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8/3/2019 Lexical and Grammatical Abilities in Deaf Italian
1/14
Lexical and Grammatical Abilities in Deaf Italian
Preschoolers: The Role of Duration of Formal
Language Experience
Pasquale RinaldiIstituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche
Dipartimento di Psicologia Dinamica e Clinica, Universita di Roma Sapienza
Cristina Caselli
Istituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche, Rome, Italy
We evaluated language development in deaf Italian pre-
schoolers with hearing parents, taking into account the du-
ration of formal language experience (i.e., the time elapsed
since wearing a hearing aid and beginning language educa-
tion) and different methods of language education. Twenty
deaf children were matched with 20 hearing children for age
and with another 20 hearing children for duration of expe-
rience. Deaf children showed a significant delay in both
vocabulary and grammar when compared to same-age hear-
ing children yet a similar development compared to hearing
children matched for duration of formal language experi-
ence. The delay in linguistic development could be attribut-
able to shorter formal language experience and not to
deafness itself. Deaf children exposed to spoken language
accompanied by signs tended to understand and produce
more words than children exposed only to spoken language.
We suggest that deaf children be evaluated based on their
linguistic experience and cognitive and communicative
potential.
Deaf children exposed to sign language by deaf parents
acquire it as a first language (Newport & Meier, 1985),
yet around 95% of deaf children have hearing parents,
most of whom are unfamiliar with sign language
(Marschark, Lang, & Albertini, 2002). Deaf children
with hearing parents have consistently revealed a gen-
eral delay in the onset of language, as well as a slower
rate of progression, resulting in poorer linguistic abil-
ities with respect to same-age hearing children (Mayne,
Yoshinaga-Itano, & Sedey, 2000; Mayne, Yoshinaga-
Itano, Sedey, & Carey, 2000; Moeller, 2000; Pizzuto,
Ardito, Caselli, & Volterra, 2001; Volterra, Capirci, &
Caselli, 2001; see Caselli, Maragna, & Volterra, 2006,
for a recent review). In particular, Mayne, Yoshinaga-
Itano, and Sedey (2000) and Mayne, Yoshinaga-Itano,
Sedey, and Carey (2000) studied the vocabulary of
preschool-aged deaf/hard-of-hearing children (2437
months old) with hearing parents using the MacArthur
Bates Communicative Development Inventories
(CDI; Fenson et al., 1993), a questionnaire filled in
by parents which is widely used for both clinical and
research purposes (Dale, Bates, Reznick, & Morisset,
1989) and which was recently validated for children
with hearing loss (Mayne, Yoshinaga-Itano, & Sedey,
2000; Mayne, Yoshinaga-Itano, Sedey, & Carey, 2000),
including those with a cochlear implant (CI; Stallings,
Gao, & Svirsky, 2002; Thal, DesJardin, & Eisenberg,
2007). The study of Mayne, Yoshinaga-Itano, Sedey,and Carey (2000) showed that deaf children produced
significantly fewer words than similar-age hearing chil-
dren and that their slower rate of acquisition resulted in
increased differences with age, so that 6-year-old deaf
children generally had a vocabulary comparable to that
of 3-year-old hearing children, independently of the
degree of deafness. Moreover, Lederberg and Spencer
We wish to thank Virginia Volterra and Traute Taeschner for their in-
sightful comments on an earlier version of the paper. We also thank the
Audiology and Speech Therapy Services of the Bambino Gesu Paediatric
Hospital of Rome for their help in recruiting deaf children and Concetta
DAmico, Melissa Franchi, Francesca Moccia, and Cristiana Varuzza for
their help with data collection, transcription, and coding. We are very
grateful to Mark Kanieff for his helpful comments and for the revision of
English. We especially thank the children and parents who participated
in the study. No conflicts of interest were reported. Correspondence
should be sent to Pasquale Rinaldi, Istituto di Scienze e Tecnologie della
Cognizione, Consiglio Nazionale delle Ricerche, Via Nomentana, 56
00161 Rome, Italy (e-mail: [email protected]).
The Author 2008. Published by Oxford University Press. All rights reserved.
For Permissions, please email: [email protected]
doi:10.1093/deafed/enn019
Advance Access publication on June 5, 2008
8/3/2019 Lexical and Grammatical Abilities in Deaf Italian
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(2001) highlighted that deaf children lack a spurt in
vocabulary development, which is characteristic in
hearing children. With regard to the development of
spoken grammar, in the early stages, some deaf and
hard-of-hearing children have age-appropriate gram-
mar skills, whereas others are significantly delayed,
with a slower rate of successive development (Blamey,2003).
