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American Annals of the Deaf, Volume 145, Number 1, March 2000,

pp. 6-14 (Article)
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DOI: 10.1353/aad.2012.0256

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Volume

14 5, No. 1,

2000

Infants with Congenital Deafness:

On the Importance of Early Sign Language Acquisition

wo boys who both had a profound bilateral hearing impairment met at a specialized
sign preschool. Their preconditions were quite different, since in one of them the
hearing impairment was detected in the maternity ward with the aid of otoacoustic
emissions, and habilitation had begun at age 4 months. The other boy's impairment
was not detected until age 2 years; habilitation was thus much delayed. Data were
collected on the two boys using interviews with parents and teachers, observation,
and video recording in the children's own environment at home and in the
specialized sign preschool. Characteristic differences between the boys are described
regarding their social and linguistic development relating to the time of detection of
the hearing impairment. This illustrates the importance of early detection and
habilitation so as to avoid separation of individuals into different groups with
differing social and academic prospects, depending on the lack of early linguistic
stimulation and consequent poor language acquisition. Giving children the
possibility of developing a language is the primary consideration.

Miriam Magnuson

Linguistic proficiency is a central requirement for human life: spoken language for
the hearing and sign language for the
Deaf. Infants have a communicative com-

the Department of

petence that was previously unknown,

and this competence is common to both
hearing and deaf children (Jusczyk &

Education and

Hohne, 1997; Trevarthen & Marwick,

Magnuson is a
doctoral student in

Psychology,
Linkping University,
Linkping, Sweden.

1986). The newborn child is able to perceive verbal sound patterns, and language
development begins in early infancy
(Marcus, Vijayan, Bandi Rao, & Vishton,
1999). In deaf children, language develop-

hearing impairment have normal hearing,

which makes communication between

parents and child difficult. Since education

in sign language can begin only when the
hearing impairment is detected, deaf chil-

dren with hearing parents thus start from a

clearly disadvantageous position. During
the very important early period of language development, these deaf children
thus do not receive any natural language
stimulation.

The conventional methods for hearing

ment proceeds in a manner that is equiva-

screening have not been sensitive enough,

lent to that of the hearing, starting with

manual babbling and evolving into lin-

remains undetected until the child's differ-

and a childhood hearing impairment often

guistic expressions (Petitto & Marentette,

ent behavior and failing speech develop-

199D. It is well known that the sign lan-

ment make it evident. Apparently, when

conventional methods are used, detection
of severe to profound hearing impairments in children occurs belatedly in all

guage of the Deaf is an advanced language rich in shades of meaning (Sacks,

1989). However, more than 90% of par-

Volume 145, No. 1, 2000

ents of children with severe to profound

American Annals of the Deaf

communities (Bamford & Davis, 1998).

the most effective strategy for obtain-

sign language, and who sign with their

The only way to enable early detection

ing a normal linguistic development in

children, tend not to continue devel-

and an early start of habilitation is uni-

deaf and profoundly hearing-impaired

infants. This can be accomplished only

oping their skills. In addition, the par-

by neonatal hearing screening.

tangible things, a shortcoming that

becomes even more pronounced

versal neonatal hearing screening,

with the aid of auditory brain stem
evoked responses (aABR) or
otoacoustic emissions (OAE) (Davis,
Bamford, Wilson, Ramkalawan,

Forshaw, & Wright, 1997; Kemp &

Ryan, 1993; Mason, Davis, Wood, &
Farnsworth, 1998). In a National Institutes of Health consensus statement

(1993), universal neonatal hearing

screening was recommended. The European Consensus Programme (1998)

recommends hearing screening of infants, and general perinatal screening

is now practiced at several centers in

the United States and Europe.

