Language Development in a Child with a Hearing Loss

     What is Language?  How does it Develop?

    Voice is the sound produced by humans and animals using the lungs and the vocal folds in the larynx, or voice box. Voice is not always produced as speech. Infants babble and coo, animals bark, moo, whinny, growl, or meow, and adult humans laugh, sing, and cry. Voice is generated by airflow from the lungs. When air is pushed past the vocal folds with sufficient pressure, the vocal folds/cords vibrate.

    Speech is the oral form of language. Humans express thoughts, feelings, and ideas orally to one another through a series of movements that change and mold the tone created by voice into specific, decodable sounds. Speech is produced by precisely coordinated muscle actions in the head, neck, chest, and abdomen. Speech development is a gradual process that requires years of practice. During this process, a child learns how to regulate these muscles to produce understandable speech. Children who stutter, and people whose voices sound rough, hoarse or nasal all have speech problems. 

    Language is different from speech. Language is a learned code, or system of rules that enables us to communicate ideas and express wants and needs. Reading, writing, gesturing and speaking are all forms of language. Language rules usually include what words mean, how to make new words (friend, friendly, unfriendly), how to combine words together, and what word combinations are best in what situations.  Language falls into two main divisions: receptive language and expressive language. When a person cannot understand the language code, then there is a receptive problem. If a person does not know enough language rules to share thoughts, ideas, and feelings completely, then there is an expressive problem. The language code can be correct, but if the right body parts are not moved at the right time, then the message will not sound right. For children who do not use language normally from birth, or those that become impaired during childhood, language may not be fully developed or acquired.

    Whether they speak early or late, are learning one language or more, are learning to talk along typical lines or are experiencing difficulties, the language acquisition of all children occurs gradually through interaction with people most important to them and their environment. Whatever your family structure, whether you are a couple raising your baby, or a sole parent or caregiver, you are the most "significant other" your baby communicates with. The way you engage with him or her will determine the path that language development takes in those important first five years. 


    Some Frequently Asked Questions from Parents:

    •  At about what age (months) would speech delays be evident in deaf or hard of hearing children if we're comparing them to another hearing child's speech ?

         From birth to about 12 months, babies react to loud sounds, turn their head toward a sound source, watch your face when you speak, vocalize pleasure and displeasure sounds (laugh, giggle, cry, or fuss), babble (say "ba-ba-ba" or "ma-ma-ma"), try to communicate by actions or gestures, or repeating sounds, and make noise when talked to.  Infants deaf from birth may exhibit some of these same characteristics, making it difficult for parents to realize that there may be a hearing loss.  But, from age 12 months to two years, a baby begins to follow simple directions accompanied by gestures, answers simple questions nonverbally, tries to imitate simple words, enjoys being read to, correctly pronounces most vowels and n, m, p, h, especially in the beginning of syllables and short words. A baby also begins to use other speech sounds, may ask for common foods by name, and start to combine words such as "more milk."  In general, children say their first words between 12 and 18 months of age and begin to use complex sentences by the age of 4 to 4 1/2 years. In comparison, a deaf toddler may have difficulty with speech and language, be unable to discriminate between words that sound alike, have difficulty repeating sounds, letters, and numbers in proper sequence, and frequently need the repetition of directions and important information.  They may pay attention to only part of what is said (for example, understand only the first or last part of a message), have difficulty locating the source of sounds not in line with their vision, be unable to follow, or attend to, stories read aloud, and use gestures rather than verbal expression.


    •  Why do parents tend to "oversee" a language delay until their child is between 12-24 months of age?

        Hearing babies are stimulated with sound 24 hours a day.  Most parents with a deaf baby are unaware of just how much sound/language their child is missing daily.  They assume that if the child turns toward a sound, then the child hears it - not taking into account how visual a child with a loss becomes.  Often, pediatricians are quick to discount parents’ concerns as merely being overactive, especially if this is their first-born child. On the other hand, parents may know a universal hearing screening was given at birth and trust the professionals to recognize a problem if it exists.  In our fast paced world, some parents are simply too busy with work, and not enough time is spent with the baby to note that something isn’t quite right until other caregivers (who are also cautious of making a judgment of this kind) point it out.  Other parents deny as long as possible that there might be a ‘defect’ of any kind in their child. Some parents understand their child’s speech and discount a problem, or blame it on the immaturity of the child.    That is why an undiagnosed hearing loss in early childhood can permanently affect a child’s ability to hear and understand subtle sounds and differences, even if the hearing loss is treated later.