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Language Choices for Deaf Infants: Advice for Parents Regarding Sign Languages

Clinical Pediatrics
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© The Author(s) 2015
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DOI: 10.1177/0009922815616891
The principle of respect for autonomy in modern medi-
cal ethics
leads doctors to avoid persuasion and aim for
neutrality when discussing language choices regarding
deaf infants. However, at times persuasion to overcome
biases is necessary and ethically mandatory.
Many parents and health professionals have faith in the
ability of cochlear implants (CIs) to allow deaf children to
“hear” and achieve normal language and speech develop-
ment. While it is good to encourage parents’ hope for their
children’s future, to avoid bias, medical professionals
must acknowledge the reality that CIs do not replace nor-
mal hearing. As of 2006, 80% of deaf infants in Northern
Europe were receiving CIs,
and as of December 2010,
roughly 40% worldwide.
Parents need to know that CI
may not guarantee their child’s language acquisition.
While a CI is usually given only to a child who will not
benefit from a hearing aid, it is important to recognize that
CIs are not “super hearing aids”; even hospitals that per-
form CI surgery make statements such as: “For most
patients, a cochlear implant will not work as well as a
hearing aid”
and studies support that statement.
because a hearing aid (HA) simply amplifies sound,
whereas with CIs sound is transformed into electrical
impulses delivered directly to the cochlear nerve. The
CI-child must undergo long-term extensive training to
interpret those electrical impulses.
Unpredictable indi-
vidual variation in outcomes is pervasive even with great
effort and dedication from caregivers and the deaf child
some deaf children receive little to no auditory benefit
from CIs in acquiring language.
The neuronal plasticity of the brain with respect to lan-
guage acquisition is maximal before the age of 3 years
; if
a child is not fluent in a language by the age of 5 years, that
child may never achieve full fluency in any language.
the same time during this critical period, the increase in
synaptic density occurs earlier and more rapidly in the
occipital cortex than in the auditory
; so the deaf infant’s
brain is primed for visual input. Sign languages provide
this visual input; access to signing can ensure language
acquisition for deaf children and avoid cognitive deficits
associated with linguistic deprivation.
The deaf child
who signs well does better academically than the deaf child
who doesn’t, regardless of all other factors,
and most
attribute this to the fact that the signing deaf child is not at
a linguistic disadvantage. Given evidence such as this, a
recent panel of specialists concluded that all children born
deaf should be taught a sign language immediately.
We are a team of specialists in education studies, lin-
guistics, pediatric medicine, and developmental psy-
chology; our work focuses on deaf individuals. In order
to help the practicing pediatrician, we offer here
responses to common family questions. Our responses
respect families’ autonomy while bearing in mind the
difficulty that many parents have coming to terms with
children who are different. The evidence-based informa-
tion related to deaf children’s language and speech
development here should help enable parents to better
be involved in making the relevant decisions.
intention is for the advice below to go directly to parents
or indirectly via those involved in the educating of deaf
What Will Give My Child the Best
Chances of Learning to Talk?
The starting point is acquiring a language, not speech per
se. Languages can be spoken or signed, and both modali-
ties are “equal citizens” in a cognitive sense
; that is,
they fully support all human communicative needs in
daily interactions and academic endeavors. A child must
understand what language communication is about
CPJXXX10.1177/0009922815616891Clinical PediatricsHumphries et al
University of California at San Diego, La Jolla, CA, USA
Rochester Institute of Technology, Rochester, NY, USA
Gallaudet University, Washington, DC, USA
Swarthmore College, Swarthmore, PA, USA
Universität Hamburg, Hamburg, Germany
University of Rochester Medical Center, Rochester, NY, USA
Corresponding Author:
Donna Jo Napoli, Department of Linguistics, Swarthmore College,
500 College Avenue, Swarthmore, PA 19081, USA.
Language Choices for Deaf Infants:
Advice for Parents Regarding Sign
Tom Humphries, PhD
, Poorna Kushalnagar, PhD
, Gaurav Mathur, PhD
Donna Jo Napoli, PhD
, Carol Padden, PhD
, Christian Rathmann, PhD
and Scott Smith, MD, MPH
by guest on November 25, 2015cpj.sagepub.comDownloaded from
2 Clinical Pediatrics
before a child can communicate with language in either
modality. As a child participates in accessible language
communication, the child begins to understand and use
language in sign and/or speech. Sign languages are
accessible to all deaf children while spoken languages
may be fully accessible only to some, via HA or CI.
Introducing 2 languages does not interfere with
acquisition of either,
whether spoken or signed.
To the contrary, many studies show signing aids
development of spoken language and reading skills in the
In a study of CI-children who had been
learning to sign since birth, they performed in English on
par with hearing peers.
CI-children exposed to sign and
speech tend to show rapid learning in both.
with deaf parents often outperform CI-children with
hearing parents on spoken language skills, presumably
because of sign competence.
Children aged 4 to 7 years
implanted at age 12 to 24 months and educated through
oral-aural combined with signing are capable of achiev-
ing “age appropriate language levels on expressive
vocabulary and receptive syntax.”
Signing deaf
children use their phonological awareness skills in sign-
ing to help them read a spoken language.
How Can I Teach My Child Signing if
I Don’t Sign Myself?
Immigrant children who go to school with peers speaking
the surrounding language become fluent and speak like
their peers and the native speakers outside their home. In
particular, while their parents usually continue to use lan-
guage that is recognizably nonnative, the children do not
replicate their parents’ language use; they replicate the
language use of native speakers. So parents do not have to
be perfect language models or even very good language
models. What matters is that the child be exposed to good
language models frequently and regularly, and models
outside the home can serve that function very well.
