Draft:Language deprivation syndrome

Language deprivation syndrome or LDS is a specific mental health outcome of the language deprivation of deaf children during the critical period of development and language acquisition (ages 0-5 years). Over many years, practitioners have clinically observed LDS as a phenomenon that has yet to be empirically investigated and defined within the DSM:.

Indications
Deaf children born to hearing parents are often not exposed to a natural sign language and have minimal access to spoken language. This can result in the lack of or limited foundational language also known as an L1 or native language and therefore affect the child’s cognitive, social and emotional development. Clinicians who treat adults with LDS can identify several common characteristics including


 * 1) Language dysfluency (disruption of natural communication) in sign language including:
 * 2) * Severely impoverished vocabulary; signs used with the incorrect meaning
 * 3) * Communication using single signs or phrases rather than full sentences
 * 4) * Sentence structure, where it exists, is simple.
 * 5) * Frequent omission of subjects and/or objects, or conveyance these haphazardly, so as to convey poorly who did what to whom or what happened
 * 6) * Spatial location and movement used haphazardly resulting in a visual message that is disorganized and unclear.
 * 7) Struggles with the concept of time
 * 8) Struggles with cause-and-effect
 * 9) Lack of awareness of a conversational partner’s need for context, and more generally lack of “theory of mind”
 * 10) Struggles with abstract concepts
 * 11) Difficulties of learning
 * 12) Struggles with emotional regulation, “acts feelings out” instead of looking introspectively
 * 13) Struggles in relationships
 * 14) Deficits in fund of information about the world (e.g., social norms, knowledge of history, government, current events, rights and responsibilities of being a citizen).

A proposed criteria for diagnosis
Historically, deafness has been viewed as a psychological condition in itself, resulting in many deaf individuals being sent to psychiatric institutions. Most likely, the psychological symptoms doctors of the time observed were due to their patients’ lack of a foundational language to communicate. Researchers like Dr. Neil Glickman, more accurately attributed these symptoms to language delays and therefore language dysfluency. Because of growing research in the field of deaf mental health, clinicians are realizing their patients’ “deficiencies in behavioral, emotional, and social adjustment’ warrant a specific criteria in order to identify and treat Language Deprivation Syndrome. The DSM-5 group of neurodevelopmental disorders contains diagnoses that may describe specific observed symptoms (e.g., intellectual disability, language disorder, social communication disorder, and specific learning disorder), but using multiple diagnoses to explain one condition is both inefficient and inappropriate. There is not enough empirical evidence to currently formulate formal diagnostic criteria, but there appears to be a need to begin empirically developing these criteria. The following is a proposed criteria from Dr. Neil Glickman.

An individual may exhibit symptoms of Language Deprivation Syndrome (LDS) if:


 * 1) They are born with hearing loss.
 * 2) Their hearing loss is severe enough to limit access to oral language.
 * 3) They are not exposed to a signed/visual language within the critical period of language acquisition (ages 0-5).
 * 4) As a result of LDS, the individual becomes dysfluent.
 * 5) From childhood, they show behaviors, such as aggression or lack of social skills, at home, school and other settings, resulting in problems.
 * 6) The person demonstrates a noted deficit in fund of information about the world (e.g., social norms, knowledge of history, government, current events, rights and responsibilities of being a citizen).
 * 7) As an adult, the person experiences great difficulties developing work skills, in particular in the interpersonal and attitudinal aspects of work, and learning to live independently.
 * 8) The person is at least 14 years of age.
 * 9) The person does not have mental retardation, schizophrenia, or another psychotic disorder. If adolescent, they do not have a conduct disorder; and if adult, they do not have antisocial personality disorder.

Further Research
While the clinical observations and preliminary criteria outlined above provide a foundational understanding of Language Deprivation Syndrome (LDS), there is a significant need for further empirical research to validate and expand upon these findings. Future research in this area should include multidisciplinary understanding and focus on several key aspects to develop a comprehensive understanding and effective intervention strategies for LDS. These could include research on LDS as it affects neurobiological and psychosocial development on an individual. Other studies could discover best practices in diagnostic criteria and mental health treatment strategies and interventions. Studies should also expand on prevention of LDS and creation of policy and advocacy in order to best support deaf children and their families.