Skip to main content

Language development in a bimodal bilingual child with cochlear implant: A longitudinal study*


To address the negative effects of deafness on spoken language acquisition, many clinicians suggest using cochlear implant (CI) and oral education and advise against sign language, even when combined with spoken language (i.e., bilingualism), believing that it may slow down spoken language development. In a deaf child with CI who was exposed at an early age to Italian Sign Language and spoken Italian, we evaluated language development and the relationship between the two languages. The number of words/signs produced by the child consistently increased with age, and the vocabulary growth rate in spoken Italian was equivalent to that of hearing peers. Before CI, the child relied almost exclusively on sign language; after CI, he gradually shifted to spoken Italian yet still used sign language when unable to retrieve words in spoken Italian. We conclude that bimodal bilingualism may scaffold the development of spoken language also in deaf children with CI.

Corresponding author
Address for correspondence: Pasquale Rinaldi, National Research Council, Institute of Cognitive Sciences and Technologies, Via Nomentana, 56, 00161 Rome, Italy
Hide All

This work was supported by the Nando Peretti Foundation (2012/34 to Maria Cristina Caselli) and by the Education, Audiovisual and Culture Executive Agency – EACEA (543264-LLP-1-2013-1-IT-KA2-KA2MP “SignMET” to Pasquale Rinaldi). We wish to thank Alessio Di Renzo for his help in collecting data, Concetta D'Amico and Susan Di Gianfelice for their help with transcribing data, and Piera Massoni for her helpful comments on an earlier version of the paper. We also wish to thank Mark Kanieff for his insightful comments and for the revision of English. Last, but not least, we are very grateful to the child who participated in this study and to his family, for the time and effort that they spent in allowing us to collect the data. The authors have no conflicts of interest. The authors are grateful for helpful comments and suggestions from three anonymous Bilingualism: Language and Cognition reviewers.

