Positive Approaches Journal, Volume 9, Issue 2

Milcic | 41-53




Positive Approaches Journal - Volume 2 Title

Volume 9 ► Issue 2 ► 2020


Language Deprivation and Its Implications

Lori R. Milcic, MAP, CI, CT, QMHI


Abstract

When it comes to communication, there are many underlying elements that impact effectiveness. Influences that are often considered are medical conditions, developmental disabilities, or mental health diagnoses, but rarely do we hear about the impact of language deprivation. The need for direct access to language is essential. This article will define language deprivation, its surprising reverberating impacts on daily functioning, and how our responses can support a positive outcome for individuals’ futures.


 

When it comes to communication, there are many underlying elements that impact effectiveness. Influences that are often considered are medical conditions, developmental disabilities, or mental health diagnoses, but rarely do we hear about the impact of language deprivation. Perhaps this is because language deprivation is considered to be rare, which would be true when describing the typical, modern, hearing population1. However, language deprivation during a child’s developmental years is rampant within the deaf population,1-4 and continues into the adult experiences of individuals with developmental or intellectual disabilities.5-7 The need for direct access to language is essential. This article will define language deprivation, its surprising reverberating impacts on daily functioning, and how our responses can support a positive outcome for individuals’ futures.

Language deprivation occurs when a child does not receive enough linguistic exposure between birth to about five years old to support the development of a fluent, native language. For a hearing person, extreme cases of this have been documented to occur only about once a century.1 This is because it is very difficult to deprive a child of language completely when they are able to passively hear ambient sound all around them from parents, peers, neighbors, crowds, media, and the like. We take in sound and language all the time, without even trying. To deprive someone of that would require intentionality. However, for someone with a hearing loss, the opposite is true. A deaf person passively takes in no language unless someone intentionally exposes them to it in ways they can access, such as through the use of a visual, signed language or with electronic devices like hearing aids paired with active training in speech and listening.1-4,8

Without this intentional linguistic exposure during those key developmental years, a person is at risk of Language Deprivation Syndrome, which is not restricted only to language difficulties but indicates further social and cognitive impairments. In fact, Language Deprivation Syndrome is functionally similar to intellectual disability.3 More information on this syndrome will be defined throughout this article. First, it is important to understand what language deprivation looks like.

Language deprivation can occur in different populations to varying degrees. Imagine the typical communication experience. Conversation is naturally reciprocal; one person speaks, another responds, the first speaks again, and so on. This interaction brings connection and satisfaction. Humans learn from each other, experience each other’s perspectives, share joy and sadness, and more. But what happens if an individual has an intellectual or developmental disability, autism, or any myriad of things that affect the ability to communicate? If a person speaks and no one responds, what happens? The speaker might try a second time, or even a third, but eventually will give up because that reward of pleasure and connection is not achieved. Over time, this pattern is repeated and can lead to a type of language deprivation outside of early developmental periods where exposure to language eventually diminishes.9-12 For children, there may be many structures in place to mitigate this and provide language immersion, regardless of their response. Students are typically in school for several hours per day, exposed to language being used around them, and often experiencing direct support and intensive interventions provided by experts in special education, speech and language pathology, and more. But we know that social opportunities, peer relationships, and community interaction can be limited for children with intellectual or developmental disabilities.9-10 Furthermore, it’s not uncommon for adults to constrain the ways they communicate with this population, limiting their exposure to complex concepts or broader vocabulary.9-11 Therefore, children with intellectual or developmental disabilities may not have a fully immersive language experience commensurate with their typically developing peers. For individuals who have hearing loss and a co-occurring intellectual or developmental disability, the adverse impacts are compounded.13

