Opportunities and Shared Decision-Making to Help Children Who Are Deaf to Communicate Karl R. White, PhD, a Louis Z. Cooper, MD b Parents and pediatricians agree about the importance of ensuring each child’s optimal physical, emotional, and social development. Largely because of its impact on communication, congenital hearing loss seriously threatens that development. In deciding how to communicate with their children, the parents of children who are deaf or hard of hearing (DHH), 92% of whom have normal hearing, 1 have been torn for many years by the acrimonious debate between advocates of sign language versus advocates of aural and oral education. Fortunately, advances in technology and practice over the past 25 years (eg, newborn hearing screening, digital hearing aids, cochlear implants, and early educational intervention) have dramatically improved the opportunities for children who are DHH to learn communication skills critical to optimal development at levels comparable to their hearing peers. The majority of parents with infants who are profoundly deaf are now opting for cochlear implants, and research about the benefits of cochlear implants and early intervention has mitigated some of the historic debate between those advocating for sign language and those advocating for aural and oral education for children who are DHH. 2–5 However, the role of sign language in helping children who are DHH communicate remains contentious. 6–8 Recent articles in Pediatrics have presented contrasting conclusions. In a 2015 Pediatrics article, 9 9 “experts in otolaryngology and language development [discussed] the pros and cons of teaching sign language in addition to teaching oral language.” After appropriately noting that “pediatricians. . .need to help parents understand the benefits and risks, ” 1 of the experts concluded that “There are no risks to learning sign language along with spoken language, but there are well-defined benefits.” A short time later, in another Pediatrics article 10 based on a systematic literature review of studies from 1995 to 2013, Fitzpatrick et al concluded that “insufficient . . . high-quality evidence exists to determine whether sign language in combination with oral language is more effective than oral language therapy alone.” In this issue of Pediatrics, Geers et al 11 provide clear evidence related to part of this debate about whether learning sign language helps deaf children who are implanted and have hearing parents. Children who received cochlear implants before 38 months of age were divided into 3 groups as follows: no use of sign language (n = 35), short-term use of sign language (n = 26), or long-term use of sign language (n = 37). The 3 groups did not differ by statistically significant margins on their demographic characteristics, measures of language, or cognition at baseline. Children were assessed prospectively until they were 9 to 11 years old on the basis of speech, language, and reading proficiency by certified examiners who did not know the child’s group membership. a Department of Psychology, Utah State University, Logan, Utah; and b Department of Pediatrics, Columbia University, New York, New York Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees. DOI: https://doi.org/10.1542/peds.2017-1287 Accepted for publication Apr 18, 2017 Address correspondence to Karl R. White, PhD, Psychology Department, Utah State University, 2615 Old Main Hill, Education Building # 430, Logan, UT 84322. E-mail: karl.white@usu.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2017 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: No external funding. POTENTIAL CONFLICT OF INTEREST: Our perspective in writing this commentary is influenced by many years of caring for families with children who are deaf or hard of hearing. Understanding, however, that personal experience creates unconscious bias, and wanting to be transparent, we acknowledge that we are both hearing parents of hearing children. COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/ 10.1542/peds.2016-3489. PEDIATRICS Volume 140, number 1, July 2017:e20171287 COMMENTARY To cite: White KR and Cooper LZ. Opportunities and Shared Decision-Making to Help Children Who Are Deaf to Communicate. Pediatrics. 2017; 140(1):e20171287 by guest on July 20, 2020 www.aappublications.org/news Downloaded from