For nearly a half a century, research has found that signed languages (e.g., American Sign Language, ASL) are comparable to spoken languages (e.g., English) when it comes to meeting the criteria of linguistic principles for a human language. However, there is limited research available on the topic of signed language disorders, even though they occur with a similar incidence to disorders in spoken language (Cripps et al., 2016: 110–12). The present study aimed to assess the effectiveness in diagnostic and therapeutic activities of two language professionals, Speech-Language Pathologists and ASL Specialists, working with deaf children who exhibit developmental signed language deficits. Pre- and post-research interviews with professionals and observations of professional–student interactions were conducted. This study occurred at a residential school for the deaf with an immersive ASL environment. Due to the lack of knowledge and resources available to language professionals working with deaf children, results suggest that deaf children are not receiving appropriate language intervention. Furthermore, current professionals identified that there is a specific need for a signed language professional, such as signed language pathologist, to specialise in the diagnosis and treatment of individuals with signed language delay and/or disorders.
Keywords: Signed language pathology, signed language specialists, speech-language pathology, signed language acquisition, signed language disorders, Autism Spectrum Disorder.
American Sign Language (ASL), one of multiple signed languages in the world, is used by deaf people in the United States and parts of Canada. ASL has its own linguistic principles, such as phonology, morphology, syntax, semantics and pragmatics (Sandler and Lilo-Martin, 2006: bk.). Deaf people have formed a close-knit community resulting in the formation of their own culture (Padden, 1980: 90; Rutherford, 1988: 186–87). Considerations for improving linguistic equality in diagnosis and treatment for individuals with signed language disorders from the signing community have not been fully addressed or even explored.
The topic of signed language pathology is a relatively new concept in the speech-language pathology (SLP) field (Cripps et al., 2016: 108). A number of studies worldwide have been conducted with deaf individuals who have language disorders in the signed modality, such as aphasia (e.g. Hickock and Bellugi, 2010: 686–701), stuttering (e.g. Whitebread, 2014: 143–61), and specific signed language impairment (SSLI; Mason et al., 2010: 2–25; Quinto-Pozos et al., 2014: 72–80) as well as deaf individuals with autism (Denmark et al., 2014: 2584–90; Shield and Meier, 2012: 1–4, 2014: 1–11).
The present study aims to investigate the diagnostic and therapeutic relationships between professions and students with language disorders in the area of signed language pathology. Unlike previous studies, this study was conducted in person through professional–student interactions as well as interviews with professionals. Various studies on signed language acquisition, development and disorders in deaf children/students have been conducted.
Development of signed language with deaf children
Language acquisition, development and use in deaf children have been the main focus for teachers of the deaf, speech-language pathologists and language-related scholars. However, it was not until the mid-1980s when a group of scholars decided to conduct signed language research studies with deaf individuals on their language acquisition development. From the studies on language acquisition, they demonstrated that signed language and spoken language develop in similar ways and along similar trajectories. For comparison, deaf children engage in signed babbling in the same way that hearing children engage in vocal babbling (e.g., Cheek et al., 2001: 294; Petitto, 2000: 43–44). Both hearing and deaf children typically produce their first true word around the age of 1 year, with two-word combinations at 18–24 months (e.g. Conlin et al., 2000: 51–67, Newport and Meier, 1985: 888–90). Hearing children typically learn spoken language through trial and error, and deaf children exhibit similar behaviours in signed language (Conlin et al., 2000: 55–62).
Delays in signed language acquisition
Research studies also indicated that a high risk of language delay is frequently found with deaf children (Lederberg et al., 2013: 15–16; Schick et al., 2007: 390–93). Approximately 10 per cent of deaf children are native signers (i.e. were raised in a household where ASL is the primary language) in the United States. The remaining 90 per cent of deaf children are born to hearing parents who typically do not know ASL (Mitchell and Karchmer, 2004: 138–58). The lack of a communicatively rich environment and fluent signed language models during the critical period of language development can place deaf children at risk of language disorders (Herman et al., 2014: 46).
Specifically, Mayberry (1994) and Newport (1990) found that deaf children who acquired ASL after the critical period of language learning demonstrated lower proficiency in their linguistic competence (i.e., phonology, morphology, syntax, semantics, and pragmatics) in signed language. Newport (1990) analysed the effects of maturation on language learning. She found deaf learners who acquired ASL at a younger age demonstrated a higher level of linguistic competence when compared to the learners who acquired the language at a later time. In a similar light, Mayberry (1994) analysed the processing differences between deaf early and late learners of ASL. Late learners of ASL exhibited mistakes in linguistic structure (i.e., morphology, syntax) while early learners were able to maintain the meaning and linguistic structure in a sentence recall task.
Deaf children with signed language disorders
More recently, a number of studies revealed a population of deaf children who exhibit the characteristics of signed language disorders. SSLI and signed stuttering are two types of signed language disorders that have been identified. Studies indicated that common characteristics of signed stuttering include fingerspelled and signed repetitions, hesitations, prolongations, blocks, involuntary interjections, unusual body movements, poor fluidity, and increased muscular tension (Cosyns et al., 2009: 746). Whitebread (2014) points out that further research needs to be conducted observing individuals with signed stuttering at first hand rather than depending on reports of teachers or interpreters.
