Mission Probable

A white paper published by in 2019 titled Mission Probable looks at the latest research from colleagues in Australia and other notable studies on auditory verbal therapy. Some of the takeaways from this white paper are:

  • Early and accurate identification of hearing loss is critical. Normal speech and language development is probable.
  • Fitting of hearing aids before 6 months of age provides better speech/language outcomes.
  • Cochlear implantation before 12 months of age provides better outcomes- Consider cochlear implantation for severity of hearing loss of 70-75 dB HL and poorer.
  • Hearing aids and cochlear implants must be fitted appropriately to optimize outcome. The use of prescriptive targets is recommended upon verification of hearing aid function.
  • Children who wore their hearing aids 10 hours a day by age 5 had optimal language outcomes. Hearing aids and CIs must be worn during all waking hours to optimize outcomes.
  • Language abilities of children who communicated solely via listening and spoken language were significantly better than children who used sign language
  • Children who are hard of hearing do not hear as well in noise. It is recommended to utilize additional technology such as remote microphone, adaptive directional microphone etc.
  • Disabilities associated with developmental delay and or low nonverbal IQ negatively influence outcomes. If additional disabilities are present, it is important to access community resources to optimize outcomes. Intensive language therapy is recommended.


Wolfe, J. (2019). Mission probable: Age-appropriate listening and spoken language      abilities for Children with Hearing Loss. [White paper]. Retrieved April 7, 2019        from           documents/Mission%20Probable%20White%20Paper_02.19.pdf


Recent Research Summaries

Early sign language exposure and cochlear implantation benefits.

Ann E. Geers, PhD, of the University of Texas at Dallas and colleagues recently completed a study in 2017, comparing the spoken language outcomes of deaf children learning language with or without sign language. Children were included in the study who were defined as having short term, long term and no exposure to sign language. This was based on parent report and no sign language was defined as none used from baseline through the first 3 years following cochlear implant (CI) surgery. Short term sign exposure was defined as sign language use at baseline and/or following 12 months post CI surgery. Long term sign exposure was defined as sign exposure through 36 months post CI surgery.

Overall, a significantly higher portion of children with no exposure to sign language had improved intelligibility of speech compared to those children with both long-term sign exposure and short-term exposure to sign language. Language scores were also significantly different among sign language exposure groups. By late elementary school, children with no sign language exposure had an average language score of 96.2, which was close to the “normative mean” of 100, while mean scores for children with exposure to sign language were lower (83.8 and 76.4 for short- and long-term exposure groups). Spoken language and reading delays continued through early and late elementary school grades (58% in children with short term sign language exposure and 61% in children with long term exposure). The portion of children who experienced continued delay in spoken language and reading dropped significantly during early to late elementary school years in those children with no sign exposure (44% to 29%).

This study truly had some interesting findings but ultimately seemed to yield three takeaway discussions: (1) Children who used spoken language exclusively indicated better auditory speech recognition and more intelligible speech than children whose families used sign language. (2) That spoken language is negatively affected by delaying access to linguistic input. Early exposure to sign did not enhance either spoken language or reading. (3) The quantity of sign exposure directly related to the amount of delay in spoken language and reading outcomes. Children with long term sign exposure were at more disadvantage as compared to children with short term sign exposure.

Geers, A. E., Mitchell, C. M., Warner-Czyz, A., Wang, N. Y., Eisenberg, L. S. & the CDaCI Investigative Team. (2017). Early sign language exposure and cochlear implantation benefits. Pediatrics 140(1) e20163489. doi:10.1542/peds.2016- 3489