Sign Language and Spoken Language for Children With Hearing Loss: A Systematic Review - American Academy of Pediatrics
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Sign Language and Spoken
Language for Children With Hearing
Loss: A Systematic Review
Elizabeth M. Fitzpatrick, PhD,a,b Candyce Hamel, MSc,c Adrienne Stevens, MSc,c,d Misty Pratt, MES,c David
Moher, PhD,c,e Suzanne P. Doucet, MEd,f Deirdre Neuss, PhD,b,g Anita Bernstein, MSc,h Eunjung Na, MSca,b
CONTEXT: Permanent hearing loss affects 1 to 3 per 1000 children and interferes with typical abstract
communication development. Early detection through newborn hearing screening and
hearing technology provide most children with the option of spoken language acquisition.
However, no consensus exists on optimal interventions for spoken language development.
OBJECTIVE: To conduct a systematic review of the effectiveness of early sign and oral language
intervention compared with oral language intervention only for children with permanent
hearing loss.
DATA SOURCES: An a priori protocol was developed. Electronic databases (eg, Medline, Embase,
CINAHL) from 1995 to June 2013 and gray literature sources were searched. Studies in
English and French were included.
STUDY SELECTION: Two reviewers screened potentially relevant articles.
DATA EXTRACTION: Outcomes of interest were measures of auditory, vocabulary, language, and
speech production skills. All data collection and risk of bias assessments were completed
and then verified by a second person. Grades of Recommendation, Assessment, Development,
and Evaluation (GRADE) was used to judge the strength of evidence.
RESULTS: Eleven cohort studies metinclusion criteria, of which 8 included only children with
severe to profound hearing loss with cochlear implants. Language development was the
most frequently reported outcome. Other reported outcomes included speech and speech
perception.
LIMITATIONS: Several measures and metrics were reported across studies, and descriptions of
interventions were sometimes unclear.
CONCLUSIONS: Very limited, and hence insufficient, high-quality evidence exists to determine
whethersign language in combination with oral language is more effective than oral
language therapy alone. More research is needed to supplement the evidence base.
aFaculty of Health Sciences and eSchool of Epidemiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; bChildren’s Hospital of Eastern Ontario Research Institute,
Ottawa, Ontario, Canada; cCentre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; dTranslational Research in Biomedicine Graduate Program,
University of Split School of Medicine, Split, Croatia; fConsultant, Moncton, New Brunswick; gAudiology Clinic, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and hVoice for
Hearing-Impaired Children, Toronto, Ontario, Canada
Dr Fitzpatrick conceptualized the project, finalized the protocol, was involved in all stages of the analysis and interpretation, wrote the first draft of this manuscript,
and is the study guarantor; Ms Hamel and Ms Pratt were involved in screening articles and extracted data; Ms Hamel conducted the quality assessment; Ms Hamel,
Ms Pratt, Ms Stevens, and Dr Moher provided input into the final manuscript; Ms Stevens contributed to the development of the methods, oversaw the screening,
To cite: Fitzpatrick EM, Hamel C, Stevens A, et al. Sign Language and Spoken Language for Children With Hearing Loss: A Systematic Review. Pediatrics.
2016;137(1):e20151974
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PEDIATRICS Volume 137, number 1, January 2016:e20151974 REVIEW ARTICLEEarly detection of permanent which might disrupt or delay spoken better spoken language outcomes
childhood hearing loss through language acquisition. However, when exposed to early intervention
population-based newborn screening another body of research suggests that uses signs to support language
has become standard care in much that visual languages such as compared with oral language
of the world. Expectations are that American Sign Language (ASL) are intervention without sign language?
early intervention through hearing processed in the brain in the same
technology will improve spoken manner as spoken languages and
language outcomes for children.1,2 are complementary to auditory METHODS
Childhood hearing loss is a relatively stimulation, and therefore provide a
The protocol and report for this
frequent disorder, affecting strong foundation for learning oral
review were prepared according
1 to 3 per 1000 live births,3–5 language.18,19 Therefore, adding
to Preferred Reporting Items for
that disrupts typical language sign language may develop bilingual
Systematic Reviews and Meta-
acquisition, placing children at risk skills and facilitate transition
Analyses for Protocols,20 and
for delays in language, literacy, and to spoken language acquisition.
the protocol was published21
social development.6–8 There is Anecdotal evidence supports various
and registered at PROSPERO
strong consensus that specialized intervention options, but there is
(Registration #CRD42013005426),22
intervention must be combined little scientifically based consensus.
an international register of
with early identification to develop This information is essential to (1)
systematic review protocols. The
communication skills in these guide families in making decisions
review was undertaken using an
children.1,9 about care for their children in
integrated knowledge translation
infancy, (2) inform clinicians so that
Historically, considerable debate approach involving knowledge-
they can tailor treatment plans to
about optimal outcomes for children user clinicians from health and
achieve the desired outcomes, and
with hearing loss have resulted education in the early stages and as
(3) inform policy makers so that they
in the evolution of a plethora of required, to ensure relevance of the
can make optimal investments in
intervention methods that constitute project for parents, clinicians, and
early intervention services.
two broad but distinct philosophies. decision-makers.
The oral approach aims to facilitate
This review is timely given the
spoken language and inclusion Literature Search
worldwide proliferation of screening
with normal-hearing peers, and
programs in the past 10 years. In Ovid Medline In-Process & Other
the manual approach focuses on
2008, the US Preventive Services Non-Indexed Citations and Ovid
visual communication systems
Task Force recommendations Medline (1946 to June week 2,
(sign language) and a Deaf culture
on newborn hearing screening 2013), Embase (1974 to June 25,
identity.10,11 Although there is wide
highlighted the need for further 2013), PsycINFO (1806 to June week
recognition that various options
research to demonstrate the 3 2013), and Cochrane CENTRAL
should be available to families,
effectiveness of the entire screening- (through May 2013 issue) databases
2 events in the past two decades
to-intervention process.2 New were searched using the Ovid
(newborn hearing screening and
possibilities due to screening interface. CINAHL was searched on
cochlear implant technology) have
and technology have reignited June 26, 2013, using the EbscoHost
made it possible for even children
the discussion on best practices interface, and SpeechBITE was
with profound deafness to develop
for children with hearing loss. searched on June 26, 2013. The
spoken language.7,12–14 Epidemiologic
Accordingly, the primary purpose search strategy (Appendix 1)
data confirm that >90% of children
of this research was to examine the was developed in Medline by an
with hearing impairment are born to
evidence for the effects of various experienced information specialist,
parents with normal hearing.15
intervention options for early- peer-reviewed using the Peer
Although there is substantial identified children with hearing loss Review of Electronic Strategies
evidence that children with hearing when the desired outcome is spoken (PRESS) standard,23 and adapted
loss can develop oral language communication. Our interest was for the other databases. The search
skills,7,14,16 there is no consensus in whether adding sign language was restricted to the pediatric age
about optimal interventions.17 facilitates spoken language, because group,24 and the date was limited to
There is a common expectation that of the increased focus on this material published in 1995 or later.
