The Effect of Sign Language on the Development of Language of Deaf and Hard-of-Hearing Children: Systematic Review
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Abstract
Objectives: To systematically review and evaluate the evidence regarding the effect of sign language on language development in deaf and hard-of-hearing children.
Method: A comprehensive search of electronic databases, including PubMed/MEDLINE, Web of Science, Scopus, EMBASE, Scholar Google, and ProQuest from 1995 until April 2024., with no language restrictions, was conducted. The two authors independently assessed the risk of bias using the Newcastle-Ottawa Scale.
Results: Six studies involving 259 participants found that sign language exposure benefits language development in deaf children with hearing aids/cochlear implants. Children exposed to sign language showed similar or even better-spoken language skills than those with limited sign language exposure. Encouraging parents to learn sign language can significantly support deaf children's communication and language development.
Conclusion: Deaf children with cochlear implants benefit most from a communication approach tailored to their needs. Early intervention, parental involvement, and a rich language environment (signed or spoken) are key. While sign language exposure shows promise, more research is needed, especially on its long-term effects and use by hearing parents. PROSPERO registration ID: CRD42023402357
Ching TYC, Dillon H, Marnane V, Hou S, Day J, Seeto M, et al. Outcomes of Early- and Late-Identified Children at 3 Years of Age. Ear Hear. 2013 Sep;34(5):535–52.
2. Marschark M, Spencer PE. Spoken Language Development of Deaf and Hard-of-Hearing Children: Historical and Theoretical Perspectives. In: Advances in the Spoken Language Development of Deaf and Hard-of-Hearing Children. Oxford University Press; 2005. p. 3–21.
3. Mitchell RE, Karchmer MA. Chasing the Mythical Ten Percent: Parental Hearing Status of Deaf and Hard of Hearing Students in the United States. Sign Lang Stud. 2004;4(2):138–63.
4. Geers AE, Strube MJ, Tobey EA, Pisoni DB, Moog JS. Epilogue: Factors Contributing to Long-Term Outcomes of Cochlear Implantation in Early Childhood. Ear Hear. 2011 Feb;32(1):84S-92S.
5. Fitzpatrick EM, Stevens A, Garritty C, Moher D. The effects of sign language on spoken language acquisition in children with hearing loss: a systematic review protocol. Syst Rev. 2013 Dec 6;2(1):108.
6. PETITTO LA, KATERELOS M, LEVY BG, GAUNA K, TÉTREAULT K, FERRARO V. Bilingual signed and spoken language acquisition from birth: implications for the mechanisms underlying early bilingual language acquisition. J Child Lang. 2001 Jun 25;28(2):453–96.
7. Petitto LA, Zatorre RJ, Gauna K, Nikelski EJ, Dostie D, Evans AC. Speech-like cerebral activity in profoundly deaf people processing signed languages: Implications for the neural basis of human language. Proceedings of the National Academy of Sciences. 2000 Dec 5;97(25):13961–6.
8. Johnston JC, Durieux-Smith A, Bloom K. Teaching gestural signs to infants to advance child development: A review of the evidence. First Lang. 2005 Jun 25;25(2):235–51.
9. Jana LA, Shu J. Heading Home With Your Newborn. American Academy of Pediatrics; 2005.
10. Shojaei E, Jafari Z, Gholami M. Effect of Early Intervention on Language Development in Hearing-Impaired Children. Iran J Otorhinolaryngol. 2016 Jan;28(84):13–21.
11. Nicholas JG, Geers AE. Will They Catch Up? The Role of Age at Cochlear Implantation in the Spoken Language Development of Children With Severe to Profound Hearing Loss. Journal of Speech, Language, and Hearing Research. 2007 Aug;50(4):1048–62.
12. Davidson K, Lillo-Martin D, Chen Pichler D. Spoken English Language Development Among Native Signing Children With Cochlear Implants. J Deaf Stud Deaf Educ. 2014 Apr 1;19(2):238–50.
