Language deprivation in deaf and hard of hearing children

Language deprivation in deaf and hard of hearing children occurs when children do not receive accessible language exposure during the critical period of language development. Language development may be severely delayed from the lack of language exposure during this period. This was observed in well-known clinical case studies such as Genie,[1] Kaspar Hauser, Anna,[2] and Isabelle,[3] as well as cases analyzing feral children such as Victor. All of these children had typical hearing, yet did not develop language typically due to language deprivation. Similarly, language deprivation in deaf and hard of hearing children often occurs when sufficient language exposure is not provided in the first few years of life. However, deaf and hard of hearing children who are exposed to sufficient language as children are able to develop typical language. Language can be provided in a variety of ways and helps children learn about and understand the world around them. Early intervention, parental involvement, and legislation work to prevent language deprivation. Deaf children who experience limited access to language—spoken or signed—may not develop the necessary skills to successfully assimilate into the academic learning milieu.[4] There are varied educational approaches for teaching deaf and hard of hearing individuals.

Access to language

Typical language development for deaf and hard of hearing children:

Although language deprivation is likely to when hearing loss restricts access to spoken language, deaf and hard of hearing children are capable of acquiring typical language! This is because language deprivation is caused by restricted language access, not by deafness itself. For deaf and hard of hearing children with no vision impairments, visual language is fully accessible to them and can protect them from experiencing language deprivation. An example of this is when Deaf parents have a deaf baby. A 2017 study worked to identify the role of language deprivation versus deafness itself with regards to child behavior. When comparing two groups, the researchers found that the group who had been exposed to language from birth did not display the behavioral issues that characterized the language deprivation group. Since the children in both groups were deaf, the researchers concluded that it was not deafness, but language exposure that protected the native signers from developing the behavioral issues characteristic of the group who had experienced language deprivation.[5] Studies such as this reveal that the timing and quality of language exposure are more important than hearing status for developing age-appropriate skills. Technology such as cochlear implants, hearing aids, and BAHAs can help provide access to spoken language. This access can vary greatly from person to person due to factors such as cause of deafness, age hearing technology is introduced, and time of language exposure. Speech therapy, audiology, and other services can help maximize the access provided through hearing technology. Even for children using hearing technology, the age they were exposed to language (whether visual or spoken) will have a role in how much they can benefit from the technology. Language exposure from birth builds and strengthens brain tissue that can be used in a variety of language contexts in the future, such as when the child is old enough to get a cochlear implant.[6] Timing and quality of language exposure, not language used or how many languages used, are the factors that matter most when determining language and literacy outcomes.[7] [8][9] When deaf and hard of hearing children are fully exposed to natural language along a timeline equivalent to their hearing peers, they will acquire language along equivalent milestones. This timeline includes babbling around 10 months and first sign around one year.[10][11] Gallaudet University Press published a timeline (here) parents of deaf children can use to track their child's language development. This resource is unique because it is normed for deaf and hard of hearing children, and can be used to establish parent expectations for their child's language progress.[12]

Critical period

The first five years of a child's life is a critical time for cognitive development and the establishment of their native language.[13] This critical period deems the first few years of life as the period during which the brain is most primed for language development. The critical period is also referred to as the sensitive period for language development, or the language acquisition window. After this critical period of language acquisition, it remains exceedingly laborious and strenuous to master a native language.[14] Studies on infancy stroke and typical language development unveiled a critical period for language acquisition.[15] Likewise, renowned researchers Elissa Newport and Rachel Mayberry support the existence of this critical stage in language development. Elissa Newport and Rachel Mayberry’s work revealed that deaf individuals who lack exposure to sign language at a young age fail to achieve full language proficiency as they develop.[16] Additionally, deaf individuals who acquired sign language after five years of age were not nearly as proficient as deaf individuals who were exposed to sign language from birth. Language deprivation influenced altered neural activation patterns in deaf individuals later exposed to sign language as compared to deaf individuals who received typical language development.[17] After this critical period of language acquisition, it remains exceedingly laborious and strenuous to master a native language.[14] Language development is not impossible after the five year mark, but will likely bear the cognitive and linguistic characteristics of language deprivation. Inconsistencies in exposure to a natural language during this critical period of language acquisition could result in persistent symptoms, known as language deprivation syndrome.[18] Symptoms of language deprivation syndrome include language dysfluency (e.g., lack of fluency in native language), knowledge gaps about the world around them, abnormal thinking, mood and/or behavior disorders, academic, and literacy delays.[19] Other studies address the neurological differences between individuals who have experienced language deprivation and those who did not. The first five years of life are foundational for many skills as the brain develops the neural connections and processes that will be built upon for years to come. Without full access and exposure to natural language during the critical period, the brain does not have the tools it needs to build the typical framework for processing and producing language.[20][21][22][23] In turn, language deprivation can cause abnormalities in other areas of cognitive functioning, particularly the establishment of concepts, processing things in a set order, and executive function.[24]

