Lexical and Grammatical Abilities in Deaf Italian

8/3/2019 Lexical and Grammatical Abilities in Deaf Italian

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Lexical and Grammatical Abilities in Deaf Italian

Preschoolers: The Role of Duration of Formal

Language Experience

Pasquale RinaldiIstituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche

Dipartimento di Psicologia Dinamica e Clinica, Universita di Roma Sapienza

Cristina Caselli

Istituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche, Rome, Italy

We evaluated language development in deaf Italian pre-

schoolers with hearing parents, taking into account the du-

ration of formal language experience (i.e., the time elapsed

since wearing a hearing aid and beginning language educa-

tion) and different methods of language education. Twenty

deaf children were matched with 20 hearing children for age

and with another 20 hearing children for duration of expe-

rience. Deaf children showed a significant delay in both

vocabulary and grammar when compared to same-age hear-

ing children yet a similar development compared to hearing

children matched for duration of formal language experi-

ence. The delay in linguistic development could be attribut-

able to shorter formal language experience and not to

deafness itself. Deaf children exposed to spoken language

accompanied by signs tended to understand and produce

more words than children exposed only to spoken language.

We suggest that deaf children be evaluated based on their

linguistic experience and cognitive and communicative

potential.

Deaf children exposed to sign language by deaf parents

acquire it as a first language (Newport & Meier, 1985),

yet around 95% of deaf children have hearing parents,

most of whom are unfamiliar with sign language

(Marschark, Lang, & Albertini, 2002). Deaf children

with hearing parents have consistently revealed a gen-

eral delay in the onset of language, as well as a slower

rate of progression, resulting in poorer linguistic abil-

ities with respect to same-age hearing children (Mayne,

Yoshinaga-Itano, & Sedey, 2000; Mayne, Yoshinaga-

Itano, Sedey, & Carey, 2000; Moeller, 2000; Pizzuto,

Ardito, Caselli, & Volterra, 2001; Volterra, Capirci, &

Caselli, 2001; see Caselli, Maragna, & Volterra, 2006,

for a recent review). In particular, Mayne, Yoshinaga-

Itano, and Sedey (2000) and Mayne, Yoshinaga-Itano,

Sedey, and Carey (2000) studied the vocabulary of

preschool-aged deaf/hard-of-hearing children (2437

months old) with hearing parents using the MacArthur

Bates Communicative Development Inventories

(CDI; Fenson et al., 1993), a questionnaire filled in

by parents which is widely used for both clinical and

research purposes (Dale, Bates, Reznick, & Morisset,

1989) and which was recently validated for children

with hearing loss (Mayne, Yoshinaga-Itano, & Sedey,

2000; Mayne, Yoshinaga-Itano, Sedey, & Carey, 2000),

including those with a cochlear implant (CI; Stallings,

Gao, & Svirsky, 2002; Thal, DesJardin, & Eisenberg,

2007). The study of Mayne, Yoshinaga-Itano, Sedey,and Carey (2000) showed that deaf children produced

significantly fewer words than similar-age hearing chil-

dren and that their slower rate of acquisition resulted in

increased differences with age, so that 6-year-old deaf

children generally had a vocabulary comparable to that

of 3-year-old hearing children, independently of the

degree of deafness. Moreover, Lederberg and Spencer

We wish to thank Virginia Volterra and Traute Taeschner for their in-

sightful comments on an earlier version of the paper. We also thank the

Audiology and Speech Therapy Services of the Bambino Gesu Paediatric

Hospital of Rome for their help in recruiting deaf children and Concetta

DAmico, Melissa Franchi, Francesca Moccia, and Cristiana Varuzza for

their help with data collection, transcription, and coding. We are very

grateful to Mark Kanieff for his helpful comments and for the revision of

English. We especially thank the children and parents who participated

in the study. No conflicts of interest were reported. Correspondence

should be sent to Pasquale Rinaldi, Istituto di Scienze e Tecnologie della

Cognizione, Consiglio Nazionale delle Ricerche, Via Nomentana, 56

00161 Rome, Italy (e-mail: [email protected]).

The Author 2008. Published by Oxford University Press. All rights reserved.

For Permissions, please email: [email protected]

doi:10.1093/deafed/enn019

Advance Access publication on June 5, 2008


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(2001) highlighted that deaf children lack a spurt in

vocabulary development, which is characteristic in

hearing children. With regard to the development of

spoken grammar, in the early stages, some deaf and

hard-of-hearing children have age-appropriate gram-

mar skills, whereas others are significantly delayed,

with a slower rate of successive development (Blamey,2003).

