The crisis for deaf children and their families:

Language deprivation

 

“The single greatest risk faced by deaf children is inadequate exposure to a usable first language. Lack of such exposure results in language deprivation syndrome

– Dr. Sanjay Gulati, Professor, Psychiatrist, Harvard Medical School, Boston Children's Hospital

 

(Gualti, 2014)

The cause of language deprivation syndrome

Ninety five percent of deaf children are born to hearing parents who do not know sign language (Mitchell &  Karchmer, 2004).

Parents are funneled towards making specific choices according to a “medicalization prescription” (e.g., implantation and spoken language only), “groomed” to accept the cochlear implant as their only option, and that “parental compliance” is very important. Visual languages like American Sign Language are considered “unscientific,” “unhealthy,” and “compensatory” within this context (Mauldin, 2016). Generally, cochlear implant researchers describe research findings having “enormous variability reported in auditory, speech, and language functioning after implantation” (Kral, Kroenenberger, Pisoni, & O’Donoghue, 2016, p. 614) and “it is well known that patients with cochlear implants have a large inter-individual variability in linguistic and auditory performances” (Ghiselli, et al., 2016). Yet, parents are forced tomake decisions without any guarantees about the level of benefit their children will receive from having cochlear implants by being told (erroneously) their child will never speak if they use sign language (Hyde, Punch, & Komesaroff, 2010, p. 162).

Two recent large-scale longitudinal studies demonstrate this extreme variability. The Childhood Development after Cochlear Implantation study measured spoken language outcomes and found even the earliest implanted children were still worse than their hearing peers; they concluded “although early implantation, on average, appears to provide an advantage for spoken language development, it did not assure the development of spoken language… for all children by school age” (Tobey et al., 2013, p. 10). Similarly, the Dallas Cochlear Implant Group measured speech perception and production in 110 implanted high school children (Davidson et al., 2011; Tobey, Geers, Sundarraja, & Lane, 2011). The range of scores for speech perception and production were essentially from 0% to 100% accuracy, with only a few achieving full scores.

Currently, 67% (Decker, Vallaton, & Johnson, 2012) to 85% of these parents express a desire for oral-only communication methods (Madell, 2014) .

 

The Greatest Irony

"Baby sign"(hearing parents signing to their hearing children) research over the last 20 years has shown that sign language accelerates the development of speech and language while decreasing disruptive behavior such as tantrums. The following video summarizes this research as well as "The Great Irony" of depriving deaf children of signing in fear of it retarding speech development.

The long term effects of language deprivation syndrome

Many deaf individuals suffer language deprivation due to late and inadequate exposure to ASL. (Glickman, 2007)

"Young deaf and hard of hearing children continue to experience delayed cognitive and language development in early childhood that lead to academic difficulties and underperformance when they begin schooling.  Despite the good intentions of government, schools, and professionals, this condition persists, resulting in significant under-education and underemployment for persons who are deaf or hard of hearing.  The effects of early language deprivation or limited exposure to language due to not having sufficient access to spoken language or sign language are often so severe as to result in serious health, education and quality of life issues for these children."  (National Association of the Deaf, 2014) click link for complete statement

Deaf life without accessible language at home = Language deprivation

The effects are:

Family life- Deaf children typically grow up in linguistically impoverished surroundings due to the inability of family members (in that small percentage of families who do choose to use sign language) to sign fluently being approximately 75%  (Goldin-Meadow & Mylander, 1990, Goldin-Meadow, 1999, Gallaudet Research Institute, 2003). Deaf children rarely experience fluent communicative signing partners at home (Steinberg, 2000). Social isolation within the child’s own family is commonplace (Crowe, 2003; Glasner, & Miller, 2010).  Deaf adolescents are more likely to run away from home than hearing adolescents (Titus, Schiller , & Guthmann, 2008). A child’s hearing loss affects the child, as well as his or her family (Jackson & Turnbull, 2004). Parenting children who are deaf presents unique long-term challenges, particularly in the area of communication, that can place them at a greater risk for elevated levels of parenting stress ( Lederberg & Golbach, 2002; Quittner et al., 2010; Zaidman-Zait & Young, 2008).