Incidental learning and access to knowledge

The importance of early accessible communication with family and peers can be seen in the ‘dinner table syndrome'[25]—the experience of observing spoken conversations between other family members and not understanding these conversations. As statistics show, 90-95% of deaf children are born to hearing parents, thus, they may often experience this phenomena if their family does not use sign language.[26][27] These parents may be unfamiliar with Deaf culture. Most importantly, these parents are often unaware of the best communication methods to assist their children with developing into contributing members of society.[28][29] A famous Deaf artist, Susan Dupor, painted an art piece called "Family Dog” to represent this experience. Her artwork candidly represents the feeling of isolation being deaf in an all hearing family. This painting was designed to emphasize deaf family members’ perspectives with the blurred faces of the family metaphorically representing the difficulties of lip reading. In these situations, deaf children are unable to participate in the conversations without using a commonly accessible language.[30] Similarly, these experiences occur during social engagements where deaf individuals cannot communicate with other individuals through a spoken language.

When hearing individuals share information with each other in a way that is not accessible to deaf individuals, the deaf individuals are not privy to incidental learning experiences. Incidental learning refers to any unprompted, unplanned, or unintended learning.[31] Hearing children typically learn incidentally when they overhear conversations between other family members in the home. This type of learning occurs in everyday communication including emotional expression, navigating arguments, and managing triggers. Language deprivation syndrome coupled with the lack of these every day incidental learning experiences may impact mental health, physical health, and academic advancements.[32][33] A lack of incidental learning can also limit an individual's general wealth of knowledge and comprehension skills used to learn about and understand the world around them.[34] Without the wealth of knowledge and language skills hearing children typically demonstrate, deaf and hard of hearing children can arrive at school already behind their peers. This trend can continue as they spend school years working to learn the things their hearing peers picked up effortlessly in the home before starting school. Incidental learning is possible for deaf and hard of hearing children when the family uses language that is fully accessible to ALL family members and includes the child with atypical hearing in family communications directly and indirectly.

Language modality

When it comes to language deprivation prevention, modality (spoken or signed language) does not matter to the brain as long as it is fully accessible. Studies from Dr. Laura-Ann Petitto reveal that brain tissue used for language accepts both auditory and visual input to develop language pathways. This is because the brain focuses on patterns in language, whether it is a pattern of sounds or a pattern of hand movements. Access to the full range of patterns embedded in a language is key for developing strong language pathways in the brain. The brain connections developed in response to linguistic input can then be utilized if/when the child is exposed to a second language. CITE. Even in cases where the brain receives absolutely no auditory input, the brain is still able to develop typical language skills when exposed to high-quality visual language. Hearing technologies can also be used to grant spoken language access, though the quality of this access varies from person to person.

Historically, there has been much conflict and controversy regarding language modality for deaf and hard of hearing children. This is due in part to the identification system. When it is discovered that a child is deaf or hard of hearing, this assessment is usually made via a "failed" hearing test in a medical setting. The first people the parents interact with after their child's hearing status is identified can be very influential. It is important that these professionals provide parents with unbiased, well-rounded information to help guide decisions they will need to make. In the past, many children have suffered due to pressure their parents experienced to choose one language modality for them as soon as possible. Furthermore, systemic bias towards deafness (called Audism) and business motivation commonly impacted what information and guidance parents received. By the time parents realized the communication modality they chose wasn't successful for their child, their child was already behind in language development.

