Growing up Bilingual with Hearing Loss

By Anna Karkovska McGlew

Across the globe, bilingualism and multilingualism are more widespread than commonly thought. Proficiency in more than one spoken language confers many cognitive, linguistic and economic advantages on children and their families, according to Ellen Rhoades, Ed.S., LSLS Cert. AVT. So it is not surprising that the desire for bilingualism is getting stronger among parents of many children. In fact, bilingualism is turning into a necessity: in the United States, more than 40 languages are spoken by over 55 million people, while English is the majority language and the language of instruction in U.S. public schools, according to Michael Douglas, M.A., CCC-SLP, LSLS Cert. AVT.

An increasing number of children who are deaf and hard of hearing are exposed to more than one spoken language. Modern hearing technology when properly programmed provides children with hearing loss effective access to soft conversational sound and allows them to learn to understand and speak more than one language successfully and comparably to their peers with typical hearing.

Factors Supporting Bilingualism with Hearing Loss

Rhoades defines bi-/multilingualism as the acquisition of two or more spoken languages via the auditory sense, so that conversational fluency in both comprehension and speech production is attained.

While the factors that foster successful bi-/multilingualism in children with hearing loss are numerous, the most important one is acoustic accessibility or early auditory exposure to those languages naturally spoken by the child’s parents and/or other persons regularly present in the child’s environment, noted Rhoades.

Factors Supporting Bi-/Multilingualism in Children with Hearing Loss


Amy McConkey Robbins, M.S., CCC-SLP, lists some of the factors that support bilingual learning for children with hearing loss:

  • Exposure to rich, natural and complex models of the languages the child is expected to learn
  • Opportunities to hear native speakers and to use the language in immersive everyday environments such as cultural groups, friendships, religious observances, school settings, family gatherings and so on
  • Specific instruction to parents about how they may foster bilingual development in their child who is deaf or hard of hearing
  • A deep commitment by the parents to the concept of helping their child become fluent in more than one spoken language
  • Early age at identification, fitting of technology, early intervention, and listening and spoken language services
  • Full-time use of state-of-the-art hearing technology, because language acquisition through incidental exposure is even more critical when children are learning multiple languages
  • Excellent speech perception skills with hearing technology
  • Evidence that the child’s language-learning ability for the “anchor language” appears intact
 

Jane Freutel, Ed.D., CED, LSLS Cert. AVT, co-author on the topic with Michael Douglas, M.A., CCC-SLP, LSLS Cert. AVT, in AG Bell’s 101 FAQs About Auditory-Verbal Practice, believes it is necessary to have a plan to foster the acquisition of more than one language.

Another integral condition, according to Rhoades, is the situational strategic process or the establishment of clear linguistic boundaries. For example, a child can learn one language at home while learning another language at school or while being immersed in another language during routine holidays at the grandparents’ country of origin. A child can learn different languages based on who speaks, such as dad speaking only Spanish and mom speaking only French to the child. Professionals need to engage the parents in identifying when a child will be exposed to each language and in determining who will be the conversation partner for that language, added Freutel.

Language of the Heart

Neonatal hearing loss is particularly prevalent among Hispanic-Americans, which presents clinicians and educators with the increased challenge of serving children with hearing loss whose parents/caregivers do not speak English, according to Douglas.

For young children learning a minority language within any majority-language country, it is critical that they become proficient in their home or minority language, often referred to as the language of the heart, says Rhoades.

All the professionals emphasized the importance of encouraging parents to become excellent language models for their children in their native language. “The language of the family is the right of the child. The culture of the home must be supported,” said Freutel. “It is critical that parents understand they are their child’s primary language facilitator,” added Rhoades.

The quality and quantity of minority home language use as well as home literacy resources, such as effective use of dual language children’s books, are predictors of successful bi-/multilingualism, says Rhoades.

Amy McConkey Robbins, M.S., CCC-SLP, employs a tag-team approach, in which she models the strategy in English and encourages the parent to immediately follow by doing the same using their native language. She focuses on fewer strategies at a time but reinforces them more often, known as the “less is more” technique.

Further, McConkey Robbins administers the Bilingual Family Interview, or BIFI, as a way of knowing what the reading, writing, speaking and comprehension ability is (in both languages) of the extended family members in the child’s environment. “These persons can often be a rich resource for parents and for me, but I need to know who they are and what role they play in the child’s life. The BIFI helps me establish that in a systematic way,” she said.

