Helen Grech

University of Malta*

Abstract

The purpose of this paper is to evaluate modes of communication applied to facilitate language acquisition in hearing impaired children in Malta and Gozo. The success of approaches used in the past is evaluated and possible detrimental factors identified. Three crucial factors facilitate verbal language acquisition in the hearing impaired: early intervention, consistent and appropriate amplification and parental guidance and counselling. Clinical research data indicates that when these factors are met spoken language acquisition in hearing impaired children usually occurs within normal expectations of hearing age though there may be a slight delay in terms of chronological age. Results of structured interviews with parents of hearing impaired individuals and educators indicate that such factors are not usually met in the Maltese Islands. Nevertheless, findings of this study favour more success with achieving spoken language through the auditory-oral approach than with the application of Total Communication. The trend for more success with the auditory-oral approach than with Total Communication is also apparent for acquired literacy skills. It is recommended that the components of the auditory-oral habilitation programme be strengthened locally.

Introduction

This paper is based on a recent project that evaluated the modes of communication used in Malta and Gozo to facilitate language acquisition in hearing impaired children. The local Education for the Hearing Impaired was initiated in 1956. Until the early 1990s the mode of communication used by educators was the oral approach (Galea, 1991). Total Communication (TC) was gradually introduced over the past few years. In February 1998, the local Commission for the Education of Individuals with Hearing Impairment recommended Bilingualism (where sign language is acquired as the first language) as a possible goal for some deaf children in local educational settings. The contentious issues regarding the type of language that hearing impaired children with a substantial hearing loss acquire and the means of communication used to establish language are still in process, not only locally but apparently world-wide.

Oralists believe that speech is accessible to deaf children and is the best mode through which language is acquired. It is believed that the auditory-oral approach they advocate provides the best opportunities for independent functioning of individuals with hearing impairment; it also opens the possibility for a more extensive range of career opportunities, more security of employment and enhances the development of reading through the existing correspondence between the spoken and written form (Ling, 1989, 1994). Supporting evidence for success of the auditory-oral approach is reported. For example, Geers and Moog (1989) report findings of their US study involving 100 hearing impaired adolescents indicating that their subjects exhibited fluency and intelligible spoken communication and achieved high literacy levels. Lynas (1994) investigated the feelings of deaf adults about their experience with oral education and mainstreaming, many of which were positive regarding oral education.

Three crucial factors for verbal language acquisition in hearing impaired children are identified. These being early intervention, appropriate and consistent amplification, plus guidance and counselling to parents. Research data is now indicating that given that these factors are met, verbal language acquisition would develop along normal or slightly delayed patterns (e.g. Cole, Oshima-Takane and Yaremko, 1994).

It is claimed that with TC deaf children would use all their sensory mechanisms to acquire language and develop communication and that TC allows the deaf child to communicate in a relaxed manner and with confidence (Meadow, 1980). Bornstein, Saulnier and Hamilton (1980) studied 20 four year old pre-lingually deaf children. Results support the use of TC in the early years. Robinshaw (1992) following her study indicates that gestures and signs may be beneficial when used in the early stages of development related to the transition from non-communicative behaviour to meaningful single word utterances. She believes that the continuous use of gestures/signs by carers beyond this stage may have a detrimental affect of residual hearing and in the development of spoken language.

Advocates of Bilingualism claim that this provides them with social identity (e.g. Bouvet, 1990). Evidence from research studies (e.g., Bellugi and Klima, 1972) indicates that sign language acquisition in deaf children exposed to it early follows a similar pattern to verbal language acquisition in hearing children. Meanwhile, Harris (1992) reports a study where even the most linguistically advanced deaf child was delayed in sign language. Experience in countries such as Denmark and Sweden has proved that hearing parents cannot be proficient sign language models for their deaf children (e.g., Davies, 1991). Bilingualism is still in its infancy and to date there is not enough experience in the UK, Canada or USA to find out whether deaf individuals come out as fluent signers and literate following a bilingual approach. In summary studies indicate that verbal language seems to be the most achievable goal today for most hearing impaired individuals, through recent technological advances. The purpose of this project was to evaluate factors associated with successful language acquisition in hearing impaired individuals and to identify the more successful approach in Malta and Gozo.