There is strong evidence that the
benefits of early intervention made
possible by neonatal hearing screening outweigh the anxiety caused by a
false positive test result (Magnuson &
Hergils, 1999; Watkin, Baldwin, Dixon,

& Beckman, 1998). It is now recognized that early detection of hearing

loss is essential if children are to have

the chance to achieve their potential

language skills. Of all the variables that

were investigated in a thorough longitudinal study of children with profound hearing impairment (Levitt,
McGarr, & Geffner, 1987), it was found

that the age when intervention began

exerted the largest influence on the
development of language and communication skills. Robinshaw (1995) stud-

ied communicative and linguistic behavior in children with severe to

profound hearing impairments who

were supplied with hearing aids at the
age of 3 to 6 months. The results
showed that children with severe to

profound hearing impairments who

are identified and supplied with amplification by the age of 6 months develop linguistic skills comparable to
those of hearing children. YoshinagaItano, Sedey, Coulter, and Mehl (1998)
found that identification of the hearing
impairment at 6 months of age, followed by appropriate habilitation, is

Volume 145, No. 1, 2000

The failure to develop an effective

and sophisticated language at an early
age has negative consequences for all
aspects of psychological development,

ents' communication is often limited to

when the child matures and needs

explanations of more complex social

and emotional subjects.

and thus for children's mental health

There is thus a consensus that early

(Hindley & Parkes, 1999) There is evidence that deaf children of deaf parents who use sign language in their
communication have significantly better linguistic, social, and academic
skills than their deaf peers with hearing parents. Deaf children of hearing
parents who have contacts with deaf
people and share the language seem
to have a similar advantage. Thus, the

detection and an early start to habilitation yield better opportunities for the
development of communication. The
earlier the hearing impairment is identified, the better is the development of
language skills. Results of previous
studies (Magnuson & Hergils, 1999, in
press) emphasize the importance of
early detection, in terms of both linguistic and social development. Parents clearly express that they want
early detection with the aid of neonatal hearing screening; they want early
knowledge of whether their child has
a hearing impairment in order to help
establish good communication within
the family (e.g., by hearing aid or sign
language), and because of concern
over the child's future development.

deaf children who are the most com-

petent in their social, cognitive, and

linguistic development are those who
have participated in active linguistic
interaction with their parents from an
early age. This applies both to deaf
parents and to hearing parents who
have learned sign language, which
permits them to interact meaningfully
with their children. The child not only
learns facts through this interaction,

but also gains behavioral and cognitive strategies, an understanding of self

and others, and a feeling of being part
of society.
Many hearing parents have little
formal training in sign language and
find the use of signs impractical for
most everyday needs. They do not feel
comfortable with sign language, especially in public, and tend to sign only
when they communicate directly with
the child (Vaccari & Marschark, 1997).

This leaves the child ignorant of what

is being said and constitutes an obstacle to the deaf child's learning of

sign language. In analogy, vocal

speech is primarily learned indirectly
by listening to other people talking,
from television and other sources, and

Aim of the Study

The aim of the present study was to

illustrate early language development
and the importance of early language
acquisition by means of a comparative, in-depth study of two characteristic cases. A large amount of data was
collected concerning two boys who
both had a profound bilateral hearing
impairment. When they met at a specialized sign preschool, their preconditions were quite different. In one of
them, the hearing impairment had
been detected in the maternity ward
with the aid of OAE, and habilitation

had begun at the age of 4 months. The

hearing impairment of the other boy
was not detected until he was 2 years
old, and habilitation was thus delayed.

less by direct teaching. Vaccari and

Marschark state that despite their best

Characteristic differences between

intentions, parents who start learning

based on interviews with the parents

early and late detection are described,

American Annals of the Deaf

Congenital Deafness and Early Sign Language Development

and teachers, and observations and

parents were hearing. The family con-

video recording in the children's own

environment, at home and in a specialized sign preschool. The issues focused upon in the present investigation were: What experiences,
opinions, and judgments could be
found regarding the two boys' com-

stellations were stable in both cases,

and both boys later got a younger sibling who was hearing. The socioeco-

months, respectively. The first interview with the parents was

semistructured (i.e., open-ended), and

nomic status of the two families was

lasted 45 minutes. The second interview lasted 45 to 60 minutes and was

about the same. The families received

carried out according to a scheme con-

sisting of one structured part for background information, and one

semistructured part to ascertain different aspects of communication in the
home setting. The individual interviews with the sign preschool teachers

