*This is a long-ie, but a good-ie... especially if you are a parent or service provider to a D/HH child. Stick with me for the ride.
More than 90% of deaf/hard-of-hearing (D/HH) children are born to hearing parents (NIDCD, 2021)
That means that less than 10% of D/HH children get immediate, reliable language input via sign language from a D/deaf parent (and that's assuming all the D/deaf parents are signers).
Seeing as most hearing people do not know "happen" to know sign language and with the improved technology in the hearing aid/cochlear implant world, it is no surprise that many parents opt to seek auditory access (access to sound) for their child by pursuing hearing assistive devices. In fact, approximately 80% of children born deaf in the developed world are implanted with cochlear devices that allow some of them access to sound with the goal of spoken language in mind (Humphries et al., 2012). This process consists of working with an audiologist to determine the child's specific type and degree of hearing loss, etiology of hearing loss (which helps to determine whether it may be progressive), and to determine the best device to support the child's auditory development (ex., hearing aids, cochlear implants, bone-anchored hearing aids (BAHAs), etc.).
As hearing assistive technology improves daily, children are receiving devices at younger ages, and many children are quickly catching up developmentally to their peers in hitting their language milestones. All good news, right?
Unfortunately, there is a looming concern that is not talked about enough and needs to be addressed. This process is
not as black-and-white as it may seem, and for the children who are falling between the cracks into that dreaded gray area, they are at a very real risk for
Retrieved from: https://www.spoonflower.com/en/shop/cochlear-implant
Language Deprivation.
What is Language Deprivation?
If a child does not have access to strong, frequent, and consistent language input from a fluent model, they will not successful develop a strong language foundation and are therefore considered to be in a state of language deprivation. There are many examples of this in history such as feral children, abused/neglected, children, children within low socioeconomic households, and, most commonly, D/HH children.
In order to achieve effective language acquisition (learning language) and ultimately achieve fluency of a language, it is imperative that children be exposed to strong language models within the critical period of language development (link) and especially within the first year of life (Friedmann & Rusou, 2015).
Here's why.
In the first few years of life, the brain is forming more than one million new neural connections every SECOND!
That's A LOT of learning happening. In an attempt to make brain circuits become more efficient, these connections begin to slow as the child ages (Center on the Developing Child, 2023). At this point, learning new things (like language) becomes more difficult.
The photo below captured from Levitt, 2009 illustrates this phenomenon. Neuroplasticity is defined as the brain's ability to form new connections and alter connections in response to new experiences. The brain's neuroplasticity is significantly greater in the earlier years of life, and therefore language learning is most efficient during this time. As the child gets older, even only by a few months, the amount of effort that building those neural connections requires is much greater. It takes longer, involves more exposures, and requires more practice.
Retrieved from: https://developingchild.harvard.edu/science/key-concepts/brain-architecture/#:~:text=In%20the%20first%20few%20years,circuits%20to%20become%20more%20efficient.
Therefore, when a child does not have access to consistent, robust, and fluent language models within the earliest years of their life, they are likely to fall quickly behind their same-aged peers requiring intensive intervention to "close the gap". If they remain in a state of language deprivation until after the critical period for language development closes, it is possible that they will NEVER close that gap.
Every second that a D/HH child is in a state of language deprivation within the first few years of life, they are missing out on millions of neural connections that they need in to effectively communicate. This includes exposure to:
Speech sounds (only if spoken language is the goal) in order to map sound combinations on to meaning (development of phonology and morphology)
New vocabulary (lexical/semantic development)
Modeled sentence structures (grammatical/syntactic development)
How that language is used to communicate/meet their wants/needs (pragmatic language development)
If a child does not have auditory access to speech sounds, then they will not learn how those sounds combine to create words.
Every day that children get older, their brain is slowing down in the number of neural connections they are creating which requires higher levels of repetition, practice, exposure, and time to create those SAME connections.
This means that without early access to a strong language foundation, a child will not be able to communicate as effectively as their peers, and thus the gap between the developmental expectations and their current skills will become wider (requiring a need to play catch up). Additionally, the effort needed to close this gap will increase. Some research even suggests that following the critical period of language development, these children will never fully "catch up", even when extreme interventions are in place (Mayberry, 1992, 1994).
*Note that this chart is simply intended to be an infographic visual to illustrate how the gap between typical language development and those of same-aged D/HH peers widens with an increased period of language deprivation (Based on research from Friedmann & Rusou, 2015).
Language deprivation not only impacts a child's ability to communicate, but can also lead to many other difficulties down the line, including:
Cognitive delays
Mental health difficulties
Lower quality of life
Higher levels of trauma
Impacted literacy skills
Poor academics
Poor grammar and sentence structure
Difficulty with social language
(Hall, 2018)
D/HH Kids are at MUCH Higher Risk for Language Deprivation
To explain, I need to remind you of our earlier statistic:
More than 90% of deaf/hard-of-hearing (D/HH) children are born to hearing parents
(NIDCD, 2021)
This statistic is important to consider for a few key reasons:
Most hearing parents want their children to have access to sound so that they will eventually speak.