Subjects and Method

The data were collected about the hearing impaired individuals currently receiving a service from the Special Education Department in Malta and Gozo. There are a total of 94 registered pupils, four of whom receive a peripatetic service at home. Eleven students attend a Special day school. The other 79 pupils are in the mainstream. Data were collected for approximately 81% of the registered hearing impaired pupils. The sample includes data from 46 boys and 30 girls. The ages of the children studied range from 1;11 to 17;10 years of age.

Permission to conduct a structured interview (i.e., completing a questionnaire) was requested from parents of all the hearing impaired pupils. The educators providing the special education service to the children (either peripatetic or directly in a special school/unit) were also informed and invited to participate. Data were collected over a five month period. The data were summarised and analysed using descriptive statistics in order to identify trends.

Results

All the subject were reported as having a sensorineural loss (except for two who were unsure). The information about the degree of loss was rather subjective. However, in most cases parents acknowledged a substantial degree of loss. Seventy (92 %) subjects were reported to have a binaural loss, while six (8%) were reported as having a monaural loss. Fifty (66%) subjects were said to have a congenital loss while 15 were reported as having an acquired loss. In 11 subjects, there was an uncertainty regarding whether the loss was congenital or acquired. In 57 subjects (75%) no additional impairments were reported. Figure 1. summarises the reported causes of hearing loss. The age of the hearing impaired individuals at identification as reported by the parents/carers is given in Figure 2 below. This Figure refers only to those subjects with a congenital loss.
 

Figure 1. Reported causes of hearing loss in 76
Maltese children ranging in age from 1;11-17;10 years
CLICK ON THE IMAGE BELOW TO VIEW FIGURE 1

Figure 2. Age at identification of subjects
reported with a congenital hearing loss
CLICK ON THE IMAGE BELOW TO VIEW FIGURE 2

Figure 3. Gap between suspicion
and identification of hearing loss
CLICK ON THE IMAGE BELOW TO VIEW FIGURE 3

Figure 4. Feelings of parents
regarding the way diagnosis was reported
CLICK ON THE IMAGE BELOW TO VIEW FIGURE 4

Data for all the 76 subjects in connection with the gap between suspicion and identification of the hearing loss are summarised in Figure 3 above. The feelings of the parents/carers about the way in which the diagnosis was reported are highlighted in Figure 4. Waiting time for hearing aids was also recorded (see Figure 5 below for group details). 9 subjects (13.2%) waited for more than a year for their first aids.

Figure 5. Waiting time for hearing aids with moulds
CLICK ON THE IMAGE BELOW TO VIEW FIGURE 5

 

Figure 6. Waiting time for earmoulds following impression taking
CLICK ON THE IMAGE BELOW TO VIEW FIGURE 6

The opinion of the parents/carers about the use of the spoken medium by the hearing impaired subjects was recorded and collated in Figure 7. No subject was reported as being Bilingual (i.e., using sign language as L1). Figure 7 highlights better results for those using the spoken mode rather than TC.

Figure 7. Functional use of spoken mode (FUSM)
(22 subjects use total communication (TC) - 29% of total sample)
(54 subjects use spoken mode only without signing(SM) - 69% of total sample)

*** percentages in respect of sample number for specific sub-division
 

Figure 8. Literacy skills
subjects use total communication (TC) - 29% of total sample)
(54 subjects use spoken mode only without signing (SM) - 69% of total sample)

*** percentages in respect of sample number for specific sub-division

Information on the acquisition of written language skills in the hearing impaired subjects is summarised in Figure 8 above. It was reported that a relatively high percentage of children who speak without using signs (64.8%) achieved functional use of written language skills in both Maltese and English, whereas this was only applicable for 9.1% of subjects using TC. 13.6% of the latter group were reported as having failed to achieve any written language skills.