children receiving oral language outcome since the advent of cochlear A broad methodological filter was
intervention should develop better implantation. Specifically, the review applied, incorporating published
language skills than those who addressed the following question: filters for controlled trials and
are also exposed to sign language, Do children with hearing loss have other study designs.25,26 In addition,
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2 FITZPATRICK et algray literature websites (A.G. Bell Relevancy of papers was assessed screened all potentially relevant
Association for the Deaf, National based on the components of the full-text articles. Disagreements
Acoustics Laboratory, National intervention described and not on were resolved by consultation and
Health Services UK Newborn Hearing the program label. consensus with a third researcher
Screening Program, CADTH Gray and knowledge-user clinicians as
The comparator of interest was oral
Matters Checklist), conference needed.
language intervention without sign
proceedings (Newborn Hearing
language.
Screening Conference Abstracts 2010 Data Extraction
and 2012), two journals (Ear and Outcomes A study-specific data extraction form,
Hearing and Journal of Deaf Studies finalized with input from knowledge-
Primary outcomes included all
and Deaf Education), and six books27– user clinicians, was developed in
33 were searched. measures of spoken language
including auditory, receptive, and Distiller SR to extract predetermined
expressive language skills (eg, data variables. Items extracted
Eligibility Criteria
vocabulary), speech production, and included (1) study characteristics
Study Designs (citation, year, setting, country,
intelligibility. These outcomes were
The following study designs were selected as clinically relevant based language, publication status, and
included: randomized controlled on a large body of literature.7,33,34 source of funding or other potential
trials; controlled clinical trials and Secondary outcomes included conflict of interest), (2) study design,
other quasi-experimental designs electrophysiologic outcomes (eg, (3) population characteristics (eg,
that include comparator groups; and cortical responses). In addition, any sample size, gender, ethnicity,
prospective and retrospective cohort adverse outcomes (eg, parent stress) etiology, age, severity of hearing
studies. were noted. loss, hearing technology, and time
with hearing technology), (4)
Population Time Frame details (type) of intervention, (5)
Studies were eligible for inclusion if We included studies from 1995 details of comparison groups, and
they included children (1) with early- onward to capture studies after (7) outcome data. One researcher
onset (before age 3 years) hearing wide implementation of cochlear extracted data and a second
loss of any severity using hearing implantation and newborn hearing researcher independently verified
aids and/or cochlear implants; (2) screening. Earlier studies were data. Discrepant and unclear data
receiving early intervention (age excluded, as previous generations of were resolved through consensus
≤3 years); and (3)bias, study design, confounders, Evaluation (GRADE) working group38 in tabular and narrative form. A
blinding, data collection methods, to rate the quality of the overall meta-analysis was not possible due
withdrawals and dropouts, integrity body of evidence for each outcome. to heterogeneity in designs, methods,
of intervention, and study analysis. Primary outcomes were assessed and outcome metrics. A narrative
One researcher conducted the quality across the domains of risk of bias, synthesis and table summary of
assessment after 2 studies were consistency, directness, precision, data were therefore completed. We
first assessed by 2 researchers, and and publication bias. GRADE results present continuous outcomes as
the second verified the remaining in a rating of the quality of the body mean differences (MDs) with 95%
assessments. A third researcher of evidence as high (very confident confidence intervals, where possible.
with content expertise rechecked all that true effect is close to the effect Planned subgroup analyses to
ratings and discussed any differences estimate), moderate (moderately examine variables related to hearing
to reach consensus. confident), low (limited confidence), loss severity, age of identification,
or very low (little confidence). and hearing technologies could not
Grading Strength of Evidence be conducted owing to the lack of
Data Synthesis studies.
We applied methodology developed
by the Grades of Recommendation, We summarized the characteristics of
Assessment, Development, and study populations and interventions RESULTS
We identified 432 records through
database searching and 113 records
through other sources, of which 470
were retained for screening after
duplicates were removed. Figure 1
outlines the flow of records through
the screening process. We assessed
352 full-text documents. As shown,
the primary reasons for exclusion
were (1) not a study design (58%)
and (2) not an intervention of
interest (32%). Eleven unique studies
were included.
Study Characteristics
Table 1 summarizes the study
characteristics. All were prospective
cohort studies published between
1999 and 2013, 4 since 2004. The
majority (n = 8) were conducted in
the United States,32,39–45 and one each
was conducted in Spain,46 the UK,47
and Denmark.48 Three studies44,46,47
were conducted specifically to
examine whether signs added to
spoken language intervention (sign
+ oral) improved outcomes. The
remaining studies evaluated hearing
technology or provided data about
language intervention as 1 of several
predictor variables in the analysis.
Participants and Interventions
Study size for reported outcomes
FIGURE 1 ranged from 13 to 90 participants.
