Comparison of intelligence quotients of first- and second-generation deaf children with cochlear implants

Written products and writing processes in Swedish deaf and hard of hearing children: an explorative study on the impact of linguistic background

The small body of research on writing and writing processes in the group of deaf and hard of hearing (DHH) children has shown that this group struggles more with writing than their hearing peers. This article aims to explore in what ways the DHH group differs from their peers regarding the written product and the writing processes. Participants are all in the age span 10-12 years old and include: (a) 12 DHH children with knowledge of Swedish sign language (Svenskt teckenspråk, STS) as well as spoken Swedish, (b) 10 age-matched hearing children of deaf adults (CODA) who know STS, (c) 14 age-matched hearing peers with no STS knowledge. More specifically we investigate how text length and lexical properties relate to writing processes such as planning (measured through pauses) and revision, and how the background factors of age, gender, hearing and knowledge of STS predict the outcome in product and process. The data consists of picture-elicited narratives collected with keystroke logging. The overall results show that age is a strong predictor for writing fluency, longer texts and more sophisticated lexicon for all the children. This confirms theories on writing development which stress that when children have automatized basic low-level processes such as transcription and spelling, this will free up cognitive space for engaging in high-level processes, such as planning and revision-which in turn will result in more mature texts. What characterizes the DHH group is slower writing fluency, higher lexical density, due to omitted function words, and extensive revisions (both deletions and insertions) on word level and below. One explanation for the last finding is that limitations in the auditory input lead to more uncertainty regarding correct and appropriate lexical choices, as well as spelling. The article contributes with more specific knowledge on what is challenging during writing for DHH children with knowledge of STS and spoken Swedish in middle school, in the developmental stage when basic writing skills are established.

Writing Development in DHH Students: A Bimodal Bilingual Approach

This article describes the lexical and syntactic development of written narratives in 24 deaf and hard-of-hearing (DHH) students aged between 8 and 18 and takes into account how their varying linguistic backgrounds may predict their written performance. All participants use spoken Swedish, but the study also considers their proficiency in Swedish Sign language, which ranged from zero to fluent. Their narrative texts were analyzed in regard to syntax and lexicon, which demonstrated a strong developmental trend in which increased age predicted more complex texts. Age of acquisition did not predict any writing outcome, which is suggested to occur because all participants were exposed to language early, that is, within the critical time window for language acquisition. Sign language proficiency showed a tendency to predict adjective density and number of clauses, which encourages future research in this area, especially since this connection argues for the benefits of early access to a language and the positive relationship between sign language proficiency and writing.

Global Regulatory Review Needed for Cochlear Implants: A Call for FDA Leadership

INTRODUCTION

Using the United States Food and Drug Administration (FDA) as example, we argue that regulatory agencies worldwide should review their guidance on cochlear implants (CIs).

METHODS

This is a position paper, thus the methods are strictly argumentation. Here we give the motivation for our recommendation. The FDA's original approval of implantation in prelingually deaf children was granted without full benefit of information on language acquisition, on childcaregiver communication, and on the lived experience of being deaf. The CI clinical trials, accordingly, did not address risks of linguistic deprivation, especially when the caregiver's communication is not fully accessible to the prelingually deaf child. Wide variability in the effectiveness of CIs since initial and updated approval has been indicated but has not led to new guidance. Children need to be exposed frequently and regularly to accessible natural language while their brains are still plastic enough to become fluent in any language. For the youngest infants, who are not yet producing anything that could be called language although they might be producing salient social signals (Goldstein et al. Child Dev 80:636-644, 2009), good comprehension of communication from caregiver to infant is critical to the development of language. Sign languages are accessible natural languages that, because they are visual, allow full immersion for deaf infants, and they supply the necessary support for this comprehension. The main language contributor to health outcomes is this combination of natural visual language and comprehension in communication. Accordingly, in order to prevent possible language deprivation, all prelingually deaf children should be exposed to both sign and spoken languages when their auditory status is detected, with sign language being critical during infancy and early childhood. Additionally, all caregivers should be given support to learn a sign language if it is new to them so that they can comprehend their deaf children's language expressions fully. However, both languages should be made accessible in their own right, not combined in a simultaneous or total communication approach since speaking one language and signing the other at the same time is problematic.

