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Positivist

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Abstract

Several studies have reported poor executive function (EF) development in deaf children with subsequent impacts on their social and academic attainment. This paper describes the results of a music-based EF intervention designed for deaf children and carried out in two sets of primary schools. This is the first classroom-based EF training study with deaf children, and it also incorporates a replication phase. The intervention was a within-subject crossover design, with 29 deaf children aged 7-11 years who participated in both an EF and an art class control activity, each lasting 10 hours over 5 weeks. Non-verbal EF skills were assessed at pre-test, the crossover point, and post-test. Findings indicated that the EF intervention led to an improvement in participants' working memory and inhibitory skills in comparison with their performance on the same tasks after the control activity. The findings were not uniform for all EFs targeted nor for all cognitive ability levels in the sample. We discuss the implications of our findings for deaf children with different ability levels and for how EF interventions can be further improved.

Executive functions (EF) are a complex set of cognitive abilities, which enable us to coordinate mental processes, manipulate information, solve novel problems, sequence information, and generate new strategies to accomplish goals in a flexible way ( Diamond, 2012; Henry, Messer, & Nash, 2012; Miyake & Friedman, 2012). In addition to storing information in short-term memory, children need to be able to process information flexibly, inhibit non-useful responses, and manage the input in order to achieve success on higher-level cognitive tasks. Much EF research focuses on three core areas: inhibition; flexibility and working memory which some suggest underpin other more complex EFs such as planning and cognitive fluency ( Friedman & Miyake, 2017).

Deaf children, like some other groups (e.g., Autism: Demetriou et al., 2018; language impairment: Henry et al., 2012), are at risk of delayed development of EF, particularly in working memory and inhibition ( Beer, Kronenberger, & Pisoni, 2011; Burkholder & Pisoni, 2003; Figueras, Edwards, & Langdon, 2008; Hintermair, 2013). There is still debate as to whether this delay is a direct result of deafness, or due to other factors affecting cognitive development, especially a delay in language development ( Botting et al., 2017; Figueras et al., 2008; Hall, Eigsti, Bortfeld, & Lillo-Martin, 2016; Jones et al., 2020; Kronenberger & Pisoni, 2020; Morgan & Dye, 2020; Pisoni & Cleary, 2003).

The fact that early experiences can lead to differential outcomes in EF skills suggests that development is sensitive to environmental factors. Consequently, research attention has focused on how to enhance EF skills in different populations, including via computerized training ( Klingberg et al., 2005), aerobic exercise ( Hillman, Erickson, & Kramer, 2008), martial arts and mindfulness ( Flook et al., 2010), and classroom curricula such as Montessori ( Lillard et al., 2017) and tools of the Mind ( Bodrova & Leong, 2007). These diverse activities have been found to have a positive impact on children and adults' EF skills with varying levels of effect size.

Music programs have been studied with a view to them potentially enhancing EF ( Bowmer, Mason, Knight, & Welch, 2018; Habibi, Damasio, Ilari, Elliott Sachs, & Damasio, 2018; Moreno et al., 2011; Williams, 2018). Correlational and intervention studies of hearing children undergoing music training consistently show that they perform better in fine-motor skill, rhythm perception, and auditory discrimination ( Besson, Schön, Moreno, Santos, & Magne, 2007; Costa-Giomi, 2005; Slater et al., 2015). The playing of music is highly complex and includes repetition and practice, and strong motivational and emotional rewards ( Diamond, 2012). A review by Benz, Sellaro, Hommel, and Colzato (2016) reports that musical training can lead to far-transfer effects in domains such as verbal intelligence and EF. In a recent meta-analysis of music training studies, Sala and Gobet (2017) found a moderate improvement in children's memory skills and a small overall improvement in other cognitive domains. Sala and Gobet (2017) highlighted the lack of active controls in past studies as a limitation in determining the true impact of music training. In many schools, music activities with deaf children are popular, especially activities, which include percussion instruments and musical games involving motor skills and rhythm perception.

In sum, deaf children are at risk of delayed EF development, but music-based training could be a way to intervene to improve their EF skills. Music-based training also fits easily into a school day and is an attractive option for many children. The current study evaluated the effectiveness of a music-based EF intervention for deaf children and addressed the following research questions:

1. Does the intervention have a positive effect on deaf children's EF skills?

2. Are some areas of EF more "trainable" than others?

In order to test the reliability of the intervention, it was used with different groups of children in two studies. This part of the research asked:

Can the intervention be replicated in different samples?

We refer to the first instance we ran the music intervention as study 1 and the second occasion as study 2. We first outline the intervention design used across both studies and the tasks used to assess changes in EF, and then describe the participants and results for each study in turn. Then, we discuss both sets of results together in the discussion section.

Method

Both studies had a within-subjects crossover design, with all participants taking part in both a music-based EF intervention and an art class active control condition. Both conditions consisted of hour-long sessions, twice a week for five weeks (i.e., 10 hours in total for each condition). All sessions were led by an experimenter (the first author), supported by a teaching assistant in each of the schools.

Intervention Design

For both studies, school-aged children between the ages of 7 and 11 years were recruited and the intervention was designed to be appropriate for this age range. Everyday music activities with deaf school children formed the basis of the intervention, and these were largely rhythm and repetition exercises using percussion instruments. Advice and feedback was given by both deaf and hearing professionals, including two specialist music instructors for deaf children, two teachers of the deaf (TODs), a primary school music teacher, and a special educational needs co-ordinator who was familiar with the use of EF activities with primary school children. See Supplementary data, Supplementary material 1 for more information on EF activities.

Differentiation and Flexibility within the Intervention

An essential feature of EF interventions is that they should be consistently challenging but not beyond the developmental ability of the child ( Diamond, 2012). We did not exclude any children in the study based on intellectual disability. Two broad cognitive ability groupings were made in consultation with teachers. Teachers considered the academic, language, and social abilities of the children in their classrooms and the demands of the intervention. The two-group memberships were corroborated by parents who completed the Behaviour Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000). This is an 86-item questionnaire, which provides detailed information about eight different aspects of children's EF, arranged into individual scales. Parents are presented with sentences about the child's behavior such as " Tries the same approach to a problem over and over even when it does not work " and is asked to respond by circling N (never), S (sometimes) or O (often). The questions are designed to address children's ability to initiate behavior, inhibit undesirable responses, demonstrate emotional control, shift attention, monitor progress, plan, and organize themselves and their possessions and use working memory.

Raw scores for the first three scales, (inhibition, shifting, and emotional control) are summed to produce a composite called the "Behavioral Regulation Index (BRI)". Initiation, working memory, planning, and organization, and monitoring scores are combined to produce a "Metacognition Index (MI)". The combination of BRI and MI composites provides a "Global Executive Composite (GEC)" for each child. The GEC is an overall summary measure comprising all eight clinical scales mentioned, and is expressed as a T-score. A higher T-score is indicative of having difficulties with EF, with T-scores from 60 to 64 considered to be mildly elevated, and T-scores from 65 to 69 considered potentially clinically elevated. T-scores at or above 70 are considered clinically elevated. GEC T-scores for participants are shown in Table 2.

No children who had been placed in the higher cognitive ability group had any specific EF difficulties reported by their parents. Therefore, low and high cognitive ability versions of each of the activities were developed and thus tailored to children's needs. See Supplementary data, Supplementary material 2 for differentiated lesson plans.

Control Activity Design

The control activity was carefully designed to ensure it involved the same amount of time and adult contact as the EF intervention, but did not specifically focus on or include EF-loaded activities. Previous studies have established art as an appropriate control comparison to music and have not found any EF advantage from these activities ( Moreno et al., 2011). To ensure continuity across the art sessions, the theme "the seasons of the year" was chosen. See Supplementary data, Supplementary material 3. This provided two sessions on each season, an additional session where the children produced a rainbow collage and another where they made a themed folder to contain their artwork. There was no need for differentiation for the control activity as teachers judged all sessions were accessible to children of every level of ability; however, each activity needed to be engaging for children between the ages of 7-11 years. The overall design is illustrated in Figure 1.

Study 1

Participants

Three schools in England were approached to take part in the intervention. Teachers identified 16 children between the ages of 7-11 years including 5 with additional special needs. The mean age of the participants was 9 years 3 months (SD = 1.17). This is a small but representative sample as it included children of different ability levels and special education needs. We were limited by the availability of children who could commit to several weeks of testing and training. As described previously, the children were divided into groups according to cognitive ability (see Table 1), with seven children in a lower cognitive ability group and nine in a higher group. All three schools were mainstream schools with specialist provision for small numbers of deaf children. Schools A and C have total communication policies with British Sign Language (BSL), Sign Supported English (SSE), and Spoken English being used. The children spend their mornings in the specialist center with a TOD teaching them the core subjects english, literacy and maths, where they receive additional support from deaf and hearing learning support assistants (LSAs). In the afternoons, they attend mainstream classes supported by LSAs and TODs who use both SSE and BSL. The deaf children at School B participate in all mainstream classes and activities. The children are educated orally, however some sign language is occasionally used. A deaf tutor visits the deaf children once a week, providing lessons in sign language and deaf culture.