Study selection. It is not possible to rule out overlap
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4 FITZPATRICK et alTABLE 1 Characteristics of Included Studies Study, Year, Design Main Study Objective and Participants, Age, Hearing Loss, Other Intervention Comparator Study Quality Country Setting Characteristics Miyamoto et al, Cohort To examine speech n = 14 for review, NR by group; CI; only TC: combined use OC Weak 1999, US39 perception, speech children implanted
TABLE 1 Continued
Study, Year, Design Main Study Objective and Participants, Age, Hearing Loss, Other Intervention Comparator Study Quality
Country Setting Characteristics
Nicholas and Cohort To examine whether n = 76, 38 SC, 38 OC (OC from SC: emphasizes OC: emphasizes Moderate
Geers, 2003, deaf children who have previously published study); age: the combination of the auditory signal
US44 the addition of signs 18–54 mo; age tested: 18–54 mo; group spoken language with or without
show an early linguistic scores reported at 18–30 mo (n = 16 with corresponding visual cues from
advantage and greater per intervention group) and 36–54 mo manual signs speaker’s lips
communicative function (n = 22 per intervention group); HL:
maturity than those with better-ear PTA threshold ≥80 dBHL,
spoken language input 103.21 vs 104.41 dBHL; HA: 27 vs 30; CI: 7
only; to examine whether vs 5; tactile aid: 0 vs 3; no device: 4 vs 0;
deaf children who age onset: birth (n = 34 vs 33) and 1–18
receive speech and sign mo (n = 4 vs 5); age diagnosis: 10.42 vs
lag behind children in OC 12.03 mo; maternal education: 14.14 vs
in their use of speech in 14.71 y; duration CI: 7.5 (n = 7) vs. 3.8
preschool mo (n = 5)
Connor and Cohort To examine the effects n = 91, 43 TC, 48 OC; 49.45% male; CI; TC: use of sign OC: use of spoken Weak
Zwolan, 2004, of multiple variables age: 11.16 ± 2.83 vs. 10.81 ± 2.53 y (for language in language only
US45 (SDT, age, SES, reading evaluation); age pre–post combination with
communication method, vocabulary tests: NR; HL: >80 dBHL; age spoken language;
pre- and postimplant onset: 0.12 vs 0.19 y; age CI: 7.40 vs 6.23 sign systems based
vocabulary) on reading y; duration CI: 3.82 ± 1.56 vs. 4.63 ± 2.51 on English, including
comprehensionb y; HL-SDT: 55.22 vs 51.72 Signed English and
(pre- and postimplant Signing Exact English
vocabulary scores were
reported by group)
Jiménez et al, Cohort To compare speech/ n = 18, NR by group; 61.11% male; CI; Bilingual: spoken + Monolingual: Moderate
2009, Spain46 language development age: mean 6.25 y, range 4 y 3 mo to sign language spoken language
after CI in children 8 y; HL: profound; groups similar for
educated using spoken gender, age (avg 6.25 y), age diagnosis
language versus spoken (avg 10 mo), age CI (avg 3.2 y), duration
and sign language CI (avg 3.1 y) (P > .05 for all)
Nittrouer, 2010, Cohort To explain the n = 118, 44 sign support, 74 spoken Spoken + sign Spoken language Moderate
US32 contributions of various language; 55% male; early-identified support; 28 of 44
independent measures (6 parents used ASL and
to developmental mo) n = 15 vs 26; age: 12–48 mo; tested 16 a manually coded
outcomes for children at 6-mo intervals; n varied per interval: English system;
with hearing loss, 1 of 16 (12 mo) to 90 (48 mo); HL: moderate parents reported
which was sign support to profound; 38 HA, 80 CI by end of using signsof participants in some studies; for therapy (Table 2). Most studies (n = authors did not report scores
example, 339,42,43 from 1999 to 2002 10) reported multiple outcomes of separately by group but concluded
included a subset of children from 1 interest, whereas 1 study41 reported that not using total communication
US cochlear implant program. Eight speech perception only (Table 3). As was 1 factor associated with greater
studies included only children with shown in Table 2, different metrics odds of age-equivalent receptive
severe to profound deafness who had (eg, standard score, raw score, age vocabulary.
received cochlear implants. The 3 equivalency, language quotient) were
remaining studies included a mix of reported in different studies. Studies Three studies also reported results
children with respect to technology also reported variations in test for expressive vocabulary. The
use.32,44,47 As shown in Table 1, administration. In 1 study, Spanish Danish study48 examined expressive
authors used various descriptions test versions (which authors reported vocabulary using a Danish norm–
and terms to describe both the as validated) were administered.46 referenced test but found no effect of
intervention (eg, sign, bilingual) and Danish test adaptations48 were intervention mode. The US preschool
comparator (oral, spoken language) used with American norms in study32 found that expressive
groups. another study except for the vocabulary results favored oral
expressive vocabulary test, which intervention only for late-identified
Quality Assessment was developed and standardized in children (>12 months) and showed
Study quality and scores are shown Danish. As noted in Table 1, tests no significant effects of intervention
in Table 1. Studies were rated as were administered in the child’s for early-identified children (8
TABLE 2 Summary of Evidence and GRADE Ratings
Outcome Measure, Test, and Length of Follow-Up Sign + Oral vs Oral Onlyb Studies (Participants) Effect Estimatec Statistical Information Quality of Evidencee
or Test Agea Provided by Authord
Language
PPVT39,42,46,48 Very low
Unknown39,42f,g In 2 studies, mean LQ 0.30–0.72 vs 2 (28) MD (no CI): −0.02 to 0.10 NS for both studies
0.32–0.62
Mean 5.4 y46h Mean standard score 66.9 vs 73.6 1 (18) MD (no CI): −6.7 NS (P > .05)
Mean 3.2 y48h (range 6 to >36 mo) Scores NR by group; reported as 1 (68) OR estimated to be P = .012 (favors oral)
odds of having age-equivalent infinity by authors
vocabulary
Viborgmaterialet48 (Danish vocabulary) Very low
Mean 3.2 yh (range 6 to >36 mo) Scores NR by group; reported as 1 (49) OR not reported NS
odds of having age-equivalent
vocabulary
Picture Vocabulary Test/EOWPVT45i Very low
Unknown45f,g Pre- and postimplant scores 1 (91) MD (no CI): 7.48 to 13.46 NS preimplant (P > .05);
66.54–74.60 vs 53.08–67.12 postimplant NR
EOWPVT32j Very low
3.5 y (early id), 2–3 y (late id)32k; test age: Raw score: 32.89 ± 8.76 vs 32.18 1 (early: 52; late: 38) MD-early (95% confidence Early id: NS; late id: P = .002
48 mo ± 10.81 (early id); 21.50 ± 13.40 vs interval): 0.71 (−4.72 to (favors oral)
32.12 ± 7.86 (late id) 6.14); MD-late: −10.62
(−18.78 to −2.45)
Reynell-R39,40,42,43,48 Very low
Unknown39,42,43g Mean LQ 0.61–0.89 vs 0.64–0.91 3 (69) MD (no CI): −0.02 to NS for all studies
−0.03
Unknown40g Mean 8- vs 9-mo increase in 1 (23) MD (no CI): −1-mo NS
language age (no CIs) language age
Mean 3.2 y, unknown by group48 Scores NR by group; odds of age- 1 (71) OR estimated to be P = .013 (favors oral)
equivalent language infinity by authors
Reynell-E39,40,42,43 Very low
Unknown39,42,43g Mean LQ 0.51–0.68 vs 0.69–0.93 3 (69) MD (no CI): −0.02 to 1 NS41; 1 NR42; 1 significant38
