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The Impact of Language Deprivation on the Overall Development of Deaf and Hard of Hearing Children

M. Natasha Kordus, Ph.D.

“Communication Access” Lauralee, age 6
“Communication Access” Lauralee, age 6


For decades psychologists, medical professionals, and researchers have known that there is a critical period for language acquisition in humans. That critical period is approximately the first 5 years of a child’s life when there is an elevated neurological sensitivity for language development (Hall et al, 2017; Gulati, S. 2014).  Language deprivation occurs due to a chronic lack of full access to a natural language during that critical period. For Deaf and Hard of Hearing students, parents and professionals must understand that access to language and language development is a crucial part of the of the overall functioning of children and adolescents. In fact, I might argue, that understanding its impact is the central issue that school and clinical psychologists must understand in order to conduct ethical and effective evaluations of cognitive, academic and social-emotional functioning. But instead of “nerding” out about the diagnostic process, let me instead explain language deprivation and what it looks like in the growing Deaf or Hard of Hearing child, talk about the ways in which language deprivation can impact the growing child, the grown adult, and whether or not hearing levels dictate the significance of language deprivation impact. This article will be heavily ladened with research references for a few reasons: 1) I hope you can use this for your own resource when you are discussing this issue with others. 2) I want you, the reader, to understand that my position is based not only on my 20+ years of experience assessing Deaf and Hard of Hearing children, but also on years of research in this field. My colleagues in this field have conducted many rich, valid studies that have helped to elucidate the field and provide the foundation for my work. Oh and 3) I’m a nerd. I mentioned that, right? I love research and numbers.

What is language deprivation?

As I mentioned above, language deprivation occurs due to a chronic lack of full access to a natural language during the critical period of a child’s life, the first five years where neuroplasticity is at its peak. First, let’s define “natural language.” By this I am referring to any spoken or signed language such as that accepted and generally used by the community / country within which the child lives. For the purposes of this article, this will mean spoken English (even when the home language may be Spanish*) and American Sign Language (ASL). ASL is distinguished from artificial, though helpful, communication systems such as Cued Speech, which can be used as a tool to help develop English skills. Natural language is also distinguished from the Listening and Spoken Language approach (LSL), which is historically known as oralism. LSL is, itself, not a language. It is a systematic approach to teaching English to Deaf children in the US (or other spoken languages in their country of origin).

Despite ample research to show that ASL is a formal language with its own grammar and linguistic rules, less than 8% of Deaf children receive regular access to sign language in the home (Liddel, SK, 2003; Institute, G.R., 2011). Although using ASL is encouraged for hearing babies to develop language skills before they can begin to speak, ASL is not routinely offered as a primary or complementary intervention for Deaf children; rather, if offered at all, it is often proposed as a last-resort option to Deaf children who have not developed speech abilities as expected (Humphries, T. et al 2012). This pattern occurs because many advocates, professionals, and educators believe that ASL acquisition will interfere with a Deaf child’s development of speech skills (Lyness, C. et al 2013; Sugar, M. 2016; Davidson, et al 2011; Duchesne et al. 2009; Lund 2015; Tobey at al, 2011) despite research showing that children with cochlear implants who use ASL actually demonstrate better speech skills, language development and intelligence scores than non-signing children (Davidson, et all 2011; Hassanzadeh, S. 2012; Amraeri, K. 2016). Based on current research, technological intervention alone (i.e., hearing aids, cochlear implants) are insufficient as a stand-alone approach for language acquisition in Deaf children (Humphries et al 2012b; Kral et al 2016). The research is showing us that hearing aids and cochlear implants, when used alone (i.e., without the support of ASL) do not give sufficient access to language to prevent language deprivation in Deaf and Hard of Hearing children.

What does this mean? The truth is, if a Deaf child or Hard of Hearing child does not have access to ASL they are likely experiencing some level of language deprivation. Yup, I said it. I am not saying ASL only, ASL instead of, ASL at the exclusion of speech. I actually believe that children should have options and parents should take advantage of the tools that the medical field offers them. But the research has spoken and it is strong: Hearing aids or cochlear implants alone do not provide adequate access to language and should be used in conjunction with ASL.

How significant is the impact?

For decades clinicians have observed that children who suffered from language deprivation during the critical period have a unique presentation. We noted that the language of many Deaf and Hard of Hearing children seemed delayed, more concrete, and lacking in fundamental components despite attempts to intervene. More recent neuroimaging studies have finally clarified the reason. Language deprivation during the critical period appears to have permanent consequences for long-term neurological development (Leybert, J. & D’Hondt, M., 2003). So much so, that specific timing and quality of language access during early childhood can cause neurostructural differences (Mayberry et al, 2011; Penicaud, et al 2013; Skotara, et al, 2012).

Language dysfluency and child presentation

Languages (auditory or visual) have rules and structures that make them languages; language dysfluency is a disruption of these rules and structures. In Deaf children with dysfluency this may look like limited vocabulary, lack of time markers (i.e., days, weeks, month, year), inaccurate spatial organization (a grammatical construct), and a lack of syntax; vocabulary may be more “concrete” and limited to actions and descriptions the child / adolescent has experienced directly (Glickman, N.S. 2007).

These children, and later adults, also demonstrate comprehensive knowledge deficits which are best described as gaps in knowledge due to an accumulate lack of environmental information or incidental learning (Schenkel, L.S. et al 2014). Understand that normal acquisition of passive information is made through media, radio, newspapers, TV, and word of mouth – avenues typically not easily accessible to Deaf and Hard of Hearing individuals. However, current social media, the internet and captioned TV makes it easier if Deaf and Hard of Hearing individuals have the vocabulary to access these resources and the communication accessibility at home to discuss these resources with their family members. When family members do not know ASL, the captioning is not turned on on TVs around the house, the internet is not captioned, newspapers or magazines are not available (and age appropriate), Deaf and Hard of Hearing children only have access to incidental learning during the 4 to 8 hours they are in a signing environment within the classroom (assuming they are placed with signing peers). The consistent lack of exposure to everyday opportunities results in an overall loss of understanding of many aspects of societal functioning, such as school interactions (when they are not in a larger program with Deaf peers), government functions, personal behaviors, etc. This can have a long term impact on a Deaf child’s physical, mental and social health.

