which found that several teachers and parents of young deaf children said more than appeared on their hands (by anywhere from 20 to 50%). The sign abilities of those parents and teachers were never examined, however, and some people are extremely good at SSE (or whatever language) and SimCom. Research over the past 30 years has shown that when teachers are highly skilled at SSE or SimCom, students learn just as much or more than with ASL from a teacher, interpreting, or spoken language alone. In our own work, we’ve recently have found the same thing, as deaf college students learned exactly the same amount when they had teachers using SimCom, voice-off ASL, or utilizing interpreters. Importantly, these were skilled teachers of the deaf, who had been using SimCom for many years with classes that included oral students, ASL students, and everything in between. Although it frequently is not discussed (at least in public) many deaf students request teachers to use SimCom and ask interpreters to include “English on the lips.” It seems likely that SimCom would be particularly beneficial for children with cochlear implants, who generally do not receive auditory input as clear as that received by hearing children.

Unfortunately, the unearned stigma associated with SSE/SimCom seems to have prevented anyone from doing the appropriate study. Meanwhile, both are used effectively in many classrooms, even if students use a natural sign language or spoken language in other settings. What is essential is that deaf and hard-of-hearing children have early access to fluent language. That usually is difficult with spoken language alone and most parents are not fluent in sign. So, SimCom/SSE might be helpful in ensuring communication for new-signing parents, but this DOES NOT mean that SimCOM/SSE can replace full access to a natural language (actually, there isn’t research one way or another). The issue clearly is more complex than we can deal with here. For full discussion of what we know and what we don’t know, see Spencer, P.E. & Marschark, M. (in press). Evidence-based practice in educating deaf and hard-of-hearing students. New York: Oxford University Press.

Does not strictly staying with the CASTLLS auditory guide reduce childs progress in closing the language gap?

Question from Peggy H. Posted September 30, 2009.

In the interests of full disclosure, let me note that I had to look up CASTLLS – an acronym for Cottage Acquisition Scales for Listening, Language & Speech (CASLLS). This guide apparentlywas developed by professionals at a private school for deaf children in Texas – Sunshine Cottage. It is a tool for auditory rehabilitation/speech-language professionals, and it follows a developmental approach and it integrates skills from four areas including listening, speech production, language and cognition. As with many commercially available programs, this one is a guide for professionals and as such, we need to keep in mind that each child has unique learning styles, capacities (gifts), and rates of progress. You ask whether diverting from this “guide” can reduce a child’s progress in closing the language gap. There is no definitive answer. One could easily ask the inverse, does strictly staying with the guide increase a child’s progress in closing the language gap? If the answer to that question was YES, I would imagine that this “guide” had magical properties. We know some things about what helps to close “gaps” in learning. First, the sooner we target intervention, the less time there is for a “gap” to become a chasm, thus we can hopefully minimize the size of the gap and begin to close it. We also know that language can and does develop in the absence of audition if there is an alternate way to expose the child to language (sign language). Having said that, if a child is using audition to learn language, there are several requisites that must be in place. The first is that audition skills must be optimized, the technology used must be working properly and consistently. Key elements also include that the child must be able to progress along the basic lines of becoming aware of sound, discriminating one sound from another, identification of sounds, and finally comprehending sounds (words, sentences). IF there is a lack of PROGRESS in this area, I would say learning language given ONLY auditory input will be slower. On this premise, if I were asked the question “if a child does not progress in the auditory skills part of an oral language learning program, will it reduce progress in closing a language gap?” , my answer would be “yes, certain listening skills are requisite in order for oral language skills to develop.

Is there any evidence that providing or exposure to sign language to cochlear implanted children could hinder speech development?

Question from Darlene A. Orange County, CA. Posted August 31, 2009.

