Position Paper on Access to National Sign Languages as a Health Need

Key points: 

• National sign languages have a critical role in ensuring deaf people’s optimal mental,  physical and social health across the lifespan. 
• Deaf children’s adverse childhood communication experiences when they do not have  access to a language they understand have a negative cascade effect on many areas  of health, education and well being.  
• Language deprivation is the persistent lack of access to a natural language during the  critical period for language acquisition and development.  
• Communication neglect is ongoing exclusion from indirect family communication and  incidental learning. 
• Language deprivation and communication neglect are caused by social and  environmental factors that stem from systems prioritizing cochlear implants and  spoken-language therapy to the exclusion of national sign languages.  
• With access to national sign languages from infancy onwards, deaf children have age appropriate language development, higher levels of proficiency in written/spoken  languages, and healthy development across all domains.  
• The Convention on the Rights of Person with Disabilities states that governments shall  provide health services, including early identification and intervention, that are  designed tominimize and prevent further disabilities, including among children.  
• Sign language should be recognized as a health need in early childhood and beyond,  and sign language services must be provided to deaf children and their families as part  of public health and health insurance systems.  
• Any policies related to national sign languages should be designed in close  consultation with the representative national association of deaf people. 

There is growing evidence for the critical role of national sign languages in ensuring deaf  people’s optimal mental, physical, and social health across the lifespan. This evidence  includes the long-term impact of many deaf people’s adverse childhood communication  experiences when they are not afforded access to a language they understand. These 

adverse childhood communication experiences include barriers to direct communication with  caregivers (language deprivation) and barriers to family communication and inclusion  (communication neglect).¹ 

Language deprivation is the persistent lack of access to a natural language during the critical  period for language acquisition and development. Given language’s foundational role in ² human development, consequences associated with language deprivation can be seen in  various developmental domains. Chronic, ongoing experiences of language deprivation in ³ deaf children appear to disrupt thinking, mood, and behavior. , in addition to contributing to ^{4 5} lower literacy levels and educational outcomes.^2,4, Language deprivation impedes verbal ⁶ memory organization, mastery of numeracy and literacy, executive function, theory of mind,  and sustained attention, all of which are critical for educational achievement.^7,8 

Communication neglect is ongoing exclusion from indirect family communication (and other  communication in a deaf child’s milieu) and incidental learning.¹ This is sometimes referred  to as “dinner table syndrome” where deaf individuals are accustomed to viewing spoken  conversations between family members while not understanding what is being said.² These  

 Kushalnagar, P., Ryan, C., Paludneviciene, R., Spellun, A., & Gulati, S. (2020). Adverse childhood ¹ communication experiences associated with an increased risk of chronic diseases in adults who are  deaf. American Journal of Preventive Medicine, 59(4), 548-554. https://doi.org/10.1016/ j.amepre.2020.04.016 

² Murray, J.J., Hall, W.C., & Snoddon, K. (2019). Education and health of children with hearing loss: The  necessity of signed languages. Bulletin of the World Health Organization, 97. https://www.who.int/ bulletin/volumes/97/10/19-229427.pdf 

 Hall, W.C., Li, D., & Dye, T.D.V. (2018). Influence of hearing loss on child behavioral and home ³ experiences. American Journal of Public Health, 108(8), 1079-1081. https://doi.org/10.2105/ ajph.2018.304498 

 Hall, W.C., Levin, L.L., & Anderson, M.L. (2017). Language deprivation syndrome: A possible ⁴ neurodevelopmental disorder with sociocultural origins. Social Psychiatry and Psychiatric Epidemiology,  52, 761-776. https://doi.org/10.1007/s00127-017-1351-7 

⁵ Du Feu, M. & Chovaz, C. (2014). Professional perspectives on deafness: Evidence and applications.  Mental health and deafness. Oxford University Press. 

