Supporting the language development of deaf and hard of hearing children: A clinical guide for pediatric providers

When Elana Meyers Taylor won gold in the women’s monobob at the 2026 Winter Olympics, she turned to her Deaf son and tearfully signed “Mommy won” in American Sign Language (ASL). The moment went viral for a good reason.¹ Taylor, a hearing parent raising 2 Deaf sons, offered a rare public glimpse of what research has long supported: a multilingual, accessible home environment gives Deaf and Hard of Hearing (DHH) children the foundation they need to thrive. That image also brings an important clinical question into focus: how can pediatric providers best support the language development of DHH children?

Early Hearing Detection and Intervention (EHDI): The 1-3-6 benchmarks

The recommended EHDI guidelines establish 3 benchmarks: screening for hearing loss before one month of age, completing a diagnostic audiological evaluation before 3 months of age, and initiating intervention services by 6 months of age.² These benchmarks exist because timing matters profoundly, yet they are not met or documented for one in four infants in the United States.³ Barriers, including limited access to care and insurance coverage gaps, contribute significantly to this statistic.⁴

Key clinical takeaway: Ask at every well-child visit whether EHDI benchmarks have been met. If not, help families navigate barriers to timely follow-up.

Early intervention: The earlier, the better

Early Intervention (EI) services are among the most powerful tools for supporting language development in DHH children. When initiated within the first 6 months of life, EI is associated with greater kindergarten readiness and higher language and literacy scores compared to those with later enrollment.^5,6 Pediatric providers play a direct role in connecting families to EI referrals without delay.

Sign language: A critical foundation

Many hearing families of DHH children prioritize spoken language as a goal which is entirely valid. However, spoken language outcomes in DHH children remain highly variable and often lag behind those of hearing peers, even with current technological advances.^7–11 What the evidence consistently shows is that early sign language exposure, beginning in the first six months of life, is not in conflict with spoken language development; rather, it actively supports it.^12,13 DHH children exposed to ASL early demonstrate stronger vocabulary, reading, and writing skills.^14–16

A common concern among hearing families is that ASL exposure will only be beneficial if family members are already fluent signers. Research does not support this worry: language benefits are observed even when parents learn sign language alongside their child.^12,17 ASL exposure in the home environment, at any parental skill level, is associated with improved ASL proficiency over time.¹⁸

For families pursuing cochlear implantation, the evidence is equally clear: DHH children with cochlear implants who had early exposure to sign language show spoken vocabulary, articulation, syntax, and phonological awareness comparable to those of their hearing peers.^19,20

Clinical guidance: Regardless of a family’s communication goals, recommend early exposure to sign language beginning in the first six months of life. Frame this as an additive, not an either/or, choice.

Hearing technology: Timing matters

For families who choose hearing augmentation, earlier initiation is consistently associated with better language outcomes:

• Hearing aids provided by 3 months of age are associated with significantly better language outcomes compared to hearing aids initiated at 24 months of age.²¹
• Cochlear implants provided by 12 months of age (currently FDA-approved for children with bilateral profound sensorineural hearing loss as young as nine months) are associated with age-expected language growth rates, higher receptive language scores, and improved speech perception and production.^21–23

Providers can support families by discussing the option of hearing technology early, connecting them with audiology specialists, and clarifying that technology decisions, including the decision not to pursue amplification, belong to the family.

Recognizing the full picture: Medical and cultural models of deafness

The medical model has historically framed deafness as a condition requiring correction. The social and cultural model frames Deafness (with a capital D) as a difference, rather than a disability, and recognizes that Deaf identity and community membership are deeply meaningful to many individuals.^7,24

As pediatric providers, holding space for both frameworks matter. Augmentation is not a prerequisite for a life rich in language and connection. Families benefit most when providers offer balanced, evidence-based information without steering toward any single path.

A timeline for clinical reference

The following diagram illustrates research-supported intervals for initiating key resources and services, with the understanding that each family’s circumstances are unique.^2,21–23

[Diagram created at BioRender.com]

References

1. Hallett V. What parents can learn from the Olympic champion who signs with her deaf sons | Education. Gallaudet University. February 23, 2026. Accessed March 1, 2026. https://gallaudet.edu/education/what-parents-can-learn-from-the-olympic-champion-who-signs-with-her-deaf-sons/

2. CDC. EHDI 1-3-6 Benchmarks. Hearing Loss in Children. May 14, 2025. Accessed March 4, 2026. https://www.cdc.gov/hearing-loss-children/articles/baby-hearing-screening-infographic.html

3. CDC. 2019 Summary of Diagnostics Among Infants Not Passing Hearing Screening. Centers for Disease Control and Prevention. June 16, 2021. Accessed May 15, 2026. https://archive.cdc.gov/www_cdc_gov/ncbddd/hearingloss/2019-data/06-diagnostics.html

4. Cree RA, Bitsko R, Grimm C, et al. Provider Perspectives: Identification and Follow-up of Infants who Are Deaf or Hard of Hearing. Am J Perinatol. 2024;41(S 01):e694-e710. doi:10.1055/a-1932-9985

