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This source is a video that focuses on a deaf school in Rhode Island. Through this video, I learned a new statistic that nine out of ten deaf children are born to hearing parents. "That means that for many parents, the first deaf person they meet is their own baby", this makes it very difficult for them to understand what the child is going through and how to help them, therefore, deaf children tend to fall behind because they are not given the opportunities that they may need, mainly because their parents don't know where to start. There is a "critical period" when a child is born, the period lasts from birth to ages 3-5 and this is when children are biologically ready to acquire language. "If children can't easily hear people talking or see people signing, they run the risk of developing what's known as language deprivation." This surrounds the idea that it is important for young deaf children to learn some sort of language at a young age so that they are able to fully develop like non-disabled child. The cochlear implant can be a very powerful tool, but people don't realize that it is not magic. It is important that children are exposed to both sign language and verbal speaking. Some people believe that if you learn ASL first it can harm cochlear implant outcomes, but there is research suggesting that having both can give children better opportunities to be able to eventually speak.

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The misunderstood reason deaf children fall behind: language deprivation | Rhode Island PBS Weekly

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I came across this poem while researching and it stuck out to me. The person who is writing this poem is sharing how they are unable to speak or communicate with their mother through words, but rather use their hands to speak the same as they would verbally. This represents how communication through sign language can act as a replacement for the deprivation of speaking verbally.

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This video was one of my favorite sources, mainly because it was a visual representation of how important sign language is from a young age. It showed the difference between growing up hearing vs not and how much it impacts your growth. When spoken to with sign language deaf children are able to put the symbols that are being made with the item or image that is being shown, similar to how speaking children puts words with the image or item that is being shown. This shows that there are ways to try and make communication for a deaf child easier, and that is by starting young. This proves that it is important for the social well-being of children, because without sign language they may not be able to communicate with speaking people, or even other deaf people.

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This article from The Conversation talks about how important sign language is for deaf children to learn at a young age and gives examples of families who chose not to and how it impacted their children. The article states that "deaf children of deaf parents, whose first language is sign language, end up having better-spoken language skills once they are implanted than deaf children of hearing parents who did not learn sign language." This goes to show how sign language is the best form of communication for deaf people and how cochlear implants alone are not a sufficient option.

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Learning how to say 'more.' JGI/Jamie Grill via Getty Images

When their newborn failed a hearing test, Quinn and Kai were distraught. Their pediatrician reassured them their baby was a candidate for a cochlear implant - an electronic device consisting of an external part worn behind the ear and an internal part surgically placed under the skin - that could partially restore hearing through electrical stimulation of the auditory nerve.

"We were told Casey would go to a mainstream school and learn to hear and talk just like any other kid," Quinn told us. "The doctors said to speak to him as if he were hearing and not to learn sign language, because it would inhibit his spoken language development." A few years later, Casey could speak some words but fell short of language milestones. Quinn and Kai's story is one that is all too familiar to parents of deaf children.

As researchers of language and literacy in deaf education, we regularly see implanted deaf children like Casey arrive at school with limited language and reasoning skills.

September is International Deaf Awareness Month. We want to debunk common misconceptions that can - and often do - harm deaf children.

Cochlear implant 'success'

Cochlear implants are not a proven substitute for natural hearing. After surgery, children must undergo ongoing, intensive therapy to train the brain to make meaning of the sound it hears. Implant users' understanding of speech is highly variable and declines substantially when talking or other environmental noise is present.

Research shows cochlear implant success is uneven. Although children implanted at younger ages have higher speech and language scores than those implanted at older ages, the majority still perform "below" to "well below" average. In a 2020 study of 136 children with cochlear implants in grades 3-6, teachers reported half had difficulty expressing "many to most" concepts in spoken English, and 13% did not speak English at all.

Sign language and speech development

It is a misconception that learning sign language hinders spoken language development for implanted children. Research shows the opposite to be true. Deaf children of deaf parents, whose first language is sign language, end up having better spoken language skills once they are implanted than deaf children of hearing parents who did not learn sign language.

