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8/9/2019 Magnuson(2000) Infants With Congenital Deafness on the Importance of Early Sign Language Acquisition. American

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American Annals of the Deaf, Volume 145, Number 1, March 2000,

pp. 6-14 (Article)

DOI: 10.1353/aad.2012.0256

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Volume 14 5, No. 1, 2000

Infants with Congenital Deafness:

On the Importance of Early Sign Language Acquisition

wo boys who both had a profound bilateral hearing impairment met at a specializedsign preschool. Their preconditions were quite different, since in one of them thehearing impairment was detected in the maternity ward with the aid of otoacousticemissions, and habilitation had begun at age 4 months. The other boy's impairmentwas not detected until age 2 years; habilitation was thus much delayed. Data werecollected on the two boys using interviews with parents and teachers, observation,and video recording in the children's own environment at home and in thespecialized sign preschool. Characteristic differences between the boys are describedregarding their social and linguistic development relating to the time of detection ofthe hearing impairment. This illustrates the importance of early detection andhabilitation so as to avoid separation of individuals into different groups withdiffering social and academic prospects, depending on the lack of early linguisticstimulation and consequent poor language acquisition. Giving children the

possibility of developing a language is the primary consideration.

Miriam Magnuson

Magnuson is adoctoral student in

the Department ofEducation and

Psychology,

Linkping University,Linkping, Sweden.

Linguistic proficiency is a central require-ment for human life: spoken language forthe hearing and sign language for theDeaf. Infants have a communicative com-

petence that was previously unknown,and this competence is common to bothhearing and deaf children (Jusczyk &Hohne, 1997; Trevarthen & Marwick,1986). The newborn child is able to per-ceive verbal sound patterns, and languagedevelopment begins in early infancy(Marcus, Vijayan, Bandi Rao, & Vishton,1999). In deaf children, language develop-ment proceeds in a manner that is equiva-lent to that of the hearing, starting withmanual babbling and evolving into lin-guistic expressions (Petitto & Marentette,199D. It is well known that the sign lan-guage of the Deaf is an advanced lan-guage rich in shades of meaning (Sacks,1989). However, more than 90% of par-

ents of children with severe to profoundhearing impairment have normal hearing,which makes communication between

parents and child difficult. Since educationin sign language can begin only when thehearing impairment is detected, deaf chil-dren with hearing parents thus start from aclearly disadvantageous position. Duringthe very important early period of lan-

guage development, these deaf childrenthus do not receive any natural languagestimulation.

The conventional methods for hearingscreening have not been sensitive enough,and a childhood hearing impairment oftenremains undetected until the child's differ-

ent behavior and failing speech develop-ment make it evident. Apparently, whenconventional methods are used, detectionof severe to profound hearing impair-ments in children occurs belatedly in all

Volume 145, No. 1, 2000 American Annals of the Deaf


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communities (Bamford & Davis, 1998).The only way to enable early detectionand an early start of habilitation is uni-versal neonatal hearing screening,with the aid of auditory brain stemevoked responses (aABR) or

otoacoustic emissions (OAE) (Davis,Bamford, Wilson, Ramkalawan,Forshaw, & Wright, 1997; Kemp &Ryan, 1993; Mason, Davis, Wood, &Farnsworth, 1998). In a National Insti-tutes of Health consensus statement