SSLI, another signed language disorder, is the diagnosis for deaf children who exhibit atypical signed language development in the absence of other impairments or diagnoses. SSLI may affect any or all of the language areas, including phonology, morphology, syntax, semantics, pragmatics, receptive or expressive language. Herman et al. (2014) utilised a specific language impairment screening questionnaire sent to teachers and SLPs to screen deaf children for characteristics of SSLI. The results indicated an estimated prevalence rate of 6.4 per cent. This result is not explicitly stated as it is difficult to determine that the deaf children who participated in the study had been early exposed to signed language (i.e., more than 90 per cent are not native signers). Nevertheless, further case studies indicated that deaf individuals with SSLI struggle with memory/recall, reasoning, sequencing tasks, and morphology (Morgan et al., 2007: 12–23; Quinto-Pozos et al., 2011: 430–34, 2013: 332–59, 2014: 83).
Deaf children with autism
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that frequently impacts deaf children's language acquisition and social behaviours. Extensive research is occurring due to the rising diagnostic prevalence of hearing children who have ASD. Until recently, more research studies were conducted with deaf children with ASD. Deaf children with ASD show deficits in palm reversal, errors in fingerspelling, lexical signs, joint attention, and perspective-taking (Denmark et al., 2014: 2589), and difficulties in palm orientation (Shield and Meier, 2012), pronouns (Shield et al., 2015), theory of mind and perspective-taking (Shield et al., 2016) and use of Autism Diagnostic Observation Schedule (Mood and Shield, 2014). Shield and Meier (2014) reviewed the current literature regarding deaf children diagnosed with ASD. They identified that no diagnostic instruments were available for assessment of deaf children with ASD. Although ASD is becoming more prevalent in the field of language research, the need for further research with deaf individuals with ASD is prevalent.
The purpose of the present study is to examine professionals' interactions with deaf students who have language and/or neurological disorders and who attend a residential deaf school. Specifically, the researchers in this study aimed to assess the effectiveness of various aspects of diagnostic and therapeutic activities by language professionals working with deaf students. The goal of the following research questions was to understand more about the professionals' interactions with the deaf students who exhibit characteristics of signed language delays or disorders and/or neurological disorders:
- What assessment tools do language professionals use to diagnose deaf children with signed language disorders?
- How do language professionals treat deaf children with signed language disorders (or neurological disorders) during their therapeutic sessions?
- Do deaf students with signed language disorders make progress in a timely manner (i.e., a three-month period) as a result of intervention by language professionals? If yes, how?
It should be noted that the present study includes a small sample size and the generalisability of the results is limited. However, the findings are important for the ongoing development of the research area of signed language pathology. The present study was reviewed and approved by the Towson University Institutional Review Board (IRB approval number 1702015385).
The study was conducted at a residential deaf school in the mid-Atlantic region of the United States. The first author of this paper, an undergraduate senior studying speech-language pathology and audiology, and deaf studies, collected the data reported in this study.
Two professionals working at the school and three deaf students who demonstrated difficulties with signed language development participated in the study. The language professionals in the school were identified to be the SLP and ASL specialist/teacher. Further explanation of both professionals will follow in the coming sections. The three students in this study exhibited some difficulties with the progress of their signed language development as indicated through their individualised education plans (IEP). All three students were under the age of 4, were enrolled in pre-kindergarten and had deaf parents who use ASL at home. The educational language of the school is ASL.
The SLP is a hearing female and she holds a Master's degree in speech-language pathology; she holds a certificate of clinical competence to practise as a speech-language pathologist. She has been employed at the school for the deaf for approximately twelve years. Upon being hired at the school for the deaf, she indicated she had little knowledge of ASL, and she learned primarily on the job through interaction with the deaf faculty, as well as ASL classes offered by the school. SLPs are the professionals who focus on individuals' use of language abilities including developing and promoting language skills in clients of all ages.
The ASL specialist is a deaf male who is in his first year working at the school. He was born deaf into an all-deaf family, and he grew up with ASL as his first language. He received a bachelor's degree in deaf studies. His main role at the school is to teach ASL classes. ASL classes in a school for the deaf are similar to English classes in a mainstream school. It was revealed after the research process was begun that his role was that of an ASL teacher rather than an ASL specialist (see Table 1, Question 3). This point will be elaborated on in later sections.
This student is a girl aged 3 years 2 months with goals focusing on language expansion (i.e., vocabulary development, increasing ASL utterance length). She frequently uses gestures and pointing to communicate rather than actual ASL signs or sentences. In addition to lack of signed words and sentences, she demonstrated limited use of lexical prepositions (on, in, under, out, etc.) and ASL classifiers, restricted signed vocabulary use (i.e. combining signs, ASL verbs), limited signed combinations, and lack of appropriate use of descriptive signs (i.e., size, shape, colour, etc.).
This student is a boy aged 4 years and 4 months, and he was recently adopted from China. He had been enrolled in the school for the deaf for approximately two months at the time of data collection. There was no known case history indicating that he came into the US with any knowledge of spoken or signed language. This student is a clear example of language deprivation (i.e. having no or limited access to language). He did not have any other known co-occurring diagnoses.