So as to compensate for their difficulties in speak-
ing, deaf children, and hearing children with linguistic
disabilities in general, rely more on the use of gestures
than do their peers (Capone, 2007; Goldin-Meadow &
Mylander, 1984; Morford, 1998; Volterra & Erting,
1994). In this light, some language education and/or
rehabilitation programs for deaf children rely on si-
multaneous communication, which consists of the spo-
ken language and the simultaneous use of lexical signs
from the sign language used in the given country, yet
following the grammatical structure of the spoken lan-
guage (in Italy, this form of communication is referred
to as bimodal). In some cases (i.e., to improve the
morphological aspects of speech), the spoken language
may be accompanied by a form of manually coded
language to highlight morphological word endings,
using above all finger spelling, for example, Manually
Coded English (MCE; Bornstein, 1990) or Italiano
Segnato Esatto (Exact Signed Italian; Beronesi,
Massoni, & Ossella, 1991). The supporters of simul-
taneous communication claim that the use of a visual
gestural modality, which is not impaired in deaf
children, may improve the acquisition of spoken lan-
guage. However, studies on the effect of the use of
manually coded systems (mostly MCE) on language
acquisition in deaf children with hearing parents show
discordant results. Some show that deaf children
learning MCE have significantly delayed vocabulary
and grammatical development, compared with hearing
children, whereas others show that vocabulary devel-
opment is similar when compared to that of hearingchildren (Bornstein & Saulnier, 1981; Bornstein,
Saulnier, & Hamilton, 1980; Schick & Moeller, 1992;
see also Schick, 2003, for a review on this topic). The
studies that found delayed vocabulary development
also found that the rate of vocabulary growth was
slower in deaf children with hearing parents compared
to hearing children or deaf children exposed to sign
language since birth. In Italy, no studies have evalu-
ated the effects of the bimodal method on language
acquisition in deaf children, although there are clinical
case reports that show that this method has positive
effects (Massoni & Maragna, 1997).
With regard to the potential factors involved in the
delayed language development of deaf children,Marschark (1995) and Marschark and Clark (1998)
have pointed out that linguistic abilities do not depend
on the degree of hearing loss but are related to differ-
ences in the family, language, and educational environ-
ment (see also Pizzuto et al., 2001). In fact, most
children with high performance levels in language tasks
had parents who were well adjusted to their childs
deafness. The parents actively participated in the
childs education, promoting the childs autonomy
and awareness of the deaf and hearing cultures and
their related languages (sign or speech). In the above-
mentioned study, Mayne, Yoshinaga-Itano, Sedey, and
Carey (2000) reported that the most important factors
related to language development were age at diagnosis
of hearing loss, age at beginning language rehabilita-
tion, and the childs general intellectual skills, demon-
strating how the plasticity of the childs brain and basic
cognitive competence are crucial for successive learn-
ing. Children diagnosed before 6 months of age showed
greater language skills than children diagnosed later,
independently of the level of hearing loss, of the
familys socioeconomic status, and of the method of lan-
guage rehabilitation, as also reported by Moeller (2000).
However, although all the above studies reported
individual variability, few deaf children showed above-
average spoken language skills and most had fallen sig-
nificantly behind their hearing peers (Blamey, 2003).
Although more recent studies have confirmed the
importance of age at diagnosis and at beginning lan-
guage rehabilitation (Yoshinaga-Itano, 2003, 2004), to
the best of our knowledge, none of the studies that
have compared deaf children with traditional hearingaids to hearing children have matched the two groups
in terms of the duration of exposure to language,
which for deaf children begins with the start of formal
language rehabilitation and for hearing children begins
at birth. Instead, this method has on a number of
occasions been used to assess language development
in deaf children with a CI. In fact, to demonstrate
64 Journal of Deaf Studies and Deaf Education 14:1 Winter 2009
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the effectiveness of the CI, which in the past decade
has been provided to many deaf children, language
development has been evaluated not in relation to
the childs age but to the time elapsed since CI activa-
tion, that is, in terms of time postimplant or time of
implant use. The results have shown that the lan-
guage capabilities of these children are not significantlydifferent from those of hearing children whose chro-
nological age corresponded to the time postimplant of
the children with the CI (Blamey et al., 2001; Ertmer,
Strong, & Sadagopan, 2003; Nikolopoulos, Archbold,
& Gregory, 2005; Svirsky, Robbins, Kirk, Pisoni, &
Miyamoto, 2000; Tomblin, Spencer, Flock, Tyler, &
Gantz, 1999).
