The Proof of the Pudding: An Early Childhood Dual Language Approach Presenters: Loralee Wolter, Parent of Jeremiah Wolter Nancy Rushmer, M.A., CED, Language Specialist Columbia Regional Program Deaf and Hard of Hearing Services (Portland,Oregon)

What is a Dual Language Approach? English and American Sign Language (ASL) Speech, sign language and sign-supported speech Prior approaches used at Columbia Regional Program (Portland) Sign language served as a “bridge” to speech for young hard-of-hearing children

Enrollment of First Young Deaf Child with a Cochlear Implant (1997) Determining and meeting her needs Dual language model evolved as result of collaboration between families and staff Staff: Infant Family Specialists, Teachers of the Deaf, Auditory-Oral Specialists, ASL Specialists, Language Consultant

What Are the Goals for the Children? Language levels commensurate with cognitive potential Age-appropriate speech and auditory skills for children with auditory potential

One Family’s Experience Loralee Wolter

Jeremiah Wolter (B.D. 9-1-99) Birth: Profound hearing loss identified 1 mo: Enrolled in early intervention (EI); hearing aids placed, worn full-time with little benefit 17 mo: Used > 100 signed words 19 mo: Received cochlear implant 20 mo: Initial activation and mapping

(Jeremiah Wolter, cont.) 26 mo: Used > 224 signed words 28 mo: Understood all language of daily routines through audition alone. Many word combinations: blue truck, moo cow, big white truck 4 yrs: Scores range from 4.3 - 6.3 yrs. on TACL (Test of Auditory Comprehension of Language)

Outcomes in Dual Language Program Which language do the children learn? Auditory learners (HOH & deaf with CI): Acquire spoken English and sign language to varying degrees Speech becomes primary communication mode, w/ eventual placement in neighborhood school program Primarily visual learners (deaf w/ & w/o CI): Tend to acquire sign language and beginning speech skills during their early childhood years

(Outcomes, cont.) Auditory learners, non-English speaking families: Learn native spoken language and sign language, which serves as bridge to spoken English in preschool Children with additional complications: May rely on sign language; can also develop speech and listening skills, sometimes at a slower rate

Why a Dual Language Approach Deserves Careful Consideration It is effective for families whose children fall roughly into two groups: Those with significant complications in addition to hearing loss; and Those who have all the critical elements for learning in place and no additional complications.

Group 1. Children with significant complications in addition to hearing loss may enter preschool at age three with delayed or minimal language. WHY? One third of deaf/HH children have disabilities in addition to hearing loss that may affect learning rate (Jones & Jones, 2003). Socio-economic and other pressures prevent some families from participating in EI services. Circumstances prevent some families from carrying out learning activities with their child, even when enrolled in appropriate early intervention.

Group 2. Children with hearing loss and all the critical elements for learning in place can enter preschool with age-appropriate language. The linguistic performance of this group can equal or surpass that of their hearing peers. Five of the six children in our study who had all the critical elements in place perform at or above the level of hearing peers linguistically. Exposure to both languages may actually provide a cognitive-linguistic boost.

How do deaf children with cochlear implants (CI) do? Auditory and speech performance vary widely in timing and rate among the 16 young children with CI followed in this program since 1997. Same-aged children with CI at similar ages display dramatically different speech and language.

Example: Two children, 3 years old, typical cognitive levels: Child A: Age-appropriate speech, comprehension of spoken English one year > hearing peers Child B: Beginning awareness of sound; babbling and language two years < age level

Factors Contributing to Learning Rate & Subsequent Speech and Language Age of onset, etiology, degree of hearing loss Age of amplification Consistency of HA use Age of enrollment in EI Auditory perception, acquisition of auditory skills with hearing aids Age at implantation (CI) Type of CI device Language levels at time of CI implantation Presence of special needs Level of family partici- pation in EI services Circumstances that allow family to focus on child’s language, listening and speech acquisition

Deaf Children with Cochlear Implants Studied by CRPDHH (N = 16, ages 1 - 9 years old) Two of the sixteen children are babies just starting out. Eight of the sixteen children, ages three to nine years, have significant complications in addition to hearing loss.

(Deaf Children with Cochlear Implants Studied by CRPDHH, continued) Six of the sixteen children have all the critical elements in place and no complicating factors (with the exception of one child who deals with four languages and is doing well). All six have transitioned from sign language to speech, and five perform linguistically at or above the level of their hearing peers.