The Specialized Sign

education in sign language when the

boys were 6 months, and 2-1/2 years
old, respectively. The families attend
periodic weekend courses where they
meet deaf persons and others skilled
in sign language.
"Rasmus" was 3 years 5 months old
when the study was completed. His

Preschool

hearing impairment was detected with

semistructured and lasted 30 to 45

At the time of the present study, both

boys were attending a specialized sign

OAE in the maternity ward the day af-

minutes for each of the teachers.

ter birth. When he was 4 months old, a

preschool, where children with im-

bilateral profound hearing impairment

paired hearing were integrated with

children who were not hearing impaired. The purpose was to give children with hearing impairments the
opportunity to interact and play with
hearing children. Experience showed,

was confirmed with diagnostic ABR.

Examples of Questions

When 6 months old, he was supplied

with bilateral hearing aids, and he was
admitted to a specialized sign preschool when he was 1-1/2 years old,
after a 6-month schooling-in period.
"William" was 4-1/2 years old when
the present study was completed. He
also had a profound bilateral sensorineural hearing impairment, which

All questions were followed by

supplementary queries. Some fundamental questions were used in all interviews, such as: What do you think it
means for Rasmus/William to go to the

groups (using sign language or vocal

speech, respectively), would require
active guidance by the supervisors
(Eilstrm, 1993). This was not practiced at the school; rather, the primary
pedagogic aim was to enable the children with impaired hearing to achieve

was not confirmed until he was 2 years

old. He was then fitted with bilateral

Questions to parents focused primarily on the communication within

hearing aids, and after 6 months of

the family: Tell me, what works well in

schooling-in he was admitted to the

communications with Rasmus/Will-

same sign preschool.

iam, and what does not? Does

sign language competence and social

Thus, the child's individual needs re-

Measuring Instrument
The children were studied by means
of interviews with the two parent

garding language development and

couples, and the teachers at the sign

social skills were the focus. At the time

preschool, of whom five were hearing

and one deaf. In addition, two mem-

municative, linguistic, and social abili-

ties? Of what importance was the sign

preschool to these children?

however, that the children with hear-

ing impairments preferred to play

within their own group.
Promoting communication between

fellowship within their own group.

when the two boys attended the preschool, there were 10 children with

different degrees of hearing impairment, and 8 hearing children. All personnel were fluent in sign language
and one of them was deaf.

Method

and the auxiliary teachers from the

Department of Audiology were

sign preschool? In your opinion, what

are the advantages/disadvantages of

early or late detection of the hearing

impairment?

Rasmus/William take the initiative to

bers of the pedagogic habilitation

team from the Department of Audiology, University Hospital, who served
as auxiliary teachers at the sign preschool, were interviewed. All interviews were done by the author using a
tape recorder. The parents were interviewed on two different occasions; the
first about 1 year after confirmation of

contact other kids and play with them,

and how does he manage? How do

you estimate the linguistic development of Rasmus/William? Give me

your impressions of his difficulties and

progress. What happens when
Rasmus/William cannot make himself
understood? How does he react? What

is your opinion with regard to sign lan-

guage? What are your plans and hopes

for Rasmus/William?

Questions to the teachers at the sign

preschool were meant to clarify linguistic and social development: Can

Rasmus/William express himself so
that you understand him? Tell me
about his interaction when playing

Subjects

the child's hearing impairment, and

Both boys were the first child in their

respective families, and both sets of

the second when the children were

with his peers. How do you evaluate

ages 3 years 5 months and 4 years 6

his linguistic development and his lan-

Volume 145, No. 1, 2000

guage skills today? How does he react

American Annals of the Deaf

when other kids do not understand

him? What happens then? Do you see

any difference between Rasmus and

William concerning their development

of language skills and behavior?
Observations and Videotaping

of 10 hearing-impaired children who

attended the school, lunchtime, and
free play in the schoolyard. Finally, a
video recording was made covering 15

enabled collection of as much infor-

mation as possible with regard to interaction and communication. The

observation exercise in the two homes
was focused on interaction situations

between the parents and the child. In

the sign preschool, five different situations were observed: free play within
the school, half- structured play, concept education with the whole group

the sign preschool. The study was approved by the Ethics Committee for
Research at the University Hospital.