This student is a boy aged 3 years and 6 months who has been diagnosed with ASD by a team at a local institute specialising in ASD. He understands ASL based on informal observations and interactions with teachers, peers and the SLP, but he does not exhibit age-appropriate levels of expressive language. Specifically, he uses simple signs in isolation (i.e., 'more', 'yes', 'jump', 'please') but needs frequent prompting to produce signed combinations. Student 3 exhibited multiple behaviours consistent with ASD, such as limited eye contact, seeking sensory input and limited social interaction initiation.
Procedures and coding analysis
Pre- and post-research questionnaires were used to assess the professionals at the beginning and end of the research process. The SLP's interviews were conducted through oral/spoken language. The ASL specialist's interviews were conducted through ASL. All interviews occurred one-on-one with the researcher (see Table 1 for pre-questionnaire questions and Table 2 for post-questionnaire questions in the results section). The researcher video-recorded the interviews with the professionals and took notes after reviewing the videotaped interviews to select certain information following the three research questions as part of data analysis.
During the in-person observations with professionals and students, field notes were collected by the primary investigator (see Creswell, 2005: 211–14). The purpose of the observations was to gather information about the students' language development and abilities through their therapeutic interactions with language professionals. The observational data was collected approximately once a week over the span of six to seven hours for three months during a semester. After conducting the observations, the researcher reviewed her field notes to analyse and report the selected professional–student interactions that reflect the research questions in this study. During the research period, the school administrators and professionals in the study were aware of the research, and permitted the researcher to collect data. They were also informed the university's IRB had approved this research project.
Pre-questionnaire and post-questionnaire
Table 1 lists the questions asked by the researcher and the answers made by the language professionals (i.e., SLP for speech-language pathologist and ASLS for ASL specialist) at the beginning of the semester.
Question 1: Are there any specific educational certifications(s) or requirement(s) you as an [SLP or ASL specialist] had to obtain in order to work with deaf children who have signed language disorders?
SLP: There are no specific certifications required for their position working with deaf children other than the ASHA Certificate of Clinical Competence.
ASLS: I have an ASL teaching certification, and I am currently working towards my state teaching certificate.
Question 2: As an [SLP or ASL specialist], have you ever done any diagnostic evaluation with deaf children who have signed language disorders? If yes, explain.
SLP: I have not performed any true diagnostic evaluations, but I do assess often. There are no standardized assessments for deaf children with language disorders, so I often modify assessments, or use checklists to look at specific skills.
ASLS: I sometimes assess student's vocabulary with checklists, but I have not done any formal diagnostic assessment.
Question 3: As an [SLP or ASL specialist] have you ever done any therapy with deaf children with a signed language disorder?
SLP: I have. Most of the children I work with are often severely delayed and have limited means of communication. I am confident enough in my ASL skills to stimulate and provide a foundation for emerging ASL communication.
ASLS: I am an ASL teacher, not an ASL specialist, so I do not focus on intervention with language delayed or disordered students.
Question 4: In your previous experience (if any), what type of instruments have shown success in diagnosing children with a signed language disorder?
SLP: Language stimulation techniques like delaying my responses, modeling, intentional situation sabotage, and expansion of utterances have shown the most success in treating language needs in deaf children.
ASLS: This question doesn't really apply to me.
Question 5: In your previous experience (if any), what type of instruments have not shown success in diagnosing children with a signed language disorder?
SLP: I try to avoid drill type exercises with my students. Most of them find them boring, or more like serious work than a fun activity. There are not many visually stimulating activities, so I make a lot of my own.
ASLS: This question does not apply to me.
Question 6: In your previous experience (if any), what methods have shown success in treating children with a signed language disorder?
SLP: Similar methods for what I use in my informal diagnostic procedures. Again, I create many of my own activities; having things that are engaging and fun for the children.
ASLS: Within my classroom, the teaching methods I provide have to be very individualized. Many of my students function differently, so I have to be prepared to modify activities to fit their learning styles.
Question 7: In your previous experience (if any), what methods have not shown success in treating children with a signed language disorder?
SLP: This is also a similar answer to the things I try to avoid in informal diagnostic assessments. If I have found things are not successful, I tend not to use them.
ASLS: I've really changed my classroom teaching style from last semester. I started having the students do a large amount of written work, but I really saw no change in their abilities over the course of the semester. This semester, I have them much more involved and constantly participating, which has shown to be more beneficial for the student's progress.
Question 8: Do you have any additional comments that you would like to share based on your previous experience(s)?
SLP: As the main 'language person' in the elementary building, sometimes I think it is kind of crazy that I'm the one working on someone's native language when it's not my native language. So, I'm interested to hear about the results of the study and suggestions for the future.
ASLS: In my experience, many individuals who work at our school are not very experienced in ASL. They use ASL effectively but do not seem to function fully or comfortably within it. I find it interesting that the elementary school has multiple SLPs, but I am the only ASL teacher.
Question 9: In an ideal situation, what kind of signed language diagnostic evaluation should be administered to deaf children who have signed language disorders?
SLP: Ideally, there should be a standardized assessment for deaf children analyzing their language use as a whole, not only their vocabulary. I would love to be the signed language therapist, but I know that's not possible since I am not a native signer. The SLPs and ASL specialists here have tried to collaborate, but due to limited time and large caseloads, it never seems to happen as we would like it.