So as to compensate for their difficulties in speak-

ing, deaf children, and hearing children with linguistic

disabilities in general, rely more on the use of gestures

than do their peers (Capone, 2007; Goldin-Meadow &

Mylander, 1984; Morford, 1998; Volterra & Erting,

1994). In this light, some language education and/or

rehabilitation programs for deaf children rely on si-

multaneous communication, which consists of the spo-

ken language and the simultaneous use of lexical signs

from the sign language used in the given country, yet

following the grammatical structure of the spoken lan-

guage (in Italy, this form of communication is referred

to as bimodal). In some cases (i.e., to improve the

morphological aspects of speech), the spoken language

may be accompanied by a form of manually coded

language to highlight morphological word endings,

using above all finger spelling, for example, Manually

Coded English (MCE; Bornstein, 1990) or Italiano

Segnato Esatto (Exact Signed Italian; Beronesi,

Massoni, & Ossella, 1991). The supporters of simul-

taneous communication claim that the use of a visual

gestural modality, which is not impaired in deaf

children, may improve the acquisition of spoken lan-

guage. However, studies on the effect of the use of

manually coded systems (mostly MCE) on language

acquisition in deaf children with hearing parents show

discordant results. Some show that deaf children

learning MCE have significantly delayed vocabulary

and grammatical development, compared with hearing

children, whereas others show that vocabulary devel-

opment is similar when compared to that of hearingchildren (Bornstein & Saulnier, 1981; Bornstein,

Saulnier, & Hamilton, 1980; Schick & Moeller, 1992;

see also Schick, 2003, for a review on this topic). The

studies that found delayed vocabulary development

also found that the rate of vocabulary growth was

slower in deaf children with hearing parents compared

to hearing children or deaf children exposed to sign

language since birth. In Italy, no studies have evalu-

ated the effects of the bimodal method on language

acquisition in deaf children, although there are clinical

case reports that show that this method has positive

effects (Massoni & Maragna, 1997).

With regard to the potential factors involved in the

delayed language development of deaf children,Marschark (1995) and Marschark and Clark (1998)

have pointed out that linguistic abilities do not depend

on the degree of hearing loss but are related to differ-

ences in the family, language, and educational environ-

ment (see also Pizzuto et al., 2001). In fact, most

children with high performance levels in language tasks

had parents who were well adjusted to their childs

deafness. The parents actively participated in the

childs education, promoting the childs autonomy

and awareness of the deaf and hearing cultures and

their related languages (sign or speech). In the above-

mentioned study, Mayne, Yoshinaga-Itano, Sedey, and

Carey (2000) reported that the most important factors

related to language development were age at diagnosis

of hearing loss, age at beginning language rehabilita-

tion, and the childs general intellectual skills, demon-

strating how the plasticity of the childs brain and basic

cognitive competence are crucial for successive learn-

ing. Children diagnosed before 6 months of age showed

greater language skills than children diagnosed later,

independently of the level of hearing loss, of the

familys socioeconomic status, and of the method of lan-

guage rehabilitation, as also reported by Moeller (2000).

However, although all the above studies reported

individual variability, few deaf children showed above-

average spoken language skills and most had fallen sig-

nificantly behind their hearing peers (Blamey, 2003).

Although more recent studies have confirmed the

importance of age at diagnosis and at beginning lan-

guage rehabilitation (Yoshinaga-Itano, 2003, 2004), to

the best of our knowledge, none of the studies that

have compared deaf children with traditional hearingaids to hearing children have matched the two groups

in terms of the duration of exposure to language,

which for deaf children begins with the start of formal

language rehabilitation and for hearing children begins

at birth. Instead, this method has on a number of

occasions been used to assess language development

in deaf children with a CI. In fact, to demonstrate

64 Journal of Deaf Studies and Deaf Education 14:1 Winter 2009


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the effectiveness of the CI, which in the past decade

has been provided to many deaf children, language

development has been evaluated not in relation to

the childs age but to the time elapsed since CI activa-

tion, that is, in terms of time postimplant or time of

implant use. The results have shown that the lan-

guage capabilities of these children are not significantlydifferent from those of hearing children whose chro-

nological age corresponded to the time postimplant of

the children with the CI (Blamey et al., 2001; Ertmer,

Strong, & Sadagopan, 2003; Nikolopoulos, Archbold,

& Gregory, 2005; Svirsky, Robbins, Kirk, Pisoni, &

Miyamoto, 2000; Tomblin, Spencer, Flock, Tyler, &

Gantz, 1999).