What areas of functioning are impacted?

There does not appear to be any evidence that language cannot be learned through multiple modalities (i.e. through a combination of ASL and the use of hearing aids or cochlear implants). Nor does there appear to be any evidence that using ASL impairs spoken language development, but there is strong evidence that a lack of language access will cause long term negative consequences (Lederberg et al 2013). The risk for secondary or tertiary diagnoses in Deaf or Hard of Hearing individuals seems more magnified due to language deprivation. There is evidence that language deprivation can cause cognitive delays (Niparko, J.K. et al 2010; Davidson, L.S., 2011; Tobey, E.A., et al 2011; Lund, E. 2015). Deaf and Hard of Hearing children who have a history of language deprivation are also more likely to experience abuse, trauma or exploitation (Pollard 2014; Schenkel et al, 2014). In addition, there are also studies that demonstration that Deaf and Hard of Hearing children who have suffered language deprivation also have much higher incidences of behavioral disorders (Stevenson, J. et al 2010; Barker, D.H., et al 2009). Furthermore, language deprivation leads to the inability to develop “theory of mind” (the idea that other people think differently than you do) (Ketelaar, Rieffe, Wiefferink, & Frijns, 2012). Finally, the failure to develop adequate language skills may be associated with failures to develop empathic attunement (empathy) with other people (Gulati, 2019).

Dr. Neil Glickman described the impact of language deprivation quite well in his introduction for a Webinar (2018): “The mental health skills we refer to as emotional self-regulation, or coping, which is the focus of so much contemporary cognitive behavioral therapy, can be done without language (think of sensory strategies like rocking or jumping for self-regulation). However, understanding the concept of self-regulation and advancing beyond sensory movement interventions, requires formal language. Certainly, language deprivation can dramatically limit one’s set of strategies for self-regulation.” Glickman goes on to note that interpersonal skills such as communication, problem-solving, and conflict resolution, which are also common foci of evidenced-based Cognitive Behavioral Therapy (CBT), require formal language (Glickman, 2009, 2017).

As mentioned above, language deprivation can have long term consequences on cognitive skills. I can share from my professional experience that I see a consistent impact on Verbal IQ as measured by the Wechsler Intelligence Tests. These happen to be my favorite intelligence tests because they have adapted well over the years, they give directions for use with Deaf and Hard of Hearing students and they include a small number of Deaf kids in their norming samples now. Of course there are other very good tests but I won’t go off on that tangent. Back to Verbal IQ. Intelligence, generally speaking, is the ability to problem solve and come up with new solutions given a new problem. Easy, right? Not so much. Problem solving, really good problem solving, requires language, organization skills, high level thinking skills, the incorporation of past knowledge and experiences, and the ability to develop and test hypotheses in one’s mind before they come to fruition. I could go on. Intelligence is not just one construct – language or spatial skills, but many different constructs.

Why am I explaining all this? First, because too often I see other psychologists (that do not frequently work with Deaf or Hard of Hearing students) ignore Verbal skills in Deaf children or, even worse, assume they are “nonverbal” if they do not speak (verbal means language not just spoken language). Second, because verbal skills are most closely linked to academic success. It is important to assess verbal skills of Deaf and Hard of Hearing children if we are to get an idea of what is impacting their academic progress. What I have seen time and again is that Deaf and Hard of Hearing children who have suffered from language deprivation during the critical early years often have lower Verbal IQ scores later. Frequently, I will see Deaf and Hard of Hearing children with Average Nonverbal IQ scores but Extremely Low Verbal IQ scores. I have noticed that when sign language intervention is provided later (after age 5), Verbal IQ scores do improve but never up to the same level as the Nonverbal IQ. As such, in my experience, the effect of early language deprivation is permanent. Unfortunately, the most negative impact is on Verbal IQ which is most highly correlated with academic functioning.

Over the course of my career I have had the honor of assessing or supervised the assessment of thousands of Deaf and Hard of Hearing children. I have observed that speech skills are not the same as having good language skills. What does this mean? I have seen many Deaf and Hard of Hearing children, raised without ASL during the first 5 years, who have intelligible speech and can carry on a conversation with a hearing person without the use of ASL. However, when I actually test their Verbal IQ, I find the same profile that I do of any child with a history of language deprivation. Many of these children can talk but speech is not language. This is an important concept to understand. Speech is not language. Speech is important but it is one component of language. Language skills are so much more complex. The most important single feature characterizing human language is its infinite productivity and creativity (i.e. ability to problem solve new problems). Human beings are unrestricted in what they can communicate; no area of experience is accepted as necessarily incommunicable, even when we discover new things or new modes of thought. Having intelligible speaking skills does not, however, mean having adequate language skills.

Is there a difference in impact based on hearing levels?

All too often I hear from parents whose children are not getting support from their school districts because the staff psychologist or audiologist or speech teacher has reported that the hearing loss is not “significant enough” to require intervention (i.e. a 504 plan or an IEP delineating special services such as a FM system, speech services, Resource Specialist Program (RSP), services by a Deaf and Hard of Hearing (DHH) itinerant teacher, placement in a Deaf program, etc.). It is my opinion, that most hearing loss warrants intervention and support. Research shows that even “minimal” hearing loss can have an impact on the educational access of a child.

This degree of hearing loss has also been described as “subtle,” “slight,” and “mild.” However, the use of these terms belies the fact that many individuals with these degrees of hearing loss exhibit more than minimal difficulties as a result. On this issue I can speak from experience. Over the last 10-15 years I have slowly lost my mid-range hearing (of those consonants in the speech banana). I still have a “mild” hearing loss, but some days it does not feel mild. In a one-to-one setting, I do just fine. But put me in a crowd or in a large space (like a classroom or gym or restaurant) and I get lost quickly. I experience ringing in my ears or I am tired or I don’t feel like putting in the extra effort to discriminate the words of the people talking around me. It is a day to day adventure because sometimes I am fine and other days I would rather not bother.