Parent interview 2
Observation
at home

Synthesi
Comparison

The precondition in the present study

was that both boys had a profound
bilateral sensorineural hearing impairment and that they attended the same
specialized sign preschool, being supervised by the same teachers. From
another viewpoint, their conditions
were quite different, on the basis of
the age at which each boy's hearing
impairment was confirmed. The inter-

Interviews with

day care school

teachers
Observation

in day care school

Video record frig
in day care school
Interviews with

audbbgfcal
pedagogsts

Figure 1

nomena were defined, which con-

sisted of opinions and experiences

expressed by the parents and teachers,
and descriptive categories were defined.

Observation

In the different situations both at home

and at school, as accounted for above,

views were the main source of infor-

it was possible to find characteristic

mation for analysis, and complemen-

similarities and differences with regard

Analysis 2

Schem fordat colectionforeachofthetwochildren,thethre -step rocedureusedina lysi,andthefinalcomparison.

<- - >
American Annals of the Deaf

at home

Interviews

different qualitatively delimited phe-

Analysis

Volume 145, No. 1, 2000

Video recording

The analysis followed a three-step procedure (see Figure 1).

After the interviews were completed

and the recorded material transcribed,

analysis 1

Parent Interview 1

observations and video recordings.

minutes in the home and 45 minutes in

Observations were made and video

recorded by the author and lasted

about 1 hour in the boys' homes and 4
hours at the sign preschool, taking the
"observer as participant" form, which

tary information was collected from

Congenital Deafness and Early Sign Language Development

to the behavior of the boys, which

served to complement the interviews.

families used to borrow videotapes

with signed fairy tales, and both children liked to watch them. The boys
seemed interested in letters and num-

Video Recordings
The video recordings contained
samples from all the different situa-

linguistic and social rules early. At the

first interview he was a little over 1

year old, and the communication by

signing had already developed. The

bers, and each was able to write his

communication between Rasmus and

own name.

his parents relied wholly on sign language. "Surely, we had no problem

tions described above; the differences

with communication; he never suf-

and similarities were observed in the

Synthesis

fered from being deaf at all," his par-

videos.

Different phases in the course of linguistic and social development of the

ents said.

is still a large difference between

In the parents' opinion, it was a

great advantage that the hearing impairment was detected early so that
they had the opportunity to learn sign
language at an early stage and to be
"in advance of the child regarding language, so one can understand each

them. Rasmus followed a development

other; that is positive."

process similar to that of a hearing

child with regard to his language and

ment was detected at age 2 years,

children could be discerned in the

Synthesis
The three parts described above were
used to find interesting aspects that
characterized the communicative ac-

tivities of the two boys (triangulation),

which enabled a comparison between
them. There is an unavoidable tension

among the data obtained by means of

these different modes of data collec-

tion, enabling a continuous reciprocal

interaction among them that serves to

deepen and extend understanding.

The validation is a continuous process
that is built into all stages of the study,
one involving continuous control with

regard to the empirical material, as the

results are expressed and made comprehensible (Hammerslay & Atkinson,
1995; Kvale, 1996; Larsson, 1994;
Merriam, 1998).

analysis; these phases are used here to

describe their progress. Both Rasmus
and William are now doing well in a
sign language environment, but there

social skills. He was confident and

soon gained a good command of and

active use of sign language. William's
linguistic and social development was
slower. In the beginning, he had difficulty grasping and using sign language, and his social interplay with
other children was primitive. As time
passed, his language and social skills
showed marked improvement, but,
when the present study was termi-

tic stimulation of the child within the

family, and the results showed a simi-

lar pattern for both families. About

twice a week, the parents used to tell

simple fairy tales to their children by

signing, and they played games together sometimes. Playing music and
singing with the children was unusual
in both families, but the children

watched television frequently. Both

Volume 145, No. 1, 2000

himself understood. He took the initia-

tive by guiding his parents, by pointing, pushing them, and pulling their
arms to make them understand what
he wanted. William was a determined

and ardent boy who made large gestures, repeating, and repeating once

The Prelingual Phase in the

Family Setting

There was no question about it, it was

Rasmus: When the hearing impair-

just to follow his direction."