(1993), universal neonatal hearingscreening was recommended. The Eu-ropean Consensus Programme (1998)recommends hearing screening of in-fants, and general perinatal screeningis now practiced at several centers in

the United States and Europe.There is strong evidence that the

benefits of early intervention madepossible by neonatal hearing screen-ing outweigh the anxiety caused by afalse positive test result (Magnuson &Hergils, 1999; Watkin, Baldwin, Dixon,& Beckman, 1998). It is now recog-nized that early detection of hearingloss is essential if children are to have

the chance to achieve their potentiallanguage skills. Of all the variables thatwere investigated in a thorough longi-tudinal study of children with pro-found hearing impairment (Levitt,McGarr, & Geffner, 1987), it was foundthat the age when intervention beganexerted the largest influence on thedevelopment of language and commu-nication skills. Robinshaw (1995) stud-ied communicative and linguistic be-havior in children with severe to

profound hearing impairments who

were supplied with hearing aids at theage of 3 to 6 months. The resultsshowed that children with severe to

profound hearing impairments whoare identified and supplied with ampli-fication by the age of 6 months de-velop linguistic skills comparable tothose of hearing children. Yoshinaga-Itano, Sedey, Coulter, and Mehl (1998)found that identification of the hearingimpairment at 6 months of age, fol-lowed by appropriate habilitation, is

the most effective strategy for obtain-ing a normal linguistic development indeaf and profoundly hearing-impairedinfants. This can be accomplished onlyby neonatal hearing screening.

The failure to develop an effective

and sophisticated language at an earlyage has negative consequences for allaspects of psychological development,and thus for children's mental health

(Hindley & Parkes, 1999) There is evi-dence that deaf children of deaf par-ents who use sign language in theircommunication have significantly bet-ter linguistic, social, and academicskills than their deaf peers with hear-ing parents. Deaf children of hearingparents who have contacts with deaf

people and share the language seemto have a similar advantage. Thus, thedeaf children who are the most com-

petent in their social, cognitive, andlinguistic development are those whohave participated in active linguisticinteraction with their parents from anearly age. This applies both to deaf

parents and to hearing parents whohave learned sign language, which

permits them to interact meaningfullywith their children. The child not onlylearns facts through this interaction,but also gains behavioral and cogni-tive strategies, an understanding of selfand others, and a feeling of being partof society.

Many hearing parents have littleformal training in sign language andfind the use of signs impractical formost everyday needs. They do not feelcomfortable with sign language, espe-cially in public, and tend to sign only

when they communicate directly withthe child (Vaccari & Marschark, 1997).This leaves the child ignorant of whatis being said and constitutes an ob-stacle to the deaf child's learning ofsign language. In analogy, vocalspeech is primarily learned indirectly

by listening to other people talking,from television and other sources, andless by direct teaching. Vaccari andMarschark state that despite their bestintentions, parents who start learning

sign language, and who sign with theirchildren, tend not to continue devel-oping their skills. In addition, the par-ents' communication is often limited to

tangible things, a shortcoming thatbecomes even more pronounced

when the child matures and needsexplanations of more complex socialand emotional subjects.

There is thus a consensus that earlydetection and an early start to habilita-tion yield better opportunities for thedevelopment of communication. Theearlier the hearing impairment is iden-tified, the better is the development oflanguage skills. Results of previousstudies (Magnuson & Hergils, 1999, in

press) emphasize the importance of

early detection, in terms of both lin-guistic and social development. Par-ents clearly express that they wantearly detection with the aid of neona-tal hearing screening; they want earlyknowledge of whether their child hasa hearing impairment in order to helpestablish good communication withinthe family (e.g., by hearing aid or signlanguage), and because of concernover the child's future development.

Aim of the Study

The aim of the present study was toillustrate early language developmentand the importance of early languageacquisition by means of a compara-tive, in-depth study of two characteris-tic cases. A large amount of data wascollected concerning two boys whoboth had a profound bilateral hearingimpairment. When they met at a spe-

cialized sign preschool, their precondi-tions were quite different. In one ofthem, the hearing impairment had

been detected in the maternity wardwith the aid of OAE, and habilitationhad begun at the age of 4 months. Thehearing impairment of the other boywas not detected until he was 2 yearsold, and habilitation was thus delayed.Characteristic differences between

early and late detection are described,based on interviews with the parents



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Congenital Deafness and Early Sign Language Development

and teachers, and observations andvideo recording in the children's ownenvironment, at home and in a spe-cialized sign preschool. The issues fo-cused upon in the present investiga-tion were: What experiences,

opinions, and judgments could befound regarding the two boys' com-municative, linguistic, and social abili-ties? Of what importance was the signpreschool to these children?