However, even if not fluent, the parents’ language use
is still important to the language development of the
child. Children need to interact directly through language
with their family members in order to develop healthy
relationships with those members; the alternative leads to
feelings of isolation and frustration. When a hearing
mother signs with her deaf child, the child shows early
language expressiveness on a par with hearing peers
regardless of her signing abilities. And deaf children who
have good family relationships have a better chance of
developing healthy psychosocial identities.
In sum, when deaf children are placed into environ-
ments with good sign language models, they learn to
sign fluently, even if their family does not.
Most cities
have deaf and hearing communication centers that offer
sign language classes for families and that can help fam-
ilies make ties with deaf community members. (A list of
useful websites is offered at the end of this article.)
Won’t There Be Less Family
Disruption and Less Work if I Raise
My Child Strictly Orally?
The presence of a deaf child changes family dynamics
regardless of language(s) used.
If your child has HA or CI, it might be possible for
him or her to become linguistically competent and happy
using speech only. The training necessary for having a
chance at speech competence requires daily commit-
ment of time and effort on the part of all those involved
in raising and educating the child. But, importantly, it
also requires enormous persistence on the part of the
deaf child. If oral language skills enable the child to
communicate with hearing strangers, these skills might
open up additional social and professional opportunities,
to be sure. However, there is no assurance that any of
this will happen, no matter how much time and effort are
devoted to training. And if it doesn’t happen, not only
will the child have wasted great amounts of time that
could have been spent in play (important to learning)
and more fruitful activities, but the child may well expe-
rience a sense of failure.
On the other hand, sign language skills ensure the
child’s cognitive health and avoid family frustration.
Furthermore, the deaf child will have a language in
which to be comfortable, where the child can acquire
knowledge, catch jokes, and appreciate nuances of lan-
guage necessary to socialize, relax, and be eloquent.
Learning a sign language will definitely require time
and effort of the family, but for the deaf child it is a natu-
ral process that does not require extra effort.
Won’t Signing Adversely Affect My
Child’s Academic Achievements?
After All, Bilingualism Is Confusing
Knowing a sign language does not impede a deaf child’s
academic achievements. In fact, good signing skills pro-
mote the acquisition of literacy, both reading and writ-
ing, as study after study has shown.
It’s actually
simple: A child needs a solid foundation in a first lan-
guage in order to understand what literacy is all about,
and a sign language is the best way to give a deaf child
that foundation.
So deaf children need to be raised bilingually—in
both their local sign language and the ambient spoken
language, at least the written form of it. Bilingualism
might be considered a luxury for hearing children in
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Humphries et al 3
some places, but bilingualism is necessary for a deaf
child, to ensure intact language capabilities and social-
cultural development.
Parents can rest assured that bilingualism will not
harm their children, but, instead, bestow “the bilingual
The bilingual brain is quick, focused, and
flexible. Bilinguals are “mental jugglers” with enhanced
executive function.
Frequent juggling between lan-
guages increases cognitive benefit—and this goes for
bimodal bilinguals too
—whether one is a “balanced
bilingual” or not, although the more nearly balanced one
is, the more benefit for spontaneous cognitive flexibil-
Bilinguals show enhanced sensitivity to language
which is an advantage in language pro-
Bilingualism retards the onset of dementia.
Being raised bilingual improves language functioning
and higher level cognitive skills in children with lan-
guage impairments.
Can’t We Wait to See if Our Child
Succeeds with a CI Before Working
to Learn to Sign?
The earlier children are exposed to a language, the
greater guarantee of fluency. Infants with an intact audi-
tory system differentiate sounds of the surrounding lan-
guage from sounds of unfamiliar languages,
and a
child’s ability to distinguish between articulations (audi-
tory or manual) of her surrounding language in the first
year of life predicts language abilities in the second and
third years of life.
Early intervention services deliv-
ered before 6 months of age result in better receptive and
expressive language.
If the CI does not provide the
deaf child this critical early language access, as it often
does not, waiting to introduce signing runs the risk that
she might miss the window for language fluency.
But Won’t I Lose My Child to Deaf
Parents who sign are not more likely to “lose” their chil-
dren. In fact, logically, parents who sign strengthen the
bond with their deaf child. Children who associate with
other deaf people are not lost to their hearing families.
Deaf children’s experience will always be different from
their hearing parents, but they will also share much with
them if the family signs. Acceptance and love build
strong family bonds, not whether someone speaks or
signs. Having a strong sense of self supported by others
with the same experience gives deaf children, just like
hearing children, a sense of purpose and happiness,
important for future success.
Useful Websites
For families:
For both families and professionals:
(This is an article: Early Beginnings for Deaf and
Hard of Hearing Children: Guidelines for Effective
For introduction to sign:
Author Contributions
All authors substantially contributed to the concept and design
of this article, helped in drafting and revising it, and approved
this final version for publication.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
1. Beauchamp TL, Childress JF. Principles of Biomedical
Ethics. 5th ed. New York, NY: Oxford University Press;
2. Shaw D, Elger B. Evidence-based persuasion: an ethical
imperative. JAMA. 2013;309:1689-1690.
by guest on November 25, 2015cpj.sagepub.comDownloaded from
4 Clinical Pediatrics
3. Boyes Braem P, Rathmann C. Transmission of sign
languages in Northern Europe. In: Brentari D, ed. Sign
Languages. Cambridge, UK: Cambridge University
Press; 2010:19-45.