In the family setting, this special

Results

The second interview with the parents,

when the children were ages 3 years 5
months, and 4 years 6 months, respectively, contained an introductory,
structured part aimed at getting background information regarding linguis-

William did not get any ordinary linguistic stimulation. Because of the lack
of spoken or sign language, he developed a method of his own to make

again when necessary, to make his

parents understand: "He had his own
language, very emphatic. If he was sitting on my shoulders and wanted to
turn right, he just pulled my right ear.

nated, he was still behind with respect

to his age.

Background Information

William: Before his hearing impair-

ment was confirmed, when the boy

was 4 months old, Rasmus's parents

were eager to start up sign language at
once, and education was supplied by

kind of communication worked rea-

sonably well as long as the parents

permitted William to be in control.

the sign language teacher at the De-

Sometimes, however, the situation be-

partment of Audiology. Rasmus's

mother said she found sign to be "a
different and interesting language. It is

came chaotic when he did not under-

great fun to learn!" Rasmus was also

fitted with bilateral hearing aids and

was probably able to perceive lowfrequency vibrations. Thus, his

prelingual phase was very brief, not
much longer than for hearing children.
Rasmus is a placid child who learned

stand what was going to happen, or

when he could not himself have the

initiative, or when he was not allowed

to decide by pointing and pulling.

When his parents did not understand
him, they had to coax him. Outside the
home, and when his family was with

other people, the communication did

not work at all, and the situation

American Annals of the Deaf

ferred to play with other children who

signed, but he had no playmates at
home. His parents found that playing
with hearing children did not work
well because of the language difference: "They simply do not understand

had gone on for some time, William

began to like learning signs. Little by
little the communication improved,

Rasmus: When Rasmus started in the

each other. With deaf children there is

infant preschool at the age of 1-1/2

years, he had already reached linguistic maturity on a level comparable to
that of a hearing child. When he was

no problem. They sign whatever they

want to say, and then they play." Everyone who was interviewed agreed
that the early detection of the hearing
impairment was an advantage for
Rasmus when he was acquiring linguistic and social competence, and
were of the opinion that the sign preschool was very important for his positive development.

years, not getting to know things, what

they are and what they mean-that
must be very important," a teacher
said. William's mood improved, and
his family viewed the sign language as
very positive. In the beginning,
William's sign language skills developed slowly, but when he was between 4 and 4-1/2 years old, his linguistic development took a large step
forward, and his social competence
improved accordingly. "Yes, and then
one must start to sign and suddenly

clearly could become difficult both for

William and his parents.

linguistic and Social Development

in the Sign Preschool

2-1/2 years old, he moved to a class

for older children. At the time, he exer-

cised active use of sign language and

showed good understanding of concepts. He was fully aware of visual
turn taking, and understood how to
act during a conversation by watching
the signing person. The teachers at the

sign preschool and the parents took

part in Rasmus's development with
much interest, and, at the time of the
second interview and observation

when he was 3 years, 5 months old, he

could pursue a fluent dialogue with

them. His linguistic and social abilities
in the interaction with playmates and
teachers were judged as comparable
to those of a hearing child of the same
age by all the interviewed persons;
some of them even considered him

advanced for his age. The deaf sign

language teacher judged his development to be equivalent to that of a deaf
child with deaf parents, who gets sign
language stimulation from the very
beginning: "Yes, he was obviously
ahead of his age, like a hearing boy
then, only he used sign language."
Rasmus quickly grasped, ahead of
the other children, the instructions
given by the teachersfor example,
when the group of children with hearing impairments were educated in the

understanding of concepts. He was

confident and helpful, and played
calmly with other signing children.
"That Rasmus was so calm was due to

the fact that he got his language so

early; he knew what was going to happen. He understood that people
wanted to sign with him," a teacher
said. At the preschool, Rasmus pre-