The main objective of this study was to assess
language development of deaf children without a CI,
considering the chronological age as well as the time
elapsed since beginning formal language training. The
specific goals of this study were to evaluate language
skills in deaf Italian preschoolers, compared to hearing
children, taking into account both chronological age
and duration of formal language training, to meet the
following three main objectives:
1. to evaluate spoken vocabulary (comprehension
and production) and early grammar skills and the re-
lationship between the two;
2. to evaluate the effects of different rehabilitation
methods (i.e., the oral method vs. the bimodal
method) on language abilities; and
3. to evaluate the rate of progression of language
development with age, comparing children with
shorter and longer formal language training.
The importance of the results lies in the fact that in
Italy, as in other countries, almost all children with severe
or profound hearing loss undergo speech therapy pro-
grams and the linguistic capabilities acquired through
this training often constitute one of the criteria for de-
ciding whether or not the child should receive a CI.
Methods
Participants
We collected data on language development from 20
deaf children, whose parents were recruited at the
Audiology and Speech Therapy Services of the
Bambino Gesu Pediatric Hospital (Rome, Italy), where
the children were undergoing regular controls of their
hearing aid. None of the deaf children had a cognitive
or neurological deficit associated with deafness. Five
children had moderate hearing loss, 5 had severe hear-
ing loss, and 10 had profound hearing loss. All thechildren had a hearing aid, whereas none of them
had a CI (many children in Italy, and in particular in
Rome, still use traditional hearing aids). All children
attended speech therapy sessions, either two or three
times a week; 10 children were taught with the oral
method (speaking without systematically using gesture
and/or signs) and 10 with the bimodal method. None
of the parents knew sign language before discovering
that their child was deaf. The parents of the 10 chil-
dren taught with the bimodal method began attending
a sign language course (once a week) within 2 months
of their childs beginning speech therapy. These
parents were encouraged to use, in the most natural
manner possible, the gestural modality together with
spoken language when communicating with their
child. All children were enrolled in regular nursery
schools or kindergartens with hearing children. None
of the teachers or the hearing children at school knew
or used either sign language or any form of bimodal
communication. The demographic characteristics of
the deaf children are reported in Table 1.
As controls, we considered 40 hearing children,
recruited at daycare centers, nursery schools, and kin-
dergartens in Rome. The 40 hearing children were
divided into two groups of 20 children each. To form
the first control group, each hearing child was individ-
ually matched with a same-age deaf child (this control
group is referred to as same-age hearing children).
To form the second control group, each deaf child was
individually matched with a hearing child whose chro-
nological age corresponded to, for the deaf child, the
amount of time that had elapsed between startinga speech therapy training (which also corresponded
to the time of receiving the hearing aid) and the time
that the questionnaire was administered. This time
was considered as the duration of formal spoken lan-
guage experience (for hearing children language expe-
rience begins with birth); this second control group
is referred to as the same duration of language
Language Development in Italian Deaf Children 65
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experience hearing children. Table 2 shows the mean
age and duration of language experience for the deaf
and hearing children. To test the correct pairing of
groups, we conducted a Students t test for age and
for duration of language experience. The results
showed that the groups were correctly paired, age:
t(19) 5 0.370; p 5 .72, and duration of language
experience: t(19) 5 0.252; p 5 .80. Moreover, the
mean age and duration of language experience of the
deaf children exposed to the oral method were equal to
those of the deaf children exposed to the bimodal
method, age: t(18) 5 0.083; p 5 .934, and duration
of language experience: t(18) 5 0.000; p 5 1.000.
To evaluate the differences in vocabulary and
grammar in relation to the duration of language expe-
rience, we subdivided both deaf and hearing children
into two subgroups each. The deaf children with a du-ration of spoken language experience of 817 months
were defined as shorter language experience deaf
children and those with a duration of spoken lan-
guage experience of 1844 months as longer language
experience deaf children. These specific durations
were chosen based on the results of previous studies
on language development in hearing children, which
were conducted using the MacArthurBates CDI and
which highlighted that at about 18 months important
developmental changes usually occur, in particular, the
lexical repertoire dramatically increases and the ability
to produce simple sentences emerges (Caselli, Casadio, &
Bates, 1999; Dale, Dionne, Eley, & Plomin, 2000;
Fenson et al., 1994). Six of the shorter language expe-
rience deaf children were exposed to the oral method
and four to the bimodal method; among the longer
language experience deaf children, four were exposed
to the oral method and six to the bimodal method.
Using the same criteria, the 20 same duration of lan-
guage experience hearing children were also divided
into two subgroups: shorter language experience
hearing children (i.e., younger children; 718 months
of age) and longer language experience hearing chil-
dren (i.e., older children; 1944 months of age).