Freutel agreed: “I try to include brothers, sisters, grandparents and caregivers—anyone who spends time with the child, who is willing to learn and share with me.” In communities such as Los Angeles, it is feasible for a family to have no real need to learn English at all. The community supports Spanish only, Korean only, Russian only neighborhoods.

When working with families who are new learners of English or may not speak it fluently, McConkey Robbins provides more written information. By taking home written information, parents may have opportunities to review it with extended family members who have high proficiency in English.

Both Freutel and McConkey Robbins noted the importance of raising the child’s transition to school with the family, since English will almost invariably be the primary language of instruction. “Parents need to have a strong and flexible repertoire of skills that support the development of listening, language and speech. I encourage parents to use dual-language books and demonstrate to the child the code switching that is our long-term goal,” said Freutel. When appropriate, minority-language parents should be encouraged to learn the majority language in order to manage their child’s education in a mainstream classroom. 

“It is not recommended that parents talk to their child in a language that the parents do not speak fluently. Doing this harms not only the child’s linguistic mastery, but also may interfere with the bonds of emotional attachment and security between parent and child—bonds which we, as professionals, are obliged to protect,” concluded McConkey Robbins.

When Bi-/Multilingualism May not Be Best

Each child and each hearing loss is unique and any concerns for promoting bilingualism should be considered on an individual basis. In addition to the two most essential variables for learning more than one spoken language mentioned above—access to soft conversational sound and consistently effective support from the child’s primary caregivers—it is important to be aware of the child’s attention and working memory skills. These core cognitive processes are critical for rapid learning.

In cases where children demonstrate poor executive capacities, Rhoades advises parents and practitioners to collaborate on which spoken language would best serve the child. A further consideration is whether the child is at risk for neurophysiologic dysfunction (such as very low birth weight) or whether there is a learning disability beyond the hearing loss.

Ultimately, the biggest hindrances for bilingual learning for children with hearing loss are often surmountable: inconsistent use of hearing devices, ineffective programming of the hearing devices and low level of family commitment to the child’s language development.

Although late age of hearing loss identification, hearing technology fitting or intervention is a concern, age by itself should not be considered a decisive variable for the facilitation of bi-/multilingualism, according to Rhoades.

Due to anatomical issues, some children may be unable to use hearing technology to access spoken language, said Freutel. “But as the auditory brainstem implant becomes more available, I see no reason that children with this device shouldn’t do well with two or more languages,” she added.

Music as Facilitator of Bi-/Multilingualism

Music is a universal language and children love to sing, said Rhoades. It plays a vital role in promoting language acquisition, in general, and bilingualism, in particular, as it brings one's culture to life and tells stories in any language.

Because all cultures have music traditions, parents will be able to sing, do finger plays, nursery rhymes and lullabies in their cultural language, said McConkey Robbins. "Music has a deep emotional component for people. We evoke images of our own upbringing, of our childhood and our parents when we sing or listen to the songs we heard as youngsters. Passing this tradition on to our children reinforces the parent-child bond that is so vital with all children who are deaf and hard of hearing." 

Freutel encourages families to share songs during sessions and asks other close relatives to come along such as grandmother, siblings and caregivers. “Bilingualism occurs when a child attaches the unique aspects of a language to the meaning of their experience,” said Freutel.

Experiences with Bilingualism

Volta Voices connected with families who have children with hearing loss who grew up bilingual or in multilingual environments. They generously shared their experiences, strategies and advice about fostering bilingualism from an early age.

The Steiger Family
For Chisako and Michael Steiger, parents of 16-year-old Michiko, who was born with profound hearing loss in both ears and received cochlear implants at the age of 2, bilingualism was always in the plans because they wanted their children to grow up in both cultures, German on the paternal and Japanese on the maternal side.

However, upon receiving Michiko’s diagnosis of hearing loss, the Steigers gave up on bilingualism and decided to concentrate on one language, “which already seemed a nearly impossible challenge at the time,” recalled Steiger. The family chose German for their daughter, because they lived in the Swiss-German part of Switzerland and their auditory-verbal therapist was German-speaking.

A family relocation to the United States coupled with Michiko’s great progress in auditory skills and language production, led the Steigers to change their mind and expose Michiko to English. Another relocation to France made multilingualism a choice, because the parents wanted Michiko and her younger sister, who has typical hearing, to be educated in mainstream schools.