−0.26
Unknown40g Mean 7- vs 10-mo increase in 1 (23) MD (no CI): −3-mo NS
language age language age
ITPA (Spanish) Auditory Reception46 Very low
5.4 y Mean standard score 34.6 vs 56.0 1 (18) MD (no CI) −21.4 Significant
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ITPA (Spanish) Auditory Association46 Very low
5.4 y Mean standard score 37.8 vs, 71.6 1 (18) MD (no CI) −33.8 Significant
ITPA (Spanish) Auditory sequential memory46 Very low
5.4 y Mean standard score 44.8 vs 59.0 1 (18) MD (no CI)−14.2 NS
ITPA (Spanish) Verbal Expression46 Very low
5.4 y Mean standard score 52.5 vs 39.2 1 (18) MD (no CI 13.3 Significant
ITPA (Spanish) Grammatical closure46 Very low
5.4 y Mean standard score 39.2 vs 71.3 1 (18) MD (no CI)−32.1 Significant
ICAP (Spanish) Social communication46 Very low
5.4 y Mean standard score 38.75 vs 53.0 1 (18) MD (no CI): −14.25 NS
Auditory Comprehension-PLS-432j Very low
FITZPATRICK et alTABLE 2 Continued
Outcome Measure, Test, and Length of Follow-Up Sign + Oral vs Oral Onlyb Studies (Participants) Effect Estimatec Statistical Information Quality of Evidencee
or Test Agea Provided by Authord
3.5 y (early id), 2–3 y (late id)k; test age: Mean raw score: 45.39 ± 8.82 vs 1 (early: 52; late: 38) MD early id (95% Early id: NS,j P = .011 (favors
48 mo 42.59 ± 10.02 (early id); 35.92 ± confidence interval): oral)
12.80 vs 43.73 ± 8.59 (late id) −2.80 (−5.48 to 5.08);
MD late id: −7.81 (−15.76
to 0.14)
Language Comprehension–SIB- R32j Very low
3.5 y (early id), 2–3 y (late id)k; test age: Mean raw score: 19.78 ± 2.78 vs 1 (early: 52; late: 38) MD early id (95% Early id: NS; late id: NS
48 mo 19.15 ± 3.46 (early id); 19.83 ± 4.71 confidence interval): 0.63
vs 18.12 ± 3.43 (late id) (−1.10 to 2.36); MD late
id: 1.71 (−1.26 to 4.68)
Language Expression - SIB-R32j Very low
PEDIATRICS Volume 137, number 1, January 2016
3.5 y (early id), 2–3 y (late id)k; test age: Mean raw score: 28.56 ± 1.89 vs 1(early: 52; late: 38) MD early id (95% Early id: NS; late id: P = .012
48 mo 27.03 ± 3.59 (early id); 23.42 ± 6.80 confidence interval): 1.53 (favors oral)
vs 26.88 ± 3.19 (late id) (0.04 to 3.01); MD late id:
−3.46 (−7.49 to 0.57)
Number of spoken words-LDS32j Very low
3.5 y - early-id; 2-3 y - late-id groupk Test Mean: 185.79 ± 103.19 vs 157.08 ± 1 (early: 51 late: 16) MD early id (95% Early id: similar number of
age: 30 mo 104.56 (early id); 38.75 ± 29.64 vs confidence interval): words; late id: sign had fewer
122.25 ± 69.34 (late id) 28.71 (−34.98 to 92.40); words (author report)
MD late id: −83.5
(−132.31 to −34.68)
BLADES47 Very low
Unknown Delay 6–24 vs 12–24 mo 1 (13) See next column No difference between groups
(author report)
Number of different words (sign or spoken)44 Very low
Rangel 7.6–19.6 mo (sign + oral), 6–18 mo Mean 13.88 ± 17.55 vs 2.65 ± 5.87 1 (76) MD (95% confidence NS
(oral); test age 18–30 mo words interval): 11.23 (5.35 to
17.11)
Rangel 25.6–43.6 (sign + oral), 24–42 mo Mean 45.50 ± 29.08 vs 38.90 ± 3.96 1 (76) MD (95% confidence NS
(oral); test age: 36–54 mo words interval): 6.60 (−2.73 to
15.93)
Words per utterance (sign or spoken)44 Very low
Test age 18–30 mo Mean 0.99 ± 0.44 vs 0.31 ± 0.5 1 (76) MD (95% confidence Significant
words interval): 0.68 (0.47 to
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0.89)
Test age 36–54 mo Mean 1.25 ± 0.18 vs 1.33 ± 0.36 1 (76) MD (95% confidence NS
words interval): −0.08 (−0.21
to 0.05)
Total number of spoken words44 Very low
Test age 18–30 mo Mean 3.56 ± 5.19 vs 5.47 ± 14.1 1 (76) MD (95% confidence NS
words interval): −1.91 (−6.69
to 2.87)
Test age 36–54 mo Mean 23.09 ± 33.03 vs 117.88 ± 1 (76) MD (95% confidence NS
207.75 words interval): −94.79 (−161.67
to −27.91)
910
TABLE 2 Continued
Outcome Measure, Test, and Length of Follow-Up Sign + Oral vs Oral Onlyb Studies (Participants) Effect Estimatec Statistical Information Quality of Evidencee
or Test Agea Provided by Authord
Number of different words spoken44 Very low
Test age 18–30 mo Mean 2.62 ± 3.59 vs 1.94 ± 4.29 1 (76) MD (95% confidence NS
words interval): 0.68 (−1.10 to
2.46)
Test age 36–54 mo Mean 12.91 ± 17.38 vs 38.67 ± 44 1 (76) MD (95% confidence Significant
words interval): −25.76 (−40.80
to −10.72)
PIHF44 Very low
Test age 18–30 mo Mean 0.23 ± 0.2 vs 0.04 ± 0.12 1 (76) MD (95% confidence Significant
words interval): 0.19 (0.12 to
0.21)
Test age 36–54 mo Mean 0.46 ± 0.17 vs mean 0.34 ± 1 (76) MD (95% confidence Significant
0.21 words interval): 0.12 (0.03 to
0.21)
ICA44 Very low
Test age 18–30 mo Mean 41.56 ± 35.71 vs 36.76 ± 1 (76) MD (95% confidence NS
35.68 words interval): 4.80 (−11.27 to
20.87)
Test age 36–54 mo Mean 121 ± 75.25 vs 131.67 ± 70.79 1 (76) MD (95% confidence NS
words interval): −10.67 (−43.52
to 22.18)
Speech
BIT39 Very low
Unknown 10.57% vs 30.62% correct words 1 (14) MD (no CI) −20.05 Significant
identified by listener
CSIM32 Very low
3.5 y (early id), 2–3 y (late id)k; test age: Mean: 58% ± 19% vs 57% ± 17% 1 (early: 49 late: 36) MD early id (95% Early id: NS; late id: P < .001
48 mo (early id); 46% ± 25% vs 59 ± 16% confidence interval): 1.0 (favors oral)
(late id) words recognized by (−9.78 to 11.78); MD late
listener id: −13.0 (−29.05 to 3.05)
Induced Phonological Register (Spanish)46 Very low
5.4 y Mean standard score 30 vs 60 1 (18) MD (no CI): −30 Significant (P < .05) (favors
oral)
Speech Perception
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Mr. Potato Head-Words39,41–43 Very low
Unknown Mean % correct 24%–56% vs 4 (105) MD (no CI): −9 to −39% 1 NS40; 1 NR42; 2 significant38,41
33%–95% (no CI)
Mr. Potato Head – Sentences39 Very low
Unknown Percent correct 39.76% vs 69.88% 1 (14) MD (no CI): −30.12% Significant
ESP-Low Verbal41 Very low
Unknown Percent correct 82% vs 90% 1 (36) MD (no CI): −8% Significant
GAEL-P Words recognized39,42 Very low
Unknown Percent correct 46%–87.38% vs 2 (28) MD (no CI): −7% to −9.3% Significant38,41
53%–96.68%
GASP-W41 Very low
FITZPATRICK et alTABLE 2 Continued
Outcome Measure, Test, and Length of Follow-Up Sign + Oral vs Oral Onlyb Studies (Participants) Effect Estimatec Statistical Information Quality of Evidencee
or Test Agea Provided by Authord
Unknown Percent correct 50% vs 63% 1 (36) MD (no CI): −13% Significant
PBK-Words41 Very low
Unknown Percent correct 20% vs 24% 1 (36) MD (no CI): −4% Significant
PBK-Phonemes41 Very low
Unknown Percent correct 29% vs 50% 1 (36) MD (no CI): −21% Significant
BIT, Beginner’s Intelligibility Test; BLADES, Bristol Language Developmental Scales; CI, confidence interval; CSIM, Children’s Speech Intelligibility Measure; EOWPVT, Expressive One Word Picture Vocabulary Test; ESP, Early Speech Perception; GAEL,
Grammatical Analysis of Elicited Language (used as closed-set speech perception measure); GASP, Glendonald Auditory Screening Procedure; ICA, intentionally communicative act; ICAP, Inventory for Client and Agency Planning; ITPA, Illinois Test of
