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Diagnosing and Treating Signed Language Disorders: A New Perspective

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Purpose: This study surveyed graduate students of speech-language pathology to determine their awareness of signed language disorders, opening the door to a possible discussion of the need for signed language pathology, including the potential for future signing-based diagnoses and therapies. Method: Thirty-two graduate speech-language pathology students completed a questionnaire identifying (a) their attitudes toward the use of signed language, (b) their awareness of signed language disorders, (c) opportunities for treatment in signed language, and (d) a need for this type of training in graduate education. Results: The majority of the students recognized American Sign Language as a human language; however, respondents lacked prior knowledge of the existence of organic disorders that could impact T the production of signed language. When informed about the existence of such disorders through the questionnaire, these students acknowledged a need for training regarding treatment to alleviate the disorders. Conclusion: Students in this speech-language pathology program, located in the same department as a Deaf Studies program teaching American Sign Language , were receptive to the use of signed language in treatment and saw value in pursuing additional education in signed language pathology in order to diagnose and treat signed language disorders.
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Cripps: Disorders in Signed Language 223
ABSTRACT: Purpose: This study surveyed graduate
students of speech-language pathology to determine
their awareness of signed language disorders, open-
ing the door to a possible discussion of the need for
signed language pathology, including the potential for
future signing-based diagnoses and therapies.
Method: Thirty-two graduate speech-language pathol-
ogy students completed a questionnaire identifying (a)
their attitudes toward the use of signed language, (b)
their awareness of signed language disorders, (c) op-
portunities for treatment in signed language, and (d) a
need for this type of training in graduate education.
Results: The majority of the students recognized
American Sign Language as a human language;
however, respondents lacked prior knowledge of
the existence of organic disorders that could impact
T
CONTEMPORARY ISSUES IN COMMUNICAT ION SCIENCE AND DISORDERS Volume 43 • 223–237 • Fall 2016 © NSSLHA
1092-5171/16/4302-0223
Diagnosing and Treating Signed
Language Disorders: A New
Perspective
Jody H. Cripps
Sheryl B. Cooper
Paul M. Evitts
Towson University, Towson, MD
Judith F. Blackburn
Baltimore City Public Schools, Baltimore, MD
the production of signed language. When informed
about the existence of such disorders through the
questionnaire, these students acknowledged a need
for training regarding treatment to alleviate the dis-
orders.
Conclusion: Students in this speech-language pathol-
ogy program, located in the same department as a
Deaf Studies program teaching American Sign Lan-
guage, were receptive to the use of signed language
in treatment and saw value in pursuing additional
education in signed language pathology in order to
diagnose and treat signed language disorders.
KEY WORDS: signed language disorders, signed
language pathology, perceptions, attitudes, training,
treatment
he concept of disorders in signed language
as a field of study has been mentioned
briefly in signed language studies (e.g.,
Nover, Christensen, & Cheng, 1998; Quinto-Po-
zos, 2014a; Wix, 1993), but the notion of pursuing
signed language treatment is still a novelty. Quinto-
Pozos (2014a) suggested that this type of treat-
ment is ripe for further investigation in the field of
speech-language pathology. Reasons for the current
lack of treatments might include that (a) not enough
is known about speech-language pathologists’ (SLPs’)
awareness/perceptions of signed language, (b) SLPs
may not possess adequate signing skills to assess and
treat signed language disorders, and/or (c) there is a
lack of preparation provided by graduate programs in
this field.
224 CONTEMPORARY ISSUES IN COMMUNICATION S CIENCE AND DISORDERS Volume 43 • 223–237 • Fall 2016
Wix (1993) suggested that a new field of signed
language pathology should be developed, parallel to
speech-language pathology, where the focus is on
the diagnosis and treatment of disorders affecting the
production of signed language. Our article differs
from other research in the field because it focuses on
changing the attitudes of, and curricula for, the next
generation of SLPs.
For purposes of our article, signed language is
defined as a natural visual–gestural language sharing
a wide range of linguistic properties with spoken lan-
guages, such as phonology, morphology, and syntax
(Klima & Bellugi, 1979; Stokoe, 1960; Stokoe, Cast-
erline, & Croneberg, 1965; Valli, Lucas, Mulrooney,
& Villanueva, 2011; Wilbur, 1979), and the deaf com-
munity is defined as those individuals who use signed
language as their primary mode of communication
(e.g., Cripps & Supalla, 2012; Padden, 1980).
William Stokoe first investigated the linguistic
properties of American Sign Language (ASL) as a
human language in the 1960s (Maher, 1996) and de-
termined that ASL met the definition of a full-fledged
human language. Similar outcomes were found across
a number of signed languages worldwide (e.g., Brit-
ish Sign Language, Indo-Pakistan Sign Language,
Swedish Sign Language; Bergman & Wallin, 1990;
Sutton-Spence & Woll, 1999; Zeshan, 2000).
For decades, the American Speech-Language-
Hearing Association (ASHA; Joint Committee of
ASHA and the Council on Education of the Deaf,
2004) has acknowledged the importance of using
signed language with children who are deaf. One
reference mentioned support of ASL as a small part
of ASHA’s early intervention policy, but no spe-
cific policy could be found regarding the diagnosis
or treatment of signed language disorders in any of
ASHA’s publications (see Cripps, Cooper, Supalla, &
Evitts, 2016).
Not surprisingly, there is a dearth of informa-
tion exploring the relationship of speech-language
pathology and signed language, and the information
that does exist is often superficial or confusing. For
example, when it comes to understanding the role of
the SLP with signed language, Ferguson and Arm-
strong (2004) suggested that it is the SLP’s job to
facilitate communication accessibility between profes-
sionals (e.g., doctors, teachers, etc.) and individuals
who are deaf. In this capacity, the SLP’s role appears
limited to advising professional colleagues to request
signed language interpreters when needed.
Vold, Kinsella-Meier, and Hughes-Hilley (1990)
created a signed language manual for audiologists
and SLPs to use when conversing with deaf clients.
The manual includes illustrations of signed vocabu-
lary along with individual phonological descriptions
of how to create signs. Chapters include sample
sentences and dialogues used in clinical settings with
both children and adults; matching illustrations are
provided.