ASLS: I would like to see a lot of collaboration happen to target children who may have language difficulties. Collaboration doesn't occur nearly as frequently as it should because of limited staff and time.
Question 10: In an ideal situation, what are the roles of an [SLP or ASL specialist] who provide therapy to deaf children who have signed language disorders?
SLP: ASL specialists knowledge of signed language and SLPs knowledge and experience in the therapeutic process are a perfect recipe for collaboration. Ideally, we would have the time to work in an interdisciplinary modality, rather than only seeing one another at IEP meetings twice a year.
ASLS: An individual who has native or native-like signing experience should absolutely be involved in the treatment if a student has a signed language disorder. Again, collaboration of various professionals is a must, but when working with deaf children and ASL, there needs to be a higher emphasis on providing signed language support.
Results from post-questionnaire.
As with Table 1, Table 2 demonstrates the post-questionnaire version which was held at the end of the semester.
Question 1: As an [SLP or ASL specialist], have you ever done any diagnostic evaluation with deaf participants with signed language disorders in this study? If yes, please explain.
SLP: I have not conducted any formal diagnostic evaluation during the course of the study. The majority of the evaluations I have conducted have focused on functional communication.
ASLS: I have not done any diagnostic evaluation, but I have assessed students need based on their class performance.
Question 2: As an [SLP or ASL specialist], have you ever done any therapy with deaf participants with signed language disorders in this study? If yes, please explain.
SLP: I have not specifically conducted any therapy with students with signed language disorders. I have worked with three children with language-based needs, but they are not specifically diagnosed with a signed language disorder.
ASLS: I have not done any therapy during this study.
Question 3: During this study, what type of instruments have shown success in diagnosing children with a signed language disorder?
SLP: I haven't done any formal diagnostic evaluations this semester, but I have used my clinician-created checklists often. They are always a great stand-by to pull out whenever I need them.
ASLS: I have not done any formal diagnostic evaluations.
Question 4: During this study, what type of instruments have not shown success in diagnosing children with a signed language disorder?
SLP: The issue of having an extremely limited number of standardized assessments that can used authentically or even be modified is still the biggest challenge. I can gather large amounts of informal data, but without standardized assessments, we will never have a truly complete evaluation process for a deaf child.
ASLS: I have not done diagnostic evaluation.
Question 5: During this study, what methods have shown success in treating children with a signed language disorder?
SLP: The PECS system I used with the student with ASD worked very well. He also enjoyed any activity where I could incorporate the iPad as motivation.
ASLS: I have not worked directly with children with signed language disorders.
Question 6: During this study, what methods have not shown success in treating children with a signed language disorder?
SLP: Similar to my answer at the beginning of the research period, I tend not to use things that have not been successful in the past. There will always be new activities that I try, and some will go better than others.
ASLS: Again, similar to my answers for question 3 and 4.
Question 7: Do you as an [SLP or ASL specialist] feel that the deaf participant(s) have progressed throughout the semester? Explain why and why not.
SLP: I feel that my students have progressed in the last semester. Some more than others, but all have made some steps of improvement.
ASLS: I have seen much more progress this semester than I saw last semester. I think the removal of the lecture style classes and written activities has proved to be the biggest contributing factor to the progress I've seen.
Question 8: Do you have any additional comments that you would like to share in regard to this study?
SLP: I think it's important for language professionals to be providing the best services possible to whatever population they work with, and sometimes I think we fall short on that goal with deaf children. Due to their variety of needs and backgrounds, and the fact that the acceptance of ASL is a relatively new concept, it's difficult to make sure they have access to all the language resources a hearing child would have.
ASLS: No additional comments.
Question 9: In the near future, what kind of signed language diagnostic evaluation should be administered to deaf children who have signed language disorders?
SLP: The field of speech-language pathology is moving more and more toward consistent collaboration with other professionals, so I think that's where we should head with signed language delays/disorders as well.
ASLS: I really enjoy collaborating with other disciplines, especially when they may need guidance about ASL related issues like grammar, nonverbal aspects, and other pieces of the linguistic structure they may not feel comfortable functioning in. Any staff member working in this building should be comfortable functioning in ASL, and I often think there's a stigma that if they ask for help they will look insufficient, but I think it's the opposite. So, I guess there should be more openness between professionals during the evaluation, assessment, and treatment process.
Question 10: In the near future, what are the roles of an [SLP or ASL specialist] who provides therapy to deaf children who have signed language disorders?
SLP: I truly think there should be a 'middleman' between a SLP and an ASL specialist. The SLPs would focus on functional communication, and once the students established a certain level of skill, an ASL therapist would pick up where the SLP could no longer effectively provide services. The ASL specialist could support both therapists in by consistent collaboration on goal writing, treatment plan development, and therapy implementation.
ASLS: Collaboration is key. Native and native-like signers should be an integral part of therapy for deaf students. I like the idea of having a career field similar to an SLP but for ASL with a more therapeutic background and the full knowledge of ASL.