As early as 1980, research started to emerge that indicated that as many as a third of children with unilateral hearing loss (UHL) failed at least one grade in school and 50% either failed a grade or required additional resources (Humes, L.E. et al 1980; Bess, F.H. & Tharpe, A.M., 1986; Bess, F.H. et al 1986; Culbertson, J.L. & Gilbert, L.E., 1986; Klee T.M. & Davis-Dansky, E.A., 1986; Bess, F.H. & Tharpe, A.M., 1984; Oyler, R.F. et a; 1988; Bovo, R. et al 1988; Hartvig Jensen J, et al 1989; Watier-Launey C. et al 1998). Another important research finding was discovered by Bess and her colleagues. They found that despite the long-held belief that children with UHL would have little difficulty listening as long as speech was directed toward their hearing ear (monaural direct with speech directed toward the normal-hearing ear and noise directed to the poor ear), Bess et al demonstrated that in quiet or with background noise, children with UHL had poorer speech perception scores than their normal hearing peers regardless of the location of the speech signal source (Bess, F.H. & Tharpe, A.M., 1986). Interestingly, research has not shown specific deficits with speech and language abilities of children with UHL versus hearing peers. However, research has shown lower verbal IQ scores in children with UHL (Klee T.M. & Davis-Dansky, E.A., 1986).

Environmental factors also impact the Hard of Hearing child in the classroom. The acoustic set up in the classroom has a significant impact on speech perception and learning in children and ultimately can have a negative impact on academic progress. Multiple studies have assessed the poor acoustics in the typical classroom (Bess, F.H. et al 1984; Knecht H.A, et al 2002; McCroskey, &F., Devens, J. 1975; Picard, M. & Bradley, J. 2001) as well as the adverse effects noise can have on the learning of children with hearing loss (Boney S. & Bess, F. 1984; Crandell, C.C. 1993; Finitzo-Hieber, T. & Tillman T. 1978; Hawkins D.B. & Yacullo, W. 1984). Typical accommodations in the classroom are seating in the front of the classroom, but does the teacher (and student) also remember to look for noise making items like the air conditioning unit, the door to the classroom, the tapping from a student’s pencil or kids talking, the cabinets or desk tops that open and close? Even when the teacher is using a FM system (assuming the teacher and student are compliant with its use), these noise makers can negatively impact the effectiveness of amplification. For the Hard of Hearing child, working all day to filter out these sounds can result in cognitive fatigue. Cognitive fatigue is simply that tiredness or fatigue that sets in after working on mentally tasking activities for long periods of time. Hard of Hearing and Deaf children using hearing aids (HAs) or cochlear implants (CIs) do not have predictable access to sound so the brain can not really habituate to noise. This means the brain is working harder all day to filter out noise and understand what is being said. This does not even take into consideration the noise variations that occur over the course of the day – from the classroom, the playground, the gymnasium, the cafeteria. All of these areas have different acoustic characteristics and staff members may not all have experience successfully using the FM system. If a child is coming home exhausted after school or is complaining about feeling too tired or is having difficulty focusing on lessons in the afternoon, it could just be from the effort involved in trying to attend to the teacher’s lecture all day, while filtering out noise.

No matter the hearing loss, the impact is experienced by the person with the hearing loss. They are the narrators of their own story and their experience needs to be understood in its entirety. As professionals and parents, we have an obligation to provide for our children all of the options needed to access their education. Deaf education has historically been tarnished by the arguments between the “oralists” and the “manualists”. The fact is, Deaf and Hard of Hearing children need access to their natural language of ASL and their parents have the right to utilize whatever medical tools are at their disposal to give their child more opportunities. Deaf children have the right to grow up bilingual – in ASL and English (spoken and / or written). Hearing aids and cochlear implants (and whatever new medical technology that comes along) need to be recognized for what they are – tools.


Is language deprivation real? Yes. Does it impact the majority of Deaf and Hard of Hearing children? I would venture to say yes, if they have not had access to ASL at school and home from birth. Do hearing aids and cochlear implants prevent language deprivation? When used alone, no. Access to ASL is needed. Access to visual information is needed. The child’s need for ASL instruction should be assessed by a qualified team of professionals. Special attention needs to be given to making sure the classroom is also acoustically accessible if the child is using HAs or CIs.

Language deprivation is preventable. We adults need to prevent it. We can do better by Deaf and Hard of Hearing children and we should (Hall, 2017).


M. Natasha Kordus, Ph.D.  Dr. Kordus received her Ph.D. from Gallaudet University in Washington DC in 1998. She has since worked at the California School for the Deaf in Fremont, St. John’s Mental Health Center in Santa Monica and the California School for the Deaf in Riverside. Dr. Kordus is a licensed Clinical Psychologist, credentialed School Psychologist and Behavior Specialist. She has her Pupil Personnel Credential in School Psychology and a Clear Credential in Administration. For the past 9 years she has supervised the Assessment Services and the California Deaf Education Resource Center at the California School for the Deaf in Riverside. She is fluent in ASL.

*Note from the author:  I am a firm believer that children with true access to multiple languages can learn them all. For Deaf and Hard of Hearing children in the United States, their access to Spanish at home varies significantly. For many of the same reasons that hearing aids (HAs) alone cannot give full access to spoken English, they cannot give access to spoken Spanish without direct instruction / intervention. Direct Spanish instruction is not provided in most American schools therefore, the primary challenge is to get our kids first fluent in, ideally, ASL and English.



Humes, L.E., Allen, S.K. & Bess, F.H. (1980) Horizontal sound localization skills of unilaterally hearing-impaired children. Audiology; 19: 508-518.

Bess, F.H. & Tharpe, A.M. (1986). Case history data on unilaterally hearing-impaired children. Ear Hear; 7:14-19.

Bess, F.H., Tharpe, A.M., & Gibler, A.M. (1986). Auditory performance of children with unilateral hearing loss. Ear Hear; 7:20-26.