Language and communication- Many deaf children of hearing parents begin formal schooling with little fluency in either a spoken or signed language (Marschark & Harris, 1996). These children can be considered semilingual (Hamers, 1998; Kannapel 1989) as they are fluent in neither English nor ASL at an age where hearing children exhibit adult-like competency in spoken English (Chin, Tsai, & Gao, 2003) . For these deaf individuals, semilingualism is sometimes a life-long struggle (Andrews et al., 2006). Mayberry et al. (2002) has shown that lack of early access to language interaction affects the child’s adult level of language competence. This observation was true for both ASL and English. Deaf adults who received no access to sign interaction before age 4 were significantly less skilled in either language when compared to deaf adults who experienced sign language in infancy.

Education- English literacy is difficult to master for many deaf individuals. Half of deaf adults read at the 4th grade level or below (Traxler, 2000). Forty four percent of deaf students do not graduate from high school as compared to 18% of hearing students.

Memory- Later signing deaf adults exhibit short term memory deficits as comapred to those who learned signs from birth (Mayberry & Fischer, 1989; Hamilton & Lillo-Martin,1986, Hamilton, 2011). Even with some access to oral language cochlear implant users were found to have simialr deficits as compared to hearing children (Dawson, et al., 2002; Burkholder & Pisoni, 2003; Castellanos, Pisoni, Kronenberger, & Beer, 2015). Learning and memory are very closely related. Without memory, learning would not be sustainable (Gathercole & Alloway, 2008). Working memory is critical for basic language skills that are required for recognizing words and understanding sentences and paragraphs. (Kronenberger, Pisoni, Colson & Henning, 2010). Also, because language learning and development require the individual to follow, retain, and integrate a stream of auditory information, working memory is likely to be a core component of language development following cochlear implants (Kronenberger & Pisoni, 2009).

Mental health-
. Ideally, parents and siblings come to terms with the deaf child being different, not disabled (Young, 1999). In general, the quality of the early interaction between parents and their deaf child is promoted by the extent to which parents succeed in establishing visual communication patterns by the early use of visual—tactile communication strategies (i.e., signing) (Loots & Devise, 2003; Loots et al., 2005), even if, ultimately, the child uses spoken language. Visual and communicative attunement provide advantages in the development of a deaf child. Research with 18- to 24-month-old deaf infants and their mothers suggests that signing promotes the development of mutual symbolicexchange and sharing of linguistic and symbolic meaning between deaf or hearing parents and their deaf child (Loots et al., 2005). The interaction between deaf children and hearing parents who selectively preferred spoken communication tended to stagnate in the transition from more basic to symbolic communication (Loots & Devise, 2003). Deaf children who are subject to more restricted communication patterns with hearing parents via speech only s are at risk of developing a delay in language development (Hauser & Marschark, 2008). Limited communication between parents and their deaf child may seriously affect the quality of interaction between them, with negative consequences to the developing ability of a child to articulate experiences; to recognizes, identify, and share emotions; to solve social dilemmas; and to develop a positive self-image later in life (Calderon & Greenberg, 2011).
Lack of communication within the family is a major source of frustration and stress. Stess is a major factor in the development of mental health issues (Titus, Schiller , & Guthmann, 2008). Deaf children and adolescents may be exposed to a range of additional environmental risk factors that may be regarded as stressors that induce more or less chronic adverse circumstances. Examples include persistent communication problems, social misunderstandings, social deprivation, loneliness, rejection and discrimination, traumatic life events (bullying, victimization, exposure to violence), familial distress and parental discord, or socioeconomic risk related to low parental educational level or immigrant status (Hindley & Van Gent, 2002; Van Gent, 2012). For instance, limited hearing or suffering from physically handicapping conditions may elicit recurrent negative thinking of serious personal shortcomings in deaf children, especially in deaf children with low self-esteem (Van Gent et al., 2011). The accumulation of risk—that is, of many such factors being present at the same time—in particular contributes to an increase in vulnerability to mental health problems (Friedman & Chase-Lansdale, 2002). To a large extent, vulnerability to mental health problems of a deaf child is determined by the consequences of being deaf in a world adjusted primarily to the needs of hearing people (e.g., Hindley & Van Gent, 2002; Van Gent, 2012). The quality of social interaction between deaf children and the environment is, to a great degree, determined by the way parents, other caregivers, siblings, teachers, and other significant people in the direct environment respond and adapt to the visual/spatial, linguistic/communicative, and emotional needs of the child.