Actually, the research is very clear that sign language does not hinder speech development in children with cochlear implants…in fact it may facilitate it. Research from the Nottingham Cochlear Implant Centre has shown that three years after cochlear implantation, deaf children’s spoken language skills are independent of whether they started out signing or utilizing spoken language only. With regard to language after receiving an implant, research has shown that parents and children move toward spoken language after implantation, at least to the extent that it works for the child. When it doesn’t, parents and children (appropriately) move toward sign language. There are a couple of older studies which indicated that deaf children with cochlear implants who were in “oral” settings had better spoken language than others in total communication settings. However, those studies were done back when the children who were received implants were the ones who already were showing particular facility for spoken language, and there is no recent evidence to support that view. In general, sign language can be acquired earlier than spoken language, and may provide a “framework” for early spoken language development. Future research will have to answer that question but, in the meantime, there is no evidence that sign language in any way has negative effects for children or young adults with cochlear implants. With regard to academic achievement, see Marschark, M., Rhoten, C., Fabich, M.  (2007). Effects of cochlear implants on children’s reading and academic achievement. Journal of Deaf Studies and Deaf Education, 12, 269-282, available at www.jdsde.oxfordjournals.org

I have a four year old profound hearing loss son. he is attending special school for the deaf since he was two. since the first day of his school until now, he did not show any improvement in spoken languange while it’s mandatory in his school. He prefers to communicate with sign language in a daily conversation. My husband and I are both working and only have weekends to teach him the spoken language. what should we do so he can improve his spoken language and pay more attention to his teacher?

Question from Claresta, Jakarta Indonesia. Posted August 12, 2009.

Research has shown that it It is difficult to predict how an individual child’s language development will progress.  For SPOKEN language, however, we know some things:

(a) It is easier to learn spoken language if a child has some hearing experience (for example, was born hearing and became deaf later, or uses a cochlear implant.).

(b) Even with hearing experience, it takes a large amount of experience with spoken language in conversations, plus regular speech-training sessions, for a child with a profound hearing loss to learn spoken language

(c) Knowing signs can actually help your child learn spoken language IF he also gets enough hearing experience, too.  It is important that parents know and use signs at home with the child so he has a strong basis for learning the meaning of each sign and can learn about the things that happen at home and in the world around him.  Many children find it easier to learn a spoken word for something after they already know a sign for it.

(d) Although there is no promise that your son can learn to speak clearly, he CAN learn language in sign language.  This will allow him to communicate with other people and learn what other children learn. With specialized teaching at school, he can use sign language to help him learn to read and write, and this is the most important skill he will need to get more education and get a good job later.

I know your time with your son is limited.  I do not know whether he is at home in the evenings during the week or only on weekends.  But every day that he is with you, there is something you can do to help his language and his education.  You can read small and easy children’s books with him.  Learn the signs to use for the words in the books, and when you are reading with the signs give him time to look at you or your hands and then at the book’s pictures.  Don’t try to sign all the words right now, but sign the important things.  Sign what he chooses to look at on each page, and let him turn the pages sometimes.  Don’t try to do this for long periods of time, just short times.  After he becomes interested, you can start speaking the words either while or after you sign them. Maybe your son’s teachers will help you learn the signs for the pictures in books if you need some help with that.  There are also free online sites you can use to learn some signs.

If your son’s teacher is complaining that he doesn’t pay attention in school, perhaps you can carefully observe at home when he pays attention and when he does not.  Then you can tell the teacher what kinds of things help his attention.  You can look at an article on http://clerccenter2.gallaudet.edu/KidsWorldDeafNEt/e-docs/visual-conversations/appendix.html to get some ideas about how to help get his attention.  If he learns more sign language, he will probably pay attention better.  But if he never seems to pay attention, you might want to see a doctor or get some additional testing to see if there are other ways to help him.

There are various theories about a “window of opportunity for language learning” for children with hearing loss. What proof do we have that this window exists? If it does exist, does a window for the deaf child using a spoken language methodology have the same parameters as a deaf child using a sign language methodology? Can significant language learning occur after the typical window of opportunity has closed (i.e. after 5 years of age)?

Question from Ruth M. Denver, Colorado. Posted June 29, 2009.