Culbertson, J.L. & Gilbert, L.E. (1986). Children with unilateral sensorineural hearing loss. Ear Hear; 7(1): 38-42.

Klee T.M. & Davis-Dansky, E.A. (1986). A comparison of unilaterally hearing-impaired children and normal-hearing children on a battery of standardized language tests. Ear Hear; 7(1):27-37.

Bess, F.H. & Tharpe, A.M. (1984). Unilateral hearing-impairment in children. Pediatrics; 74(2):206-216.

Oyler, R.F., Oyler, A.L., & Matkin, N.D. (1988). Unilateral hearing loss: demographics and educational impact. Language Speech Hearing Services in Schools; 19:201-210.

Bovo, R., Martini, A., Agnoletto, M, et al (1988). Auditory and academic performance of children with unilateral hearing loss. Scandinavian Auditory Supplementum: 30:71-74

Hartvig Jensen J, Borre S., & Johansen, P.A. (1989). Unilateral sensorineural hearing loss in children: cognitive abilities with respect to right / left differences. British Journal of Audiology; 23:215-220.

Watier-Launey C., Soin, C., Manceau, A., & Ployet, M.J. (1998). Necessity of auditory and academic supervision in patients with unilateral hearing disorder: retrospective study of 175 children. Ann Otolaryngol Chir Cervicofac; 115:149-155.

Hall, W., Levin, L.L. & Anderson, M.L. (Febuary, 2017). Language deprivation syndrome: a possible neurodevelopmental disorder with sociocultural origins. Social Psychiatry and Psychiatric Epidemiology.

Liddel SK (2003) Grammar, gesture, and meaning in American Sign Language. Cambridge University Press, New York, NY

Institute GR (2011) Regional and national summary report of data from the 2009-10 annual survey of deaf and hard of hearing children and youth. pp 1-12

Humphries T, Kushalnager P, Mathur G, Napoli DJ, Padden C, Rathmann C, Smith SR (2012) Language acquisition for deaf children: reducing the harms of zero tolerance to the use of alternative approaches. Harm Reduct J 9:16. doi:10.1186/1477-7517-9-16.

Lyness C, Woll B, Campbell R, Cardin V (2013) How does visual language affect crossmodal plasticity and cochlear implant success? Neurosci Biobehav Rev 37:2621-2630.

Sugar M (2016) Dispelling myths about deafness. Accessed 4 Apr 2016

Hassanzadeh S (2012) Outcomes of cochlear implantation in deaf children of deaf parents: comparative study. Journal of Laryngology and Otology 126(10):989-994. doi:10.1017/S0022215112001909

Amraei K, Amirsalari S, Ajallouiyan M (2016) Comparison of intelligence quotients of first- and second-generation deaf children with cochlear implants. International Journal of Pediatric Otorhinolaryngol 92:167-170. doi:10.1016/j.ijporl.2016.10.005

Humphries T, Kushalnagar P, Mathur G, Napoli DJ, Padden C, Rathmann C, Smith SR (2016) Avoiding linguistic neglect of deaf children. Social Services Review 90(4):589-619. doi:10.1086/689543

Kral A, Kronenberger WG, Pisoni DB, O’Donoghue GM (2016) Neurocognitive factors in sensory restoration of early deafness: a connectome model. Lancet Neurology 15(6):610-621.doi:10.1016/S1474-4422(16)00034-X

Leybaert J, D’Hondt M (2003) Neurolinguistic development in deaf children: the effect of early language experience. International Journal of Audiology 42(Suppl 1):S34-S40

Mayberry RI, Chen JK, Witcher P. Klein D (2011) Age of acquisition effects on the functional organization of language in the adult brain. Brain and Language 119(1):16-29. Doi:10.1016/j.bandl.2011.05.007

Penicaud S. Klein D, Zatorre RJ, Chen JK, Witcher P, Hyde K. Mayberry RI (2013) Structural brain changes linked to delayed first language acquisition in congenitally deaf individuals. Neuroimage 66:42-49. Doi:10.1016j.neuroimage.2012.09.076

Skotara N, Salden U, Kugow M, Hanel-Faulhaber B, Roder B (2012) The influence of language deprivation in early childhood on L2 processing: an ERP comparison of deaf native signers and deaf signers with a delayed language acquisition. BMC Neuroscience 13:44, doi:10.1186/1471-2202-13-44

Glickman NS (2007) Do you hear voices? Problems in assessment of mental status in deaf persons with severe language deprivation. Journal of Deaf Studies and Deaf Education 12(2):127-147. doi:10.1093/deafed/enm001

Schenkel LS, Rothman-Marshall G, Schlehofer DA, Towne TL, Burnash DL, Priddy BM (2014) Child maltreatment and trauma exposure of deaf and hard of hearing young adults. Child Abuse Neglect 38(10):1581-1589. doi:10.1016/j.chiabu.2014.04.010

Lederberg AR, Schick B, Spencer PE (2013) Language and literacy development of deaf and hard of hearing children: successes and challenges. Developmental Psychology 49(1):15-30. Doi:10.1037/a0029558

Davidson LS, Geers AE, Blamey PJ, Tobey EA, Brenner CA (2011) Factors contributing to speech perception scores in long-term pediatric cochlear implant users. Ear Hear 32(1 Suppl):19S-26S. doi:10.1097/AUD.0b013c3181ffdb8b

Bess, F.H., Sinclair, S. & Riggs, D. (1984). Group amplification in schools for the hearing-impaired. Ear Hear; 5: 138-144.

Knecht H.A, Nelson, P. Whitelaw, G., & Feth, L. (2002). Background noise levels and reverberation times in unoccupied classrooms: predictions and measurements. American Journal of Audiology; 11:65-71.

McCroskey, & F., Devens, J. (1975). Acoustic characteristics of public school classrooms constructed between 1890 and 1960. NOISEXPO Proceedings: 101-103.

Picard, M. & Bradley, J. (2001). Revisiting speech interference in classrooms. Audiology; 40: 221-244.

Boney S. & Bess, F. (November, 1984). Noise and reverberation effects in minimal unilateral sensorineural hearing loss. Paper presented at American Speech-Language-Hearing Association annual convention; San Francisco, CA.