Psycho-linguistic Abilities; LDS, Language Development Survey; id, identified; LQ, language quotient; MD, mean difference; NR, not reported; NS, not statistically significant; OR, odds ratio; PBK, Phonetically Balanced Kindergarten Test; PIHF, Proportion
of Informative or Heuristice Functions; PLS, Preschool Language Scale; PPVT, Peabody Picture Vocabulary Test; SIB-R, Scales of Independent Behavior-Revised
a Follow-up measured from time of intervention.
b Outcomes data; higher score = better performance.
PEDIATRICS Volume 137, number 1, January 2016
c Minus sign (−) indicates higher score in oral group.
d No meta-analysis due to insufficient data and different metrics reported; statistics reported are those from authors.
e Based on GRADE ratings.
f Length of follow-up (from diagnosis of hearing loss) with language intervention of interest is unknown. Studies39–43,45 report duration of cochlear implant use and age at assessment (details in Table 1).
g Authors stated that language measures were adapted and administered in child’s preferred communication modality. signed and spoken responses accepted,45 or instructions given nonverbally and certain vocabulary considered less likely to
be known by children using sign was removed.32
h Calculated based on information provided in article.
i Picture Vocabulary Test (PVT) of the Woodcock Johnson Test of Cognitive Ability or EOWPVT administered preimplant; PVT postimplant.
j Study reports 25 different language scores at 6-mo test intervals from 12 to 48 mo; table includes 6 clinically relevant test measures that reflect overall findings at last test age (5 standardized language measures and 1 speech intelligibility
measure). Remaining results (not shown in table) relate to specific aspects of language from language sample analysis (e.g., number of responses, number of pronouns): for early-identified children, 18 results showed no statistically significant
differences and 1 favored oral intervention; for late-identified children, 14 results favored oral intervention. Statistical information provided is based on authors’ report of simple effects analysis (signs, prosthesis, test age) for early- and late-
identified hearing loss.
k Calculated based on early group identified at 12 mo of age up to 24 mo of age. Results for last test age reported.
l Calculated from age of diagnosis and test age range; applies for all measures for study.44
test.
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comprehension only.
statistical significance.
language intervention to be
subtest only. One additional
Various subtest scores were
version of the Illinois Test of
study from the UK47 (n = 13)
for 2 standardized measures
preschool study32 consistently
Three additional studies32,46,47
language intervention reached
of intervention compared with
measures, all yielding different
American norms of the Reynell
using a Danish adaptation with
also reported in the study of 18
2002. According to the authors,
comprehension measure but no
The same 4 US cochlear implant
intervention for early-identified
for late-identified children, with
there were no significant effects
children46 that used the Spanish
quotients, and 1 study, language
reported no significant effects of
children at 48 months. However,
Psycholinguistic Abilities (ITPA).
results. As shown in Table 1, a US
results favoring oral intervention
received cochlear implants before
for expressive language measured
The authors reported significantly
receptive and expressive language
receptive subtest reported spoken
language–only group. Mean scores
higher standard scores in auditory
reported language outcomes using
the study produced mixed findings
Only 1 study39 that favored spoken
did not report expressive language.
grammatical closure for the spoken
reception, auditory association, and
statistically significant, for language
age scores). Only the Danish study48
on another language comprehension
were significantly higher for the sign
by the Reynell test. The Danish study
studies also reported similar findings
+ oral group on the verbal expression
significant difference in interventions
controls (3 studies reported language
(expressive language) and 1 language
provided results for a variety of other
11developmental scales to measure development. A study by Nicholas sign + oral group at 18 to 30 months;
expressive language in the areas of and Geers44 reported findings for 2 number of different words spoken,
pragmatics, semantics, and syntax. age groups, 18 to 30 months and 36 which favored the oral group at 36
The authors reported delays ranging to 54 months, for 38 children who to 54 months; and the Proportion of
from 6 to 24 months in both groups received sign + oral intervention Informative or Heuristic Functions,
and concluded that intervention did and compared results to a historical which favored sign + oral in both age
not influence outcomes. cohort of 38 children in oral language groups. Of the 19 natural language
intervention. As shown in Table 2, results reported in the Nittrouer32
Language Results: Natural Language
of 12 different results, statistically study, 18 showed no statistically
Sample Analysis
significant differences were reported significant difference for early-
Finally, 2 studies reported scores for only for words per utterance (sign identified children (18 of 51 had sign
various aspects of communication or spoken words), which favored the + oral), whereas 1 measure (number
TABLE 3 Overview of Outcome Measures for All Included Studies
Measure/tool Study, reference no. Sign + Oral Oral
39 40 41 42 43 47 44 45 46 32 48
PPVT1 • • • • 1
Viborgmaterialeta •
PVT/EOWPVT • • 1b
Reynell Receptive • • • • • 1
Reynell Expressive • • • • 1
ITPAc Auditory Reception • 1
ITPA Auditory Association • 1
ITPA Auditory Sequential Memory •
ITPA Verbal Expression • 1
ITPA Grammatical Closure • 1
ICAP •
PLS-4 Auditory Comprehension • 1b
Language Comprehension SIB-R •
Language Comprehension SIB-R • 1b
BLADES Expressive •
Number of different wordsd • •
Words per utteranced • 1
Total number of spoken wordsd •
Number of different words spokend • 1
PIHFd • 2
Intentionally communicative actsd •
Language-11 communication actse • 7f
Language–5 grammar/syntaxe • 5b
Language-3 vocalizationse • 2b
Beginner’s Intelligibility Test • 1
CSIM • 1b
Induced Phonological Register • 1
Mr. Potato Head—Words • • • • 2
Mr. Potato Head—Sentences • 1
ESP-Low Verbal • 1
GAEL-P Wordsg • • 2
GASP—Words • 1
PBK—Words • 1
PBK—Phonemes • 1
Total 4 36
Numbers in boxes refer to number of studies reporting statistical significance for sign + oral or oral group. BLADES, Bristol Language Developmental Scales; CSIM, Children’s Speech
Intelligibility Measure; ESP, Early Speech Perception; EOWPVT, Expressive One Word Picture Vocabulary Test; GAEL-P, Grammatical Analysis of Expressive Language: Presentence Level; GASP,
Glendonald Auditory Screening Procedure; ICAP, Inventory for Client and Agency Planning; Lang, language; PBK, Phonetically Balanced Kindergarten Test; PLS-4, Preschool Language Scale;
PVT, Picture Vocabulary Test of the Woodcock Johnson Test of Cognitive Ability; SIB-R, Scales of Independent Behavior-Revised.
