Auditory-Based Bilingual Children in North America: Differences and Choices

By Ellen A. Rhoades, Ed.S., LSLS Cert. AVT, Martha Perusse, M.Sc.(A), Wm. Michael Douglas, M.A., CCC-SLP, LSLS Cert. AVT, Cristina Zarate, Lic. Fonoaudiologia, Bilingual SLP Asst.

BilingualSpeaking multiple languages constitutes the norm in many countries. In Quebec, Canada, additional French education is expected for all English-speaking children. However, in the United States, bilingualism is still becoming an increasingly desired choice for many families. And in both countries, supporting a family’s anchor language is an educationally necessary option (the anchor or native language is the language most often spoken at home and outside the classroom). There are data that show when the language spoken at home is not supported until linguistic proficiency is established, the child may never learn the majority language well enough for effective communication and for reading purposes. This is known as subtractive language acquisition, as it negatively impacts learning (Pearson, 2008).

There are many advantages to speaking more than one language. Data show that, compared to monolingual children, bilingual children demonstrate improved executive functioning. This includes better divergent thinking, greater cognitive flexibility, improved selective attention and a broader level of understanding of other perspectives. Bilingual children also demonstrate increased metalinguistic awareness, such as improved communicative sensitivity and a higher degree of introspection. Moreover, bilingual children show increased cultural sensitivity as well as greater access to their family heritage and extended family network. Last but not least, bilingual children represent an improved future economic asset in our increasingly global market (Rhoades, 2008).

Given current hearing technology, children with hearing loss can learn to understand and speak more than one language. At the recent AG Bell Biennial Convention in Milwaukee, Wis., a variety of video presentations demonstrated this ability during a short course.  The purpose of the short course was to review and share existing data (Phillips, 1999; Thomas, El-Kashlan & Zwolan, 2008; Waltzman, Robbins, Green & Cohen, 2003) and discuss current studies-in-progress that support multiple-language acquisition for children with severe to profound hearing loss.

However, there can be obstacles on the road to bilingualism. One big obstacle is the lack of bilingual teachers and clinicians in every program. Another obstacle is the lack of sufficient immersion in two languages. It is well known that with less than 20 percent exposure to any language, children may understand that language but not speak it (Pearson, 2008). Some children become simultaneously bilingual, prior to three years of age. Other children learn two languages sequentially; that is, they learn the second language at three years of age or later. It is also well known that children who do not attain linguistic competency in their native language will have far greater difficulties learning a second language (Rhoades, 2006). Therefore, first and foremost, parents must actively participate in the language acquisition process so that the child has sufficient exposure to the native languages being learned.

In a bilingual family in the Unites States, when a young child with a hearing loss does not yet show dominance in one language, it is critical to actively support the language spoken at home while simultaneously conducting weekly therapy sessions in English, the majority language in the United States. A child who has weak neurological building blocks, such as poor working memory, may not be a good candidate for bilingual education since personal resources can be over taxed when learning two spoken languages simultaneously.

The interdependency of culture and language must be considered. In order to meet the needs of bilingual children, an intensive fact-finding mission should be initiated. Ideally, this includes a home visit and many questions to learn about each family’s cultural and language practices (Rhoades, 2007). Of course, this should also include determination of the child’s auditory potential and current communicative proficiency in whichever languages are spoken.

In order to meet the unique needs of both the family and the child with hearing loss, one of a variety of immersion models or situational processes can be implemented. In general, having clear linguistic boundaries is recommended. Low vocabulary scores are typically noted among bilingual language learners; however, the total vocabulary of both languages should be combined during ongoing monitoring of each child’s progress (Pearson, 2008). With any language, it takes approximately four years for the typical-hearing child to learn a language well enough for effective conversational fluency. However, it may take as long as seven-ten years for any child to develop academic proficiency in a language.

Majority Language: Language spoken by culture and in the classroom.
Minority Language:  Language spoken at home and outside the classroom.
Code-Switching: bilingual speakers may switch between languages or codes. This can happen between sentences or within sentences. This is a skill that children learn in the process of becoming bilingual.  However, not all children choose to engage in code-switching across all situations.

Case Studies

The Montreal Oral School for the Deaf (MOSD) in Montreal, Quebec, has been instructing children in both French and English for about 15 years. Longitudinal data support their success with bilingualism, even with children whose hearing loss was identified after infancy. Approximately 50 percent of MOSD families in early childhood programs speak a language other than English or French; this means that first supporting the child’s home language necessitates the child eventually becoming multilingual. Moreover, over 25 percent of children in the preschool program have multiple needs beyond hearing loss. Children who are mainstreamed, and receive additional instruction from MOSD itinerant specialists, all receive French instruction from 33-100 percent of their day, with the majority being taught in both French and English an equal amount of time.