In the Philadelphia airport, an English-speaking passenger told me that she gave up hope of teaching her six year old Spanish because someone had told her it was too late after 24 months.  What exactly was too late?  Learning to pronounce Spanish sounds like a native? Learning any Spanish at all?  Language is a highly complex and multi-faceted system, and there are many languages in the world.  When researchers ask if there is a particular age by which language can be learned or not, they typically measure one aspect of one language and then make generalizations.  Although hearing children learn much language by age 5, they learn the bulk of their adult vocabulary at older ages in school and do not master some complex grammatical structures until after the age of five.

Linguistically, we can describe language as being made up of a vast vocabulary, syntactic and morphological rules, and a phonological, or sub-lexical unit, system.  Communicatively, we express language through multiple modes: face-to-face comprehension and self-expression, accompanying gesture, and reading and writing.  It is important to consider this complexity because there are several hypotheses as to what specific aspect of language may be sensitive age of learning.  For example, the ability to pronounce a foreign or second language without an accent appears to depend on the age of language learning, although there are exceptions.  However, the adult ability to use and comprehend a second language depends more on the linguistic overlap between of the first and the second languages and how many years of education are done in the second language than age of learning alone.

What about learning a first language?  From retrospective studies where we measure the language skills of adults in relation to their early linguistic experiences, we know that children need to learn language in early life, any language, regardless of whether it is signed or spoken.  Adults who learned little spoken language during early childhood and then learned sign language at older ages show long-lasting deficits in their ability to comprehend any language, which is linked to lower reading levels and associated with specific cognitive deficits.  Moreover, not learning language in early childhood affects how the brain processes language in adulthood.

There seems to be a gradual decline in the ability to learn language efficiently, rather than an abrupt cutoff, for spoken and signed languages. How much language can be learned after early childhood appears to depend upon how much language was successfully learned in early childhood, regardless of whether it was signed or spoken.  In other words, language learning is cumulative and reciprocal across the languages that a person knows.  The more language a child knows, the easier and quicker he or she can learn additional language and skills, and other languages as well.

Learning a language at an early age is important, but it needs to be functional.  A child with hearing loss may be able to pronounce many speech sounds beautifully but still be in linguistic jeopardy.  Likewise, a child may produce signs in rapid succession but be at risk for comprehension problems.  The question is whether the child understands what is said or signed to him or her at an age appropriate level.  Can the child make himself specifically understood?  All children learn language, signed or spoken, by having lots of daily conversations with other children and adults.  So a child may begin to learn spoken or signed language at an early age, but if the child is not making real progress, this means that the child is not receiving enough linguistic input for language learning.  Children who do not make progress learning a spoken language nearly always learn to sign later.  Although they can produce sign, they often have marked comprehension problems.  How severe these comprehension problems are depends upon how much or little language they acquired at a young age (Mayberry, in press). For more information, see Mayberry, R. I. (in press). Early language acquisition and adult language ability:  What sign language reveals about the critical period for language. In M. Marschark & P. Spencer (Eds.), Oxford handbook of deaf studies, language, and education (Vol. 2). New York: Oxford University Press. and  Mayberry, R. I., Lock, E., & Kazmi, H. (2002). Linguistic ability and early language exposure. Nature, 417, 38.

I have a son aged 17 yrs. He had cochlear implanted at the age of 12 yrs. Previously, he attended a school school, but now he is at home. He spent two years taking a computer design course. He did okay, but not as well as he could, because he is unable to understand the language of the classroom. Now, he is not cooperating with us to improve his language, speech, hearing, or listening skills. Our city does not have much support for someone like him. Can you guide me how I can improve my child memory, listening capacity, language and speech. Perhaps you could suggest some tools like books, cds, dvd or online courses.

Question from V. Udaipur, India. Posted June 25, 2009.

This is really too large a question for us to answer fully here, but we do have some suggestions:

Bionics offers the Listening Room with various levels for listening practice: www.hearingjourney.com/listening_room/index.cfm?langid=1

Randall’s ESL Cyber Lab offers listening practice for all levels and games: www.esl-lab.com/

Many students with CIs like listening to music and tracking lyrics. www.lyrics.com has many of the words to songs.

For listening and language enrichment our students also use www.manythings.org/ and http://dailyesl.com/.