The main objective of this study was to assess

language development of deaf children without a CI,

considering the chronological age as well as the time

elapsed since beginning formal language training. The

specific goals of this study were to evaluate language

skills in deaf Italian preschoolers, compared to hearing

children, taking into account both chronological age

and duration of formal language training, to meet the

following three main objectives:

1. to evaluate spoken vocabulary (comprehension

and production) and early grammar skills and the re-

lationship between the two;

2. to evaluate the effects of different rehabilitation

methods (i.e., the oral method vs. the bimodal

method) on language abilities; and

3. to evaluate the rate of progression of language

development with age, comparing children with

shorter and longer formal language training.

The importance of the results lies in the fact that in

Italy, as in other countries, almost all children with severe

or profound hearing loss undergo speech therapy pro-

grams and the linguistic capabilities acquired through

this training often constitute one of the criteria for de-

ciding whether or not the child should receive a CI.

Methods

Participants

We collected data on language development from 20

deaf children, whose parents were recruited at the

Audiology and Speech Therapy Services of the

Bambino Gesu Pediatric Hospital (Rome, Italy), where

the children were undergoing regular controls of their

hearing aid. None of the deaf children had a cognitive

or neurological deficit associated with deafness. Five

children had moderate hearing loss, 5 had severe hear-

ing loss, and 10 had profound hearing loss. All thechildren had a hearing aid, whereas none of them

had a CI (many children in Italy, and in particular in

Rome, still use traditional hearing aids). All children

attended speech therapy sessions, either two or three

times a week; 10 children were taught with the oral

method (speaking without systematically using gesture

and/or signs) and 10 with the bimodal method. None

of the parents knew sign language before discovering

that their child was deaf. The parents of the 10 chil-

dren taught with the bimodal method began attending

a sign language course (once a week) within 2 months

of their childs beginning speech therapy. These

parents were encouraged to use, in the most natural

manner possible, the gestural modality together with

spoken language when communicating with their

child. All children were enrolled in regular nursery

schools or kindergartens with hearing children. None

of the teachers or the hearing children at school knew

or used either sign language or any form of bimodal

communication. The demographic characteristics of

the deaf children are reported in Table 1.

As controls, we considered 40 hearing children,

recruited at daycare centers, nursery schools, and kin-

dergartens in Rome. The 40 hearing children were

divided into two groups of 20 children each. To form

the first control group, each hearing child was individ-

ually matched with a same-age deaf child (this control

group is referred to as same-age hearing children).

To form the second control group, each deaf child was

individually matched with a hearing child whose chro-

nological age corresponded to, for the deaf child, the

amount of time that had elapsed between startinga speech therapy training (which also corresponded

to the time of receiving the hearing aid) and the time

that the questionnaire was administered. This time

was considered as the duration of formal spoken lan-

guage experience (for hearing children language expe-

rience begins with birth); this second control group

is referred to as the same duration of language

Language Development in Italian Deaf Children 65


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experience hearing children. Table 2 shows the mean

age and duration of language experience for the deaf

and hearing children. To test the correct pairing of

groups, we conducted a Students t test for age and

for duration of language experience. The results

showed that the groups were correctly paired, age:

t(19) 5 0.370; p 5 .72, and duration of language

experience: t(19) 5 0.252; p 5 .80. Moreover, the

mean age and duration of language experience of the

deaf children exposed to the oral method were equal to

those of the deaf children exposed to the bimodal

method, age: t(18) 5 0.083; p 5 .934, and duration

of language experience: t(18) 5 0.000; p 5 1.000.

To evaluate the differences in vocabulary and

grammar in relation to the duration of language expe-

rience, we subdivided both deaf and hearing children

into two subgroups each. The deaf children with a du-ration of spoken language experience of 817 months

were defined as shorter language experience deaf

children and those with a duration of spoken lan-

guage experience of 1844 months as longer language

experience deaf children. These specific durations

were chosen based on the results of previous studies

on language development in hearing children, which

were conducted using the MacArthurBates CDI and

which highlighted that at about 18 months important

developmental changes usually occur, in particular, the

lexical repertoire dramatically increases and the ability

to produce simple sentences emerges (Caselli, Casadio, &

Bates, 1999; Dale, Dionne, Eley, & Plomin, 2000;

Fenson et al., 1994). Six of the shorter language expe-

rience deaf children were exposed to the oral method

and four to the bimodal method; among the longer

language experience deaf children, four were exposed

to the oral method and six to the bimodal method.