The Specialized SignPreschool

At the time of the present study, bothboys were attending a specialized signpreschool, where children with im-

paired hearing were integrated withchildren who were not hearing im-

paired. The purpose was to give chil-dren with hearing impairments theopportunity to interact and play withhearing children. Experience showed,however, that the children with hear-ing impairments preferred to playwithin their own group.

Promoting communication betweengroups (using sign language or vocal

speech, respectively), would requireactive guidance by the supervisors(Eilstrm, 1993). This was not prac-ticed at the school; rather, the primary

pedagogic aim was to enable the chil-dren with impaired hearing to achievesign language competence and socialfellowship within their own group.Thus, the child's individual needs re-garding language development andsocial skills were the focus. At the time

when the two boys attended the pre-

school, there were 10 children withdifferent degrees of hearing impair-ment, and 8 hearing children. All per-sonnel were fluent in sign languageand one of them was deaf.

Method

SubjectsBoth boys were the first child in theirrespective families, and both sets of

parents were hearing. The family con-stellations were stable in both cases,and both boys later got a younger sib-ling who was hearing. The socioeco-nomic status of the two families was

about the same. The families received

education in sign language when theboys were 6 months, and 2-1/2 yearsold, respectively. The families attendperiodic weekend courses where theymeet deaf persons and others skilledin sign language.

"Rasmus" was 3 years 5 months oldwhen the study was completed. Hishearing impairment was detected withOAE in the maternity ward the day af-ter birth. When he was 4 months old, a

bilateral profound hearing impairmentwas confirmed with diagnostic ABR.When 6 months old, he was suppliedwith bilateral hearing aids, and he wasadmitted to a specialized sign pre-school when he was 1-1/2 years old,after a 6-month schooling-in period.

"William" was 4-1/2 years old whenthe present study was completed. Healso had a profound bilateral senso-rineural hearing impairment, whichwas not confirmed until he was 2 yearsold. He was then fitted with bilateral

hearing aids, and after 6 months ofschooling-in he was admitted to thesame sign preschool.

Measuring InstrumentThe children were studied by meansof interviews with the two parentcouples, and the teachers at the signpreschool, of whom five were hearingand one deaf. In addition, two mem-

bers of the pedagogic habilitationteam from the Department of Audiol-ogy, University Hospital, who servedas auxiliary teachers at the sign pre-school, were interviewed. All inter-views were done by the author using atape recorder. The parents were inter-viewed on two different occasions; thefirst about 1 year after confirmation ofthe child's hearing impairment, andthe second when the children were

ages 3 years 5 months and 4 years 6

months, respectively. The first inter-view with the parents wassemistructured (i.e., open-ended), andlasted 45 minutes. The second inter-view lasted 45 to 60 minutes and was

carried out according to a scheme con-

sisting of one structured part for back-ground information, and onesemistructured part to ascertain differ-ent aspects of communication in thehome setting. The individual inter-views with the sign preschool teachersand the auxiliary teachers from theDepartment of Audiology weresemistructured and lasted 30 to 45

minutes for each of the teachers.

Examples of QuestionsAll questions were followed bysupplementary queries. Some funda-mental questions were used in all in-terviews, such as: What do you think itmeans for Rasmus/William to go to thesign preschool? In your opinion, whatare the advantages/disadvantages ofearly or late detection of the hearingimpairment?

Questions to parents focused pri-marily on the communication withinthe family: Tell me, what works well incommunications with Rasmus/Will-

iam, and what does not? DoesRasmus/William take the initiative to

contact other kids and play with them,and how does he manage? How doyou estimate the linguistic develop-ment of Rasmus/William? Give me

your impressions of his difficulties andprogress. What happens whenRasmus/William cannot make himselfunderstood? How does he react? What

is your opinion with regard to sign lan-guage? What are your plans and hopesfor Rasmus/William?