 Spellun, A., & Kushalnagar, P. (2018). Sign language for deaf infants: A key intervention in a ⁶ developmental emergency. Clinical Pediatrics, 57(4), 1613-1615. https://doi.org/ 10.1177%2F0009922818778041 

 Humphries, T., Kushalnagar, P., Mathur, G., Napoli, D.J., Padden, C., & Rathmann, C., (2014). ⁷ Ensuring language acquisition for deaf children: What linguists can do. Language, 90(2), e31-e52.  https://doi.org/10.1353/lan.2014.0036 

experiences directly contribute to gaps in world knowledge, social and academic skills, and  health literacy as well as psychological distress.^1,4 Deaf children’s adverse childhood  communication experiences have a negative cascade effect on many areas of health,  education, and well being across the lifespan. Adverse childhood communication experiences  have been shown to be associated with an increased risk for certain chronic health conditions  including diabetes, heart disease, hypertension, lung disease, and depression and anxiety  disorders.¹ Deaf children are also at higher risk of mental health disorders due to heightened  neurological, psychological, and social risk factors, including delay in acquiring a first  language, in addition to a vulnerability to abuse in childhood. Compounded by language  deprivation and communication neglect, deaf individuals are at greater risk of experiencing  emotional, physical, and sexual abuse, and face greater barriers to accessing health care.^2,8  

Language dysfluency, or lack of fluency in any language, is much more common among deaf  people than it is in nondeaf people and presents challenges to the provision of mental health  and other health services, as well as in education.⁹ However, language deprivation is due to  social and environmental factors, particularly medical and educational policies that restrict  deaf children’s access to sign languages, and not to an innate lack of ability to acquire  language.⁴ Publicly-funded and government-administered infant hearing screening and early  intervention programs may often restrict or lack support for sign language services when a  child receives a cochlear implant.¹⁰ Simultaneously, these programs promote beliefs that deaf  children’s language development is dependent on children’s ability and and families’ work  ethic, shielding themselves from accountability for the ultimately poor outcomes often  experienced by deaf people. ^, Early intervention systems that prioritize cochlear implants ^{11 12} and spoken-language therapy to the exclusion of natural national sign languages create high  risks for language deprivation in cases of deaf children who do not benefit from CI or spoken  language therapy.⁷ This exclusion of sign language in early intervention has long-term  

 Humphries, T., Kushalnagar, P., Mathur, G., Napoli, D.J., Padden, C., Rathmann, C., & Smith, S. ⁸ (2016). Avoiding linguistic neglect of deaf children. Social Service Review, 90(4), 589-619. https:// doi.org/10.1086/689543 

 Glickman, N., & Hall, W.C. (2019). Introduction: Culture and disability. In N.S. Glickman & W.C. Hall ⁹ (Eds.), Language deprivation and deaf mental health (pp. 1-23). Routledge. 

¹⁰ Snoddon, K. & Paul, J.J. (2020). Framing sign language as a health need in Canadian and  international policy. Maternal and Child Health Journal, 2974. https://doi.org/10.1007/ s10995-020-02974-8 

 Ministry of Children and Youth Services. (2018). Language development services guidelines: Ontario ¹¹ Infant Hearing Program.Version 2018.2. Toronto, ON: Ministry of Children and Youth Services. 

 Hecht, J. (2020). Responsibility in the current epidemic of language deprivation (1990-present). ¹² Maternal and Child Health Journal, 24, 1319–1322. https://doi.org/10.1007/s10995-020-02989-1

impacts on literacy and educational outcomes.⁴ Furthermore, delayed or late learning of sign  language does not prevent language deprivation or remediate its lifelong effects on mental,  physical, and social health, and on education.⁵ 

In contrast, when deaf children and their families are afforded access to national sign  languages from infancy onwards, children have age-appropriate language development and  higher levels of proficiency in written/spoken languages in addition to healthy development  across all domains. Multilingual education in national sign languages and written/spoken ¹³ languages from early childhood protects deaf children and youth from language deprivation  and supports the development of health literacy across the lifespan, in addition to optimal  educational and health outcomes.^6, Multilingual early intervention and education also ¹⁴ facilitates social networks for deaf children and their families so children and youth enjoy a  range of social relationships that support a positive deaf identity, well being and social  capital.^5,8,15 

Article 25 of the UN Convention on the Rights of Persons with Disabilities states that  governments shall provide those health services needed by persons with disabilities  specifically because of their disabilities, including early identification and intervention as  appropriate, and services designed to minimize and prevent further disabilities, including  among children.  