Most hearing parents do not know sign language when their child is born and therefore cannot give them quality language input right away.
Many parents don't realize the grave importance of early exposure to language and how significantly development can be impacted when language exposure is withheld.
Few hearing parents are able and/or willing to learn sign language, especially when hearing devices like cochlear implants are presented as an option. Approximately 1 in every 4 parents of D/HH children know or learn sign language (Weaver & Starner, 2010).
However, D/HH children do not often have access to spoken language. This is because they do not have auditory access (the ability to hear and perceive speech sounds). Auditory access is required to learn that combinations of speech sounds create words that are mapped on to certain meanings. Understanding the meaning being referenced based on combinations of speech sounds is called speech perception.
For example, if a child hears someone say the word "cat", they are perceiving each individual speech sound within that word and learning that the combination of those sounds creates a word that holds meaning.
/k/ "C" + /æ/ "A" + /t/ "T" = the small, furry animal that says "meow"
Additionally, if the /s/ "s" sound is added to the end of the word ("cats") this now changes the meaning again. Now, you may infer that there is more than one furry "meowing" animal (ex. Look at those cats!). Or, perhaps the speaker is referencing something that belongs to that furry animal (ex. "Here is the cat's food). Language is very intricate, and speech sounds (or phonemes) are the foundation to developing spoken language.
If a child is unable to hear all of the phonemes within their spoken language, they are not going to be able to effectively map meaning on to those words the way hearing people can. Even children with a mild hearing loss may miss key speech information needed to effectively perceive speech the way that their normal hearing peers can. (FIND HL VIDEO WITH WORDS MISSING? IN CF RIVER SCHOOL PRESENTATION???)
Given that hearing parents often don't know sign language (Weaver & Starner, 2010), this means that their child's language acquisition relies on having auditory access (with a hearing assistive device) in order to develop spoken language. If the child does NOT have reliable auditory access AND they are not getting language input through a signed language, they are now in a state of language deprivation during their critical period of language development.
That is a BIG problem.
Every child's hearing loss looks slightly different, and thus the severity of language deprivation will vary. Let's discuss an example of an extreme case of language deprivation first:
A child is born with a profound hearing loss, meaning that they do not have access to ANY speech sounds spoken at a conversational, or even an elevated, volume. This child does not have auditory access to speech, and would therefore at this point, not be able to acquire spoken language.
There are a few directions you can go from here...
(*and note that your options will vary based on your child's etiology, type, and degree of hearing loss):
Decide to immediately provide your child with robust language input through a signed language (most often American Sign Language from a fluent, native signer). If/when they have reliable auditory access via a hearing assistive device, then you may choose to provide spoken language input and continue modeling both languages separately, allowing the child to decide which language they prefer OR continue to use both.
Provide your child with sign language and choose not to provide your child with auditory access via hearing assistive devices.
Work with an audiologist to try to get your child auditory access (e.g., hearing aids, cochlear implants, BAHA, etc.) without any introduction of a signed language. The process of determining whether a child has auditory access using their hearing devices can often take up to several months, which means several months of no language input within their critical period of language development.
Options 1️⃣ and 2️⃣ provide the child with access to guaranteed, robust language input during the most critical period of language development.
On the contrary, option 3️⃣ potentially leaves the child in a state of language deprivation during the earliest, most CRITICAL period of their language development.
Other considerations:
Because baby's are not able to report whether they are benefiting from hearing assistive devices and testing is less reliable, it can often taken several months to acquire/adjust hearing assistive technology and determine if the child is getting a benefit from their device (s) (can hear speech sounds while using them). Devices do not always offer accessible language to many D/HH children, and by the time it is clear that the child is not acquiring spoken language, the critical period may be closing (Humphries et al., 2012).
The success rate of cochlear implants and other hearing technologies are often variable from child-to-child and depend a great deal on etiology (cause) of hearing loss, degree (severity) of hearing loss, anatomy, wear time, age at implantation, and random variation even when variables are controlled (Humphries et al., 2012).
The etiology of a child's hearing loss is often unknown at birth. For some children, their hearing loss is progressive (get worse over time). This means that sometimes, even when the child is getting a current benefit from hearing devices, their auditory skills may still decline with time.
Now, let me be clear. This is not a blame game. No parent wishes a state of language deprivation on their child. This happens because they are not being provided relevant, unbiased, evidence-based, accurate, and CRITICAL information with an appropriate level of urgency from the right professionals. It is a flawed system that it leading too way too many children falling through the cracks.
Thus, there is a systematic problem in getting parents of D/HH children immediately connected to the most knowledgeable and qualified professionals who can guide them and help them LEARN and UNDERSTAND that:
1) Language deprivation is a very real possibility for their child
2) There are ways to make sure that it NEVER happens
So, where do we go from here?
The brain has no preference for language input.
...Let me repeat that.
THE ❗BRAIN ❗HAS ❗NO ❗PREFERENCE ❗FOR ❗LANGUAGE❗ INPUT❗
However, the brain in the early years of life is ready and primed for whatever language input is thrown its way. Whether that language is in the form of a verbal language (ex., English, Spanish, Russian, Japanese, etc.) or a visual language (ex. American Sign Language, British Sign Language, French Sign Language, etc.). A strong language foundation, is a strong language foundation.
