Research shows how sign language exposure affects young cochlear implant recipients

In a new, multisite study of deaf children with cochlear implants, UT Dallas researchers have found that children with either no exposure or limited exposure to sign language end up with better auditory, speaking and reading skills later. The paper is one of the first nationwide longitudinal studies of how sign language exposure affects young cochlear implant recipients.

The topic of whether children with cochlear implants should begin their communication experience with sign language has been controversial. However, Dr. Andrea Warner-Czyz, assistant professor in the School of Behavioral and Brain Sciences (BBS) and co-author of the study, said the research clarifies outcomes for such decisions.

"If you want your deaf child to be an oral communicator and have reading and language measures on par with their normal hearing peers, then signing to them may not provide the easiest route to that outcome," she said.

The study recently was published in the journal Pediatrics.

A cochlear implant is a biomedical device surgically implanted in the cochlea to replace the function of the damaged inner ear. The Food and Drug Administration has approved cochlear implantation for children with severe to profound hearing loss as young as 1-year-old.

Dr. Ann Geers, a BBS research scientist who was the lead author of the study, said a major question for normal hearing parents and the professionals who work with pediatric cochlear implant users is whether spoken language skills are best developed by focusing on the auditory speech signal or whether early exposure to an unambiguous visual language provides an important foundation for learning a spoken language.

To determine the answer, Geers, Warner-Czyz and researchers from six cochlear implant centers across the U.S. studied about 100 elementary-age children who had cochlear implants. The children, like 95 percent of all children born with hearing loss, had parents with normal hearing. The children either had early exposure to sign language that continued more than two years after the implantation, early sign language exposure that stopped before two years post-implant, or had no sign language exposure.

Each year, the researchers looked at how the children performed in the areas of speech perception, speech intelligibility, language and reading. The study showed that the children who continued to sign after two years of having a cochlear implant had poorer outcomes across all communication domains, particularly compared to those who didn't sign at all.

"This study provides the most compelling support yet available for the benefits of listening and spoken language input for promoting verbal development in children implanted by 3 years of age," Geers said. "Contrary to earlier published assertions, there was no advantage to parents' use of sign language. This result affirms the decision of many hearing parents who choose not to use sign language when their child receives a cochlear implant."

The researchers said the study's findings should be a powerful counseling tool for families, especially those whose native language is spoken rather than signed.

"A lot of these families think that once their child receives a cochlear implant, then that's it. But there's a lot of work that goes into getting these kids with the successful outcomes -- some of which has to do with how you use spoken language gt vto communicate with your child," Warner-Czyz said.


  1. Louise Porter Louise Porter United Kingdom says:

    Not an expert but my initial thoughts on reading this article are that young children need to develop socially, emotionally, physically and culturally alongside their communication development. These aspects of development may be easier to access through visual communication. Also, introducing sign language in childhood leaves a door open for an introduction to the Deaf community in later life.

  2. Scott Smith Scott Smith United States says:

    These articles do not convince me at all because:
    1) they equated "language" with spoken/verbal language development (which is a clear evidence of research bias right out of the gate)
    2) only one measure of reading was used (we all know that they actually probably administered 3-5 reading tests and they chose the one that happened to showed a significant relationship) and Figure 1 results of the reading test with the error bars are actually unimpressive to me - they achieved a p=0.02 on this one single measure of reading probably because they controlled for so many other factors;
    3) they did not control for post-CI rehabilitation ("over 95% of the children received specialized intervention during some or all of the first 3 years postimplant") - it is very likely that those parents who chose to sign more are those who did receive very much post-implant services, which is important because post-implantation rehabilitation is an educational experience. Anybody who gets additional educational experience is likely to show some benefits from the services, independent of whether or not their CI actually benefits them.
    4) "The selected sample had statistically significantly younger age at implant activation (21.8 vs 37.3 months) and a higher percentage of families with white race (70% vs 55%) and with maternal education level at college graduate or higher (57% vs 42%) compared with those 91 families in the database who were not included in these analyses." - that is 91 families out of 188 children in the database (about 50%) so really, this is very likely just a study of the top 50% CI achievers. These important discrepant demographic variables between families who were selected in this study and families who were not selected and cannot be ignored without at least one study that actually includes the bottom 50% CI achievers.  Especially without case-matching, this is a clear evidence of subtle SELECTION BIAS since we all know that white people with higher education levels will have children who read better.

  3. Janet Pemberton Janet Pemberton United States says:

    Is there a study about the effects of teaching oralism without allowing lip reading or sign on the socializing skills and quality of life of moderately to profoundly deaf people?

  4. Tony Devlin Tony Devlin United States says:

    All of this research is great until your child's Cochlear shorts out from static electricity and the poor kid is left with no language. I would much rather have a speech impediment that we can work on. Learning sign also gives them a second, sometimes primary language.

  5. Alasdair Grant Alasdair Grant United Kingdom says:

    I disagree with the findings. I had found that an oralist education had deprived me of a social life and destroyed my scientific education with the result I have suffered depression and unable to pursue a scientific education. The findings are flawed because they only relate to laboratory conditions and not the real world scenario. Hearing people have always wanted the Deaf to be like then and have constantly refused to adopt the social model of Disability and to embrace a different world to their own. I used to be a strong oralist advocate and now a strong bsl user. I have become so much happier being within the Deaf Community and have ceased mental health issues as a result. BSL has given me better employment and social life prospects. The scores would be artificially higher because the children have been forced to do so and the study never looks at the long term implications of oralism and the feelings of the Deaf children. It is obsessed with speech and not the bigger picture. The situation is particularly distorted. I was oralist and gained a 2.2 at uni because I couldnt follow the lecturer despite speech to text reporting. Throw in a BSL interpreter and I nearly gained a distinction for my Masters. BSL really makes a difference. I get so fed up from hearing from Teachers of the Deaf who say I have got beautiful speech. Does that give me a better quality of life - no. It only suits the bloody hearing people around me and not myself. The only hearing people that I interact with are sign language users themselves. Oralism had damaged my employment prospects. I am now long term unemployed. I have used BSL at an early age I would probably be a Team Leader in the Civil Service now. Oralism destroys deaf people lives.

  6. Matt Dye Matt Dye United States says:

    Given the criticisms that have been levied against the Geers et al. article by a large number of academics and physicians (see Pediatrics comments section), this UT Dallas press release is highly misleading. In fact, Geers et al. have singularly failed to demonstrate that using a sign language such as ASL has any effect at all on the acquisition of a spoken language such as English. For many of us, the fear was that the findings of the Geers et al. article would be uncritically circulated in a way that would not allow correction or comment, perpetuating the myth that exposure to one language somehow magically harms the acquisition of another language. This article in News Medical has confirmed those fears.

  7. Kevin McCready Kevin McCready New Zealand says:

    Oh the irony. Ann Geers own data shows she is wrong and that 1/3 of CI kids end up with no proper language.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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