Crandell, C.C. (1993). Speech recognition in noise by children with minimal degree of sensorineural hearing loss. Ear Hear; 14: 210-216.

Finitzo-Hieber, T. & Tillman T. (1978). Room acoustics effects on monosyllabic word discrimination ability for normal-hearing and hearing-impaired children. Journal of Speech and Hearing Research; 21:440-458.

Hawkins D.B. & Yacullo, W. (1984). Signal-to-noise ratio advantage of binaural hearing aids and directional microphones under different levels of reverberation. Journal of Speech and Hearing Disorders; 49:409-418.

Glickman, N. (2018) Language Deprivation and Deaf Mental Health: Introduction to the Webinar

Ketelaar, L., Rieffe, Wiefferink, C., & Frijns, J. H. N. (2012). Does hearing lead to understanding? Theory of mind in toddlers and preschoolers with cochlear implants. Journal of Pediatric Psychology, 37(9), 1041–1050.

Gulati, S. (2019). Language deprivation syndrome. In N. Glickman & W. Hall (Eds.), Language deprivation and Deaf mental health. New York City: Routledge.

Glickman, N. (2009). Cognitive behavioral therapy for deaf and hearing persons with language and learning challenges. NYC: Routledge.

Glickman, N. (2017). Preparing deaf and hearing persons with language and learning challenges for CBT: A pre-therapy workbook.New York City: Routledge.

Gulati, S. (2014) Language deprivation syndrome. ASL Lecture Series.,BrownUniversity

Tobey, E.A., Geers, A.E., Sundarrajan, M. & Shin S (2011). Factors influencing speech production in elementary and high school aged cochlear implant users. Ear Hear 32 (1 Supplement): 27S-38S. doi: 10.1097/AUD.0b013e3181fa41bb

Lund, E. (2015). Vocabulary knowledge of children with cochlear implants: a meta-analysis. Journal of Deaf Studies and Deaf Education 21(2): 107-121. doi: 10.1093/deafed/env060

Pollard, R.Q. Jr., Sutter, E., & Cerulli, C. (2014). Intimate partner violence reported by two samples of deaf adults via computerized American Sign Language survey. Journal of Interpersonal Violence 29(5): 948-965. doi:10.1177/0886260513505703

Stevenson, J., McCann, D., Watkin, P., Worsfold, S., & Kennedy, C. (2010). Hearing Outcomes Study: The relationship between language development and behavior problems in children with hearing loss. Journal of Child Psychology and Psychiatry 51(1): 77-83.

Barker, D.H., Quittner, A.L., Fink, N.E., Eisenberg, L.S., TObey, E.A., & Niparko, J.K. (2009). Team CDI: Predicting behavior problems in deaf and hearing children: the influences of language, attention, and parent-child communication. Developmental Psychopathology 21(2): 373-392. doi:10.1017/S0954579409000212

Niparko, J.K., Tobey, E.A., Thal, D.J., Eisenberg, L.S., Wang, N.Y., Quittner, AL., & Fink, N.E. (2010). Team CDI: Spoken language development in children following cochlear implantation. JAMA 303(5):1498-1506. doi:10.1001/jama.2010.451

Duchesne, L. Sutton, A., & Bergeron, F. (2009). Language achievement in children who received cochlear implants between 1 and 2 years of age: group trends and individual patterns. Journal of Deaf Studies and Deaf Education 14(4): 465-485. doi.10.1093/deafed/enp010

A Deaf Child’s Right To Language

One of my favorite professors in college, Shoshannah Stern, is a famous Deaf actress and an incredible teacher (See: Weeds, The Hammer, Jericho). She asked us one day to consider what our reactions would be if we gave birth to a child one day who could only speak French. Well, I can only speak English. And we’re not in France, we’re in America. Would my first reaction be to learn French? Well, maybe a few key terms, but my focus would really be on trying to teach my kid English. Try to assimilate them into the culture and country in which they live. Having a deaf child is no different. That child is automatically born into a culture different than the parent, and that doesn’t happen to other families unless in very special circumstances, like a black child being adopted by a white family. That black child will never be white, and a child who is born deaf can never become hearing. Even cochlear implants, which are highly experimental and do not take the place of true hearing, are questionable in their value when they are not accompanied by sign language. It’s understandable why a hearing parent would want their child to be implanted, and why they would speak tirelessly and refrain from using sign language. They just want their kid to be like the others. That attitude, however, is detrimental.

Did you know that the vast majority of Deaf adults do not want to be hearing? Deaf people love being Deaf. “Deaf” is spelled with a capital “D” when in reference to someone who is culturally Deaf, and that means that this person is more than just someone who can’t hear – they are engaged in their own rich culture that has its own history, art, language, people, and community. These culturally Deaf individuals reject the label “disabled” and refuse to focus on deficit. The American Deaf community takes great pride in their American Sign Language (ASL), and one of the biggest battles that the community faces is the right to use it. Ninety percent of deaf children are born to hearing parents. Ninety percent of deaf children cannot communicate effectively with their parents. Ninety percent of deaf children are placed in an oral mainstreamed program without use of their natural signed language. The milestones that these children miss due to lack of language only builds and compounds on itself to further hinder a child’s ability to learn. Withholding a natural signed language leads to linguistic, social, and cognitive delays that may never be overcome. With early exposure, the benefits of using American Sign Language can influence their language, literacy, and cognitive development, and even serve to assist in bilingual learning, in order to make sure each and every child can live up to their full potential.