Due to the wide variation in language levels, preferred method of communication, and educational experiences of deaf children, matching participants with appropriate control participants is extremely difficult. A within-subjects design whereby each child took part in both the music intervention and art (control) sessions was adopted, enabling each child to act as their own control in a crossover design.

In order to fit into the local dynamics of the schools we worked with, there were different patterns of how the intervention and control sessions were run. School B children began with the music intervention for five weeks and concluded with five weeks of art control sessions. At schools A and C, both group sessions were run concurrently. Table 2 also indicates whether children participated in the control condition first, followed by the intervention (C-I), or completed the intervention activities before taking part in the control condition (I-C). As it was necessary for the experimenter to become familiar with individual children's communication preferences and to build relationships with them, for this study, all children in the lower ability groups took part in the art control sessions first, followed by the music intervention, and all of the children in the higher ability groups completed the music intervention first, before switching to the art sessions.

Executive Function Assessments

Children completed the following six non-verbal EF tasks at baseline, post-intervention, and post-control testing times. Testing took approximately one hour, split into four sessions each lasting 15-20mins.

Spatial span task

The spatial span task is a measure of visuospatial working memory. Children are presented with an array of 10 blue blocks mounted on a platform in an irregular pattern. They are instructed to tap the blocks in the same order as the experimenter (who is able to see numbers on each of the blocks to aid in the administration of the test). Testing begins with two block strings (with two trials at each level), then increases up to nine block strings, or until the child makes errors in both trials of a particular level. The child's score consists of the number of correct trials achieved before the task ends or is discontinued.

A second "backwards" condition requires the children to tap the blocks in the reverse order to the examiner (starting with the last block that the examiner tapped) and is scored in the same manner as the "forward" condition. The task begins with two practice trials in both the forward and backward conditions to ensure that the child understands the task. One point is awarded for each trial correctly repeated ( Wechsler & Naglieri, 2006).

Odd one out task

The odd one out task is a test of executive-loaded visuospatial working memory. Children are presented with three shapes on a power point slide. Two of the shapes are identical, one of them different. Children are asked "which shape is the odd one out?" and to point to the different shape. The following slide has a grid with three empty boxes, and the child is asked to point to the location of the previously identified "odd one out" shape.

Complexity is increased after four trials, when children are asked to recall the position of the missing shapes after being presented with two pairs of stimuli on teach trial. After four more trials, complexity increases again to three stimuli to recall, and continues up to a maximum of six stimuli per trial. The test is stopped when children make an error on two (or more) trials in a set. Prior to the start of the test, two practice trials are administered to help the child to understand the task procedure: a single-item and a two-item trial. Correct responses to the practice items are revealed to the child if they do not initially answer correctly. During the test, children are dissuaded from verbalizing to help them remember the location of the shapes (for example, by repeating the location to themselves "right, middle, right," etc.) and are not allowed to use their hands to mark the location and thus aid their recall ( Henry, 2001).

Sun apple task

Tower of London task

The Tower of London task was administered on a laptop using Psychology Experiment Building Language (PEBL) Test Battery Software ( Mueller & Piper, 2014). This assessment is a traditional problem-solving and planning task, which tests the child's ability to make and follow plans. It is a task that is regularly included in EF test batteries ( Shallice, 1982).

Children are presented with two sets of colored discs, arranged across three columns. The experimenter says to the child- "Look at the discs with different colors. These discs here [pointing to the top array] belong to the computer. You cannot move them. These discs here [pointing to the lower array] belong to you. You need to make your discs look the same as the computer's." To ensure the child understands how to complete the task, the experimenter assists the child with the first trial (which is subsequently excluded from data analysis). The experimenter tells the child to "click on the red disc" and then shows them where to put it. "Can you see, that is the same as the computer's? Now, can you make the rest the same by yourself? Try to use as few moves as possible and do it as fast as you can". If the child struggles on the first trial, the experimenter is able to assist them and give prompts until they complete the trial. On all subsequent trials, no assistance is given other than encouraging prompts (e.g., "You are nearly there") to encourage the children to keep going. There are eight trials, and achievement is measured by time taken to complete the task, the number of moves taken to complete each trial, and the number of extra moves (i.e., moves made on top of the minimum possible) taken to complete each trial ( Shallice, 1982).

Color trails task

As a measure of cognitive flexibility, children were given the color trails task. This is a paper and pencil task consisting of two parts. The first task requires the children to connect 15 numbered circles of alternate yellow and pink colors whilst the experimenter times them. This provides a baseline time of the children's performance on the task. In the second part of the test, they are presented with 30 circles numbered 1-15, 15 of which are yellow and fifteen pink. They are instructed to start on the yellow color and then "connect it to the next number which is a different color". This requires them to remember the rule of switching between colors as they connect circles, and to ignore the distractor circles. The experimenter was careful not to use the words "pink" or "yellow" when giving instructions in accordance with the task protocol. The children are timed on this task, and any color or number errors they make are noted on their score sheet to be included in later analysis. The child's score on the task consists of the time taken to complete each task, and an interference score is calculated by taking their time to complete the second task from their baseline time on the first task ( Llorente, Williams, Satz, & D'Elia, 2003).

The design fluency task, taken from the NEPSY-II battery ( Korkman et al., 2007), is a pen and paper task designed to measure planning, flexibility and self-monitoring skills. The design fluency task has two conditions. In the first condition children are presented with an array of dots set out in a square structure and are told that they need to create different designs by joining the dots. The experimenter demonstrates the task, emphasizing that they can join as many or as few dots as they please (although it has to be at least two) and that every design they create needs to be different. The experimenter demonstrates two example designs on a practice sheet, and then asks the child to create two more different designs. At this stage, if the child replicates a previous design, they are reminded that every design needs to be different. The child is then presented with an array of 35 boxes of dots, and told to "draw as many designs as you can, until I tell you to stop". The experimenter times the child and instructs them to stop after 1 minute. The child's score on this task is the number of unique and accurately drawn designs they produce in 1 minute.

Results

In order to reduce any potential experimenter effects, such as scoring bias, data scoring and analysis began only once data collection had been completed. Scorers were not blind to which participants were in which condition. Children's average scores on each of the tasks according to ability group are shown in Table 2.

The results for each task are reported as changes in children's performance on the task at different testing time points. This was calculated from pre- and post-music intervention test scores and pre- and post-art control test scores ( Table 3). Comparisons are then made between these two change scores, using a repeated measures t-test ( Table 4). Differences in the number of participants on some tasks are due to children not completing the tasks at all three timepoints because of school absences.

Results demonstrate that children's scores on the visuospatial span task, odd one out, number of moves on the Tower of London task, and design fluency improved significantly after the music intervention, but not their accuracy scores on the Tower of London, color trails or sun apple tasks. (Note that in the case of the number of moves in the Tower of London task, a lower score indicates fewer moves and therefore a better performance). The art intervention caused no significant changes in score for any of the EF tasks except for the amount of time taken in the Tower of London task. When the change scores for the music and art intervention were directly compared, change scores were significantly higher for the visuospatial span task, odd one out, and design fluency.

Study 2

Study 2 was carried out to investigate whether the results of study 1 could be replicated in a different set of children, as well as increasing the numbers of participants in the overall intervention. We also wanted to remove the confound between cognitive level and amount of practice on the EF tasks that was present in study 1 (where the lower ability children were all tested in the order control-intervention and therefore had had more practice with the tasks at the post-intervention measurement point compared to the high-ability children, who were all tested in the order intervention-control and who had therefore had less practice with the tasks at the post-intervention measurement point). After considering the results for study 1 and feedback from teachers concerning the time taken to complete the assessments, fewer EF assessments were used in study 2 to reduce time testing while still covering all areas of EF. This reduced the testing time from 60 to 40 minutes. The three main areas of EF (working memory, inhibition and cognitive flexibility) were tested in the spatial span task (visuospatial working memory), the odd one out task (executive-loaded visuospatial working memory), a Simon task (inhibition), and the color trails task (cognitive flexibility).

Participants

Participants were recruited from two primary schools in England. Both schools are mainstream schools with specialist provision for deaf children. The children attending school D remain in mainstream classes throughout the day, supported by specialist teaching assistants. Children from school E spend the morning at an on-site center focusing on literacy skills, before attending mainstream classes in the afternoon.

Information about the children who took part in study 2 is provided in Table 5, including their sex, age, use of aids (hearing aids or cochlear implants), language preference, and the order in which they took part in the intervention and control conditions. In contrast to study 1, all of the children in study 2 had spoken English as their preferred language, and no children had any additional statement of special educational need. BRIEF questionnaires were not administered in study 2.

Executive Function Assessments

Because of technical issues, the sun apple task was substituted with a comparable "Simon task," which is a similar task of inhibitory response but in its running includes a greater number of trials.