However, in our opinion, this manual (Vold et
al., 1990) provides very limited opportunities for
face-to-face communication with deaf individuals
for several reasons. First, the vocabulary choices in
the manual are limited. Second, the manual provides
some rudimentary signs to use to communicate to
a deaf person but does not provide any opportunity
to learn receptive signing skills; that is, to practice
understanding what the deaf person may be commu-
nicating in response to various questions. Third, most
of the sample sentences in the manual are presented
in English word order, which may not be understood
by deaf people whose first language is ASL, which
uses a significantly different grammar than English.
Finally, this basic level of signed vocabulary does
not provide anywhere near the depth of knowledge
needed to diagnose disorders in the production of
signed language.
More recently, Quinto-Pozos (2014b) edited a
book that focuses on how disorders of signed lan-
guage might be considered within the contexts of
acquiring and using language, but not specifically on
the remediation of acquired deficits. This article will
briefly review studies concerning the existence of dis-
orders that are commonly addressed by SLPs, such as
aphasia, stuttering, and specific language impairment
(SLI), and document how these disorders may appear
in a signed language. Attitudes of SLPs toward a va-
riety of populations other than deaf people will also
be examined. The article will conclude with a de-
scription of our preliminary study examining the atti-
tudes of speech-language pathology graduate students
toward signed language and its potential disorders,
with recommendations for future research.
Previous Research Studies of
Signed Language and its Disorders
As evidenced by a plethora of professional journals in
the eld, there are a large number of research stud-
ies on speech and spoken language disorders. From
the extensive body of research available, it is clear
that people with spoken language disorders frequently
seek speech and/or spoken language treatment. The
pathology of signed language, on the other hand, has
received little attention in the eld of speech-language
pathology, deaf education, ASL instruction, or any
other eld. Yet, several studies have identied signed
language disorders involving aphasia, stuttering, and
SLI (e.g., Bellugi, Klima, & Hickok, 2010; Corina,
1998; Cosyns, Van Herreweghe, Christiaens, & Van
Cripps: Disorders in Signed Language 225
Borsel, 2009; Hickok, Pickell, Klima, & Bellugi,
2009; Marshall, Denmark, & Morgan, 2006; Mason et
al., 2010; Morgan, 2005; Morgan, Herman, & Woll,
2007; Quinto-Pozos, Forber-Pratt, & Singleton, 2011;
Quinto-Pozos, 2014a; Snyder, 2009; Whitebread, 2004,
2014). Unfortunately, treatment for these disorders
does not appear to have found its place in the litera-
ture of evidence-based practice.
Signed Language Aphasia Studies
Among the approximately 5,000 deaf survivors of
stroke in the United States, approximately 1,000 of
them have aphasia (see Salk Institute for Biological
Studies, n.d.b., for more information related to this
topic). An adapted version of the Boston Diagnostic
Aphasia Examination was developed by the Salk Insi-
tute for use with deaf stroke patients using ASL (see
Salk Institute for Biological Studies, n.d.a., for more
information). Difficulties were identified in signed
language production and comprehension among deaf
individuals with aphasia with damage in their left
cerebral hemisphere. As with disorders in spoken
language, a number of deaf clients with aphasia who
have damage in the Broca’s region may have difficul-
ties in signed language production (e.g., Bellugi et
al., 2010; Poizner, Klima, & Bellugi, 1987). Similar
to the findings with the Broca’s region, deaf patients
with left hemisphere damage in the Wernicke’s region
(in the left brain, which is responsible for language
comprehension) demonstrated difficulty with language
comprehension (e.g., Bellugi et al., 2010; Hickok &
Bellugi, 2010; Poizner et al., 1987). (See Emmorey,
2002, and Quinto-Pozos, 2014a, for a comprehensive
review of recent studies on signers with aphasia.)
Signed language aphasia includes characteris-
tics such as halting and effortful signed production,
single-sign utterances, absence of syntactical and
morphological markings, and disordered grammati-
cal markings such as errors in spatialized markings
(Hickok & Bellugi, 2001). Throughout their years of
study with deaf people with aphasia, Bellugi, Hickok,
and Klima (Bellugi et al., 2010; Hickok & Bellugi
2001, 2010) identified the properties of aphasic
signed language disorders. In these studies, signers
with aphasia demonstrated language deficiency in the
linguistic properties of ASL phonology, such as er-
rors with handshape(s), location(s), and movement(s),
when signing (Brentari, Poizner, & Kegl, 1995;
Poizner et al., 1987); production errors with the
sublexical, lexical, and sentence-level processes (e.g.,
Bellugi, Poizner, & Klima, 1989; Hickok & Bellugi,
2001; Hickok, Kritchevsky, Bellugi, & Klima, 1996;
Hickok et al., 2009; Poizner et al., 1987); and poor
comprehension when perceiving signed lexicons and
sentences (e.g., Hickok, Love, Buchsbaum, & Bellugi,
2002; Hickok, Love-Geffen, & Klima, 2002).
These studies focusing on ASL provide a founda-
tion of evidence for aphasia in the signed modality
(see Bellugi et al., 2010; Hickok & Bellugi, 2001,
2010, for a literature review of additional properties
in aphasic signed language disorders). However, no
documentation, evidence-based practice, instruction
manuals, or other guidance could be found to instruct
professionals on how to provide signed language
treatment for deaf individuals with aphasia. The Salk
Institute’s Laboratory for Cognitive Neuroscience
website video (n.d.a.) clearly states that no treatment
is presently available for individuals with aphasia
who sign.
Signed Stuttering Studies
To identify the characteristics of signed stuttering,
Whitebread (2004) interviewed 10 Gallaudet Universi-
ty faculty members who were active in the deaf com-
munity and had experience interacting with people
who demonstrated stuttering in ASL. As a result of
these interviews, Whitebread proposed nine character-
istics of signed stuttering: inconsistent interruptions
in sign and fingerspelling, stuttered symptoms most
often occurring at the initiation of a gesture, hesita-
tion of sign movement, repetition of sign movement
while keeping the original handshape, exaggerated
signs or prolonged signs, unusual body movements
completely unrelated to linguistic communication,
poor fluidity of the sign, inappropriate muscular ten-
sion (in the arms and hands) associated with signing,
and adding a schwa (gestures included before a sign
that serve no storytelling meaning).