13. Trovato S. A Stronger Reason for the Right to Sign Languages. Sign Lang Stud. 2013;13(3):401–22.
14. Hall ML, Hall WC, Caselli NK. Deaf children need language, not (just) speech. First Lang. 2019 Aug 13;39(4):367–95.
15. Fitzpatrick EM, Hamel C, Stevens A, Pratt M, Moher D, Doucet SP, et al. Sign Language and Spoken Language for Children With Hearing Loss: A Systematic Review. Pediatrics. 2016 Jan 1;137(1).
16. Geers AE, Mitchell CM, Warner-Czyz A, Wang NY, Eisenberg LS. Early sign language exposure and cochlear implantation benefits. Pediatrics [Internet]. 2017;140(1). Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L617228624&from=export
17. Hassanzadeh S. Outcomes of cochlear implantation in deaf children of deaf parents: comparative study. J Laryngol Otol. 2012 Oct 21;126(10):989–94.
18. Delcenserie A, Genesee F, Champoux F. Exposure to sign language prior and after cochlear implantation increases language and cognitive skills in deaf children. Dev Sci. 2024 Jul 7;27(4).
19. Hall ML, Hall WC, Caselli NK. Deaf children need language, not (just) speech. First Lang [Internet]. 2019;39(4):367–95. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85063026416&doi=10.1177%2f0142723719834102&partnerID=40&md5=dc409af74d1b7895c21ffb4893657e11
20. Yanbay E, Hickson L, Scarinci N, Constantinescu G, Dettman SJ. Language outcomes for children with cochlear implants enrolled in different communication programs. Cochlear Implants Int [Internet]. 2014;15(3):121–35. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L604124570&from=export
21. Marshall C, Jones A, Denmark T, Mason K, Atkinson J, Botting N, et al. Deaf children’s non-verbal working memory is impacted by their language experience. Front Psychol. 2015 May 5;6.
22. Dettman S, Wall E, Constantinescu G, Dowell R. Communication outcomes for groups of children using cochlear implants enrolled in auditory-verbal, aural-oral, and bilingual-bicultural early intervention programs. Otol Neurotol [Internet]. 2013 Apr 1 [cited 2023 Nov 5];34(3):451–9. Available from: https://europepmc.org/article/MED/23442569
23. Lyness CR, Woll B, Campbell R, Cardin V. How does visual language affect crossmodal plasticity and cochlear implant success? Neurosci Biobehav Rev. 2013 Dec;37(10):2621–30.
24. Bergeson TR, Pisoni DB, Davis RAO. Development of Audiovisual Comprehension Skills in Prelingually Deaf Children With Cochlear Implants. Ear Hear. 2005 Apr;26(2):149–64.
25. Markman TM, Quittner AL, Eisenberg LS, Tobey EA, Thal D, Niparko JK, et al. Language development after cochlear implantation: an epigenetic model. J Neurodev Disord. 2011 Dec 19;3(4):388–404.
26. Giraud AL, Price CJ, Graham JM, Truy E, Frackowiak RSJ. Cross-Modal Plasticity Underpins Language Recovery after Cochlear Implantation. Neuron. 2001 May;30(3):657–64.
27. LU J, JONES A, MORGAN G. The impact of input quality on early sign development in native and non-native language learners. J Child Lang. 2016 May 29;43(3):537–52.
28. Mushtaq F, Wiggins IM, Kitterick PT, Anderson CA, Hartley DEH. The Benefit of Cross-Modal Reorganization on Speech Perception in Pediatric Cochlear Implant Recipients Revealed Using Functional Near-Infrared Spectroscopy. Front Hum Neurosci. 2020 Aug 14;14.
29. MacSweeney M. Neural systems underlying British Sign Language and audio-visual English processing in native users. Brain. 2002 Jul 1;125(7):1583–93.
30. Finney EM, Fine I, Dobkins KR. Visual stimuli activate auditory cortex in the deaf. Nat Neurosci. 2001 Dec 12;4(12):1171–3.
31. Fine I, Finney EM, Boynton GM, Dobkins KR. Comparing the Effects of Auditory Deprivation and Sign Language within the Auditory and Visual Cortex. J Cogn Neurosci. 2005 Oct 1;17(10):1621–37.