Brian Mitchell/Corbis Documentary via Getty Images

Research also shows a relationship between sign language and spoken English in school-aged children with cochlear implants: The children who scored highly in sign language were the same ones who scored highly in English. And the children with weak sign language skills also struggled with spoken English.

In fact, sign language is so good for the developing brain some hearing parents teach it to their hearing children to boost brain development and jump-start communication before speech.

The window of opportunity for language development

The idea that sign language can be introduced later, if a cochlear implant is not successful, ignores the basic facts of language development.

Huntstock via Getty Images

In the first years of life, children absorb language like sponges, as long as social interactions are accessible. The longer a child waits for meaningful language input, the greater the risk of never fully acquiring language. The first five years are a critical period for acquisition.

Research shows that deaf children exposed to sign language later - after unsuccessfully developing spoken language - demonstrate rapid word learning but stop short of attaining complex grammatical structures.

The long-term implications of language deprivation are quite serious. A wide range of adverse childhood experiences are known to be associated with adult disease and health problems. Communication exclusion and neglect experienced by deaf children create toxic stress that can trigger physiological and psychological responses.

Limited access to communication in childhood is linked to heart problems, lung disease, diabetes, hypertension, depression and anxiety disorders as well as chronic mental illness.

In severe cases, individuals may be institutionalized with language deprivation syndrome. They struggle with social and emotional skills, memory, problem solving and judgment, all of which can impact their ability to live independently.

Audism in the medical community

Just as racism is at the root of structural inequalities towards Black, Indigenous and other people of color, audism is institutionalized discrimination against deaf people. The medical community is steeped in hearing-at-all-costs attitudes and beliefs that can lead to language deprivation in deaf children.

Doctors are trained to treat and remedy specific physical ailments. Unfortunately, their training is unlikely to include topics of early language acquisition and sign language.

When a deaf baby is born, parents receive the bulk of their information and advice from the medical community - audiologists, ENTs and pediatricians. These doctors too often discourage sign language, suggesting it impedes speech development. As a result, deaf children risk growing up without a solid foundation in any language, which is dehumanizing and reduces their quality of life.

The way forward

We believe the medical community must be educated about deaf children's need for sign language education.

Families can learn sign language along with their babies. It takes two years to acquire conversational skills and five to seven years to develop language fluency, which perfectly matches a child's language development timeline.

Free services are available to families, including home visits, sign language classes and deaf mentorship. Schools for the deaf are a great resource, as are civil rights organizations like the National Association of the Deaf. For deaf children and their families, taking part in the deaf community can deepen their understanding and appreciation of the deaf experience and increase their linguistic role models, which in turn provides a long-term educational advantage.

The catastrophe of language deprivation is entirely preventable with early sign language exposure. Lack of awareness is all that stands in the way.

[ Understand new developments in science, health and technology, each week. Subscribe to The Conversation's science newsletter.]

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Why sign language is vital for all deaf babies, regardless of cochlear implant plans

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When their newborn failed a hearing test, Quinn and Kai were distraught. Their pediatrician reassured them their baby was a candidate for a cochlear implant - an electronic device consisting of an external part worn behind the ear and an internal part surgically placed under the skin - that could partially restore hearing through electrical stimulation of the auditory nerve.

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This blog from a research and charity page, Aussie Deaf Kids, was very interesting because it talked about the importance of starting at an early age. The article states that "infants are born with the potential to learn any human language" which raises the question, why wouldn't you teach deaf children sign language as soon as possible? Furthermore, this article explores the idea of "manual babbling", a linguistic phenomenon that has been observed in deaf children born to deaf parents who have been exposed to sign language. The idea of manual babbling explores infants gesturing in an attempt to communication. This shows how important it is to see parents signing in order for a child to be able to understand and later use the same skills.