Observations of professional–student interactions
|Student||Number of observations||Duration of observations|
|Student 1||3||30 minutes (each)|
|Student 2||3||30 minutes (each)|
|Student 3||3||30 minutes (each)|
In the first session, the most noticeable observation was the student's frequent use of gestures. Instead of using signed words in ASL to create an age-appropriate signed combination, she pointed to an object, mimed or physically carried out an action. For example, instead of signing 'my shoe, I will take it off', she would explain by physically removing her shoe. In another situation, a picture of a person running was shown to Student 1. When asked in ASL sentence, what the person was doing, Student 1 mimed the action of running rather than using the ASL word for 'run'. The student responded through visual and tactile means to expand her utterances. The SLP often modelled the appropriate utterance and had Student 1 copy the utterance immediately after (i.e., 'man, he runs').
In the second and third sessions, Student 1 struggled with focusing on an activity and following directions. For example, an activity using a colouring page was developed to prompt Student 1 with one-step directions (i.e. 'Where is the car?' *wait for Student 1 to identify the car*, then the SLP encouraged the expansion of the dialogue). The prompting in the activity allowed opportunities for object identification as well as following directions. However, when the activity was carried out, Student 1 had trouble focusing on the directions as she was more interested in simply colouring the picture the way she desired. The SLP stated that with the progress Student 1 has been making, sessions will soon reach the point where the concepts begin to reach out of her comfort zone of ASL use and understanding of the language at the discourse level.
The initial sessions focused on gathering linguistic information on Student 2 since not much was known about his language abilities. Simple tasks were performed (e.g., object identification, turn-taking, language stimulation/modelling) to informally assess Student 2. He exhibited stimulability for learning new vocabulary and using various pragmatic skills. There was a short time period between the initial informal assessments to determine if the student needed explicit language intervention and the beginning of the intervention. This time period was needed to develop specific language goals and create an IEP. During this approximately three-week break, Student 2's language abilities had developed rapidly. The next time he was seen by the SLP, he was able to identify over fifteen objects correctly on the first attempt, use appropriate turn-taking and requesting skills, and followed one-step directions. The gains observed in his language abilities were not surprising since he was previously language-deprived and now immersed academically and socially in a language-rich environment.
By the third observation period, the student was consistently using a plethora of new vocabulary, initiating greetings and interactions with adults and peers, requesting, using appropriate ASL facial expression, and age-appropriate ASL phonology, morphology and syntactic skills (i.e. 'car colour blue', 'want green please' etc.). His parents and the school for the deaf provided language-rich and accessible environments. Due to the delay of his ASL acquisition, Student 2's interactions with the language professionals continued to ensure he is able to catch up to his peers with age-appropriate language, as well as to develop and maintain his own acquired language skills.
The third student was observed in during multiple sessions focusing on language. His diagnoses of ASD required more one-on-one attention and stimulation in order to maintain motivation. Initially in the first observation, Student 3 exhibited a limited expressive signed vocabulary (i.e., 'more', 'jump', 'want', 'iPad'), but understood on a frequent basis through participating appropriately in clinician-led activities. Student 3 frequently exhibited the characteristic consistent with ASD of limited eye contact, making sessions more challenging since ASL is mainly used in the visual means. However, in his situation, he required frequent tactile prompting during sessions. The SLP targeted to expanding his expressive vocabulary through tactile prompting and visual cues. Visual cues consisted of modelling signs and holding activities until Student 3 attempted to or successfully mimicked the sign himself. Student 3 would spontaneously request activities with no prompting if he was motivated and focused. However, spontaneous requests were inconsistent throughout observations.
Throughout all sessions, Student 3 exhibited some skills in writing and word identification for his age. A Picture Exchange Communication System (PECS; Bondy and Frost, 2001) was used in sessions in order for Student 3 to choose the activity he desired. More often than not, if the tile of 'markers' was an option on the PECS, they were his first choice. Tactile and/or visual stimulation were usually needed during colour selection, but he was often able to use the PECS effectively by himself. He demonstrated over 85 per cent accuracy in the picture-to-word matching. The team working with Student 3 consistently exhibited knowledge, patience and understanding of Student 3's needs.
The results of the present study showed that there is a gap in the language services being provided to deaf children. The students' signed language needs are inadequately assessed for delays and/or disorders (see Cripps et al., 2016: 110–12 for further discussion on insufficient formal signed language assessments nationwide). It is difficult to identify if there are any true signed language disorders among deaf children in this study since the informal diagnosis of signed language delay is being used as a blanket term for all children receiving explicit language services. These findings indicate the explicit need for more specific diagnostic procedures and explicit qualifications for services for deaf children. The lack of a clear role regarding signed language professionals, specifically the ASL specialist and/or language pathologist in the elementary school at a school for the deaf, is another obvious issue.
Based on the observations and the interviews in this study, the data collected showed that there are limited tools for diagnostic evaluations of deaf children with signed language delays/disorders, supporting the results of previous studies. On the other hand, the authors of this study want to note that there are benefits for using informal measures in language evaluation. The SLP in the present study utilised mostly self-created informal or criterion-referenced measures to assess language. The lack of formal assessments for signed language disorders places a strong reliance on informal language measures, making it difficult for professionals to formally diagnose.
