Languages and Communication Systems for Deaf and Hard of Hearing Children

A child’s family dynamics and language learning environment are key considerations in counseling families/care partners about language and communication planning and the desired outcomes for their child (Erbasi et al., 2017; Maddell, 2015; Moeller & Tomblin, 2015; Porter et al., 2018; Spencer & Marschark, 2010). Conversations with families/care partners about language and communication can be complex, particularly as they encounter information from different perspectives. Providing families with evidenced-based information to make the best informed decisions for their child and family is an ongoing process (Humphries et al., 2019; Lenihan & Gardiner-Walsh, 2020; Singer et al., 2020; Thompson Beckley, 2016). Some families/care partners initially explore a range of languages and communication systems and may change or combine approaches over time to adjust to their child’s and family’s needs and preferred outcomes (Ching, Scarinci, et al., 2018; DesGeorges, 2016; Knoors, 2016; National Center for Hearing Assessment and Management, 2021; Putz, 2012; Scarinci et al., 2018). Positive outcomes require that children have early and consistent access to a language, exposure to proficient language models, opportunities to communicate fully and effectively in their daily routines, and appropriate supports and services implemented with fidelity (American Speech-Language-Hearing Association [ASHA], 2013; Beal-Alvarez, 2014; Ching, Dillon, et al., 2018; Joint Committee on Infant Hearing, 2019; Moeller & Tomblin, 2015; National Association of State Directors of Special Education [NASDSE], 2018; Tomblin et al., 2015; White, 2018).

Communication Approaches

Children who are deaf and hard of hearing (DHH) use different languages, tools, systems, technologies, and strategies to communicate based on the child’s and the family/care partner’s needs and desired outcomes. Languages as well as communication tools and systems may include, but are not limited to, the following:

• languages
  • signed languages (e.g., American Sign Language [ASL], Mexican Sign Language)
  • spoken languages (e.g., English, Spanish)
  • a combination of signed and/or spoken languages (e.g., bilingualism/multilingualism)
• visual supports and tools
  • signing systems to support or represent spoken languages (e.g., Manually Coded English [MCE], Signing Exact English)
  • cueing systems (e.g., cued speech)
  • gestures, facial expressions, pictures, and written words
• augmentative and alternative communication (AAC)
• a combination of languages, supports and tools, and/or AAC (e.g., total communication, multimodal communication)

Language and communication plans require ongoing assessment of the child’s access to language in various contexts as they grow to determine if they are making expected progress and if the current services and supports continue to meet the child and family’s goals, priorities, and linguistic needs (NASDSE, 2018; Nussbaum, Waddy-Smith, & Doyle, 2012; Scarinci et al., 2018).

Languages

Spoken languages—such as English, Spanish, and Arabic—are rule-governed languages that have auditory and oral components to convey linguistic information. Children and families/care partners targeting spoken language may engage in listening and spoken language (LSL) interventions that emphasize the development, use, and understanding of spoken languages through listening. LSL goals emphasize early and consistent use of well-fit hearing technologies (e.g., hearing aids, cochlear implants, digital modulation systems) and engagement of families/care partners as the child’s primary language facilitators to enable spoken language development comparable to hearing peers by early childhood (AG Bell Academy for Listening and Spoken Language, 2007, 2017; Ching, Dillon, et al., 2018; Cole & Flexer, 2019; Wolfe, 2019, 2020).

LSL specialists provide guidance and coaching to families/care partners on auditory, speech, and language strategies and how to maintain devices. They also work with students and school staff to develop and execute plans that maximize receptive and expressive spoken language, literacy, functional listening, and access to academic programming for auditory learners (Estabrooks et al., 2020; Flexer, 2017; Houston & Bradham, 2011; NASDSE, 2018; Rosenzweig, 2017; Soman & Nevins, 2018).

Signed languages, such as ASL, are distinct, rule-governed visual languages that consist of handshapes, locations, movements, palm orientations, and nonmanual markers to convey linguistic information (Valli et al., 2011). ASL is independent from spoken English, other signed languages (e.g., British Sign Language), and MCE systems, such as Signing Exact English (Pittman et al., 2016; Rendel et al., 2018).

All spoken and signed languages have social, ethnic, and geographic variations and dialects and possess their own phonology, morphology, semantics, syntax, and pragmatics (ASHA, 2019). Signed languages have no standardized written form, although some written systems have been proposed (e.g., Sutton, n.d.). When developing literacy, children learn the written form of a spoken language through bilingual and second-language acquisition methods.

Individuals qualified to teach signed languages can provide intensive training when a signed language is not the family/care partner’s heritage language to promote consistent, fluent access to the language. Professionals qualified to assess signed language acquisition track language development to ensure that the child’s social, academic, and linguistic needs are being met (Cripps et al., 2016; Quinto-Pozos & Cooley, 2020; Quinto-Pozos et al., 2011; Simms et al., 2013). These assessments may include interdisciplinary efforts from teams including teachers of the DHH, ASL specialists, speech-language pathologists, Deaf mentors, and others.