5. Meinzen-Derr J, Wiley S, Grove W, et al. Kindergarten Readiness in Children Who Are Deaf or Hard of Hearing Who Received Early Intervention. Pediatrics. 2020;146(4):e20200557. doi:10.1542/peds.2020-0557

6. Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early Hearing Detection and Vocabulary of Children With Hearing Loss. Pediatrics. 2017;140(2):e20162964. doi:10.1542/peds.2016-2964

7. Bower C, Reilly BK, Richerson J, Hecht JL, COMMITTEE ON PRACTICE & AMBULATORY MEDICINE, SECTION ON OTOLARYNGOLOGY–HEAD AND NECK SURGERY. Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening. Pediatrics. 2023;152(3):e2023063288. doi:10.1542/peds.2023-063288

8. Szagun G, Schramm SA. Sources of variability in language development of children with cochlear implants: age at implantation, parental language, and early features of children’s language construction. J Child Lang. 2016;43(3):505-536. doi:10.1017/S0305000915000641

9. Walker EA, Redfern A, Oleson JJ. Linear Mixed-Model Analysis to Examine Longitudinal Trajectories in Vocabulary Depth and Breadth in Children Who Are Hard of Hearing. J Speech Lang Hear Res JSLHR. 2019;62(3):525-542. doi:10.1044/2018_JSLHR-L-ASTM-18-0250

10. Edquist G, Flynn T, Jennische M. Expressive vocabulary of school-age children with mild to moderately severe hearing loss. Int J Pediatr Otorhinolaryngol. 2022;162:111281. doi:10.1016/j.ijporl.2022.111281

11. Werfel KL, Reynolds G, Fitton L. Oral Language Acquisition in Preschool Children Who are Deaf and Hard-of-Hearing. J Deaf Stud Deaf Educ. 2022;27(2):166-178. doi:10.1093/deafed/enab043

12. Caselli N, Pyers J, Lieberman AM. Deaf children of hearing parents have age-level vocabulary growth when exposed to ASL by six-months. J Pediatr. 2021;232:229-236. doi:10.1016/j.jpeds.2021.01.029

13. Hall WC. What You Don’t Know Can Hurt You: The Risk of Language Deprivation by Impairing Sign Language Development in Deaf Children. Matern Child Health J. 2017;21(5):961-965. doi:10.1007/s10995-017-2287-y

14. Allen TE, Morere DA. Early visual language skills affect the trajectory of literacy gains over a three-year period of time for preschool aged deaf children who experience signing in the home. PLoS ONE. 2020;15(2):e0229591. doi:10.1371/journal.pone.0229591

15. Allen TE. ASL Skills, Fingerspelling Ability, Home Communication Context and Early Alphabetic Knowledge of Preschool-Aged Deaf Children. Sign Lang Stud. 2015;15(3):233-265. doi:10.1353/sls.2015.0006

16. Scott JA, Hoffmeister RJ. American Sign Language and Academic English: Factors Influencing the Reading of Bilingual Secondary School Deaf and Hard of Hearing Students. J Deaf Stud Deaf Educ. 2017;22(1):59-71. doi:10.1093/deafed/enw065

17. Humphries T, Kushalnagar P, Mathur G, Napoli DJ, Rathmann C, Smith S. Support for parents of deaf children: Common questions and informed, evidence-based answers. Int J Pediatr Otorhinolaryngol. 2019;118:134-142. doi:10.1016/j.ijporl.2018.12.036

18. Hernandez B, Allen TE, Morere DA. ASL Developmental Trends Among Deaf Children, Ages Birth to Five. J Deaf Stud Deaf Educ. 2022;28(1):7-20. doi:10.1093/deafed/enac036

19. Davidson K, Lillo-Martin D, Chen Pichler D. Spoken English Language Development Among Native Signing Children With Cochlear Implants. J Deaf Stud Deaf Educ. 2014;19(2):238-250. doi:10.1093/deafed/ent045

20. Delcenserie A, Genesee F, Champoux F. Exposure to sign language prior and after cochlear implantation increases language and cognitive skills in deaf children. Dev Sci. 2024;27(4):e13481. doi:10.1111/desc.13481

21. Ching TYC, Dillon H, Button L, et al. Age at Intervention for Permanent Hearing Loss and 5-Year Language Outcomes. Pediatrics. 2017;140(3):e20164274. doi:10.1542/peds.2016-4274

22. Dettman SJ, Dowell RC, Choo D, et al. Long-term Communication Outcomes for Children Receiving Cochlear Implants Younger Than 12 Months: A Multicenter Study. Otol Neurotol. 2016;37(2):e82. doi:10.1097/MAO.0000000000000915

23. Yang Y, Chen M, Zheng J, et al. Clinical evaluation of cochlear implantation in children younger than 12 months of age. Pediatr Investig. 2020;04(02):99-103. doi:10.1002/ped4.12202

24. Gale E. Exploring Perspectives on Cochlear Implants and Language Acquisition Within the Deaf Community. J Deaf Stud Deaf Educ. 2010;16(1):121-139. doi:10.1093/deafed/enq044