Volume 145, No. 1, 2000

William started at the sign pre-

school at 2-1/2 years of age, after his

hearing impairment had been confirmed. This certainly meant a large
change for him. He now had to adapt
to using hearing aids, and education in
sign language was started for him as
well as his parents. His social behavior
was in accordance with his language
development, and he did not know
what to do outside his home environ-

ment. The special communication

mode that he had developed within
the family was impossible to use in the
new environment, and the conven-

tional sign language was totally unknown to him. He was at first insecure

and sad since he did not understand

his new playmates and teachers, and

they did not understand him. "William,
who did not get signs so early; he was
very uneasy, making trouble, and
seemed to avoid eye contact," a
teacher said. Previously he had been
used to taking initiatives, but now,
when he could no longer take the lead
and decide upon having a certain toy,
for example, he would push his play-

and it was easier to understand what

he wanted and to explain things to

him. "So much was missed the first 2

understand how to use it. It must take

some time, mustn't it? But now he

seems to be getting along fine," one of

the teachers remarked. William ap-

peared happier and more secure and

played in a more relaxed way with his
mates. All interviewed persons found
that the sign preschool was very important to William, not only for learning sign language but also for social
development. He learned many concepts and was able to ask questions
and give answers to questions, but he
still had difficulty using the language
actively and taking part in dialogues.
He appeared to lack concentration,
and the visual turn taking was an obvious difficulty-that is, making William
focus on the signing person and keeping his attention as long as needed to
convey the message. "The difficult
thing is to gain his attention, to have
visual contact long enough to think
through the matter and convey the
message," one of the teachers said. At
the second interview (when William

mates. Sometimes he withdrew from

was 4-1/2 years old) his parents' opin-

the others, wanting to be left alone. He

was unhappy and angry when he

ion was that the communication

could not have his own way. "Then

worked much better since they could

mostly understand what he wanted to

there was crying and despair unless he

say, as well as he them.

William showed himself to be social

got what he wanted," was a comment

made by the teachers.

by making contact with other children

When the sign language education

and adults, although he was sad when

American Annals of the Deaf

Congenital Deafness and Early Sign Language Development

he could not make himself understood

hearing impairments. "It is really im-

sometimes; this improved as he

learned more sign language. The companionship with hearing children was
still poorly developed since the children did not understand each other,
and he had no playmates at home. "He
is quite a social boy who really wants

portant that he meets other children

to talk, but he does not know that the

pairments in their home community,

To learn more, they took part in weekend training programs with their children. As a result of the early detection,
Rasmus's parents had a lead over their
son with respect to sign language,
which they regarded as very positive.

the family is prepared to move to an-

The present study shows that it is im-

other town where there is one. "He

portant for hearing parents to start

communicating early with their deaf
child in sign language. The early start
is crucial, even though hearing parents
are naturally far from fluent in sign
language at the time.

with the same language," one of his

parents said. Since there is no special

school for children with hearing im-

will go in a class for hearing impaired

others do not understand him when

children; one cannot know if he will

he is signing," one of William's parents

said. The parents sometimes found
William's hearing impairment to be a

manage in an ordinary class," one of

his parents said.

handicap when they were outside the

family environment, but never at

home. The teachers at the sign preschool evaluated his linguistic and social development as being below average for his age: "His sign language was
rather poor then, so it was difficult to
communicate with him in any way.
There has been a change, but there is
still quite a good deal lacking."