The Simon Task (Inhibition)

This task is a measure of response inhibition, and is presented on a laptop using PEBL software ( Mueller & Piper, 2014). In the Simon task, children have to make a rapid judgment of the color of a stimulus while ignoring its horizontal position. A red or blue circle appears on the screen and the children have to respond by pressing the left shift key for a red circle and the right shift key for a blue circle. Colored smiley face stickers were placed over the corresponding shift keys to remind children of the response keys. The task consisted of 140 trials; 70 congruent (where the circle appears on the same side of the screen as the response key) and 70 incongruent (where the circle appears on the opposite side of the screen to the response key). Accuracy of participants' responses was recorded in an output file. Interference scores were calculated for data analysis by subtracting accurate responses to congruent trials from accurate responses to incongruent trials.

Results

As with study 1, data scoring and analysis began only once data collection had been completed, in order to reduce any potential experimenter effects or scoring bias. Children's average scores on each of the tasks according to ability group are shown in Table 6.

The changes in children's performance on the tasks at different testing time points were calculated from pre- and post-music intervention test scores and pre- and post-art control test scores ( Table 7). Comparisons were then made between these two change scores, using a repeated measures t-test ( Table 8) to determine whether the music intervention was effective.

Results show that children's scores on all tasks except for the color trails task increased significantly after the music intervention. The art intervention led to no significant changes in score for any of the EF tasks. When the change scores for the music and art intervention were directly compared, changes scores were significantly higher after the music intervention for all tasks, with the exception of color trails.

Discussion

The first research question asked: Does the music-based intervention have a positive effect on deaf children's EF skills? The results revealed improvement in deaf children's visuospatial/executive-loaded visuospatial working memory. Significant improvements were also found in post-intervention design fluency scores (a measure of flexibility and planning) in study 1. In the second study inhibitory skills also improved. This is the first study to find that EFs can be improved in deaf children. This finding is strengthened by the inclusion of an active control condition and replication in two separate samples. It is also promising that improvements were found following a relatively short intervention of 10-hours duration. The possibility of an EF intervention being successful is important, considering the negative impact poor EF has on a range of outcomes for deaf children ( Botting et al., 2017; Figueras et al., 2008; Hall et al., 2016; Jones et al., 2020; Morgan & Dye, 2020). These abilities are an important part of children's wider success in controlling and regulating social and emotional skills ( Andersson, 2008; Blair & Razza, 2007; Thorell, Lindqvist, Bergman Nutley, Bohlin, & Klingberg, 2009). At the same time, we did not find large improvements, nor across all EFs, for all deaf children.

The final research question asked: Can the intervention be replicated in different samples? We observed improvements to EF in both studies, which suggests the intervention was robust enough to transfer to other samples. Replication entailed a range of school settings and across a heterogeneous group of deaf children using different languages and communication systems. We did not find large effect sizes across all EFs and for all deaf children. Both studies were small scale and included children of different abilities. The inclusion of a wide range of children in both studies strengthens the ecological validity of the intervention, and its suitability for real-world classroom environments. This is positive in terms of how representative the sample is but can make any consistent group effects difficult to attain.

There are some limitations to our study that we raise here. Any research design carries strengths and weaknesses. We chose a crossover design because matching participants with appropriate control participants is extremely difficult with deaf children due to the high heterogeneity. Our design enabled each child to act as their own control in a crossover design. However, crossover designs are less powerful in producing lasting impact on the outcome of interest. There is also the limitation imposed by the necessary test-retest methodology of assessment ( Chan, Shum, Toulopoulou, & Chen, 2008). The improvements made by children on some of the tasks over time may represent expected practice effects as a function of increased familiarity with the tasks, and this was a particular limitation of study 1 where ability group and intervention order were conflated, meaning that the low-ability group had more practice with the task at the post-intervention testing point. As a result, it is possible that the effectiveness of the intervention for the low-ability group was over-estimated and, conversely, its effectiveness for the high-ability group under-estimated. This limitation was addressed by the way we allocated children in study 2, where we decoupled ability grouping from intervention order. Future work in this area might instead beneficially use a single-subject design. Single-subject designs are frequently used in intervention studies, which involve atypical populations, as they provide a powerful tool for determining the effects of different treatment conditions ( Lee Swanson & Sachse-Lee, 2000, for a meta-analysis of single-subject interventions). Such designs are less vulnerable to the concerns about practice effects that were a limitation of our study 1, and are more suitable for interventions that are expected to have a lasting impact.

While we observed the EF intervention had a positive impact, by looking at EF performance in the group that had the control then intervention activity we see these effects were not maintained once intervention was completed. There is the possibility that our crossover design requiring time between conditions to allow consolidation before a control condition phase. Future replications of our intervention might usefully include a period of consolidation between conditions. Additionally, the short-term effects we observed suggest the importance of continued EF intervention in deaf children so as to achieve sustained results. It is assumed, longer interventions will produce more robust effects ( Bowmer et al., 2018; Diamond & Lee, 2011). Thus, future replications could consider more than a 5-week intervention period.

In conclusion, working memory and inhibition can be improved through short time-scale, classroom-based musical training. Future studies should include more time between intervention and control conditions, as well as, post intervention in order to evaluate maintenance. Related to varying cognitive abilities of deaf children, our research shows improvements after training were not uniform across all participants. The study highlights the importance of supporting the development of EF skills alongside or in tandem with any therapy work around speech and language in educational settings.

Funding

Grant 620-28-600 Deafness, Cognition, and Language Research Centre.

References

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

# data[].attributes.attachment_link.title
Executive Function Training for Deaf Children: Impact of a Music Intervention

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Several studies have reported poor executive function (EF) development in deaf children with subsequent impacts on their social and academic attainment. This paper describes the results of a music-based EF intervention designed for deaf children and carried out in two sets of primary schools.

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Positivist

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Teacher Coaching: Increasing Deaf Students' Active Engagement Through Flexible Instructional Arrangements

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(2020). Early intervention intensity and language outcomes for children using cochlear implants. Deafness & Education International: Vol. 22, No. 2, pp. 156-174.

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Parent-to-parent support for the families of deaf children has been provided in an East London district as an adjunct to the existing Early Support programme. Two parents of deaf children were employed as Parent Support Workers. They were members of a multi-disciplinary team of audiologists, teachers of the deaf and a specialist speech therapist. A questionnaire was used to obtain the views of the parents of a 10-year cohort of 35 deaf children who had received the peer support. There were high levels of satisfaction. Twenty-two respondents (63%) judged that a parent who had a shared experience was the person best placed to offer help and advice immediately following the diagnosis of childhood deafness with 27 (77%) considering the counselling and guidance of the teacher or therapist as most useful in the pre-school period after this initial period. An overwhelming 34 (97%) would recommend peer support as being useful. Twelve professionals, including five teachers, submitted free text on their views of the support. This was evaluated using thematic analysis. There were concerns about training and governance of the Parent Support Workers, with one teacher considering that the role may conflict with that of the teacher. However, ten professionals considered it to be a beneficial addition to existing programmes and none wanted it withdrawn. Most recognised that the "shared experience" of caring for a deaf child enabled the support workers to get close to families and provide a link with the home, which helped the parents engage with the intervention of the multi-disciplinary team.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Kinjal Mehta is a Clinical Audiologist who was employed at Whipps Cross University Hospital in Leytonstone, East London and was a member of the multi-disciplinary team providing Early Support for the families and children attending the EaST 17 Centre in the Chapel End Early Years Centre. She is currently undertaking post-graduate research at University College, London.

Enid Hilton is a Teacher of the Deaf employed by the Whitefield Academy Trust in Walthamstow. She is a long-standing member of the multidisciplinary team providing Early Support for the families, infants and pre-school children who attend the EaST 17 Centre.

Margaret Baldwin was Consultant Audiological Scientist at Whipps Cross University Hospital and a founder member of the EaST 17 Centre. She has now retired.

Peter Watkin was Consultant in Audiological Medicine at Whipps Cross Hospital and he has also retired. He was a participant in the initial setting up of the EaST 17 Centre as part of the UK Government DfES Early Excellence programme which explored and disseminated models of integrated professional practice.

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Parent-to-parent support for the families of deaf children identified by the newborn hearing screen

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Parent-to-parent support for the families of deaf children has been provided in an East London district as an adjunct to the existing Early Support programme. Two parents of deaf children were employed as Parent Support Workers. They were members of a multi-disciplinary team of audiologists, teachers of the deaf and a specialist speech therapist.

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Interpretivist

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This paper reviews and synthesizes research into the ways in which parents support their child across three major developmental domains in early childhood: early language, play and early literacy. We show how these domains are linked to each other and suggest that there is some evidence that interventions in all of them will promote mutual development. Early interventions that focus on parent-child interactive experiences that are both routine and 'exotic' in nature are likely to be more powerful than practitioner-dominated interventions.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Associate Professor P. Margaret Brown is a Principal Fellow at the Melbourne Graduate School of Education, The University of Melbourne, Australia. Her research interests are in the early development of deaf children and how their interactions with parents support learning.

Dr Linda M. Watson is an Honorary Senior Lecturer at the University of Birmingham, UK. Her research interests are the language and literacy development of deaf children.

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Language, play and early literacy for deaf children: the role of parent input

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This paper reviews and synthesizes research into the ways in which parents support their child across three major developmental domains in early childhood: early language, play and early literacy. We show how these domains are linked to each other and suggest that there is some evidence that interventions in all of them will promote mutual development.