To evaluate the differences in the transversal pro-
files of the deaf children, from the shorter language
experience group to the longer language experience
group, compared to the hearing control groups, we
Table 1 Demographic characteristics of the deaf
participants
Characteristics M SD N %
Chronological age 41.60 10.44
Age at identification
of deafness
13.80 11.91
Age at amplification
(hearing aids)
17.95 11.23
Months after hearing aids 23.65 9.94
Age at beginning speech
therapy
20.50 11.81
Months after beginning
speech therapy
21.30 11.09
Here referred as duration
of language experience
Degree of hearing loss
(in better ear)
Severe
Aided pure-tone average 46.07 dBa 15.88
Gender
Male 11 55Female 9 45
Cause of hearing loss
Unknown 10 50
Genetic 4 20
Meningitis 2 10
Other 4 20
aThese data are available only for 14 participants.
Table 2 Chronological age and duration of language experience of deaf children and hearing children
Children Number
Chronological age Duration of language experience
Range
(months)
Mean
(months) SD
Range
(months)
Mean
(months) SD
Deaf 20 1861 41.6 10.4 844 21.3 11.1
Oral method 10 2861 41.8 11.0 844 21.3 13.1
Bimodal method 10 1855 41.4 10.4 835 21.3 9.3
Hearing
Same chronological age 20 1960 41.6 10.3
Same duration of language experience 20 744 21.4 11.1
66 Journal of Deaf Studies and Deaf Education 14:1 Winter 2009
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performed an analysis of variance (ANOVA), with two
factors at two levels each. The first factor was hearing
status, with two levels: deaf and hearing. The
second factor was duration of spoken language expe-
rience, with two levels: shorter and longer. In each
analysis, we tested the statistical significance of the
interaction between the two factors and, if lacking,we tested the significance of the factor duration of
language experience.
Table 3 shows the mean duration of language ex-
perience, range, and standard deviation and the results
of the statistical tests, which show that the groups of
deaf and hearing children were correctly matched.
Instrument and Procedures
To evaluate language development in deaf children, we
used the MacArthurBates CDI (Fenson et al., 1993),
a questionnaire that has been adapted to more than 40
languages. Various studies have found that this parent
report measure is effective in characterizing childrens
early language skills (Dale et al., 1989; Fenson et al.,
1994; Thal, OHanlon, Clemmons, & Fralin, 1999). It
has been used in both populations with typical devel-
opment (e.g., Dale et al., 2000; Farrar & Maag, 2002;
Feldman et al., 2003) and those with atypical develop-
ment, including deaf children (Mayne, Yoshinaga-
Itano, & Sedey, 2000; Mayne, Yoshinaga-Itano, Sedey,
& Carey, 2000; Stallings et al., 2002; Thal et al., 2007;
Yoshinaga-Itano, Snyder, & Day, 1998). For the Italian
version, norms are available for hearing children be-
tween 8 and 36 months of age (Caselli & Casadio,
1995; Caselli, Pasqualetti, & Stefanini, 2007). Short
forms of the CDI have also been developed (Eriksson,
Westerlund, & Berglund, 2002; Fenson et al., 2000).
The short form of the Italian version has been vali-
dated among 800 Italian hearing children (Caselli
et al., 2007). In this study, we used this short form,
which we adapted for use with hearing parents with
deaf children. In particular, we included an evaluation
of lexical comprehension and lexical production in
terms of both the spoken word and/or gestures orsigns (adapted version referred to as Il Primo Voca-
bolario del Bambino Sordo, PVB-s [The First Vo-
cabulary of the Deaf Child]; Caselli & Rinaldi, 2005).
The questionnaire was filled in on one day by the
parents of both deaf and hearing children. Of the five
sections of the questionnaire, in this analysis we con-
sidered Vocabulary and Sentences, given that
these are the sections used for children greater than
18 months of age (Caselli et al., 2007; Fenson et al.,
1994). The Vocabulary section consists of a list of 100
meanings (the same used in the short version for hear-
ing children) expressing both content words (i.e.,
nominal, such as Cane/Dog, Cappello/Hat) and pred-
icates, such as Dormire/To sleep, Caldo/Hot), and
function words (such as Perche/Why, Ancora/More).