Later, Cosyns et al. (2009) refined the definition
of signed stuttering as including manual repetitions,
prolongations, blocks, choppy manipulations, jerky
and hesitant signs, involuntary interjections, and extra
movements, as found in natural signed languages
around the world. Snyder (2009) speculated that
signed stuttering in ASL exists as a disorder that is
indicative of cognitive processing errors, be it in a
signed or spoken modality.
Whitebread (2014) recently completed a litera-
ture review of several studies on stuttering among
deaf people, identifying Voelker and Voelker’s (1937)
study as the earliest. In reviewing the various ar-
ticles, no data regarding the percentage of signers in
the United States and Canada who stutter could be
found. Additionally, no standardized assessment or
treatment could be found for individuals who exhibit-
ed signed stuttering, even though some attempts have
been made to remediate this disorder (e.g., Quinto-
Pozos, 2014a).
226 CONTEMPORARY ISSUES IN COMMUNICATION S CIENCE AND DISORDERS Volume 43 • 223–237 • Fall 2016
Specific Signed Language
Impairment (SSLI) Studies
SLI is an isolated linguistic problem that is found in
children with atypical language development and no
other obvious impairments. Symptoms of SLI in-
clude problems with phonology, morphology, syntax,
semantics, pragmatics, or listening and expressing
language (Leonard, 1998). Quinto-Pozos and col-
leagues (Quinto-Pozos et al., 2011, 2013; Quinto-Pozos,
Singleton, Hauser, & Levine, 2014) conducted studies
validating the existence of SLI in ASL users through
interviews with professionals and a limited number of
in-depth case studies. One case study (Quinto-Pozos
et al., 2013) examined a native-signing deaf girl. Both
linguistic and nonlinguistic (cognitive-motor, visual-
spatial, and memory skills) instruments were used to
determine the presence of atypical signed language de-
velopment in ASL. Quinto-Pozos et al. (2013) identied
the child as having difculties with the spatial aspects
of ASL (i.e., classiers and referential shifting).
Summary of Previous Findings
Although some individualized treatments have been
attempted, at this time, there are no standardized ap-
proaches to the diagnosis or treatment of any of these
disorders (i.e., signed language aphasia, signed stut-
tering, and SSLI) and no known graduate programs,
or standardized in-service training opportunities, for
professionals to develop skill in providing signed
language diagnosis and treatment using ASL.
Attitudes Toward Individuals
With Speech-Language Disorders
It is important to acknowledge that the acceptance
of ASL as a language has unquestionably increased
since the 1980s, and use of the language has become
more widespread (Cooper, 1997; Cooper, Reisman,
& Watson, 2008, 2011; Quinto-Pozos, 2011; Rosen,
2008; Wilcox & Wilcox, 1997). As ASL becomes
more entrenched in society as an acceptable alterna-
tive mode of communication, it is critical that com-
munication professionals, including the next genera-
tion of SLPs, accept the emerging concept of signed
language pathology.
The deaf community is a sociolinguistic phenom-
enon where deaf individuals use signed language and
consider themselves part of a cultural and linguistic
minority rather than a disability group (Charrow &
Wilbur, 1989; Johnston & Erting, 1989; Padden, 1980;
Reagan, 1985, 1995; Rutherford, 1988). Historically,
people have held negative attitudes toward indi-
viduals with hearing loss and those who use signed
language (e.g., Bauman, 2004; Eckert & Rowley,
2013; Humphries, 1977; Lane, 1999). In fact, Ralston,
Zazove, and Goreno (1996) found that many profes-
sionals who provide services to the deaf community
may hold negative attitudes toward this population.
Even in the field of communication disorders,
studies have found that some SLPs demonstrate
negative attitudes toward clients of culturally diverse
populations (e.g., Robinson & Stockman, 2009). In
their review of research regarding the perceptions of
professionals such as teachers and vocational coun-
selors, Bebout and Arthur (1992) indicated that these
individuals were likely to have negative views of
individuals with communication disorders. Bebout and
Arthur administered a questionnaire to students of
diverse ethnic and linguistic backgrounds from two
university settings to elicit their perceptions concern-
ing different types of spoken language disorders. Uni-
versity students born outside the United States tended
to demonstrate negative views toward people with
spoken language disorders. Based on these findings,
Bebout and Arthur suggested that SLPs’ attitudes
toward their clients could be impacted by cultural
differences. Thus, SLPs’ self-awareness of possible
cultural attitudes and biases regarding their service
population could enable them to cope more efficiently
with problems arising from differences between their
belief systems and those of their clients.
In a related study, Robinson and Stockman
(2009) examined SLPs’ perceptions of a minority
group using African American English (AAE) dialect.
Robinson and Stockman used spoken samples of AAE
and asked SLPs to rate the speech of AAE speakers
with different levels of dialect density. The authors
found that SLPs in the study did not have experience
with AAE and were unfamiliar with the grammar
rules of AAE. They concluded that the SLP raters’
lack of knowledge in AAE resulted in their rating the
AAE speakers as being less intelligible than people
who speak standard English.
Data have also been collected regarding teachers’
attitudes toward AAE speakers. Survey results from
Blake and Cutler (2003) found that the majority of
teachers in New York public schools had positive at-
titudes toward AAE speakers. Unlike in the Robinson
and Stockman (2009) study, in the Blake and Cutler
study, sensitivity to students who use AAE as their
primary language was evident in the responses from
urban teachers. Whereas many of the participants in
the Robinson and Stockman study indicated negative
attitudes toward AAE, only 14% of the teachers in
the Blake and Cutler study considered AAE as a lazy
form of English. Likewise, Fogel and Ehri (2006) as-
sessed the impact of attitudes toward AAE speakers in
classroom teachers who had received training regard-
ing the rules of AAE. They administered a survey
Cripps: Disorders in Signed Language 227
to teachers before and after the training in order to
obtain the teachers’ perceptions of the structure and
usefulness of AAE. The outcome of the study indi-
cated that the teachers improved their attitudes toward
AAE speakers through training, moving from slightly
negative to neutral. However, there were no correla-
tions between knowledge and attitude after training,
which suggests that learning the rules of AAE is not
enough to change one’s attitude toward AAE speakers.
