How Bilingualism Contributes to Healthy Development in Deaf Children: A Public Health Perspective

An approach designed to fail deaf children and their parents and how to change it

The matter of raising and educating deaf children has been caught up in percepts of development that are persistently inaccurate and at odds with scientific research. These percepts have negatively impacted the health and quality of life of deaf children and deaf people in general. The all too prevalent advice is to raise the child strictly orally and wait to see what happens. Only when the child is seriously behind is a completely accessible language - a sign language - introduced, and that is far too late for protecting cognitive health. The medical profession, along with others, needs to offer parents better advice and better supports so that neither the children nor their parents wait and watch as the oral-only method fails. All must take responsible action to assure an approach that succeeds.

Systems that support hearing families with deaf children: A scoping review

BACKGROUND

Over 90% of deaf children are born to hearing parents who have limited knowledge about deafness and require comprehensive support and information to support and communicate with their deaf child. However, little is known about the systems that support hearing families with deaf children. We performed a scoping review to provide an overview of current literature on the topic.

METHODS

The protocol of the scoping review was prepared using the PRISMA statement guidelines for scoping reviews. Relevant search terms were used to identify eligible studies following discussion with the study's steering group. Databases searched were CINAHL, Medline, ProQuest Central and ASSIA, as well as grey literature from relevant journals and online sources. Included were studies published from 2000 to 2021 and available in English.

RESULTS

A search of databases identified 1274 articles. After excluding duplicates, screening titles and abstracts and full texts, 65 papers matched the identified inclusion criteria. Results included 1 RCT, 7 comparative studies, 6 literature reviews, 4 PhD theses, and 47 further empirical studies.

CONCLUSION

There is limited quality evidence on what supports hearing parents with deaf children. It is evident that further studies are needed to ensure comprehensive support is accessible and effective for hearing parents of deaf children.

Deaf and Hearing American Sign Language-English Bilinguals: Typical Bilingual Language Development

Some studies have concluded that sign language hinders spoken language development for deaf and hard-of-hearing (DHH) children even though sign language exposure could protect DHH children from experiencing language deprivation. Furthermore, this research has rarely considered the bilingualism of children learning a signed and a spoken language. Here we compare spoken English development in 2-6-year-old deaf and hearing American Sign Language-English bilingual children to each other and to monolingual English speakers in a comparison database. Age predicted bilinguals' language scores on all measures, whereas hearing status was only significant for one measure. Both bilingual groups tended to score below monolinguals. Deaf bilinguals' scores differed more from monolinguals, potentially because of later age of and less total exposure to English, and/or to hearing through a cochlear implant. Overall, these results are consistent with typical early bilingual language development. Research and practice must treat signing-speaking children as bilinguals and consider the bilingual language development literature.

Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening

Children who are deaf or hard of hearing (D/HH) are at high risk for permanent deficits in language acquisition and downstream effects such as poor academic performance, personal-social maladjustments, and emotional difficulties. Identification of children born D/HH through newborn hearing screening and subsequent timely early intervention can prevent or reduce many of these adverse consequences. Ongoing surveillance for changes in hearing thresholds after infancy is also important and should be accomplished by subjective assessment for signs of atypical hearing and with objective screening tests. Scheduled hearing screening may take place in the primary care setting, or via referral to an audiologist according to the Bright Futures/American Academy of Pediatrics "Recommendations for Preventive Pediatric Health Care" (also known as the periodicity schedule). This report covers hearing assessment beyond the newborn period, reviews risk factors for hearing level change, and provides guidance for providers of pediatric primary care on the assessment and care of children who are D/HH.

Family ASL: An Early Start to Equitable Education for Deaf Children

Deaf and hard of hearing (DHH) children experience systematic barriers to equitable education due to intentional or unintentional ableist views that can lead to a general lack of awareness about the value of natural sign languages, and insufficient resources supporting sign language development. Furthermore, an imbalance of information in favor of spoken languages often stems from a phonocentric perspective that views signing as an inferior form of communication that also hinders development of spoken language. To the contrary, research demonstrates that early adoption of a natural sign language confers critical protection from the risks of language deprivation without endangering spoken language development. In this position paper, we draw attention to deep societal biases about language in information presented to parents of DHH children, against early exposure to a natural sign language. We outline actions that parents and professionals can adopt to maximize DHH children's chances for on-time language development.