Deaf children and adolesentes have been reported to experience various mental health issues at a rate of 15 to 77% ( Bailly, Dechoulydelenclave & Lauwerier, 2003; van Gent, Goedhart, Hindley, & Treffers, 2007; Dammeyer, 2009) . For deaf adoloescents, mental health issues are reported significantly more often (2 to 7 times more often) than hearing peers (Titus, Schiller , & Guthmann, 2008; Brown & Cornes, 2015) regardless of whether the child was oral with a cochlear implant or attended a school where signing was used. All chlidren in these two groups have hearing parents. Hearing parents of deaf adolescents reported significantly more concernson social behavior and thinking ability scales than did parents of hearing children and adolescents (Remine & Brown, 2010). Deaf adults report mental health issues, particularly anxiety, 5 to 10 times more often than hearing individuals (Kvam, et al, 2007). Language Deprivationt Syndrome, the lack of early exposure to a usable language, affects deaf individuals mental health by stunting brain devlopment ( Pénicaud, 2013) and causes increased levels of harmful behavior to self and others (Gulati, 2014). Axis II which include paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, dependent, obsessive-compulsive disorders and childhood behavior problems are three to six times more prevalent for deaf persons (Haskins;2000; Chritchfield, 2002). 

Behavioral issues- With regard to the broad category of behavioral disorders including disruptive behavior and attention deficit hyperactivity disorder (ADHD), Van Gent et al. (2012b) found more disorders in deaf or hard-of-hearing children with hearing parents (35%; n = 362) than in children with deaf or hard-of-hearing parents (30%; n = 27) or hearing children with hearing parents (29%; n = 3339). Oppositional behavior, distractibility, and overactivity can be an expression of underlying feelings of impotence, anxiety, sadness, or frustration with communication difficulties (Hindley & Kroll, 1998). Deaf children and adolescents exhibit higher than average levels of behavioral and attention-deficit/hyperactivity disorders then the general population (Haskins;2000; Chritchfield, 2002).

Emotional issues- Most prevalence studies in deaf children and adolescents have found increased rates of emotional difficulties or disorders in deaf children and young people compared with the general population (Stevenson et al., 2015; Van Gent et al., 2007). Emotional mental health problems were even found more often than behavioral problems in representative samples of schoolchildren with moderate to profound hearing loss (Fellinger et al., 2009) and deaf adolescents (Van Gent et al., 2007).

Substance abuse- Stess is also a major factor in the development of substance abuse. Lack of communication within the family is a major source of frustration and stress(Titus, Schiller , & Guthmann, 2008). Deaf adolescents youths reported substance use behaviors indicative of a more severe level of involvement than hearing adolescents (Titus, Schiller , & Guthmann, 2008).

Suicide rates- In one year attempted suicide rates for all indviduals in the united states was .6% (CDC, 2015). The rates of attempted suicide in deaf individuals during 2004 ranged from 1.7% to 18%, with lifetime rates as high as 30% (Turner, Windfurh & Kapur, 2007).

