Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language

Rapid Increases in Children's Spontaneous and Responsive Speech Vocalizations Following Cochlear Implantation: Implications for Spoken Language Development

OBJECTIVES

Cochlear implants are the most effective means to provide access to spoken language models for children with severe to profound deafness. In typical development, spoken language emerges gradually as children vocally explore and interact with caregivers. But it is unclear how early vocal activity unfolds after children gain access to auditory signals, and thus spoken language, via cochlear implants, and how this early vocal exploration predicts children's spoken language development. This longitudinal study investigated how two formative aspects of early language-child speech productivity and caregiver-child vocal interactions-develop following cochlear implantation, and how these aspects impact children's spoken language outcomes.

DESIGN

Data were collected via small wearable recorders that measured caregiver-child communication in the home pre- and for up to 3 years post-implantation (N = 25 children, average = 167 hours/child, 4,180 total hours of observation over an average of 11 unique days/child). Spoken language outcomes were measured using the Preschool Language Scales-5. Growth trajectories were compared with a normative sample of children with typical hearing (N = 329).

RESULTS

Even before implantation, all children vocalized and vocally interacted with caregivers. Following implantation, child speech productivity (β = 9.67, p < 0.001) and caregiver-child vocal interactions (β = 12.65, p < 0.001) increased significantly faster for children with implants than younger, hearing age-matched typical hearing controls, with the fastest growth occurring in the time following implant activation. There were significant, positive effects of caregiver-child interaction on children's receptive, but not expressive, spoken language outcomes.

CONCLUSIONS

Overall, children who receive cochlear implants experience robust growth in speech production and vocal interaction-crucial components underlying spoken language-and they follow a similar, albeit faster, developmental timeline as children with typical hearing. Regular vocal interaction with caregivers in the first 1 to 2 years post-implantation reliably predicts children's comprehension of spoken language above and beyond known predictors such as age at implantation.

Language anxiety: understanding past research and new directions with d/Deaf, DeafBlind, and hard of hearing communities

Language anxiety occurs when people associate negative emotional responses with using, expressing, or understanding language. In this review, we summarize past language anxiety research regarding specific language processes or subtypes: reading, writing, speaking, listening, and foreign language anxieties. Language anxiety is associated with poorer language proficiency and hinders learning and improving language skills. By conceptualizing language anxiety processes together, we identify common patterns and themes which will be vital for understanding how anxiety is detrimental to language performance. We discuss existing knowledge and propose applying theoretical framework names from another educational anxiety domain to more broadly understand language anxiety. These frameworks explain similar affective, cognitive, and behavioral relationships seen across subtypes of language anxiety. Past research suggests that some people are more likely to experience language anxiety and its detrimental effects on language. Through this review, we underscore the need for future directions to focus on individuals from diverse language backgrounds who are at greater risk for developing language anxiety. Social and linguistic factors, particularly in early life, foster negative emotional associations with and challenges to language acquisition. Future research collaborations with those who have lived experiences with language deprivation and language anxiety will clarify how emotion influences language development. We discuss how some d/Deaf, DeafBlind, and hard of hearing people have greater risk for developing language anxiety. Language anxiety is a prevalent, genuine barrier to learning and improving proficiency for deaf individuals who have difficulty acquiring language skills and experience adverse childhood communication experiences. Characterizing language anxieties toward signed and spoken languages will also clarify efforts to reduce anxiety for diverse language learners. Engaging underrepresented groups in language anxiety research can clarify how emotion plays a role in language development and identify groups that would benefit from future language anxiety-focused interventions. By focusing on and gaining a better understanding of emotional, diverse language experiences, we can build effective language anxiety interventions and improve language outcomes for all.