Unfortunately, there is very minimal research on language deprivation in the adult years; however, there is some evidence of its devastating effects. These impacts can include, but are not limited to, progressive isolation, withdrawal, and decompensation of mental health conditions.10,14-15 Once transitioned into adulthood, many, if not all, of the interventions available during childhood are discontinued, either due to unavailability or the individual’s apparent choice. Consider the previous example of interacting with a non-responsive communication partner. During the developmental years, professionals and lay people tend to have more patience and often feel empowered to do more for a child, directing them to engage in activities they may not seem interested in or providing them with opportunities they did not independently request. The same situation with an adult might evoke a different response. For example, someone might determine that a non-responsive adult does not want to communicate, prefers to be alone, or feels annoyed by repeated prompts to engage. With adults, people feel less empowered to provide experiences that are not explicitly requested by the individual. Additionally, for those adults who require specialized communication modalities (such as the use of assistive technology or American Sign Language), there are often fewer professionals available with the expertise to provide immersive language experiences. Any of these circumstances can lead to an experience of language deprivation in adulthood, leading to waning language skills, progressive isolation, behavioral challenges, and cognitive decompensation.

How serious can these language deficits be? For those who experience language deprivation during those key early years of development, the impacts can be serious enough to lead to a diagnosis of Language Deprivation Syndrome (LDS). While this terminology is relatively new, the data behind it are not. As early as the 1960s, clinicians have been documenting certain observations of functional deficits in people with hearing loss who were not adequately exposed to language during childhood.1,16 A constellation of symptoms was noted in this population, including difficulty sequencing events (describing what came first, second, third, etc.), understanding the concept of time, struggles with cause and effect, lack of Theory of Mind and empathy, and aggressive behavior directed toward self and others.1,3,17 There is also a deficit seen in world knowledge or “common sense”, what is often clinically termed Fund of Information. Dr. Sanjay Gulati1 noted that people with even mild language deprivation can exhibit these symptoms, however, it appears that the severity of the symptoms have a positive correlation to the severity of the deprivation. For adults, the “use it or lose it” principle applies. Individuals who once had access to language and communication and are later deprived of those interactions begin to lose their fluency and can experience impacts across categories of functioning, as well, including cognitive, social, and behavioral/mental health.11,14-15

For children with hearing loss, support systems continue to advocate for outdated intervention approaches while the research grows in opposition. The medical perspective typically encourages fixing the hearing loss with procedures like cochlear implantation.16,18 In parallel, the educational system in our country has leaned toward teaching spoken and aural language for decades.2,4 However, research shows cochlear implant (CI) success rates as low as 30% with spoken language fluency2,18 and negative impacts for these children in social gains, as well.2,4,16,18 There simply is insufficient research available to justify the oral/aural approach as the top choice of physicians and educators across the country. However, there is a great deal of data available that supports development of any fluent, native language (especially sign language) for positive achievement in all areas of development for this population.1-4,8,14,16,18-19 In other words, immersion in a visually accessible language, like sign language, would be a better foundation for further learning and development, or to gain back language that has been lost due to deprivation occurring in adulthood. In fact, there is some promising empirical research on this, as well, including Functional magnetic resonance imaging (fMRI) studies that show positive brain changes for teenagers with severe language deprivation experiences after living in an immersive language environment, a place where they had access to sign language all day, every day.20

One excellent example of a person dealing with Language Deprivation Syndrome is the story of Sonya (pseudonym). She was a profoundly deaf child who had no access to language from birth to age ten. No one knows whether she was born deaf or lost her hearing due to an illness later in childhood. However, during her developmental years, she could not hear well enough to make out the sounds of English and was not provided access to American Sign Language. Therefore, she learned to use behaviors to communicate, albeit ineffectively. By age ten, her behaviors had become aggressive and dangerous to both herself and others. Her large physical size, together with her aggressive behaviors, led to feelings of fear in others and an inability to keep her safe. At this time, she was placed in a behavioral health program that specialized in supporting children with hearing loss. This was an immersive American Sign Language (ASL) program, meaning that all students and staff used ASL to communicate. Over time, Sonya began to learn this language and after a while, she began to use that language to connect with other people and to make her feelings and needs known. Her aggressive behaviors eventually ceased altogether and today, she is thriving as an adult with many friends, a job, and her own apartment. However, because she had no access to language for the first ten years of her life, she still struggles linguistically. She is unable to “time stamp” events that occurred before she learned ASL. When she describes experiences in her youth, she cannot tell you when or where they happened, nor can she answer direct questions about those experiences. She doesn’t know the names of people or places that appear in these stories and often tells memories out of order. She also cannot tell you how many total years she remained in the behavioral health program. Sonya struggles, even to this day, with language dysfluency. While she uses ASL very well today, there are still grammatical elements missing from her expressive language that can leave communication partners guessing at who did what to whom, or where an event occurred, or whether she is telling a story about her past or talking about a dream for her future. She continues to struggle with abstract concepts and common world knowledge.