Parents were asked to indicate their childs compre-
hension of meanings and their production, whether
spoken and/or using a gesture or a sign of Italian Sign
Language, and even if using a different pronunciation
or if making an imprecise sign (e.g., slightly modified
hand shape). When both a spoken word and a gesture/
sign were reported for a single item, we counted this
as one meaning. Parents were instructed not to record
meanings expressed by a pointing gesture, unless ex-
plicitly requested, such as for body parts (e.g., eyes) or
pronouns (e.g., me). The Sentences section is for in-
vestigating the emergence of grammatical skills in
Table 3 Duration of language experience for deaf and hearing children with a shorter and a longer duration of language
experience
Groups Number
Duration of language experience
Range
(months)
Mean duration
of language
experience
(months) SD t
Significance
(two-tailed),
df5 9
Shorter duration of language experience, deaf children 10 817 12 3.882 0.000 1.000
Shor ter duration of language experience, hearing children 10 718 12 4.518
Longer duration of language experience, deaf children 10 1944 30 7.777 20.429 0.678
Longer dur ation of language experience, hearing children 10 2144 30 7.457
Language Development in Italian Deaf Children 67
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spoken Italian. If the child has already begun to pro-
duce sentences, the level of completeness of sentences
is explored. The first level consists of incomplete sen-
tences, such as those with no function words or pred-
icate (e.g., mella bimba/candy baby or bimbo
piange, caduto/baby cry, fall). The second level
consists of complete sentences and the use of functionwords (e.g., do la caramella alla bimba/I give the
candy to the baby or il bimbo piange perche e caduto/
the baby is crying because he fell). The same ques-
tionnaire was used for all children, except that the
parents of hearing children were asked about gestures
but not about Italian Sign Language.
Results
Comprehension and Production of Meanings
The deaf children understood a mean of 64 of the 100meanings (SD 5 29.7), which was lower than the
mean of 88 meanings (SD 5 19.0) understood by
the same-age hearing children, t(38) 5 23.054, p , .01,
yet not statistically different from the mean of
53 meanings (SD 5 33.5) understood by hearing chil-
dren with the same duration of language experience,
t(38) 5 1.030, p 5 .31 (Figure 1).
Among the deaf children, controlling for age and
duration of language experience, the mean number of
meanings understood was similar when comparing
those exposed to the oral method (61 meanings;
SD 5 34.6) and those exposed to the bimodal method(66 meanings; SD 5 25.4), t(18) 5 20.391, p 5 .70
(Figure 1).
With regard to production, the deaf children pro-
duced a mean of 47 spoken words (SD 5 32.4; with or
without an accompanying gesture/sign) and an addi-
tional five gestures/signs (SD 5 5.7; Figure 2). The
same-age hearing children produced a mean of 75
spoken words (SD 5 30.2) and one other gesture
(SD 5 1.8), and the hearing children with the same
duration of language experience produced a mean of
34 spoken words (SD 5 36.9) and an additional three
gestures (SD 5 3.4; Figure 2).
When comparing the groups in terms of spoken
words (with or without gesture/sign), the deaf chil-
dren produced fewer words than the same-age hearing
children, t(38) 5 22.823, p , .01, whereas when
considering only gestures/signs, they produced more
Figure 1 Mean number of meaning understood by hearing
children (same duration of language experience and same
chronological age as deaf children) and by deaf children
(bimodal and oral method).
Figure 2 Mean number of meaning produced by hearing
children (same duration of language experience and same
chronological age as deaf children) and by deaf children
(bimodal and oral method).
68 Journal of Deaf Studies and Deaf Education 14:1 Winter 2009
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meanings, t(38) 5 2.960, p , .01. When comparing
the deaf children to the hearing children with the same
duration of language experience, no significant differ-
ences were found in the number of either spoken
words, t(38) 5 1.188, p 5 .24, or meanings produced
only with a gesture/sign, t(38) 5 1.452, p 5 .16.
When considering the total number of meanings (spo-ken and gesture/sign), deaf children produced fewer
meanings thansame-age hearingchildren, t(38) 5 22.548,
p , .05; when compared to the hearing children with
the same duration of language experience the differ-
ence was not significant, t(38) 5 1.469, p 5 .15.
Among deaf children, the mean number of spoken
words (with or without gesture/sign) did not differ
significantly by educational method, t(18) 5 20.182,
p 5 .86, mean of 46 (SD 5 36.0) for those exposed to
the oral method and 49 (SD 5 30.2) for those exposed
to the bimodal method (Figure 2). The mean number
of meanings expressed with only a gesture/sign was
higher for deaf children exposed to the bimodal
method (mean of 7; SD 5 6.3), compared to deaf
children exposed to the oral method (mean of 3; SD 5
4.4), though the difference was not significant, t(18) 5
21.686, p 5 .11 (Figure 2).
