Language exposure for children is the act of making language readily available and accessible during the critical period for language acquisition. Early exposure to language enables the brain to develop cognitive function more fully and facilitates the development of language skills that support language fluency and comprehension later in life. Children who are d/Deaf and hard of hearing, compared to their hearing peers, tend to face barriers in developing language. Consequently, deaf and hard of hearing children are more likely to experience language deprivation, which may lead to cognitive delays and additional negative impacts on their health. However, research has guided the development of strategies to enhance language development and reduce deprivation. Examining language acquisition in deaf and hard of hearing children has resulted in more substantial evidence regarding the risks and benefits of early language exposure. Much of this research focuses on children in the United States, which limits its generalizability.
Critical period The critical period for first language acquisition is a linguistic theory that suggests there is a specific window of time when a language can be acquired. After this period, it becomes significantly more challenging to develop a first or second language. Many theories exist regarding the exact timing of the critical period for language acquisition; however, research indicates that when a child does not receive language exposure during their first few years of life, they may experience long-term language development deficits. Much of the research on language exposure, the critical period, and language acquisition is based on spoken languages and hearing children. In reality, these same ideas also apply to deaf and hard of hearing children. For hearing children, first language exposure often begins with their parents' native language. The same is true for deaf and hard of hearing children with Deaf parents; they are exposed to sign language at birth. However, language exposure for deaf and hard of hearing children born to hearing parents is often delayed. Early in life, deaf and hard of hearing children are typically primarily exposed to spoken language, as their parents may not have learned sign language. Consequently, deaf individuals often do not encounter sign language until later in childhood or even adulthood, regardless of their success in spoken languages. Research concludes that it is not hearing loss itself that affects language impairment, but rather a lack of sufficient language input during the first year of life. Children who are exposed to language during their first year of life typically exhibit normal language development, even if they later develop hearing loss.
Early hearing detection and intervention (EHDI) Currently, within the United States, newborn hearing screening practices are in place that inform parents of their newborn's hearing status within the first few weeks of the child's life. The HRSA-funded Early Hearing Detection and Intervention (EHDI) protocol adheres to a 1-3-6 rule: an infant should have their hearing screened by one month of age, diagnosed by three months, and enrolled in early intervention services by six months. Programs in the United States are divided into states and territories, and aim to screen, provide diagnoses, develop family support systems, and coordinate services for deaf and hard of hearing children to achieve language milestones. Data is collected from these programs to assess the success of screening and intervention programs in the hopes of optimizing care for deaf and hard of hearing children.
Diagnosis Approximately 90–95% of deaf and hard of hearing children are born to hearing parents, while 5–10% are born to Deaf parents. After an infant is born, they undergo a hearing screening using an auditory brainstem response (ABR). This test involves placing electrodes on the infant’s head to present pure tones and observe the resulting electrical activity in the brain. In the event that the infant fails the newborn hearing screening, a follow-up screening appointment will be scheduled. Should the infant also fail the second screening, it is essential to schedule a consultation with an audiologist to determine the next steps. If the audiologist diagnoses the infant with hearing loss, they will typically refer the child to an Ear, Nose, and Throat (ENT) specialist, specifically a pediatric otologist. This specialist focuses on ear conditions to help ensure that the baby develops language skills effectively. However, some physicians report that they are not confident in informing parents of deaf and hard of hearing children about additional steps to take beyond visiting an audiologist.
Later language ability There has been additional research on fluent sign language users and their ability to acquire spoken language later in life. Both signed and spoken language establish a strong foundation in the general language abilities, needed for reading, learning and basic expressive and receptive language skills. If language is acquired after the critical period for language acquisition, this foundation is not established. Additionally, research indicates that children who learn sign and spoken language during the critical period of language acquisition develop comparably to bilingual children.
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