Secondly, the professionals observed in the present study interacted with their students in functional, appropriate and beneficial ways. Although no students were formally diagnosed with a signed language disorder specifically, the SLP mainly worked with students who were severely delayed in their signed language development. In contrast, the ASL teacher taught classes of ten to twenty students. Both professionals often made and adapted their own informal activities to fulfill individual student needs. It is difficult to pinpoint exact aspects of treatment of signed language disorders since no student was formally diagnosed. Following the results from this study, the professionals consistently supported their students and worked on appropriate language concepts and targets which benefits for students with signed language delays.
Regarding the observations, all three students who received intervention from language professionals showed various levels of progress. Some of them achieved higher levels of improvement, but all made strides of improvement towards reaching their language-related IEP goals throughout three observation periods. Student 1 exhibited growth in her vocabulary by the end of the research period. Student 2 made impressive progress over the span of the study. He entered the school for the deaf with little to no language or linguistic ability due to language deprivation, yet when placed in an ASL rich environment, his skills developed rapidly (see Supalla and Cripps, 2008: 174 for the relevance of signed language being linguistically accessible for deaf children). Student 3 exhibited notable progress at the third observation. He consistently used PECS to request activities and demonstrated understanding of requesting and attending to communication tasks as well as using appropriate utterances with the help of visual cues.
The current literature shows there are no tools for assessing and formally diagnosing deaf children with signed language delays and/or disorders. The present study's observations and interviews supported this assertion. Direct observations from this study demonstrated that there are children currently enrolled in schools for the deaf who are exhibiting characteristics of these diagnoses, yet the professionals know very little about them. Their ability to treat and diagnose these deaf children with delays or/and disorders in signed language is limited. Indeed, the professionals in this study who are working directly with these students are doing what they can, and their students are making progress. However, there is much room for improvement in serving the signed language needs of deaf children.
Limitations of the study and future directions
The present study had several limitations. First, the researcher did not have control over the sample. Generally, it seems that deaf students who have signed language disorders are few in number, which it made harder for the researcher to find them in an elementary residential school. Second, the confusion on the roles of ASL teacher contributed to the limitations of this study. None of the students focused upon in the study were seen in a one-on-one setting with the ASL teacher since he was not acutely trained in the diagnosis and treatment of language delays/disorders. Therefore, the majority of the language-related observational data was collected in sessions with the SLP.
Third and lastly, as seen in the results section, the school did not have any specific diagnosis for individuals with signed language delays or disorders. The initial goal of the study was to analyse language professionals' interactions with deaf students with signed language disorders; however, the goal of this study had shifted from signed language disorders to signed language delay. As a result, the three students in the study exhibited delay in signed language but none had a definitive diagnosis of a signed language disorder.
Future studies are needed to assess the specific roles of a signed language pathologist in comparison with a SLP and ASL specialist. A signed language pathologist would ideally have similar training to an SLP. However, the signed language pathologist would specialise in the signed modality while SLPs specialise in the spoken modality (see Cripps et al., 2016 for further explanation). Moreover, future research should focus on developing assessments that are designed to identify signed language delays and/or disorders. Since the diagnoses of a delay vs. a disorder are different, it is recommended that separate assessments be developed for each. Therapeutic models and training for both professionals working with deaf children and individuals with signed language delay or disorders are much needed in the language pathology field. The critical period of language development occurs largely in the time of elementary education and promoting deaf children to become proficient signed language users require attention in the given society.
The authors would like to acknowledge the participants and the school in question for their willingness to participate in the study. They also want to thank Christina Yeager Pelatti, PhD, CCC-SLP for her inputs in the earlier draft and two anonymous reviewers for their tremendous positive feedback.
List of tables
Table 1: Q&A during pre-questionnaire sessions.
Table 2: Q&A during post-questionnaire sessions.
Emma P. Shipley is currently pursuing her Master of Science in Speech-Language Pathology at Towson University in Towson, Maryland with an expected graduation date of May 2019. She graduated from Towson University in 2017 with a dual Bachelor of Science in Speech-Language Pathology and Audiology, and Deaf Studies. Her interests in the field include signed language pathology, spoken and signed language acquisition, exercise physiology, aphasia, and motor speech disorders. Emma hopes to work with individuals across the lifespan, targeting communication and overall functioning to improve client/patient quality of life.
Jody H. Cripps is an Assistant Professor of American Sign Language at Clemson University, in Clemson, South Carolina. He received double B.A. degrees in Sociology and Deaf Studies from Gallaudet University, an M.A. degree in Signed Language Studies from the University of Arizona, and a Ph.D. in Second Language Acquisition and Teaching from the University of Arizona. His areas of expertise include Universal Design, signed language pathology, social responsibility, signed music, applied linguistics, and literacy. He is a member of the Society for American Sign Language.
 SLPs are the professionals who focus on individuals' use of language abilities including developing, promoting and supporting language skills in clients of all ages.
 ASL specialists are the professionals who work with individuals who may exhibit a delay in learning ASL (see Wix, 1993: 37–45 for in-depth job descriptions of ASL specialists). The school does have an ASL specialist; however, they do not service the elementary school students, only the middle and high school students. The ASL teacher was the designated professional in the elementary school.