Using the same criteria, the 20 same duration of lan-

guage experience hearing children were also divided

into two subgroups: shorter language experience

hearing children (i.e., younger children; 718 months

of age) and longer language experience hearing chil-

dren (i.e., older children; 1944 months of age).

To evaluate the differences in the transversal pro-

files of the deaf children, from the shorter language

experience group to the longer language experience

group, compared to the hearing control groups, we

Table 1 Demographic characteristics of the deaf

participants

Characteristics M SD N %

Chronological age 41.60 10.44

Age at identification

of deafness

13.80 11.91

Age at amplification

(hearing aids)

17.95 11.23

Months after hearing aids 23.65 9.94

Age at beginning speech

therapy

20.50 11.81

Months after beginning

speech therapy

21.30 11.09

Here referred as duration

of language experience

Degree of hearing loss

(in better ear)

Severe

Aided pure-tone average 46.07 dBa 15.88

Gender

Male 11 55Female 9 45

Cause of hearing loss

Unknown 10 50

Genetic 4 20

Meningitis 2 10

Other 4 20

aThese data are available only for 14 participants.

Table 2 Chronological age and duration of language experience of deaf children and hearing children

Children Number

Chronological age Duration of language experience

Range

(months)

Mean

(months) SD

Range

(months)

Mean

(months) SD

Deaf 20 1861 41.6 10.4 844 21.3 11.1

Oral method 10 2861 41.8 11.0 844 21.3 13.1

Bimodal method 10 1855 41.4 10.4 835 21.3 9.3

Hearing

Same chronological age 20 1960 41.6 10.3

Same duration of language experience 20 744 21.4 11.1



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performed an analysis of variance (ANOVA), with two

factors at two levels each. The first factor was hearing

status, with two levels: deaf and hearing. The

second factor was duration of spoken language expe-

rience, with two levels: shorter and longer. In each

analysis, we tested the statistical significance of the

interaction between the two factors and, if lacking,we tested the significance of the factor duration of

language experience.

Table 3 shows the mean duration of language ex-

perience, range, and standard deviation and the results

of the statistical tests, which show that the groups of

deaf and hearing children were correctly matched.

Instrument and Procedures

To evaluate language development in deaf children, we

used the MacArthurBates CDI (Fenson et al., 1993),

a questionnaire that has been adapted to more than 40

languages. Various studies have found that this parent

report measure is effective in characterizing childrens

early language skills (Dale et al., 1989; Fenson et al.,

1994; Thal, OHanlon, Clemmons, & Fralin, 1999). It

has been used in both populations with typical devel-

opment (e.g., Dale et al., 2000; Farrar & Maag, 2002;

Feldman et al., 2003) and those with atypical develop-

ment, including deaf children (Mayne, Yoshinaga-

Itano, & Sedey, 2000; Mayne, Yoshinaga-Itano, Sedey,

& Carey, 2000; Stallings et al., 2002; Thal et al., 2007;

Yoshinaga-Itano, Snyder, & Day, 1998). For the Italian

version, norms are available for hearing children be-

tween 8 and 36 months of age (Caselli & Casadio,

1995; Caselli, Pasqualetti, & Stefanini, 2007). Short

forms of the CDI have also been developed (Eriksson,

Westerlund, & Berglund, 2002; Fenson et al., 2000).

The short form of the Italian version has been vali-

dated among 800 Italian hearing children (Caselli

et al., 2007). In this study, we used this short form,

which we adapted for use with hearing parents with

deaf children. In particular, we included an evaluation

of lexical comprehension and lexical production in

terms of both the spoken word and/or gestures orsigns (adapted version referred to as Il Primo Voca-

bolario del Bambino Sordo, PVB-s [The First Vo-

cabulary of the Deaf Child]; Caselli & Rinaldi, 2005).

The questionnaire was filled in on one day by the

parents of both deaf and hearing children. Of the five

sections of the questionnaire, in this analysis we con-

sidered Vocabulary and Sentences, given that

these are the sections used for children greater than

18 months of age (Caselli et al., 2007; Fenson et al.,

1994). The Vocabulary section consists of a list of 100

meanings (the same used in the short version for hear-

ing children) expressing both content words (i.e.,

nominal, such as Cane/Dog, Cappello/Hat) and pred-

icates, such as Dormire/To sleep, Caldo/Hot), and

function words (such as Perche/Why, Ancora/More).