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Introduction - the importance of language

The development of language is essential for the cognitive and social development of all children, including, of course, those children who are deaf. Expressive language ability in any modality plays a major role in the development of spoken language (Yoshinaga-Itano, in press). However, the ways in which language, cognitive and other aspects of development can best be stimulated and enhanced, and which language or languages should be learnt, are topics for on-going debate in the field of education of deaf children.

Some educators and other professionals who work with deaf children believe that the simultaneous acquisition of a signed and spoken language is confusing for an infant. Others in the field hold the view that not only is simultaneous language acquisition not confusing, the process of learning two languages at the same time is beneficial for the process of acquiring both.

This paper sets out to review research on language acquisition with particular focus on simultaneous acquisition of signed and spoken languages. The aim is to highlight the benefits of early exposure to sign language and the important role that sign language can play in the acquisition of English.

Language acquisition versus language learning

Infants are born with the potential to learn any human language. Which language or languages they actually learn depends on which languages they have access to (Woll, 1998). The first six months of life represents a particularly sensitive period in early language development, as the child progresses from babbling to syllabic combinations. In subsequent months, the parents and other caregivers begin to perceive the child's utterances as intentional and respond to them, which sets the groundwork for interaction and further language development.

Acquisition in the circumstances described above, happens without conscious effort on the part of the learner; learning requires study (Fischer, 1998, original emphasis). Children are very adept at language acquisition; adults who have acquired a first language then usually become very good at learning other languages. The opposite, however, is not always true. Fischer (1998) believes that young deaf children have often been forced to learn when they might more easily acquire. This situation comes about due to a choice having been made between which type of communication to use: signed or spoken.

I suggest that a choice does not need to be made, children can (and should, I believe) be exposed to both signed and spoken languages from the time a hearing loss is discovered. Petitto and Holowka (2002) believe that we are in fact "compelled" to provide young children with the earliest possible bilingual language exposure, not only because of the multi-linguistic and multi-cultural world in which we now live, but also because research shows that the critical window for language learning (traditionally identified as being from birth to five years of age) is the most optimal period to do so, whether the languages concerned are two spoken ones or a spoken and signed language.

Evidence in support of early exposure to sign language

Research has indicated that "manual babbling" can be observed in infants exposed to sign languages (Woll, 1998). Petitto and Marentette (1991) found that parents who used sign language with their children responded to this manual babbling as if it were intentional communication from the baby. "Manual babbling thus provides a motivation for both infant and parent to engage in conversation in the same way as vocal babbling does" (Petitto & Marentette, cited in Woll, 1998).

The language milestones observed in children acquiring a spoken language have also been observed in monolingual deaf babies acquiring signed languages (Petitto & Holowka, 2002). Woll (1998) reports that while these milestones in British Sign Language (BSL) have been based on research with children of deaf parents who were exposed to BSL from infancy, preliminary research evidence from deaf children in hearing families who have had access to fluent signers from any early age (via language role models in bilingual education programs) indicate that the development of their BSL skills appears to be identical to that of deaf children of deaf parents.

Swanwick (2001) reported on a small number of case studies which have explored sign bilingual language development, with particular emphasis on the effect of early sign language acquisition on the development of spoken language. She found that "these studies have demonstrated that early sign language acquisition does not prevent deaf children from learning vocal language, but can support this process" (p. 65). Importantly, use of sign language from an early age does not inhibit the motivation and interest in the learning of speech (Caselli, 1987; Maxwell, 1989, cited in Swanwick, 2001).

Petitto, Karterelos, Levi, Gauna, Tatrault and Ferraro (2001) studied six bilingual children and discovered a great deal about language milestones. They found that both a baby girl acquiring spoken French and English simultaneously and a baby boy, who was acquiring spoken French and Quebec Sign Language (Langue de Signes Quebecoise - LSQ), achieved classic linguistic milestones and exhibited patterns of lexical growth that were consistent with monolingual norms.