Language "options" include spoken language, signed language, and communication systems such as cued speech, SSE, SEE, and total communication. Children whose parents selected the spoken language route would use hearing technology to receive spoken language input and would be encouraged to go to speech therapy to work on expressive language skills. They would speak and listen to language. Medical professionals would perform cochlear implant surgery if elected, or audiologists could test residual hearing and order hearing aids. This method is often a good fit for families who utilize spoken language at home and cannot or will not learn sign language. However, modern research reveals the wide range of results this method produces, and explores the background factors that impact the success of this method such as family socioeconomic status, location, parental employment, quality of the language model at home, and the child's residual hearing. Children whose parents selected the signed language route would benefit from signed language models, such as a Deaf mentor. The family would take signing classes and ideally engage in Deaf community events. Everyone, including the child, would learn to sign together and use their skills to communicate with one another. This method would ensure the child has full language access, but poses challenges to the family as they work to learn a new language. Quality of linguistic input may suffer, although the quantity of accessible language is far more than other methods provide. Communication systems such as cued speech, SSE, SEE, and total communication also historically have been presented as options to parents. These systems are closely linked to English and therefore usually easier for acquisition by people whose native language is English. However, these methods are not defined by the same language characteristics that all language systems include such as morphology, phonology, syntax, and semantics.

Modern research supports bilingual language development as ideal for deaf and hard of hearing children. By prioritizing the child's visual and auditory language equally from birth, children are given every opportunity and tool to develop language. As children grow and become adults, they may naturally prefer one modality over the other, but will have developed useful skills in both. Code switching (when an individual switches from using one language to another depending on who they are communicating with) allows bilingual individuals to experiences all the benefits of each language they know. Some research even shows how skills on one language can transfer and strengthen the other language. For deaf and hard of hearing children especially, a strong language foundation in a signed language paired with focus on a spoken language (or written) sets the stage for literacy later on.

Prevention

Early Intervention

Early intervention is one of the main methods of preventing language deprivation. A main focus of early intervention programs and services for deaf and hard of hearing children is language development. Early interventionists are able to work with the family during the early, critical years for language acquisition. Early intervention can take many forms and usually depends on where the family lives. In the United States, the School for the Deaf in the state the family lives in likely provides programs and resources. Other services can come from the state itself, national programs, and educational centers. These services may be paid for through state and federal funds. Independent organizations like the National Association of the Deaf and the American Society of Deaf Children in the United States and the National Deaf Children's Society in London can provide additional resources and support.

The importance of a cooperative team for the success of early intervention cannot be emphasized enough. Members of the early intervention team include education and medical professionals, therapists (speech, occupational, physical, psychological), specialists (vision, hearing/deafness, family dynamics, and kinesthetic), the audiologist, a social worker, the interventionist, and the family.[35] A Deaf mentor can also be included as a key member of the team. Deaf mentors provide a role model for the child that they may not see anywhere else, as well as providing a language model for the whole family. Deaf mentors are instrumental in helping parents understand what their deaf child is capable of and establishing high expectations for the child to fulfill their potential. Early interventionists can also work with the family in the home through game play, language and communication instruction and activities, providing strategies, helping establish routines and discipline methods, and more.

Home visits are one way early intervention can take place, but it is not limited to the home given the broad range of services provided. Geographic location of the family influences available services and resources due to distance, but virtual intervention measures have helped address this challenge. Early intervention has also helped prevent language deprivation in the United States through the newborn hearing screening. Before universal hearing screening was established in hospitals shortly after birth, many deaf children's hearing status was not identified until years after birth, when language milestones were not being met. At the time of identification the child was already behind. Newborn hearing screening supports early identification and allows professionals to help keep the child's language development on track.

Legislation

Another way language deprivation can be prevented is through legislation. One current example of legislation in the United States is LEAD-K, which stands for Language Equality & Acquisition for Deaf Kids. LEAD-K varies from state to state because each state is responsible for drafting its own version of the bill to present to the state government before it can be passed. The main focus of LEAD-K is full language development in English, ASL, or both, for school readiness and the prevention of language deprivation.[36] The model bill for LEAD-K calls for five actions:

1) Create a resource for informal parental use to chart their deaf or hard of hearing children’s language growth. This resource will be based on milestones for typical language and English literacy development.

2) Provide a similar resource for educators that, instead of being created through LEAD-K, is chosen from current methods.