With regard to the relationship between the spo-
ken word and gestures/signs, for deaf children, the
mean percentage of meanings expressed only withthe spoken word was lower than that for the same-
age hearing children, t(38) 5 23.477, p , .01, yet it
was not different from that for hearing children with
the same duration of language experience, t(34) 5
20.919,p 5 .36 (Figure 3). The percentage of meanings
expressed by deaf children with only a gesture/sign
was higher than that among same-age hearing chil-
dren, t(38) 5 2.011, p 5 .05, yet similar to that among
the hearing children with the same-duration of lan-
guage experience, t(34) 5 20.325, p 5 .75. Regarding
the percentage of meanings expressed using the spo-
ken word combined with a gesture/sign, this percent-
age was higher among deaf children, compared to both
Figure 3 Percentage of meanings produced, by type of communication (only spoken word, only gesture/sign, both) for
hearing children (same duration of language experience and same chronological age as deaf children) and for deaf children
(bimodal and oral method).
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same-age hearing children, t(38) 5 3.051, p , .01, and
hearing children with the same-duration of language
experience, t(34) 5 1.969, p 5 .06.
When comparing deaf children by educational
method (Figure 3), the two groups did not differ in
terms of the percentage of meanings expressed only
with a gesture/sign, t(18) 5 20.589, p 5 .56, whereas
deaf children exposed to the oral method had a higher
percentage of meanings expressed only with a spokenword, compared to the other group, t(18) 5 2.162,
p , .05, and consequently a lower percentage of
meanings expressed using both modalities, t(18) 5
22.673, p , .05.
Early Spoken Grammar
The percentage of deaf children who combined two or
more words to form a sentence (whether complete or
incomplete; 80.0%) was similar to that for same-age
hearing children (90.0%), t(38)5 2
0.872, p5
.39,yet it was higher than that for the hearing children
with the same duration of language experience (45.0%),
t(38) 5 2.390, p , .05.
Regarding the number and completeness of sen-
tences (Table 4), deaf children, compared to same-age
hearing children, produced slightly fewer sentences
(difference not significant), t(38) 5 21.882, p 5 .07,
and significantly fewer complete sentences, t(38) 5
25.013, p , .01. The deaf children were similar to
the hearing children with the same-duration of
language experience in terms of both the total number
of sentences, t(38) 5 21.291, p 5 .21, and the number
of complete sentences, t(38) 5 20.000, p 5 1.
Among deaf children, the percentage who formedsentences was 80% for both the oral method and the
bimodal method group. The total number of sentences
produced was also similar for the two groups, t(18) 5
0.261, p 5 .80, whereas the number of complete sen-
tences was slightly higher for deaf children exposed to
the oral method, though not significantly, t(18) 5
1.578, p 5 .13 (Table 3).
Regarding the relationship between vocabulary
level and early spoken grammar, for both deaf and
hearing children, there was a significant correlation
(Table 5).
Language Abilities by Age Group
The mean number of meanings understood and pro-
duced for the deaf and hearing children, by duration
Table 4 Number of sentences and of complete sentences produced by hearing children and deaf children
Same duration of
language experience
hearing children
Same
chronological age
hearing children
Deaf
children
Deaf (oral
method)
children
Deaf (bimodal
method)
children
Number of sentences produced
(out of 12)
5.3 10.2 7.5 7.8 7.2
Number of complete sentences
(out of total produced)
3.0 9.3 3.0 4.3 1.7
Table 5 Correlation between vocabulary and early grammar skills for deaf children and hearing children (same duration of
language experience and same chronological age as deaf children)
Word production
Deaf children
Same duration of language
experience hearing
children
Same chronological
age hearing
children
Use of sentences r 5 .64 r 5 .80 r 5 .77
p , .01 p , .01 p , .01
Total sentences r 5 .86 r 5 .81 r 5 .81
p , .01 p , .01 p , .01
Complete sentences r 5 .76 r 5 .78 r 5 .85
p , .01 p , .01 p , .01
70 Journal of Deaf Studies and Deaf Education 14:1 Winter 2009
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of language experience, is shown in Figure 4. For
comprehension, the ANOVA showed that the inter-
action between the two factors was significant,
F(1.36) 5 7.931, p , .01. For hearing children, the
number of words understood increased with increasing
duration of language experience, whereas for deaf chil-
dren, it basically remained stable.There was also a significant interaction between
the two factors for production (spoken word with or
without gesture/sign), F(1.36) 5 6.208, p , .05, re-
vealing that for hearing children, the number of words
produced increased with increasing duration of lan-
guage experience, whereas for deaf children, it basi-
cally remained stable.