a Danish version of test.
b Nittrouer32 reported significant difference for late-identified sign group only; results for early-identified group were not significant.
c Spanish version of ITPA for all subtests.
d Results for 2 age groups (18–30 mo and 36–54 mo for each measure in this study43).
e Various aspects of communication/language reported from analyses of language samples (e.g., number of responses, total words, number of pronouns, jargon).
f Both early- and late-identified groups showed significant difference for 1 communication act (number of inquiries); 6 others showed significance for late-identified group only.
g GAEL-P administered as closed-set speech perception test.
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12 FITZPATRICK et alof inquiries made by child) favored significant results for sign + oral and expressive language outcomes.
oral intervention. However, results intervention and 36 for oral language Three studies addressing speech
were markedly different for the late- only (9 related to speech perception, significantly favored oral language
identified children (12 of 37 had sign 17 for late-identified group in US therapy only (except 1 early-
+ oral), in whom 14 of 19 results preschool study32). identified group32). Closed-set speech
favored oral intervention. perception studies mostly favored
spoken language only, whereas
We retrieved only 1 study that
DISCUSSION open-set speech perception studies
addressed other aspects of language
statistically favored spoken language
functioning considered relevant to There continue to be questions about
but with small clinical significance.
this review. Using the Inventory for the advantages or disadvantages
The majority of studies were
Client and Agency Planning, Jiménez of adding sign language to
methodologically weak, with a few
et al46 reported no significant interventions focused on spoken
scoring a moderate rating. However,
differences between groups in social language development in children
when rated according to GRADE
communication skills. with hearing loss. This review found
criteria, the overall quality of the
that few studies have systematically
Speech Results evidence per outcome is very low.
addressed the issue. Eight of the
Three studies addressed aspects 11 studies in this review included According to GRADE, cohort studies
of speech production, 2 related to only children with severe to are initially considered as low quality
speech intelligibility32,39 and 1 to profound deafness who were using before applying the assessment
phonological production.46 In 2 cochlear implants. This is likely criteria, as they are at a greater
studies,39,46 scores were significantly because many children received risk of bias, generally. The risk of
better for the oral intervention preimplant intervention with a bias for the body of evidence for
groups based on author reports, signing component in addition outcomes was deemed to have
whereas in the US preschool study,32 to spoken language, owing to the serious limitations. The overall
scores were significantly better profound nature of hearing loss, quality of evidence for each outcome
for oral intervention in the late- particularly in the 1990s when we assessed was limited because of
identified but not early-identified cochlear implantation was a new the small number of included studies,
children. option. Evidence to address the issue which resulted in low ratings for the
for children with less than profound precision of results and an inability
Speech Perception degrees of hearing loss is severely to assess for consistency. There was
Four cochlear implant studies39,41–43 lacking, as this review retrieved only also considerable variation in the
(1999 to 2002) specifically 3 studies32,44,47 that included children measurements of outcomes, which
investigated speech perception and with hearing loss using hearing aids. made comparison across studies
included 3 closed-set measures difficult. Furthermore, the full
Measures of language development,
(response selected from defined process of care from time of diagnosis
including receptive vocabulary
word set) and 2 open-set measures is unknown, as is whether crossover
and receptive and expressive
(no word set available). All scores interventions occurred. Therefore,
language skills, contributed the most
were significantly better for the oral additional studies in contemporary
information to this review. When
group, with the exception of 1 closed- cohorts of children are needed to
comparing sign and oral language
set test (Mr. Potato Head, words) in supplement the evidence base. Most
intervention with oral language
141 (n = 36) of the 4 studies, which studies were conducted before
intervention alone, individual
was not statistically significant. 2002 with children with severe to
studies showed no differences
However, for open-set monosyllabic profound deafness and therefore may
between groups for receptive and
words, the differences were clinically not reflect current practice, in which
expressive vocabulary outcomes,
small despite statistical significance children with congenital deafness
with the exception of 1 study’s32
(eg, 20% vs 24%). No speech are likely to be identified and receive
results that favored oral intervention
recognition measures were reported early intervention well before 1 year
only for late-identified children
for children with hearing aids. of age. Accordingly, new information
(n = 12 in sign group). However,
about the effects of intervention
Table 3 provides an overview of a variety of measures and metrics
in children across the spectrum
measures extracted in the included were used across studies that limit
of hearing loss severity has the
studies and the interventions that the generalizability of the evidence.
potential to change the conclusions.
showed statistically significant Overall, mixed results of statistical
differences. Of 61 total test scores significance and no differences were Since completing our review, we
reported, only 4 showed statistically observed in studies for receptive are aware of 1 recent retrospective
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PEDIATRICS Volume 137, number 1, January 2016 13cohort study conducted in Australia that include comparator groups outcomes and reporting metrics
with young children who used since previous reviews.51,52 Despite would be very useful in comparing
cochlear implants that compared a strong conclusions based on expert future study results.
sign and oral language intervention opinion and intervention results There is insufficient information to
group (n = 10) with 2 oral without comparator groups, this guide parents about contemporary
intervention groups (auditory-oral, n review indicates that very limited, cohorts of children who have
= 14, and auditory-verbal, n = 18).50 and hence insufficient, evidence benefited from early detection and
No significant differences in receptive exists to determine whether adding early access to hearing technology.
vocabulary, auditory comprehension, sign language to spoken language is The field would gain from carefully
or expressive language were found more effective than spoken language controlled prospective studies with
across the 3 groups after controlling intervention alone to foster oral today’s children.
for confounders such as age of language acquisition.
hearing loss management and family
involvement in the intervention APPENDIX 1: MEDLINE SEARCH
program. These results are aligned CONCLUSIONS STRATEGY
with the overall findings of our MEDLINE
review and would not change the This review showed that there
1. exp Hearing Loss/
conclusions. are important gaps in knowledge
concerning the effectiveness of sign 2. (hearing adj (loss or impair$ or
Limitations
and oral language intervention, disorder*)).tw.