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Interpretivist

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Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Notes on contributors

Dr Teresa Y. C. Ching is Head of Communication Sciences Department at the National Acoustic Laboratories, Australia. Her current research focuses on investigating efficacy of early intervention for populations of children with bilateral hearing loss or unilateral hearing loss, identifying factors affecting outcomes, determining sound discrimination ability in infants with hearing loss or auditory neuropathy spectrum disorder using cortical auditory evoked potential measurements and behavioral responses, evaluating effectiveness of amplification, devising methods for prescribing hearing aids and electric-acoustic stimulation (bimodal fitting) for children and adults, and exploring perspectives of professionals and families on management of hearing loss in young children.

Dr Nerina Scarinci is Head of Speech Pathology in the School of Health and Rehabilitation Sciences at The University of Queensland. Nerina's research focuses on the application of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) and family-centred care (FCC) principles for individuals with communication disability and their family members. Nerina has a special interest in improving communication outcomes for children with hearing loss, and children with language delay.

Vivienne Marnane is a researcher in the Communication Sciences Department at the National Acoustic Laboratories, with qualifications in speech pathology and epidemiology. She is currently involved in research investigating the efficacy of early intervention and amplification, and the factors that affect short- and long-term outcomes for pediatric populations with hearing loss, including those with unilateral hearing loss.

Jessica Sjahalam-King is a research audiologist within the Audiology department at the National Acoustic Laboratories. Jessica works with the families and children currently participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) and Children with Unilateral Hearing Loss (CUHL) studies. Prior to her current role, Jessica had a background in anthropology and working with children and adolescents with cognitive disabilities.

Laura Button is a research Speech Pathologist, and Speech Pathology Manager in the Communication Sciences Department at the National Acoustic Laboratories. She is involved in the research teams investigating the outcomes of children with hearing loss, family experiences, and alternate delivery models.

Jessica Whitfield is a research speech pathologist working within the Communication Sciences Department of the National Acoustic Laboratories, Australia. She has a clinical background providing assessment and intervention to children with speech, language and literacy difficulties. Jessica joined the National Acoustic Laboratories in 2010 as a research speech pathologist to work with the families and evaluate the speech and language outcomes of children currently participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) and Children with Unilateral Hearing Loss (CUHL) studies.

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Factors influencing parents' decisions about communication choices during early education of their child with hearing loss: a qualitative study

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(2018). Factors influencing parents' decisions about communication choices during early education of their child with hearing loss: a qualitative study. Deafness & Education International: Vol. 20, Decision making in the education and development of infants, children and young people who are deaf or hard of hearing, pp. 154-181.

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Positivist

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The lack of early identification, suboptimal language stimulation and limited remedial services in Sri Lanka for children who are deaf or hard-of-hearing place them at-risk of language delay. The reality for many preschool and primary school children entering formal education in Sri Lanka is a language delay in spoken language and/or sign language compared to their age-matched hearing peers. The aim of this study was to evaluate the effectiveness of the Colourful Semantics approach as a whole-class language enrichment programme to develop the use and responses to target wh questions. Thirty primary school children who are deaf or hard-of-hearing between the ages of five-ten years were included. The programme was offered once a week for 12 weeks through the class teacher. Individual pre- and post-language measures and statistical analyses were undertaken on receptive knowledge and expressive use of the target wh questions using a picture naming task and tasks based on three local children's story books. A statistically significant improvement was observed in the understanding of target wh questions post-intervention by all the children. There was also a positive change in the responses to the target wh questions by all the children post-intervention with many combining signs or spoken words with signs. The Colourful Semantics approach has potential as a whole-class language-teaching approach to strengthen the understanding and use of wh question forms. This study emphasizes the benefits of collaborative partnerships between speech and language therapists and teachers in delivering intervention particularly in resource-limited contexts.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Shyamani Hettiarachchi is a Speech and Language Therapist and Senior Lecturer at the Department of Disability Studies, University of Kelaniya, Sri Lanka and a Visiting Research Fellow at the School of Social Work and Social Policy, Trinity College Dublin, The University of Dublin, Ireland. Her research interests include speech sound disorders, cross-cultural and linguistic considerations in speech and language assessment and intervention, access to education and the intersection between gender and disability.

Mahishi Ranaweera is a Senior Lecturer at the Department of English Language Teaching, University of Kelaniya, Sri Lanka. Her research interests include second language acquisition, Corpus Linguistics and World Englishes.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

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The effectiveness of using the Colourful Semantics approach to support language development with children who are deaf or hard-of-hearing

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The lack of early identification, suboptimal language stimulation and limited remedial services in Sri Lanka for children who are deaf or hard-of-hearing place them at-risk of language delay. The reality for many preschool and primary school children entering formal education in Sri Lanka is a language delay in spoken language and/or sign language compared to their age-matched hearing peers.

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Unsure

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ABSTRACT
The national policy in deaf education in Mainland China primarily focuses on oral/aural instruction and hearing rehabilitation. The curriculum in primary grades is specifically structured on speech and hearing skills for language development. But there is little evidence that documents what early literacy instruction looks like or how teachers conduct the teaching of reading and writing in classrooms with Chinese deaf children. By analyzing videotapes from the first and second grade classrooms, we describe how reading and writing are taught to deaf children in China. The key findings are that the primary grade literacy instruction (1) shares features of Gradual Release of Responsibility model with a focus on speech and hearing skills; (2) uses multimodal strategies and pedagogical tools such as lip-reading, Pinyin phonetic symbols, Pinyin Finger Spelling, Chinese Sign Language (CSL), and Signed Chinese (SC). Moreover, the curriculum reflects low expectations for deaf students as it lacks the academic content provided to their hearing peers. We conclude with implications for literacy instruction in deaf education, and suggest a future research agenda.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Qiuying Wang, Ph.D., is a literacy faculty at Oklahoma State University, Stillwater, OK. She takes cross-cultural and cross-linguistic comparative perspectives on literacy education, examining the literacy development of children from different language backgrounds and from different language learning environments. She is the Director of the Randall and Carol White Reading and Math Center in which undergraduate and graduate literacy students provide low-cost tutoring to children.

Jean F. Andrews, Ph.D., is professor emerita in the Department of Deaf Studies and Deaf Education, Lamar University, Beaumont, Texas. Her research interest include language and literacy of deaf individuals, including literacy issues related to forensics.

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Literacy instruction in primary level deaf education in China

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ABSTRACT The national policy in deaf education in Mainland China primarily focuses on oral/aural instruction and hearing rehabilitation. The curriculum in primary grades is specifically structured on speech and hearing skills for language development. But there is little evidence that documents what early literacy instruction looks like or how teachers conduct the teaching of reading and writing in classrooms with Chinese deaf children.

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Interpretivist

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ABSTRACT
Deaf education faces many challenges in Malawi, making it more difficult to offer quality education to deaf children. Since the 1990s, Malawi has shifted from a special education system to an inclusive education system. The major emphasis has been on enabling deaf children to learn alongside other children in inclusive mainstream classrooms. However, the field remains confused, particularly since many deaf children are struggling in inclusive mainstream schools. Special schools for the deaf are boarding schools, which are too expensive for most deaf children who come from poor families. Consequently, the aim of this study is to find what needs to be done to enable deaf children to access quality education. Qualitative data was collected in three schools for deaf children and two mainstream schools where deaf children are enrolled. It was found that deaf children feel isolated and lonely in mainstream schools, which leads to some children withdrawing from these schools and joining schools for the deaf. Similarly, some deaf children are denied access to education because they have to choose between paying to enrol in schools for the deaf where they can enjoy the company of deaf peers, and enrolling in mainstream schools where their access to education is very limited. Teachers at mainstream schools lack understanding of deaf children's educational needs. It is recommended that a collective effort should be made by the state and society to surmount the many challenges that hinder deaf children from accessing quality education in Malawi.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Malonje Phiri
Malonje Phiri is a deaf researcher and rights disability advocate. He holds a BA in Arts and Humanities from the University of Malawi and an MSc in Inclusive and Special Education from the University of Edinburgh, Scotland. Currently, he is studying for a PhD at Stellenbosch University in South Africa. His research interests are deaf education and deaf communities.

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Challenges Faced by Deaf Children in Accessing Education in Malawi

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ABSTRACT Deaf education faces many challenges in Malawi, making it more difficult to offer quality education to deaf children. Since the 1990s, Malawi has shifted from a special education system to an inclusive education system.

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Pragmatist?

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Social media use for deaf and hard of hearing students in educational settings: a systematic review of literature

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The pedagogical benefits of the social media may be most pronounced when they impact groups of learners who are at a disadvantage in conventional face-to-face contexts. Among such disadvantaged groups are the deaf or hard of hearing (DHH) students who may experience new opportunities with the help of the social media.