 Prior to the research study, there was an agreement between school administrators and the researcher that she would be placed with the SLP and the ASL specialist during her internship.
 Additional note: the ASL specialist/teacher said that he was not working directly with any students who have signed language disorders.
 For clarification, the written component represents written English, not a written system of signed languages.
 A Picture Exchange Communication System (PECS) is a term of alternative/augmentative communication (AAC) for individuals who have limited or no verbal output. It can be as simple as printed picture cards and as advanced as an electronic device with an extensive vocabulary options. The system consisted of five picture cards denoting options for activities (i.e. markers, iPad, etc.). The individual taking this system had to select a correct picture and place it next to the card saying 'I want' and was required to hand it to the SLP before receiving his requested activity (Frost and Bondy, 1985: bk.).
 ASL was formally introduced by William Stokoe, a signed language linguist, in 1960 and it took time for people to accept that ASL is a real human language. It applies to the SLP field.
 All of the signed words and phrases were translated into English for convenience.
11] The behaviours exhibited may stem from a variety of different causes; nonetheless, they are affecting her language development.
 ASL also can be done via tactile means and it is frequently used among the deafblind population (see Collins and Petronio, 1998, and Quinto-Pozos, 2002, for further discussion on the topic of ASL tactility).
 In addition to his Pre-K classroom teacher, a one-on-one aide was also present with Student 3 throughout his day to assist in education, participation and social interaction.
 Ideally, a combination of a standardised ASL assessment such as ASLPA (Maller et al., 1999: 249–67) and a formal diagnostic assessment would assist signed language professionals in analysing all areas of language. ASLPA is the assessment that measures students' proficiency in ASL. In contrast, a diagnostic assessment would pinpoint the specific disorder in signed language. In the present study, the school did not have specific qualification criteria for receiving language-related services.
 It is important to note that the students in the present study may have experienced one-on-one intervention with the ASL specialist/teacher in the past when the students attend ASL class.
Bondy, A., and L. Frost (2001), 'The picture exchange communication system', Behavior Modification, 25(5), 725–44
Cheek, A., K. Cormier, A. Repp and R. P. Meier (2001), 'Prelinguistic gesture predicts mastery and error in the production of early signs', Language, 77(2), 292–323
Collins, S. and K. Petronio (1998), 'What happens in tactile ASL?', in Lucas, C. (ed.), Pinky Extension and Eye Gaze: Language Use in Deaf Communities, Washington, DC: Gallaudet University Press, pp. 17–37
Conlin, K. E., G. Mirus, C. Mauk and R. P. Meier (2000), 'The acquisition of first signs: Place, handshape, and movement', in Chamberlain, C., J. P. Morford and R. I. Mayberry (eds), Language Acquisition by Eye, Mahwah, NJ: Lawrence Erlbaum, pp. 51–69.
Cosyns, M., A. Van Herreweghe, G. Christiaens and J. Van Borsel (2009), 'Stutter-like dysfluencies in Flemish Sign Language users', Clinical Linguistics & Phonetics, 23(10), 742–50
Creswell, J. W. (2005). Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Research. Upper Saddle River, NJ: Pearson Education
Cripps, J. H., S. B. Cooper, S. J. Supalla and P. M. Evitts (2016), 'Meeting the needs of signers in the field of speech and language pathology: Some considerations for action', Communications Disorders Quarterly, 37(2), 108–16
Denmark, T., J. Atkinson, R. Campbell, and J. Sweetenham (2014), 'How do typically developing deaf children and deaf children with Autism Spectrum Disorder use the face when comprehending emotional facial expressions in British Sign Language?', Journal of Autism and Developmental Disorders, 44(10), 2584–92
Frost, L. A. and A. S. Bondy (1985), PECS: The Picture Exchange Communication System. Newark, DE: Pyramid Educational Consultants
Herman, R., K. Rowley, C. Marshall, K. Mason, J. Atkinson, B. Woll and G. Morgan (2014), 'Profiling SLI in deaf children who are sign language users', in Quinto-Pozos, D. (ed.), Multilingual Aspects of Sign Language Communication and Disorder, Tonawanda, NY: Multilingual Matters, pp. 45–69
Hickock, G., and U. Bellugi (2010), 'Neural organization of language: Clues from sign language aphasia,' in Guendouzi, J., F. Loncke, and M. J. Williams (eds), The Handbook of Cognitive Processes: Perspectives in Communication Disorders, London: Psychology Press, pp. 685–706
Lederberg, A. R., B. Schick and P. E. Spencer (2013), 'Language and literacy development in deaf and hard-of-hearing children: Successes and Challenges', Developmental Psychology, 49(1), 15–30
Maller, S. J., J. L. Singleton, S. J. Supalla and T. Wix (1999), 'The development and psychometric properties of the American Sign Language Proficiency Assessment', Journal of Deaf Studies and Deaf Education, 4(4), 249–69
