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COMMUNICATION SYSTEMS & THE DECISION-MAKING PROCESS
By Ellen A. Rhoades, Ed.S., LSLS Cert. AVT
Volta Voices, 3, 12-15.
How a child develops language is an ongoing hot topic in the field of deafness.
Parents who are new to hearing loss are often met with varied and conflicting
opinions. This article aims to demystify the topic of communication system,
particularly as related to learning more than one language (e.g., English, Spanish,
American Sign Language, etc.) at a time. Communication system refers to the
method of communication, which can be spoken, signed or written. Communication
between people can be verbal, nonverbal or both. In this article, we write about
communication systems or how information is exchanged between people.
Parents tend to view the diagnosis of their child’s hearing loss through the prism of their
own hearing status and their own culture. Whether parents are fluent in a signed or
spoken language, it is important that infants learn their “language of the heart,” which is
how they will interact naturally with their parents. When the parent and child share the
same “home” or “heart” language, their turn-taking in communication promotes positive
personal development.
Since 93 percent of children with hearing loss are born to typically hearing parents,
spoken language is most often the home language. A small number of infants with
hearing loss have a deaf parent already fluent in a signed communication system; their
home language is signed. There are also young children with hearing loss who have
typically hearing and speaking parents, but another family member, such as an aunt or
grandparent, might rely on a signed language. In these cases, children might be best
served by learning both languages.
The characteristics of all cultures should be recognized and respected. Listening and
Spoken Language practitioners are charged with supporting each family’s culture and
home language, whether signed or spoken. Evidence supports the validity and positive
outcomes of both communication systems.
Attaining Spoken Language Competency
In 1993, Universal Newborn Hearing Screening was recommended by the National
Institutes of Health, and now each state and territory in the United States conducts this
vital screening on newborns (which is also true in many other countries). Without
screening, families were often unaware of their child’s hearing loss until the child
reached age two or later when spoken language failed to develop. An overwhelming
majority of these children experienced significant language delays, and consequently,
were often functionally illiterate, demonstrating poor psychosocial functioning and low
academic achievement.
Poor developmental outcomes were largely due to two factors that hindered effective
communication between parents and infants. The first involved hearing aids that did not
provide sufficient access to sound for children diagnosed with profound deafness. For the
most part, this has been addressed through improvements to hearing aids and the
invention of cochlear implants. The second factor involved parents using a signed
language even though their home language was spoken. When parents are interacting
with infants, they need to express their thoughts and feelings in meaningful and natural
ways and encourage their baby to respond. To succeed in this turn-taking process, infants
need to hear their parents’ words and the tone of their voice. Parent-infant interactions are
bidirectional, gradually becoming more complex over time. At the end of the 20th
century, evidence showed us that:
• Parent-infant interactions are critical for establishing linguistically-based
communication systems;
• Family-centered early intervention programs are ideal for facilitating the best
interactions between parents and infants; and
• Programmable hearing technology, including multichannel cochlear implants,
provides access to the sounds needed for spoken language learning.
During the first 15 years of the 21st century, longitudinal studies were conducted to
determine if developmental outcomes for young children with significant hearing loss
could be improved. The results strongly supported exclusive use of spoken language with
early and consistent use of appropriate hearing technology.
Positive developmental outcomes for many children with significant hearing loss are now
reported. The majority of children with profound deafness achieve age-equivalent
language, educational and psychosocial outcomes. This is not to say that the speech of
early-implanted children sounds exactly like the speech of their typically hearing peers,
but that their speech is certainly intelligible based on the promptness of intervention.
Early intervention is vital. Long-term developmental benefits were generally proven to be
age-related rather than communication system-related. For example, when infants access
hearing and spoken language prior to six months of age, they perform as much as 20–40
percent higher on school-related measures than do children who were older than six
months when they first accessed early intervention services.
Recognizing Great Variability in Outcomes
Evidence supports the use of spoken language and aggressive audiological management
in early intervention, but success in spoken language varies due to other factors.
Longitudinal studies demonstrated that:
• The child’s age matters. The first two years of life are a child’s most sensitive period
of brain growth; early intervention is critical. Infants who consistently use well-fitting
hearing devices demonstrate optimal development in listening and speech perception,
which is necessary for the spoken language learning process. Although there seem to be
exceptions, such as in the perception of intonation, developmental outcomes tend to be
age-related. This stresses the importance of Listening and Spoken Language practitioners
and parents focusing on typical verbal and non-verbal developmental milestones for
expected growth.