Associations of childhood hearing loss and adverse childhood experiences in deaf adults

Childhood trauma and adverse childhood experiences have a strong relationship with health disparities across the lifespan. Despite experiencing approximately doubled rates of trauma, Adverse Childhood Experiences (ACEs) are poorly characterized in deaf populations. We sought to characterize deaf-specific demographic factors and their association with multiple experiences of ACEs before the age of 18 years old. An analytical cross-sectional approach was used to ascertain associations of deaf-specific demographic factors and experiences with ACEs. The complete dataset included 520 participants for a total response rate of 56%. After adjusting for confounding effects, less severe hearing loss of 16-55 dB (2+ OR: 5.2, 4+ OR: 4.7), having a cochlear implant (2+ OR: 2.1, 4+ OR: 2.6), and not attending at least one school with signing access (2+ OR: 2.4, 4+ OR: 3.7) were significantly and independently associated with reported experiences of multiple ACEs. We conclude that factors associated with childhood hearing loss and language experiences increase risk of experiencing ACEs. Given the strong relationship between ACEs and poor social outcomes, early intervention clinical practice and health policies should consider interventions to support healthy home environments for deaf children.

Deaf Identity Under Pressure: Experiences of Deaf Persons in Iceland

Over the past decades, changes in technology and policy have made developing and maintaining identity and community increasingly challenging for Deaf individuals. This is particularly obvious in Iceland, where the Deaf community is threatened in its existence. This paper reports on an empirical study that explores how Deaf individuals experience developing and maintaining a positive identity in various areas, including family life, working life, and social life. The study approaches deaf identities as multifaceted and dynamic, and particular emphasis is placed on the role of social interactions in identity-related processes. Qualitative interviews were conducted among members of the Icelandic Deaf community and analyzed using a phenomenological approach. The results indicate that social interactions within the Deaf community are a key factor in developing and maintaining Deaf identity. However, decreasing numbers in the Deaf community make its members explore other opportunities, and they experience being Deaf in Iceland as an insecure identity.

Deaf Children Need Rich Language Input from the Start: Support in Advising Parents

Bilingual bimodalism is a great benefit to deaf children at home and in schooling. Deaf signing children perform better overall than non-signing deaf children, regardless of whether they use a cochlear implant. Raising a deaf child in a speech-only environment can carry cognitive and psycho-social risks that may have lifelong adverse effects. For children born deaf, or who become deaf in early childhood, we recommend comprehensible multimodal language exposure and engagement in joint activity with parents and friends to assure age-appropriate first-language acquisition. Accessible visual language input should begin as close to birth as possible. Hearing parents will need timely and extensive support; thus, we propose that, upon the birth of a deaf child and through the preschool years, among other things, the family needs an adult deaf presence in the home for several hours every day to be a linguistic model, to guide the family in taking sign language lessons, to show the family how to make spoken language accessible to their deaf child, and to be an encouraging liaison to deaf communities. While such a support program will be complicated and challenging to implement, it is far less costly than the harm of linguistic deprivation.

Somatosensory processing in deaf and deafblind individuals: How does the brain adapt as a function of sensory and linguistic experience? A critical review

How do deaf and deafblind individuals process touch? This question offers a unique model to understand the prospects and constraints of neural plasticity. Our brain constantly receives and processes signals from the environment and combines them into the most reliable information content. The nervous system adapts its functional and structural organization according to the input, and perceptual processing develops as a function of individual experience. However, there are still many unresolved questions regarding the deciding factors for these changes in deaf and deafblind individuals, and so far, findings are not consistent. To date, most studies have not taken the sensory and linguistic experiences of the included participants into account. As a result, the impact of sensory deprivation vs. language experience on somatosensory processing remains inconclusive. Even less is known about the impact of deafblindness on brain development. The resulting neural adaptations could be even more substantial, but no clear patterns have yet been identified. How do deafblind individuals process sensory input? Studies on deafblindness have mostly focused on single cases or groups of late-blind individuals. Importantly, the language backgrounds of deafblind communities are highly variable and include the usage of tactile languages. So far, this kind of linguistic experience and its consequences have not been considered in studies on basic perceptual functions. Here, we will provide a critical review of the literature, aiming at identifying determinants for neuroplasticity and gaps in our current knowledge of somatosensory processing in deaf and deafblind individuals.

Access to Effective Communication Aids and Services among American Sign Language Users across North Carolina: Disparities and Strategies to Address Them

OBJECTIVE

To examine the extent to which communication aids and services used by American Sign Language (ASL) users and their healthcare providers aligns with preferences, satisfaction, and unmet needs; and to elicit from stakeholders strategies to address disparities.

METHODS

A cross-sectional study was conducted of ASL users in North Carolina. Respondents completed an online survey presented in ASL and English (N = 189). McNemar's tests were used to compare rates of preferred and actual methods of communication. Logistic regression models explored relationships of accessible communication with dissatisfaction and unmet need. Qualitative interviews explored satisfaction with communication and reflections on what works, what does not, and outcomes (N = 54).

RESULTS

While 45% of respondents used a professional sign language interpreter, 65% of respondents preferred to do so. Accessible communication was associated with lower odds of dissatisfaction with communication (OR = .19, p < .05). Dissatisfaction with communication was associated with greater odds of unmet need for healthcare (OR = 8.95, p < .05). Interview respondents emphasized their preference for on-site interpreters, explaining how video remote interpreting was subject to technical difficulties while writing back-and-forth led to important gaps in understanding.

