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.

Alternative Communication Systems

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.
Response from Jacqueline Leybaert - Université libre de Bruxelles

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’ve seen and heard Marc Marschark say repeatedly that there is no evidence showing Cued Speech supports reading skills. He also writes “.In its more than 60 years of existence, it has never been found to facilitate the acquisition of reading skills by deaf children who are learning English.”

My question is has anyone ever bothered to do a proper unbiased research study on using cued speech with D/HH students to learn literacy?

Question from C.T., Washington. Posted December 27, 2013.

You’re almost correct. What he says is that there is no evidence to support cued speech facilitating the acquisition of literacy skills in deaf or hard-of-hearing children learning English. He readily acknowledges that there is a wealth of supportive evidence from children learning French. The difference appears to be that French (and Spanish and Italian) have very regular sound-to-spelling correspondence whereas English does not (see Alegria & Lechat, 2005).

Even if he can’t do the math (cued speech was developed in 1965-1966), Marschark explains that if, after more than 40 years,  there are no published studies supporting cued speech for English, the alternatives are that either (a) the research has not been done or (b) there has not been positive evidence. In fact, there has been a number of studies conducted aimed at supporting cued speech for deaf children in the United States, but apparently none have yielded sufficiently positive results and been “unbiased” enough to have been published in a peer-reviewed journal.

Cued English clearly facilitates speech reception and may support literacy subskills for some deaf or hard-of-hearing children, but English is simply too irregular for it to be of benefit more generally.

Recommended reading:  Alegria, J., & Lechat, J. (2005).  Phonological processing in deaf children: When lipreading and cues are incongruent.  Journal of Deaf Studies and Deaf Education, 10, 122-133.

Which reading curriculum(la) do you recommend using with deaf/hh students? Do you support using cued speech with English speaking deaf/hh students?

Question from D.D., Arkansas. Posted December 9, 2013.

Thank you for providing the opportunity to remind visitors that this site tries to provide people with evidence-based information about raising and educating deaf children. Only in rare circumstances does the site offer opinions or preferences, and then we ensure that the person writing the response is clear about that.

I do not recommend any particular reading curriculum for deaf and hard-of-hearing students. I know of different schools and programsusing different curricula, and I’m not aware of any evidence that suggests that one is any better than the other. The issue is the extent to which the curriculum is appropriate for the student and matches their strengths and needs (and is delivered in a corresponding manner).

With regard to cued speech, I used to be a stronger proponent than I am now. Cued speech clearly supports the reception of spoken language by deaf and hard-of-hearing individuals. I infer, however, that your question relates to reading. There has never been any evidence that cued speech supports deaf children learning to read English.  The evidence demonstrating cued speech to support reading subskills comes from work involving French or Spanish, which are far more regular in their sound-to-spelling correspondence. Clearly, cued speech has its proponents, and some children succeed well with it. But the evidence for supporting the the reading of English is lacking, and has been for the more than 40 years since cued speech was created.

What is the difference between American Sign Language and Signed English? Is there another name that people refer to Signed English? Is it preferable to teach kids Signed English?

Question from S.T, Kentucky. Posted October 31, 2013.

Sign (or signed) languages are not universal languages, nor are they invented ones. They are, like spoken languages, natural languages, grown and transmitted in communities of language users. In the case of sign languages, the cores of these communities are deaf people and their deaf or hearing relatives. Languages constitute one of the most important characteristics of the cultural and psychological identities of various peoples. This process of cultural identification explains why deaf people in the United States use American Sign Language (ASL), deaf people in France use French Sign Language (la Language des Signes Francais), and deaf people in the Netherlands use Sign Language of the Netherlands (Nederlandse Gebarentaal). The structure of sign languages resembles that of spoken languages with their own vocabulary, phonology (albeit in manual form), morphology, syntax, and pragmatics; so ASL is not a form of English.

There are also systems that combine speech and sign according to different rules, and Signed English is one of these (as are Signed Dutch and Signed Polish). These systems differ in the extent to which they represent the lexical and grammatical properties of the spoken language in the sign channel. Some systems are strict, designed to represent the elements of a spoken language 100% in manual components. They manually encode English or Dutch fully, or at least that is the intention.

There are claims that deaf children will learn to read better if they learn a manually-coded form of the spoken/written language (like English), but there is little evidence to support that claim. Although systems like Signed English have the advantage of being more English-like, they do not “hold together” structurally the way natural languages like ASL do. Different children will find different modes of communication easier to master, and one could probably argue either way. ASL is a true language and at the heart of the Deaf community, however, while Signed English is an artificial sign system intended as an educational tool and is not often used in conversation.

Recommended Reading:

Holcomb, T. K. (2013). An introduction to American deaf culture. New York: Oxford University Press.

Marschark, M. (2007). Raising and educating a deaf child, Second edition. New York: Oxford University Press.

Is research on Cued Speech being taken into account when evaluating and recommending a communication mode that promotes literacy in deaf children?

Question from R.M., Colorado. Posted October 13, 2013.

The wording of your question makes it a difficult, or perhaps sensitive one to answer (especially for someone who has been an advocate of cued speech). For those know unfamiliar with it, cued speech involves the use of handshapes and locations around the mouth to distinguish speech sounds that look the same. It thus supports the visual perception of speech (i.e., speechreading or lipreading). A recent study involving a large nationally-representative sample of deaf high school students indicated that over 50% of their parents thought they were using cued speech in school. The true figure is less than 5%, suggesting that many parents (and perhaps students themselves) are not familiar with the terminology used in educating deaf students.