4. National Institute on Deafness and Other Communication
Disorders. Science Capsule: Cochlear Implants.
Bethesda, MD: National Institute on Deafness and Other
Communication Disorders; 2014. http://www.nidcd.
Cochlear-Implants.aspx. Accessed June 10, 2015.
5. Baylor College of Medicine. Cochlear Implants. Houston,
TX: Baylor College of Medicine.
cochlear-implants. Accessed June 10, 2015.
6. Figueras B., Edwards L., Langdon D.. Executive function
and language in deaf children. J Deaf Stud Deaf Educ.
7. Mauldin L. Parents of deaf children with cochlear
implants: a study of technology and community. Social
Health Illn. 2012;34:529-543.
8. Pisoni DB, Conway CM, Kronenberger WG, Horn DL,
Karpicke J, Henning SC. Efficacy and effectiveness
of cochlear implants in deaf children. In: Marschark
M, Hauser PC, eds. Deaf Cognition: Foundations
and Outcomes. Oxford, UK: Oxford University Press;
9. Humphries T, Kushalnagar P, Mathur G, et al. Language
acquisition for deaf children: reducing the harms of zero
tolerance to the use of alternative approaches. Harm
Reduct J. 2012;9:16. http://www.harmreductionjournal.
com/content/9/1/16. Accessed June 10, 2015.
10. Sharma A, Dorman MF, Spahr AJ. Rapid development
of cortical auditory evoked potentials after early cochlear
implantation. Neuroreport. 2002;13:1365-1368.
11. Pénicaud S, Klein D, Zatorre RJ, et al. Structural brain
changes linked to delayed first language acquisition in
congenitally deaf individuals. Neuroimage. 2012;66:
12. Huttenlocher P, Dabholkar A. Regional differences in
synaptogenesis in human cerebral cortex. J Comp Neurol.
13. MacSweeney M. Cognition and deafness. In: Gregory S,
Knight P, McCracken W, Powers S, Watson L, eds. Issues
in Deaf Education. London, UK: David Fulton; 1998:
14. Rönnberg J. Working memory, neuroscience, and lan-
guage: Evidence from deaf and hard-of-hearing individu-
als. In: Marschark M, Spencer P, eds. The Handbook of
Deaf Studies, Language, and Education. Oxford, UK:
Oxford University Press; 2003:478-490.
15. Remmel E, Peters K. Theory of Mind and language in
children with cochlear implants. J Deaf Stud Deaf Educ.
16. Kushalnagar P, Mathur G, Moreland CJ, et al. Infants and
children with hearing loss need early language access. J
Clin Ethics. 2010;21:143-154.
17. Freel BL, Clark MD, Anderson ML, Gilbert GL, Musyoka
MM, Hauser PC. Deaf individuals’ bilingual abilities:
American Sign Language proficiency, reading skills, and
family characteristics. Psychology. 2011;2:18-23.
18. Mellon N, Niparko J, Rathmann C, et al. Should all deaf
children learn sign language? Pediatrics. 2015;136:
170-176. doi:10.1542/peds.2014-1632.
19. Mathur G, Napoli DJ, Padden C. Option Grid. Deafness in
Infancy and Childhood: Language Options. 2013. http:// Accessed
June 12, 2015.
20. Global Coalition of Parents of Children Who are Deaf and
Hard of Hearing. Position Statement. 2010. https://sites. Accessed June 10, 2015.
21. Emmorey K. Language, Cognition and the Brain: Insights
From Sign Language Research. Mahwah, NJ: Lawrence
Erlbaum; 2002.
22. Genesee F. Early bilingual development: one language or
two. J Child Lang. 1989;16:161-179.
23. Genesee F, Nicoladis E, Paradis J. Language differen-
tiation in early bilingual development. J Child Lang.
24. Comeau L, Genesee F, Mendelson M. A comparison
of bilingual and monolingual children’s conversational
repairs. First Lang. 2010;30:354-374.
25. Lyness CR, Woll B, Campbell R, Cardin V. How does
visual language affect crossmodal plasticity and cochlear
implant success? Neurosci Biobehav Rev. 2013;37:
26. Zanjani MMO, Hasanzadeh S, Rahgozar M, et al.
Comparing the effect of auditory-only and auditory-visual
modes in two groups of Persian children using cochlear
implants: a randomized clinical trial. Int J Pediatr
Otorhinolaryngol. 2013;77:1545-1550.
27. Petitto LA, Katerelos M, Levy BG, Gauna K, Tétreault K,
Ferraro V. Bilingual signed and spoken language acquisi-
tion from birth: implications for the mechanisms under-
lying early bilingual language acquisition. J Child Lang.
28. Robbins AM. How does total communication affect
cochlear implant performance in children? Paper pre-
sented at: 4th ACFOS International Conference on The
Impact of Scientific Advances on the Education of Deaf
Children; November 8-10, 2002; Paris, France. http://
bins_acfos4.pdf. Accessed June 12, 2015.
29. Nussbaum D, Scott S. Children With Cochlear Implants:
Where Does Sign Language Fit in? Washington, DC:
Gallaudet University; 2004. http://www.audiology-
where-1092. Accessed June 12, 2015.
30. Mitchiner J, Nussbaum DB, Scott S. The implications of
bimodal bilingual approaches for children with cochlear
implants. NSF Science of Learning Center on Visual
Language and Visual Learning (Research Brief No. 6).
Washington, DC: Gallaudet University; 2012.
