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l Austra ia
Early Intervention with deaf infants/children
Supplementary Paper
Disability Royal Commission submission
December 2022
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About Deaf Australia
Deaf Australia acknowledges the Traditional Owners and Custodians of the lands on which we work and pay our respects to Indigenous Elders past and present. Sovereignty has never been ceded. It always was and always will be, Aboriginal land.
We recognise the past atrocities against Aboriginal and Torres Strait Islander peoples of this land and that Australia was founded on the genocide and dispossession of First Nations people. We acknowledge that colonial structures and policies remain in place today and recognise the ongoing struggles of First Nations people in dismantling those structures; and especially that of Deaf, Deafblind and hard of hearing First Nations peoples.
We also acknowledge and respect the members of the Deaf Community in Australia, who preserve their rich heritage, culture, and our language; Auslan. We acknowledge our custodians of Auslan, promoting awareness, equality, and access through our sign language.
Deaf Australia was founded in 1986 as a not-for-profit organisation that represents all Deaf, Deafblind, and hard of hearing people, and others who are fluent and knowledgeable about Auslan. The focus has and continues to be on developing access to information and accessible communication. We work with Australian governments and collaborate with key stakeholders to make sure that Australia complies with the United Nations Convention on the Rights of Persons with Disabilities. The UN Convention and the National Disability Strategy guides our work; we aspire to achieve equity for Deaf people across all areas of life.
Deaf Australia advises that this document may be publicly distributed, including by placing a copy on our website.
Contact Details:
Authored by: Catherine Miller
Email: info@deafaustralia.org.au
Postal Address: PO Box 31 Northcote, Victoria 3070
Website: www.deafaustralia.org.au
CEO: Mx Jen Blyth
Chairperson of the board: Ms. Debra Swan © Copyright Deaf Australia 2022
This publication is copyright, apart from use by those agencies for which it has been produced. Non profit associations and groups have permission to reproduce parts of this publication if the original meaning is retained and proper credit is given to Deaf Australia. All other individuals and Agencies seeking to reproduce material from this publication should obtain the permission of the CEO of Deaf Australia.
Key Notes
This section includes key information about the submission that the reader should be aware of while reading.
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In this submission, Deaf Australia will use Deaf person/people/community to refer to all d/Deaf, Deafblind, and hard of hearing people who use Auslan as their language of preference, unless otherwise stated.
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We write broadly about signing Deaf people, but recognise that Deaf people are intersectional beings, and that this paper was written by a white Deaf cis-het woman, so important nuances covering Aboriginal and Torres Strait Islander Peoples, trans-women, non-binary peoples and men, BIPOC and all other intersecting identities are likely to be missing from this paper
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Introduction
It is time for the early intervention system to acknowledge that research does not support exclusive listening and speaking practices.
Early intervention in Australia is one of the most least-scrutinised practices in the life of the deaf child. There is little to no data published to see how successful early intervention is and high-quality evidence of interventions and outcomes remain scarce and heavily biased to spoken-language-only approaches.
In theory early intervention’s approach to the identification of deafness is one of neutrality, providing balanced options with all communication approaches. The reality is vastly different - there is a strong binary model offered for parents of deaf children: non-deaf professionals in this space provide an either/or option: choose between learning to speak and listen with hearing devices (usually cochlear implants) or learning Auslan. There is also always a clear implication that to choose Auslan means choosing against the child learning English in any of its forms in this binary offer.
The continued observation of gaps in language acquisition points to inconsistencies that exist between theory and practice. Hearing aids and/or cochlear implants are the standard of care for deaf children in Australia and they are frequently accompanied by restrictions on access to Auslan in early intervention and education.
Based on the scarce evidence available early intervention continues to operate that medical perspective of deafness by operating on the assumption that speech and listening is the preferred options of parents of deaf babies. Families are not offered the opportunities of bilingual and bimodal programs unless they are specifically asked for by the family. A deaf child’s early years of life are often spent developing listening and speaking skills at the cost of full access to a language, meaning that they are at risk for language deprivation.
How Early Intervention Works
Sign languages across the world are natural languages with linguistic features comparable with spoken languages and the developmental milestones for sign languages are also comparable to those of spoken languages. We know and we advocate for the position because there is numerous research that shows the use of Auslan at the earliest possible opportunity will stimulate and support later acquisition of spoken language because Auslan is a visual language fully accessible to deaf babies 1.
In an ideal world, the national screening program could be beneficial for the deaf baby in identifying deafness early on and providing opportunities for language in both Auslan and English. Deaf workers highly experienced in early intervention would work with the family into how to communicate with their deaf baby and create connections to quality services and the Deaf community. If the parents decided that cochlear implants were the way to go, the cochlear implant clinic would provide best practise in ensuring that there is age-appropriate language development and not indicate either directly, by policy or by using interventionist approaches to ban access to Auslan. They would understand the concept of listening fatigue and how the brain works overtime to adapt to artificially listening to environmental sounds.