Child abuse- Research evidence indicates an increased prevalence of abuse and neglect among children and youth with hearing loss (National Child Traumatic Stress Network [NCTSN], 2006; Sullivan & Knutson, 1998), especially sexual abuse (Kvam, 2004; Sullivan, Vernon, & Scanlon, 1987). A study at Rochester Institute of Technology indicates that the incidence of maltreatment, including neglect and physical and sexual abuse, is more than 25 percent higher among deaf and hard-of-hearing children than among hearing youths. The research also shows a direct correlation between childhood maltreatment and higher rates of negative thinking about themselves, depression, and post-traumatic stress in adulthood. Severity of deafness appears to increase the risk of being victimized. (Rothman et al., 2014). Most abuse of deaf children occurs at home. Hearing parents of deaf children are more likely to physically abuse these children than are parents of hearing children (Knutson, Johnson, & Sullivan, 2004). THis is possibly due to an inability to manage a child's behvior verbally rather than physically. Study of deaf adults (mainly college students) found that 50% of deaf children are sexually abused, 41.6% of deaf children are physically abused and 26% of deaf children are neglected (Sullivan & Knutson, 1989). True abuse statistics are likely much higher, as only 4% of deaf people attend college (Allen, 1994). Those who do attend college are more likely to have more supportive families, financial resources, and access to education via American Sign Language and interpreters (VanCleve, 1989). In another study of college students, Burnash et al. (2010) found that deaf and hard-of-hearing students reported significantly more instances of child maltreatment than the hearing respondents (77% vs 49%). Deaf children are often viewed as "easy prey" due to their lack of communication skills (Sullivan, Vernon, & Scanlan, 1987; Glickman, 2013).

Criminal justice system- The data from the United States indicates that deaf and hard-of-hearing people are substantially overrepresented in the criminlal justice system. A series of studies of prisons all over the United States showed that hearing loss severe enough to interfere with everyday functioning was two to five times more prevalent among prison inmates than among the regular population (LaVigne & Vernon, 2003; Vernon & Greenberg, 1999; Miller, Vernon, & Capella, 2005).

Employment- Approximately half of deaf adults are employed (McNeill, 2000; Blanchfield et al. 2001 Walter & Dirmeyer, 2012). Reading and writing are often critical to workplace settings (Foster & MacLeod, 2003). Workers who are deaf often lack the ability to communicate effectively in written language due to weak English reading and writing skills (Appelman et al., 2012; Houston et al., 2010; McKee, Schlehofer, & Thew, 2013). Garberoglio, Cawthon, and Bond (2014) found that higher literacy skills of adult workers who are deaf predicted higher wage earnings. Deaf people who graduate with a baccalaureate degree will earn about 68% more over their working lifetime than those who did not (Walter, Clarcq, & Thompson, 2001, Walter & Dirmeyer, 2012).

Monetary cost to society - The lack of employment for deaf individuals costs society financially. Lifetime costs for those with prelingual onset exceed $1 million. Most of these losses (67%) are due to reduced work productivity. Results indicate that an additional $4.6 billion will be spent over the lifetime of persons who acquired their impairment in 1998. The particularly high costs associated with prelingual onset of severe to profound hearing impairment suggest interventions aimed at children, such as early identification and appropriate intervention may have a substantial payback. (Mohr, et al. 2000)Th

 

Language deprivation=Child neglect

The Federal Child Abuse Prevention and Treatment Act (CAPTA), (42 U.S.C.A.§5106g), as amended and reauthorized by
the CAPTA Reauthorization Act of 2010, defines child abuse and neglect as, at minimum:
“Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of serious harm.”

The long term results of not signing as described above fit this definition of child neglect as it puts the child at risk of serious immediate and long-term harm.

 

Why does this happen?

"We want him to be like us." hearing parent of deaf child .

Speech is the holy grail.

The problem is not speech. The problem is "language deprivation"

Well-meaning professionals guide the parents through a difficult process (made difficult by well-meaning professionals) of deciding on the best communication mode or modes for their family in order to help their child be successful in all aspects of life. Often, the doctors, audiologists, speech therapists and parent-infant specialists who interact with parents warn them that their child will never speak if they use sign language and that they must only use listening (Mellon et al. , 2015) .