CONCLUSIONS

While ASL users prefer to use professional, on-site sign language interpreters to communicate with providers, most use some other form of communication instead. Findings emphasize the need for policy strategies to facilitate access to high quality, well-functioning professional interpreter services and to have those services delivered on-site to overcome disparities.

Effects of Age-of-Acquisition on Proficiency in Polish Sign Language: Insights to the Critical Period Hypothesis

This study focuses on the relationship between the age of acquisition of Polish Sign Language (PJM) by deaf individuals and their receptive language skills at the phonological, morphological and syntactic levels. Sixty Deaf signers of PJM were recruited into three equal groups (n = 20): (1) a group exposed to PJM from birth from their deaf parents; (2) a group of childhood learners of PJM, who reported learning PJM between 4 and 8 years; (3) a group of adolescent learners of PJM, who reported learning PJM between 9 and 13 years. The PJM Perception and Comprehension Test was used to assess three aspects of language processing: phonological, morphological and syntactic. Participants were asked to decide whether a series of signs and sentences were acceptable in PJM. Results show that the age of PJM acquisition has a significant impact on performance on this task. The earlier deaf people acquire PJM, the more likely they were to distinguish signs and sentences considered permissible and impermissible in PJM by native signers. Native signers had significantly greater accuracy on the phonological, morphological, and syntactic items than either the Childhood or the Adolescent signers. Further, the Childhood signers had significantly greater accuracy than the Adolescent signers on all three parts of the test. Comparing performance on specific structures targeted within each part of the test revealed that multi-channel signs and negative suffixes posed the greatest challenge for Adolescent signers relative to the Native signers. The above results provide evidence from a less-commonly studied signed language that the age of onset of first language acquisition affects ultimate outcomes in language acquisition across all levels of grammatical structure. In addition, this research corroborates prior studies demonstrating that the critical period is independent of language modality. Contrary to a common public health assumption that early exposure to language is less vital to signed than to spoken language development, the results of this study demonstrate that early exposure to a signed language promotes sensitivity to phonological, morphological and syntactic patterns in language.

Measuring Receptive ASL Skills in Novice Signers and Nonsigners

We tested the utility of two standardized measures of receptive skills in American Sign Language (ASL) in hearing adults who are novice signers: the ASL Comprehension Test (ASL-CT; Hauser, P. C., Paludneviciene, R., Riddle, W., Kurz, K. B., Emmorey, K., & Contreras, J. (2016). American Sign Language Comprehension Test: A tool for sign language researchers. Journal of Deaf Studies and Deaf Education, 21(1), 64-69. https://doi.org/10.1093/deafed/env051) and the ASL Receptive Skills Test (ASL-RST; Allen, T. E., & Enns, C. (2013). A psychometric study of the ASL Receptive Skills Test when administered to deaf 3-, 4-, and 5-year-old children. Sign Language Studies, 14(1), 58-79. https://doi.org/10.1353/sls.2015.0006; Enns, C. J., & Herman, R. C. (2011). Adapting the Assessing British Sign Language Development: Receptive Skills Test into American Sign Language. Journal of Deaf Studies and Deaf Education, 16(3), 362-374. https://doi.org/10.1093/deafed/enr004). We also administered these tests to hearing nonsigners, with the goal of identifying items where the correct answer can be readily deduced through iconicity and/or test-taking skills, even by people with no prior ASL knowledge. We predicted that removing such items would strengthen the correlation between test score and ASL experience (as measured by semesters of instruction). We found that this relationship was stronger for the ASL-CT than the ASL-RST in this population, but still weaker than previously reported, and not substantially improved by any item selection strategy that we employed.

Language development in deaf bilinguals: Deaf middle school students co-activate written English and American Sign Language during lexical processing

Bilinguals, both hearing and deaf, activate multiple languages simultaneously even in contexts that require only one language. To date, the point in development at which bilingual signers experience cross-language activation of a signed and a spoken language remains unknown. We investigated the processing of written words by ASL-English bilingual deaf middle school students. Deaf bilinguals were faster to respond to English word pairs with phonologically related translations in ASL than to English word pairs with unrelated translations, but no difference was found for hearing controls with no knowledge of ASL. The results indicate that co-activation of signs and written words is not the outcome of years of bilingual experience, but instead characterizes bilingual language development.

Responsibility in the Current Epidemic of Language Deprivation (1990-Present)

Language deprivation syndrome (LDS) is a permanent and preventable disability affecting language, cognition, and behavior that is epidemic in the deaf population. Since 1990, systemic and technological changes in the health care of deaf children have created a new paradigm that perpetuates this crisis. Physicians and other professionals have been largely unaware of their roles in this recent epidemic. An evidenced based system of care that addresses the causes and potential solutions can reverse this trend and prevent early language deprivation in deaf children.