1 See for example: Clark, et. Al (2020), Early intervention protocols: Proposing a default bimodal bilingual approach for deaf children. Maternal and Child Health Journal, 24: 1339-1344.
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Evidence based medical research emphasises the need to access quality, evidence-based information and consider preferences so patients feel they are making informed decisions before intervention is implemented. The medical model view of deafness is not premised on evidence based practices at all; in fact, doctors and those in the medical profession do not have any knowledge of or understanding of how language develops over the lifespan of an individual, let alone a deaf individual.
Early intervention implicitly follows this medical model; how early intervention works in Australia is the opposite of evidence-based practices. As a result, only a very small fraction of the deaf children can use cochlear implants as a tool effectively. Published data on said effective use of cochlears must be viewed with suspicion because they do not tell the full story2• No Auslan is to be allowed as an opportunity to have first age-appropriate language development. Most of the deaf population experience the lifelong consequences of language deprivation and related poor mental health.
There is comprehensive and peer reviewed research to demonstrate best practices in early intervention. There is no comprehensive and peer reviewed research to demonstrate that a spoken only approach works best for ALL deaf children. The language used upon discovery of deafness is frankly appalling and does not reflect well on those who use it. We have anecdotal evidence of Deaf parents being told “I am so sorry your baby is deaf” or “Congratulations, your baby has passed the test.” Both are highly offensive because it implies several things:
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Being deaf is as bad as having a terminal disease;
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Being deaf is the worst thing that could happen to your baby;
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Being deaf means that your baby has failed right from the start and is therefore automatically a future failure;
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“Passing a test” implies that not being deaf means your baby is perfect. Imagine what it is like to be a hearing parent who has never encountered another Deaf person and discovers that their baby is deaf. To be told “I’m so sorry” implies that deafness is a fate worse than death. To be told that your baby is less than perfect in the eyes of the medical profession is a terrible weight to carry on top of the incomprehensibility of this new pathway opening.
This pattern occurs because many advocates, professionals and educators erroneously believe that sign language acquisition will interfere with deaf children’s development of speech skills. This persists despite research demonstrating that signing implanted children demonstrate better language development, speech development and intelligence scores than non-signing implanted children. This persists despite Deaf parents of both hearing and deaf children sharing anecdotal evidence of their children have grown up bilingual and bimodal with age-appropriate language development3•
Yet this is ignored by professionals with no understanding of language development, connections to the Deaf community or best practices based on evidence based and peer reviewed research. Due to the differences in hearing levels and the varying effectiveness of hearing technology spoken language cannot always be assumed to be fully accessible to deaf children. The inability to predict who will benefit from hearing technologies while relying on spoken language only leads to a large
2 See: Hall, W.C. (2017). What you don’t know can hurt you: The risk of language deprivation by impairing sign language development in deaf children. Maternal and Child Health Journal, 21: 961-965.
3 See: We’ve Got This by Eliza Hull (2022)
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variability in language proficiency. Therefore, medical professionals cannot and should never guarantee that hearing aids and cochlear implants will result in positive language outcomes.
As a result, delayed exposure to sign language is a “ … common educational occurrence arising from the priority frequently given to speech over sign by rehabilitation professionals and hearing parents“ (Hall, et. al, 20174) Deaf individuals who experience language deprivation show altered neural activation patterns compared to deaf individuals with typical language development.
Recommendations
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Early intervention should implement a default practice of bimodal bilingualism from day one of the child’s identification of deafness to provide the best possible educational outcomes.
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High quality educated and experienced in early intervention best practices staff should be the norm, not the exception.
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Deaf professionals should be utilised as a way for families to be introduced to Deaf successful adults using a variety of communication approaches. Being inclusive of all language opportunities will alleviate families’ adjustment processes.
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Deaf mentors would provide language modelling and serve as an important source of support for families of deaf children. This cannot be overstated.
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Language opportunities should be the focus, not communication options (i.e., modalities and hearing technologies). To that end, family friendly Auslan curriculums need to be made available and accessible to help hearing non-signing parents navigate visual and joint attention with their babies.
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Presenting timely information about the impact of bimodal and bilingual research can alleviate the fear that the child may not be able to communicate with their families.
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The early intervention team should be unified in presenting a bilingual and bimodal approach. Full stop.
4 See: Hall, W.C., Levin, L.L. & Anderson, M.L. (2017). Language deprivation syndrome: A possible neurodevelopmental disorder with sociocultural origins. Vol. 52, 6: 761-776.