Retrospective Examination of Six Deaf Children (Oregon Study) S: Profound hearing loss identified at birth 3 mo: Hearing aid placement and full time use 12 mo: Cochlear implant, initial mapping at 13 mo. 23 mo: 180 spoken and signed words 26 mo: Almost all communication through speech. Understood all language of daily routines & activities through audition alone. 36 mo: Age-appropriate speech and language

H: Profound congenital hearing loss ID at 12 mo. Vibro-tactile responses only 13 mo: H.A.s placed; full-time use, little benefit 28 mo: Cochlear implant followed by illness 30 mo: Initial mapping 5.10 yr: TACL scores ranged from 5.8 - 6.2 yrs. M: Profound congenital hearing loss ID at 13 mo. Full-time hearing aid use 20 mo: CI; initial mapping 21 months 28 mo: 409 signed words 3.6 yrs: TACL scores ranged from 4 - 4.6 yrs. Speech intelligibility 100 %

JW: See slides #6 & 7 S: Profound congenital hearing loss ID at 19 mo. 19 mo: H.A.s fitted, vibro-tactile responses only 32 mo: Cochlear implant w/initial mapping 34 mo. “Globe Trotter” child living alternately in Japan and U.S. and exposed to spoken Japanese and English, as well as Japanese and American Sign Language. S: Profound congenital hearing loss ID at 18 mo. 19 mo: Hearing aids with full-time use 33 mo: Cochlear implant 9 yrs: Enrolled in 3rd grade, age-level school work

Young Deaf Children Colorado Study “Their productive communication was exclusively through sign language and when they received a cochlear implant they transitioned to intelligible speech that is comparable to the speech of children with normal hearing—their vocabulary development in sign language served as a ‘piggyback’ to spoken English.” ~Christine Yoshinaga-Itano (2003)

One Size Fits All? (No…) Because of the dramatic range in ability to learn with a cochlear implant, it is critical that communities not adopt a One Size Fits All approach to the selection of services for children. This has happened in some communities in which children move to an “oral only” educational setting as soon as they are implanted, regardless of age and language base. Those children who do not make auditory and speech progress are at risk for falling further and further behind.

What Families and Their Children Have Taught Us. . .

1. Individualized programming with individualized language modeling and stimulation are essential. 2. Deaf children without cochlear implants and/or whose primary language is American Sign Language must be ensured access to a complete ASL model and sufficient communication partners to acquire the language.

3. There must be a focus on listening and a sufficient amount of developmentally appropriate listening challenges for deaf children with cochlear implants. 4. Hard of hearing children in the dual language model seem to acquire speech with less focused, individualized auditory programming than deaf children with cochlear implants.

Families and Children Have Taught Us. . . We have said about hard of hearing children in this model: “One could not suppress their developing speech. It happened so naturally.” This does not seem to be the case with the deaf children with cochlear implants. They need to be alerted to attend to sound and to figure out its meaning through an individualized focused sequential auditory learning program, at least in the beginning.

5. Children with significant cognitive, sensory, behavioral, and/or relationship issues may progress at a slower rate in listening and speech (as well as language) development than do children without these additional concerns. 6. Families of high (sign) language deaf children with CIs know when and how to pace their child’s transition from signs to speech, e.g, when to provide increasingly challenging listening tasks for their child without putting the child at a linguistic disadvantage.

Concluding Comments

With the advent of newborn hearing screening, constantly improving hearing aids and cochlear implants, the education of children who are deaf/ hard of hearing will never be the same!

Our evidence shows that visual language can be helpful to the speech development of children who are deaf and hard of hearing. The position that visual language may be harmful to the speech development of deaf/hh children results in political conflict and programs that are divided and in opposition to one another. Access to visual language will remain necessary for a portion of the population and at the same time, can enhance learning for others—like Hope.

Our special thanks to all the children and families of Columbia Regional Program in Portland, Oregon. . . `

. . .especially to Jeremiah and his mom & dad, Loralee and Bill Wolter.

Columbia Regional Program Deaf and Hard of Hearing Services 833 N.E. 74th, Portland, OR 97213 Tel: (503) 916-5570 TTY: (503) 916-5577 Nancy Rushmer Kramisrn@aol.com Loralee Wolter Lwolter@compassvision.com