Oral advocate-1993

Audiologist-1993

Doctor and speech therapist-2011

Parent-1993

Parent-2013

 

 

 

2016

A parent speaks in the New York Times May, 2016 (see complete article)

"As the parent of a 2-year-old whose hearing loss was recently diagnosed, the arguments (over communication mode) only heightened my anxiety about how to address my son Sam’s needs. After his diagnosis, Sam’s doctors assumed he would get hearing aids, which he would need for the rest of his life. ASL (sign language) was not mentioned as an option. Because Sam has residual hearing — his loss is mild in one ear and moderate to severe in the other — I went along with their recommendation.

One friend, a speech therapist whose brother is deaf, told me not to sign at all with Sam because he would use it as a crutch instead of learning to speak. This made sense to me, and for a while after Sam was aided, his therapist, a teacher of the deaf, focused on his listening and speaking skills. The hearing aids gave him more access to sound, but he still had trouble processing all that new information and figuring out how to replicate it through spoken language.

Although his speech did improve, the frustration I continued to see in his face when he tried to tell me something was heartbreaking. Tantrums were frequent. Sam started coming up with his own signs, such as a chomping motion with his arms when he wanted to wear his dragon shirt. He was searching for any way to communicate. Instead of a united front advocating for deaf and hard-of-hearing children, I’ve found a community struggling with internal conflict. As in politics, extremists on either side have created an environment that makes it hard for those in the middle to feel comfortable discussing the issues."

Tina Donvito, parent of deaf child

Also see Four Things Parents of Deaf Children Need to Know in the Huffington Post May 30, 2016

Do oral deaf children learn to speak?

Some do

1993
2011

2015

Some don't

 

1993

2011

 

2015

 

Do signing deaf children learn to speak?

Some do

Several studies show that signing supports the acquisition of speech (Connor, Hieber, Arts, & Zwolan, 2000; Geers, Brenner, & Tobey, 2011; Giezen, Baker, & Escudero, 2014; Seal, Nussbaum, Belzner, Scott, & Waddy-Smith, 2011; Spencer & Tomblin, 2006; Yoshinaga-Itano, 2006). Two studies have been recently completed showing that Signing helps cochlear implant users comprehend in the classroom (Marschark, 2016). I don’t know if any of those would help. A review of the literature by Walker & Tomblin (2014) sums up the work on learning to sign and speak as a young deaf child and finds that signing doesn’t interfere with learning to speak. Here are examples of successful signers-speakers

 

Carol Padden- born to deaf parents, learned ASL as her first language, currently a professor at the University of California San Diego (UCSD)

Carol Padden signing and speaking

 

 

 

Heather Artinian- born to deaf parents learned ASL as her first langugae, currently a college student at Georgetown University

Heather was featured in the video "Sound and Fury" (a must watch)

Heather as a child and a young adult

 

 

 

Thomas Moody- 13 year old deaf son of hearing parents, Georgia resident

 

 

 

What percentage of deaf signing children become intelligible speakers by adulthood?

Zaidman-Zait (2008) researched hearing parents’ satisfaction from the oral method of raising their cochlear-implanted deaf children. Nearly 40 percent of the parents stated they were not always able to understand their children’s speech and frequently became frustrated. The parents were “expressing dismay that they and their children did not share an easily understood, mutually accessible language”

 

The alternative for deaf children - a bilingual approach

Deaf life with accessible language at home

Conversely, the early language experience of deaf children born to deaf parents tends to be very different from that of deaf children born to hearing parents. (See Marschark & Harris, 1996, for a thorough review of this literature.) First, deaf children with deaf parents tend to have a more enriched early language environment because their parents effectively communicate with them from an early age. Other things equal, language development provides a foundation for reading and writing development, crucial skills for employment. Indeed, deaf children of deaf parents tend to read and write better than do deaf children of hearing parents (Perfetti & Sandak, 2000) better preparing them for the world of employment. By sharing a common language with their family, deaf children are not socially isolated but full participants in family life and deaf culture. In the area of mental health, research shows that individuals who are active members of the deaf community report fewer depressive and post-traumatic stress symptoms (Burnash, et. al, 2010; Rothman et al., 2014) . Good sign language proficiency of the parents, regardless of their hearing status, is associated with greater levels of self-esteem in their deaf children (Bat-Chava, 1993; Desselle, 1994), whereas support for signing early in life as well as good-quality social communication between parents and deaf adolescents as perceived by both is related to greater levels of global self-worth in deaf adolescents (Van Gent et al., 2012a).