Bimodal–bilingual refers to the development and use of language through two modalities (auditory and visual) and two languages (signed and spoken), such as ASL and English (Emmorey et al., 2005, 2008; Nussbaum, Scott, & Simms, 2012; Rinaldi & Caselli, 2014). The two languages are taught independently with equal value, with the goal of enhancing development in both languages (Davidson et al., 2014; Mitchiner et al., 2012; Petitto et al., 2001; Petitto & Kovelman, 2003; Yoshinaga-Itano, 2006). Bimodal–bilingual development is unique to each child depending on their backgrounds, goals, access to each language, and needs in their communication and learning environments (Hyde & Punch, 2011; Swanwick, 2016). Some DHH children may be bimodal–multilingual, having the ability to communicate in a combination of multiple signed and/or spoken languages (e.g., ASL, English, Spanish).

Communication Systems and Tools

Systems and tools are different from languages. The visual, manual, and/or augmentative systems and communication tools described below can be ways to visually represent, support, or supplement spoken and signed languages, but they are not true languages (Nussbaum & Scott, 2011; Scott & Dostal, 2019).

Sign Systems

Manually Coded English (MCE) refers to the various sign systems invented to represent the spoken English language visually on the hands. Unlike signed languages, which developed naturally in Deaf communities and have their own linguistic structure, MCE systems are linear and generally follow English language rules (Schick, 2011).

Signed English, Seeing Essential English (SEE1), and Signing Exact English (SEE2) are terms associated with forms of MCE. Each uses borrowed or modified ASL signs as a base and generally follows the grammar of English, with variations depending on each system. Many MCE systems include initialized signs and signs for grammatical markers or articles that do not exist in ASL to more clearly approximate English on the hands (Rendel et al., 2018).

Conceptually Accurate Signed English (CASE) (also called Pidgin Signed English [PSE]) or contact sign) combines features of ASL and English. It uses a wider variety of ASL concept signs than MCE in conjunction with English word order (Lenihan & Gardiner-Walsh, 2020; Stredler-Brown, 2010). Fingerspelling may be used in combination with any of these systems to spell out words that do not have a sign, introduce an unfamiliar sign, and/or add emphasis.

When the intent is to sign and speak at the same time, sign systems are often paired with spoken languages in approaches referred to as simultaneous communication (SimCom) or sign-supported speech (Lenihan & Gardiner-Walsh, 2020; Paul, 2009; Pittman et al., 2016; Schick, 2011). These systems are not recommended for infants and toddlers who have not yet developed language because they are not complete languages. They are sometimes used in educational settings once a child has developed a full language to facilitate communication access and English literacy (NASDSE, 2018).

Signed languages such as ASL cannot be used simultaneously with spoken English because ASL and English have distinct grammatical structures and some English words do not have an equivalent sign in ASL. For example, the grammar of ASL often includes the use of space and nonmanual markers that are incongruent with speaking English simultaneously.

Cued Speech

Cued Speech is a system of distinct handshapes and movements used in different locations near the mouth to visually depict the sounds and syllables of spoken language. It is not a language like ASL or other signed languages. It is generally used to support oral speech and language development, speechreading, and literacy by providing a visual representation for the phonology of a spoken language. For example, cued speech can help a child distinguish between sounds that look the same when spoken (e.g., /p/, /b/, and /m/). Cued speech can aid in auditory skill development when combined with early, consistent, and appropriate use of hearing technology. Cueing systems are available for approximately 60 languages. They can be used in conjunction with signed languages when families/care partners have a goal of bimodal bilingualism (LaSasso et al., 2010; National Cued Speech Association, 2019).

AAC

AAC tools and techniques may be beneficial for some children who are identified as DHH. AAC strategies can aid in spoken language development for those who are not yet using speech in a functional way and/or struggling with language concepts (Meinzen-Derr, 2018; Meinzen-Derr et al., 2019, 2021; Resource Materials and Technology Center for the Deaf/Hard of Hearing, 2018). DHH individuals who use sign language are entitled to an interpreter. At times, AAC may be a way to support communication for DHH children. Approximately 35%–50% of children who are identified as DHH also have additional diagnoses (e.g., autism, intellectual disability, visual impairment) and complex communication and/or motor needs that may benefit from the use of AAC as a primary expressive communication method (Mitchell & Karchmer, 2006; Singer et al., 2020). In such instances, these children still require similar considerations to other DHH children in selecting accessible languages and communication tools for their receptive communication development.

See ASHA’s Practice Portal page on Augmentative and Alternative Communication.

Total Communication

Total Communication encourages multimodal communication and includes a combined use of amplification, signed and/or spoken languages, MCE, Cued Speech, fingerspelling, gestures, body language, facial expressions, and AAC. However, it does not necessarily mean multimodal at all times.

The goal of Total Communication is to enhance language development using methods that are most effective for an individual child and family in a given context. In the classroom, different methods may be used at different times depending on the child’s needs and activities. A child who has been identified as deaf-blind might use tactile sign language, ProTactile communication, touch cues, tangible symbol systems, LSL, and/or AAC (National Center on Deaf-Blindness, 2021). The implementation of Total Communication may vary widely from child to child. Proponents of Total Communication consider multiple modalities to support one another in providing fuller access to language and learning (Gibbons & Szarkowski, 2019; Nussbaum & Scott, 2011; Thomas & Zwolan, 2019).

Total Communication is often mistaken for and implemented as SimCom, or sign-supported speech, in which talking and signing occur at the same time. SimCom may be used as part of a Total Communication philosophy, but is not considered synonymous with Total Communication, nor does it imply that SimCom is the desired outcome for DHH children who use multiple modalities (Mayer et al., 2016).

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