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Interpretivist

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ABSTRACT

ABSTRACT
This empirical qualitative study aims (1) to understand the Chinese context in promoting accessible high-quality education for deaf communities and (2) to create an opportunity for deaf experts to contribute to sign language research, instruction, interpreting programmes, and deaf education in China. Using a focus group methodology, we gathered data from 48 participants from four different stakeholder groups (10 teachers, 16 administrators/researchers, 6 interpreters, 16 community members) identifying concerns and solutions to achieving educational access. Video recorded discussions were transcribed, analysed and consolidated into themes. Results show a fragile trust between deaf and hearing professionals, a need for continued investigation on sign language standardisation and preservation, and a desire for worldwide collaboration and inclusion of deaf and hearing scholars in establishing a deaf university in China. This participatory, community-based research method yielded insights toward improving deaf education and sign language training within Chinese special education and toward the design, implementation and establishment of a future university serving only deaf students in China.

This empirical qualitative study aims to understand the Chinese context in promoting accessible high-quality education for deaf communities and to create an opportunity for deaf experts to contribute to sign language research, instruction, interpreting programmes, and deaf education in China. Using questionnaire and focus group methodologies, we gathered data from a total of 48 participants from four different stakeholder groups in China (10 teachers, 16 administrators/researchers, 6 interpreters, 16 community members) to identify concerns and solutions for achieving educational access. Focus group discussions were analysed through the lens of grounded theory (Corbin & Strauss, 2014), extracting initial statements and themes from participants' verbal statements, and creating memos. This process involves the researchers "deriving a general, abstract theory of process, action, or interaction grounded in the views of participants in a study" (Creswell, 2009, p. 13), where the refinement and interrelationships of categories of information are compiled (Charmaz, 2006; Corbin & Strauss, 2014). This participatory, community-based research method yielded insights toward improving deaf education and sign language training within Chinese special education and toward the design, implementation and establishment of a future university serving only deaf students in China.

President Xi Jinping has a vision to revitalise the country with the people's positive attributes and "hard-working spirit" (Xinhua, 2019). Inspired by this, deaf Chinese individuals seek to contribute to society by investigating educational matters and introducing deaf perspectives into the larger academic discourse. "Nothing about us without us" is a tenet extrapolated from the disability empowerment movement (Charlton, 1998) reiterating the importance of including "the researched" in the research enterprise (Singleton et al., 2014). Through this research study, deaf agency and participation is enabled and has the potential to benefit the developing infrastructure and policy designed to meet educational and social needs of all deaf Chinese individuals. These matters have traditionally been on the shoulders of hearing educational leaders who may have little understanding of the deaf experience. This study aims at bringing together deaf Chinese leaders, teachers and community members along with hearing administrators/researchers to engage and exchange valuable insights related to deaf education and sign language access.

Background

According to the Center for World University Ranking report ( 2019- 2020), China is a rising economic giant with 250 universities in the top 2000 in the world. The dedication to improving education for its 1.4 billion citizens has no doubt been a result of the implementation of the National People's Congress Compulsory Education Law of the People's Republic of China (1986). This law required all Chinese children, including those with disabilities, to receive nine years of education, including six years of elementary school and three of middle school. With 87 million individuals with disabilities in China, comprising 6% of the Chinese population (China Disabled Persons Federation, 2018), the Law of the People's Republic of China on the protection of Disabled Persons (1990) insisted on a collaborative effort from families, schools and professionals to meet the compulsory education requirement for students with disabilities. By 2004, 80% of 20.57 million deaf and hard of hearing Chinese (compared to 93% of the general population) met the compulsory education requirement compared to only 6% in 1988 (DeCaro & DeCaro, 2006).

The World Federation of the Deaf (WFD, n.d.) is a global organisation led by Deaf individuals working to ensure equal rights for over 70 million estimated deaf people worldwide. Their vision promotes the human right to sign language for all deaf people. Included in WFD's strategic focus is inclusive education through sign languages. Within the Chinese context, the compulsory education and special education policies outlined above place deaf children either in regular education or separate schools for the deaf; even so, the majority of these deaf children will not have formal exposure to a signed language in school. For example, by 2006, Chinese officials had established 600-900 residential deaf schools across the nation. However, the majority of the instructional staff are hearing with no specialised training in deaf education, and the language of instruction is uniformly spoken Chinese with little use of signing (Dingqian et al., 2019).

The recommendation for inclusive education by the State Education Commission through the Trial Measures for Arranging Disabled Children and Teenagers in Learning in Regular Classrooms was made in 1994 and aimed at integrating children with disabilities into Chinese society. This implementation was not well received by local teachers, who felt students with disabilities were inadequately placed and incapable of progress (Ellsworth & Zhang, 2007). Nonetheless, within 10 years, some 65% of students with disabilities were enrolled in regular education classrooms. Placement decisions for deaf students depended mostly on their speech and hearing skills after experimental speech rehabilitation and training programmes; if they were not on par with their hearing peers, they remained in special education programmes. While no precise data is available on the academic and social outcomes of mainstreamed deaf students, the number of residential deaf schools has declined to 437 in recent years (Ministry of Education, 2017). Interpreter availability for mainstreamed deaf students is scarce, raising questions with regard to content access and exposure to fluent language models.

Higher education, therefore, remains inaccessible to most deaf students due to them not passing the "gaokao," a ten-hour long test lasting 3 days. This national test determines university eligibility and selection. In 2014, the Ministry of Education provided accommodations to deaf students by allowing the use of hearing aids, providing extended time, and giving permission to be exempted from the aural section of English exams during the gaokao examinations (Shuo, 2018). Sign language accommodations are non-existent for deaf test takers. With so few college-bound students, 25 special education universities in the late 1990s were built to ensure that individuals with disabilities receive tertiary vocational training (Dingqian et al., 2019). Tertiary majors for deaf students typically include computer applications, animation, horticulture/gardening, weaving, photography, farming, sewing, woodworking, leather making, food processing, and art (Dingqian et al., 2019). No social science, mathematics or economics courses are available to deaf students.

While education is a common right for all Chinese citizens, the incorporation of sign language in general instruction may be downplayed by educational policy makers. Including sign language in deaf education is a shared value for many deaf citizens globally (WFD, n.d.), but initiating this approach within the Chinese context will require a concurrent focus on scaling up sign language instruction for hearing individuals who take primary responsibility in the delivery of deaf education. The academic infrastructure to support these dual tracks (sign language in deaf education and sign language education for educators of the deaf) is presently undeveloped, even though Lytle et al. ( 2005) made strong recommendations regarding such an infrastructure. Understanding communication and educational accessibility in contemporary China and exploring how programmes could be implemented to achieve similar progress to that made by so many deaf individuals worldwide is the objective of this study.

Deaf education teacher preparation in China

Unlike the specialised deaf education teacher training provided in some countries, special education teacher certification in China covers all disabilities (Deng & Harris, 2008). With a dearth of special education training, so-called "qualified" general education teachers are often asked to teach deaf students (Education Law of the People's Republic of China, 1999; Teachers' Law of the People's Republic of China, 1999). In 2018, of all 9,160,800 Chinese "qualified" teachers, none had training in special education (Dingqian et al., 2019). The Special Education Promotion Plan/Enhancement Program of 2014-2016 aimed at popularising the special education field by strengthening the quality and availability of teaching and learning courses. No mention of sign language proficiency requirements for teachers are in place to work with deaf children in China. According to Liu et al. ( 2013), 73% of teachers of deaf students report that they learned to sign from their students, from colleagues, and from school staff, but not from their university training (Jones, 2013). This raises questions about the effectiveness of content delivery without formal sign language training for educators.

The standardisation of Putonghua as a national unified language of instruction across schools in China primarily accommodates the majority Han community. For sign language users, however, standardisation efforts were not based on natural signing used by the deaf; rather, a "signed Putonghua" was developed. In 1987, the official/national Chinese Sign Language (CSL) "Yellow Book" was published by the China Deaf Association in Beijing, with revisions added in 2003. This work aligned the spoken language with certain "equivalent" signs. This initiative brought about drastic linguistic and social challenges for the following reasons: (1) the Yellow Book's lexical signs were not understood by the majority of deaf Chinese communities (Xiao et al., 2015); (2) as illustrated in Table 2, there is much diversity of regional sign languages throughout China (Fischer & Gong, 2010); and (3) even with the Yellow Book's availability, deaf children with hearing families still experience language delays and little contact with signing language models.

To evaluate the Yellow Book dictionary and its effectiveness, in 2014 a survey was sent out by the National Centre for Sign Language and Braille to 949 Chinese Deaf adults and 2,709 stakeholders. The results showed that 68% of deaf adults did not find sign selections from the Yellow Book helpful, whether the signs were regional or invented, but instead found them confusing. Nonetheless, 63% of deaf adults and 85% of hearing teachers of the deaf expressed support for a national CSL that followed the Chinese written language. As a result of this survey, a taskforce was set up that included a majority of deaf signers, outnumbering hearing committee members. The task force revised the Yellow Book to produce a national dictionary titled "Lexicon of Common Expressions in Chinese National Sign Language" published in 2018, by the China Disabled Persons' Federation, Ministry of Education of the People's Republic of China. About 80% of the Yellow Book was revised by the task force, bringing CSL one step closer to a standardisation based on natural sign languages used by Chinese deaf communities. However, learning a sign language requires much more than learning vocabulary or simple phrases; learners must experience the full embodiment of sign language phonology, morphology, syntax and discourse within a well-designed sign language curriculum.