Parents were asked to indicate their childs compre-

hension of meanings and their production, whether

spoken and/or using a gesture or a sign of Italian Sign

Language, and even if using a different pronunciation

or if making an imprecise sign (e.g., slightly modified

hand shape). When both a spoken word and a gesture/

sign were reported for a single item, we counted this

as one meaning. Parents were instructed not to record

meanings expressed by a pointing gesture, unless ex-

plicitly requested, such as for body parts (e.g., eyes) or

pronouns (e.g., me). The Sentences section is for in-

vestigating the emergence of grammatical skills in

Table 3 Duration of language experience for deaf and hearing children with a shorter and a longer duration of language

experience

Groups Number

Duration of language experience

Range

(months)

Mean duration

of language

experience

(months) SD t

Significance

(two-tailed),

df5 9

Shorter duration of language experience, deaf children 10 817 12 3.882 0.000 1.000

Shor ter duration of language experience, hearing children 10 718 12 4.518

Longer duration of language experience, deaf children 10 1944 30 7.777 20.429 0.678

Longer dur ation of language experience, hearing children 10 2144 30 7.457



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spoken Italian. If the child has already begun to pro-

duce sentences, the level of completeness of sentences

is explored. The first level consists of incomplete sen-

tences, such as those with no function words or pred-

icate (e.g., mella bimba/candy baby or bimbo

piange, caduto/baby cry, fall). The second level

consists of complete sentences and the use of functionwords (e.g., do la caramella alla bimba/I give the

candy to the baby or il bimbo piange perche e caduto/

the baby is crying because he fell). The same ques-

tionnaire was used for all children, except that the

parents of hearing children were asked about gestures

but not about Italian Sign Language.

Results

Comprehension and Production of Meanings

The deaf children understood a mean of 64 of the 100meanings (SD 5 29.7), which was lower than the

mean of 88 meanings (SD 5 19.0) understood by

the same-age hearing children, t(38) 5 23.054, p , .01,

yet not statistically different from the mean of

53 meanings (SD 5 33.5) understood by hearing chil-

dren with the same duration of language experience,

t(38) 5 1.030, p 5 .31 (Figure 1).

Among the deaf children, controlling for age and

duration of language experience, the mean number of

meanings understood was similar when comparing

those exposed to the oral method (61 meanings;

SD 5 34.6) and those exposed to the bimodal method(66 meanings; SD 5 25.4), t(18) 5 20.391, p 5 .70

(Figure 1).

With regard to production, the deaf children pro-

duced a mean of 47 spoken words (SD 5 32.4; with or

without an accompanying gesture/sign) and an addi-

tional five gestures/signs (SD 5 5.7; Figure 2). The

same-age hearing children produced a mean of 75

spoken words (SD 5 30.2) and one other gesture

(SD 5 1.8), and the hearing children with the same

duration of language experience produced a mean of

34 spoken words (SD 5 36.9) and an additional three

gestures (SD 5 3.4; Figure 2).

When comparing the groups in terms of spoken

words (with or without gesture/sign), the deaf chil-

dren produced fewer words than the same-age hearing

children, t(38) 5 22.823, p , .01, whereas when

considering only gestures/signs, they produced more

Figure 1 Mean number of meaning understood by hearing

children (same duration of language experience and same

chronological age as deaf children) and by deaf children

(bimodal and oral method).

Figure 2 Mean number of meaning produced by hearing

children (same duration of language experience and same

chronological age as deaf children) and by deaf children




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meanings, t(38) 5 2.960, p , .01. When comparing

the deaf children to the hearing children with the same

duration of language experience, no significant differ-

ences were found in the number of either spoken

words, t(38) 5 1.188, p 5 .24, or meanings produced

only with a gesture/sign, t(38) 5 1.452, p 5 .16.

When considering the total number of meanings (spo-ken and gesture/sign), deaf children produced fewer

meanings thansame-age hearingchildren, t(38) 5 22.548,

p , .05; when compared to the hearing children with

the same duration of language experience the differ-

ence was not significant, t(38) 5 1.469, p 5 .15.

Among deaf children, the mean number of spoken

words (with or without gesture/sign) did not differ

significantly by educational method, t(18) 5 20.182,

p 5 .86, mean of 46 (SD 5 36.0) for those exposed to

the oral method and 49 (SD 5 30.2) for those exposed

to the bimodal method (Figure 2). The mean number

of meanings expressed with only a gesture/sign was

higher for deaf children exposed to the bimodal

method (mean of 7; SD 5 6.3), compared to deaf

children exposed to the oral method (mean of 3; SD 5

4.4), though the difference was not significant, t(18) 5

21.686, p 5 .11 (Figure 2).

