Best of 2017: The Debate That Never Ends

Editor’s Note: This post garnered most readership in 2017. It first appeared on June 27, 2017 at Hearing and Kids.


An article published last week in Pediatrics reports on research which will add critical information to the debate about using sign language and/or spoken language when educating children who are deaf and hard of hearing.

As we all know, 92% of children with hearing loss are born to families with normal hearing who do not know sign language. When they have a child who is born with a hearing loss, they are overwhelmed with information and decisions about how to make decisions for their child. Unfortunately, parents do not always have all the information they need when they are making decisions. The article published this week by Geers and colleagues will go a long way to adding actual data to this debate.


Spoken Language and Sign Language and the Effect of Language and Literacy


Everyone seems to be sure that they know exactly what is the best method to educate children with hearing loss. The problem is that everyone has a different answer. Obviously, the same answer is not the same for every child and for every family but that has not prevented us from acting as if there was only one right answer. Each of us will provide the best possible language modeling for our children if we communicate in the language we know well. Each child is different and what works for one will not work for all. Children born into families with deaf parents who are fluent signers are in a different situation than children born to families with normal hearing parents who do not know sign language at the time of diagnosis. While families who are fluent signers will be able to provide their children with good language, families who don’t sign will not. Think about how it is to learn a new language. I am trying to learn Italian. I feel sorry for any child who has to learn Italian from me.

But there is an additional issue and that is literacy. Language learning is critical for developing literacy. Children who do not have good language  and phonologic will not have good literacy. And, if you want a child to learn to read in English, they need to have good English language skills. ASL skills do not necessarily transfer to English literacy skills.


The Geers et al study


Ann Geers is a well respected clinician and researcher as are her co-authors. Geers has published extensively. Her most recent paper was just published in Pediatrics. She evaluated the relationship between early sign language exposure and cochlear implant benefits. The article reports that most children with hearing loss learn spoken language and that most children with hearing loss are born to parents who have normal hearing and do not know sign language. The debate that has been raging for as long as I have been in this field (more than 50 years) is whether parents should be encouraged to learn sign language and to teach their deaf children to sign. This study evaluated parents use of sign language before and after cochlear implantation and the influence of parents sign language use on speech recognition, speech intelligibility, spoken language, and reading outcomes.

Three groups of children with CI’s from a national data base who were matched for demographic, auditory and linguistic characteristic but differed in duration of early sign language exposure provided in their homes were compared through elementary school grades.

Children without early sign language exposure achieved better speech recognition skills over the first three years after implantation and were statistically significantly better in spoken language and reading near the end of elementary school then children who were exposed to sign language. Over 70% of children who had no sign language exposure had age appropriate spoken language compared to only 39% of those exposed to sign language for 3 or more years. Early speech perception predicted speech intelligibility in middle school years.




All three groups received reading comprehension scores similar to hearing peers in early years but those without sign language exposure exhibited a statistically significant reading advantage over the long term sign subjects. For children with no sign language exposure only 11% were delayed in early elementary years increasing to 23% in late elementary years. For children exposed to sign language in early years, the percentage of children with less than average reading scores increased from <20% in early elementary years to >50% in late elementary years.


Study discussion


This article clearly provides the most compelling evidence that there is no advantage to early sign language use. Children who’s families used spoken language only, had better auditory speech recognition and more intelligible speech than children who’s families used sign language. Even short term sign use resulted in poorer speech intelligibility in elementary school. Even children whose families who used sign language minimally had poorer outcomes then children not exposed to sign language.


My conclusions


Most parents of children with hearing loss do not know sign language and the process of learning sign language, just like learning any other language, is long and arduous process meaning that they will not be exposing their children to good language models during the early years. The children who are listening exclusively to spoken language have the opportunity to hear good spoken language models and incorporate this into their speech recognition and spoken language. Children with poor reading skills have limited employment opportunities.Very significantly, the reading results alone  make a case for using spoken language exclusively by parents.


THE WORLD HAS CHANGED. Newborn hearing screening and improvements in technology have changed the world for children with hearing loss. When I started in this field children where identified with hearing loss at age 2-3 years and if they had severe to profound hearing loss they did not do well with hearing aids. They lost lots of time and many never successfully learned spoken communication but NO MORE. Babies are now identified at birth and fit with technology in early months. As soon as they receive technology they are hearing their families speak to them and learning language.

Children who have good listening and spoken language and good literacy skills have opportunities in life that those who do not have those skills just don’t have. Learning sign language later is always an option but learning it early destroys possibilities. That is the point – it only works if children have early exposure to spoken language.

It is unfair to be making decision for today’s children based on results of children who did not have the same opportunities – who were identified later and had technology that did not provide sufficient gain. Please let’s stop doing it.


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