Hide All
Archbold, S. M., Sach, T. H., O'Neill, C., Lutman, M. E., & Gregory, S. (2006). Deciding to have a cochlear implant and subsequent after-care: Parental perspectives. Deafness and Education International, 8, 190206.
Baldassari, C. M., Schmidt, C., Schubert, C. M., Srinivasan, P., Dodson, K. M., & Sismanis, A. (2009). Receptive language outcomes in children after cochlear implantation. Otolaryngology – Head and Neck Surgery, 140, 114119.
Bedore, L. M., Peña, E. D., García, M., & Cortez, C. (2005). Conceptual versus monolingual scoring: When does it make a difference? Language, Speech, and Hearing Services in Schools, 36, 188200.
Bello, A., Giannantoni, P., Pettenati, P., Stefanini, S., & Caselli, M. C. (2012). Assessing lexicon: Validation and developmental data of the Picture Naming Game (PiNG), a new picture naming task for toddlers. International Journal of Language & Communication Disorders, 47, 589602.
Blamey, P., Barry, J., Bow, C., Sarant, J., Paatsch, L., & Wales, R. (2001). The development of speech production following cochlear implantation. Clinical Linguistics & Phonetics, 15, 363382.
Boudreault, P., & Mayberry, R. I. (2006). Grammatical processing in American Sign Language: Age of first-language acquisition effects in relation to syntactic structure. Language and Cognitive Processes, 21, 608635.
Caselli, M. C., Maragna, S., & Volterra, V. (2006). Linguaggio e sordità. Gesti, segni e parole nello sviluppo e nell'educazione [Language and deafness: Gestures, signs and words in development and education]. Bologna: Il Mulino.
Caselli, M. C., Pasqualetti, P., & Stefanini, S. (2007). Parole e frasi nel “Primo vocabolario del bambino”. Nuovi dati normativi tra 18 e 36 mesi e scheda breve del questionario [Words and sentences in “The first vocabulary of the child”: New normative data from 18 to 36 months and short form of the questionnaire]. Milano: Franco Angeli.
Caselli, M. C., & Rinaldi, P. (2005). Il Primo vocabolario del bambino sordo. Forma breve [The first vocabulary of the deaf child: Short form]. Roma: ISTC-CNR.
Caselli, M. C., Rinaldi, P., Stefanini, S., & Volterra, V. (2012a). Early action and gesture “vocabulary” and its relation with word comprehension and production. Child Development, 83, 526542.
Caselli, M. C., Rinaldi, P., Varuzza, C., Giuliani, A., & Burdo, S. (2012b). Cochlear implant in the second year of life: Lexical and grammatical outcomes. Journal of Speech, Language, and Hearing Research, 55, 382394.
Crowe, K., & McLeod, S. A systematic review of cross-linguistic and multilingual speech and language outcomes for children with hearing loss. International Journal of Bilingual Education and Bilingualism, doi:10.1080/13670050.2012.758686. Published online by Taylor & Francis, February 8, 2013.
Dale, P. S., Bates, E., Reznick, J. S., & Morisset, C. (1989). The validity of a parent report instrument of child language at twenty months. Journal of Child Language, 16, 239249.
Dale, P. S., Dionne, G., Eley, T. C., & Plomin, R. (2000). Lexical and grammatical development: A behavioural genetic perspective. Journal of Child Language, 27, 619642.
Davidson, K., Lillo-Martin, D., & Chen Pichler, D. Spoken English language development in native signing children with cochlear implants. Journal of Deaf Studies and Deaf Education, doi:10.1093/deafed/ent045. Published online by Oxford University Press, October 21, 2013.
Donati, C., & Branchini, C. (2013). Challenging linearization: Simultaneous mixing in the production of bimodal bilinguals. In Biberauer, T. & Roberts, I. (eds.), Challenges to linearization, pp. 93128. Berlin: Mouton de Gruyter.
Duchesne, L., Sutton, A., & Bergeron, F. (2009). Language achievement in children who received cochlear implants between 1 and 2 years of age: Group trends and individual patterns. Journal of Deaf Studies and Deaf Education, 14, 465485.
Emmorey, K., Borinstein, H., Thompson, R., & Gollan, T. H. (2008). Bimodal bilingualism. Bilingualism: Language and Cognition, 11, 4361.
Emmorey, K., Petrich, J. A. F., & Gollan, T. H. (2012). Bilingual processing of ASL–English code-blends: The consequence of accessing two lexical representations simultaneously. Journal of Memory and Language, 67, 199210.
Farrar, M. J., & Maag, L. (2002). Early language development and the emergence of a theory of mind. First Language, 22, 197213.
Feldman, H. M., Dollaghan, C. A., Campbell, T. F., Colborn, D. K., Janosky, J., Kurs-Lasky, M., Rockette, H. E., Dale, P. S., & Paradise, J. L. (2003). Parent reported language skills in relation to otitis media during the first 3 years of life. Journal of Speech, Language, and Hearing Research, 46, 273287.
Fenson, L., Marchman, V. A., Thal, D. J., Dale, P. S., Reznick, J. S., & Bates, E. (2007). MacArthur-Bates communicative development inventories: User's guide and technical manual (2nd edn.). Baltimore, MA: Brookes.