• The child’s characteristics matter. Some children with hearing loss have genetic or
cognitive differences causing special needs that can add to learning challenges and
linguistic difficulties. The importance of a multi-disciplinary team to meet the unique
needs of each child and family system cannot be underestimated.
• The family’s characteristics matter. Socioeconomic status is a predictor of language
delays for children with hearing loss, particularly the mother’s education level and the
family’s economic difficulties. Nevertheless, with the appropriate provision of
information to parents and the use of digital technology through family-centered
interventions, it has been demonstrated that children with hearing loss can attain
language-age equivalencies.
Regardless of the communication system chosen by the family, these factors, individually
or collectively, influence the development of auditory perceptual learning. Families need
support when dealing with other factors while they are in the decision-making process.
Sharing the Evidence to Facilitate
the Parental Decision-Making Process
It is important to recognize that when parents are communicating with the service
provider in a language that is not their native language, their intuition or decision-making
may be compromised. There may be communication barriers, but beyond that, their
decision-making on communication systems may include their knowledge, aspirations,
values, beliefs, etc., and all are affected by the information that practitioners share with
them.
Putting aside fears and biased judgments, it is important that practitioners understand the
characteristics of high-quality research studies, strength of evidence, and replicability of
such findings. For example, typically hearing children are non-verbal during the first year
of infancy. The use of signs has recently been popularized to improve developmental
outcomes (for example, better language growth with reduced temper tantrums); However,
there is insufficient evidence to support the use of both signed and spoken languages.
There is no definitive proof of the superiority of any particular communication system.
Selection of an early communication system is a time-dependent process that should
result in an informed parent choice focused on the child’s needs and based on evidence
shared by the practitioner.
There is no clear demonstration that using one communication system or another will
result in better developmental outcomes. To do that requires using randomized well-
controlled group studies. Until there is indisputable evidence for one communication
system over another, it is important to recognize that:
• Language is a key element of each family’s culture;
• In any country, signed languages are legitimate systems; each has its own
grammar and word order that is different from the community’s spoken
communication system, but signed languages everywhere are usually not the
home language of most parents;
• With early access to appropriate and consistent use of hearing technology,
relying exclusively on spoken language can enable children with significant
hearing loss to develop listening skills so that the family’s home language can be
understood and lead to typical developmental outcomes.
Given appropriate support, most children with hearing loss, even those considered deaf at
birth, can learn to listen and talk. While parents may be compelled by service providers to
learn both a spoken language and a signed language, it is critical that children develop at
least one robust language. For this reason, parents may want to focus their limited time
and resources on ensuring transfer of their home language to their child.
Final Comments
Best practices in audiology still have not been widely implemented simply because in
general, practitioners have not successfully shared their knowledge base with parents.
This is also true for best practices in family-centered early intervention. Multidisciplinary
teams need to ensure that each child’s learning capacities and needs are appropriately
identified. Before any determination about bimodal bilingualism (competency in at least
one oral language and at least one sign language) is made, these underlying critical
practices must first be in place. Until these two broad challenges are met, any evidence
gleaned from studies involving bimodal bilingualism may be suspect.
GLOSSARY
Appropriate Hearing Technology–refers to well-fit hearing aids and/or cochlear
implants that are consistently used during all of the child’s waking hours. Hearing
devices must be programmed to optimize audibility, enabling the child access to soft
conversational sound. Best audiological practice necessitates frequent audiological
monitoring, e.g., every few months.
Early Intervention–accessing appropriate hearing technology and intervention services
during the first three years of a child’s life, in their infancy and toddlerhood.
Spoken Language–involves the development of auditory perceptual skills. In turn,
listening skills facilitate the comprehension of spoken words. When words are heard and
understood, then words are produced or spoken.
Signed Language–involves the development of visual perceptual skills. In turn, visual
perception facilitates the comprehension of signed words. When signed words are
understood, then words are used or signed.
Citation Source:
Rhoades, E.A. (2017). Communication systems and the decision-making process.
Volta Voices, 3, 12-15.