32. Bauer E, Sánchez L, Wang Y, Vaughan A. A Transdisciplinary Lens for Bilingual Education. New York: Routledge; 2021.
33. Lieberman AM, Mitchiner J, Pontecorvo E. Hearing parents learning American Sign Language with their deaf children: a mixed-methods survey. Applied Linguistics Review. 2024 Jan 29;15(1):309–33.
34. Caselli N, Pyers J, Lieberman AM. Deaf Children of Hearing Parents Have Age-Level Vocabulary Growth When Exposed to American Sign Language by 6 Months of Age. J Pediatr. 2021 May;232:229–36.
35. Prinz PM, Strong M. ASL Proficiency and English Literacy within a Bilingual Deaf Education Model of Instruction. Top Lang Disord. 1998 Aug;18(4):47–60.
36. Scott JA, Hoffmeister RJ. Superordinate Precision: An Examination of Academic Writing Among Bilingual Deaf and Hard of Hearing Students. The Journal of Deaf Studies and Deaf Education. 2018 Apr 1;23(2):173–82.
37. Knoors H, Marschark M. Language Planning for the 21st Century: Revisiting Bilingual Language Policy for Deaf Children. J Deaf Stud Deaf Educ. 2012 Jul 1;17(3):291–305.
38. Mayer C, Wells G. Can the Linguistic Interdependence Theory Support A Bilingual-Bicultural Model of Literacy Education for Deaf Students? J Deaf Stud Deaf Educ. 1996 Apr 1;1(2):93–107.
39. Davidson K, Lillo-Martin D, Chen Pichler D. Spoken English Language Development Among Native Signing Children with Cochlear Implants. J Deaf Stud Deaf Educ. 2014 Apr 1;19(2):238–50.
40. Hoffmeister R, Henner J, Caldwell-Harris C, Novogrodsky R. Deaf Children’s ASL Vocabulary and ASL Syntax Knowledge Supports English Knowledge. The Journal of Deaf Studies and Deaf Education. 2021 Dec 16;27(1):37–47.
41. WOLL B. The consequences of very late exposure to BSL as an L1. Bilingualism: Language and Cognition. 2018 Nov 20;21(5):936–7.
42. Hassanzadeh S. Outcomes of cochlear implantation in deaf children of deaf parents: comparative study. J Laryngol Otol. 2012 Oct 21;126(10):989–94.
43. Park GY, Moon IJ, Kim EY, Chung E wook, Cho YS, Chung WH, et al. Auditory and Speech Performance in Deaf Children with Deaf Parents After Cochlear Implant. Otology & Neurotology. 2013 Feb;34(2):233–8.
2. Marschark M, Spencer PE. Spoken Language Development of Deaf and Hard-of-Hearing Children: Historical and Theoretical Perspectives. In: Advances in the Spoken Language Development of Deaf and Hard-of-Hearing Children. Oxford University Press; 2005. p. 3–21.
3. Mitchell RE, Karchmer MA. Chasing the Mythical Ten Percent: Parental Hearing Status of Deaf and Hard of Hearing Students in the United States. Sign Lang Stud. 2004;4(2):138–63.
4. Geers AE, Strube MJ, Tobey EA, Pisoni DB, Moog JS. Epilogue: Factors Contributing to Long-Term Outcomes of Cochlear Implantation in Early Childhood. Ear Hear. 2011 Feb;32(1):84S-92S.
5. Fitzpatrick EM, Stevens A, Garritty C, Moher D. The effects of sign language on spoken language acquisition in children with hearing loss: a systematic review protocol. Syst Rev. 2013 Dec 6;2(1):108.
6. PETITTO LA, KATERELOS M, LEVY BG, GAUNA K, TÉTREAULT K, FERRARO V. Bilingual signed and spoken language acquisition from birth: implications for the mechanisms underlying early bilingual language acquisition. J Child Lang. 2001 Jun 25;28(2):453–96.
7. Petitto LA, Zatorre RJ, Gauna K, Nikelski EJ, Dostie D, Evans AC. Speech-like cerebral activity in profoundly deaf people processing signed languages: Implications for the neural basis of human language. Proceedings of the National Academy of Sciences. 2000 Dec 5;97(25):13961–6.