Exploration of parental perspectives and involvement in therapeutic communication approaches for deaf and/or hard-of-hearing children at special schools in South Africa

Family-centred intervention optimises the development of communication abilities and academic outcomes in children with hearing loss. Cognisance of family values, respect for family differences and adaptations to cultural and linguistic diversity ensure the collaboration of parent-professional relationships. This study investigated the parental involvement and parental perceptions regarding the communication intervention approaches implemented (i.e., traditional speech-language therapy and listening and spoken language-South Africa-adapted Auditory Verbal Therapy) for children with profound hearing loss. The study was conducted at special schools for children with hearing loss across four provinces in South Africa, where grade-level core skills are taught using a mainstream curriculum complemented by specialised instruction. Data were collected through a parental self-administered survey and a retrospective record review. An inductive analysis of transcripts was conducted, and the Fisher's exact test assessed associations between data sets. Findings demonstrated limited informational counselling provided to parents regarding communication intervention options. Following the initiation of the communication intervention process, findings indicate parental buy-in, fuelled by their aspirations for their child with a hearing loss. Although results suggest that parents prefer a listening and spoken language therapeutic communication modality, this approach is hindered by the lack of culturally sensitive and linguistically appropriate care. This is an important finding, particularly in multilingual and multicultural contexts like South Africa. These context-specific outcomes emphasise that communication interventionists must be cognizant of parental-informed decision-making, cultural contexts and linguistic sensitivity for effective parent-professional collaborations.

Bilingual children reach early language milestones at the same age as monolingual peers

In this longitudinal study, we compare the age of reaching early developmental milestones in bilingual and monolingual children and between the bilinguals' two languages. We present data from 302 Polish bilinguals (living outside of Poland with various majority languages) and 302 Polish monolinguals, aged M = 12.78 months on study entry (range: 0-24 months), matched on sex, age at study entry, duration of parental reporting, and parental education. The milestones under investigation include crawling, walking, babbling, first, 10th, 50th word, and first multi-word utterances. The data was collected with a specially designed mobile app, in which parents reported their children's development repeatedly. Using this relatively big sample and looking at a wide range of investigated milestones, we present evidence that typical bilingual development follows a trajectory similar to monolingual development. We also evaluate the feasibility and usefulness of online data collection using mobile apps to study early language development.

Neurocognitive outcomes in young adults with cochlear implants: The role of early language access and crossmodal plasticity

Many children with profound hearing loss have received cochlear implants (CI) to help restore some sense of hearing. There is, however, limited research on long-term neurocognitive outcomes in young adults who have grown up hearing through a CI. This study compared the cognitive outcomes of early-implanted (n = 20) and late-implanted (n = 21) young adult CI users, and typically hearing (TH) controls (n=56), all of whom were enrolled in college. Cognitive fluidity, nonverbal intelligence, and American Sign Language (ASL) comprehension were assessed, revealing no significant differences in cognition and nonverbal intelligence between the early and late-implanted groups. However, there was a difference in ASL comprehension, with the late-implanted group having significantly higher ASL comprehension. Although young adult CI users showed significantly lower scores in a working memory and processing speed task than TH age-matched controls, there were no significant differences in tasks involving executive function shifting, inhibitory control, and episodic memory between young adult CI and young adult TH participants. In an exploratory analysis of a subset of CI participants (n = 17) in whom we were able to examine crossmodal plasticity, we saw greater evidence of crossmodal recruitment from the visual system in late-implanted compared with early-implanted CI young adults. However, cortical visual evoked potential latency biomarkers of crossmodal plasticity were not correlated with cognitive measures or ASL comprehension. The results suggest that in the late-implanted CI users, early access to sign language may have served as a scaffold for appropriate cognitive development, while in the early-implanted group early access to oral language benefited cognitive development. Furthermore, our results suggest that the persistence of crossmodal neuroplasticity into adulthood does not necessarily impact cognitive development. In conclusion, early access to language - spoken or signed - may be important for cognitive development, with no observable effect of crossmodal plasticity on cognitive outcomes.

