Deaf Children’s Joint Attention in Social Interactions

The issue

Cochlear implants (CIs) are an engineering and medical milestone in the treatment of sensorineural hearing loss, as they provide many deaf children access to auditory experience. CIs do not restore normal hearing ability and there is a significant amount of variability in outcomes following cochlear implantation. Many children with CIs display substantial benefits in recognizing speech and processing spoken language following implantation, but a significant number of children have poor outcomes and display less than optimal speech and language skills following implantation. Two of the overarching questions in the field of pediatric hearing loss concern how to predict language outcomes and how to facilitate language development in deaf children following cochlear implantation.

What we know

Language learning begins primarily within social interactions, which includes parents talking about objects, and children learning the associations between words and objects. In such everyday contexts, parents provide the words and choose the moments when to supply them. Parents also guide their children’s attention to the intended object, creating moments of joint attention (when parents and children focus on the same object at the same time). Research reveals strong associations between the amount of time parents and children engage in joint attention and later language learning in both deaf and hearing children.

Several factors may influence the ease of coordinating joint attention between parents and children, including hearing status, interaction style, and maternal linguistic input. For example, mother-child dyads that share hearing status (a deaf mother with a deaf child or a hearing mother with a hearing child) spend more time in joint attention than mother-child dyads that do not share hearing status (a deaf mother with a hearing child or a hearing mother with a deaf child). Parents also may facilitate episodes of joint attention by providing the word for an object already in the child’s attentional focus or may regulate episodes of joint attention by redirecting the child’s attentional focus to objects. Observational studies suggest that object naming provided by parents while following their hearing toddler’s attentional focus facilitates joint attention and larger vocabulary sizes.

The kinds of linguistic information hearing parents provide to children differ as a function of the child’s hearing status (whether hearing or deaf and hard-of-hearing, DHH). Mothers of DHH toddlers often provide language that is more directive in nature (“Show me the blue toy”) than mothers of age-matched hearing peers. On the other hand, mothers of hearing toddlers often ask more open-ended questions (“What can we do with the blue toy?”) than mothers of DHH peers. In hearing dyads, parents’ use of linguistic information to direct their toddler’s visual attention and behavior is associated with shorter episodes of mother-child joint attention and less knowledge of object-word pairings in toddlers. These findings suggest that highly directive parental styles are not conducive to early language learning in hearing toddlers.

What we don’t know

Only a limited number of studies have investigated the effect of hearing loss on children’s joint attentional skills and therefore, much of what we know about joint attention comes from research on hearing mothers and their hearing toddlers. Dyads consisting of a hearing mother and a deaf child are at a disadvantage when engaging in joint attention because they may be unable to fully rely on linguistic information to direct or maintain episodes of joint attention. Consequently, several interesting questions may be explored, for example: Before cochlear implantation, how do hearing parents achieve joint attention with their deaf child? How are visual, auditory, and motor behaviors spatially and temporally aligned during episodes of parent-child joint attention following cochlear implantation? Are hearing parents more likely to follow their deaf child’s attentional focus or are they more likely to regulate episodes of joint attention by redirecting the child’s attentional focus to labeled objects? Does maternal language containing more directives facilitate or impede episodes of joint attention and language learning.


Examining the role of joint attention during children’s language learning has both clinical and educational implications. Frequent monitoring of CI users’ attention during tasks, especially peer-to-peer and group tasks is paramount for promoting learning and academic success among those children. The work may also identify specific targets for clinical interventions, such communicative behaviors by parents that could be modified to promote more effective labeling events for their children.

Posted on Jan. 12, 2018 by
Irina Castellanos
Chi-hsin Chen
Chen Yu
Derek M. Houston
The Ohio State University
Irina.Castellanos {at}


Further reading