Sign language research, teaching and the interpreter industry

Scholarship in sign language from other countries is providing new platforms for developing and publishing Chinese sign linguistics textbooks. Two textbooks that focused on grammatical structures in natural CSL were published in 2015 by two hearing scholars (Chen, 2015; Ni, 2015). These linguistic advancements are yet to be officially incorporated within any interpreter or teacher training curriculum.

The interpreting field emerged in China around 2004 with some small training programmes in various regions (Zhengzhou, Nanjing, Yingkou, and Hangzhou), prompting 212 television stations to provide signed TV news for deaf communities across China (Xiao & Yu, 2009). While this exciting media initiative appears to raise society's awareness about sign language and provides deaf students with access to daily news, the signed translation outcomes have, unfortunately, been a huge disappointment to the vast majority of deaf viewers. Most were unable to understand the signed message (Xiao et al., 2015; Xiao & Yu, 2009). This inability is not due to cognitive limitations of deaf viewers, but rather the syntactic and morphemic distortions of Signed Chinese. Upon graduation from the universities that provide small sign language training programmes, new sign language interpreters realised that they were not being understood by local deaf communities (M. Meng, personal communication, August 17, 2017). Conversely, deaf community viewers began to doubt the validity of their own natural sign language since it was completely different from the signing used by the TV interpreters/signers. Initiatives have been submitted to the government to improve natural CSL proficiency in interpreters in order to enhance the Chinese TV experience of deaf viewers (Xiao et al., 2015).

DeCaro and DeCaro ( 2006) completed a report for the China Disabled Persons Federation that was based on interviews with administrators, teachers, faculty, and community members. The report identified eight recommended areas of improvement: (1) Improve the quality of education, (2) Diversify majors for deaf students, (3) Create access to mainstream courses/programmes, (4) Improve college education, (5) Establish partnerships with employers, (6) Increase opportunities for student leadership development, (7) Improve communication competencies and, lastly, (8) Work to change perceptions regarding deaf persons.

The present study gathers current insights by deaf and hearing Chinese participants who have expertise in sign language research, instruction, interpreter training programmes, and deaf education. These results reiterate the importance of including Chinese deaf experts in policy, design, and implementation decisions. These experts can point us toward the ultimate objective of founding a Deaf University to serve the Chinese deaf community.

Authors' positionality

The authors' positionality statement is a reminder of the importance of transparency in research by and with deaf people. This statement is also a reiteration that being deaf does not interfere with the planning or execution of a research study, or with data analysis and interpretation of results. This point is particularly important in China, where deaf researchers are scarce. The authors of this paper are: (1) Jones, a deaf researcher and professor at an American university who has visited China extensively over 13 years to study Chinese deaf education, (2) Ni, a deaf CSL instructor involved with advocacy and interpreter training work in China, and (3) Wang, a deaf Chinese community services director who is involved in setting up video relay services for deaf people in China. All team members were involved in developing and translating questions for the questionnaire and focus group discussions. We collaborated on transcript translation and verification and writing up the manuscript.

Method

This study was initiated in August 2016 and completed in the summer of 2019. The study adopts a community-based participatory research paradigm to "equitably involve community members, organisational representatives, and researchers in all aspects of the research process in which all partners contribute expertise and share in decision making and ownership" (Israel et al., 2005). The study was initiated as a result of a community discussion prior to a Language and Deaf Education conference where individuals expressed a need to document deaf and hearing perspectives about deaf education, sign language access and the establishment of a deaf university. The authors proceeded with the implementation and planning of the study through WeChat and video-conferencing. The authors also met to review the questions and its translations. Data was collected from focus group discussions. The analysis and interpretations of findings were shared with the team in both Chinese and English.

Focus groups were conducted in natural CSL, which allowed deaf professionals to easily engage in academic discussions. Prior to a planned national conference on Sign Language and Deaf Education, 200 invitations were sent to registrants via email asking them to volunteer for the focus group of their choice. A two-hour time slot was allotted for the four concurrent focus group sessions respectively regarding sign language research, sign language instruction, interpreter training programmes, and deaf education. With the approval of the Institutional Review Board from University of California, San Diego, the night before the conference informed consent documents and permission to videotape forms were explained and distributed to all participants. For video identification purposes, upon registering participants received a coloured wristband to represent their profession or status: researcher/ administrator (green), teacher (blue), interpreter (light purple), or community member (burgundy).

Participants, research set-up, and protocol

Forty-eight participants (23 females, 25 males) were involved in this study. In this pool were 29 deaf professionals/paraprofessionals and 19 hearing professionals. Together, these groups of professionals consisted of 6 interpreters, 10 teachers, 16 administrators/researchers and 16 deaf community members. The groups were organised following the topics of sign language research ( n=17), sign language instruction ( n = 9), interpreter training programmes ( n=10), and deaf education ( n=12). Three cameras were set up for each focus group to record all signing spaces. A circular arrangement of chairs enabled visual access for all participants. A bilingual voice interpreter was provided for those participants who were not fluent in CSL. A hearing real-time typist transcribed verbatim what the bilingual voice interpreter translated from CSL into spoken Chinese (see Figure 1). Each group had a deaf discussion leader who was responsible for facilitating discussion around a set of guiding questions related to past, present and future research in their field; the quality of education; the role of Chinese regional and national sign languages; and barriers and solutions (see Table 1). The following questions were used across all stakeholder groups:

1. What are the issues and challenges in sign language research, instruction, interpreter training, and deaf education?

2. What are your views on best practices to ensure sign language and education access?

Nothing about us without us: Deaf education and sign language access in China

Nothing about us without us: Deaf education and sign language access in China

The translation process included stages where deaf research assistants transcribed the signed comments into written Chinese, then a trilingual author triangulated the three Chinese translation sources to ensure accuracy and validation. The translation sources consisted of CSL to written Chinese; spoken Chinese recorded from the voice interpreter onsite, and verbatim typed transcripts completed on site. Bilingual research assistants worked with the authors to create an English text translation of the Chinese sources. Areas of uncertainty, especially concerning variation in regional signs, were re-evaluated by the team before a final transcript was produced.

Analysis of data

Transcripts were initially coded following the principles of the grounded theory approach, where statements were analysed and themes extracted (Holton, 2007). To make the study more inclusive and accessible to the collaborative team, the analysis was conducted in both Chinese and English. After summarising themes, an across-group analysis was performed to find the most common overarching themes. Once all individual groups had been coded, the within-group themes were brought together in categories to be analysed across groups. Table 3 presents a coding sample with thematic coding for the Deaf Education Focus Group. We synthesised the within- and across-group themes. Four themes were identified within groups and across groups and are discussed in the following sections.

Nothing about us without us: Deaf education and sign language access in China

Results

The results were compiled into two sections regarding within- and across-group themes. Each focus group presented its case from the perspective of its field, addressing issues of sign language access, quality and education and reiterating how these themes share a larger framework for a stronger collaborative enterprise. In the following sections, for each focus group category findings are summarised, and themes extracted from each of the four focus groups are described.

Within-groups themes

Sign language research

Data analysis revealed the following themes from the sign language research focus group: (1) a growing awareness of Chinese sign linguistics research; (2) a conflicting focus of research in national CSL versus natural/regional CSL; and (3) research ownership and exchange of knowledge. Each of these themes is discussed in more detail below. The deaf participants' discovery of sign linguistics as an academic subject catalysed their passion to pursue this field. One participant expressed the transformative experience of this realisation:

Confusion regarding which sign language should be the language of instruction was overshadowed by the general consensus that Signed Chinese is an elite option compared to natural/regional sign language (Zheng, 2018). Some participants believed that aligning individual signs with each written character exposes deaf individuals to correct Chinese structure. Other participants disagreed and argued that the regional natural signing of deaf Chinese people was the legitimate CSL, and this should be taught to all students, interpreters and researchers. With regional variation among deaf communities in China, there was tension over which signs ought to be used for standardisation efforts. But this kind of decision is not unnatural for the Chinese, as hearing individuals also contend with spoken dialect variation and standardisation efforts among Mandarin speakers. Participants, including deaf participants, expressed criticism of facial expressions used by signers to convey linguistic information, viewing signers' expressions as exaggerated and too informal for a legitimate language. Ownership and leadership in sign linguistics were topics of concern. Who has the right to study sign linguistics, and who should do this work? As one researcher shared:

As one hearing male researcher stated, "Since hearing researchers lack language skills and deaf researchers often lack theoretical linguistic foundations, collaboration is the ideal solution to this problem, but it is not happening." Ethical dilemmas about the research enterprise were raised in the focus group. Hearing researchers do not know natural CSL, and they are not training deaf researchers to participate. Deaf individuals are researched, but not positioned as researchers. There are few deaf students studying linguistics.

Sign language instruction

It is noteworthy that according to the sign language instruction focus group, sign language instruction targets hearing interpreters and/or teachers who are learning sign language as a second language. An analysis of data gathered from participants in this group yielded two themes: (1) a lack of clarity with regard to which CSL to use for instruction; and (2) a lack of national standards for CSL instructor qualifications.