With regard to the relationship between the spo-

ken word and gestures/signs, for deaf children, the

mean percentage of meanings expressed only withthe spoken word was lower than that for the same-

age hearing children, t(38) 5 23.477, p , .01, yet it

was not different from that for hearing children with

the same duration of language experience, t(34) 5

20.919,p 5 .36 (Figure 3). The percentage of meanings

expressed by deaf children with only a gesture/sign

was higher than that among same-age hearing chil-

dren, t(38) 5 2.011, p 5 .05, yet similar to that among

the hearing children with the same-duration of lan-

guage experience, t(34) 5 20.325, p 5 .75. Regarding

the percentage of meanings expressed using the spo-

ken word combined with a gesture/sign, this percent-

age was higher among deaf children, compared to both

Figure 3 Percentage of meanings produced, by type of communication (only spoken word, only gesture/sign, both) for

hearing children (same duration of language experience and same chronological age as deaf children) and for deaf children




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same-age hearing children, t(38) 5 3.051, p , .01, and

hearing children with the same-duration of language

experience, t(34) 5 1.969, p 5 .06.

When comparing deaf children by educational

method (Figure 3), the two groups did not differ in

terms of the percentage of meanings expressed only

with a gesture/sign, t(18) 5 20.589, p 5 .56, whereas

deaf children exposed to the oral method had a higher

percentage of meanings expressed only with a spokenword, compared to the other group, t(18) 5 2.162,

p , .05, and consequently a lower percentage of

meanings expressed using both modalities, t(18) 5

22.673, p , .05.

Early Spoken Grammar

The percentage of deaf children who combined two or

more words to form a sentence (whether complete or

incomplete; 80.0%) was similar to that for same-age

hearing children (90.0%), t(38)5 2

0.872, p5

.39,yet it was higher than that for the hearing children

with the same duration of language experience (45.0%),

t(38) 5 2.390, p , .05.

Regarding the number and completeness of sen-

tences (Table 4), deaf children, compared to same-age

hearing children, produced slightly fewer sentences

(difference not significant), t(38) 5 21.882, p 5 .07,

and significantly fewer complete sentences, t(38) 5

25.013, p , .01. The deaf children were similar to

the hearing children with the same-duration of

language experience in terms of both the total number

of sentences, t(38) 5 21.291, p 5 .21, and the number

of complete sentences, t(38) 5 20.000, p 5 1.

Among deaf children, the percentage who formedsentences was 80% for both the oral method and the

bimodal method group. The total number of sentences

produced was also similar for the two groups, t(18) 5

0.261, p 5 .80, whereas the number of complete sen-

tences was slightly higher for deaf children exposed to

the oral method, though not significantly, t(18) 5

1.578, p 5 .13 (Table 3).

Regarding the relationship between vocabulary

level and early spoken grammar, for both deaf and

hearing children, there was a significant correlation

(Table 5).

Language Abilities by Age Group

The mean number of meanings understood and pro-

duced for the deaf and hearing children, by duration

Table 4 Number of sentences and of complete sentences produced by hearing children and deaf children

Same duration of

language experience

hearing children

Same

chronological age

hearing children

Deaf

children

Deaf (oral

method)

children

Deaf (bimodal

method)

children

Number of sentences produced

(out of 12)

5.3 10.2 7.5 7.8 7.2

Number of complete sentences

(out of total produced)

3.0 9.3 3.0 4.3 1.7

Table 5 Correlation between vocabulary and early grammar skills for deaf children and hearing children (same duration of

language experience and same chronological age as deaf children)

Word production

Deaf children

Same duration of language

experience hearing

children

Same chronological

age hearing

children

Use of sentences r 5 .64 r 5 .80 r 5 .77

p , .01 p , .01 p , .01

Total sentences r 5 .86 r 5 .81 r 5 .81

p , .01 p , .01 p , .01

Complete sentences r 5 .76 r 5 .78 r 5 .85

p , .01 p , .01 p , .01



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of language experience, is shown in Figure 4. For

comprehension, the ANOVA showed that the inter-

action between the two factors was significant,

F(1.36) 5 7.931, p , .01. For hearing children, the

number of words understood increased with increasing

duration of language experience, whereas for deaf chil-

dren, it basically remained stable.There was also a significant interaction between

the two factors for production (spoken word with or

without gesture/sign), F(1.36) 5 6.208, p , .05, re-

vealing that for hearing children, the number of words

produced increased with increasing duration of lan-

guage experience, whereas for deaf children, it basi-

cally remained stable.