There are some negative stigmas around ASL, and the perpetuation of these fallacies are really damaging. American Sign language is a “natural, full-fledged language that ensures full and complete communication” (Grosjean, 2001) between users. Research actually proves that the auditory cortex of the brain responds the exact same way to spoken language as it does to signed language – that means that there is no difference, neurologically speaking, between these two types of languages. The idea that ASL is somehow less-than, unable to communicate elaborate ideas or complex terminology, is inaccurate. Language is language. Spoken or signed. A lot of the reluctance coming from hearing parents is based in their concern that using ASL as a first language will somehow stifle learning, or else destine their child to be less intelligent than other kids. In fact, the opposite is true. Early contact with American Sign Language is vital during the “critical period” of a child’s life in order to ensure proper linguistic and cognitive development. The Critical Period Hypothesis states that between the ages of 0-5, the brain is the most receptive to language learning and development. After the age of 5, the plasticity of the brain begins to gradually decrease. A child who has not acquired a language by that time runs the risk of not acquiring native like fluency in any language (Humphries et al, 2012). Early exposure to American Sign Language prevents language deprivation—it also allows for full and complete communication between a parent and child while simultaneously developing the child’s language skills.

In the earliest years, between 0-1, a form of language called “motherese” is used, which is often referred to as “baby talk”. Motherese can be in any language and it is used in American Sign Language as slow, cyclic, repetitive signs. Since signing motherese requires the adult signer to be aware of the Deaf child’s visual gaze, infant-directed sign may actually play a greater role in early signed language development than infant directed-speech plays in early spoken language development (Morford & Mayberry, 2000, p.121), suggesting that awareness to a child’s attentional state, which is critical for signed motherese, is actually benefitting a deaf child’s language development in ways that hearing children don’t receive from speech. Furthermore, Deaf children who are exposed to language at earlier ages have consistently outperformed Deaf individuals exposed to language at later ages on the tests of signed language knowledge and processing (Morford & Mayberry, 2000, p.113). Therefore, natural, signed language exposure during the critical period clearly benefits a Deaf child and is fundamental to ensure a healthy language development later in life.

After the critical early years, the plasticity of the brain diminishes, and it becomes harder to learn language. However, it is not only language development that suffers. Up to 90 percent of what hearing children learn is categorized as incidental learning, which means that the information the child is receiving and storing is essentially “overheard”. Television, radio, conversations other people are having over the phone, and what two people are talking about on the bus is information gained that a Deaf child has little or no access to. Deaf children need to be taught directly many of the skills that hearing children learn incidentally and exposure to language is the key to a successful transfer of information.

Additionally, early exposure to American Sign Language is beneficial for literacy and can serve as a bridge to bilingualism. Tabor asserts that Deaf children “…begin literacy learning with language and that enhancing their language development by providing them with rich and engaging language environments during the first 5 years is the best way to ensure their success as readers” (as cited in Erting, 2003). Deaf children can actually have an easier time of learning the alphabet, as emergent readers, as they learn that fingerspelling can be linked to letters on a page and that a written concept can be matched to a familiar sign.

Furthermore, early exposure to sign language creates a gateway to English, and today, it is generally accepted that there are many cognitive benefits to bilingualism, such as enhanced creative thinking, cognate flexibility, and metalinguistic awareness. The theory of cognitive academic language proficiency (CALP) states that it is the knowledge of one language that helps to make a second language comprehensible. As opposed to learning a concept and an English vocabulary word, a Deaf child that is already proficient in ASL can apply an English word to a known concept and a known sign, significantly lessening the difficulty of acquiring that particular vocabulary word. To give you the bottom line, all children who are exposed to Sign Language early in life are actually stronger in their acquisition of spoken and written English compared to children who are only exposed to spoken language instruction.

In conclusion, early exposure to American Sign Language is beneficial for any child in many ways. It is essential for the development of their language, literacy, and cognitive skills, as well as supporting second language skills (bilingualism), inclusion within classroom settings, and, perhaps most importantly, a relationship with their parents. “We know that early exposure to two languages, early exposure to language, is the absolute paramount most important thing we can do for a normal, typical development in the human child” (Gallaudet, 2013).

– Melanie Laufer



Chamberlain, C., Morford, J. P., & Mayberry, R. I. (2000). A Reexamination of “Early Exposure” and Its Implications for Language Acquisition by Eye. In Language acquisition by eye (pp. 111-127). Mahwah, NJ: Lawrence Erlbaum Associates.

Firkins, K. (n.d.). The Deaf Learner’s Language & Literacy Development, Part II[powerpoint]. Retrieved from

Gallaudet University. (n.d.). What the Eyes Reveal About the Brain [Video file]. Retrieved from

Grosjean, F. (n.d.). The right of the deaf child to grow up bilingual. Retrieved from

Holcomb, T. K. (2013). Introduction to American deaf culture. New York: Oxford University Press.

Johnson, R. E., Liddell, S. K., & Erting, C. J. (1989). A model program for education for

deaf children. In Unlocking the curriculum: Principles for achieving access in deaf education (pp. 15-19). Washington, DC: Gallaudet University.


Melanie Laufer is a recent graduate of California State University, Northridge with a degree in Deaf Studies and an interest in working with young deaf children and their families.

The History of AB3632 and Educationally Related Mental Health Services in CA(1)

In 1975, congress passed what is now commonly referred to as IDEA (Individuals with Disabilities Education Act)(2). This act ensured that every child – no matter of ability or disability – is entitled to a free appropriate public education. In 1984, in response to major concerns that mental health services were not being adequately provided to students who needed such services in order to benefit from their education, California passed Assembly Bill 3632, which required counties to provide these services. From 1984 through 2010(3), the county departments of mental health were in charge of completing mental health assessments, recommendations, and case management for students. These services were coordinated with the students’ individualized education program (IEP).

In October, 2010, AB3632 was brought to an abrupt halt when it was defunded. Over the next year, there were attempts to transition these services back from the county mental health departments to the schools(4,5).

Currently, schools (under IDEA) are required to provide any related services the IEP team deems necessary to support the student’s ability to benefit from his/her education. These related services can include a variety of mental health services, including, but not limited to, individual, group, or family counseling, or therapeutic residential placement.(6,7) Because these services have been provided by a separate entity for the past 25 years, many schools are still adjusting to the transition and working out implementation plans for their individual districts or planning areas.

1) We have provided a very brief and simplified overview of the history of this law. There are many more details and factors that went into the creation of AB3632, how these services were provided and the challenges that ensued during the transition resulting from the removal of funding. It is not our intention to provide a comprehensive review here, but rather an easy-to-understand overview.

