Communication in its broadest sense: working
with deaf children and their communities
Bencie Woll
In memory of Sheila Wirz
• This talk reflects on research and interventions
with deaf children over the past 25 years
which have aligned with the priorities which
Sheila Wirz brought to the field:
– low cost, community-based
– broadly-defined perspectives on communication
and language
– with the involvement of deaf people.
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From the Brazilian reseearch group
London 1993! First meeting between Brazil and England, represented by Ida Lichtig and Sheila Wirz.
The awakening of a common aim towards a community based rehabilitation, placing speech therapy in a new and
wide social context. A scientific and international link starts between the University of São Paulo and the University
of London, with the participation of various researchers from both countries.
Brazil 1995! All the Brazilian group (researchers and students ) are waiting for the new English researcher, Dr.
Sheila Wirz. After her arrival she meets them and starts straightaway her enquiring based on the research
questions : How many deaf are there in Brazil ? How many in São Paulo city? How many deaf children are in schools
? How many are attending speech-therapy sessions? How.....? Where.....? Why ......? People looked at each other
and this look meant “this one really came to work ...she is a workaholic”….
At lunchtime her choice was walking in the woods instead of the car ride; “it’s healthier ,” she said. First lesson:
“Down with sedentarism
She looked disappointed when asked about São Paulo ... If we would be able to read her thoughts they would
transmit something like this: “The city is too big. It is crowded with well dressed people, beautifull cars and
buildings !!! Where are the snakes? and the monkeys? This is not the Brazil which needs our help, our support …
Then the students arrive, the teachers, sign language interpreters, and the deaf instructors …. Confusion and
embarrassment due to the difficulty in communicating in different languages. Parents arrive… reality is shown
completely and crudely: unpreparedness to deal with so many difficult situations!!! Sheila cheers up and seems to
find a real reason now for her coming to Brazil. She wanted to know and learn more ... as much as she could about:
slums, beaches, concerts, the Brazilian way of being ... The serious researcher gives place to a glad woman, eager to
learn more about the Brazilians´ social, educational and cultural reality. Light and happy she dances , sits on the
floor and is touched by everything she sees. This is Sheila!!! A generous person, competent and righteous in her
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way of being and teaching !!! Thanks for the received generosity, hospitality ,teachings and affection.
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The Sao Paulo Project
• Challenges
– A country with well-developed services for deaf children
– But - limited access for poorer families to those services
• The project
– designed to identify deafness
– provide a service delivery plan to support deaf children
and their families
• used a low cost tool developed in Zimbabwe (Wirz et al., 2001) to
identify hearing impairment in children
• Developed tools for assessing communication skills as part of the
first stage of a programme of intervention
– Created an intervention programme involving members of
the Deaf community
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Assessing deaf children’s communication
• Following recognition by the Brazilian government in 2002 of
Brazilian Sign Language (also known as LIBRAS) as the official
language of the Brazilian Deaf community, it is now used more
widely in educational and health settings
• However, 95% of deaf children are born to hearing parents,
who usually do not know sign language before their child's
diagnosis, and who also find it difficult to communicate with
their deaf child by means of spoken language
• As a consequence the child may not fully develop either SpL
or SL but may communicate in a mixture of signs, words and
gestures.
• “Modality-free” measures were developed to provide an
assessment of communication which do not depend only on
language proficiency measures
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The programme for children
• 23 prelingually deaf children, ranging in age from three to six years
old and their parents
• All children were resident in low income neighbourhoods of São
Paulo city and had hearing parents who did not know LIBRAS.
• Formal education begins in Brazil at 7 and the majority of children
were not enrolled in other pre-school programmes at the beginning
of the programme. By the end of the programme, most were
attending pre-school on a part-time basis.
• The programme comprised 10 sessions
• For the children
– 2 groups: a 45 minute LIBRAS activity group, followed by a spoken
Portuguese activity group
– A break, where refreshments were available for the children, parents and
team.
– A storytelling workshop for the children led by the Deaf staff member
– A final free play session where children could choose toys and interact
freely.