Questions to the teachers at the signpreschool were meant to clarify lin-guistic and social development: CanRasmus/William express himself sothat you understand him? Tell meabout his interaction when playingwith his peers. How do you evaluatehis linguistic development and his lan-

guage skills today? How does he react



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clearly could become difficult both forWilliam and his parents.

linguistic and Social Developmentin the Sign Preschool

Rasmus: When Rasmus started in theinfant preschool at the age of 1-1/2years, he had already reached linguis-tic maturity on a level comparable tothat of a hearing child. When he was2-1/2 years old, he moved to a classfor older children. At the time, he exer-cised active use of sign language andshowed good understanding of con-cepts. He was fully aware of visualturn taking, and understood how toact during a conversation by watchingthe signing person. The teachers at thesign preschool and the parents tookpart in Rasmus's development withmuch interest, and, at the time of thesecond interview and observation

when he was 3 years, 5 months old, hecould pursue a fluent dialogue withthem. His linguistic and social abilitiesin the interaction with playmates andteachers were judged as comparableto those of a hearing child of the sameage by all the interviewed persons;some of them even considered himadvanced for his age. The deaf signlanguage teacher judged his develop-ment to be equivalent to that of a deafchild with deaf parents, who gets signlanguage stimulation from the verybeginning: "Yes, he was obviouslyahead of his age, like a hearing boythen, only he used sign language."

Rasmus quickly grasped, ahead ofthe other children, the instructions

given by the teachersfor example,when the group of children with hear-ing impairments were educated in theunderstanding of concepts. He wasconfident and helpful, and playedcalmly with other signing children."That Rasmus was so calm was due to

the fact that he got his language soearly; he knew what was going to hap-pen. He understood that peoplewanted to sign with him," a teachersaid. At the preschool, Rasmus pre-

ferred to play with other children whosigned, but he had no playmates athome. His parents found that playingwith hearing children did not workwell because of the language differ-ence: "They simply do not understand

each other. With deaf children there isno problem. They sign whatever theywant to say, and then they play." Ev-eryone who was interviewed agreedthat the early detection of the hearingimpairment was an advantage forRasmus when he was acquiring lin-guistic and social competence, andwere of the opinion that the sign pre-school was very important for his posi-tive development.

William started at the sign pre-

school at 2-1/2 years of age, after hishearing impairment had been con-firmed. This certainly meant a largechange for him. He now had to adaptto using hearing aids, and education insign language was started for him aswell as his parents. His social behaviorwas in accordance with his languagedevelopment, and he did not knowwhat to do outside his home environ-

ment. The special communicationmode that he had developed withinthe family was impossible to use in thenew environment, and the conven-tional sign language was totally un-known to him. He was at first insecure

and sad since he did not understand

his new playmates and teachers, andthey did not understand him. "William,who did not get signs so early; he wasvery uneasy, making trouble, andseemed to avoid eye contact," ateacher said. Previously he had been

used to taking initiatives, but now,when he could no longer take the leadand decide upon having a certain toy,for example, he would push his play-mates. Sometimes he withdrew from

the others, wanting to be left alone. Hewas unhappy and angry when hecould not have his own way. "Thenthere was crying and despair unless hegot what he wanted," was a commentmade by the teachers.