RESULTS

Again, because this is a position paper, our results are our recommendations. We call for the FDA (and similar agencies in other countries) to review its approval of cochlear implantation in prelingually deaf children who are within the sensitive period for language acquisition. In the meantime, the FDA should require manufacturers to add a highlighted warning to the effect that results with CI vary widely and CIs should not be relied upon to provide adequate auditory input for complete language development in all deaf children. Recent best information on users' experience with CIs (including abandonment) should be clearly provided so that informed decisions can be made. The FDA should require manufacturers' guidance and information materials to include encouragement to parents of deaf children to offer auditory input of a spoken language and visual input of a sign language and to have their child followed closely from birth by developmental specialists in language and cognition. In this way parents can align with providers to prioritize cognitive development and language access in both audio-vocal and visuo-gestural modalities.

DISCUSSION

The arguments and recommendations in this paper are discussed at length as they come up.

Spelling in Deaf, Hard of Hearing and Hearing Children With Sign Language Knowledge

What do spelling errors look like in children with sign language knowledge but with variation in hearing background, and what strategies do these children rely on when they learn how to spell in written language? Earlier research suggests that the spelling of children with hearing loss is different, because of their lack of hearing, which requires them to rely on other strategies. In this study, we examine whether, and how, different variables such as hearing degree, sign language knowledge and bilingualism may affect the spelling strategies of children with Swedish sign language, Svenskt teckenspråk, (STS) knowledge, and whether these variables can be mirrored in these children's spelling. The spelling process of nineteen children with STS knowledge (mean age: 10.9) with different hearing degrees, born into deaf families, is described and compared with a group of fourteen hearing children without STS knowledge (mean age: 10.9). Keystroke logging was used to investigate the participants' writing process. The spelling behavior of the children was further analyzed and categorized into different spelling error categories. The results indicate that many children showed exceptionally few spelling errors compared to earlier studies, that may derive from their early exposure of STS, enabling them to use the fingerspelling strategy. All of the children also demonstrated similar typing skills. The deaf children showed a tendency to rely on a visual strategy during spelling, which may result in incorrect, but visually similar, words, i.e., a type of spelling errors not found in texts by hearing children with STS knowledge. The deaf children also showed direct transfer from STS in their spelling. It was found that hard-of-hearing children together with hearing children of deaf adults (CODAs), both with STS knowledge, used a sounding strategy, rather than a visual strategy. Overall, this study suggests that the ability to hear and to use sign language, together and respectively, play a significant role for the spelling patterns and spelling strategies used by the children with and without hearing loss.

Executive Function in Deaf Children: Auditory Access and Language Access

Purpose

Deaf children are frequently reported to be at risk for difficulties in executive function (EF); however, the literature is divided over whether these difficulties are the result of deafness itself or of delays/deficits in language that often co-occur with deafness. The purpose of this study is to discriminate these hypotheses by assessing EF in populations where the 2 accounts make contrasting predictions.

Method

We use a between-groups design involving 116 children, ages 5-12 years, across 3 groups: (a) participants with normal hearing (n = 45), (b) deaf native signers who had access to American Sign Language from birth (n = 45), and (c) oral cochlear implant users who did not have full access to language prior to cochlear implantation (n = 26). Measures include both parent report and performance-based assessments of EF.

Results

Parent report results suggest that early access to language has a stronger impact on EF than early access to sound. Performance-based results trended in a similar direction, but no between-group differences were significant.

Conclusions

These results indicate that healthy EF skills do not require audition and therefore that difficulties in this domain do not result primarily from a lack of auditory experience. Instead, results are consistent with the hypothesis that language proficiency, whether in sign or speech, is crucial for the development of healthy EF. Further research is needed to test whether sign language proficiency also confers benefits to deaf children from hearing families.