For the production of gestures/signs only, there

was no significant interaction, F(1.36) 5 2.782,

p 5 .10. Moreover, the significance of the duration

of language experience effect, F(1.36) 5 11.390,

p , .01, shows that, independently of whether or

not the children were deaf or hearing, the use of only

gestures/signs decreases with increasing duration of

language experience.

The scores obtained for the number of sentences

produced by deaf and hearing children for the two

levels of duration of language experience were sub-

jected to the same statistical analysis. According to

the results (Figure 5), for hearing children, the num-ber of sentences produced increased with increasing

duration of language experience, whereas for deaf chil-

dren, it basically remained stable.

Figure 5 shows the scores obtained for the number

of morphologically complete sentences. Again, for

hearing children, the number of morphologically com-

plete sentences produced increased with increasing

duration of language experience, whereas for deaf

children, it basically remained stable, F(1.36) 5

4.976, p , .05.

Discussion

In this study, we used a questionnaire filled in by

parents to study the language development of

preschool-aged deaf children and to highlight the sim-

ilarities and differences with respect to children who

acquire the spoken language in typical contexts. To

this end, the data for deaf children were compared to

data on two groups of hearing children who were

matched with deaf children in terms of age and dura-

tion of language experience. We are aware that when

Figure 4 Number of meanings understood and produced

by spoken word (accompanied or not by gesture/sign) and

by gesture/sign only, for hearing children and deaf children,

with shorter and longer duration of language experience.

Figure 5 Number of sentences and number of complete

sentences produced by hearing children and deaf children,

with shorter and longer duration of language experience.



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deaf children begin formal language training, they

probably have already been exposed to language and

have some communicative and linguistic experience.

However, given that exposure is mainly auditory for

deaf children with hearing parents, uptake is probably

quite low until formal language training begins.

The results showed that deaf children, comparedto same-age hearing children, have a significant delay

in both vocabulary and grammar, confirming the find-

ings of other studies conducted using a similar tool on

children exposed to English (Mayne, Yoshinaga-Itano,

& Sedey, 2000; Mayne, Yoshinaga-Itano, Sedey, &

Carey, 2000; Yoshinaga-Itano, 2003, 2004). The results

are also consistent with those of other studies using

direct observation through formal testing and with the

results of longitudinal studies (Blamey, 2003; Pizzuto

et al., 2001). With regard to grammar, deaf children

produced fewer sentences, which were shorter and had

fewer function words. Thus, weaknesses in free mor-

phology, which were previously demonstrated for

older children acquiring Italian (Volterra et al.,

2001), are already evident in the early stages of lan-

guage acquisition. Moreover, the differences that we

observed in grammar development are probably inten-

sified by the fact that the younger hearing children

(mean age of 12 months) clearly did not yet produce

sentences, whereas all the older hearing children

(mean age of 30 months) produced sentences that in

most cases were morphologically complete.

With regard to the finding that the differences

between deaf and hearing children were greater for

grammar than for vocabulary, this could indicate that

these are domains of language that develop autono-

mously as proposed by other studies (Pinker, 1994).

However, we found a close correlation between the

number of words produced and the development of

grammar, as previously reported for hearing/typically

developing children (Bates & Goodman, 1997; Caselli

et al., 1999) as well as for children with language and/or cognitive impairment (Caselli, Monaco, Trasciani, &

Vicari, 2008; Vicari, Caselli, Gagliardi, Tonucci, &

Volterra, 2002). One possible explanation for the def-

icit in grammar could be that the deafness causes se-

rious problems in the processing of acoustic events

(e.g., verbal strings, phonemic sequences, rhythms in

sequence) and thus atypical construction of morpho

phonological representations, resulting in atypical pro-

cesses in acquiring and mastering morphological

aspects (Volterra et al., 2001).

Despite these considerations, when comparing

language development in deaf and hearing children

with comparable duration of language experience, we

found no differences in the number of words producedor in the number or completeness of sentences, indi-

cating that the duration of formal language experience

is an important element which should be taken into

consideration when evaluating deaf childrens spoken

language abilities. These findings confirm those of pre-

vious studies, which have reported that only spoken

language ability is impaired in deaf children, leaving

intact the more general linguistic and cognitive capaci-

ties (Marschark, 1995, 2006).

Deaf and hearing children with comparable dura-

tion of language experience were also similar in terms

of the use of nonverbal modalities: signs and/or

gestures were used to name events or objects for

which the child did not know the corresponding word.