In the arrea of behavioral disorders including disruptive behavior and attention deficit hyperactivity disorder (ADHD), Van Gent et al. (2012b) found the incidence of such problems in children with deaf or hard-of-hearing parents (30%; n = 27) and hearing children with hearing parents (29%; n = 3339) to be essentially equal while deaf children of hering parents exhibites such disorders at hoigher rate (35%; n = 362).

High-quality parent-child communication has been related positively to global self-esteem in deaf adolescents, which in itself may protect from emotional mental health problems (Van Gent et al., 2012a). Overall, studies indicate that language ability, regardless of modality, is an important predictor of psychosocial well-being in children, even those with CIs (Dammeyer, 2009).

"Baby sign" and hearing children: "The GREAT IRONY"

Ironically, it is now popular for hearing parents to speak Englisn and use ASL signs to communicate to their hearing babies. "Baby sign" has been shown to enhance the speech, communication, and IQ of hearing children (Acredolo & Goodwyn, 2000, Goodwyn, Acredolo & Brown, 2000; Vallotton & Ayoub, 2010). See more information online . A recent article in the Hyffington Post details this irony as does a YouTube video .

What about deaf children of hearing parents?

For young deaf childen a bilingual approach would entail parents using both spoken English and American Sign Language (not one or the other exclusively) to enhance communication and language developent of their child.

"(Mellon et al., 2015) - The benefits of learning sign language clearly outweigh the risks. For parents and families who are willing and able, this approach seems clearly preferable to an approach that focuses solely on oral communication. Sign language is a useful tool for the family of a deaf child regardless of whether the child is able to make full use of cochlear implants (CIs). There are 3 strong reasons to learn both signed and written/spoken language.

First, a speech-only approach risks linguistic deprivation at a crucial period of development. The risk arises because of the variability in the spoken language development of deaf children who have CIs.(Szagun & Stumper, 2012). In contrast, both sign language and early reading are visually accessible to the deaf child. This bilingual approach virtually guarantees that the child will develop linguistic competence.

Second, bilingualism is beneficial. Bilingual children display better mental flexibility and cognitive control as well as more creative thinking, especially in problem solving (Kushalnagar, Mathur, & Moreland ,2010; Kushalnagar, Hannay, & Hernandez, 2010). These benefits extend to social and academic settings.

Third, sign language development correlates positively with written English (Strong & Prinz, 1997; Padden & Ramsey, 2000; Rinaldi, Caselli, Onofrio, & Volterra, 2014; Marschark & Lee, 2014) and spoken English development (Marschark & Hauser, 2011) . No evidence has been found that the use of a visual language affects the outcome of cochlear implantation (Lyness, Woll, Campbell, & Cardin, 2013). In fact, children with CIs with early exposure to and, importantly, continued use of a sign language outperform children with only CIs on a variety of standardized language measures of English, even when both groups have the same age of implantation and the same years of CI use. It seems that early and continued exposure to sign language “may provide a ‘framework’ for early spoken language development”(Marschark & Hauser, 2011) in deaf children within hearing families as well as within deaf families (Davidson, Lillo-Martin, & Chen Pichler, 2014).

The following article discusses this topic in more depth "Should all deaf children learn sign language? Pediatrics, Mellon, et al., 2015

Other countries - Other countries are taking the lead in providing sign language to their deaf children. Viet Nam has taken such steps with positive results

What do deaf people say?

  California has passed a bill addressing this issue. SB-210 (see the bill)

Other videos of interest

Sound and fury

Through your child's eyes

One deaf child

 

References