In response to these concerns, Blackburn (2012)
conducted a study based on previous research on
AAE dialect features and attitudes toward AAE
speakers (Blake & Cutler, 2003; Fogel & Ehri, 2006).
The sample included 63 undergraduate students
majoring in speech-language pathology who were
enrolled in a Phonetics of American English course in
which they learned about AAE through the techniques
of Fogel and Ehri’s (2006) dialect instruction model.
Using a pretest/posttest format, results indicated that
the students significantly improved their knowledge
of the phonological and grammatical features of AAE
as well as changed their attitudes toward clients who
use AAE in schools.
The findings in Blackburn’s (2012) study suggest
that speech-language pathology students can improve
their knowledge of AAE through explicit instruc-
tion on its features (i.e., phonology and grammar)
and can change their attitudes toward AAE speakers
in their clinical practices. Blackburn’s findings have
significant implications for SLPs who work with
diverse groups, such as deaf people who sign. These
results might be generalized to suggest that with
more instruction, exposure, and practice, the attitudes
of SLPs toward people who sign, with or without
signed language disorders, could also be changed in
a positive direction. Although no research could be
found investigating the attitudes of SLPs toward the
existence of signed language disorders, one purpose
of this article was to open the discussion about at-
titudes toward deaf people who use signed language.
The Preliminary Study
In an effort to predict future attitudes of SLPs toward
deaf people, signed language, and signed language
disorders, this study targeted graduate students who
were likely to become speech-language pathology ex-
perts working with people with speech and language
disorders. The objectives of the study were to deter-
mine if these graduate students (a) were receptive to
signed language in general, (b) would acknowledge
that there are signed language disorders, (c) have any
special training for treatment in signed language, or
(d) see a need for this type of training in their gradu-
ate education.
METHOD
Questionnaire Development
The online questionnaire, titled “Speech-Language Pa-
thologists’ Perspectives on American Sign Language,”
was adapted from one by Evitts, Kopf, and Kauffman
(2014) and consisted of various styles of questions
(see the Appendix). Some of these were Likert-scale
questions with six possible responses (e.g., strongly
agree to strongly disagree, or prefer not to respond).
Participants were invited to add comments in addition
to answering the survey items. The questions were
modified to fit the topic of attitudes toward signed
language disorders. The questions were designed to
obtain participants’ (a) general demographic informa-
tion (including actual clinical experience); (b) percep-
tion, awareness, and knowledge of ASL and signed
language disorders (i.e., aphasia, stuttering, and SLI);
(c) any training or course work related to ASL; and
(d) any experience treating language disorders in
individuals who are deaf.
Participants and Procedure
The questionnaire was distributed to graduate students
in their first or second year of the speech-language
pathology program at a large university in the mid-
Atlantic region via a listserv email that included a
link to the campus lab’s online survey system (www.
studentvoice.com). The graduate speech-language pa-
thology students shared classroom space with students
in the Deaf Studies program, the latter offering ASL
for credit. The Department of Audiology, Speech-
Language Pathology, and Deaf Studies includes two
graduate programs (a master’s in speech-language
pathology and a clinical doctorate in audiology) and
two undergraduate programs (bachelor’s degrees in
speech-language pathology/audiology and Deaf Stud-
ies). Responses were gathered during a 2-week time
period in the spring semester of 2012. The online
survey system provided an electronic compilation of
results. Descriptive statistics were used to describe
the results through the use of percentages. Partici-
pants’ comments from the open-ended questions in
the questionnaire were summarized.
RESULTS
Demographics
The questionnaire was sent to 85 first- and second-
year graduate students in the speech-language pathol-
ogy program. The response rate was 44.7% (n = 38).
228 CONTEMPORARY ISSUES IN COMMUNICATION S CIENCE AND DISORDERS Volume 43 • 223–237 • Fall 2016
Two responses were excluded because the participants
were already certified SLPs and the intention of the
study was to target graduate students who were still
in training and could become educated in this area.
Of the remaining 36, all of whom were female, 32
participants completed the questionnaire, and four
participants left some items blank. Of the 36 partici-
pants, four (11.11%) identified themselves as working
full time in the field of speech-language pathology,
16 (44.44%) identified as full-time graduate students,
six (16.67%) indicated that they were employed part
time (field not specified), and 10 (27.78%) identi-
fied themselves as unemployed. The four participants
who indicated being employed full time worked in
schools, hospitals, or other medical environments,
and other work settings. Most of the participants had
no experience working as an SLP (n =15, 45.45%),
12 indicated 1 year of experience (36.36%), six
(18.18%) indicated 2 years of experience, and three
failed to respond to the question.
Knowledge of ASL and the Deaf Community
Data describing the participants’ responses to questions
about their knowledge of ASL and the deaf commu-
nity are provided in Table 1. Of the 32 participants
who answered questions within this category, only two
were extremely or very familiar with ASL, less than
half were moderately familiar, and more than half
admitted that they were not very familiar or not at
all familiar with ASL. Participants indicated that they
had received their education about ASL and the deaf
community through a variety of sources, with some
of them indicating that they had received this training
from more than one source (by checking off all of
the ways that they had been exposed to ASL). Four-
teen participants learned from dedicated course(s) on
deaf culture and ASL in their undergraduate program;
11 from a mixture of undergraduate courses; one
from a dedicated course(s) in graduate school; five
from a mixture of graduate courses; two from clinical
Table 1. Participants’ knowledge of American Sign Language (ASL) and the Deaf community.
