title: Sign Language and Spoken Language for Children With Hearing Loss: A Systematic Review.
abstract: BACKGROUND
  Permanent hearing loss affects 1 to 3 per 1000 children and interferes with typical communication development. Early detection through newborn hearing screening and hearing technology provide most children with the option of spoken language acquisition. However, no consensus exists on optimal interventions for spoken language development.
  
  
  OBJECTIVE
  To conduct a systematic review of the effectiveness of early sign and oral language intervention compared with oral language intervention only for children with permanent hearing loss.
  
  
  METHODS
  An a priori protocol was developed. Electronic databases (eg, Medline, Embase, CINAHL) from 1995 to June 2013 and gray literature sources were searched. Studies in English and French were included.
  
  
  METHODS
  Two reviewers screened potentially relevant articles.
  
  
  METHODS
  Outcomes of interest were measures of auditory, vocabulary, language, and speech production skills. All data collection and risk of bias assessments were completed and then verified by a second person. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the strength of evidence.
  
  
  RESULTS
  Eleven cohort studies met inclusion criteria, of which 8 included only children with severe to profound hearing loss with cochlear implants. Language development was the most frequently reported outcome. Other reported outcomes included speech and speech perception.
  
  
  CONCLUSIONS
  Several measures and metrics were reported across studies, and descriptions of interventions were sometimes unclear.
  
  
  CONCLUSIONS
  Very limited, and hence insufficient, high-quality evidence exists to determine whether sign language in combination with oral language is more effective than oral language therapy alone. More research is needed to supplement the evidence base.
authors.affiliation: Faculty of Health Sciences and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; elizabeth.fitzpatrick@uottawa.ca.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Fitzpatrick
authors.affiliation: Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;
authors.forename: Candyce
authors.initials: C
authors.lastname: Hamel
authors.affiliation: Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Translational Research in Biomedicine Graduate Program, University of Split School of Medicine, Split, Croatia;
authors.forename: Adrienne
authors.initials: A
authors.lastname: Stevens
authors.affiliation: Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;
authors.forename: Misty
authors.initials: M
authors.lastname: Pratt
authors.affiliation: Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada;
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.affiliation: Consultant, Moncton, New Brunswick;
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Doucet
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Audiology Clinic, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Neuss
authors.affiliation: Voice for Hearing-Impaired Children, Toronto, Ontario, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Bernstein
authors.affiliation: Faculty of Health Sciences and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada;
authors.forename: Eunjung
authors.initials: E
authors.lastname: Na
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003638:Deafness / Q000534:rehabilitation*; D006320:Hearing Tests; D006801:Humans; D007802:Language; D007804:Language Development; D007808:Language Therapy / Q000379:methods*; D012813:Sign Language