2) The law was originally named the Education for All Handicapped Children Act (EAHCA or EHA or Public Law 94-142). In 1990, revisions to the law were made and the name was changed to the Individuals with Disabilities Education Act. In 1997, additional revisions were made to the law. In 2004, more revisions were made and the name was changed to the Individuals with Disabilities Education Improvement Act (IDEIA).

3) In 1996, California passed AB2726, which made adjustments to AB3632, including transferring the financial responsibility for residential placements from the school districts to the county departments of mental health.

4) While we have used “schools” for ease of understanding to identify who is providing services, the responsibility actually falls on the Local Education Agency (LEA), which is typically the school district.

5) In 2011, California passed AB114 which removed funding (and therefore access to services) from the AB3632/AB2726 laws. As a temporary measure to transition services from the county mental health departments to the LEAs, specialized funding was approved for the 2011-12 fiscal year.

6) IDEA and California law require that local educational agencies provide students the special education and related services that each child with a disability requires to benefit from their education, including but not limited to:

  • assessment of mental health needs, including interpretation of such assessments and integration of information in service planning;
  • consultation with the student, family, and staff to develop an appropriate program to serve the youth;
  • individual, group, family, and parent counseling;
  • individual, group, family, and parent psychotherapy;
  • parent counseling to assist parents in understanding their child, provide parents with information about their child’s development, and help parents acquire skills to enable them to support implementation of their child’s IEP;
  • day treatment;
  • planning, providing, and managing positive behavior intervention, including one-on-one behavioral aides if necessary;
  • therapeutic behavioral services;
  • identifying and securing community resources;
  • assessment for, and administration and management of medications; and
  • residential placement.

34 C.F.R. §§ 300.34(a), .34(c)(2), .34(c)(8), .34(c)(10), .34(c)(14), .104; Cal. Educ. §§ 56363(a), (b)(9), (b)(10), (b)(11), (b)(13); 2 C.C.R. §60020(i).  This list is illustrative, not exhaustive. Cal. Educ. § 56363(b); See also 34 C.F.R. § 300.34.

7) For more information, see the California Department of Education’s Mental Health Services FAQ at

Inefficiency is Depleting Special Education Funds

There are so many complaints about how special education costs are depleting our tax dollars and diverting money that might be used elsewhere to support children’s learning. But in the view from the trenches, the expense of special education is not the culprit, inefficient spending is.

As an advocate, I attend IEP (Individualized Education Program) meetings frequently. These meetings are held on an annual basis (or more often, if needed) to review the special education program for a student and to ensure the student’s unique educational needs are being met. Since the presence and input of multiple school personnel (teachers, administrator, and often the school psychologist, nurse, and any other specialists who are providing services for the student) are needed at these meetings, using the time efficiently is of the utmost importance.

When teachers are in the IEP meetings, their classes still need to be taught. Substitute teachers are hired (at additional cost) to cover their classes. Inefficiently run meetings mean teachers are away from their classrooms for longer than necessary.

School psychologists play an important role in the IEP process. They assess the students’ needs and are in a position to provide vital information to the IEP team. A high-quality assessment can provide detailed and specific information about how a child learns, providing the IEP team with essential information that will help to fine-tune the IEP document and ensure it is meeting the needs of a specific student. The more thorough the assessments, the more likely the IEP team can create an appropriate and effective IEP that will truly address the students’ needs. Ensuring school psychologists’ time is devoted to activities that will make the most significant difference for students, is crucial.

The same is true for other specialists (speech and language, occupational, or physical therapists; adaptive physical education teachers, and the many other professionals that serve students). The more time spent in inefficient ventures, the less time they have to provide important services to students.

I want to clarify: I am, in no way, suggesting that spending time at IEP meetings is a waste of time. On the contrary, these meetings can be a wonderfully collaborative and efficient way to bring families and professionals together to create a learning environment that will support a highly successful generation of young people who have the skills, knowledge, and experience, to contribute to the workforce and become productive members of society. This is what IEP meetings are designed for, and, if run efficiently, are likely to regenerate every dollar spent by creating successful young men and women who give back to society and their communities in a multitude of ways.

So what is contributing to the inefficiency of these meetings? Here are my observations:

1) Teachers, school administrators, and other members of the IEP team are rarely taught the special education laws by which they must abide. Most districts I’ve encountered school their personnel on district policies (which, in writing, are typically aligned with the laws, but which, in reality, are not enacted as such), but not the actual laws they are bound to uphold. This can result in school professionals arguing against the very thing they are obligated to provide, and causes delays in obtaining the services or placement that will best meet the students’ needs. Additional time and meetings (which are associated with extra costs) are often the result. It’s not fair to the school professionals (who are in this field because they want to help children) to keep them in the dark and not provide them with an understanding of the laws they are required to implement.

2) Ineffective district policies requiring school professionals to “jump through hoops” and follow protocols that prolong the IEP process and make it extremely tedious. These policies can effectively remove the school professionals’ power to make decisions, require additional time and resources that are not legally required to make such decisions, and emasculate the very people who work with the students on a daily basis. Decisions are delayed and made by personnel who have no real understanding of the student and are therefore more likely to be ineffective and cause disagreements (which, in turn, take more time and money to resolve).

3) People get stuck in the mantra “this is how we do it”. The mindset of “This is how we’ve always done it, therefore this is the only way we will do it”, is a very dangerous way of operating. Being unwilling to open to new ideas and truly listen to suggestions and recommendations from other perspectives, precludes collaboration. IEPs, by design, are purposefully structured to be collaborative meetings. If we’re not able to get past the past (i.e. “this is how we’ve always done it”) and actually focus on the future (i.e. “what does this student need to be successful?”), there will be constant and persistent battles that fixate on status quo, rather than on the individual needs of the child.

The positive side is that all three of these issues are easy to solve.

1) Train school professionals in education and special education laws.

2) Ensure district policies are aligned with special education laws – in print and in practice.

3) Be open to new ideas and to seeing things from new perspectives. (Isn’t this what we want to teach our children?)