3) Distribute the parent and educator resources to relevant individuals and organizations and equip these recipients for its use.

4) Hold IEP and IFSP teams accountable for the child's language development progress.

5) Establish an advisory committee. The model bill outlines the responsibilities of the committee as well as the requirements for its composition to ensure the creation of a balanced, knowledgable, and diverse team.[37]

LEAD-K has faced opposition by spoken language focused groups such as ASHA (American Speech-Language-Hearing Association) and ACIA (American Cochlear Implant Alliance). Both groups released statements regarding their concerns about parental choice of modality for their child.[38][39] It is unclear which version of LEAD-K these statements are in response to as LEAD-K has been adjusted since its first version in 2015 and varies between states. One notable revision came via a collaboration between LEAD-K and the A.G. Bell Foundation, a historically spoken language only group. These two traditionally opposed groups were able to reach an agreement by focusing on the shared desire to provide equal language acquisition opportunities for deaf and hard of hearing children as are received by their hearing peers and promote the spread of accurate and balanced information.[40]

LEAD-K is just one example among many of legislation in the United States concerning the language rights of deaf and hard of hearing children. Other related laws include national legislation such as the ADA (Americans with Disabilities Act), IDEA (Individuals with Disabilities Education Act), and the Rehabilitation Act of 1973.[41] Globally, there are countless laws and policies that also relate to the topic of language deprivation.

American Deaf Educational Philosophy

General Education

One education option for students who are deaf or hard of hearing is general (or mainstream) education. This method integrates students requiring special education services into a general education classroom based on their skills. The Individuals with Disabilities Education Act (IDEA) mandates the specificities of this integration. IDEA protects students who are typically a part of the special education classroom by granting the right to access the same education setting as their peers. The student also has a right to the school-provided accommodations and services necessary for him or her to be able to participate in the general education classroom. The student's needs, services, and goals are detailed in his or her IEP (Individualized Education Plan). In terms of deaf students, deafness is considered a low-incidence disability. This translates to the possibility of one deaf child belonging to a classroom of all “hearing” children[42] and can result in unique barriers. For example, teachers and students within the general education setting may not know sign language, causing significant communication and cultural barriers to social interaction, friendship, and learning. Deaf students may overcome this challenge through accommodations such as a sign language interpreters, communication access real-time translation (CART), or a FM system. These accommodations work to increase access, but for students using sign language in general education settings, communication will be indirect since it is through the interpreter. Students who use hearing technology and spoken language can be supported by reducing classroom background noise, seating close to the instructor, and speakers who face the class while talking one at a time.[43] Learning can be difficult when these conditions are not provided. More tips for supporting deaf and hard of hearing students in a general education setting can be found here. All deaf and hard of students have a right to access general education instruction at their local school with their peers, but it depends on the individual if this option will be the best fit.

Bilingual-Bicultural

Deaf children without early access to signed language remain at risk for starting school unprepared for the rigors of academic learning.[44] One challenge for deaf children is not having the ability to use their natural language and be able to associate it with formal written language.[45] This is where an educational philosophy known as the Bilingual-bicultural (Bi-Bi) method can be beneficial for deaf students. The goal of this method is to provide deaf and hard of hearing students with instruction in both signed and written languages, and both Deaf and other cultural contexts. Bi-Bi emphasizes that deaf children learn visually and education should be provided through a visual language. Bi-Bi supporters' argue because of the variability in cochlear implant and hearing aid outcomes, sign language access is crucial for preventing deaf and hard-of-hearing children from experiencing inequalities in education. However, since it is a method with a bilingual focus, the written form of the majority spoken language is given equal value. Deaf and hard of hearing students have a right to the same academic content as their peers and to literacy.

This approach began to emerge in schools during the late 1980s in the United States, Denmark, and Sweden.[46] In the United States, the ASL/English Bi- Bi is designed to facilitate academic success and provide education to deaf students by teaching sign language as a first language, followed by a written or spoken language (such as English) as their second language.[47][48] Furthermore, state schools specifically for the deaf offer exposure to Deaf culture—a unique facet not provided by general education. Through the Bi-Bi approach, deaf students may develop multiple cultural identities: one based on their hearing status and others based on that of their family or local majority culture.

See also

References
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