Petitto and Holowka (2002) concluded that the young bilinguals they studied were not delayed in the achievement of early language milestones in either of their respective native languages."The babies achieved the classic language milestones in each of their languages on a similar time course relative to their other language and, crucially, on a similar time course relative to the established norms for monolingual children... Dramatic delays or asynchronies in the timing of the bilingual children's achievement of the linguistic milestones across either the spoken or signed modalities were not observed; interestingly, there was no bias or preference for speech in these hearing babies, as both languages (LSQ and French) in both modalities (signed and spoken, respectively) were learned equally" (p. 10).

Meadow (2005) reported on a study from 1966 which concluded that, "There ... appears to be no statistical support for the currently popular opinion that manual communication is detrimental to or incompatible with the development of speech or lip reading" (p. 327). She concludes her argument by stating that "... some evidence was reported to the effect that children who are most likely to be judged as having good communicative skills are those who were exposed to both oral and manual training at an early age" (p. 328).

Yoshinaga-Itano (in press) undertook case studies of the spoken language development of a number of profoundly deaf children. Of the total number studied, three of the children had substantial sign vocabulary before implantation. All three wore amplification, but had no documented speech perception or speech discrimination skills prior to cochlear implantation. She found that these three children appeared to fast map their speech production onto their sign vocabulary after cochlear implantation. For these children, chronological-age-appropriate or near-age-appropriate spoken vocabulary was acquired within 12-14 months post-implant. Yoshinaga-Itano believes that this development appears to be evidence of an oral phonology piggy-back onto the lexical sign language foundation. That is, these three children discovered that the sounds they were hearing with the cochlear implant were another code for the sign vocabulary that they used to communicate. Following this discovery, a rapid mapping of the sounds of English onto the sign vocabulary appears to have happened.

Models of deafness

Given the evidence outlined in regard to the benefits of early sign exposure and use, I wish to examine briefly how the practice of "making a choice" in regards to communication method has evolved when looking at communication with young deaf children and outline why I believe the practice of "choosing" does not serve deaf children well, because of the values and beliefs which underlie the practice.

We are all familiar with the statistics which state that the overwhelming majority of deaf children are born to parents who can hear (usually a figure of 90% is quoted). Hearing parents who have a deaf child are generally informed very early on that they need to make a choice about the way in which they will communicate with and educate their children: either with or without the use of signs. The birth of their deaf child may be the parents' first encounter with hearing loss, which is confronting and confusing. Many parents find it difficult to accept Deaf people's view of themselves as "normal, just not able to hear" (Power, 2005, p. 452). Parents in this situation experience shock, denial, grief and distress at the discovery of their infant's loss and are "very susceptible" (Power, 2005) to the attractions of cochlear implant programs and the promise of "normalisation", the basis of which is a medical view of deafness as something to be "cured" or an illness to be eradicated.

Owing to the way in which many early diagnosis and intervention programs in Australia operate, parents are rarely given the opportunity to explore the socio-cultural view of deafness. The socio-cultural model contrasts with the medical model. Proponents of the socio-cultural perspective of deafness point to the fact that members of the Deaf community lead "normal" family, social, and work lives, communicating via sign language, writing, and (in many cases) speech, and are able to interact in both the Deaf and hearing communities (Power, 2005). The socio-cultural perspective recognises that a deaf child or deaf person is normal in their own terms (not in comparison to hearing children) and will develop characteristically as a deaf person, with their own strengths, weaknesses and talents (Young & Tattersall, 2007).

For some children the promise of the implant is achieved, which is a wonderful outcome. Critics argue that the cochlear implant and the subsequent therapy often become the focus of the child's identity, at the expense of the development of a deaf identity, exposure to information about the deaf community and ease of communication in sign language. Measuring the child's success by their success in hearing and speech will lead to a poor self-image as "disabled" (because the implants do not produce normal hearing) rather than having the healthy self-concept of a proud deaf person (Hyde & Power, cited in Power, 2005).