By making these three simple changes, we can decrease the length of IEP meetings (ensuring teachers and other school professionals are not away from their students more than necessary; thereby reducing the cost associated with substitute teachers who cover their classes during these times), facilitate more agreements (which reduces costs associated with additional meetings, as well as the costs of attorneys when disagreements are fought in court), and encourage a collaborative, thoughtful environment geared toward supporting students (isn’t this the goal of education?).

All of this, accomplished in an efficient manner, ensures special education funds are being spent on funding special education services that make a significant and important impact on the future of our children and our society.

The Importance of Understanding Each Person’s Role in an IEP Meeting

Many parents feel overwhelmed simply showing up to an IEP (Individualized Education Program) meeting. Looking across a table at a sea of education professionals can be daunting. Teachers and school professionals often feel similarly when attorneys or advocates attend IEP meetings. But intimidation and disempowerment do not have to be the result.

By understanding the individual and unique roles of each member of the IEP team, we can better understand and appreciate their perspective and contribution. Keeping in mind the various roles of everyone in the meeting will help in understanding where everyone is coming from and the reasons behind their positions.


Special Education Teacher

The role of the special education teacher is to share how the student is progressing in the special education class or setting, or to describe what the special education setting would look like (for a student who is not currently receiving these services). She is responsible for providing updates on the goals she is working on with the student. If she has completed any testing or assessments of the student, she will present the results of those to the IEP team. Additionally, if she is the student’s primary teacher, her insights are extremely valuable for understanding how the student is functioning in that environment.

General Education Teacher

The role of the general education teacher is to share how the student is faring in his general education classes, and to describe what the general education environment looks like. If the student is in the general education setting for any part of his day, it is required to have the perspective of a teacher who is familiar with the student and is teaching non-disabled peers.


The administrator’s role is to ensure the meeting addresses the legal mandates and that school professionals are following school and district policies. She often helps lead the IEP meetings and helps keep the team focused on the issues that need to be addressed.

School Psychologist

The school psychologist’s role at the IEP meeting is to share the results of any and all testing or assessments he has completed. These assessments can provide valuable insights into the student’s cognitive, academic, and socio-emotional functioning at school. He utilizes this information to provide recommendations that will help tailor the IEP goals, accommodations, modifications, and services to meet the unique needs of the student.


Parents have a vital role in IEP meetings. They know their child in ways no one else has experienced. They see the child at home and in the community and can bring valuable insights regarding effective interventions and accommodations, as well as perspective in how the student’s needs are similar or different in the education setting (compared to other settings). This information can provide the team with helpful observations and insights on how the student responds in different scenarios and environments. Comparing and contrasting this information with that presented by the school team allows all members of the IEP team to gain a more thorough understanding of what is effective and what is not for this student. Parents are also tasked with being their child’s primary advocate. When something doesn’t “feel” right, it’s not only their legal right, but their role within this meeting, to share their concerns with the IEP team.


The role of the advocate is to facilitate the student’s receipt of an appropriate individualized education program that effectively meets her needs. This also includes supporting families with understanding their rights, helping them to navigate the special education system, translating educational terms and jargon, and providing the family with recommendations based on the student’s educational situation and history.


While some attorneys function as advocates, most are called in when IEP discussions have come to a stalemate, or when there have been grievous errors causing the student to not receive the educational program he is entitled to. Attorneys can provide legal guidance and advice pertaining to the specific circumstances of the student.


There are many other specialists who frequent IEP meetings: Language and Speech Pathologists, Occupational Therapists, Physical Therapists, Adaptive Physical Education Specialists, Social Workers, District Representatives, etc. Each one has a unique focus and perspective regarding the student. Each of these professionals is tasked with bringing their specialized expertise and observations (and sometimes assessments) to the team in an effort to support the student’s learning and educational progress.


The student is an integral part of the IEP team. His insights about the learning experience (what it “feels” like, how much he feels he’s learning, what areas he would like to concentrate on, etc.) provide essential feedback to the team about the effectiveness of the current program and what changes may be needed.


The common denominator is that each person is at the meeting to ensure the student has an educational program that is designed to meet her needs. If each member of the IEP team is able to go in to a meeting remembering this fact and keeps in mind each other’s particular role, IEP meetings become more focused and increasingly collaborative.

Introduction to the Juvenile Mental Health Court

Hello Healthy Minds followers!

We wanted to start off our blogging journey by sharing a bit about one of the specialized services we provide. We’ll venture through numerous topics in the Healthy Minds Blog, addressing a variety of subjects related to education, child development, mental health, and special needs. Today, we start with our work in the court system.

Unique in its design, the Juvenile Mental Health Court (JMHC) is composed of an interdisciplinary team including a judge, public defender(s) and defense attorney(s), probation officers, a psychiatric social worker, a consulting psychiatrist and psychologist, and an education specialist. This specialized court room is part of the Los Angeles County juvenile delinquency court system and serves youth with developmental delays and/or significant mental health needs. The team has specialized knowledge and expertise in mental health and works collaboratively to ensure the youth and their families have the support needed to increase positive outcomes and reduce recidivism. In other words, we help the youth get back on track so that they don’t continue to get in trouble with the law.

Healthy Minds Consulting is honored to be in its 7th year of service with the Juvenile Mental Health Court (JMHC). (My, how time flies!) We provide educational consultation to the court team and families, and provide advocacy support for the youth, facilitating access to an educational program that will support their current and future goals. Most of the youth who are part of the JMHC are kids who have fallen through every crack in every system, and are now in trouble with the law as well. For many, it may be the first time their developmental disability or mental health needs have ever been adequately or thoroughly assessed. Identifying these needs is the first step toward accessing appropriate and supportive services – at school, at home, and in the community.

Being part of this extraordinary team allows for a rare opportunity to collaborate with many different professionals with varying perspectives, ensuring the youth are provided with a well thought-out set of services tailored to their individual needs. Identifying the youths’ often complicated needs and connecting them with the supports and services that can best address those needs, often gives the families a renewed sense of hope and the support the youth need to become productive citizens who contribute positively to their communities.