For the production of gestures/signs only, there
was no significant interaction, F(1.36) 5 2.782,
p 5 .10. Moreover, the significance of the duration
of language experience effect, F(1.36) 5 11.390,
p , .01, shows that, independently of whether or
not the children were deaf or hearing, the use of only
gestures/signs decreases with increasing duration of
language experience.
The scores obtained for the number of sentences
produced by deaf and hearing children for the two
levels of duration of language experience were sub-
jected to the same statistical analysis. According to
the results (Figure 5), for hearing children, the num-ber of sentences produced increased with increasing
duration of language experience, whereas for deaf chil-
dren, it basically remained stable.
Figure 5 shows the scores obtained for the number
of morphologically complete sentences. Again, for
hearing children, the number of morphologically com-
plete sentences produced increased with increasing
duration of language experience, whereas for deaf
children, it basically remained stable, F(1.36) 5
4.976, p , .05.
Discussion
In this study, we used a questionnaire filled in by
parents to study the language development of
preschool-aged deaf children and to highlight the sim-
ilarities and differences with respect to children who
acquire the spoken language in typical contexts. To
this end, the data for deaf children were compared to
data on two groups of hearing children who were
matched with deaf children in terms of age and dura-
tion of language experience. We are aware that when
Figure 4 Number of meanings understood and produced
by spoken word (accompanied or not by gesture/sign) and
by gesture/sign only, for hearing children and deaf children,
with shorter and longer duration of language experience.
Figure 5 Number of sentences and number of complete
sentences produced by hearing children and deaf children,
with shorter and longer duration of language experience.
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deaf children begin formal language training, they
probably have already been exposed to language and
have some communicative and linguistic experience.
However, given that exposure is mainly auditory for
deaf children with hearing parents, uptake is probably
quite low until formal language training begins.
The results showed that deaf children, comparedto same-age hearing children, have a significant delay
in both vocabulary and grammar, confirming the find-
ings of other studies conducted using a similar tool on
children exposed to English (Mayne, Yoshinaga-Itano,
& Sedey, 2000; Mayne, Yoshinaga-Itano, Sedey, &
Carey, 2000; Yoshinaga-Itano, 2003, 2004). The results
are also consistent with those of other studies using
direct observation through formal testing and with the
results of longitudinal studies (Blamey, 2003; Pizzuto
et al., 2001). With regard to grammar, deaf children
produced fewer sentences, which were shorter and had
fewer function words. Thus, weaknesses in free mor-
phology, which were previously demonstrated for
older children acquiring Italian (Volterra et al.,
2001), are already evident in the early stages of lan-
guage acquisition. Moreover, the differences that we
observed in grammar development are probably inten-
sified by the fact that the younger hearing children
(mean age of 12 months) clearly did not yet produce
sentences, whereas all the older hearing children
(mean age of 30 months) produced sentences that in
most cases were morphologically complete.
With regard to the finding that the differences
between deaf and hearing children were greater for
grammar than for vocabulary, this could indicate that
these are domains of language that develop autono-
mously as proposed by other studies (Pinker, 1994).
However, we found a close correlation between the
number of words produced and the development of
grammar, as previously reported for hearing/typically
developing children (Bates & Goodman, 1997; Caselli
et al., 1999) as well as for children with language and/or cognitive impairment (Caselli, Monaco, Trasciani, &
Vicari, 2008; Vicari, Caselli, Gagliardi, Tonucci, &
Volterra, 2002). One possible explanation for the def-
icit in grammar could be that the deafness causes se-
rious problems in the processing of acoustic events
(e.g., verbal strings, phonemic sequences, rhythms in
sequence) and thus atypical construction of morpho
phonological representations, resulting in atypical pro-
cesses in acquiring and mastering morphological
aspects (Volterra et al., 2001).
Despite these considerations, when comparing
language development in deaf and hearing children
with comparable duration of language experience, we
found no differences in the number of words producedor in the number or completeness of sentences, indi-
cating that the duration of formal language experience
is an important element which should be taken into
consideration when evaluating deaf childrens spoken
language abilities. These findings confirm those of pre-
vious studies, which have reported that only spoken
language ability is impaired in deaf children, leaving
intact the more general linguistic and cognitive capaci-
ties (Marschark, 1995, 2006).
Deaf and hearing children with comparable dura-
tion of language experience were also similar in terms
of the use of nonverbal modalities: signs and/or
gestures were used to name events or objects for
which the child did not know the corresponding word.