Our students like using the online dictionary dictionary.reference.com/ for looking up definitions and listening to the pronunciation of the word (there’s an icon that you can click and listen to the word). The site also offers lots of synonyms and antonyms for each word. For more English, here’s another language website that might be helpful with online exercises and software one can purchase http://learn-englishtoday.com/.

In terms of speech (i.e. articulation, pronunciation), there are software and computer programs, but he would need an audiologist to assess his levels and then a speech-language pathologist guide him through some appropriate instruction and practice. Those professionals also might be able to motivate him more than his parents (we know how teenagers are!).

The ASL specialist at my school insists that research has shown SimCom [simultaneous communication – use of speech and sign together] to be harmful to deaf children’s language and educational growth. True or false?

Question from Name withheld. Posted June 2, 2009.

From Marc: This is a common myth in the field, but one without any evidence to support it. We do know from a couple of early studies in the 1970s that parents and teachers who are not skilled in using speech and sign together say much more than they sign. This would suggest that at least in the hands of novices, simultaneous communication would not provide optimal access to language (although there does not appear to be any published evidence indicating that it either hurts or helps language development). In the educational domain, in contrast, there is abundant evidence that students from middle school through university learn just as much from teachers who are skilled in using simultaneous communication as they do from teachers using ASL. Surprisingly, recent evidence also indicates that high school and college students can learn just as much from text as they do from deaf or hearing teachers using natural sign languages (e.g., ASL or Auslan – Australian Sign Language). This is not one to say that there is anything wrong with using natural sign languages in the classroom, just that language development and learning involves more than just using one mode of communication or another. For more information see Marschark, M. & Wauters, L. (2008). Language comprehension and learning by deaf students. In M. Marschark & P. C. Hauser (Eds.), Deaf cognition: Foundations and outcomes (pp. 309-350). New York: Oxford University Press. (Marc Marschark)

From Barbara: It is difficult to see change coming and fear it won’t be for the better. There are some things you can do that may influence the outcome. First, make sure you have the correct information. Contact the school superintendent or a member of the school board, or someone who is in a position to know what is going on. Confirm whether or not what you heard is true. Share this information with other parents of deaf and hard of hearing children and community members. Meet with the officials who will be making this decision to let them know your views. Usually when proposals like this are put forward there are public meetings. Attend these meetings with other parents and speak up. Write letters.

While the main concern you expressed is about social interactions, there are other issues you may want to raise. You could consider:

  • Given the fact that the program is strong and stable where it is, it would be a mistake to dismantle it and try to reestablish it with new staff in a new environment. The program was in place for (number of) years, and it grew and matured over that time. The services are highquality, and maintaining them on the existing campus – rather than starting up new services on a different campus – will use resources more efficiently. Much would be lost by trying to start it again in a new place. “If it’s not broke, don’t fix it.”
  • Transportation time could be an issue. If students are now attending school near their homes but are transferred across the city, the amount of time they spend traveling to and from school could be excessive. Many districts and states have policies limiting the amount of time a child can spend on the bus, so you may want to explore this.

Of course, there is the Individualized Education Program (IEP) as well. The services listed on the children’s IEPs must be provided. IDEA requires that the IEP Team consider the language and communication needs of the child, including opportunities for direct communication with peers and professional personnel in the child’s language and communication mode. Wisconsin uses a document called a communication plan to ensure that deaf and hard of hearing children’s language and communication needs are addressed in the development of the IEP. You can emphasize the opportunities that exist at the current school and the difficulty of ensuring that these opportunities will exist at the new school. So this is not “just” a social issue, it is an issue of language development and the need for these children to develop and maintain age-appropriate language for them to be able to access the general education curriculum and succeed in school. For more information about IDEA requirements, go to www.deafchildren.org, click on Resources, click on Individuals with Disabilities Education Act.

During your communications with decision makers of course you should be polite and civil. Offer to work with them to find the best solution for all. Thank them for meeting with you and considering your concerns. Stay in touch with them until the matter is resolved. (Barbara Raimondo, Esq.)