In both deaf and hearing children, this behavior was

closely related to the development of spoken vocabu-

lary: the number of signs/gestures produced de-

creased with increasing lexical repertoire. This

finding is consistent with the results of numerous

studies on hearing children, which show that in the

early stages of language development, when the num-

ber of words is limited, gestures are more numerous

and more commonly used than in successive stages

(Capirci, Contaldo, Caselli, & Volterra, 2005; Capirci,

Iverson, Pizzuto, & Volterra, 1996; Iverson, Capirci, &

Caselli, 1994). A recent study conducted on hearing

children in Italy confirmed that co-speech gestures

decreased but did not disappear with increasing age

and spoken naming competence (Stefanini, Bello,

Caselli, Iverson, & Volterra, 2008). Older hearing chil-

dren in diverse observational settings have been shown

to produce gestures, which may help them to expressideas that they do not succeed in expressing with spo-

ken language and to convey a substantial proportion

of their knowledge (Alibali, Kita, & Young, 2000;

Guidetti, 2002; Pine, Lufkin, Kirk, & Messer, 2007).

As reported in other studies (Lederberg, 2003;

Mayne, Yoshinaga-Itano, & Sedey, 2000; Mayne,

Yoshinaga-Itano, Sedey, & Carey, 2000; Moeller,



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2000; Yoshinaga-Itano, Sedey, Coulter, & Mehl, 1998),

yet in contrast to our hypotheses, we found no statis-

tically significant differences between deaf children

exposed to the bimodal method and those exposed to

the oral method, in either vocabulary or grammar.

However, the lack of significant differences could be

due to the small number of participants in each sub-group. Nonetheless, our data show that the deaf chil-

dren exposed to the bimodal method tended to

understand and produce more words, which could in-

dicate that the use of visualgestural modality does not

hinder the learning of the spoken language and that it

can instead constitute a useful means of support for

learning to speak. In fact, children exposed to the

bimodal method tend to use more frequently the ges-

tural modality to express new meanings for which they

do not know the corresponding word, as well as mean-

ings for which they do know the spoken word.

The similarities between deaf children and hearing

children with a similar duration of formal language

experience could suggest that these groups undergo

similar phases in language development. In light

of this finding, we divided the children into groups

based on whether the duration of spoken language

experience was shorter or longer, in an attempt to

simulate a longitudinal perspective. According to the

results, the increases in language development with

increasing duration of language experience were quite

evident for the hearing children and much less evident

for the deaf children. This could be due to the fact

that hearing children are exposed to the spoken lan-

guage not only when it is specifically directed at them

but also when others around them are speaking (e.g.,

their parents or other adults and other children), in

what could be referred to as a natural context. In-

stead, deaf children are only exposed to language

through face-to-face interactions and undergo a long,

slow, arduous process of formal exposure, consisting

of a highly structured didactic processes.In interpreting the results of this study, some

potential limitations should be considered. First of

all, the results derive from indirect observations (i.e.,

a questionnaire filled in by parents). However, as pre-

viously reported, numerous studies have shown that

this is a valid method, although direct observation is

necessary to better understand the use of language in

different modalities and in different contexts. Second,

the study population was not large, and there were few

children in each of the subgroups considered. More-

over, the comparison of children with a shorter dura-

tion of language experience and those with a longer

duration was cross-sectional in design, and the results

can only be used to make general inferences regardinglanguage development over time.

With regard to the clinical implications of our

findings, in terms of language education for deaf chil-

dren, these data could help speech therapists and

teachers in planning interventions that combine

gestural modality with speech, so as to improve the

language capabilities of deaf children. Moreover,

measurements similar to that of time postimplant used

to evaluate the effectiveness of the CI (Blamey et al.,

2001; Ertmer et al., 2003; Nikolopoulos et al., 2005;

Svirsky et al., 2000; Tomblin et al., 1999) could be

very useful in understanding the effectiveness of

speech therapy also for children with the traditional

hearing aid, to determine whether the progress made

is consistent with expectations based on the duration

of formal language experience. In fact, this informa-

tion could help clinicians to decide whether or not to

change the type of hearing aid and/or the type of

language education and to decide whether or not the

child is a candidate for a CI.

To conclude, the delay in linguistic development

in deaf children, compared to same-age hearing chil-

dren, may in part be attributable to less language

experience (and not to deafness itself). In this light,

we suggest that the language abilities of deaf children

be evaluated in a different perspective: instead of es-

timating deficiencies compared to hearing children,

deaf children should be evaluated based on their lin-

guistic experience and cognitive and communicative

potential.

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Received July 27, 2007; revisions received April 11, 2008;

accepted April 16, 2008.



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Lexical and Grammatical Abilities in Deaf Italian

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