Question n %
1. How familiar are you with ASL?
Extremely familiar 1 3.13
Very familiar 1 3.13
Moderately familiar 12 37.50
Not very familiar 16 50.00
Not at all familiar 2 6.25
Prefer not to respond 0 0
2. Where did you receive your education on people who are
Deaf and use ASL? (Check all that apply)
Dedicated course(s) in undergraduate school 14 43.75
Mixture of courses in undergraduate school 11 34.38
Dedicated course(s) in graduate school 1 3.13
Mixture of courses in graduate school 5 15.63
Clinical practicum 2 6.25
Continuing education opportunities 1 3.13
Deaf family members 1 3.13
Deaf friends, neighbors, coworkers, etc. 1 3.13
Other
Undergraduate research 1 3.13
N/A or none 4 12.50
3. Please indicate your level of agreement with the following
statement: ASL should be treated equally as one of the human
languages.
Strongly agree 24 75.00
Moderately agree 6 18.75
Neither agree nor disagree 0 0
Moderately disagree 2 6.25
Strongly disagree 0 0
Prefer not to respond 0 0
Cripps: Disorders in Signed Language 229
practicum experiences; one from continuing educa-
tion opportunities; one from deaf family members;
one from deaf friends, neighbors, coworkers, and
so on; one from undergraduate research; and four
had no education regarding people who are deaf and
use ASL. When asked to select their level of agree-
ment with the statement that ASL should be treated
equally as one of the human languages, almost all
(94%) of the participants agreed; two moderately
disagreed.
Knowledge of Language Disorders in ASL
Table 2 provides data regarding the participants’
knowledge of spoken language disorders and signed
language disorders. Three-quarters of the participants
were familiar with the concept of SLI (the ques-
tionnaire did not ask specifically about this relative
to spoken or signed mode). Only four participants
indicated that they knew of signed language aphasia,
only one participant knew of signed stuttering, and
eight had not heard of any of these disorders, be it in
spoken or ASL users. When posed with the statement
that deaf persons who have language disorders can
benefit from treatment in ASL, almost all (97%) of
the participants agreed.
Personal Experience, Training,
and Self-Assessment
Table 3 provides data regarding the participants’
personal experiences of working with deaf people
or people with hearing loss and self-assessments of
their signed language skills. Less than half of the 36
participants indicated that they had practiced speech-
language pathology with individuals with hearing
loss; more than half acknowledged that they had
not. When asked if they had practiced speech-lan-
guage pathology with individuals who are deaf and
use ASL, four of the participants did not respond,
three responded affirmatively, and 29 responded that
they had not. Only two of the three participants who
responded affirmatively provided the ages of the
clients with whom they had worked. One participant
indicated that she had worked with more than 50
individuals who were deaf and used ASL from ages
0 to 65+, and one participant indicated that she had
worked with fewer than 10 individuals, all in the 0
to 5 age category.
When asked whether they felt they had the ap-
propriate training needed to treat disorders using
ASL, 91% of the participants stated that they felt
unprepared to treat people with signed language
disorders who sign. When asked whether they felt
they had the expertise needed to assess and treat deaf
people with signed language disorders, almost all
(92%) of the participants felt that they did not. Ap-
proximately one-third of the 32 participants indicated
that they had specialty training for SLI, and one
indicated specialty training for cognitive–linguistic
disorders; the remaining two-thirds of the participants
did not have any specialty training in these areas.
Open-Ended Questions
The questionnaire invited additional comments and
suggestions, specifically regarding training for and
working with deaf people who sign and have signed
Table 2. Participants’ knowledge of language disorders.
Question n %
1. Which of the following language disorders are you aware of?
(Check all that apply)
Signed language aphasia 4 12.50
Signed stuttering 1 3.13
Specific language impairment 24 75.00
None of the above 8 25.00
2. Please indicate your level of agreement with the following
statement: Deaf persons who have language disorders can
benet from taking therapy in ASL.
Strongly agree 17 53.13
Moderately agree 14 43.75
Neither agree nor disagree 1 3.13
Moderately disagree 0 0
Strongly disagree 0 0
Prefer not to respond 0 0
230 CONTEMPORARY ISSUES IN COMMUNICATION S CIENCE AND DISORDERS Volume 43 • 223–237 • Fall 2016
Table 3. Participants’ personal experience, training, and self-assessment.
Question n %
1. Do you have experience practicing speech-language pathology
with individuals with hearing loss?
Yes 15 41.67
No 21 58.33
2. Have you practiced speech-language pathology with individuals
who are Deaf and who use ASL?
Yes 3 9.38
No 29 90.63
3. Please indicate your level of agreement with the following
statements: I have the appropriate training needed to treat
disorders using ASL.
Strongly agree 0 0
Moderately agre 1 3.13
Neither agree nor disagree 1 3.13
Moderately disagree 8 25.00
Strongly disagree 21 65.63
Prefer not to respond 1 3.13
4. Please indicate your level of agreement with the following
statements: I have the expertise to assess and treat people
who are Deaf with ASL disorders.
Strongly agree 0 0
Moderately agree 1 3.13
Neither agree nor disagree 2 6.25
Moderately disagree 6 18.75
Strongly disagree 23 71.88
Prefer not to respond 0 0.00
5. In which of the following areas do you have specialty
training? (Check all that apply)
Signed language aphasia 0 0
Signed stuttering 0 0
Specific language impairment 10 31.25
Other: Cognitive-linguistic disorders 1 3.13
None of the above 22 68.75
6. For how many years have you been working with
individuals who are Deaf and use ASL?
(Please enter a number only)
0 years 30 100.00
7. Approximately how many people who are Deaf have you
treated for language disorders using ASL?
None 30 93.75
1–10 1 3.13
11–20 0 0
21–30 0 0
31–40 0 0
41–50 0 0
More than 50 1 3.13
Prefer not to respond 0 0
Cripps: Disorders in Signed Language 231
language disorders. Five participants provided com-
ments indicating that the survey opened their minds
to new ideas and that now they would like to learn
more about ASL and signed language disorders. When
asked for additional comments or suggestions, three
participants stated that more education about ASL and
signed language disorders was needed at the under-
graduate level, and five felt that this information
should be included in graduate curricula in speech-
language pathology. One participant regretted that
her undergraduate program did not provide adequate
training in ASL. One participant indicated interest in
working with bilingual children who have English
as a second language, acknowledging the benefits of
providing bilingual treatment, regardless of the lan-
guage, and including ASL as a language. One partici-
pant indicated that she had experience communicating
in ASL previously and was eager to continue signing
and applying this knowledge to her speech-language
pathology practice. Several students indicated interest
in learning, or continuing to learn, more about ASL.
