University of Edinburgh

Working with children with cochlear implants in sign bilingual settings

Presented on 17 January 2008

Moving on with spoken language

Sue Archbold

Fact or fiction? Spoken language development

  • Speech perception equals spoken language
  • Speech intelligibility equals spoken language
  • Vocabulary counts equal spoken language
  • Early signing/gesture prevents later spoken language development
  • Spoken language development happens quickly
  • It is complete by age five
  • Children implanted early have normal language development

How do we move on with spoken language?

Remember hearing age versus chronological age.

Importance of early communication and interaction

  • Mark Marschark (2002): deaf children with the highest literacy level at age 16 are those who had a good communication (spoken or signed) with their parents in early life.
  • Tait, 2000: pre-implant communication skills predicted outcomes three years after implantation (whether vocal or gestural).

Ensuring early communication skills develop to support the later use of the implant system.

What makes successful communication?

Let's think about parents after early diagnosis - in weeks not years.

  • Parents know about deafness earlier - before they have established a relationship.
  • May affect the parent/child communication very early... and hence the development of language...

Disruptions to communication with a deaf baby - why?

Sound plays a crucial part in early communication: deaf babies don't react as hearing babies do and hence parents don't.

Parents' quotations

  • "We stopped talking because we thought he can't hear, so why am I talking? I forgot talking and laughing all the time, just quiet"
  • "at first it was hard to actually talk as normal to her, knowing that she couldn't hear us... when you do feel down some days you don't particularly feel like talking anyway. So some days yes, I may have thought well there's no point because she can't hear me."

When babies are born they prefer:

  • Familiar voices, eg; mother's voice
  • familiar language, that is language spoken by the family
  • familiar stories
  • speech rather than other sounds

But other things are also important especially for a deaf baby

  • Rapid recognition of mother's face - babies of 7 hours preferred to look at a picture of mother than of a stranger with the same colour hair (Walton & Bower 1991).
  • Smiling - by 6 weeks babies smile to mother's face and voice. By 3 months the baby's smiles are synchronised with the mother's (and father's).

We all use sound and vision together

When mothers talk to their children this brings attention to the mother's face.

The new technologies may:

  • Increase the socio-emotional and communication match between deaf babies and hearing parents (Lichert, 2005) by facilitating early communication.
  • Give beter and earlier access to spoken language than ever before.
  • Require early multi-modal communication to maximise benefit (Spencer, 2005).

So, the new technologies could:

  • Provide us with better opportunities than ever before to provide useful hearing to bring together hearing and vision earlier and more effectively than before.
  • We want to make sure the new hearing is part of the child's communication system.

It should be possible that:

  • Early diagnosis of hearing loss and good parental support can allow the development in good communication in the first year of life.
  • Increased awareness of sound following implantation can built on the communicative patters that have already been established.

We still have a problem:

  • We know that earlier implantation is more successful - we don't know yet how early.
  • But we also know that there are important things for parents to do with a young baby.

For parents with a deaf infant:

  • Learning sign language is not easy
  • Need to be relaxed communicators
  • Managing the technology is not easy

The changes:

  • Before implantation, the child does not have sufficient audition to process spoken language successfully
  • after implantation, the child should have sufficient audition to do so
  • this audition develops over som time ... years ... the child's needs may change over time
  • what do we do in the classroom?

After implantation: Priorities - how can they be provided in a sign bilingual setting?

  • Wearing it!
  • monitoring the implant functioning
  • developing listening skills
  • using hearing in the development of communication and language.

But only if they wear them. "It's fine - she keeps the processor in the bag, and puts it on for speech therapy."

Managing the technology

  • At home and at school
  • do you know if the implant is working?
  • If not, who would?
  • Who does it?
  • What is the daily check?
  • Where are the spares?

At school

  • acoustics: listen
  • peer group
  • need to develop responsibility for own learning - to repair conversational breakdown
  • demands of the curriculum

Means: Reasons: Opportunities; to learn spoken language - which of these do your children have for learning spoken language?

Think: how are they communicating now?
What is the next step in their communication and language learning?

Children learning to communicate:

1. Means: Sign, Spoken language

2. Reasons: Spoken language encouraged, Desire to get message across

3. Opportunities: When do they need to / can they use spoken language?

1. Remember HOW your child communicates

Means: sign, spoken language, both

How your child communicates is their Means of communication

2. Your child's reasons for communicating

Reasons: why do they use spoken language or sign language?

  • to attract attention
  • to refuse something
  • to give information
  • to buy a Coke at the shop

Is the child having the experiences other hearing childre of their age have, eg; football, hobbies, Brownies?

3. Opportunities for spoken language

  • at home
  • at school
  • in the community
  • how often?

Opportunities: when do they need to / can they use spoken language?