In both Switzerland and the United States, the family worked with listening and spoken language professionals who were very supportive and encouraged them to expose Michiko to English. In France, they were met with resistance and skepticism, but the parents persevered. Michiko now moves freely between German, English and French on an academic level and is set to start the International Baccalaureate program in the United Kingdom, choosing French as her higher level subject.

“We consider ourselves lucky to have started our path in monolingualism. After convincing ourselves of Michiko’s excellent auditory skills and speech development we ventured into a bilingual lifestyle,” said Steiger.

To foster their children’s multilingualism, the Steigers did not have any specific rules and strategies. They viewed language as a communication tool and spoke the language of the community they were in, with German as the anchor language of the home.

Steiger initiated an online forum in Japan—Cheers"R"Us, or seientai in Japanese—for parents of children who are deaf and hard of hearing aimed at providing support and encouragement to parents who desire a listening and spoken language outcome for their children with hearing loss. The forum is in Japanese at www.seientai.com.

She offered these words of advice for families who wish bilingualism for their child with hearing loss: “When diagnosed with hearing loss you don’t have to give up your dreams you wanted to share with your family. Don’t immediately give up a second parental language (as I did with Japanese), but be quick to get your child the best hearing device and the best Listening and Spoken Language Specialist. Above all, watch your child well and be the first one to ask yourself if you are only imposing your ideal of bilingualism or if the child is growing up naturally and comfortably in two languages and cultures.”

Stephanie Lloyd and Steve Guimond
Stephanie Lloyd and Steve Guimond are raising their two children, Evie, 6, and Ellis, 14 months, in Montreal, Quebec, a highly bilingual city. Both children have bilateral congenital profound hearing loss and use bilateral cochlear implants. At home, the family speaks in English, but the whole family spends their days immersed in French. Evie received her diagnosis at 17 months, since newborn hearing screening was not in place and still only available in certain hospitals in Quebec. Ellis was diagnosed at birth.

Evie was already integrated into a French daycare when she was diagnosed with hearing loss. The family inquired with therapists and other families of children with hearing loss about the suitability of learning multiple languages and kept getting one answer: "There is no reason you should expect Evie not to speak two or more languages."

"Evie is a quick-minded girl who displays a great deal of perseverance and enthusiasm to communicate, so we decided to keep the two languages in her life. We planned to review our strategy, if need be, but that has never been necessary. Ellis is a tireless communicator with a great sense of both humor and tenacity. We see no reason not to put him on the same path as Evie," said Lloyd. 

The family consciously chose to place both children in environments where they would fully develop both languages. “After Evie’s diagnosis, it seemed as though opening up her ears and brain to as much language stimulation as possible just made sense by capitalizing on the plasticity of her young brain to respond to the sounds around her and to understand the different sounds of particular vowels and consonants in each language.”

To support Evie’s French, the parents encourage her to interact as much as possible in public by ordering in cafés and restaurants, playing with kids in the park and other social activities. They also enlist the grandparents, who live locally and are bilingual, in helping Evie with her homework, which is in French.

Lloyd offered these words of advice for families who wish bilingualism for their child with hearing loss: “Dive in and watch carefully! Every child is different, but children who use cochlear implants or hearing aids to hear are perfectly capable of learning multiple languages at once. Having Evie work with both English and French itinerant teachers over the years has actually provided us with additional insights into the range of sounds she hears best or less well, giving us supplemental information to guide her MAPs.”

The Sindell Family
Dale Sindell, who was originally from New York, met her husband, Carlos, as a college junior while studying abroad in Spain. She started losing her hearing in college, and now has severe to profound hearing loss and wears a hearing aid.

Sindell and her husband settled in Madrid. Their third child, James, was diagnosed with moderate to severe hearing loss at age 2 and a half. Since Sindell was hard of hearing and immersed in a bilingual environment, James’s diagnosis did not change her plans to raise him bilingual like her other two children and have him attend international school in English in Madrid.

“The benefit of being multilingual and multicultural means that you can communicate with more people. It helps you understand that there is more than one way to convey ideas, and allows you to be a part of a bigger, more interrelated world. When you have a bilingual palette, you hear the world in color. Communicating with someone in their native tongue lets you pick up on the nuances that each language offers and gives you deeper insight into how people think and feel," explained Sindell.