31. Davidson K, Lillo-Martin D, Chen Pichler D. Spoken
English language development in native signing chil-
dren with cochlear implants. J Deaf Stud Deaf Educ.
2014;19:238-250. doi:10.1093/deafed/ent045
by guest on November 25, 2015cpj.sagepub.comDownloaded from
Humphries et al 5
32. Davidson K, Goodwin C, Lillo-Martin D. Language
Transfer in ASL/English Bimodal Bilingual Children
With CIs. Paper presented at: Theoretical Issues in Sign
Language Research; July 2013; London, UK. http://
Accessed June 10, 2015.
33. Giezen MR, Baker AE, Escudero P. Relationships between
spoken word and sign processing in children with cochlear
implants. J Deaf Stud Deaf Educ. 2014;19:107-125.
34. Hassanzadeh S. Outcomes of cochlear implantation
in deaf children of deaf parents: comparative study. J
Laryngol Otol. 2012;126:989-994.
35. Yoshinaga-Itano C, Baca RJ, Sedey AL. Describing the
trajectory of language development in the presence of
severe to profound hearing loss: a closer look at children
with cochlear implants versus hearing aids. Otol Neurotol.
36. McQuarrie L, Abbott M. Bilingual deaf students’ phono-
logical awareness in ASL and reading skills in English.
Sign Lang Stud. 2013;14:80-100.
37. Spencer PE. The expressive communication of hearing
mothers and deaf infants. Am Ann Deaf. 1993;138:275-283.
38. Leigh IW. Who am I? Deaf identity issues. In: Lindgren
KA, DeLuca D, Napoli DJ, eds. Signs and Voices: Deaf
Culture, Identity, Language and the Arts. Washington,
DC: Gallaudet University Press; 2008:21-29.
39. Singleton JL, Newport EL. When learners surpass their
models: the acquisition of American Sign Language from
inconsistent input. Cogn Psychol. 2004;49:370-407.
40. Kushalnagar P, Krull K, Hannay J, Mehta P, Caudle S,
Oghalai J. Intelligence, parental depression, and behavior
adaptability in deaf children being considered for cochlear
implantation. J Deaf Stud Deaf Educ. 2007;12:335-349.
41. MacSweeney M. Cognition and deafness. In: Gregory
S, Knight P, MacCracken W, Powers S, Watson L, eds.
Issues in Deaf Education. London, UK: David Fulton;
42. Mayer C, Akamatsu T. Bilingualism and literacy. In:
Marschark M, Spencer P, eds. The Handbook of Deaf
Studies, Language, and Education. Oxford, UK: Oxford
University Press; 2003:136-150.
43. Padden C, Ramsey C. American Sign Language and read-
ing ability in deaf children. In: Chamberlain C, Morford J,
Mayberry R, eds. Language Acquisition by Eye. Mahwah,
NJ: Erlbaum; 2000:165-189.
44. Strong M, Prinz P. Is American Sign Language skill
related to English literacy. In: Chamberlain C, Morford J,
Mayberry R, eds. Language Acquisition by Eye. Mahwah,
NJ: Lawrence Erlbaum; 2000:131-142.
45. Wilbur R. Sign language and successful bilingual devel-
opment of deaf children. J Inst Social Res. 2001;56:
46. Chamberlain C, Mayberry R. American Sign Language
syntactic and narrative comprehension in skilled and
less skilled readers: bilingual and bimodal evidence for
the linguistic basis of reading. Appl Psycholinguist.
47. Hermans DH, Ormel E, Knoors H, Verhoeven L. The
relationship between the reading and signing skills of deaf
children in bilingual education programs. J Deaf Stud
Deaf Educ. 2008;13:518-530.
48. Paul P. Processes and components of reading. In:
Marschark M, Spencer P, eds. The Handbook of Deaf
Studies, Language, and Education. Oxford, UK: Oxford
University Press; 2003:97-109.
49. Wilbur R. How to prevent educational failure. In:
Lindgren KA, DeLuca D, Napoli DJ, eds. Signs & Voices:
Deaf Culture, Identity, Language and Arts. Washington,
DC: Gallaudet University Press; 2008:117-138.
50. Mounty JL, Pucci CT, Harmon KC. How deaf American
Sign Language/English bilingual children become profi-
cient readers: an emic perspective. J Deaf Stud Deaf Educ.
51. Bialystok E, Craik FIM. Cognitive and linguistic pro-
cessing in the bilingual mind. Curr Dir Psychol Sci.
52. Kroll JF, Dussias PE, Bogulski CA, Kroff JRV. Juggling
two languages in one mind: what bilinguals tell us about
language processing and its consequences for cognition.
Psychol Learn Motiv. 2012;56:229-262.
53. Macnamara BN, Conway AR. Novel evidence in support
of the bilingual advantage: influences of task demands
and experience on cognitive control and working mem-
ory. Psychon Bull Rev. 2014;21:520-525. doi:10.3758/
54. Ibrahim R, Shoshani R, Prior A, Share D. Bilingualism
and measures of spontaneous and reactive cognitive flex-
ibility. Psychology. 2013;4:1-10.
55. Byers-Heinlein K, Fennell CT. Perceptual narrowing in
the context of increased variation: insights from bilingual
infants. Dev Psychobiol. 2013;56:274-291. doi:10.1002/
56. Petitto LA, Berens MS, Kovelman I, Dubins MH, Jasinska
K, Shalinsky M. The “Perceptual Wedge Hypothesis” as
the basis for bilingual babies’ phonetic processing advan-
tage: new insights from fNIRS brain imaging. Brain Lang.