One participant provided her perspective that ASL
was a dialect variance of Spoken English.
DISCUSSION
The purpose of this study was to survey graduate stu-
dents of speech-language pathology to determine their
awareness of signed language disorders, opening the
door to a possible discussion of the need for signed
language pathology, including the potential for future
signing-based diagnoses and therapies. Three items
emerged from this study. First, graduate students in
this speech-language pathology program recognized
ASL as a language. Second, graduate students in this
speech-language pathology program were not suffi-
ciently familiar with ASL and were therefore unaware
of the existence of signed language disorders. Third,
graduate students did not feel comfortable provid-
ing diagnoses and treatment to people who may have
signed language disorders based on the students’ lack
of knowledge in this area.
ASL as a Language
The fact that more than 90% of the participants per-
ceived ASL as a human language is significant. The
students participating in this study were not required
to have any previous knowledge of ASL or the deaf
community, but still acknowledged the existence of
ASL as a language. It should be noted that this study
occurred in a university where the speech-language
pathology program is housed in the same depart-
ment as an undergraduate Deaf Studies program, so
there may be incidental exposure to signing and to
deaf faculty in the building, friends taking or who
have taken ASL classes, and more. Consequently, the
participants were likely to have some awareness of
ASL and deaf people due to the academic environ-
ment, with or without formal training. The incidental
exposure to signed language found in this unique
environment can be seen as a positive and realistic
influence, leading to participants’ perception of ASL
as an equal language.
Familiarity With ASL and its Disorders
Linguists have shown, and speech-language pathology
students appear willing to accept, that ASL is in-
deed a language (Klima & Bellugi, 1979; Valli et al.,
2011; Wilbur, 1979). Given that protocols exist for
diagnosing and treating disorders in other languages,
it appears to be a logical next step to identify and
treat disorders in the production and reception of
ASL. Preliminary studies in this area, cited in the lit-
erature review, indicate that these disorders exist. No-
tably, none of the participants in this study disagreed
with the concept that deaf people who have signed
language disorders could benefit from participating in
treatment in ASL.
This small study coincides with the suggestion by
Quinto-Pozos (2014a) that a new line of research in
the area of signed language pathology and treatment
is warranted, and that ASL pathology and treatment
has the potential to become a field parallel to, or
within, the field of speech-language pathology and
treatment. For children who are deaf, use ASL as
their primary mode of communication, and demon-
strate signed language disorders, this type of treat-
ment should become a priority. It should be noted
that other groups of people could be impacted by
this new field, notably children of deaf adults, ASL
students in colleges and universities, and other sign-
ers (e.g., adult signers who might exhibit a signed
fluency disorder or who suffer a stroke, and, in turn,
possible aphasia). These individuals could also ben-
efit from the availability of diagnosis and treatment
to improve their signed communication skills.
Diagnosing and Providing
Treatment to Signers
It is understandable that graduate students do not
feel comfortable providing diagnoses and treatment
to people who may have signed language disorders
based on the students’ lack of knowledge of ASL or
its possible disorders. When coupled with their ac-
ceptance of ASL as a language, and their dedication
to the profession of improving human communication,
232 CONTEMPORARY ISSUES IN COMMUNICATION S CIENCE AND DISORDERS Volume 43 • 223–237 • Fall 2016
the goal of establishing diagnoses and therapies for
signers seems imperative. Students need to look to
their national professional association for guidance,
and here is where the American Speech-Language-
Hearing Association (ASHA) can be of help.
ASHA identifies its mission as empowering and
supporting SLPs, audiologists, and speech, language,
and hearing scientists by (a) advocating on behalf of
persons with communication and related disorders,
(b) advancing communication science, and (c) pro-
moting effective human communication (www.asha.
org). ASHA defines effective communication for deaf
children as the ability to use language, such as signed
language, effectively in a variety of sociocultural
contexts (ASHA, 2004). With a mission of advocating
for and enhancing the lives of people with com-
munication disorders, ASHA has the opportunity to
serve as a conduit in ameliorating signing disorders.
Children, and other signers, are entitled to a signed
language as a linguistic compensation for their hear-
ing loss (Supalla & Cripps, 2008).
Limitations and Future Directions
The present study, while enlightening, has some limi-
tations that could be rectified in follow-up studies.
Any follow-up versions of this study should include
clear examples of SSLI for those participants who
are unfamiliar with the concept. The study could
be repeated with a larger sample and with addi-
tional inferential statistical analyses. The proposed
larger sample could include responses from groups
of graduate students in speech-language pathology
programs at universities where the use of signed
language is pervasive compared to graduate speech-
language pathology programs without any exposure to
ASL. This study could include use of a pre/posttest
format to examine the impact of providing awareness
of and training on signed language disorders. Another
suggestion for future research would be to survey
speech-language pathology students in a setting with-
out a Deaf Studies program on campus.
Additional research in this area could include a
study of practicing professionals and how training in
signed language disorders could be incorporated into
continuing education. It may also be interesting to
compare the attitudes of current SLPs with speech-
language pathology students on this topic.
Another consideration, not discussed in this ar-
ticle, is for the scope of practice of SLPs to include
the assessment of, and treatment for, deaf children
who acquire signed language as their first language
after the critical period of language learning (see
Cripps et al., 2016, for further discussion on the
issues about signed language delay in the field of
speech-language pathology). Additionally, designated
professionals must be identified within each educa-
tional system to assume responsibility for intervention
in these cases (see Snoddon, 2008, for further infor-
mation on ASL intervention).
Similar to the eld of secondary education, where
expertise in both a subject area and pedagogy is
needed, this proposed new eld will require a double
expertise. In addition to an advanced level of language
pathology skills, practitioners will need to have an
advanced level of ASL skills that may require more
than the typical 4 years of undergraduate training. A
master’s degree in this eld, or at least a track in a
speech-language pathology program, should be devel-
oped. The speech-language pathology program could
be developed with parallel tracks for deaf and hearing
people wishing to pursue the eld of signed language
pathology, with courses focused on the diagnosis and
treatment of signed language disorders. Any university
with a Deaf Studies program and a speech-language
pathology program could consider establishing this
type of program. Gallaudet University, the world’s
only liberal arts university dedicated to ensuring the
intellectual and professional advancement of deaf indi-
viduals through ASL and English, has the potential to
develop this type of program with its cadre of experts
in ASL and speech-language pathology.