Students tracked by MOSD staff in bilingual programs in Quebec continue to make good progress in their acquisition of English, though it may be a struggle for some to make 12 months progress in vocabulary acquisition for every 12 months of age. Looking at 38 students for whom data were collected over three or more years, 60 percent either maintained or improved their English vocabulary level. For the remainder, the gap continued to widen between their chronological age and their vocabulary age. This can be attributed to many factors including the lack of newborn screening in Quebec, resulting in many children being diagnosed with hearing loss later; neither English nor French being the native language; and the impact of multiple learning needs.

MOSD data from 2000-2007 indicate that for students leaving high school (excluding children with additional special needs), 81 percent successfully completed high school French exams for graduation. The remaining 19 percent were exempt from passing French since they passed all other core subjects. Students in vocational programs are often able to learn sufficient French, allowing them to enter a bilingual work place.

Another case to consider is The Center for Hearing & Speech in Houston, Texas, which began providing bilingual support for families two years ago. Approximately 50 percent of the children at the center come from families that speak a language other than English. Nearly half of these families only spoke Spanish at home, and the remaining families spoke some English with Spanish generally being the primary language spoken at home. Data continue to be collected in this longitudinal project and will be subject to statistical analyses in the near future.

Today, of the 30 children supported in a bilingual capacity by the center during the past two years, 11 are on an auditory-verbal track, 17 are on an auditory-oral track and two engage in total communication. According to standardized norm-referenced assessment instruments, initial findings from The Center for Hearing & Speech in Houston show significant progress is being made; that is, approximately 12 months of progress was made over a 12-month period of intervention. Video documentation shows how some children with hearing loss experience the same stages on the road toward becoming bilingual as many children with normal hearing. These children typically transitioned from a silent or pre-production period to single words for concepts, just like monolingual language learners. Ultimately, children are able to engage in code-switching as they become conversationally fluent in speaking two languages. This typically occurs after about two years of bilingual language learning. In short, for young children, learning two languages was no more difficult than learning one language.


Some of the general recommendations for professionals working with children in a bilingual environment include: 

  • Assure that children use appropriate hearing prostheses and have consistent access to soft conversational sound.
  • Develop good listening and speech perception skills.
  • Providing the above two recommendations are followed, welcome, respect and support parental attempts to have bilingual children.
  • With any language, employ the sequential auditory-based strategies of observe, wait, listen and speak (OWLS).
  • With both languages, employ all evidence-based language intervention strategies such as modeling, expansion, repetition and extension.
  • For monolingual families speaking a minority language, have parents provide auditory-based therapy at home; ensure that the child is immersed in the home language for no less than 35 hours weekly.
  • For monolingual families speaking a minority language, the majority language can be learned as a second language in peer play and center-based therapy sessions with the use of an interpreter for communication with parents.
  • For bilingual families, establish clear and consistent linguistically situational boundaries, such as “one parent, one language” with the child immersed in both majority and minority languages. 

Where English is the primary language, it was concluded that facilitating bilingualism among children with hearing loss when the home language is not English necessitates dual immersion as soon as possible with active parent involvement. The achievement of bilingualism is not necessarily related to the parent’s education level, but relies on programming flexibility among all team members and fully understanding that dual language learning is no less difficult than enabling children with hearing loss to learn one language. In short, by and large, children with all degrees of hearing loss can learn more than one language.


Pearson, B. Z. (2008). Raising a bilingual child. NY: Bantam House.

Phillips, A. H. (1999). Retrospective study of 48 hearing impaired children who participated in MOSD Parent Infant and/or Nursery programs (birth dates 1987-1993). Research reports, Gouvernement du Quebec.

Rhoades, E. A. (2008). Working with multicultural and multilingual families of young children. In J. R. Madell & C. Flexer (eds.). Pediatric audiology: Diagnosis, technology, and management. Pp 262-268. NY: Thieme.

Rhoades, E.A. (2007). Setting the stage for culturally responsive intervention. Volta Voices, 14(4), 10-13. Editors Note: Interview questions can be found at

Rhoades, E. A. (2006). Auditory-based therapy when the home language is not English (HOPE). Available at  Accessed November 30, 2006.

Thomas, E., El-Kashlan, H., Zwolan, T. A. (2008). Children with cochlear implants who live in monolingual and bilingual homes. Otology & Neurotology, 29, 230-234.

Waltzman, S. B., Robbins, A. M., Green, J. E., & Cohen, N. L. (2003). Second oral language capabilities in children with cochlear implants. Otology & Neurology, 24(5), 757-63.