When the sign language education

had gone on for some time, Williambegan to like learning signs. Little bylittle the communication improved,and it was easier to understand what

he wanted and to explain things tohim. "So much was missed the first 2

years, not getting to know things, whatthey are and what they mean-thatmust be very important," a teachersaid. William's mood improved, andhis family viewed the sign language asvery positive. In the beginning,William's sign language skills devel-oped slowly, but when he was be-tween 4 and 4-1/2 years old, his lin-guistic development took a large stepforward, and his social competenceimproved accordingly. "Yes, and then

one must start to sign and suddenlyunderstand how to use it. It must take

some time, mustn't it? But now heseems to be getting along fine," one ofthe teachers remarked. William ap-

peared happier and more secure andplayed in a more relaxed way with hismates. All interviewed persons foundthat the sign preschool was very im-

portant to William, not only for learn-ing sign language but also for socialdevelopment. He learned many con-cepts and was able to ask questionsand give answers to questions, but hestill had difficulty using the languageactively and taking part in dialogues.He appeared to lack concentration,and the visual turn taking was an obvi-ous difficulty-that is, making Williamfocus on the signing person and keep-ing his attention as long as needed toconvey the message. "The difficultthing is to gain his attention, to have

visual contact long enough to thinkthrough the matter and convey themessage," one of the teachers said. Atthe second interview (when William

was 4-1/2 years old) his parents' opin-ion was that the communication

worked much better since they couldmostly understand what he wanted tosay, as well as he them.

William showed himself to be social

by making contact with other childrenand adults, although he was sad when



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he could not make himself understood

sometimes; this improved as helearned more sign language. The com-panionship with hearing children wasstill poorly developed since the chil-dren did not understand each other,

and he had no playmates at home. "Heis quite a social boy who really wantsto talk, but he does not know that theothers do not understand him when

he is signing," one of William's parentssaid. The parents sometimes foundWilliam's hearing impairment to be ahandicap when they were outside thefamily environment, but never athome. The teachers at the sign pre-school evaluated his linguistic and so-cial development as being below aver-age for his age: "His sign language wasrather poor then, so it was difficult tocommunicate with him in any way.There has been a change, but there isstill quite a good deal lacking."

The Future

Rasmus's parents viewed his linguisticand communicative ability as normalfor his age and found it difficult todecide whether to let him have a co-

chlear implant. After careful consider-ation of possible advantages and risks,they ultimately opted for implantation.However, they are of the opinion thatthere are no activities for Rasmus in

their home community and that hecannot get any playmates there. Sincethere is no school for the Deaf in their

hometown, they plan to move to an-other town where such a school is lo- ;

cated. The parents want him to go to a

class for deaf children, using sign lan-guage. "Suppose he gets an implant sohe can hear, he will still be in a groupwith deaf children, and, of course,what I want is that he will have his

sign language," one of his parentssaid.

William's parents came early to theconviction that he should have a co-

chlear implant. They were also of thedefinite opinion that the best for himwould be a class for children with

hearing impairments. "It is really im-portant that he meets other childrenwith the same language," one of hisparents said. Since there is no specialschool for children with hearing im-

pairments in their home community,

the family is prepared to move to an-other town where there is one. "Hewill go in a class for hearing impairedchildren; one cannot know if he willmanage in an ordinary class," one ofhis parents said.

Discussion

The Role of the Parents

In the present study, Rasmus's and

William's parents participated very ac-tively in continuous sign languagetraining. All four found the progress oftheir children to be very positive andwere encouraged to continue learningand using sign language in interactionswith their children. Parents must take

responsibility early on for orchestrat-ing an interaction based on waiting forthe child's attention before starting tosign, and then maintaining visual at-

tention long enough for the messageto be given. As time passes, such at-tention switching becomes natural for

both the parents and the child, andvisual turn taking is developed, whichpromotes effective communication in-stead of directing it (Power, Wood,Wood, & MacDougall, 1990). Motherswith better social support are morepositive in the interaction with theirchild. Receiving support as soon as

possible after the diagnosis of the

child's hearing impairment is particu-larly important. The parent then trans-fers the positive interaction behaviorto the child, and children who havedeveloped a good social and commu-nicative ability within the family are

better furnished to brave the step intothe social world outside the family(Vaccari & Marschark, 1997).