A simplified and partly nongramDiscussion

mothers in their communication with

The Role of the Parents

order not to confuse the child, they

William's parents participated very actively in continuous sign language

tend to simply use hand signs with

respect to Wh- questions, keeping a
neutral face, while using facial expressions only when expressing affection.
This permits the child to read only

training. All four found the progress of

their children to be very positive and

were encouraged to continue learning

and using sign language in interactions

"one visual channel at a time." When

with their children. Parents must take

the child reaches the age of 2 years,

the mother, without being conscious
of the change, shifts her strategy and
starts using the adult language with

responsibility early on for orchestrat-

Rasmus's parents viewed his linguistic

and communicative ability as normal

there is no school for the Deaf in their

ing an interaction based on waiting for

the child's attention before starting to
sign, and then maintaining visual attention long enough for the message
to be given. As time passes, such attention switching becomes natural for
both the parents and the child, and
visual turn taking is developed, which
promotes effective communication instead of directing it (Power, Wood,
Wood, & MacDougall, 1990). Mothers
with better social support are more

hometown, they plan to move to an-

positive in the interaction with their

other town where such a school is lo- ;

cated. The parents want him to go to a

class for deaf children, using sign language. "Suppose he gets an implant so
he can hear, he will still be in a group

child. Receiving support as soon as

possible after the diagnosis of the
child's hearing impairment is particularly important. The parent then transfers the positive interaction behavior

with deaf children, and, of course,

to the child, and children who have

decide whether to let him have a co-

chlear implant. After careful consideration of possible advantages and risks,

they ultimately opted for implantation.
However, they are of the opinion that
there are no activities for Rasmus in

their home community and that he

cannot get any playmates there. Since

the child during the first 2 years. In

In the present study, Rasmus's and

The Future

for his age and found it difficult to

matical sign language is used by deaf

"two simultaneously active visual

channels," where the hand signs are

complemented with grammatically
correct facial expressions (Reilly &
Bellugi, 1996).
For a deaf child with hearing parents, it is vital that parents start signing
with their child to initiate communica-

tion, though the signing may first be

simple and incomplete. This provides
the opportunity for the child to start
developing language. Thus, it is essential to communicate with the child by

sign language, even though the parents may eventually opt for cochlear
implantation.

what I want is that he will have his

developed a good social and commu-

sign language," one of his parents

nicative ability within the family are

The Importance of the Sign

said.

better furnished to brave the step into

the social world outside the family

Preschool

William's parents came early to the

conviction that he should have a co-

chlear implant. They were also of the

definite opinion that the best for him

would be a class for children with

Volume 145, No. 1, 2000

One must pay attention to the fact that

each child has a unique set of charac-

(Vaccari & Marschark, 1997).

In the present study, the parents

teristics that will contribute to how

were eager to learn sign language and

used it consistently with their children.

development will proceed, and the

child must be given individual support

American Annals of the Deaf

according to his or her own conditions. Thus, one important factor that
will influence development is the flexibility of the habilitation, and a program adapted to continuous individual

development can greatly reduce the

risk of a social and linguistic handicap
(Apuzzo & Yoshinaga-Itano, 1995)
The results of the present study
were certainly influenced by the fact
that the two boys and their parents

hearing impairments who are supplied

with hearing aids are also given sign
language training as a complement,
with the aim of stimulating use of the
language. To make speech easier to
understand, signs are then used simultaneously with speech. Spoken and
written Swedish is seen as the first lan-

study, the child's profound hearing

impairment was detected early, and

sign language introduced at age 6

months. The parents chose not to view
Rasmus as disabled, since they ac-

cepted that he was deaf and used

signs as a primary language. They
were ready to move to another town

guage, and signs are used only to support speech.

where there was a school for deaf chil-

Deciding which communication

found it difficult to decide for or

were supervised by a habilitation team

method the child will learn is a critical

consisting entirely of professionals,

choice for the family and for the deaf

child, and one that is influenced by a
variety of factors (Reamy & Brackett,
1999). More than a simple choice of
method is involved, since the method

against cochlear implantation. However, they ultimately opted for the

opportunity to do so.
In the other family, the hearing impairment was detected considerably
later, and the sign language education

that is chosen is the decisive factor in

did not start until William was 2-1/2

how well the child will manage in the

future, both inside and outside the
family. The attitude of the family with
respect to hearing impairment, the acceptance of having a child with hearing impairments, and the expectations
of the family with regard to the child's
social role in the family during upbringing and education are important

years old. The parents naturally chose

sign language as a first language, but
they were disposed to opt for a cochlear implant from the beginning.
Therefore, they intend to let William
join a hearing-impaired group. The
family also intends to move to another
town with a specialized school for

factors (Luterman, 1999).