Mason, K., K. Rowley, C. R. Marshall, J. R. Atkinson, R. Herman, B. Woll and G. Morgan (2010), 'Identifying specific language impairment in deaf children acquiring British Sign Language: Implications for theory and practice', British Journal of Developmental Psychology, 28(1), 33–49
Mayberry, R. I. (1994), 'The importance of childhood to language acquisition: Evidence from American Sign Language', in Goodman, J. C. and H. C. Nausbaum (eds), The Development of Speech Perception: The Transition from Speech Sounds to Words, Cambridge, MA: MIT Press, pp. 57–90
Mitchell, R. E. and M. A. Karchmer (2004), 'Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing children in the United States', Sign Language Studies, 4(2), 138–63
Mood, D. and A. Shield (2014), 'Clinical use of the Autism Diagnostic Observation Schedule – Second Edition with children who are deaf', Seminars in Speech and Language, 35(4), 288–300
Morgan, G., R. Herman and B. Woll (2007), 'Language impairments in sign language: Breakthroughs and puzzles', International Journal of Language & Communication Disorders, 42(1), 97–105
Newport, E. L. (1990), 'Maturational constraints on language learning', Cognitive Science, 14(1), 11–28
Newport, E. L. and R. P. Meier (1985), 'The acquisition of American Sign Language', in Slobin, D. I. (ed.), The Cross-linguistic Study of Language Acquisition: Vol. 1: The Data, Hillsdale, NJ: Lawrence Erlbaum, pp. 881–938
Padden, C. A. (1980), 'The deaf community and the culture of the deaf people', in Baker C. and R. Battison (eds), Sign Language and the Deaf Community, Silver Spring, MD: National Association of the Deaf, pp. 89–103
Petitto, L. A. (2000), 'The acquisition of natural signed languages: Lessons in the nature of human language and its biological foundations', in Chamberlain, C., J. P. Morford and R. I. Mayberry (eds), Language Acquisition by Eye, Mahwah, NJ: Lawrence Erlbaum, pp. 41–50
Quinto-Pozos, D. (2002), 'Deixis in the visual/gestural and tactile/gestural modalities', in Meier, R. P., K. Cormier and D. Quinto-Pozos (eds), Modality and Structure in Signed and Spoken Languages, Cambridge: Cambridge University Press, pp. 442–67
Quinto-Pozos, D., A. J. Forber-Pratt and J. L. Singleton (2011), 'Do developmental communication disorders exist in the signed modality? Perspectives from professionals', Language, Speech, and Hearing Services in Schools, 42(4), 423–43
Quinto-Pozos, D., J. L. Singleton, P. Hauser and S. Levine (2014), 'A case-study approach to investigating developmental signed language disorders', in Quinto-Pozos, D. (ed.), Multilingual Aspects of Signed Language Communication and Disorder, Tonawanda, NY: Multilingual Matters, pp. 70–89
Quinto-Pozos, D., J. L. Singleton, P. C. Hauser, S. C. Levine, C. L. Garberoglio and L. Hou (2013), 'Atypical signed language development: A case study of challenges with visual-spatial processing', Cognitive Neuropsychology, 30(5), 332–59
Rutherford, S. D. (1988), 'The culture of American deaf people', Sign Language Studies, 59, 129–47
Sandler, W. and D. Lilo-Martin (2006), Sign Language and Linguistic Universals, Cambridge: Cambridge University Press
Schick, B., J. de Villiers, P. de Villiers and R. Hoffmeister (2007), 'Language and theory of mind: A study of deaf children', Child Development, 78(2), 276–396
Shield, A. and R. P. Meier (2012), 'Palm reversal errors in native-signing children with autism', Journal of Communication Disorders, 45(6), 439–54
Shield, A., R. P. Meier and H. Tager-Flushberg (2015), 'The use of signed language pronouns by native-signing children with autism', Journal of Autism and Developmental Disorders, 45(7), 2128–45
Shield, A., J. Pyers, A. Martin and H. Tager-Flushberg (2016), 'Relations between language and cognition in native-signing children with autism spectrum disorder', Autism Research, 9(12), 1304–15
Shield, A. and R. P. Meier (2014), 'The acquisition of sign language by deaf children with Autism Spectrum Disorder', in Quinto-Pozos, D. (ed.), Multilingual Aspects of Sign Language Communication and Disorder, Tonawanda, NY: Multilingual Matters, pp. 90–122
Supalla, S. J. and J. H. Cripps (2008), 'Linguistic accessibility and deaf children', in Spolsky, B. and F. M. Hult (eds), The Handbook of Educational Linguistics, Oxford: Blackwell, pp. 174–91
Whitebread, G. (2014), 'A review of stuttering in signed languages', in Quinto-Pozos, D. (ed.), Multilingual Aspects of Signed Language Communication and Disorder, Tonawanda, NY: Multilingual Matters, pp. 143–61
Wix, T. R. (1993), 'The American Sign Language specialist: the development of a model position in deaf education', unpublished Master's thesis, University of Arizona
To cite this paper please use the following details: Shipley E.P. and Cripps J.H. (2018), 'Exploring Signed Language Pathology: A Case Study of Professionals Working with Deaf Students Who Have Delay/Disorders in Signed Language Development', Reinvention: an International Journal of Undergraduate Research, Volume 11, Issue 2, http://www.warwick.ac.uk/reinventionjournal/archive/volume11issue2/shipley. Date accessed [insert date]. If you cite this article or use it in any teaching or other related activities please let us know by e-mailing us at Reinventionjournal at warwick dot ac dot uk.