Hearing Loss and Autism Spectrum Disorder

CASE

Gretta is a 3.5-year-old girl with a history of congenital cytomegalovirus, congenital bilateral profound sensorineural hearing loss (SNHL), and bilateral vestibular dysfunction, resulting in frequent falls. She underwent cochlear implantation at 12 months of age and was diagnosed with autism spectrum disorder at 2.5 years of age.On presentation for follow-up in the developmental-behavioral pediatrics (DBP) clinic, Gretta's mother reports that Gretta has refused to wear her cochlear implants for the past 5 months. Before that, she seemed to enjoy having access to sound and like dancing to music, and her receptive and expressive language skills, including speech, were progressing. Initially, the rejection of her devices occurred only at preschool. When frustrated or overwhelmed, she would close her eyes and remove her devices for up to 5 minutes before allowing them to be reapplied. Over time, this progressed to a complete refusal to wear her devices at school and then at home, rendering her without access to sound and spoken language.Gretta's mood has become sullen, and she is now having tantrums at school. She physically startles when attempts are made to reintroduce her devices. Her ability to participate in classroom learning or interact with her classmates is limited, as she attends a spoken-language-focused preschool program. A board-certified behavioral analyst, hired by the family, recommended that Gretta not be allowed to participate in classroom activities unless she wears her devices. She now becomes visibly anxious even when in the same room as her devices and repetitively states "no implant, no implant." Her mother is worried about her inability to communicate and has "no idea" what may have changed or sparked her initial refusal to wear the devices.What factors would you consider when determining the cause and function of Gretta's refusal to wear the cochlear implants? How would you guide her parents, teachers, and clinicians to ensure the best developmental and behavioral outcomes for her?

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.

Awake craniotomy with English and British sign language mapping in a patient with a left temporal glioblastoma reveals discordant speech-sign language maps

The aim of this case study was to describe differences in English and British Sign Language (BSL) communication caused by a left temporal tumour resulting in discordant presentation of symptoms, intraoperative stimulation mapping during awake craniotomy and post-operative language abilities. We report the first case of a hearing child of deaf adults, who acquired BSL with English as a second language. The patient presented with English word finding difficulty, phonemic paraphasias, and reading and writing challenges, with BSL preserved. Intraoperatively, object naming and semantic fluency tasks were performed in English and BSL, revealing differential language maps for each modality. Post-operative assessment confirmed mild dysphasia for English with BSL preserved. These findings suggest that in hearing people who acquire a signed language as a first language, topographical organisation may differ to that of a second, spoken, language.

Caregiver response types and children language outcomes in preschoolers with and without hearing loss in Aotearoa New Zealand

Recent advances in audiological early intervention and hearing technologies have significantly improved access to spoken language for children with hearing loss (CwHL), but many CwHL require additional support to match the language development of their peers with normal hearing (PwNH). Programmes such as It Takes Two to Talk®, the Hanen Program® and Talking Matters focus on supporting parents to enhance children's language development in natural environments. Analysis of response types has become a significant trend, facilitated by technological developments like Language ENvironment Analysis (LENA®), which provides uninterrupted recordings and automated calculations of adult-child interactions. This research examined three child language measures, child vocalisation counts, total number of words, and mean length of utterance, comparing CwHL and PwNH. Transcribed excerpts of LENA recordings were coded to determine caregivers' use of 'high-level' responses in exchanges with their children and were correlated with child language outcomes. The results confirm the crucial role of caregiver response types in enhancing child language outcomes and exemplify the bidirectional relationship of caregiver-child interactions. The findings add to the literature to suggest that families and educators would benefit from guidance and coaching to acquire and apply high-level response types during natural spoken language interactions with CwHL.