What then happens for these children, who may be well beyond the "critical period" for acquiring language? If all deaf children are given the opportunity to acquire sign language from an early age, they will be in a better position to learn another language from the base of a solid first language. Even for a child for whom a cochlear implant is a success, he or she will still be a deaf child when in the swimming pool or in the bath tub, or any other situation when the cochlear implant is not in place and where communication is necessary. He or she will still be a deaf child while awaiting surgery and prior to the implant being switched on (a period which can vary from 5 - 17 months). Access to sign language means access to language and communication in all situations. Viewing deafness from a socio-cultural perspective values deaf people as a vital part of our multi-cultural society (not as inferior hearing people) and sees hearing loss as a normal part of the human condition, not an abomination.

Conclusion

No-one would dispute the statement that if the deaf child is to communicate effectively with the hearing world, he/she must acquire facility in speech, speech reading and writing. Meadow (2005) also notes that if the child is to communicate effectively within the Deaf community, he/she must acquire both receptive and expressive facility in fingerspelling and sign language. In addition, the child should feel comfortable about his/her identity as a deaf person and about his/her own communicative skills and be willing to use these skills to communicate with any person, either deaf or hearing.

Good early communication for deaf children, no matter what modality is used, should capitalise on deaf children's talent for acquisition by providing a rich environment from which they can internalise the language naturally. Deaf children have a right to all worlds, not just deaf, not just hearing.
References

Hyde, M. & Power, D. (2006). Some ethical dimensions of cochlear implantation for deaf children and their families. Journal of Deaf Studies and Deaf Education. 11(1), 102-111.

Fischer, S.D. (1998). Critical periods for language acquisition: consequences for deaf education. In A. Weisel (Ed.). Issues unresolved: New perspectives on language and deaf education. Washington, D.C.: Gallaudet University Press.

Meadow, K.P. (2005). Early manual communication in relation to the deaf child's intellectual, social and communicative functioning. Journal of Deaf Studies and Deaf Education. 10(4), 321-329.

Petitto, L.A. and Holowka, S. (2002). Evaluating attributions of delay and confusion in young bilinguals: Special insights from infants acquiring a signed and spoken language. Sign Language Studies, 3(1), 4-34.

Petitto, L.A., Katerelos, M., Levi, B., Gauna, K., Tetrault, K, & Ferraro, V. (2001). Bilingual signed and spoken acquisition from birth: Implications for the mechanisms underlying early bilingual language acquisition. Journal of Child Language, 28(2), 1-44.

Power, D. (2005). Models of deafness: Cochlear implants in the Australian daily press. Journal of Deaf Studies and Deaf Education. 10(4), 451-459.

Swanwick, R. (2001). The demands of a sign bilingual context for teachers and learners: An observation of language use and learning experiences. Deafness and Education International, 3(2), 62-79.

Woll, B. (1998). Development of signed and spoken languages. In Gregory, S., Knight, P. McCracken, W., Powers, S. & Watson, L. (Eds.). Issues in deaf education. London: David Fulton Publishers.

Young, A., & Tattersall, H. (2007). Universal newborn hearing screening and early identification of deafness: Parents' responses to knowing early and their expectations of child communication development. Journal of Deaf Studies and Deaf Education, 12(2), 209-220.

About Dr Maree Madden
Maree works in Brisbane, Queensland as an interpreter and interpreter trainer. She originally trained as a teacher of deaf students, and has taught in primary, secondary and tertiary settings. Maree was principal of the Thomas Pattison School at the Royal Institute for Deaf and Blind Children from 2002-2005. Her particular interests are: sign bilingual education for deaf students, language acquisition of deaf students, Auslan to English interpreting skills and Auslan storytelling. She is a published author and reviewer for the Journal of Deaf Studies and Deaf Education. Read more about Dr Madden...
Disclaimer: The information contained on this website is not intended as a substitute for independent professional advice.

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Early exposure to sign language: an advantage to parents and children

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Introduction - the importance of language The development of language is essential for the cognitive and social development of all children, including, of course, those children who are deaf. Expressive language ability in any modality plays a major role in the development of spoken language (Yoshinaga-Itano, in press).