57. Bialystok E, Craik FIM, Luk G. Bilingualism: con-
sequences for mind and brain. Trends Cogn Sci.
58. Buchweitz A, Prat C. The bilingual brain: flexibility and con-
trol in the human cortex. Phys Life Rev. 2013;10:428-443.
59. Kuhl PK. Brain mechanisms in early language acquisi-
tion. Neuron. 2010;67:713-727.
60. Kuhl PK. Early language acquisition: Phonetic and word
learning, neural substrates, and a theoretical model.
In: Moore B, Tyler L, Marslen-Wilson W, eds. The
Perception of Speech: From Sound to Meaning. New
York, NY: Oxford University Press; 2009:103-131.
61. Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL.
Language of early- and later-identified children with hear-
ing loss. Pediatrics. 1998;102:1161-1171.
62. Solomon A. Far From the Tree: Parents, Children and the
Search for Identity. New York, NY: Simon & Schuster;
by guest on November 25, 2015cpj.sagepub.comDownloaded from
... En niñas y niños con discapacidad auditiva (NDA) la intervención principal es el desarrollo del lenguaje y aprendizaje, lo que repercute en el desarrollo emocional y social de esta población (World Health Organization, 2020). La existencia de hitos críticos transversales como; 1) el diagnóstico e intervención temprana (Yoshinaga-Itano, Sedey, Wiggin, & Mason, 2018) , 2) el acceso a una lengua funcional antes de los cinco años de edad (Humphries et al., 2015), 3) y un sistema de educación oportuno y atingente serían esenciales para una intervención exitosa. Sin embargo, existe discusión en el trabajo conjunto que los sectores de salud, social y educación desarrollan para llevar a cabo la inclusión social de NDA. ...
... El énfasis en objetivos formativos y diversidad en el área de la educación, por sobre sólo objetivos comunicativos normotípicos, podría explicar este fenómeno. En este sentido, los objetivos comunicativos propuestos, a pesar de la mirada actual sobre discapacidad de la CIF, estarían aún ligados a modelos biomédicos o perspectivas netamente clínicas de atención basados en perseguir objetivos de lenguaje supuestamente ligados a la normalidad (Humphries et al., 2015). Lo anterior, adicionado a la jerarquía descrita del área de salud por sobre las otras áreas, podría influir negativamente en los objetivos educativos y de inclusión social de esta población, esto cada vez que las iniciativas de estas áreas entren en conflicto con las indicaciones entregadas por salud. ...
... En este sentido, llama la atención la visión generalizada de éxito ligada a la adquisición de lengua oral en ambas regiones, especialmente en el área de salud. Lo anterior propio de la perspectiva clínica podría deberse, entre otras variables, a que la mayoría de padres de NDA son oyentes, junto a la idea entregada desde algunos grupos sobre la recuperación exitosa de la audición, desarrollando y estimulando sólo la lengua oral (Humphries et al., 2015). Sin embargo, la evidencia ha sugerido que la lengua de signos no interfiere en el desarrollo de lengua oral, y al mismo tiempo, su ausencia podría provocar deprivación comunicativa y cognitiva en usuarios que la requieran (Hall, 2017). ...
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La vinculación de políticas públicas y el trabajo intersectorial entre salud, educación y servicios sociales ha cobrado relevancia en el abordaje temprano y biopsicosocial en personas con discapacidad. En el campo de la discapacidad auditiva infantil, existirían controversias endicha vinculación debido alas discrepancias existentes entrela perspectiva clínica y sociocultural,referentesincluso alas modalidades deacceso al lenguaje para esta población. Este estudio de tipo cualitativoanalizaentrevistas semi-estructuradas buscandodescribir las percepciones de diferentes actores en País Vasco de España y Región Metropolitana de Chile. Fueron analizados 565 minutos de entrevistas de 27 participantes, a partir de 3 categorías emergentes: políticas y áreas existentes, intersectorialidad entre áreas, y servicio ofrecido por áreas. Los resultados muestran una percepción positiva sobre la vinculación política y trabajo intersectorial, pero persiste la preferencia del modelo biomédico y perspectiva clínica de la discapacidad por sobre el modelo biopsicosocial y el desarrollo de la perspectiva sociocultural. Esto ocurriría toda vez que el éxito se asocia al desarrollo normal a través de la adquisición de la lengua oral por sobre la diversidad de otras intervenciones en esta población. Las percepciones de los profesionales de las áreas estudiadas difieren en torno a los logros considerados como indicadores de éxito. Un centro coordinador de políticas y trabajo intersectorial, junto con la determinación de momentos de mayor relevancia de cada área en el proceso deatención podrían beneficiar el trabajo hacia este grupo.
... In many cases parents are advised by doctors and educators to adopt an oralist approach supporting the use of technologies meant to facilitate the learning of spoken languages, denying sign input (Lillo-Martin, 2021). Even with early intervention through hearing aids or cochlear implants, though, language access is delayed if not provided through a fully accessible input, which in the case of deaf children is in the visualgestural modality (Humphries et al., 2016;Hall et al., 2019, among others). In a very small percentage of cases, hearing parents decide to learn sign language and expose their child to it (cf. ...