Despite a comprehensive search compared with oral language 3. deaf$.tw.
by an information specialist, it is intervention only, for children with
possible that some studies were 4. (prelingual$ or pre-lingual$).tw.
hearing loss when spoken language
not included owing to the range is the intended outcome. To date, 5. (sensorineural$ or sensori-
of descriptions of intervention there is no evidence that adding neural$).tw.
methods. During study selection, sign language facilitates spoken 6. congenital.mp.
program descriptions were language acquisition. However, this
sometimes difficult to discern. For 7. or/1-6
review also found no conclusive
example, it was difficult to know evidence that adding sign language 8. auditory verbal.tw.
whether interventions included the interferes with spoken language 9. ((speech or auditory) adj2
same level of emphasis on spoken development. Overall, the literature feedback).tw.
language when sign language was related to intervention methods
added. Although we contacted 10. cued speech.tw.
for children with hearing loss lacks
authors for clarity of interventions properly designed cohort studies 11. (listen* and (spoken or speak*)).
and outcomes, we did not contact of today’s generation of children. tw.
them for additional sample It will be important to conduct 12. oral approach$.tw.
characteristics or statistical data. A more research to supplement this
further important limitation is that 8 evidence base and to update this 13. aural.tw.
of the 11 studies, although meeting review as those studies become 14. Lipreading/
inclusion criteria, were not designed available. Given the current context 15. (lipread$ or lip read$ or
to directly examine the central of widespread neonatal screening, speechread$ or speech read$).
question of this review. data can be collected prospectively tw.
from diagnosis, allowing for more
Implications for Practice 16. or/8-15
accurate data regarding onset,
Although the question of intervention severity, and changes in hearing loss, 17. Manual Communication/ or Sign
effectiveness and specifically the as well as specific characteristics and Language/
contribution of sign language changes related to intervention, than 18. (sign$ language or sign$ english).
combined with oral language is was possible for study participants tw.
longstanding, there is strikingly in this review. Interventions should
limited new research to guide be reported with specific detail, and 19. ASL.tw.
clinical or policy decision-making. if definitions can be developed and 20. visual language.tw.
The question of the contribution of adopted on an international level, 21. (baby sign or infant sign).tw.
sign language to the development of comparisons of similar programs
spoken language remains elusive, and would be more feasible. In addition, 22. or/17-21
there has been little growth in studies agreement on a common set of core 23. Communication Methods, Total/
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14 FITZPATRICK et al24. total communication.tw. 39. ((consecutive or clinical) adj2 45. 42 and (child* or adolescent or
25. simultaneous communication.tw. case$).tw. infan*).mp.
26. (multilingual or multi-lingual). 40. ((control$ or intervention or 46. 44 or 45
tw. evaluation or comparative or
effectiveness or evaluation or 47. limit 46 to yr=”1985 -Current”
27. (bicultural or bi-cultural).tw. feasibility) adj3 (trial or studies
28. (bilingual or bi-lingual).tw. or study or program or design)).
29. bi bi.tw. tw. ACKNOWLEDGMENTS
30. or/23-29 41. or/31-40 We thank Margaret Sampson, MLIS,
31. exp clinical trial/ 42. 7 and ((16 and 22) or 30) and 41 PhD, AHIP (Children’s Hospital of
43. 42 and ((Infan* or newborn* Eastern Ontario), for developing the
32. clinical trial.pt. or randomized. electronic search strategies and Janet
ti,ab. or placebo.ti,ab. or or new-born* or perinat* or
neonat* or baby or baby* or Joyce, MLIS, for peer review of the
randomly.ti,ab. or trial.ti,ab. or MEDLINE search strategy. We also
groups.ti,ab. babies or toddler* or minors
or minors* or boy or boys or thank Pauline Quach for assistance
33. ((control$ or clinical or boyfriend or boyhood or girl* with the quality assessment.
comparative$) adj2 (trial$ or or kid or kids or child or child*
stud$)).mp. or children* or schoolchild*
ABBREVIATIONS
34. exp Epidemiologic studies/ or schoolchild).mp. or school
or Case-control studies/ or child.ti,ab. or school child*.ti,ab. ASL: American Sign Language
Retrospective studies/ or Cohort or (adolescen* or juvenil* or GRADE: Grades of
studies/ or Longitudinal studies/ youth* or teen* or under*age* Recommendation,
or Cross-sectional studies/ or pubescen*).mp. or exp Assessment,
pediatrics/ or (pediatric* or Development, and
35. between group design$.mp.
paediatric* or peadiatric*).mp. Evaluation
36. control group$.mp. or school.ti,ab. or school*.ti,ab. or ITPA: Illinois Test of
37. (cohort stud$ or longitudinal). (prematur* or preterm*).mp.) Psycholinguistic Abilities
mp. MD: mean difference
44. limit 43 to (“in data review”
PPVT: Peabody Picture
38. (case adj2 (series or control$)). or in process or “pubmed not
Vocabulary Test
mp. medline”)
was involved in extracting data and quality assessment, conducted the GRADE ratings, assisted with data interpretation; Dr Moher assisted with the development
of the study protocol and consulted on the quality assessment and data interpretation as required; Ms Doucet (a knowledge-user clinician), Dr Neuss (a
knowledge-user clinician), and Ms Bernstein (a knowledge-user clinician) provided input into the inclusion criteria and data abstraction form, helped clarify
data interpretation when needed, and commented on the manuscript; Ms Na verified and provided input into the synthesis tables and made comments on the
manuscript; and all authors approved the final manuscript.
This review is registered at PROSPERO: #CRD42013005426, http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013005426#.VWeaU-vqc6I.