Moving from sign to spoken language - What are the issues?

How do you make the opportunities for spoken language in sign bilingual settings?

  • Is there a role for sign support rather than sign language?
  • If so how?

Giving visual clues - how?

  • Is it always sign language or signed support?
  • We may need to think through changing support for children after implantation.

The value of conversation: talk time

  • When was the last time you had a conversation with the children you teach?
  • You didn't give them instructions, impart information or direct behaviour - you had a conversation!
  • Do you make time for conversation in class?
  • If so, what form does it take?

Moving on with spoken language

  • Use everyday spoken phrases in context, eg; put your coat on, the taxi is here; time for dinner; do you want tea or coffee?
  • Expose your child to the rhythm and sound of spoken language and other spoken language clues such as lipreading.

Giving visual clues

  • Using written word
  • using age-appropriate activities
  • pre-reading activities, eg; left to right patterning with young children.

Using story time

  • Not just reading the book
  • developing thinking skills
  • extending language
  • listening to others' contributions.

Phonic approach to reading

  • Now very relevant for deaf children: the can hear all speech sounds
  • gives visual support to listening
  • give new word learning skills.

Using the written word

  • Read to the child, rather than they read to you
  • Why?

Following a text and stopping

"I went shopping with Mummy and bought a jumper for Daddy's birthday. It's red with blue stripes. Daddy's birthday is on Sunday - I hope he likes his jumper."

Using the curriculum

  • We don't have time to do anything else!
  • Use the curriculum to develop listening skills.
  • Old-fashioned dictation.

Use of technology

  • taped sounds
  • computer programs - opportunities for listening side by side
  • gives opportunities for visual reinforcement and repetition

Helping listening abilities

  • Using more complex language: I went shopping and I bought...
  • Visualisation: Can you see the picture in your head?
  • Barrier games: describing something for the child to draw - have you got the same?


Children with implants have

  • a moderate hearing loss
  • a unilateral hearing loss

When would you move on with spoken language?

  • How would you know when to change the balace of sign and speech?
  • Ho could you do it?

Speech tracking - Why would you do it?

  • If you want to help the child's listening abilities or monitor them over time.
  • It's the closest we can get to an assessment which looks at monitoring listening to conversation over time.
  • We can use speech tracking to provide training or to assess a child.
  • They like it and it's fun!

The communication journey

  • Sign bilingualism means two languages
  • How do we decide on the balance?


  • Children's potential and needs change after implantation.
  • How can we provide flexible support which changes over time?
  • How do we assess changing needs?

Pat Spencer's work


  • Use oral or auditory verbal methods
  • Use simultaneous speech and sign
  • Use sign and speech independently (bi - bi)

NB it is not necessary to choose one approach for ever!

Pat Spencer's ideas

  • Deaf children with cochlear implants are still deaf although most will have access to auditory information.
  • Older ages at implantation usually require more structured listening practice.
  • Flexibility is important, sensitive to changing child and family needs.
  • Children may understand and produce spoken language and still use sign language and maintain deaf identity.
  • Research from 5 years ago is too old.

The options actually make family decisions more difficult

  • We don't really know enough yet. Need to keep open minds
  • and constantly evaluate progress
  • study the results of all the options
  • modify or change approach if child not happy or showing progress (Spencer).

Spencer's Quest for Peace

Can we find ways to help deaf children use and reach all their potential?

  • For sign and deaf identity
  • For spoken language and access to general community
  • For literacy and academic achievement


  • Disagreement about typical degree of 'match' between signed and spoken representations
    Sensitive, fluently signing parents tend to produce sign supported speech after CI? - deserves more research
    Parents of hearing infants learn simple signs
  • 'Real' sign language requires other models
    Special role for deaf teachers and other professionals
    Sensitive/critical period for sign as well as speech.

Why sign?

  • Seems to support vocabulary development - mediator (Connor et al, case studies)
  • Covering the risk in outcome - and supportig social/cognitive growth as speech develops

Identity and self-esteem issues

  • Still not Hearing
    - Adolescent CI groups. Signers teach oters
  • Bicultural identity relates to stronger self-esteem (Bat-Chava 2000)

Decreasing communication frustration

  • Hearing children using signs show good spoken language development (Acredolo)
  • If they hear it, they will say it.

To support bilingual-bicultural development of children with CIs

  • Provide rich, fluent spoken language experience.
  • Provide support from signs - and in different context, rich fluent sign language experience.
  • Support parents' communication intuitions.
  • Monitor individual development and be flexible.
  • Show respect for child and parent preferences - and for Deaf and hearing communities and languages.

Pat Spencer's Quest for Peace

Can we find ways to help deaf children use and reach all their potential?

  • For their own identity
  • for spoken language and access to general community
  • for literacy and academic achievement
  • and move on from the old arguments.