You may not feel language deprived, but many deaf children are.
First, I want to congratulate everyone who wrote and signed this letter. You are all clearly successful people who have worked so hard to overcome the societal barriers attached to hearing loss – essentially "oral successes." I know a little bit about being an oral success, I am a deaf person with a doctoral degree who is often described by the hearing people around me as having good speaking and writing skills. I think I was born deaf (my parents did not know until I was 2), I was not exposed to American Sign Language during my childhood, and I grew up in the mainstreamed school system – just like you.
Open dialogue is important while we are seeking a path forward that best supports all deaf children and their healthy development. To that aim, I am responding because I found several claims in your letter that concerned me on a personal level as a deaf person, and on a professional level as a researcher focusing on language deprivation. Below, I will quote specific claims from your letter and explain the issues I see with them.
"We do not use sign language, instead choosing to communicate via hearing and spoken language."
You did not choose to communicate solely via hearing and spoken language. Your parents made that choice for you, and it is very possible that they did not make a fully informed choice.
A new book came out recently titled "Made to Hear: Cochlear Implants and Raising Deaf Children" by Laura Mauldin. This book is a description of one researcher's experience following professionals, parents, and children in a NYC cochlear implant center. In it, she highlights that parents are funneled towards making specific choices according to a "medicalization script" (e.g., implantation and spoken language only), "groomed" to accept the cochlear implant as their only option, and that "parental compliance" is very important. Visual languages like American Sign Language are considered "unscientific," "unhealthy," and "compensatory" within this context. This all occurs during a period of extreme grief for parents where these same medical professionals have framed yours and my deafness as a very negative occurrence that dramatically lowers any possibility of a successful, happy life.
"Because we use spoken language, we consider ourselves to be participating members of not only the deaf community but of the entire world."
I am a full ASL user now, I am just as much a participating member of the entire world as you are. The perception of ASL somehow removing deaf people from general society is flawed – this is "misleading and divisive rhetoric" as you claimed Nyle DiMarco was spreading in your first paragraph. Having a language foundation allows you to be a full participant in the world – whether it is spoken or signed.
"The ability of children born deaf to learn to hear and speak will only continue to improve as technology continues to advance, and the ages of diagnosis and implantation continue to drop... We are not exceptional... There are also many recent scientific, peer -reviewed research studies whose findings support what we have experienced with regards to language acquisition and use."
This part is a little long, but please read through it carefully as this responds to the most flawed claim I saw in your letter.
It is true that earlier ages of diagnosis and implantation tend to have better outcomes. It is also true that you all are exceptional. You are a minority of success in a larger group of implanted children; children who do not succeed as well as you and have no safety net when that happens. Let's look at the "recent scientific, peer-reviewed research studies" to see what their findings suggest.
Generally, cochlear implant researchers describe research findings having "enormous variability reported in auditory, speech, and language functioning after implantation" (Kral, Kroenenberger, Pisoni, & O'Donoghue, 2016, p. 614) and "it is well known that patients with cochlear implants have a large inter-individual variability in linguistic and auditory performances" (Ghiselli, et al., 2016). Essentially, "parents must make decisions without any guarantees about the level of benefit their children will receive from having cochlear implants" (Hyde, Punch, & Komesaroff, 2010, p. 162).
What they are saying above is that some kids do really well, some kids do very poorly, and everything in between. On an individual basis, no one really knows and can predict which child will or will not develop a full language foundation through just the cochlear implant and spoken language only.
Two recent large-scale longitudinal studies demonstrate this extreme variability. The Childhood Development after Cochlear Implantation study measured spoken language outcomes and found even the earliest implanted children were still worse than their hearing peers; they concluded "although early implantation, on average, appears to provide an advantage for spoken language development, it did not assure the development of spoken language... for all children by school age" (Tobey et al., 2013, p. 10). Similarly, the Dallas Cochlear Implant Group measured speech perception and production in ~110 implanted high school children (Davidson et al., 2011; Tobey, Geers, Sundarraja, & Lane, 2011). The range of scores for speech perception and production were essentially from 0% to 100% accuracy, with only a few achieving full scores.
Now it is important to remember the above conclusions largely apply to people such as yourself – those who do not use any sign language growing up. Also remember that sign languages are generally considered unscientific, unhealthy, and compensatory by the medical system who advised your parents on their options when they were deciding to go ahead with implantation.
A study comparing 14 implanted children (7 who had sign language from birth and 7 who did not) found the native signing implanted children outperforming the non-signing implanted children on three measures of spoken language (Hassanzadeh, 2012). A second study comparing five implanted native signers to their hearing bilingual siblings saw no differences between them and test norms on any measurement of language, spoken or otherwise (Davidson, Lillo-Martin, & Pichler, 2013); a comparison of the scores from the Davidson study and a previous one looking at non-signing implanted children (Nicholas & Geers, 2008) also saw the signing implanted children outperforming the non-signing children on all language measures.
These studies are small. A lot more research is needed to conclusively point us in one direction or the other. What we are seeing, though, is a lot of failures in a spoken language-only approach, and none in a sign language-inclusive approach. From a big picture angle, what we can take away from current research right now is that the cochlear implant is unreliable and at minimum, sign language does not harm anyone.
In actuality, sign language likely has benefits for everyone – including hearing children. But for children who are at risk of not developing a full language foundation through the cochlear implant only (which is currently every child based on scientific, peer-reviewed research), sign language is necessary as a safety net to help them avoid potential consequences of language deprivation. When Nyle DiMarco claims millions of deaf kids suffer from language deprivation by not being provided sign language, these are the children he is referring to. He is not referring to the minority of oral successes, we the privileged few.
Respectfully,
Wyatte C. Hall, Ph.D.
References
Davidson, L. S., Geers, A. E., Blamey, P. J., Tobey, E., & Brenner, C. (2011). Factors contributing to speech perception scores in long-term pediatric CI users. Ear and Hearing, 32(1 Suppl), 19S.
Davidson, K., Lillo-Martin, D., & Pichler, D. C. (2013). Spoken English language development in native signing children with cochlear implants.Journal of deaf studies and deaf education, ent045.
Ghiselli, S., Gheller, F., Trevisi, P., Rampazzo, P., Ermani, M., & Martini, A. (2016). The Impact of Age and Duration of Cochlear Implant in a Congenital Deaf Population: An ERP Study. Journal of Biomedical Science and Engineering, 9(08), 384.
Hassanzadeh, S. (2012). Outcomes of cochlear implantation in deaf children of deaf parents: comparative study. Journal of Laryngology and Otology,126(10), 989.
Hyde, M., Punch, R., & Komesaroff, L. (2010). Coming to a decision about cochlear implantation: Parents making choices for their deaf children. Journal of Deaf Studies and Deaf Education, 15(2), 162-178.
Kral, A., Kronenberger, W. G., Pisoni, D. B., & O'Donoghue, G. M. (2016). Neurocognitive factors in sensory restoration of early deafness: a connectome model. The Lancet Neurology, 15(6), 610-621.
Nicholas, J. G., & Geers, A. E. (2008). Expected test scores for preschoolers with a cochlear implant who use spoken language. American Journal of Speech-Language Pathology, 17(2), 121-138.
Tobey, E. A., Geers, A. E., Sundarrajan, M., & Lane, J. (2011). Factors influencing elementary and high-school aged cochlear implant users. Ear and hearing, 32(1), 27S.
Tobey, E. A., Thal, D., Niparko, J. K., Eisenberg, L. S., Quittner, A. L., & Wang, N. Y. (2013). Influence of implantation age on school-age language performance in pediatric cochlear implant users. International journal of audiology, 52(4), 219-229.
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