Children acquire language without instruction as long as they are regularly and meaningfully engaged with an accessible human language. Today, 80% of children born deaf in the developed world are implanted with cochlear devices that allow some of them access to sound in their early years, which helps them to develop speech. However, because of brain plasticity changes during early childhood, children who have not acquired a first language in the early years might never be completely fluent in any language. If they miss this critical period for exposure to a natural language, their subsequent development of the cognitive activities that rely on a solid first language might be underdeveloped, such as literacy, memory organization, and number manipulation. An alternative to speech-exclusive approaches to language acquisition exists in the use of sign languages such as American Sign Language (ASL), where acquiring a sign language is subject to the same time constraints of spoken language development. Unfortunately, so far, these alternatives are caught up in an "either - or" dilemma, leading to a highly polarized conflict about which system families should choose for their children, with little tolerance for alternatives by either side of the debate and widespread misinformation about the evidence and implications for or against either approach. The success rate with cochlear implants is highly variable. This issue is still debated, and as far as we know, there are no reliable predictors for success with implants. Yet families are often advised not to expose their child to sign language. Here absolute positions based on ideology create pressures for parents that might jeopardize the real developmental needs of deaf children. What we do know is that cochlear implants do not offer accessible language to many deaf children. By the time it is clear that the deaf child is not acquiring spoken language with cochlear devices, it might already be past the critical period, and the child runs the risk of becoming linguistically deprived. Linguistic deprivation constitutes multiple personal harms as well as harms to society (in terms of costs to our medical systems and in loss of potential productive societal participation).

A survey of reports of sign order from 42 sign languages leads to a handful of generalizations. Two accounts emerge, one amodal and the other modal. We argue that universal pressures are at work with respect to some generalizations, but that pressure from the visual modality is at work with respect to others. Together, these pressures conspire to make all sign languages order their major constituents SOV or SVO. This study leads us to the conclusion that the order of S with regard to verb phrase (VP) may be driven by sensorimotor system concerns that feed universal grammar.

Every year, 10 000 infants are born in the United States with sensorineural deafness. Deaf children of hearing (and nonsigning) parents are unique among all children in the world in that they cannot easily or naturally learn the language that their parents speak. These parents face tough choices. Should they seek a cochlear implant for their child? If so, should they also learn to sign? As pediatricians, we need to help parents understand the risks and benefits of different approaches to parent–child communication when the child is deaf.

Parents of small deaf children need guidance on constructing home and school environments that affect normal language acquisition. They often turn to physicians and spiritual leaders and, increasingly, the internet. These sources can be underinformed about crucial issues, such as matters of brain plasticity connected to the risk of linguistic deprivation, and delay or disruption in the development of cognitive skills interwoven with linguistic ability. We have formed a team of specialists in education, linguistics, pediatric medicine, and psychology, and at times specialists in theology and in law have joined our group. We argue that deaf children should be taught a sign language in the early years. This does not preclude oral-aural training and assistive technology. With a strong first language (a sign language), the child can become bilingual (with the written form of the ambient spoken language and, perhaps, the spoken form), accruing the benefits of bilingualism. We have published in medical journals, addressing primary care physicians, in a journal with a spiritual-leader readership, and in a health-law journal. Articles in progress address medical educators and practitioners. Team members present findings at conferences, work on lobbying and legislative efforts with the National Association of the Deaf, and spread the word at conferences of target audiences. We share our work in Word format, so that anyone can easily appropriate it for our common interests. One of our articles has been downloaded over 27,000 times (as of April 2014), and we are asked to consult with committees in other countries as they draft national policies.

No abstract