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Who is a native signer? Since around 95% of deaf infants are born into a hearing family, deaf signers are exposed to a sign language at various moments of their life, and not only from birth. Moreover, the linguistic input they are exposed to is not always a fully fledged natural sign language. In this situation, is the notion of native signer as someone exposed to language from birth of any use? We review the results of the first large-scale cross-linguistic investigation on the effects of age of exposure to sign language. This research involved about 45 Deaf adult signers in each of three sign languages (Catalan Sign Language, French Sign Language, and Italian Sign Language). Across the three languages, participants were divided into three groups – those exposed from birth, those between 1 and 5 years of age, and those exposed between 6 and 15 years of age – and received a battery of tests designed for each language targeting various aspects of morphosyntactic competence. In particular, the tests focused on both those morphosyntactic phenomena that are known from the spoken language literature to be good detectors of language impairment or delay (i.e., wh-interrogatives and relative clauses) and on morphosyntactic phenomena that are sign language specific (i.e., role shift and directional verbs). The results showed a clear effect of being native, with significant differences across languages and tests between signers exposed to sign language from birth and those exposed in the 1st years of life. This confirms the life-long importance of language exposure from birth and the reliability of the notion of “nativeness”, at least for syntax. On the other hand, while in most domains the differences observed between populations might be differences in performance, for some specific constructions, signers belonging to the three groups may have different grammars. This latter finding challenges the generalized use of native signers’ grammar as the baseline for language description and language assessment.
... For DHH children, a growing body of literature on language deprivation shows significant neurocognitive and social-psychological delays associated with lack of whole language input during the critical language development period of 0-5 years (Brown University, 2014;Hall, 2017;Glickman & Hall, 2019), with effects observed especially in the area of literacy (Humphries, et al., 2016). DHH children are also at risk for "chronic child cognitive fatigue" when they are expected to rely on auditory perception alone (Spellun & Kushalnagar, 2018, p. 1). ...
... This may reflect additional challenges for a deaf child with ASD accessing learning and using a signed language; although there is no research, we are aware of confirming this belief. It is also possible that common misunderstandings about language acquisition for deaf children (Humphries et al, 2016) may mean some parents are advised not to use sign language with their deaf children despite evidence that this may be harmful (Hall, 2017). ...
Lay abstract: Autism assessment processes need to improve for deaf children as they are currently being diagnosed later than their hearing counterparts and misdiagnosis can occur. We took one of the most commonly used parent developmental interviews for autism spectrum disorder the Autism Diagnostic Interview-Revised and adapted it using international expert advice. Modifications were proposed and agreed by the expert panel for 45% of items; the remaining 55% of items were unchanged. We then tested the revised version, adapted for deaf children (Autism Diagnostic Interview-Revised Deaf Adaptation), in a UK sample of 78 parents/carers of deaf children with autism spectrum disorder and 126 parents/carers with deaf children without autism spectrum disorder. When compared to National Institute for Health and Care Excellence guideline standard clinical assessments, the Autism Diagnostic Interview-Revised Deaf Adaptation diagnostic algorithm threshold scores could identify those deaf children with a definite diagnosis (true autism spectrum disorder positives) well (sensitivity of 89% (79%-96%)) and those deaf children who did not have autism spectrum disorder (true autism spectrum disorder negatives) well (specificity of 81% (70%-89%)). Our findings indicate that the Autism Diagnostic Interview-Revised Deaf Adaptation is likely to prove a useful measure for the assessment of deaf children with suspected autism spectrum disorder and that further research would be helpful.
... As a result, Deaf 4 signing communities are very heterogeneous: few individuals have signing parents/relatives and are exposed to a sign language from birth (i.e. they are native signers in the narrow sense), whereas the vast majority, having non-signing parents, are exposed only to a spoken language in their early life and discover sign language later. This group is composed of people with quite different linguistic profiles, since outcomes of exposure to spoken language through hearing aids only are very variable across individuals, and late exposure to a sign language does not ensure full language acquisition (see Humphries et al. 2016). ...
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Relativization is a robust subordinating type across languages, displaying important typological variability concerning the position of the nominal head that the relative clause modifies, and sign languages are no exception. It has been widely assumed since Keenan & Comrie (1977) that the subject position is more accessible to relativization than object and oblique positions. The main aim of this paper is to investigate the extension of this famous generalization both across modalities (sign as opposed to spoken languages) and across relativization typologies (internally as opposed to externally headed relatives), and to verify how it interacts with age of first language exposure. We here report the results of a sentence-to-picture matching task assessing the comprehension of subject and object relative clauses (RCs) in three sign languages: French Sign Language (LSF), Catalan Sign Language (LSC), and Italian Sign Language (LIS). The results are that object RCs are never easier to comprehend than subject RCs. Remarkably, this is independent from the type of relative clause (internally or externally headed). As for the impact of age of exposure, we found that native signers outperform non-native signers and that a delay in language exposure emphasizes the subject/object asymmetry. Our results introduce a new potential diagnostic for LF movement: the existence of a Subject Advantage in comprehension can be used as a reliable and measurable cue for the existence of long-distance dependencies, including covert ones.
... If they accept a natural sign language as a language in the home, they must find ways to learn it themselves and expose their child to multiple fluent signers. Since doctors and educators may recommend avoiding the use of a sign language and instead encourage an approach that employs hearing technology and spoken language only, the child may well experience a period without accessible linguistic input (Hall et al. 2019, Humphries et al. 2016, Spellun & Kushalnagar 2018. Hearing technology devices (e.g., hearing aids, cochlear implants) do not turn a deaf child into a hearing child; rather, they are ways to increase access to sound. ...