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This article from the National Library of Medicine discusses how sign language is an important foundation for any deaf child to ensure healthy growth in all areas. It talks about the negative effects of lack of access to language including cognitive delays, mental health difficulties, lower quality of life, and higher trauma. This provided me with more insight into the developmental effects of language and how important it is to set sign language as a base for any further developments including cochlear implants.

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For hundreds of years, language philosophies and education of deaf children have been mired in an "either-or" dilemma between sign language-inclusive and spoken language-only approaches. It has been described as a "highly polarized conflict" with widespread misinformation about what is the best approach ( Humphries et al., 2012b), such as the belief that sign language acquisition interferes with spoken language acquisition. In fact, bilinguals are associated with better cognitive outcomes when compared with monolinguals ( Adesope, Lavin, Thompson, & Ungerleider, 2010), especially at earlier ages of active bilingualism ( Luk, De Sa, & Bialystok, 2011). This belief of sign language-interference has endured despite a long-standing lack of empirical evidence that spoken language-only approaches are more effective ( Henner, Caldwell-Harris, Novogrodsky, & Hoffmeister, 2016; Humphries et al., 2016).

In a recent systematic review of sign language and spoken language interventions compared to spoken language-only interventions, the authors concluded "...very limited, and hence, insufficient evidence exists to determine whether adding sign language to spoken language is more effective than spoken language intervention alone to foster [spoken] language acquisition" ( Fitzpatrick et al., 2016, p. 14). Such reviews are fundamentally flawed in failing to distinguish natural sign languages from artificial communication systems, which would not enable bilingualism or language transfer (e.g., sign-supported speech or signing exact English) ( M. L. Hall, Caselli, & Hall, 2017). Additionally, the authors approach the system review as if the "burden of evidence" is in only one direction; however, if the evidence is supposedly insufficient in one direction - ipso facto, it is insufficient in the other direction and there is insufficient evidence of spoken language-only approaches being more effective.

Medical and educational advice is frequently rooted in a framework of viewing deaf children as "defective hearing people" ( Bailes, Erting, Erting, & Thumann-Prezioso, 2009), an approach that becomes a self-fulfilling prophecy. In fact, medical school education does not address language development for deaf and hard-of-hearing children ( Humphries, Kushalnagar, Mathur, Napoli, Padden, Pollard, et al., 2014), which can lead to flawed medical advice. Additionally, parents often rely on community sources (e.g., teachers, ministers, other community members) that are not knowledgeable about language, cognitive, and brain development of deaf children ( Humphries, Kushalnagar, Mathur, Napoli, Padden, Rathmann, et al., 2014).

Some hearing loss professionals and organizations advocate for preventing sign language exposure through the Listening and Spoken Language approach, what is historically known as oralism ( Sugar, 2016; Sugar & Goldberg, 2015). This opposition to sign language is not based on empirical evidence supporting the harm of sign language exposure, thus perpetuating misinformation such as the sign language acquisition window being longer than the spoken language window. Rather, this systematic exclusion of sign language in deaf child development is described as being rooted in bias and prejudice ( Humphries et al., in press). As a result, parents can become misinformed about the "potential and probable implications" of not exposing their deaf child to a fully accessible visual language such as sign language ( Bailes et al., 2009, p. 449). If spoken language is not fully accessible to the deaf child and sign language exposure is delayed, then there is a strong possibility of permanent brain changes.

During the critical period of language acquisition (approximately the first five years of development), there is a high degree of brain plasticity. Language delays affect development of neuro-linguistic structures in the brain, especially those related to developing grammar and second language acquisition ( Skotara, Salden, Kugow, Hanel-Faulhaber, & Roder, 2012), and appear to decrease grey matter in certain parts of the brain ( Penicaud et al., 2013). Altogether, a fundamental and irreversible biological impact - on the brain and on healthy development - appears to occur when an accessible language is not provided by a certain early time period in brain development.