Conclusion
Results of this study suggest that professionals enter-
ing the field of enhancing interpersonal communica-
tion today are prepared to acknowledge the need for
diagnoses and treatment plans for disorders of both
spoken and signed languages, and the need for more
investigation in this area.
The results of this study extend the preliminary
findings of Quinto-Pozos et al. (2011), and even be-
yond the suggestion that the diagnosis and treatment
of signed language disorders is a critical need in
schools using signed language (Quinto-Pozos, 2014a).
That is, this need exists across a much broader
community, including a variety of adult signers and
across a wide range of signing skills. There is also a
need for this type of treatment to be standardized.
Overall, the current study suggests that the field
of communication disorders, through the eyes of its
incoming professionals, may be ready to broaden its
perspectives to include the diagnosis and treatment
of individuals with signed language disorders. If so,
the field of preparing incoming professionals will
need to expand, and emerging changes in attitudes
and perceptions will likely open new doors for excit-
ing future research and practice in signed language
pathology.
Cripps: Disorders in Signed Language 233
ACKNOWLEDGMENT
We would like to acknowledge the significant contribu-
tions of Samuel Supalla and Rachel Hyle to earlier drafts
of this article.
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Contact author: Jody H. Cripps, Associate Professor,
Deaf Studies, Dept. of Audiology, Speech-Language Pathol-
ogy & Deaf Studies, Towson University, 8000 York Road,
Towson, MD 21252-0001. Email: jcripps@towson.edu
236 CONTEMPORARY ISSUES IN COMMUNICATION S CIENCE AND DISORDERS Volume 43 • 223–237 • Fall 2016
APPENDIX (p. 1 of 2). QUESTIONNAIRE
1. How familiar are you with American Sign Language (ASL)?
Extremely Very Moderately Not very Not at all Prefer not
familiar familiar familiar familiar familiar to respond
2. Where did you receive your education on people who are Deaf and use ASL? (Check all that apply)
Dedicated course(s) in undergraduate school
Mixture of courses in undergraduate school
Dedicated course(s) in graduate school
Mixture of courses in undergraduate school
Clinical practicum
Continuing education opportunities
Deaf family members
Deaf friends, neighbors, coworkers, etc.
Other
Undergraduate research
N/A or none
3. Which of the following language disorders are you aware of? (Check all that apply)
Signed language aphasia
Signed stuttering
Specific language impairment
None of the above
4. Please indicate your level of agreement with the following statement: Deaf persons who have language disorders can ben-
efit from taking therapy in ASL.
Strongly Moderately Neither agree Moderately Strongly Prefer not
agree agree nor disagree disagree disagree to respond
5. Please indicate your level of agreement with the following statement: ASL should be treated equally as one of the human
languages.
Strongly Moderately Neither agree Moderately Strongly Prefer not
agree agree nor disagree disagree disagree to respond
6. Do you have experience practicing speech-language pathology with individuals with hearing loss?
______ Yes ______ No
7. Have you practiced speech-language pathology with individuals who are deaf and who use ASL?
______ Yes ______ No
8. Please indicate your level of agreement with the following statement: I have the appropriate training needed to treat disor-
ders using ASL.
Strongly Moderately Neither agree Moderately Strongly Prefer not
agree agree nor disagree disagree disagree to respond
9. Please indicate your level of agreement with the following statement: I have the expertise to assess and treat people who
are deaf with ASL disorders.
Strongly Moderately Neither agree Moderately Strongly Prefer not
agree agree nor disagree disagree disagree to respond
10. In which of the following areas do you have specialty training? (Check all that apply)
Signed language aphasia
Signed stuttering
Specific language impairment
Other: Cognitive-linguistic disorders
None of the above
Cripps: Disorders in Signed Language 237
APPENDIX (p. 2 of 2). QUESTIONNAIRE
11. For how many years have you been working with individuals who are deaf and use ASL? (Please enter a number only)
12. Approximately how many people who are deaf have you treated for language disorders using ASL?
None
1–10
11–20
21–30
31–40
41–50
More than 50
Prefer not to respond
13. Are there any other comments that you would like to share about people who are deaf who sign and/or have language
disorders in ASL?
14. Do you have any additional comments or suggestions?
_____ Yes (please explain) _____ No
... The level of awareness of deaf people's stuttering-like behaviors while signing is poor (Cripps, Cooper, Evitts, & Blackburn, 2016a) and there is no known therapeutic practice for stuttering-like behaviors in the signed language modality (Cripps, Cooper, Supalla, & Evitts, 2016b). Within this background, it may be necessary to adopt the term of stuttering-like for ASL users when studying this phenomenon among deaf people. ...
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The general understanding about stuttering is well-established, but its relationship to American Sign Language (ASL) is little understood. While some preliminary research evidence exists to support the notion that stuttering-like behaviors occur among deaf people who know and use ASL on a daily basis, it is best to describe this phenomenon as stuttering-like, based on the level of knowledge obtained to date. This study used a survey-based research design, which included a comprehension set of questions to ask a large number of professionals and non-professionals who associate with deaf children and adults about their perceived prevalence of signed language stuttering. This study represents a new step for investigating stuttering-like behaviors in the signed language modality. A 19-item survey was developed and divided into two sections: 1) respondents' demographic information and ASL knowledge and experience; and 2) questions regarding stuttering-like behaviors. A majority of the respondents reported that they have observed deaf individuals who 'stutter' while signing. These respondents were able to identify with specific atypical behaviors as reported in the literature for the signed language modality. Some of the universal stuttering-like behaviors such as the location of atypical behaviors occurring in the beginning and the middle of an utterance are included in the findings. The respondents also confirmed other behaviors and the impact of communicative settings for deaf signers that are associated with hearing speakers who stutter.