What You Don't Know Can Hurt You: The Risk of Language Deprivation by Impairing Sign Language Development in Deaf Children

A long-standing belief is that sign language interferes with spoken language development in deaf children, despite a chronic lack of evidence supporting this belief. This deserves discussion as poor life outcomes continue to be seen in the deaf population. This commentary synthesizes research outcomes with signing and non-signing children and highlights fully accessible language as a protective factor for healthy development. Brain changes associated with language deprivation may be misrepresented as sign language interfering with spoken language outcomes of cochlear implants. This may lead to professionals and organizations advocating for preventing sign language exposure before implantation and spreading misinformation. The existence of one-time-sensitive-language acquisition window means a strong possibility of permanent brain changes when spoken language is not fully accessible to the deaf child and sign language exposure is delayed, as is often standard practice. There is no empirical evidence for the harm of sign language exposure but there is some evidence for its benefits, and there is growing evidence that lack of language access has negative implications. This includes cognitive delays, mental health difficulties, lower quality of life, higher trauma, and limited health literacy. Claims of cochlear implant- and spoken language-only approaches being more effective than sign language-inclusive approaches are not empirically supported. Cochlear implants are an unreliable standalone first-language intervention for deaf children. Priorities of deaf child development should focus on healthy growth of all developmental domains through a fully-accessible first language foundation such as sign language, rather than auditory deprivation and speech skills.

Language deprivation syndrome: a possible neurodevelopmental disorder with sociocultural origins

PURPOSE

There is a need to better understand the epidemiological relationship between language development and psychiatric symptomatology. Language development can be particularly impacted by social factors-as seen in the developmental choices made for deaf children, which can create language deprivation. A possible mental health syndrome may be present in deaf patients with severe language deprivation.

METHODS

Electronic databases were searched to identify publications focusing on language development and mental health in the deaf population. Screening of relevant publications narrowed the search results to 35 publications.

RESULTS

Although there is very limited empirical evidence, there appears to be suggestions of a mental health syndrome by clinicians working with deaf patients. Possible features include language dysfluency, fund of knowledge deficits, and disruptions in thinking, mood, and/or behavior.

CONCLUSION

The clinical specialty of deaf mental health appears to be struggling with a clinically observed phenomenon that has yet to be empirically investigated and defined within the DSM. Descriptions of patients within the clinical setting suggest a language deprivation syndrome. Language development experiences have an epidemiological relationship with psychiatric outcomes in deaf people. This requires more empirical attention and has implications for other populations with behavioral health disparities as well.

American Sign Language Syntax and Analogical Reasoning Skills Are Influenced by Early Acquisition and Age of Entry to Signing Schools for the Deaf

Failing to acquire language in early childhood because of language deprivation is a rare and exceptional event, except in one population. Deaf children who grow up without access to indirect language through listening, speech-reading, or sign language experience language deprivation. Studies of Deaf adults have revealed that late acquisition of sign language is associated with lasting deficits. However, much remains unknown about language deprivation in Deaf children, allowing myths and misunderstandings regarding sign language to flourish. To fill this gap, we examined signing ability in a large naturalistic sample of Deaf children attending schools for the Deaf where American Sign Language (ASL) is used by peers and teachers. Ability in ASL was measured using a syntactic judgment test and language-based analogical reasoning test, which are two sub-tests of the ASL Assessment Inventory. The influence of two age-related variables were examined: whether or not ASL was acquired from birth in the home from one or more Deaf parents, and the age of entry to the school for the Deaf. Note that for non-native signers, this latter variable is often the age of first systematic exposure to ASL. Both of these types of age-dependent language experiences influenced subsequent signing ability. Scores on the two tasks declined with increasing age of school entry. The influence of age of starting school was not linear. Test scores were generally lower for Deaf children who entered the school of assessment after the age of 12. The positive influence of signing from birth was found for students at all ages tested (7;6–18;5 years old) and for children of all age-of-entry groupings. Our results reflect a continuum of outcomes which show that experience with language is a continuous variable that is sensitive to maturational age.