A brain imaging study of deaf adults who could not functionally communicate in spoken English and used American Sign Language (ASL) for 30+ years, but were exposed to ASL at different times (birth to 3 years, 4 to 7 years, and 8 to 14 years), found an "age of acquisition" effect on their ability to understand grammar ( Mayberry, Chen, Witcher, & Klein, 2011). More specifically, later exposure demonstrated more activation in posterior visual brain regions, and less in anterior language brain regions while watching ASL sentences; the reverse was true for those who were exposed to ASL earlier. Later exposure meant that linguistic information was more likely to be processed as visual information, a far less efficient means of language processing. Even after decades of language use, later exposure to ASL meant less processing in language brain regions - highlighting that the sign language acquisition window is not longer than spoken language. Generally, delayed acquisition leads to less specialization of language in the brain ( Leybaert & D'Hondt, 2003).

Parents have high expectations for successful outcomes of the cochlear implant (a neuro-prosthesis that bypasses the ear and provides sound stimulation to the brain); many are convinced that it is the only option for their deaf child to acquire language ( Humphries et al., 2012; Humphries, Kushalnagar, Mathur, Napoli, Padden, Rathmann, et al., 2014; Hyde, Punch, & Komesaroff, 2010). Receiving a cochlear implant, however, between one and two years of age does not guarantee normal spoken language skills five years after implantation: non-signing implanted children can display significant language deficits relative to their hearing peers, including lower vocabulary knowledge and inconsistent speech production/perception ( L. S. Davidson, Geers, Blamey, Tobey, & Brenner, 2011; Duchesne, Sutton, & Bergeron, 2009; Lund, 2015; Tobey, Geers, Sundarrajan, & Shin, 2011). Indeed, the cochlear implant has been described as being able to "provide an advantage for spoken language development, [but does not] assure development of spoken language in the normal range for all children by school age..." ( Tobey et al., 2013, p. 10).

In contrast, a study of implanted children - who sign from birth - suggest that they can demonstrate comparable scores on standardized language testing (including speech skills) to their hearing peers ( K. Davidson, Lillo-Martin, & Chen-Pichler, 2013). The implanted signing children's scores were also better than results shown in previous studies of implanted children who did not sign from birth. The authors concluded that "without a period of language deprivation before the implantation of the cochlear implant, children with cochlear implants can develop spoken language skills appropriate for [their age]... sign language input does no harm to a deaf child's spoken language development after h/she receives an implant" (p. 247). Similar results were seen in a group comparison of 14 signing and non-signing implanted children; the signing-implanted children outperformed the non-signing children on three measures of spoken language ( Hassanzadeh, 2012). More recently, a study of general intelligence in signing and non-signing implanted deaf children found sign language to significantly benefit cognitive outcomes, leading the authors to suggest that "the use of sign language before cochlear implants is recommended" ( Amraei, Amirsalari, & Ajallouiyan, 2017).

Language deprivation, through the exclusion of a fully accessible visual language such as sign language, appears to be a more likely cause of poor language outcomes in deaf people. In the case of the cochlear implant, for example, learning how to hear and learning a spoken language simultaneously is considerably more burdensome than already having a growing language foundation that can be used to help cochlear implant skill development. The common recommendation of using sign language as a "last resort," only after noticeable failure to develop speech skills, creates the possibility for language deprivation to occur given that there is only one time-sensitive language acquisition window regardless of visual or auditory modalities.

There does not appear to be any evidence that language cannot be learned via multiple modalities or that using sign language impairs spoken language development, but there is strong, and growing, evidence that lack of language access can cause negative development ( Lederberg, Schick, & Spencer, 2013). "Evidence from deaf people who have failed to develop spoken language in an oral environment suggests that when sign language is learnt later in life, they will never display the typical neural circuitry of natively learnt languages" ( Lyness, Woll, Campbell, & Cardin, 2013, p. 2628).

Language deprivation can cause cognitive delays and mental health difficulties across the lifespan. Mental health clinicians often see language deprivation and language dysfluency being a common "symptom" in deaf individuals who seek treatment, and are subsequently admitted to inpatient hospitals ( Black & Glickman, 2006). For some of these deaf patients, language deprivation is so severe that it may be its own mental health disorder - a "language deprivation syndrome" ( Glickman, 2007, 2009; Gulati, 2003, 2014; W. C. Hall, Levin, & Anderson, in press; Humphries et al., 2016b).