In the present study, the parentswere eager to learn sign language andused it consistently with their children.

To learn more, they took part in week-end training programs with their chil-dren. As a result of the early detection,Rasmus's parents had a lead over theirson with respect to sign language,which they regarded as very positive.

The present study shows that it is im-portant for hearing parents to startcommunicating early with their deafchild in sign language. The early startis crucial, even though hearing parentsare naturally far from fluent in signlanguage at the time.

A simplified and partly nongram-matical sign language is used by deafmothers in their communication with

the child during the first 2 years. Inorder not to confuse the child, they

tend to simply use hand signs withrespect to Wh- questions, keeping aneutral face, while using facial expres-sions only when expressing affection.This permits the child to read only"one visual channel at a time." When

the child reaches the age of 2 years,the mother, without being consciousof the change, shifts her strategy andstarts using the adult language with"two simultaneously active visual

channels," where the hand signs arecomplemented with grammaticallycorrect facial expressions (Reilly &Bellugi, 1996).

For a deaf child with hearing par-ents, it is vital that parents start signingwith their child to initiate communica-

tion, though the signing may first besimple and incomplete. This providesthe opportunity for the child to startdeveloping language. Thus, it is essen-tial to communicate with the child by

sign language, even though the par-ents may eventually opt for cochlearimplantation.

The Importance of the SignPreschool

One must pay attention to the fact thateach child has a unique set of charac-teristics that will contribute to how

development will proceed, and thechild must be given individual support



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according to his or her own condi-ions. Thus, one important factor that

will influence development is the flex-bility of the habilitation, and a pro-

gram adapted to continuous individualdevelopment can greatly reduce the

risk of a social and linguistic handicap(Apuzzo & Yoshinaga-Itano, 1995)The results of the present study

were certainly influenced by the factthat the two boys and their parentswere supervised by a habilitation teamconsisting entirely of professionals,who focused on their individual

needs. The overall pedagogical frame-work was equal for both hearing-im-paired and hearing children in the in-tegrated sign preschool. However, in

Sweden, sign language is regarded asthe primary language for the Deaf, andthis carried over into the pedagogicalpractice (Lgr 80, 1983). Since theteachers found it to be a necessary ar-rangement, the children with hearingimpairments were often gathered to-gether in a group of their own to prac-tice sign language and understandingconcepts. Even though the childrenwere allowed to play freely with theirmates, they were also trained throughstructured play, without knowing thatthe interaction was designed to de-velop the language. The teachers dis-cussed and evaluated the needs of in-

dividual children with the auxiliaryteachers, who were also working withhearing pedagogy at the Departmentof Audiology.

Sign Language and Spoken

LanguageSign language holds a strong positionin Sweden, where it is designated thefirst language of the Deaf. In 1981,sign language was declared the officiallanguage for the education of deafchildren. This means that spoken andwritten Swedish is also seen as a sec-

ond language for children with con-genital hearing impairments who arecandidates for cochlear implantation.Children with moderate to severe

hearing impairments who are suppliedwith hearing aids are also given signlanguage training as a complement,with the aim of stimulating use of thelanguage. To make speech easier tounderstand, signs are then used simul-

taneously with speech. Spoken andwritten Swedish is seen as the first lan-guage, and signs are used only to sup-

port speech.Deciding which communication

method the child will learn is a critical

choice for the family and for the deafchild, and one that is influenced by avariety of factors (Reamy & Brackett,1999). More than a simple choice ofmethod is involved, since the methodthat is chosen is the decisive factor in

how well the child will manage in thefuture, both inside and outside thefamily. The attitude of the family withrespect to hearing impairment, the ac-ceptance of having a child with hear-ing impairments, and the expectationsof the family with regard to the child'ssocial role in the family during up-

bringing and education are importantfactors (Luterman, 1999).