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The programme for parents
• LIBRAS classes led by the Deaf staff member, including the Deaf
staff member talking about experiences of deafness, growing up,
and adulthood
• Sessions led by the SaLT and Deaf staff member discussing
deafness, the parents’ needs, and answering questions about
their child’s development
• Observations by the parents of the sessions led by the Deaf staff
member. For many of them the first time they had seen their
child able to communicate freely and fully, profoundly changing
their views of their children as disabled
• This experience in turn helped break down prejudices against
sign language and encourage their efforts to learn LIBRAS.
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The programme for SaLTs
• The children were visited three times in their homes
during the programme by a Deaf member of staff or
LIBRAS interpreter, together with a speech and
hearing therapist. The team:
– gained an understanding of the children’s home
circumstances
– observed their relationship with family members
– were able to match the intervention programme to the
reality of the children’s home lives.
• The home visits also had the aim of improving the
relationship between the staff and the families, by
giving family members the opportunity to express
their problems, doubts and feelings
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A deaf-hearing partnership
• The vast majority of intervention teams are
directed by and include only hearing people
• Mixed deaf and hearing teams of service
providers face enormous challenges in
developing effective working relations, including
the language used between deaf and hearing
team members and the consequences of that
communication
Part of Sheila’s commitment to the community
as the basis of intervention
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Research at DCAL with deaf
children and their families
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What is DCAL?
• Research centre funded by ESRC
• The largest research centre in this field in
Europe with over 30 staff and research
students, about 1/3 of whom are deaf
• DCAL places sign language and deaf people in
the centre of our general understanding of
how language and communication work
within linguistics, psychology and child
development
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Some of our research studies
• Assessing early language development: spoken
and signed
• Language, interaction and socio-cognitive
development
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Deaf children’s language development
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Deafness and development
• 90% of deaf children learn language in atypical
ways
• Many deaf children do well but language delay
is still common
• Even with early diagnoses and cochlear
implants, language development is still an
issue for deaf children
• Emphasis on speech can lead to other areas
being neglected
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The advantages of bilingualism
• Educators and policy makers have often
suggested that knowing 2 languages is bad
for a child’s academic and intellectual
development
• New insights:
• Being bilingual can have a profound effect on
your brain, improving cognitive skills not
related to language and even shielding against
dementia in old age
• In a bilingual’s brain, both language systems
are always active
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• The bilingual experience improves executive
function — a command system that directs the
attention processes used for planning, solving
problems and performing various other mentally
demanding tasks
• These include ignoring distractions to stay
focussed, being able to switch attention, and
holding complex information in mind
• Bilingual people not only perform better on many
cognitive tasks, but they also do so with less
activity in parts of the brain involved in
monitoring: their brains are more efficient
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Assessing Language
Correct score (%)
100
80
60
40
20
0
0
1
2
3
4
5
6
7
8
9 10 11
Age (years)
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The MacArthur Bates CDI
• to assess early child language.
• parents indicate vocabulary production and
comprehension by ticking items on a list of words
grouped into categories such as ‘animals’, ‘toys’
and ‘actions’
• translated and adapted into many languages
• Widely used in educational and clinical settings
– Children with autism, developmental language
disorders
– deaf children (including those with cochlear implants
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The BSL-CDI: 569 items in 22
categories
• The entire checklist is available in BSL on the
project website
– to clarify the intended meaning of the English words
used on the checklist
– to give examples of the BSL signs
• The list has also since been widely used by hearing
parents, teachers and therapists
http://www.ucl.ac.uk/HCS/research/EBSLD/
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Sample of the BSL CDI website
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Sample checklist category: People
PEOPLE (U – UNDERSTANDS, S = SIGNS)
U
S
U
S
U
S
1. aunt