Prevalence of mental health issues appears to be proportionally elevated in the deaf population, along with a lower quality of life ( Fellinger et al., 2005; Fellinger, Holzinger, & Pollard, 2012). Higher rates of interpersonal trauma are also a concern as are distinct traumas unique to being a deaf child raised in a hearing world ( Anderson & Leigh, 2011; Anderson, Wolf Craig, Hall, & Ziedonis, 2016). In a study of mental health status of implanted deaf children and their hearing peers, teacher ratings of peer problems and general issues were elevated for implanted students ( Huber & Kipman, 2011). Additionally, one study of deaf college students demonstrated higher rates of child maltreatment, lifetime trauma, and post-traumatic stress symptoms compared to their hearing peers ( Schenkel et al., 2014).

In the studies described above with suggested protective factors, all were connected to language. This included deaf community identification, socialization with deaf peers, and early access to communication with family and peers. Parental communication appears to be a more significant predictor than parental involvement in education for positive language and academic development in deaf children ( Calderon, 2000). The implication of these protective factors is that language deprivation may be partially responsible for health disparities experienced by deaf people - which is a growing concern in the field of health literacy and knowledge connected with language skills ( Barnett, McKee, Smith, & Pearson, 2011; McKee, Barnett, Block, & Pearson, 2011; McKee & Paasche-Orlow, 2012; McKee et al., 2015; Smith, Kushalnagar, & Hauser, 2015).

Claims that spoken language-only approaches are more effective are not rooted in an objective research foundation, and may interfere with healthy development of deaf children. Parents and professionals should be aware that the cochlear implant is currently unreliable as a standalone first-language intervention for the deaf child ( Humphries et al., 2012b; Kral, Kronenberger, Pisoni, & O'Donoghue, 2016). The benefits of early language exposure are not disputed and when the choice is between more (sign language-inclusive) or less (spoken language-only) language exposure, the standards of clinical practice should demand overwhelming evidence of the gains made by less language exposure rather than the current demand for evidence supporting more language exposure.

The lifelong consequences of language deprivation are too far-reaching, from early childhood to adulthood, to limit a deaf child's time-sensitive language acquisition opportunities. Rather than focusing on auditory deprivation and speech skills, developmental approaches for deaf children should prioritize healthy, expected development of all developmental domains (e.g., cognitive, academic, socio-emotional) that comes with the guaranteed full acquisition of a fully accessible first-language language foundation such as sign language.

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What you don't know can hurt you: The risk of language deprivation by impairing sign language development in deaf children

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For hundreds of years, language philosophies and education of deaf children have been mired in an "either-or" dilemma between sign language-inclusive and spoken language-only approaches. It has been described as a "highly polarized conflict" with widespread misinformation about what is the best approach ( Humphries et al., 2012b), such as the belief that sign language acquisition interferes with spoken language acquisition.

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The novel, "El Deafo" by Cece Bell follows the life of a young girl (portrayed by a bunny) who loses her hearing at a young age. It focuses on the struggles that she faces being a deaf child. She is self-conscious of her hearing aid and therefore creates a superhero persona to gain confidence. This story opened my eyes to what life is like without hearing and the struggles one may face. I had never put myself in the shoes of a deaf person before and this novel allowed me to do so. Rather than using sign language as her main form of communication, Cece adapted to hearing aids. This is a different form of communication that deaf people may use to engage with their community. Cece never learned sign language because she was once able to hear and learn English. Eventually, when she learned sign language as an adult (this is a true story) it was more difficult for her because she had never practiced it prior. For Cece, she was able to use her hearing aids as a way to connect with people and help her social life.

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Read 7,659 reviews from the world's largest community for readers. Starting at a new school is scary, even more so with a giant hearing aid strapped to you...