In 2007, Sindell founded and now directs a not-for-profit website in Spanish, t-oigo.com, to help Spanish-speaking families with children who have hearing loss, where one of the biggest topics is bilingualism. T-oigo.com offers a free program to support kids with hearing loss who want to learn English. It is present in five cities and expanding in 2014. In November, Sindell and her organization are hosting a conference on bilingualism for children with hearing loss who use hearing technology in Madrid, Spain, which will feature research on the topic by Mark Guiberson, Ph.D., CCC-SLP, who interviewed 71 Spanish families on choosing bilingualism for their child.

After James’s diagnosis, his speech-language pathologist recommended that the family pick one language for him. However, the family was immersed in a completely bilingual environment. The children were studying in English all day. At home, the family, including Sindell's husband, generally spoke in English, but as soon as the children participated in the greater community, they had to speak and understand Spanish. Their paternal relatives all spoke Spanish. "So in the end, I just followed my intuition, despite the recommendation of the best professionals, and we decided to go bilingual from the start," recalled Sindell.

Sindell enrolled in the John Tracy Clinic program by mail and followed the exercises they sent in English. She also requested the exercises in Spanish, and their Spanish nanny from Ecuador did those with James. She exposed James to English and Spanish all at once. Once a week, James met with an English-speaking speech-language pathologist and also with a Spanish-speaking speech-language pathologist.

Bilingualism evolved organically in the family. Despite being aware of expert guidance regarding clear linguistic boundaries, the family was skipping and hopping from one language to another, and “somehow it worked for us—the children figured it out, because multilingual people just respond to a stimulus without thinking about it,” said Sindell. Still, bilingualism takes time to emerge and requires support and commitment from everyone involved—parents, teachers and professionals.

Sindell offered these words of advice for families who wish bilingualism for their child with hearing loss: “The commitment to a second language is like learning a new skill—you need to dedicate time to it every day and over many years, just as you would if you wanted your child to be an expert pianist or tennis player. Sometimes people give up when the going gets rough or lose patience and attribute it to the hearing loss, when in fact, not everyone has the perseverance or time to reach their goal.”

We would love to hear from you and your family! Please share your story with the AG Bell community on our Facebook group or submit your story for consideration in Volta Voices  or online at ListeningandSpokenLanguage.org.

Resources for Parents of Children with Hearing Loss Who Are Growing up Bi-/Multilingual

Douglas, M. (2011). Spoken language assessment considerations for children with hearing impairment when the home language is not English. Perspectives on Hearing and Hearing Disorders in Childhood, 21(1), 4-19. doi: 10.1044/hhdc21.1.4

Douglas, M. (2011). Teaching children with hearing impairment to listen and speak when the home language is not English. Perspectives on Hearing and Hearing Disorders in Childhood, 21(1), 20-30. doi: 10.1044/hhdc21.1.20

Douglas, M. (2011). The Center for Hearing and Speech: Bilingual support services through videoconferencing technology. The Volta Review, 112(3), 345–356.

Douglas, M., & Freutel, J. (2012). How do children in auditory-verbal programs who are learning more than one spoken language perform on formal language measures?" In W. Estabrooks (Ed.), 101 Frequently Asked Questions About Auditory-Verbal Practice (pp. 409-413). Washington, DC: Alexander Graham Bell Association for the Deaf and Hard of Hearing.

John Tracy Clinic (n.d.). Parent Distance Education. Available in English and Spanish through http://www.jtc.org/services/parent-distance-education.

Manolson, A., Ward, B., & Dodington, N. (1996). Usted hace la diferencia: Para que su hijo pueda aprender (Spanish Edition). Toronto, Canada: The Hanen Centre.

McConkey Robbins, A. (2007). Clinical management of bilingual families and children with cochlear implants. Loud and Clear, 1. Retrieved from http://www.amymcconkeyrobbins.com/PDF/Clinical_Management_of_Bilingual_Families.pdf

Rhoades, E. A. (2009). Learning a second language: Potentials & diverse possibilities. Hearing Loss, 30(2), 20-22. Retrieved from http://www.hearingloss.org/sites/default/files/docs/HLM_MarApr_2009.pdf

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., Perusse, M., Douglas, W. M., & Zarate, C. (2008). Auditory-based bilingual children in North America: Differences and choices. Volta Voices, 15(5), 20-22.

Rossi, K. (n.d.). Learn to Talk Around the Clock. Available through http://www.listeningandspokenlanguage.org/bookstore/

Zurer Pearson, B. (2008). Raising a Bilingual Child. NY: Living Language.