In both deaf and hearing children, this behavior was
closely related to the development of spoken vocabu-
lary: the number of signs/gestures produced de-
creased with increasing lexical repertoire. This
finding is consistent with the results of numerous
studies on hearing children, which show that in the
early stages of language development, when the num-
ber of words is limited, gestures are more numerous
and more commonly used than in successive stages
(Capirci, Contaldo, Caselli, & Volterra, 2005; Capirci,
Iverson, Pizzuto, & Volterra, 1996; Iverson, Capirci, &
Caselli, 1994). A recent study conducted on hearing
children in Italy confirmed that co-speech gestures
decreased but did not disappear with increasing age
and spoken naming competence (Stefanini, Bello,
Caselli, Iverson, & Volterra, 2008). Older hearing chil-
dren in diverse observational settings have been shown
to produce gestures, which may help them to expressideas that they do not succeed in expressing with spo-
ken language and to convey a substantial proportion
of their knowledge (Alibali, Kita, & Young, 2000;
Guidetti, 2002; Pine, Lufkin, Kirk, & Messer, 2007).
As reported in other studies (Lederberg, 2003;
Mayne, Yoshinaga-Itano, & Sedey, 2000; Mayne,
Yoshinaga-Itano, Sedey, & Carey, 2000; Moeller,
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2000; Yoshinaga-Itano, Sedey, Coulter, & Mehl, 1998),
yet in contrast to our hypotheses, we found no statis-
tically significant differences between deaf children
exposed to the bimodal method and those exposed to
the oral method, in either vocabulary or grammar.
However, the lack of significant differences could be
due to the small number of participants in each sub-group. Nonetheless, our data show that the deaf chil-
dren exposed to the bimodal method tended to
understand and produce more words, which could in-
dicate that the use of visualgestural modality does not
hinder the learning of the spoken language and that it
can instead constitute a useful means of support for
learning to speak. In fact, children exposed to the
bimodal method tend to use more frequently the ges-
tural modality to express new meanings for which they
do not know the corresponding word, as well as mean-
ings for which they do know the spoken word.
The similarities between deaf children and hearing
children with a similar duration of formal language
experience could suggest that these groups undergo
similar phases in language development. In light
of this finding, we divided the children into groups
based on whether the duration of spoken language
experience was shorter or longer, in an attempt to
simulate a longitudinal perspective. According to the
results, the increases in language development with
increasing duration of language experience were quite
evident for the hearing children and much less evident
for the deaf children. This could be due to the fact
that hearing children are exposed to the spoken lan-
guage not only when it is specifically directed at them
but also when others around them are speaking (e.g.,
their parents or other adults and other children), in
what could be referred to as a natural context. In-
stead, deaf children are only exposed to language
through face-to-face interactions and undergo a long,
slow, arduous process of formal exposure, consisting
of a highly structured didactic processes.In interpreting the results of this study, some
potential limitations should be considered. First of
all, the results derive from indirect observations (i.e.,
a questionnaire filled in by parents). However, as pre-
viously reported, numerous studies have shown that
this is a valid method, although direct observation is
necessary to better understand the use of language in
different modalities and in different contexts. Second,
the study population was not large, and there were few
children in each of the subgroups considered. More-
over, the comparison of children with a shorter dura-
tion of language experience and those with a longer
duration was cross-sectional in design, and the results
can only be used to make general inferences regardinglanguage development over time.
With regard to the clinical implications of our
findings, in terms of language education for deaf chil-
dren, these data could help speech therapists and
teachers in planning interventions that combine
gestural modality with speech, so as to improve the
language capabilities of deaf children. Moreover,
measurements similar to that of time postimplant used
to evaluate the effectiveness of the CI (Blamey et al.,
2001; Ertmer et al., 2003; Nikolopoulos et al., 2005;
Svirsky et al., 2000; Tomblin et al., 1999) could be
very useful in understanding the effectiveness of
speech therapy also for children with the traditional
hearing aid, to determine whether the progress made
is consistent with expectations based on the duration
of formal language experience. In fact, this informa-
tion could help clinicians to decide whether or not to
change the type of hearing aid and/or the type of
language education and to decide whether or not the
child is a candidate for a CI.
To conclude, the delay in linguistic development
in deaf children, compared to same-age hearing chil-
dren, may in part be attributable to less language
experience (and not to deafness itself). In this light,
we suggest that the language abilities of deaf children
be evaluated in a different perspective: instead of es-
timating deficiencies compared to hearing children,
deaf children should be evaluated based on their lin-
guistic experience and cognitive and communicative
potential.
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Received July 27, 2007; revisions received April 11, 2008;
accepted April 16, 2008.
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