12. doctor


23. people


2. baby


13. fireman


24. people


3. babysitter


14. friend


25. pet’s name


4. babysitter’s name


15. girl


26. police


5. boy


16. grandma


27. Father Christmas


6. brother


17. grandpa


28. sister


7. child’s own name


18. Indian


29. teacher


8. child/kid


19. postman


30. uncle


9. clown


20. man


31. woman


10. cowboy


21. mummy


11. daddy


22. nurse


Other words
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Positive Support Project
• Parent-led monitoring of key outcomes for
deaf children in the first years of life
• Relating these to type and extent of specific
interventions
• Key outcomes
– Language
– Communication
– Social behaviour
– Family functioning
– Motor and physical development
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Use with the Positive Support Sample
• English language (Oxford CDI standardised on
British English-speaking children)
• BSL CDI
• One or both completed by parents when
children reached 24m or at end of project (if
child less than 24m). Repeat data 12 months
later
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Current analyses: bilingual DCHP
• Comparing language development in English
and BSL
• Effect of degree of hearing loss on BSL and
English language development
• Comparing vocabularies in English and BSL
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Mean age (months)
% Moderate-severely
deaf
% Severely deaf
% Profoundly deaf
Bilingual
(N = 16)
18-24
23.2 29
21
43
7
Monolingual
English (N = 13)
14-24
20.6 53
14
29
4
% Moderately deaf
Age (months)
Sample
Groups.
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English and BSL in bilingual DCHP at 24m
300
250
200
UK MacArthur-Bates
CDI
150
BSL CDI
100
50
0
Comprehension
Production
No significant differences between English and BSL skills in either Comprehension
or Production
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Bilingualism and the cumulative
lexicon
CI and mother-child interaction
• The hearing mother and implanted deaf child share a
sensory world to a greater extent than a child with an
(ineffective) HA.
• However, this benefit may depend on previously
developed effective vision and touch-based interaction
• Currently, the dominant method of clinical preparation
for CI in relation to communication skills focuses on
‘auditory-verbal’ preparation, and explicitly excludes
non-auditory interactions
• A focus on parent-child communication may have
better cognitive outcomes
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Socio-cognitive development
• Many studies report delays in Theory of Mind
understanding (from 2-3 years to lifelong)
• This might be due to language demands of the
tasks used but even nonverbal measures show
difficulties
• Why would deafness lead to ToM difficulties?
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False Belief tests
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Incorrect location
Correct location
True and false belief conditions
Results - Cat and mouse
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Results - Cat and mouse
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Conversational study
• 19 hearing children (9 female, mean age 28
months)
• 20 deaf children (16 female, mean age 28
months)
• All had hearing parents. 16 had CIs and 4 had
hearing aids.
Morgan, Meristo, Geraci, Mann, Iozzi, Hjelmquist, Surian, Siegal (2014)
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Categories of talk
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Mother’s talk to their children
DoH HoH
20
18
proportion of utteran
16
14
12
10
8
6
4
2
0
desire
emotion
mod.assert
think/know
elab.
links ch. Life
Less connected and more failed conversation turns
when children are deaf
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Language delay and socio-cognitive
development
• Deaf children experience poorer early
interaction involving connected conversation
about the mind.
• ToM delays appear early in spontaneousresponse measures
• Delays in ToM are only overcome late
• Evidence for a remaining atypical pattern
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Implications for hearing parents of
deaf children – and for professionals
• Importance of early and sufficient exposure
to language and communication
– Role for signing at the pre-implant stage
– Disadvantages of leaving sign language until
after evidence of spoken language failing
• Language mixing as normal bilingual behaviour
• Helping families focus on communication – not
speech
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Thank you – and thank you, Sheila
DCAL, University College London
49 Gordon Square, London WC1H 0PD
www.dcal.ucl.ac.uk
Email: dcal@ucl.ac.uk
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