8. Johnston JC, Durieux-Smith A, Bloom K. Teaching gestural signs to infants to advance child development: A review of the evidence. First Lang. 2005 Jun 25;25(2):235–51.
9. Jana LA, Shu J. Heading Home With Your Newborn. American Academy of Pediatrics; 2005.
10. Shojaei E, Jafari Z, Gholami M. Effect of Early Intervention on Language Development in Hearing-Impaired Children. Iran J Otorhinolaryngol. 2016 Jan;28(84):13–21.
11. Nicholas JG, Geers AE. Will They Catch Up? The Role of Age at Cochlear Implantation in the Spoken Language Development of Children With Severe to Profound Hearing Loss. Journal of Speech, Language, and Hearing Research. 2007 Aug;50(4):1048–62.
12. Davidson K, Lillo-Martin D, Chen Pichler D. Spoken English Language Development Among Native Signing Children With Cochlear Implants. J Deaf Stud Deaf Educ. 2014 Apr 1;19(2):238–50.
13. Trovato S. A Stronger Reason for the Right to Sign Languages. Sign Lang Stud. 2013;13(3):401–22.
14. Hall ML, Hall WC, Caselli NK. Deaf children need language, not (just) speech. First Lang. 2019 Aug 13;39(4):367–95.
15. Fitzpatrick EM, Hamel C, Stevens A, Pratt M, Moher D, Doucet SP, et al. Sign Language and Spoken Language for Children With Hearing Loss: A Systematic Review. Pediatrics. 2016 Jan 1;137(1).
16. Geers AE, Mitchell CM, Warner-Czyz A, Wang NY, Eisenberg LS. Early sign language exposure and cochlear implantation benefits. Pediatrics [Internet]. 2017;140(1). Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L617228624&from=export
17. Hassanzadeh S. Outcomes of cochlear implantation in deaf children of deaf parents: comparative study. J Laryngol Otol. 2012 Oct 21;126(10):989–94.
18. Delcenserie A, Genesee F, Champoux F. Exposure to sign language prior and after cochlear implantation increases language and cognitive skills in deaf children. Dev Sci. 2024 Jul 7;27(4).
19. Hall ML, Hall WC, Caselli NK. Deaf children need language, not (just) speech. First Lang [Internet]. 2019;39(4):367–95. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85063026416&doi=10.1177%2f0142723719834102&partnerID=40&md5=dc409af74d1b7895c21ffb4893657e11
20. Yanbay E, Hickson L, Scarinci N, Constantinescu G, Dettman SJ. Language outcomes for children with cochlear implants enrolled in different communication programs. Cochlear Implants Int [Internet]. 2014;15(3):121–35. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L604124570&from=export
21. Marshall C, Jones A, Denmark T, Mason K, Atkinson J, Botting N, et al. Deaf children’s non-verbal working memory is impacted by their language experience. Front Psychol. 2015 May 5;6.
22. Dettman S, Wall E, Constantinescu G, Dowell R. Communication outcomes for groups of children using cochlear implants enrolled in auditory-verbal, aural-oral, and bilingual-bicultural early intervention programs. Otol Neurotol [Internet]. 2013 Apr 1 [cited 2023 Nov 5];34(3):451–9. Available from: https://europepmc.org/article/MED/23442569
23. Lyness CR, Woll B, Campbell R, Cardin V. How does visual language affect crossmodal plasticity and cochlear implant success? Neurosci Biobehav Rev. 2013 Dec;37(10):2621–30.
24. Bergeson TR, Pisoni DB, Davis RAO. Development of Audiovisual Comprehension Skills in Prelingually Deaf Children With Cochlear Implants. Ear Hear. 2005 Apr;26(2):149–64.
25. Markman TM, Quittner AL, Eisenberg LS, Tobey EA, Thal D, Niparko JK, et al. Language development after cochlear implantation: an epigenetic model. J Neurodev Disord. 2011 Dec 19;3(4):388–404.
26. Giraud AL, Price CJ, Graham JM, Truy E, Frackowiak RSJ. Cross-Modal Plasticity Underpins Language Recovery after Cochlear Implantation. Neuron. 2001 May;30(3):657–64.
