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

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What You Don't Know Can Hurt You: the Risk of Language Deprivation by Impairing Sign Language Development in Deaf Children Matern Child Health J DOI 10.1007/s10995-017-2287-y COMMENTARY What You Don’t Know Can Hurt You: The Risk of Language Deprivation by Impairing Sign Language Development in Deaf Children Wyatte C. Hall1 © Springer Science+Business Media New York 2017 Abstract A long-standing belief is that sign language all developmental domains through a fully-accessible first interferes with spoken language development in deaf chil- language foundation such as sign language, rather than dren, despite a chronic lack of evidence supporting this auditory deprivation and speech skills. belief. This deserves discussion as poor life outcomes con- tinue to be seen in the deaf population. This commentary Keywords Hearing loss · Sign language · Language synthesizes research outcomes with signing and non-sign- deprivation · Deaf child development · Cochlear implant ing children and highlights fully accessible language as a protective factor for healthy development. Brain changes associated with language deprivation may be misrepre- For hundreds of years, language philosophies and edu- sented as sign language interfering with spoken language cation of deaf children have been mired in an “either-or” outcomes of cochlear implants. This may lead to profes- dilemma between sign language-inclusive and spoken lan- sionals and organizations advocating for preventing sign guage-only approaches. It has been described as a “highly language exposure before implantation and spreading mis- polarized conflict” with widespread misinformation about information. The existence of one—time-sensitive—lan- what is the best approach (Humphries et al. 2012b), such guage acquisition window means a strong possibility of as the belief that sign language acquisition interferes with permanent brain changes when spoken language is not fully spoken language acquisition. In fact, bilinguals are associ- accessible to the deaf child and sign language exposure is ated with better cognitive outcomes when compared with delayed, as is often standard practice. There is no empiri- monolinguals (Adesope et al. 2010), especially at earlier cal evidence for the harm of sign language exposure but ages of active bilingualism (Luk et al. 2011). This belief there is some evidence for its benefits, and there is growing of sign language-interference has endured despite a long- evidence that lack of language access has negative impli- standing lack of empirical evidence that spoken language- cations. This includes cognitive delays, mental health dif- only approaches are more effective (Henner et al. 2016; ficulties, lower quality of life, higher trauma, and limited Humphries et al. 2016). health literacy. Claims of cochlear implant- and spoken In a recent systematic review of sign language and spo- language-only approaches being more effective than sign ken language interventions compared to spoken language- language-inclusive approaches are not empirically sup- only interventions, the authors concluded “…very lim- ported. Cochlear implants are an unreliable standalone ited, and hence, insufficient evidence exists to determine first-language intervention for deaf children. Priorities of whether adding sign language to spoken language is more deaf child development should focus on healthy growth of effective than spoken language intervention alone to fos- ter [spoken] language acquisition” (Fitzpatrick et al. 2016, p. 14). Such reviews are fundamentally flawed in failing to * Wyatte C. Hall distinguish natural sign languages from artificial commu- [email protected] nication systems, which would not enable bilingualism or 1 Clinical & Translational Science Institute, University language transfer (e.g., sign-supported speech or signing of Rochester Medical Center, Rochester, NY, USA exact English) (M. L. Hall et al. 2017). Additionally, the Vol.:(0123456789)1 3 Matern Child Health J authors approach the system review as if the “burden of et al. 2011). More specifically, later exposure demon- evidence” is in only one direction; however, if the evidence strated more activation in posterior visual brain regions, is supposedly insufficient in one direction—ipso facto, it is and less in anterior language brain regions while watch- insufficient in the other direction and there is insufficient ing ASL sentences; the reverse was true for those who evidence of spoken language-only approaches being more were exposed to ASL earlier. Later exposure meant that effective. linguistic information was more likely to be processed as Medical and educational advice is frequently rooted in visual information, a far less efficient means of language a framework of viewing deaf children as “defective hear- processing. Even after decades of language use, later ing people” (Bailes et al. 2009), an approach that becomes exposure to ASL meant less processing in language brain a self-fulfilling prophecy. In fact, medical school education regions—highlighting that the sign language acquisition does not address language development for deaf and hard- window is not longer than spoken language. Generally, of-hearing children (Humphries et al. 2014), which can delayed acquisition leads to less specialization of lan- lead to flawed medical advice. Additionally, parents often guage in the brain (Leybaert and D’Hondt 2003). rely on community sources (e.g., teachers, ministers, other Parents have high expectations for successful out- community members) that are not knowledgeable about comes of the cochlear implant (a neuro-prosthesis that language, cognitive, and brain development of deaf chil- bypasses the ear and provides sound stimulation to the dren (Humphries et al. 2014). brain); many are convinced that it is the only option for Some hearing loss professionals and organizations advo- their deaf child to acquire language (Humphries et al. cate for preventing sign language exposure through the Lis- 2012, 2014; Hyde et al. 2010). Receiving a cochlear tening and Spoken Language approach, what is historically implant, however, between one and two years of age known as oralism (Sugar 2016; Sugar and Goldberg 2015). does not guarantee normal spoken language skills five This opposition to sign language is not based on empirical years after implantation: non-signing implanted children evidence supporting the harm of sign language exposure, can display significant language deficits relative to their thus perpetuating misinformation such as the sign language hearing peers, including lower vocabulary knowledge acquisition window being longer than the spoken language and inconsistent speech production/perception (Davidson window. Rather, this systematic exclusion of sign language et al. 2011; Duchesne et al. 2009; Lund 2015; Tobey et al. in deaf child development is described as being rooted in 2011). Indeed, the cochlear implant has been described bias and prejudice (Humphries et al. in press). As a result, as being able to “provide an advantage for spoken lan- parents can become misinformed about the “potential and guage development, [but does not] assure development of probable implications” of not exposing their deaf child to spoken language in the normal range for all children by a fully accessible visual language such as sign language school age…” (Tobey et al. 2013, p. 10). (Bailes et al. 2009, p. 449). If spoken language is not fully In contrast, a study of implanted children—who sign accessible to the deaf child and sign language exposure from birth—suggest that they can demonstrate compa- is delayed, then there is a strong possibility of permanent rable scores on standardized language testing (including brain changes. speech skills) to their hearing peers (Davidson et al. 2013). During the critical period of language acquisition The implanted signing children’s scores were also better (approximately the first five years of development), there than results shown in previous studies of implanted chil- is a high degree of brain plasticity. Language delays affect dren who did not sign from birth. The authors concluded development of neuro-linguistic structures in the brain, that “without a period of language deprivation before the especially those related to developing grammar and sec- implantation of the cochlear implant, children with coch- ond language acquisition (Skotara et al. 2012), and appear lear implants can develop spoken language skills appro- to decrease grey matter in certain parts of the brain (Peni- priate for [their age]… sign language input does no harm caud et al. 2013). Altogether, a fundamental and irrevers- to a deaf child’s spoken language development after h/she ible biological impact—on the brain and on healthy devel- receives an implant” (p. 247). Similar results were seen in a opment—appears to occur when an accessible language group comparison of 14 signing and non-signing implanted is not provided by a certain early time period in brain children; the signing-implanted children outperformed the development. non-signing children on three measures of spoken language A brain imaging study of deaf adults who could not (Hassanzadeh 2012). More recently, a study of general functionally communicate in spoken English and used intelligence in signing and non-signing implanted deaf chil- American Sign Language (ASL) for 30+ years, but were dren found sign language to significantly benefit cognitive exposed to ASL at different times (birth to 3 years, 4–7 outcomes, leading the authors to suggest that “the use of years, and 8–14 years), found an “age of acquisition” sign language before cochlear implants
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