William can get the best possible education together with his hearing-impaired peers.
Leaving their present homes and
occupations to make a new start will
certainly be a big change, but both

who focused on their individual

needs. The overall pedagogical framework was equal for both hearing-impaired and hearing children in the integrated sign preschool. However, in
Sweden, sign language is regarded as
the primary language for the Deaf, and
this carried over into the pedagogical
practice (Lgr 80, 1983). Since the

teachers found it to be a necessary arrangement, the children with hearing

impairments were often gathered to-

gether in a group of their own to practice sign language and understanding

concepts. Even though the children
were allowed to play freely with their
mates, they were also trained through
structured play, without knowing that
the interaction was designed to de-

velop the language. The teachers discussed and evaluated the needs of in-

dividual children with the auxiliary

teachers, who were also working with
hearing pedagogy at the Department
of Audiology.
Sign Language and Spoken
Language

Sign language holds a strong position

in Sweden, where it is designated the
first language of the Deaf. In 1981,
sign language was declared the official
language for the education of deaf

children. This means that spoken and

written Swedish is also seen as a sec-

There is nothing to indicate that the

combination of signs and speech mitigates the development of concepts.
One study indicates that the child
seems to be able to code-switch in relation to the actual context and his or

her partner (Preisler & Ahlstrm,

1997). There are also no data to show

children with hearing impairments, so

families have considered the advan-

tages and disadvantages thoroughly,

focusing on what will be best for the

that sign language as a first language

will inhibit spoken language. Deaf

child. A common factor that has pre-

children who learn sign language as a

their conviction that a child is disabled

first language usually have better skills

in reading and writing than deaf children who have only been exposed to
spoken language (Marschark, 1993)-

only when not provided with optimal

Several factors contribute to the

choice of communication mode, such

as the prevailing view toward sign language in the country concerned (i.e.,
the status of the language) and the
access to specialized schools for the

ond language for children with congenital hearing impairments who are
candidates for cochlear implantation.

Deaf. Also, the time when the family

Children with moderate to severe

In one of the families in the present

Volume 145, No. 1, 2000

dren. This view meant that the parents

starts habilitation does seem to contribute to a subtle difference of views.

pared both families to move may be

conditions for future development.

Conclusion

The examples of Rasmus and William

demonstrate that a profound hearing
impairment means a disadvantageous
position for linguistic and social development, unless the impairment is detected early so that linguistic stimulation can be effected by the fitting of
hearing aids, sign language education,
or both. This early stimulation enables

American Annals of the Deaf

Congenital Deafness and Early Sign Language Development

the child to gain confidence by knowing what is going on. The child learns
where to look for visual cues, which
makes communication meaningful
and enables the child to feel that he or

she is participating in a social relationship.

The early detection of Rasmus's
hearing impairment meant that habilitation could start at the age of 4
months; he soon acquired sign language, which provided an effective
means of two-way communication.
Rasmus's parents and his supervisors
at the sign preschool, including the
auxiliary teachers from the audiological team, found his linguistic and social skills to be adequate and appropriate for his age.
In William's case, because of the

late detection of the hearing impairment, a prelingual phase without

words lasted more than 2 years.
William's family started sign language
education when he was 2-1/2 years
old, and the start was not at all easy
since the old "private code" that had
been developed within the family was
of no use in the new environment at

the sign preschool. He had to learn

new manners and an entirely new and

achieved. For a deaf child with hearing

parents, it is a matter of vital importance to provide the opportunity for
the child to start developing language
by signing, even though the parents
may eventually opt for cochlear implantation.
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American Annals of the Deaf