Geers, A. E., Moog, J. S., Biedenstein, J., Brenner, C., & Hayes, H. (2009). Spoken language scores of children using cochlear implants compared to hearing age-mates at school entry. Journal of Deaf Studies and Deaf Education, 14, 371385.
Geers, A., Spehar, B., & Sedey, A. (2002). Use of speech by children from total communication programs who wear cochlear implants. American Journal of Speech-Language Pathology, 11, 5058.
Hassanzadeh, S. (2012). Outcomes of cochlear implantation in deaf children of deaf parents: Comparative study. Journal of Laryngology & Otology, 126, 989994.
Haug, T. (2012). Methodological and theoretical issues in the adaptation of sign language tests: An example from the adaptation of a test to German Sign Language. Language Testing, 29, 181201.
Humphries, T., Kushalnagar, P., Mathur, G., Napoli, D. J., Padden, C., Rathmann, C., & Smith, S. R. (2012). Language acquisition for deaf children: Reducing the harms of zero tolerance to the use of alternative approaches. Harm Reduction Journal, doi:10.1186/1477-7517-9-16. Published online by BioMed Central Ltd., April 2, 2012.
Jiménez, M. S., Pino, M. J., & Herruzo, J. (2009). A comparative study of speech development between deaf children with cochlear implants who have been educated with spoken or spoken + sign language. International Journal of Pediatric Otorhinolaryngology, 73, 109114.
Kaplan, E., Goodglass, H., & Weintraub, S. (1983). The Boston Naming Test. Philadelphia, PA: Lea & Febiger.
Knoors, H., & Marschark, M. (2012). Language planning for the 21st Century: Revisiting bilingual language policy for deaf children. Journal of Deaf Studies and Deaf Education, 17, 291305.
Lillo-Martin, D., Quadros, R. M., Koulidobrova, H., & Chen Pichler, D. (2010). Bimodal bilingual cross-language influence in unexpected domains. In Costa, J., Castro, A., Lobo, M. & Pratas, F. (eds.), Language Acquisition and Development: Proceedings of GALA 2009, pp. 264275. Newcastle upon Tyne: Cambridge Scholars Press.
Marchman, V. A., Fernald, A., & Hurtado, N. (2010). How vocabulary size in two languages relates to efficiency in spoken word recognition by young Spanish–English bilinguals. Journal of Child Language, 37, 817840.
May, S. (2005). Language and minority rights. New York: Routledge.
Mayberry, R. I. (2007). When timing is everything: Age of first-language acquisition effects on second-language learning. Applied Psycholinguistics, 28, 537549.
Mayne, A. M., Yoshinaga-Itano, C., & Sedey, A. (2000). Receptive vocabulary development of infants and toddlers who are deaf or hard of hearing. Volta Review, 100, 2952.
Mayne, A. M., Yoshinaga-Itano, C., Sedey, A., & Carey, A. (2000). Expressive vocabulary development of infants and toddlers who are deaf or hard of hearing. Volta Review, 100, 128.
Michel, A., Tizmann, P. F., & Silbereisen, R. K. (2012). Language shift among adolescent ethnic German immigrants: Predictors of increasing use of German over time. International Journal of Intercultural Relations, 36, 248259.
National Institutes of Health – National Institute on Deafness and Other Communication Disorders (2011). January 27, 2014.
Niparko, J. K., Tobey, E. A., Thal, D. J., Eisenberg, L. S., Wang, N., Quittner, A. L., & Fink, N. E. for the CDaCI Investigative Team (2010). Spoken language development in children following cochlear implantation. Journal of the American Medical Association, 303, 14981506.
Onofrio, D., Rinaldi, P., & Pettenati, P. (2012). Il primo sviluppo del linguaggio in bambini che imparano più lingue: una proposta per la valutazione e l'interpretazione del profilo linguistico [Early linguistic development of children who are learning more than one language: A proposal for linguistic evaluation and for linguistic profile interpretation]. Psicologia Clinica dello Sviluppo, 16, 661669.
Patterson, J. L. (2004). Comparing bilingual and monolingual toddlers’ expressive vocabulary size: Revisiting Rescorla and Achenbach (2002). Journal of Speech, Language, and Hearing Research, 47, 12131215.
Pearson, B. Z., Fernandez, S. C., & Oller, D. K. (1993). Lexical development in bilingual infants and toddlers: Comparison to monolingual norms. Language Learning, 43, 93120.
Percy-Smith, L., Cayé-Thomasen, P., Breinegaard, N., & Jensen, J. H. (2010). Parental mode of communication is essential for speech and language outcomes in cochlear implanted children. Acta Otolaryngology, 130, 708715.
Pettenati, P., Vacchini, D., Stefanini, S., & Caselli, M. C. (2011). Parole e frasi nel primo vocabolario di bambini bilingui Italiano–Spagnolo [Words and sentences in early vocabulary of Italian–Spanish bilingual children]. Rivista di Psicolinguistica Applicata, 11, 4967.
Pizzuto, E., Ardito, B., Caselli, M. C., & Volterra, V. (2001). Cognition and language in Italian deaf preschoolers of deaf and hearing families. In Marshark, M., Clark, D. & Karchmer, M. (eds.), Cognition, context and deafness, pp. 4970. Washington, DC: Gallaudet University Press.