There is nothing to indicate that thecombination of signs and speech miti-gates the development of concepts.One study indicates that the childseems to be able to code-switch in re-lation to the actual context and his or

her partner (Preisler & Ahlstrm,1997). There are also no data to show

that sign language as a first languagewill inhibit spoken language. Deafchildren who learn sign language as afirst language usually have better skillsin reading and writing than deaf chil-

dren who have only been exposed tospoken language (Marschark, 1993)-Several factors contribute to the

choice of communication mode, suchas the prevailing view toward sign lan-guage in the country concerned (i.e.,the status of the language) and theaccess to specialized schools for theDeaf. Also, the time when the familystarts habilitation does seem to con-

tribute to a subtle difference of views.

In one of the families in the present

study, the child's profound hearingimpairment was detected early, andsign language introduced at age 6months. The parents chose not to viewRasmus as disabled, since they ac-cepted that he was deaf and used

signs as a primary language. Theywere ready to move to another townwhere there was a school for deaf chil-

dren. This view meant that the parentsfound it difficult to decide for or

against cochlear implantation. How-ever, they ultimately opted for theopportunity to do so.

In the other family, the hearing im-pairment was detected considerablylater, and the sign language educationdid not start until William was 2-1/2

years old. The parents naturally chosesign language as a first language, butthey were disposed to opt for a co-chlear implant from the beginning.Therefore, they intend to let Williamjoin a hearing-impaired group. Thefamily also intends to move to anothertown with a specialized school forchildren with hearing impairments, soWilliam can get the best possible edu-cation together with his hearing-im-

paired peers.Leaving their present homes and

occupations to make a new start willcertainly be a big change, but bothfamilies have considered the advan-

tages and disadvantages thoroughly,focusing on what will be best for thechild. A common factor that has pre-

pared both families to move may betheir conviction that a child is disabled

only when not provided with optimalconditions for future development.

Conclusion

The examples of Rasmus and Williamdemonstrate that a profound hearingimpairment means a disadvantageous

position for linguistic and social devel-opment, unless the impairment is de-tected early so that linguistic stimula-tion can be effected by the fitting ofhearing aids, sign language education,or both. This early stimulation enables



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the child to gain confidence by know-ing what is going on. The child learnswhere to look for visual cues, whichmakes communication meaningfuland enables the child to feel that he or

she is participating in a social relation-

ship.The early detection of Rasmus'shearing impairment meant that habili-tation could start at the age of 4months; he soon acquired sign lan-guage, which provided an effectivemeans of two-way communication.Rasmus's parents and his supervisorsat the sign preschool, including theauxiliary teachers from the audiologi-cal team, found his linguistic and so-cial skills to be adequate and appropri-ate for his age.

In William's case, because of thelate detection of the hearing impair-ment, a prelingual phase withoutwords lasted more than 2 years.William's family started sign languageeducation when he was 2-1/2 yearsold, and the start was not at all easysince the old "private code" that had

been developed within the family wasof no use in the new environment at

the sign preschool. He had to learnnew manners and an entirely new andunfamiliar language.

The specialized sign preschool,with teachers skilled in sign languageand playmates who also used sign lan-guage in their interaction, was veryimportant for both children in gainingsocial and linguistic skills. Obviousdifferences could be observed be-

tween the two boys regarding theirsocial and linguistic development re-

lating to the time of detection of thehearing impairment. This illustrates theimportance of early detection and ha-bilitation for the avoidance of an un-

desired separation of individuals intodifferent groups with differing socialand academic prospects depending ongood or poor linguistic stimulationduring infancy.

Universal neonatal hearing screen-ing is the only means by which earlydetection and habilitation can be

achieved. For a deaf child with hearingparents, it is a matter of vital impor-tance to provide the opportunity forthe child to start developing language

by signing, even though the parentsmay eventually opt for cochlear im-

plantation.

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Volume 145 No 1 2000 American Annals of the Deaf

magnuson(2000) infants with congenital deafness on the importance of early sign language...

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