The first theme stems from the challenge of not having a standardised natural CSL. No unified CSL instructional resources or curriculum exist. One hearing participant raised the following question: "What is CSL? Is it the Yellow Book or is it the natural/regional sign language?" Another hearing participant stated, "CSL is not just the Yellow Book; it includes the unified and local SL."

The second theme addressed the lack of national standards in CSL in two contexts: standards for sign language teachers (i.e. qualifications or mastery credentials) and learning outcomes or progress levels for students learning to sign. The qualifications and identity of the instructor was an issue for participants:

The participants agreed that collaboration amongst hearing and deaf teachers is critical for providing quality and theoretically grounded pedagogy. Deaf teachers convey authentic and high-quality natural CSL, while hearing instructors offers theoretical explanations.

Differing viewpoints on the role of spoken language in a sign language course were addressed. Hearing participants rely on spoken Chinese to understand a deaf instructor's signing. In countries where formal learning of sign language as a second language is commonplace, immersive language learning is the standard model (Rosen, 2010). In fact, many sign language teachers follow a "voice-off" policy. But our participants held steadfastly to their belief that hearing students would not thrive in this kind of immersive sign learning environment. This suggests that second language pedagogical research in China is important, as cultural contexts may differ and warrant a certain instructional approach. The problem is compounded by the fact that there is no formal sign language instructor training programme in China. One deaf participant wished to hone his language teaching skills by completing a CSL teaching specialisation degree. In lieu of formal training, online sharing has become a platform for knowledge exchange. All of the focus group participants agreed to advocate for national CSL proficiency and mastery guidelines for sign language instructors that are similar to the Common European Framework of Reference for Languages (CEFR), but tailored to fit the Chinese context.

Another issue identified by participants was the need for a shared curriculum that outlines mastery objectives for sign language learners. What specific sign language skills are expected after one year of CSL instruction? According to this participant, visual vernacular is the foundation of all sign languages:

Interpreter training programmes

Regarding the interpreter training programme focus group, the following themes were identified: (1) the qualifications of interpreter trainers/teachers, (2) opportunities for professional practice; and (3) the desire for the government to cover the cost of interpreting services at a professional wage.

The participants had conflicting views about teacher qualifications for interpreter training programmes. Deaf participants asserted that deaf instructors are the best teachers, whereas hearing participants valued interpreter trainers with a high level of teaching or interpreting experience. Having community experience and being an excellent sign language model were considered assets in the interpreting field.

As mentioned in another focus group, hearing teachers instructing in Signed Chinese, the purported national standard, are favoured by hearing participants but not by deaf participants. As one female hearing interpreter claimed, hearing teachers would qualify before deaf instructors because of a preferred order to the sign language acquisition process, which is more suitable to a hearing instructor: "In our program, we teach vocabulary, conversation, formal sign language [Signed Chinese], and then natural sign language." Another hearing female interpreter participant believed mastery of natural sign language was not required for interpreters, but was an optional skill: "Interpreters don't need to know natural sign language; they can interpret based on the individual's needs. They are to transcribe into Signed Chinese and if necessary, local sign languages."

Interpreters in the focus group thought deaf-related conferences were an excellent venue to enhance signing and voicing skills. The speed and heavy content knowledge required by these conferences mean skilled interpreters are needed to keep up, but unfortunately the number of qualified interpreters in China is miniscule. Sign language interpreter salaries in China are extremely low and sometimes non-existent, making the job market undesirable.

Deaf education

In the deaf education group, the following themes were addressed: (1) a lack of language role models for curriculum delivery; (2) a lack of professional training and deaf education resources, and qualifications of school teachers, and (3) a lack of access to higher education for deaf students.

Sign language proficiency in content pedagogy, delivery, and teacher qualifications is of concern, as one deaf participant summarised:

Both hearing and deaf participants mentioned that in America, "communication is barrier-free in the classroom," fuelling motivation for teaching and learning.

According to a female deaf educator, "the important role of sign language in learning written Chinese is deemed to be the solution ... learning Signed Chinese will positively affect the learning of Chinese. We teach the deaf because we think it can raise their literacy skills." Standards for teacher qualifications rely heavily upon using best practices in teaching, in which deaf individuals have no formal training and are seen as lacking professional expertise. A hearing administrator stated the following:

This participant's comment alluded to the educational barriers that deaf individuals face. Access to higher education is restricted, and educational policies do not allow deaf students to become teachers. Institutional change requires government officials to recognise the importance of sign language instruction and the pedagogical training of deaf individuals. Despite these significant barriers, the deaf education focus group agreed to advocate for hiring deaf teachers and providing quality higher education to deaf learners:

However, it is important to recognise that deaf individuals' access to higher education is limited due to the unavailability of interpreters. Much of the discussion was centred around higher education when in fact, the topic was all levels of education. No discussion was raised about elementary or secondary deaf education.

Across-group themes

Having summarised the themes within focus groups, this section of the paper addresses shared themes across groups with a view to the current situation and moving forward to an improved platform for a future deaf university. The following common themes were drawn from within focus groups and shared across groups: (a) deaf and hearing collaboration, trust and ownership; (b) involving deaf communities in sign language standardisation and regional sign language research through tertiary education; and (c) research and training of professionals using outside resources to solve local challenges.

Deaf and hearing collaborations between professionals to strengthen trust and ownership of services

In synthesising and interpreting the underlying themes, we identified issues of trust between deaf and hearing professionals that lie in longstanding cultural misconceptions of what is possible for deaf children (Yang, 2006). Historically, deaf individuals were destined to complete only manual labour training in vocationally oriented tracks. Ironically, sign language research is suitable for deaf individuals who wish to become sign linguists, but opportunities to enroll in higher education are not available. Without accessible teacher training programmes for deaf people and without sign language proficiency among hearing teachers and interpreters, how can deaf professionals achieve the level of trust required for collaboration with hearing professionals? Deaf Chinese people often assume that hearing people know more regarding academic content knowledge and pedagogical theory. At the same time, deaf people carry self-doubt about their own rich sign language and even in their own intellectual abilities. The issue of trusting non-signing hearing professionals was raised by a deaf participant, who questioned whether a hearing researcher could investigate a language they do not use or understand and be viewed as a field expert. This argument raises issues regarding qualifications. Without a well-founded sign linguistic training course in higher education, hearing professionals will not master sign expertise nor gain practical experience in the language.

Involving deaf communities in standardization and regional sign

Language research through tertiary education

The frequent discussions about sign language standardisation versus regional sign languages requires the time and place to critically evaluate the fields of sign language research and instruction, and the language of instruction in deaf education. Accessible tertiary education for deaf learners is a stepping stone toward enhanced sign language research and instruction, and deaf education. The tension between establishing a national/natural CSL and preserving regional sign languages also involves the need to provide a language-rich environment for deaf students with an available sign language (see Disabled Persons Federation and China Association for the Deaf and hard of hearing, 2003; Yang, 2011). A standardisation process needs a commitment to a dynamic language environment in which multiple ways of signing are respected, and teachers, interpreters, and students constantly work to achieve comprehensible input and output? As the focus group discussions revealed, hearing and deaf participants are keen on preserving and maintaining both a common natural sign language across China and the regional dialects.

Training of professionals: outside mentoring but Inside problem solving

The issues of training and resources were raised in all focus groups. The hearing and deaf participants who had study-abroad experiences benefited from professional development for research, sign linguistics, standardisation guidelines, interpreter expertise and bilingual deaf programme development. The participants referred to European models. The Common European Framework of Reference for Languages (CEFR, 2020) is a promising model that has provided support to a wide range of European sign languages. Whether or not it is possible to preserve regional sign languages alongside a standardised CSL, issues remain regarding the efficiency of service systems which can provide interpreters who can communicate with deaf communities in hospitals, universities, and the public sector. Many of the recommendations by stakeholders included soliciting the assistance of deaf expertise from abroad through lectures, conferences and textbooks. By using outside resources and expertise, the Chinese are more attuned to their historical and situational challenges. Deaf Chinese people are ready to contribute problem-solving strategies, but several participants shared that deaf people face challenges to being included in the national discourse surrounding sign language, deaf education, and interpreter training and provision.

Recommendations for a deaf Chinese university

An additional survey was sent out to all participants prior to the focus groups, which will not be fully examined due to the scope of this paper, included one question related to establishing a national deaf university. A majority of survey respondents (44 out of 48) called for deaf experts from around the world to participate in infrastructure and curriculum design, and in ensuring the accessibility of visual resources and services, and instruction and evaluation services that will assist in coordinating this national effort. The following is a list of recommendations from our stakeholders regarding the structure of a national bilingual Chinese deaf university:

1. A centralised Chinese Sign Linguistics centre where both national and regional sign languages are valued.

2. An academic think tank where issues, concerns, and problem-solving strategies are shared and implemented through a modelling approach, or on an experimental basis.

3. A research and dissemination centre focusing on deaf education, interpreter training, and sign language research across all regions of China.

4. A rigorous academic and research-focused education where visual learning is the mode of knowledge exchange.

5. Study-abroad opportunities for deaf students to further learn sign linguistics, deaf culture, and sign language and educational research methods.