Natural sign languages of deaf communities are acquired on the same time scale as that of spoken languages if children have access to fluent signers providing input from birth. Infants are sensitive to linguistic information provided visually, and early milestones show many parallels. The modality may affect various areas of language acquisition; such effects include the form of signs (sign phonology), the potential advantage presented by visual iconicity, and the use of spatial locations to represent referents, locations, and movement events. Unfortunately, the vast majority of deaf children do not receive accessible linguistic input in infancy, and these children experience language deprivation. Negative effects on language are observed when first-language acquisition is delayed. For those who eventually begin to learn a sign language, earlier input is associated with better language and academic outcomes. Further research is especially needed with a broader diversity of participants. Expected final online publication date for the Annual Review of Linguistics, Volume 7 is January 14, 2021. Please see for revised estimates.
... In contrast to our results, though, prior studies find that delayed access to language has broad cognitive effects 77,78 , including delayed development of language comprehension and production [79][80][81][82] , literacy 83,84 , and executive functions 85 , differences in language-related brain development [86][87][88] , and consequences for mental health 89,90 . This discrepancy is likely related to characteristics of our sample. ...
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Language provides a rich source of information about other people’s thoughts and feelings. Consequently, delayed access to language may influence conceptual development in Theory of Mind (ToM). We use functional magnetic resonance imaging and behavioral tasks to study ToM development in child (n = 33, 4–12 years old) and adult (n = 36) fluent signers of American Sign Language (ASL), and characterize neural ToM responses during ASL and movie-viewing tasks. Participants include deaf children whose first exposure to ASL was delayed up to 7 years (n = 12). Neural responses to ToM stories (specifically, selectivity of the right temporo-parietal junction) in these children resembles responses previously observed in young children, who have similar linguistic experience, rather than those in age-matched native-signing children, who have similar biological maturation. Early linguistic experience may facilitate ToM development, via the development of a selective brain region for ToM.
The article presents a review of research conducted by foreign psychologists on the role of sign language in the communicative, cognitive and social development of children with hearing disorders. Each national sign language is a kind of linguistic system that has a complex grammar, specific vocabulary and syntax. The main problems that arise in deaf children in the situation of ignoring the possibilities of sign language are discussed. A number of studies have shown that deaf children of deaf parents are not inferior to hearing children in their cognitive capabilities, that the use of sign language has a positive effect on cognitive functions and leads to greater creative activity, a better understanding of spatial relationships, and greater flexibility in solving problems. Researchers recognize the need for early acquisition of sign language by deaf children, even in case of use of modern rehabilitation techniques. It is sign language that could make up for the lack of communication tools characteristic of the initial stages of a child's mental development, which would serve to develop the cognitive sphere and personality and create conditions for emotional well-being. The review focuses on the difficulties in using sign language that are observed when selecting diagnostic tools and conducting psychological examinations.
This study explored differences between the two hemispheres in processing written words among deaf readers. The main hypothesis was that impoverished phonological abilities of deaf readers may lead to atypical patterns of hemispheric involvement. To test this, deaf participants completed a metalinguistic awareness test to evaluate their orthographic and phonological awareness. Additionally, they were asked to read biased or neutral target sentences ending with an ambiguous homograph, with each sentence followed by the request to make a rapid lexical decision on a target word presented either to the left (LH) or right hemisphere (RH). Targets were either related to the more frequent, dominant, meaning of the homograph, to the less frequent, subordinate, meaning of the homograph or were not related at all. An Inverse Efficiency Score based on both response latency and accuracy was calculated and revealed that deaf readers’ RH perform better than their LH. In contrast to hearing readers who in previous studies manifested left hemisphere dominance when completed the same research design. The apparent divergence of deaf readers’ hemisphere lateralization from that of hearing counterparts seems to validate previous findings suggesting greater reliance on RH involvement among deaf individuals during visual word recognition.
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The aim of this article is to increase awareness of language practices in the deaf community that affect communication needs and health outcomes, focusing particularly on the prevalence of bilingualism among deaf adults. Language deprivation and poor health outcomes in the deaf population are risks that cannot be addressed solely by hearing intervention. We propose that bilingualism acts as a protective measure to minimize the health risks faced by deaf individuals. Provision of culturally and linguistically appropriate services to deaf stakeholders, and particularly hearing families of deaf children, requires familiarity with the developmental and social ramifications of bilingualism.
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The objective of this chapter is to provide research support for the use of natural sign languages in the early education of deaf children, especially when the aim is to develop sophisticated language, literacy, academic, and social skills. To achieve this objective, the reader needs to understand several conceptual and terminological distinctions. The remainder of the chapter addresses the benefits to all deaf children of early sign language acquisition. The literature indicates that early learning of sign language benefits cognitive and memory development, overall socioeducational performance, and reading and writing ability by providing a complete language base. Also, it does not interfere with learning English or limit speech potential. A longstanding research conclusion is that knowledge of American Sign Language (ASL) is invaluable in the education of deaf children (Johnson, Liddell, and Erting 1989; Charrow and Wilbur 1975).