... Self-perception research reported that those who possessed a Deaf cultural identity perceived themselves as nondisabled (Bell et al., 2016). Attitudinal research by Cripps, Cooper, Evitts, and Blackburn (2016) suggested that mere exposure to signed language could induce hearing persons to perceive ASL communication as an equal language. Similar literature by Cripps, Cooper, Supalla, and Evitts (2016) argued that more formal education on signed language could result in speech language pathologists having more favorable perceptions and positive attitudes about ASL communicators. ...
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This study concentrated on small group communication amongst Deaf basketball players. The central aim of the current research was to explore how outsiders perceive the communication of Deaf athletes who communicate via American Sign Language (ASL) in the sport of college basketball. Cultural identity theory (CIT) provided a theoretical foundation for the current research, while the extant literature on small groups was discussed to provide insight on intrateam messages. The participants in this study completed a pretest that centered on sports communication, partook in a distraction exercise, were informed they were analyzing Deaf athletes who communicate in ASL, and then completed a post-test that centered on sports communication. One of the main findings was that Deaf basketball players were perceived to share messages of acceptance with one another. Additional results revealed that Deaf basketball players were perceived to resolve conflict in a positive manner and were less likely to engage in negative conflict while communicating with teammates. Implications for CIT were a focal point in the study discussion as were practical implications tied to effective communication in team sports.
... The level of awareness of deaf people's stuttering-like behaviors while signing is poor (Cripps, Cooper, Evitts, & Blackburn, 2016a) and there is no known therapeutic practice for stuttering-like behaviors in the signed language modality (Cripps, Cooper, Supalla, & Evitts, 2016b). Within this background, it may be necessary to adopt the term of stuttering-like for ASL users when studying this phenomenon among deaf people. ...
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Traditional deaf education practices for teaching reading to deaf children are subject to evaluation in regards to validity of decoding and linguistic comprehension. Special education has its own premise for how reading should be taught to children with disabilities. This includes 'supports' with its emphasis on accessing information and activities, which are targeted for their effectiveness. Two support approaches for deaf children differ based on the use of English and American Sign Language (ASL). Deficiencies of the English and ASL support approaches become apparent when compared to the innovative reading instruction approach known as ASL gloss. ASL gloss falls in line with the Universal Design for Learning (UDL) conceptualization. Unlike special education, UDL emphasizes access to learning. ASL gloss allows deaf children to experience decoding and linguistic comprehension in an authentic manner. The text matching with what deaf children know in ASL contributes to such outcome. Signed language reading is proposed as an important feature for the education of deaf children. A short description on ASL gloss as a methodology provides a rationale for successful signed language reading. Discussion includes how ASL gloss is also designed to facilitate deaf children’s transition to written English as their second language.
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Purpose The purposes of this study were (a) to introduce “language access profiles” as a viable alternative construct to “communication mode” for describing experience with language input during early childhood for deaf and hard-of-hearing (DHH) children; (b) to describe the development of a new tool for measuring DHH children's language access profiles during infancy and toddlerhood; and (c) to evaluate the novelty, reliability, and validity of this tool. Method We adapted an existing retrospective parent report measure of early language experience (the Language Exposure Assessment Tool) to make it suitable for use with DHH populations. We administered the adapted instrument (DHH Language Exposure Assessment Tool [D-LEAT]) to the caregivers of 105 DHH children aged 12 years and younger. To measure convergent validity, we also administered another novel instrument: the Language Access Profile Tool. To measure test–retest reliability, half of the participants were interviewed again after 1 month. We identified groups of children with similar language access profiles by using hierarchical cluster analysis. Results The D-LEAT revealed DHH children's diverse experiences with access to language during infancy and toddlerhood. Cluster analysis groupings were markedly different from those derived from more traditional grouping rules (e.g., communication modes). Test–retest reliability was good, especially for the same-interviewer condition. Content, convergent, and face validity were strong. Conclusions To optimize DHH children's developmental potential, stakeholders who work at the individual and population levels would benefit from replacing communication mode with language access profiles. The D-LEAT is the first tool that aims to measure this novel construct. Despite limitations that future work aims to address, the present results demonstrate that the D-LEAT represents progress over the status quo.
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Deaf individuals who use American Sign Language (ASL) are rarely the focus of professionals in speech-language pathology. Although society is widely thought of in terms of those who speak, this norm is not all-inclusive. Many signing individuals exhibit disorders in signed language and need treatment much like their speaking peers. Although there is validation of the existence of disorders in signed language, provisions for signed language therapies are rare. Spoken language bias is explored with a focus on the concerning history of therapies provided for spoken language only. This article explores attitudes regarding ASL along with how signed language reading can help identify and treat language learning disabilities among deaf children. Addressing the topic of signed language disorders aims at meeting the needs of individuals who are deaf, which could lead to professional training and treatment options in signed language pathology (e.g., aphasia, stuttering).
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While reports of stuttering-like behaviors occurring in sign language have been available for almost 70 years, relatively little attention has been given to its existence and how the existence of stuttered sign may impact our understanding of the stuttering phenomenon. This manuscript provides a brief literature review of stuttered sign and offers a list of potential stuttered sign behaviors. Data is presented suggesting that stuttering is a phenomenon occurring in expressive communication, rather than speech and sign alone. Consequently, it is proposed that the prevailing theoretical constructs fail to account for stuttering in expressive modalities other than speech. It is suggested that the field of speech-language pathology reevaluate and possibly abandon the current pre-paradigmatic views concerning the nature of stuttering so that another perspective can emerge that better accounts for the stuttering phenomenon.
Chapter
“Specific language impairment” (SLI) is a term applied to children who show significant deficits in language learning ability but age-appropriate scores on non-verbal tests of intelligence, normal hearing, and no clear evidence of neurological impairment. Children who meet this definition are not identical in their characteristics, though some linguistic profiles are rather common. Boys outnumber girls, with a ratio of approximately 2.8 to 1 (Robinson, 1987). At age five years, the prevalence of SLI might be as high as 7% (Tomblin, 1996). This percentage is probably lower at older ages, due to the fact that some proportion of children with milder language difficulties achieve normal levels of ability within a few years, often with the help of intervention.