Rinaldi, P. (2008). Competenze lessicali di bambini sordi bilingui in età prescolare [Lexical competencies in bilingual deaf preschoolers]. Rivista di Psicolinguistica Applicata, 8, 93107.
Rinaldi, P., Baruffaldi, F., Burdo, S., & Caselli, M. C. (2013). Linguistic and pragmatic skills in toddlers with cochlear implant. International Journal of Language & Communication Disorders, 48, 715725.
Rinaldi, P., & Caselli, M. C. (2009). Lexical and grammatical abilities in deaf Italian preschoolers: The role of duration of formal language experience. Journal of Deaf Studies and Deaf Education, 14, 6375.
Rinaldi, P., Caselli, M. C., Onofrio, D., & Volterra, V. (2014). Language acquisition by bilingual deaf preschoolers: Theoretical, methodological issues and empirical data. In Tang, G., Knoors, H. & Marschark, M. (eds.), Bilingualism and bilingual deaf education, pp. 85116. New York: Oxford University Press.
Riva, D., Nichelli, F., & Devoti, M. (2000). Developmental aspects of verbal fluency and confrontation naming in children. Brain and Language, 71, 267284.
Roid, G. H., & Miller, L. J. (1997). Leiter International Performance Scale – Revised. Firenze: Giunti OS.
Spencer, L. J., & Bass-Ringdahl, S. (2004). An evolution of communication modalities: Very young cochlear implant users who transitioned from sign to speech during the first years of use. International Congress Series, 1273, 352355.
Spencer, P. E. (2004). Individual differences in language performance after cochlear implantation at one to three years of age: Child, family, and linguistic factors. Journal of Deaf Studies and Deaf Education, 9, 395412.
Spencer, P. E., & Marschark, M. (eds.) (2006). Advances in the spoken language development of deaf and hard-of-hearing children. New York: Oxford University Press.
Stallings, L. M., Gao, S., & Svirsky, M. A. (2002). Assessing the language abilities of pediatric cochlear implant users across a broad range of ages and performance abilities. Volta Review, 102, 215235.
Stella, G., Pizzoli, C., & Tressoldi, P. E. (2000). Peabody – R. Test di vocabolario recettivo [Peabody-R: Receptive vocabulary test]. Torino: Omega.
Szagun, G., & Stumper, B. (2012). Age or experience? The influence of age at implantation and social and linguistic environment on language development in children with cochlear implants. Journal of Speech, Language, and Hearing Research, 55, 16401654.
Thal, D., DesJardin, J. L., & Eisenberg, L. S. (2007). Validity of the MacArthur-Bates communicative development inventories for measuring language abilities in children with cochlear implants. American Journal of Speech-Language Pathology, 16, 5464.
Thal, D. J., O'Hanlon, L., Clemmons, M., & Fralin, L. (1999). Validity of a parent report measure of vocabulary and syntax for preschool children with language impairment. Journal of Speech, Language, and Hearing Research, 42, 482496.
Tobey, E. A., Rekart, D., Buckley, K., & Geers, A. E. (2004). Mode of communication and classroom placement impact on speech intelligibility. Archives of Otolaryngology – Head & Neck Surgery, 130, 639643.
Tomasuolo, E., Fellini, L., Di Renzo, A., & Volterra, V. (2010). Assessing lexical production in deaf signing children with the Boston Naming Test. Language, Interaction and Acquisition, 1, 110128.
Tomasuolo, E., Valeri, G., Di Renzo, A., Pasqualetti, P., & Volterra, V. (2013). Deaf children attending different school environments: Sign language abilities and theory of mind. Journal of Deaf Studies and Deaf Education, 18, 1229.
Watson, L. M., Archbold, S. M., & Nikolopoulos, T. P. (2006). Changing communication mode after implantation by age at implant. Cochlear Implants International, 7, 7791.
Watson, L. M., Hardie, T., Archbold, S. M., & Wheeler, A. (2008). Parents’ views on changing communication after cochlear implantation. Journal of Deaf Studies and Deaf Education, 13, 104116.
Wie, O. B., Falkenberg, E. S., Tvete, O., & Tomblin, B. (2007). Children with a cochlear implant: Characteristics and determinants of speech recognition, speech-recognition growth rate, and speech production. International Journal of Audiology, 46, 232243.
Yoshinaga-Itano, C. (2006). Early identification, communication modality, and the development of speech and spoken language skills: Patterns and considerations. In Spencer & Marschark (eds.), pp. 298327. New York: Oxford University Press.
Yoshinaga-Itano, C., Snyder, L. S., & Day, D. (1998). The relationship of language and symbolic play in children with hearing loss. Volta Review, 100, 135164.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Bilingualism: Language and Cognition
  • ISSN: 1366-7289
  • EISSN: 1469-1841
  • URL: /core/journals/bilingualism-language-and-cognition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 29
Total number of PDF views: 188 *
Loading metrics...

Abstract views

Total abstract views: 791 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st March 2018. This data will be updated every 24 hours.