Early Intervention with Linguistically and Culturally Diverse Deaf and Hard-of-Hearing Children

The issue

As different parts of the world become increasingly connected due to ease of travel and immigration patterns, early interventionists and educators are more likely to have daily encounters with children who vary in their proficiency levels in English, come from homes where a language other than English is spoken, and/or come from a different culture. The issue becomes further complicated when children who are linguistically and culturally diverse (LCD) are deaf or hard of hearing (DHH). Some of the important factors that impact the language development of DHH children who are LCD include the lack of appropriate assessment tools in the child’s language(s); the communication modes used by the child such as spoken language, sign language, sign supported speech; the cultural identity, beliefs and practices of the family; the extent of auditory access with/without the use of hearing devices; and competency skills of professionals to identify language abilities of the child.

What we know

  • Assessing receptive and expressive language skills in LCD children is a challenge, as the majority of the assessment tools are developed in English. A further complication arises when a child uses a visual language like American Sign Language (ASL), where assessment tools are limited
  • Children vary in their skills across the different components of language(s) (phonology, semantics, syntax, pragmatics)
  • Children may be misclassified as language delayed due to inaccurate assessments
  • Beliefs and practices of LCD families regarding hearing loss, knowledge of intervention and support, and the use of assistive technology can facilitate/impede language outcomes in children
  • Beliefs and practices of LCD families can impact the use of a visual languages ; this can critically impede language development, especially if visual language is the only mode of communication accessible to the child
  • Professionals need to identify their own competency levels  and acquire the necessary skills in linguistic and cultural diversity prior to assessing a LCD child’s language(s), sociolinguistic, cognitive and emotional skills
  • DHH LCD children come from various backgrounds, with the consequence that one assessment approach does not fit all children and families; rather, assessment has to be tailored towards each linguistic and cultural group

What we don’t know

  • Are DHH LCD children more vulnerable to language delays/deficits and literacy challenges than monolingual DHH children?
  • Are DHH LCD children at greater risk for long-term educational and academic challenges?
  • Irrespective of cultural background, are there currently strategies used by professionals to maximize language outcomes for DHH LCD children?
  • What is the influence of parents and extended family members on a DHH LCD child, and what is the impact of their expectations? Are parental expectations and professional expectations similar for a child’s language outcomes?


Understanding language abilities of LCD children who are DHH is critical for appropriate early intervention and optimal language development. Alternative cross-linguistic/cultural measures that include informal or dynamic procedures can assist in identifying language competencies early in the child’s life. These procedures aid in obtaining information on language use across different environments such as daycare, school, and home. It is also helpful to gather information about the child’s language use with family, peers, and others prior to providing intervention services. Dynamic and informal procedures can also identify specific cognitive and socio-emotional needs of the child. Such procedures provide opportunities for parents to clearly articulate the child’s abilities in various settings and can provide a better understanding of the global as well as specific language needs of LCD children.
Clinicians, teachers, special educators, family members, and policy makers need to be educated on several factors that are involved in working with DHH LCD children and their families. Interacting with DHH LCD children and families involves complex interactions requiring more preparation and planning time, not only in identifying appropriate assessment and treatment procedures but also in building rapport and identifying cultural determinants of the family that can facilitate/hinder intervention services. Other important influences are the use of interpreters and identifying one’s own roles and responsibilities and culturally determined management styles. These factors seldom operate in isolation, but rather are interconnected.
In addition, the dearth in knowledge of characteristics and variations in language development and outcomes of DHH LCD children across various settings is striking. Such knowledge requires reviewing case studies and simulations of DHH LCD children within and across specific cultural groups. The key is investing time and working collaboratively with families to identify strategies that will ultimately provide an environment that will optimize language development opportunities for DHH LCD children.

Posted on April 4, 2017 by
Noreen Simmons
BC Family Hearing Resource Centre
nsimmons {at} bcfamilyhearing.com


Further reading