Because you are writing from the United States an honest answer to your question would be “if research on cued speech is taken into account when evaluating and recommending a communication mode that promotes literacy in deaf children, it should not be used.” Cued speech has been shown to support the acquisition of reading-related subskills, when used both at school and at home, among deaf children who are learning French and Spanish as their first language. In its more than 60 years of existence, it has never been found to facilitate the acquisition of reading skills by deaf children who are learning English. According to Leybaert, Aparicio,  and Alegria (2011), well-respected proponents of cued speech, this likely is because relative to French and Spanish, the sound-to-spelling correspondences of English are highly irregular.

Recommended reading: Leybaert, J., Aparicio, M., & Alegria, J. (2011). The role of cued speech and language development of deaf children. In M. Marschark and P. Spencer (Eds.) The The Oxford handbook of deaf studies, language, and education, volume 1, 2nd edition (pp. 276-289). New York: Oxford University Press.

Are there assessment tools to help determine what type of sign language modality would be most effective for an 8 year old child? Are there assessments that measure the effectiveness of various sign language modalities? Are there resources that describe and illustrate (video tapes) the different sign language modalities (ASL, SSE, Conceptually Accurate Sign Language, etc.)?

Question from J.G., Illinois. Posted March 16, 2012.

We carry out specialized individual assessments of deaf children’s signing skills at City University London’s Compass Centre (http://www.city.ac.uk/health/public-clinics/compass-centre). Our assessment team includes deaf native signers and hearing staff who are fluent signers. When considering the best modality for a child, we compare their sign language abilities with their spoken language and, if applicable, their sign-supported communication. With 8 year olds we can assess their BSL comprehension and production skills using standardized tests (Herman et al 1999 http://www.forestbooks.com/products/pages/search.php and Herman et al 2004 http://www.city.ac.uk/health/public-clinics/compass-centre/sign-language-assessment-clinic/assessing-bsl-development-production-test). There are similar tests available for other sign languages (see Haug’s website http://www.signlang-assessment.info/index.php/sign-language-acquisition.html). We do not know of any similar assessment tools for SSE. The final decision about the best modality takes account of test results alongside careful consideration of the child’s communication environment. This includes observation of their everyday communication with native signers, communication at school and at within the family and discussion at the assessment appointment about how they communicate with deaf and hearing people in general. In this way, we try to determine the best communication approach for a particular child. We do not know of any assessment tools for SSE but there are also assessment tools for speech reading in children of this age available: http://www2.cmp.uea.ac.uk/~bjt/avsp2009/proc/papers/paper-36.pdf

References (for BSL)

Herman, R., Holmes, S., & Woll, B. (1999). Assessing British Sign Language Development: Receptive Skills Test.  Forest Bookshop.  Gloucestershire, UK.

Herman, R., Grove, N., Holmes, S., Morgan, G., Sutherland, H. & Woll, B. (2004). Assessing BSL Development: Production Test (Narrative Skills).  City University Press.

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.

I hear that research is showing that deaf children who use Cued Speech as are achieving literacy rates similar to those of their hearing peers. Also, I am reading that there is Brain research to support that cueing children are processing language in a manner that allows them to have access to the phonological awareness ( which is essential reading and literacy) in the same manner as hearing children.) I’d like to find more information on this subject. any idea?

Question from S. K.. Posted June 25, 2009.

You might look at the earlier response to Ginny R. about cued speech and literacy. I cannot find any research relating to cued speech and brain activity, but there is research by Jacqueline Leybaert and her colleagues in Belgium indicating that cued speech (when used at both school and at home) facilitates phonological/phonemic awareness and other literacy subskills for children learning French. Leybaert previously had found that some deaf children develop phonological (sound-related) codes by combining information from lipreading, residual hearing, printed, fingerspelling, and feedback from their own speech. This is similar to the way that many blind people develop visual images for things they have never seen by combining information from several sources. Unfortunately, we do not yet know how to predict which deaf children will develop such codes and which will not. Meanwhile, cued speech has not been shown to facilitate the development of literacy skills for English, and there appears to be very little research going on in this domain, perhaps because of the increasing popularity of cochlear implants.

My son has a bilateral, severe hearing loss and will be entering the third grade. His second grade teacher suggested that cued speech might help with his reading, which is really hard for him. She says cued speech easy to learn, but it sounds too good to be true. Is it?

Question from Ginny R. Littleton, NC. Posted June 19, 2009.

It has been estimated that only about 20% of English is fully visible on the lips (which is what makes lip reading or “speech reading” so difficult). Cued speech is a system of hand shapes and positions intended to make mouth movements unambiguous, for example, by adding different cues to “b,” “m,” and “p.”  (Note, these are not signs!) Cueing clearly helps with speech reception although, interestingly, most cued speech kids I have encountered do not cue themselves (that is, they do not use it when they speak). There is a wealth of evidence from the French-speaking part of Belgium, and a little from Spain, indicating that when cued speech is used both at school and at home, it significantly improves reading in deaf children. However, despite 40 years of trying, no one has ever shown it to help reading for children who are learning English. The folks in Belgium have suggested that this is because French (and Spanish and Italian) are very regular in their sound-to-spelling correspondences, while English is one of the most irregular languages. Add that to the fact that English has well over five times as many words as French, and the situation is not so surprising. Unfortunately, people hear about the French results and assume  they apply to English.  For more information on cued speech, language, and literacy, see the review by Jacqueline Leybaert and Jesus and Alegria in the Oxford Handbook of Deaf Studies, Language, and Education Oxford University Press, 2003, edited by M. Marschark & P.E. Spencer).

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.)