DOI: 10.1542/peds.2015-1974
Accepted for publication Oct 7, 2015
Address correspondence to Elizabeth M. Fitzpatrick, Audiology and Speech-Language Pathology Program, Faculty of Health Sciences, University of Ottawa, 451
Smyth Road, Ottawa, Ontario, Canada K1H 8L1. E-mail: elizabeth.fitzpatrick@uottawa.ca
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2016 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: This systematic review was funded by a Canadian Institutes of Health Research (CIHR) Knowledge Synthesis Grant (FRN-124600). The funding agency
was not involved in developing the protocol and was not involved in any aspect of the review (data collection, analysis, or interpretation) or publications. Dr
Fitzpatrick’s work is also supported by a CIHR New Investigator and a Canadian Child Health Clinician Scientist Program award. Dr Moher holds a University of
Ottawa Research Chair. All researchers are independent from the funding agencies.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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PEDIATRICS Volume 137, number 1, January 2016 15REFERENCES
1. American Academy of Pediatrics, Joint hearing: an international consensus 19. Petitto LA, Zatorre RJ, Gauna K, Nikelski
Committee on Infant Hearing. Year statement. J Deaf Stud Deaf Educ. EJ, Dostie D, Evans AC. Speech-like
2007 position statement: principles 2013;18(4):429–445 cerebral activity in profoundly deaf
and guidelines for early hearing 10. Marschark M, Spencer PE. Spoken people processing signed languages:
detection and intervention programs. language development of deaf and implications for the neural basis of
Pediatrics. 2007;120(4). Available at: hard-of-hearing children: Historical human language. Proc Natl Acad Sci
www.pediatrics.org/cgi/content/full/ and theoretical perspectives. In: USA. 2000;97(25):13961–13966
120/4/e898 Spencer PE, Marschark M, eds. 20. Moher D, Liberati A, Tetzlaff J, Altman
2. Nelson HD, Bougatsos C, Nygren P; Advances in the spoken language DG; PRISMA Group. Preferred reporting
2001 US Preventive Services Task development of deaf and hard-of- items for systematic reviews and
Force. Universal newborn hearing hearing children. New York: Oxford meta-analyses: the PRISMA statement.
screening: systematic review to update University Press; 2006:3–21 BMJ. 2009;339:b2535
the 2001 US Preventive Services Task 11. Durieux-Smith A, Fitzpatrick EM. History 21. Fitzpatrick EM, Stevens A, Garritty C,
Force Recommendation. Pediatrics. of the management of hearing loss Moher D. The effects of sign language
2008;122(1). Available at: www. in children. In: Seewald R, Tharpe on spoken language acquisition
pediatrics.org/cgi/content/full/122/1/ AM, eds. Comprehensive handbook in children with hearing loss: a
e266 of pediatric audiology. San Diego, CA: systematic review protocol. Syst Rev.
3. Fortnum HM, Summerfield AQ, Plural Publishing; 2011:617–629 2013;2:108
Marshall DH, Davis AC, Bamford JM. 12. Thoutenhoofd ED, Archbold SM,
Prevalence of permanent childhood 22. Fitzpatrick EM, Stevens A, Garritty C, et
Gregory S, Lutman ME, Nikolopoulos al. A systematic review of the effects
hearing impairment in the United TP, Sach TH. Paediatric cochlear
Kingdom and implications for of using sign language on spoken
implantation: Evaluating outcomes. language acquisition in children
universal neonatal hearing screening: London: Whurr Publishers Ltd.; 2005
questionnaire based ascertainment with early-identified hearing loss.
study. BMJ. 2001;323(7312):536–540 13. Geers AE, Moog JS, Biedenstein J, PROSPERO 2013:CRD42013005426
Brenner C, Hayes H. Spoken language Available at: www.crd.york.ac.uk/
4. Prieve BA, Stevens F. The New York scores of children using cochlear PROSPERO/display_record.asp?ID=
State universal newborn hearing implants compared to hearing age- CRD42013005426#.VWeaU-vqc6I.
screening demonstration project: mates at school entry. J Deaf Stud Deaf Accessed October 13, 2015
introduction and overview. Ear Hear. Educ. 2009;14(3):371–385
2000;21(2):85–91 23. Mcgowan J, Sampson M, Lefebvre C. An
14. Fitzpatrick EM, Crawford L, Ni A, evidence based checklist for the peer
5. Watkin PM, Baldwin M. Identifying Durieux-Smith A. A descriptive analysis review of electronic search strategies
deafness in early childhood: of language and speech skills in 4- to (PRESS EBC). Evid Based Libr Inf Pract.
requirements after the newborn 5-yr-old children with hearing loss. Ear 2010;5(1):149–154
hearing screen. Arch Dis Child. Hear. 2011;32(5):605–616
2011;96(1):62–66 24. Leclercq E, Leeflang MMG, van Dalen
15. Mitchell R, Karchmer M. Chasing the EC, Kremer LC. Validation of search
6. Kennedy CR, McCann DC, Campbell mythical ten percent: parental hearing filters for identifying pediatric studies
MJ, et al. Language ability after early status of deaf and hard of hearing in PubMed. J Pediatr. 2013;162(3):629–
detection of permanent childhood students in the United States. Sign 634.e2
hearing impairment. N Engl J Med. Lang Stud. 2004;4(2):138–163
2006;354(20):2131–2141 25. Glanville JM, Lefebvre C, Miles JNV,
16. Niparko JK, Tobey EA, Thal DJ, et al; Camosso-Stefinovic J. How to identify
7. Ching TY, Dillon H, Marnane V, et al. CDaCI Investigative Team. Spoken randomized controlled trials in
Outcomes of early- and late-identified language development in children MEDLINE: ten years on. J Med Libr
children at 3 years of age: findings following cochlear implantation. JAMA. Assoc. 2006;94(2):130–136
from a prospective population-based 2010;303(15):1498–1506
study. Ear Hear. 2013;34(5):535–552 26. Scottish Intercollegiate Guidelines
17. Spencer PE, Marschark M. Evidence- Network. Search filters. Available at:
8. Wake M, Poulakis Z, Hughes EK, Carey- based practice in educating deaf and www.sign.ac.uk/methodology/filters.
Sargeant C, Rickards FW. Hearing hard-of-hearing students. New York: html. Accessed June 27, 2013
impairment: a population study of age Oxford University Press; 2010
at diagnosis, severity, and language 27. Spencer PE, Marschark M, eds.
18. Petitto LA, Katerelos M, Levy BG,
outcomes at 7-8 years. Arch Dis Child. Advances in spoken language
Gauna K, Tétreault K, Ferraro V.
2005;90(3):238–244 development of deaf and hard-of-
Bilingual signed and spoken language
hearing children. New York: Oxford
9. Moeller MP, Carr G, Seaver L, Stredler- acquisition from birth: implications
University Press; 2006
Brown A, Holzinger D. Best practices for the mechanisms underlying early
in family-centered early intervention bilingual language acquisition. J Child 28. Brisk ME, Harrington MM. Literacy
for children who are deaf or hard of Lang. 2001;28(2):453–496 and bilingualism: a handbook for all
Downloaded from www.aappublications.org/news by guest on September 16, 2021
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