The Earliest Interventions: When Parents Discover they have a Deaf Child

The issue

sass-lehrerExpectant parents eagerly await the birth of their child and celebrate the baby’s arrival.  Parents fully expect their baby to resemble them physically and in temperament. The confirmation that their baby is deaf is usually unexpected, and parents are often unprepared for this news.  Most parents with deaf or hard-of-hearing babies born in the United States discover their child’s hearing level soon after birth.  Differences in hearing levels occur in roughly 2 -3 births per 1000, and in almost all of these instances, the parents are hearing.

When parents discover their baby is deaf or hard of hearing, they likely have many questions. How does being deaf or hard of hearing affect development? How do deaf children acquire language?  What’s in store for my child’s future?  Who can help guide us?  Most parents do not realize that the opportunities for deaf children have never been greater. Deaf and hard-of-hearing children born in countries with newborn hearing screening and effective early intervention have the potential to function very similar to their hearing peers in all areas of development. Although outcomes vary and depend upon a number of factors, the benefits of early intervention have exceeded expectations.

What we know and what we don’t know

There is ample evidence that newborn hearing screening leads to earlier provision of early intervention services.  Comprehensive early intervention programming provided by knowledgeable and skilled specialists leads to better child outcomes than when these programs and specialists are not available.  Unfortunately, a significant number of children in need of services do not receive early intervention in a timely manner, that is, by 6 months of age.  Several factors may hinder families from accessing early intervention, however, a multifaceted solution to ensuring that all children receive timely early intervention has not yet been found.

Infants’ brains are wired for language that is accessible to them through either visual (signs) or auditory (spoken) modalities.  Young children are capable of acquiring more than one language, even when those languages are presented via different modalities. The achievement of language milestones in either sign language or spoken language is crucial to the overall development of the child.  Children whose language development is delayed in the early years of life often face difficulties catching up. Hearing and visual technologies can provide at least partial access to language, however, we do not yet know how to predict which technologies (e.g., hearing aids, cochlear implants) will work best for which child.

One of the primary goals of early intervention is to support parent-child communication.  Language, spoken or signed, provides a foundation for the development of critical thinking and the acquisition of additional languages.  In order to acquire language naturally, the child needs access to language through hearing or vision and opportunities to use language through meaningful and consistent interactions with primary caregivers.  Researchers generally agree that early visual language models support a strong foundation for language and literacy.

Hearing family members can learn to communicate effectively with their children with support from professionals and deaf or hard-of- hearing adults. Family involvement including effective family-infant communication, along with timely early intervention, is the strongest predictor of early language development.  Infants and toddlers who are deaf or hard of hearing and their families are extremely diverse and, services should be tailored to meet the needs of the children and the families’ resources and priorities. There is little evidence to suggest the most effective ways to promote family involvement for all families, or the best ways for families to learn how to communicate with their deaf or hard-of-hearing children.


Research, expert opinion and consumer experience suggest several implications for policy and practice including the following:

  1. Ensure early intervention programs incorporate the evidence-based best practice guidelines endorsed by the Supplement to the JCIH 2007 Position Statement
  2. Minimize loss to follow up from newborn hearing screening to early intervention
  3. Build capacity of knowledgeable and skilled professionals (including those who are deaf, hard of hearing and individuals from underrepresented groups) to provide quality early intervention services
  4. Provide guidance and support for families to acquire skills to communicate effectively with their children (e.g., deaf and hard-of-hearing mentors)
  5. Provide opportunities for all children, regardless of financial means, to the technologies and resources (auditory and visual) that will provide maximum access to language.
  6. Promote collaboration among agencies and providers to maximize developmental outcomes, family-child relationships, and support to families during the early years.
  7. Monitor quality of early intervention through appropriate child and family outcome measures.


Posted on October 23, 2013 by
Marilyn Sass-Lehrer, Gallaudet University, Washington, DC

Further reading

Calderon, R. & Greenberg, M. (2011). Social and emotional development of deaf children: Family, school and program effects. In M. Marschark & P. Spencer (Eds.). The Oxford handbook of deaf studies, language, and education, volume 1, second edition (pp. 188-199). New York: Oxford University Press. view details

Hintermair, M. (2006). Parental resources, parental stress, and socioemotional development of deaf and hard-of-hearing children. Journal of Deaf Studies and Deaf Education, 11, 493-513.view details

Moeller, M., Carr, G., Seaver, L., Stredler-Brown, A. & Holzinger, D. (2013). Best practices in family-centered early intervention for children who are deaf or hard-of-hearing: An international consensus statement. Journal of Deaf Studies and Deaf Education, 18, 429-445.view details

Sass-Lehrer, M. (2011). Early intervention: Birth to three. In M. Marschark & P. Spencer (Eds.). The Oxford Handbook of Deaf studies, language, and education, volume 1, second edition, (pp. 63-81). New York: Oxford University Press.view details

Young, A., & Tattersall, H. (2007). Universal newborn hearing screening and early identification of deafness: Parents’ responses to knowing early and their expectations of child communication development. Journal of Deaf Studies and Deaf Education, 12, 209-220.view details

Yoshinaga-Itano, C. (2003). From screening to early identification and intervention: Discovering predictors to successful outcomes for children with significant hearing loss. Journal of Deaf Studies and Deaf Education, 8, 11-30.view details