"I am deaf." What a seemingly simple phrase! But in actuality, "I am deaf" is a complex phrase, with various meanings depending on the background and experience of the individual making that statement. The person diagnosed as audiologically deaf from birth, the person who navigates a progressive or late-life hearing loss, and the deaf person growing up in a culturally Deaf family: Each one has a different self-perception of deaf. Whatever deaf means to each deaf individual has great salience for that person's identity evolution. While the concept of identity has long been explored in the psychology, sociology, and anthropology literature, its relevance has exploded in recent decades, as evidenced by increased publications on the topic. This explosion has been fueled by the increase in cultural diversity and subsequent interest in cultural or ethnic group membership and social identity within the United States and other countries (Sue and Sue 2003). Because of the present acknowledgment of a longexisting Deaf culture (Padden and Humphries 2005), researchers interested in the implications of diversity and deaf people have begun to move from the traditional focus on self-concept and self-esteem toward developing studies that explore deaf identity, how it evolves in deaf individuals, and its role in the psychological health of deaf individuals. The role of group perspectives in the reinforcement of deaf identity evolution is also of interest to researchers. As we know, people have multiple identities, depending on their environment and what is most salient at any given point in time. These identities, which help individuals define and understand themselves as well as align with social groups, tend to be forged through perceptions of differences and classifications, including gender, ethnicity, educational levels, career categories, sexual orientation, hearing status, and so on (Corker 1996; Waterman 1992; Woodward 1997). Healthy identity development is a critical component of positive psychological adjustment (Erikson 1980). Exactly what is identity? Identity consists of self-perceptions that evolve out of social constructions (Baumeister 1997; Holland, Lachicotte, Skinner, and Cain 1998). These social constructions are based on interactions with others in multiple ongoing social contexts (Baumeister 1997; Grotevant 1992; Harter 1997; Kroger 1996). As new information about oneself emerges, mostly through lifelong, ongoing experiences and the responses of others toward the self, there is often a process of identity restructuring (Grotevant 1992). In turn, as Woodward (1997) indicates, identities influence how people select their self-representations and behaviors, depending on social context.
Bilingual approaches in the education of deaf students have been in place for almost three decades and debate continues as to the merits of these programs, particularly with respect to the relationship between bilingualism and the development of text-based literacy. This chapter is divided into three parts. The first section examines the theoretical frameworks which that underpin the move to bilingual models of education for deaf students with a particular emphasis on the expectations with respect to the development of literacy. References are made to other bilingual contexts in which the research on this point has been more extensive and exhaustive. This is followed by a review of the literature within the context of deaf education beginning with the earliest studies from the 1980's. The chapter concludes with a summary and synthesis of what has been learned from the research to date and positions this review in the context of the outcomes suggested by the theory and by the research from other bilingual settings. Suggestions are made and questions posed as to directions for future study and research.
This paper reviews research on language development of deaf children, comparing those who have early access to natural sign language with those who do not. Early learning of sign language does not create concerns for the child's development of other languages, speech, reading, or other cognitive skills. In fact, it can contribute directly to establishment of more of the high-level skills needed for successful bilingual development. The global benefit of learning a sign language as a first language is that in the resulting bilingual communicative setting, teachers and learners can take advantage of one language to assist in acquiring the other and in the transfer of general knowledge. As part of this discussion, English and ASL are compared as representatives of spoken and signed natural languages to provide explicit examples of their similarities and differences.
Divergent hypotheses exist concerning the types of knowledge underlying early bilingualism, with some portraying a troubled course marred by language delays and confusion, and others portraying one that is largely unremarkable. We studied the extraordinary case of bilingual acquisition across two modalities to examine these hypotheses. Three children acquiring Langues des Signes Quebecoise and French, and three children acquiring French and English (ages at onset approximately 1;0, 2;6 and 3;6 per group) were videotaped regularly over one year while we empirically manipulated novel and familiar speakers of each child's two languages. The results revealed that both groups achieved their early linguistic milestones in each of their languages at the same time land similarly to monolinguals), produced a substantial number of semantically corresponding words in each of their two languages from their very first words or signs (translation equivalents), and demonstrated sensitivity to the interlocutor's language by altering their language choices. Children did mix their languages to varying degrees, and some persisted in using a language that was not the primary language of the addressee, but the propensity to do both was directly related to their parents' mixing rates, in combination with their own developing language preference. The signing-speaking bilinguals did exploit the modality possibilities, and they did simultaneously mix their signs and speech, but in semantically principled and highly constrained ways. It is concluded that the capacity to differentiate between two languages is well in place PRIOR to first words, and it is hypothesized that this capacity may result from biological mechanisms that permit the discovery of early phonological representations. Reasons why paradoxical views of bilingual acquisition have persisted are also offered.
Psycholinguistics has traditionally focused on language processing in monolingual speakers. In the past two decades, there has been a dramatic increase of research on bilingual speakers, recognizing that bilingualism is not an unusual or problematic circumstance but one that characterizes more language speakers in the world than monolingualism. Most critically, cognitive scientists and neuroscientists have come to see that understanding the way that bilinguals negotiate the presence of two languages in the mind and brain may reveal processes that are otherwise obscured in monolingual speakers. In this chapter, we review the new research on language processing in bilinguals. Our starting point is the observation that both languages are active when bilinguals intend to use one language alone. The parallel activation of the two languages creates competition across the two languages, which renders the bilingual a mental juggler. Surprisingly, the resolution of cross-language competition imposes relatively few processing costs to bilinguals because they appear to develop a high level of cognitive control that permits them to switch between the two languages and, at the same time, effectively select the intended language with few errors. The expertise that bilinguals develop in juggling the two languages has consequences for language processing, because both the native and second languages change as bilingual skill is acquired, and also for domain general cognitive processes, with the result that executive function is enhanced in bilinguals relative to monolinguals. We suggest that recent research on language and cognitive processing in bilinguals requires important revisions to models of language processing based on monolingual speakers alone. In this way, bilingualism is not only an interesting phenomenon in its own right, but an important tool for cognitive and language scientists.