Discussion

Reports of parents/carers involved in this project indicate that most children born with a congenital hearing loss in Malta and Gozo after 1980 were identified after one and a half years of age (Figure 2). Markides (1986) indicated that the earlier hearing impaired children are identified and supported by an appropriate habilitation programme, the better their achievement in speech production and linguistic competence. The US National Joint Committee on Infant Hearing (1994) agreed that all new-borns with a hearing loss should be identified before 3 months of age and that all hearing impaired infants should be involved in intervention by 6 months of age. There is no neonatal screening programme currently in Malta and Gozo. This may be one reason for late identification of most children with permanent hearing impairment.

The fact that parents were not always satisfied with the way the news about the identification of the hearing loss was given out to them (see Figure 4) is an important aspect to consider since parents recalled that this experience left an impact on them, which reflected later on the grieving process and on their bonding with the hearing impaired child. One third of the subjects were given the aids within a relatively short time following diagnosis (see Figure 5). This indicates that an efficient service is possible and is given in a number of cases. Ear moulds were of concern for most carers. Waiting time for moulds following impression taking is highlighted in Figure 6 above. Factors possibly related to the unnecessary long waiting time for hearing aids and earmoulds may be limited personnel and stock.

This project revealed that a number Maltese hearing impaired children managed to access this system in spite of some unfavourable conditions. Figure 7 reveals that more than 3/4 of the hearing impaired children exposed to the auditory-oral approach have achieved 'functional use' of verbal language and only 7.4% of them were unsuccessful. Meanwhile, results for those subjects exposed to Total Communication are not as favourable. Reasons could be various; for example, a number of children were exposed to the latter approach inconsistently since as previously mentioned teachers adopted it when they felt the need for a supporting manual system. The trend for more success with the auditory-oral approach than with TC is also apparent for acquired literacy skills.

Conclusion

Although the auditory-oral approach presents a challenge to the hearing impaired individual, his family, educators and other professionals, findings from this study indicate that it offers a better future than Total Communication to the Maltese individuals in terms of acquisition of written language and interaction with the hearing world. More success is predicted if the components of management and habilitation supporting the auditory-oral approach be strengthened in the Maltese Islands. It is highly unlikely that a Maltese deaf child would reach the stage of functional use of sign language by school age since resources to support this approach are scarce. Besides, Maltese Sign Language is still not well developed (Aloisio, 1998). Learning sign language later in life as a second language is more feasible. This way the hearing impaired individual would be getting the 'best of both worlds'.

References

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Bellugi U. and Klima E. (1972) The roots of language in the sign talk of the deaf. Psychology Today 6: 61-76.

Bornstein H., Saulnier K. and Hamilton L. (1980) Signed English: a first evaluation. American Annals of the Deaf 125: 467-481.

Bouvet D. (1990) The Path to Language: Bi-lingual Education for Deaf Children. Clevedon. Multilingual Matters.

Cole E. Oshima-Takane Y. and Yaremko R. (1994) Case studies of pronoun development in two hearing impaired children. Normal, delayed or deviant? European Journal of Disorders of Communication 29:113-129.

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Galea A. (1991) An outline of the growth and the present state of education of the deaf in Malta. Proceedings of the Third Conference of IDETW. 27 July-3 August, 1991. Malta Ministry for Social Policy.

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Markides A. (1986) Age at fitting of hearing aids and speech intelligibility. British Journal of Audiology 20; 165-168.

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Robinshaw H. Communication and language development in deaf and hearing infants. Unpublished Ph.D. thesis. University of Cambridge. 1992.

*Thanks are extended to all the parents/carers and educators who participated in this project. Special thanks go to Dr. Fred Brooks.