27. LU J, JONES A, MORGAN G. The impact of input quality on early sign development in native and non-native language learners. J Child Lang. 2016 May 29;43(3):537–52.
28. Mushtaq F, Wiggins IM, Kitterick PT, Anderson CA, Hartley DEH. The Benefit of Cross-Modal Reorganization on Speech Perception in Pediatric Cochlear Implant Recipients Revealed Using Functional Near-Infrared Spectroscopy. Front Hum Neurosci. 2020 Aug 14;14.
29. MacSweeney M. Neural systems underlying British Sign Language and audio-visual English processing in native users. Brain. 2002 Jul 1;125(7):1583–93.
30. Finney EM, Fine I, Dobkins KR. Visual stimuli activate auditory cortex in the deaf. Nat Neurosci. 2001 Dec 12;4(12):1171–3.
31. Fine I, Finney EM, Boynton GM, Dobkins KR. Comparing the Effects of Auditory Deprivation and Sign Language within the Auditory and Visual Cortex. J Cogn Neurosci. 2005 Oct 1;17(10):1621–37.
32. Bauer E, Sánchez L, Wang Y, Vaughan A. A Transdisciplinary Lens for Bilingual Education. New York: Routledge; 2021.
33. Lieberman AM, Mitchiner J, Pontecorvo E. Hearing parents learning American Sign Language with their deaf children: a mixed-methods survey. Applied Linguistics Review. 2024 Jan 29;15(1):309–33.
34. Caselli N, Pyers J, Lieberman AM. Deaf Children of Hearing Parents Have Age-Level Vocabulary Growth When Exposed to American Sign Language by 6 Months of Age. J Pediatr. 2021 May;232:229–36.
35. Prinz PM, Strong M. ASL Proficiency and English Literacy within a Bilingual Deaf Education Model of Instruction. Top Lang Disord. 1998 Aug;18(4):47–60.
36. Scott JA, Hoffmeister RJ. Superordinate Precision: An Examination of Academic Writing Among Bilingual Deaf and Hard of Hearing Students. The Journal of Deaf Studies and Deaf Education. 2018 Apr 1;23(2):173–82.
37. Knoors H, Marschark M. Language Planning for the 21st Century: Revisiting Bilingual Language Policy for Deaf Children. J Deaf Stud Deaf Educ. 2012 Jul 1;17(3):291–305.
38. Mayer C, Wells G. Can the Linguistic Interdependence Theory Support A Bilingual-Bicultural Model of Literacy Education for Deaf Students? J Deaf Stud Deaf Educ. 1996 Apr 1;1(2):93–107.
39. Davidson K, Lillo-Martin D, Chen Pichler D. Spoken English Language Development Among Native Signing Children with Cochlear Implants. J Deaf Stud Deaf Educ. 2014 Apr 1;19(2):238–50.
40. Hoffmeister R, Henner J, Caldwell-Harris C, Novogrodsky R. Deaf Children’s ASL Vocabulary and ASL Syntax Knowledge Supports English Knowledge. The Journal of Deaf Studies and Deaf Education. 2021 Dec 16;27(1):37–47.
41. WOLL B. The consequences of very late exposure to BSL as an L1. Bilingualism: Language and Cognition. 2018 Nov 20;21(5):936–7.
42. Hassanzadeh S. Outcomes of cochlear implantation in deaf children of deaf parents: comparative study. J Laryngol Otol. 2012 Oct 21;126(10):989–94.
43. Park GY, Moon IJ, Kim EY, Chung E wook, Cho YS, Chung WH, et al. Auditory and Speech Performance in Deaf Children with Deaf Parents After Cochlear Implant. Otology & Neurotology. 2013 Feb;34(2):233–8.
| Issue | Articles in Press | |
| Section | Review Article(s) | |
| Keywords | ||
| Deaf, Hard of hearing, Language, Sign language, Systematic review | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Jarollahi F, Fallahnezhad T, Aslibeigi F. The Effect of Sign Language on the Development of Language of Deaf and Hard-of-Hearing Children: Systematic Review. jmr. 2025;(-).