As long as the brain is provided with robust language models during the critical period of language development, a strong language foundation CAN and WILL be achieved in any language.
Introducing signed language provides GUARANTEED language input (as long as the baby has normal vision of course) and a strong language foundation for the baby.
I bet I know what you're thinking...
"
Ok...but will introducing sign language impact my baby's spoken language development?"
The answer to that question is a resounding and emphatic...
NO!
SAY 👏 IT 👏 WITH 👏 ME 👏.
No seriously, say it with me. Like, out loud... 🔊
"Sign language, when presented 1) with strong language models and 2) separately from spoken language, will NOT interfere with a baby's ability to develop spoken language."
Introducing sign language will guarantee a few things:
Ensure that your baby is not falling into a state of language deprivation.
Allow your baby to communicate more effectively and expressively communicate earlier in their life (first words at ~ 9 months) than they would with access to spoken language only (first word at ~12 months) (IDEAL, n.d.).
Give your baby the opportunity to grow up bilingual! Whattt how cool is that?
There is no evidence that sign language exposure interferes with spoken language development, but there is evidence that is benefits overall language development and growing evidence that lack of language access has negative implications. The bottom line is that even when the goal is spoken language, hearing assistive devices are often not a reliable method of language input alone for D/HH children (Hall, 2018). Not when the stakes of language deprivation are this high.
Now, before we wrap this up, I want to make a few things very clear:
★ Introducing sign language to your baby does not mean that you cannot pursue spoken language for your child.
★ It does not mean that you have to choose between sign language and spoken language. You can use both with your child.
★ It does not mean that your baby shouldn't have a cochlear implant or auditory access.
★ It does not mean your baby cannot be a part of the Deaf world.
★ And it certainly does not mean that you are hindering spoken language development.
What it DOES mean, is that:
➜ Your baby will not suffer from language deprivation.
➜ Your baby will have a way to communicate their wants and needs, in their early years.
➜ Your baby will have access to a variety of languages which ultimately allows your child to make the choice of how they would like to communicate.
They will tell you.
They will show you.
& they might even do a little bit of both.
🖤
Sources
Friedmann, N. & Rusou, D. (2015). Critical period for first language: the crucial role of language input during the first year of life. Current Opinion in Neurobiology, 35 (27-34). doi: 10.1016/j.conb.2015.06.003 ·
National Institute on Deafness and Other Communication Disorders (NIDCD). (2021). Quick Statistics about Hearing. Retrieved from: https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing#:~:text=About%202%20to%203%20out,in%20one%20or%20both%20ears.&text=More%20than%2090%20percent%20of%20deaf%20children%20are%20born%20to%20hearing%20parents.&text=Approximately%2015%25%20of%20American%20adults,over%20report%20some%20trouble%20hearing.
Harvard University's Center on the developing Child (2023). Brain Architecture. Retrieved from: https://developingchild.harvard.edu/science/key-concepts/brain-architecture/#:~:text=In%20the%20first%20few%20years,circuits%20to%20become%20more%20efficient.
Levitt, P. (2009). The Science of Early Brain Development: A Foundation for the Success of Our Children and the State Economy. National Scientific Council on the Developing Child. Retrieved from: https://www.purdue.edu/hhs/hdfs/fii/wp-content/uploads/2015/07/s_wifis32ppt_pl.pdf
Hall, W. C. (2018). What you don’t know can hurt you: The risk of language deprivation by impairing sign language development in deaf children. Maternal and Child Health Journal, 21(5), 961-965. doi: 10.1007/s10995-017-2287-y
Humphries, T., Kushalnage, P., Mathur, G., Napoli, D., Padden, C., Rathmann, C. & Smith, S. R. (2012). Language acquisition for deaf children: Reducing the harms of zero tolerance to the use of alternative approaches. Harm Reduction Journal, 9(16), 1-9.
MAYBERRY R.I-, 1992 : The cognitive development of deaf children : Recent insights. In Rapin & S. Segalowitz (Eds.), Child Neuropsychology, Volume 7 in Handbook of Neuropsychology, F. Boiler & J. Grafman (Series Eds.) (pp. 51-68). Amsterdam: Elsvier.
MAYBERRY R.L, 1994 : The importance of childhood to language acquisition: Insights from American Sign Language. In J.C. Goodman & H.C. Nusbaum (Eds.), The Development of Speech Perception : The Transition from Speech Sounds to Words, (pp. 57-90). Cambridge; MIT Press.
Weaver, K.A., & Starner, T. (2010). We Need to Communicate! Helping Hearing Parents of Deaf Children Learn American Sign Language. Annual ASSETS Conference. Retrieved from: https://eric.ed.gov/?id=ED530818
IDEAL. American sign language and english language developmental milestones [PowerPoint Slides] Retrieved from: https://www.in.gov/health/cdhhe/files/ideal-language-milestones-english-american-sign-language.pdf
https://www.bu.edu/articles/2017/asl-language-acquisition/
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