Article 24 of the Convention obligates States Parties to ensure the provision of quality and  inclusive education for deaf children through inclusive bilingual sign language educational  settings in the national sign language and national written language. Such settings must follow  the official governmental curriculum taught by teachers fluent in the national sign language with  near native-level fluency. Additionally, deaf children must receive the opportunity of being  surrounded by their signing peers and adult role models. 

This means that sign language should be recognized as a health need in early childhood and  beyond, and sign language services must be provided to deaf children and their families as  

¹³ Caselli, N., Pyers, J., & Lieberman, A.M. (2021). Deaf children of hearing parents have age-level  vocabulary growth when exposed to ASL by six months. The Journal of Pediatrics. Ahead of print.  https://doi.org/10.1016/j.jpeds.2021.01.029  

 Wilkinson, E., & Morford, J.P. (2020). How bilingualism contributes to healthy development in deaf ¹⁴ children: A public health perspective. Maternal & Child Health Journal, 24, 1330–1338. https://doi.org/ 10.1007/s10995-020-02976-6 

 Snoddon, K. & Underwood, K. (2014). Toward a social relational model of Deaf childhood. Disability & ¹⁵ Society, 29(4), 530-542. https://doi.org/10.1080/09687599.2013.823081 

part of public health and health insurance systems. It is essential that early intervention and  sign language services are guided by deaf professionals and community members, deaf sign  language teachers, and deaf advocacy organizations.¹⁶ Article 4.3 of the Convention, combined  with the CRPD Committee General Comment No 7 on the participation of persons with disabilities  in the monitoring and implementation of the Convention, highlight the obligation of States parties  to meaningfully involve persons with disabilities through their representative organisations for the  design of legislation, policies and/or programs concerning them. Meaningful involvement of  persons with disabilities must take place in an accessible environment and at every stage of the  process – from the outset to the outcome – and at each possible level of governance, from local to  global. 

 It is incumbent on health, medical, and social service professionals and governments to  combat misinformation and discourses of prejudice against national sign languages that  perpetuate poor health and educational outcomes in deaf people.^6, Instead, health and ¹⁷ medical professionals and governments must promote deaf children and families’ free access  to and learning of sign language from the earliest possible age. 

The World Federation of the Deaf calls on governments to recognize national sign languages  as an essential health need for all deaf children. We further call for steps to be taken to ensure  early intervention and education systems are designed to maximize deaf children and youth’s  access to fluent sign language input and rich, plentiful interactions with deaf professionals  and community members.  

 Gale, E. (2020). Collaborating with deaf adults in early intervention. Young Exceptional Children. ¹⁶ Ahead of print. https://doi.org/10.1177%2F1096250620939510 

 Humphries, T., Kushalnagar, P., Mathur, G., Napoli, D.J., Padden, C., Rathmann, C., & Smith, S. ¹⁷ (2017). Discourses of prejudice in the professions: The case of sign languages. Journal of Medical  Ethics, 43, 648-652. http://dx.doi.org/10.1136/medethics-2015-103242

Recommendations: 

The World Federation of the Deaf calls upon governments to:  

● Recognize national sign languages as an essential health need for all deaf children  and put into place policies which secure access to sign languages for all deaf children; ● Provide national sign language services to deaf children and their families as part of  public health and health insurance systems; 

● Ensure early childhood education and care systems provide access to fluent national  sign language input and rich, plentiful interactions with deaf professionals and  community members; 

● Ensure early intervention and sign language services are guided by deaf professionals  and community members, deaf sign language teachers, and deaf advocacy  organizations; 

● Ensure that health, medical, and social service professionals provide accurate and  proper information on national sign languages and promote deaf children and their  families’ free access to and learning of national sign language(s) from the earliest  possible age. 

Nongovernmental associations, national and international organizations, and development  projects should ensure adherence to these recommendations in their policies and projects.