Max’s story reveals another side of the coin. He was born with hearing loss and an intellectual disability and attended deaf-focused education programs throughout his schooling years. He was moderately fluent in ASL as a child and enjoyed relationships with peers and caring adults at school. His family, who loved him very much, did not use ASL at home. When Max (pseudonym) became an adult, he transitioned into a residential program for people with intellectual disabilities in his home area, which was rural and had few resources for people who use sign language. His support staff were very caring, but they only knew about ten words in sign language. Max was unable to be understood in his native language, ASL, and received communication through a few signed words, gestures, and pictures. Max learned to accommodate this change and began using gestures and pictures expressively, as well. Over the years, support staff came and went and eventually everyone thought this was how it had always been for Max. Then one day, many years later, Max met someone who used ASL with him. His face lit up with joy and he was able to communicate in his native language again. The support staff were amazed. No one knew that he had been fluent in ASL or that he was a social person. It was widely believed that he preferred to be alone and did not wish to communicate much, other than to request items he wanted by pointing or gesturing. Max knew he wanted to live in an environment where people used ASL. Unfortunately, by this time, Max had forgotten a great deal of sign language. He could not remember basic vocabulary and did not use complete, grammatical sentences. It was hard for him to make his desires clear to others. He struggled with many of the same language issues Sonya did, even though he had known ASL in the past. At his advanced age, he never did regain his ASL fluency back completely, but moving into an accessible environment allowed Max to thrive in community and with connection.

So why is an understanding of language deprivation and its impacts important? First, it is essential to recognize that language deprivation has far reaching implications on an individual’s functioning. It’s not just that a person may not know the vocabulary to discuss a topic, but that multiple areas of social and cognitive functioning can be impacted. Second, remediation requires intensive language immersion. This approach has the added benefit of not only improving language fluency but impacting social and cognitive gaps in a way that reverberates into all areas of everyday life. Furthermore, when someone has experienced language deprivation, whether in childhood or adulthood, we cannot accurately diagnose their needs in other domains until we address the communication gap. It is impossible to recognize where support needs lie unless the impacts of language deprivation can be identified for each individual. Once communication needs are met, the veil is lifted and the need for other interventions becomes clearer. Support services will continue to encounter frustrations if they put the cart before the horse.

The biggest takeaway here, is to start with effective communication. Children and adults both need access to a mode of communication that provides them with the highest possibility of fluency, whether that is a spoken language, a signed language, or even an alternative or augmentative communication mode. The mode may differ based on the individual, but the need for intense immersion across all settings remains a common thread. The good news is that with an immersive communication environment, great strides can be made across multiple domains and positive changes can occur in people’s lives, no matter their age.




References

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Biography

Ms. Milcic has spent decades studying language deprivation, both formally and informally, and is currently pursuing her doctoral degree in developmental psychology with a research emphasis on Language Deprivation Syndrome. She is fluent in American Sign Language, holds the rare Qualified Mental Health Interpreter specialty certificate, and currently serves as the Deaf Services Coordinator for the Pennsylvania Department of Human Services.

Contact Information

Lori R. Milcic, MAP, CI, CT, QMHI

PA Office of Developmental Programs, Special Populations Unit

301 Fifth Ave, Piatt Place, Suite 490, Pittsburgh, PA 15222-1210

412-252-2315