6. Bilingual teacher training programme to attain language and content competency for elementary and secondary school instruction.

Discussion

In the context of China, recognising cultural and linguistic diversity within deaf communities is necessary in order to develop a high-quality and sustainable sign language-based infrastructure. The diversity of deaf communities is embodied through alternative ways of experiencing language, culture, and cognition through visual channels (Holcomb, 2010).

From the findings of the focus group discussions in this study, it is clear that deaf individuals in China do not receive an adequate education, nor do they have access to qualified teachers and interpreters, a language-rich content curriculum, deaf role models, or higher education (see Yang, 2011). The recruitment of deaf professionals for these fields requires access, time, trust, and training. Investing in CODAs as experienced interpreters will enhance communication and strengthen trust between deaf and hearing professionals. Investing in tertiary education that is accessible to deaf students will enable them to critically engage with colleagues in designing best practices.

Deaf expertise has yet to be fully realised in China. Without educational, social, or employment opportunities, or a platform to exhibit the cultural and linguistic wealth of deaf citizens, their expertise remains hidden to the public (Yosso, 2005). The involvement of deaf communities in building a deaf university will build confidence in deaf people's own funds of knowledge and contributions. The opporutunities for contributions would stimulate reflective intellectual discourse which are needed especially given the fact that Deaf Chinese individuals display a lack of critical thinking styles (see Cheng et al., 2014). By filling teaching and administrative positions, deaf Chinese community members will construct a larger cohesive deaf ecosystem. In other parts of the world such as the United States and Europe, research on sign linguistics, deaf culture, deaf history, deaf bilingual education and interpreter education is led in part by deaf scholars. Interactions with deaf role models will strengthen deaf students' language skills and cognitive development. History shows us that when deaf people share their unique knowledge, experience, and expertise, advances are made in terms of sign language proficiency guidelines, sign linguistics research, bilingual teacher instructional strategies, and signed literature and poetry (Andrews et al., 2015; Bauman & Murray, 2010; Kusters et al., 2017).

Establishing cross-cultural exchanges of expertise between deaf and hearing communities does not come without resistance or ambivalence. For successful collaboration to occur, it first requires building levels of cognitive-based trust as well as affect-based trust. Cognitive-based trust is the "confidence built on perception of other's reliability and competence" (Chua et al., 2012). Affect-based trust is the ability to allow oneself to be vulnerable to sharing mutual connections without being judged or taken advantage of. Hearing individuals need to trust deaf people's sign language knowledge and contributions on an intellectual level. Investing in deaf researchers in sign linguistics increases the reliability, generalizability, and application of ethical principles in research with deaf scholars (Kusters et al., 2017).

Sign language standardisation and dictionary work are ongoing challenges faced by other Asian countries (e.g. Indonesia, India, Cambodia, Nepal). In these contexts, sign language work must benefit deaf communities by protecting and preserving regional sign languages (Moriarty Harrelson, 2019; Palfreyman, 2019). Article 21 of the United Nations Convention on the Rights of Persons with Disabilities refers to involving organisations of deaf people who are actively consulted in issues concerning their lives, including their native languages. Each country has unique challenges, and therefore it is wise to evaluate language ideologies on a case by case basis. Recommendations to improve training and qualifications for teachers and interpreters can be met by training deaf instructors of sign linguistics and pedagogy, and by including deaf Chinese scholars in the planning and development of research and education for deaf individuals. The establishment of a deaf university as a central headquarters for research and training can make these initiatives a reality.

This study's relatively small sample size indicates the need for more studies with a larger, nation-wide sample population. A demographic analysis could better account for diverse socio-economic statuses and regional or urban/rural population factors. Including both deaf and hearing professionals in this research endeavour will allow for a balanced perspective in determining the steps for future policy decisions. In the focus groups in this study, two-hour discussions could not adequately cover the depth and breadth of current issues. For example, the groups' discussion of deaf education focused only on the tertiary level and did not address deaf education from an early age. Therefore, more focus groups in specialised educational settings are recommended.

Conclusion

A unified yet diverse Chinese deaf community can be a source of strength for the nation while contributing to a cohesive, industrious and collaborative enterprise to produce materials and infrastructure for the people. A cross-cultural collaboration between hearing teachers and deaf sign language experts will enable knowledge exchange. Further research on this collaboration and the impact of deaf communities' involvement in professional development will enhance university contexts and other professional venues.

Group #1 Deaf Education

Group #2 Sign language Instruction

Group #3 Interpreting Programme

Group #4 Sign Language Research

Survey Question related to Deaf university: If you were to build a Deaf university, what would you do?

Deaf Education Focus Group Coding Sample

Translated Transcript

Initial Coding

Themes

Memos

The current challenges are (1) limited majors, (2) Deaf people cannot hear (3) no (deaf) teachers in colleges. Few qualified SL interpreters and professional SL training institutions. Teachers water down the content and do not translate effectively. There are few Deaf teachers, which leads to mental health issues in deaf students because Deaf students need communication. I studied in America before and saw so many people signing. Communication was everywhere in Deaf Education.

Identifying limited major choices in higher education

Recognising lack of deaf teachers, qualified interpreters and training programmes

Evaluating curriculum (watering down- translation challenges)

Raising mental health issues- lack of deaf teachers

Emphasising the need for SL communication

Comparing deaf education in USA where SL is prevalent

Higher education limitations

Access to deaf teachers/interpreter

Qualifications & training programmes.

Curriculum quality delivery

SL proficiency

SL as language of instruction

Communication as mental health issue

Government established vocational jobs in special education universities for deaf people based on manual rather than academic abilities. Interpreter training programmes created in 2004. Signed Chinese "Yellow Book" as requirement but 80% revised as of 2018.

Acknowledgment

Special thanks to Ailong Love Deaf Association for providing the space to set up the focus groups during the conference, the Yantai volunteers for typing verbatim the focus groups, to David Huang, Qi Chen, Fanfan Li, Lihuan Zhou for their Chinese/English translation services.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Gabrielle A. Jones
Gabrielle A. Jones, Assistant Professor in Education Studies, University of California San Diego, Director of the MA-ASL programme, a bilingual teacher credential programme. Formerly an elementary and middle school teacher of the deaf, she mentored in-service and pre-service teachers. Her PhD studies at the University of Illinois in Educational Psychology in Cognitive Science, Teaching and Learning involved doing research investigating Chinese reading instruction in deaf classrooms and how teachers map language to print. She published in the area of Chinese Deaf sociocultural learning, Chinese Deaf Teachers and research ethics. Currently a visiting professor at the ZhongzhouUniversity of Engineering and Technology since 2018.

Dawei Ni
Dawei Ni, born in Qingtian, China, is currently a Lecturer in Sign Language Linguistics and Interpreting at the University of Applied Sciences in Landshut Hochshule, Germany. He completed two Masters in Social Work in Vienna, Austria and in Sign Linguistics in Hamburg, Germany. He has done extensive interpreting and advocacy work in Austria, Germany, Indonesia, Switzerland and China related to sign languages including Chinese Sign language, interpreting, Deaf culture and sign linguistics.

Wei Wang
Wei Wang, born in Beijing, China, formerly the Director of Video Production Centre for Hand Voice Information Technology in Zhuzhou for three years, helping with establishing Video Phone relay services to the Deaf in China and distributing educational news to the Chinese online platform. Graduated from American University gaining a Masters in Producing for Film and video and a Masters of Fine Arts in Film and Electronic Media. She worked for Visual Language and Visual Learning (VL2) a Scientific Centre of Learning at Gallaudet University in Washington D.C as a media specialist for seven years.

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Nothing about us without us: Deaf education and sign language access in China

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ABSTRACT ABSTRACT This empirical qualitative study aims (1) to understand the Chinese context in promoting accessible high-quality education for deaf communities and (2) to create an opportunity for deaf experts to contribute to sign language research, instruction, interpreting programmes, and deaf education in China.

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Interpretivist

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Deaf students' linguistic access in online education: The case of Trinidad

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ABSTRACT Comparatively little research on linguistic access in deaf education has occurred in the Caribbean when compared to the rest of the world. During the COVID-19 pandemic, many Caribbean countries attempted large-scale e-learning for the first time. This study investigates how an emergent system of e-learning that started during crisis conditions affects the linguistic access of deaf students in Trinidad and Tobago.

# data[].attributes.headline
Each person should select up to 10 recent articles from their journal and create a link to each article from the Padlet. In the comments under each article you should note what paradigmatic assumptions it relies on (e.g. positivist? post-positivist? realist? critical realist? Interpretivist? pragmatist?). If you are not sure you can write 'unsure', and ask the others in your group to help. When you (or your group) are happy that the Padlet is complete, send a link to it to me (rachel.oneill@ed.ac.uk).

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Each person should select up to 10 recent articles from their journal and create a link to each article from the Padlet. In the comments under each article you should note what paradigmatic assumptions it relies on (e.g. positivist? post-positivist? realist? critical realist? Interpretivist? pragmatist?). If you are not sure you can write 'unsure', and ask the others in your group to help. When you (or your group) are happy that the Padlet is complete, send a link to it to me (rachel.oneill@ed.ac.uk).