Delayed auditory experience results in past tense production difficulties and working memory deficits in children with cochlear implants: A comparison with children with developmental language disorder

Extent evidence has shown that morphosyntax is one of the most challenging linguistic areas for children with atypical early language experiences. Over the last couple of years, comparisons between deaf children with CIs and children with DLD have gained interest - as cases of atypical early language experiences, including, but not restricted to, delayed onset of exposure to language input and language-processing difficulties. Evidence suggests that the morphosyntactic difficulties experienced by deaf children with CIs and children with DLD are very similar in nature. However, the few studies that have directly compared both groups are inconclusive, with deaf children with CIs either performing significantly better or on par with children with DLD. These differences in findings can be attributed, in part at least, to a failure to implement essential methodological controls - even more so given that deaf children with CIs comprise a very diverse population. The goal of the present study was to directly compare the performance of deaf children with CIs to that of children with DLD on a morphosyntactic ability known to be particularly difficult for both groups. Specifically, the present study conducted a detailed examination of the past tense marking abilities of deaf children with CIs and children with DLD while controlling for factors specific to deaf children with CIs, for children's basic cognitive abilities as well as for children's age, sex assigned at birth, and SES. Past tense verbs are particularly relevant as they are used as a marker of developmental language disorder (DLD) in children learning French. Moreover, extent evidence shows that deaf children with CIs and children with DLD have important WM difficulties, but also that there is an association between auditory perception, processing abilities, and working memory (WM) abilities as well as with the acquisition of morphological features, including tense marking. Unfortunately, no study has examined the relation between the accurate production of past tense verbs and WM abilities in children with CIs and children with DLD learning French. Fifteen deaf children with CIs between 5 and 7 years of age were compared to 15 children with DLD and to 15 typically-developing monolingual controls (MON), matched on important variables, using a past tense elicitation task as well as measures of phonological and nonverbal WM abilities. The results confirm that the deaf children with CIs and the children with DLD both performed significantly lower than the MON controls on the past tense elicitation task - suggesting that difficulties with past tense verbs in French might not only be a marker of DLD but, instead, a correlate of atypical language acquisition. Of importance, the present study is the first to show that deaf children with CIs perform significantly lower than children with DLD on a past tense elicitation task - highlighting the importance of using methodological controls. As well, significant correlations were found between the performance of the deaf children with CIs and of the children with DLD on the past tense elicitation task and their phonological and nonverbal WM abilities. Taken together with previous studies conducted in the same populations, this represents another evidence suggesting that early atypical language experiences result in language and WM deficits, including morphosyntactic difficulties.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Cultural & Global Implications

This article is the third in a series of eight articles that comprise this special issue on family-centered early intervention for children who are deaf or hard of hearing and their families (FCEI-DHH). It highlights the origins of FCEI-DHH in Western contexts and well-resourced locations and emphasizes the role of culture(s) in shaping FCEI-DHH. This article also cautions against the direct application of the 10 FCEI-DHH Principles presented in this issue across the globe without consideration of cultural implications. Cultural perceptions of decision-making processes and persons who can be decision-makers in FCEI-DHH are explored. Deaf culture(s) and the benefits of exposure to DHH adults with diverse backgrounds are introduced. Structural inequities that impact families' access to FCEI-DHH programs/services and systems, within and among nations and regions, are noted. The need to consider the cultural influences on families is emphasized; this applies to all levels of FCEI, including the development of systems through implementation of supports.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Support Principles

This article is the sixth in a series of eight articles that comprise a special issue on Family-Centered Early Intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, or FCEI-DHH. The Support Principles article is the second of three articles that describe the 10 Principles of FCEI-DHH, preceded by the Foundation Principles, and followed by the Structure Principles, all in this special issue. The Support Principles are composed of four Principles (Principles 3, 4, 5, and 6) that highlight (a) the importance of a variety of supports for families raising children who are DHH; (b) the need to attend to and ensure the well-being of all children who are DHH; (c) the necessity of building the language and communication abilities of children who are DHH and their family members; and (d) the importance of considering the family's strengths, needs, and values in decision-making.

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.