Hearing Counterparts Research Articles

The Charactertistics and neural mechanisms of trait and state empathy in deaf individuals

Empathy deficiencies are prevalent among deaf individuals. It has yet to be determined whether they exhibit deficiencies in both trait empathy and state empathy, along with the effect of top-down attention. Here, the current study employed the IRI-C scale and physiological pain empathy tasks (A-P task and A-N task) to explore the temporal dynamics of neural activities when deaf individuals were processing second-hand painful/non-painful stimuli. For trait empathy, we found that deaf individuals have deficiencies in both emotional and cognitive empathy compared to their hearing counterparts. For state empathy, we found that deaf individuals showed stronger automatic emotional empathy responses and paid more cognitive evaluation resources. Moreover, the differential processing of empathy between deaf individuals and hearing individuals towards others’ pain could be regulated by top-down attention, which occurs both in the early and late processing stages of pain empathy.

Differences in the type of vocabulary understood by deaf and hearing students: Results to guide interventions

IntroductionVocabulary knowledge is an essential element in language development. There is evidence of significant differences in vocabulary knowledge between deaf children and hearing peers of the same age. These differences put deaf students at a disadvantage when compared to their hearing counterparts. The aim of this study was to investigate whether certain types of words characterise the lexical difficulties of deaf students. Our starting point is that this knowledge is needed to design interventions that are adapted to the particular needs of these students for their lexical development. MethodsWe evaluated the lexical comprehension of 90 Spanish students. The sample comprised 45 hearing students and 45 students with severe or profound hearing loss. Both groups were attending the later years of primary school (8 to –12-year-olds). They were tested using the Spanish Peabody Picture Vocabulary Test-III. The performance of both groups was statistically compared using percentiles and standard scores as well as a selected set of words from the test. ResultsNo significant differences between hearing and deaf groups were found by age, sex, and sociocultural level. Significant differences were found between groups in their percentile and standard scores. There were no significant differences in performance between the two groups on only five of the 25 words with the highest error rate in the deaf group. The qualitative analysis of the remaining 20 words that were especially challenging for deaf students reveals results of interest which could help guide interventions. ConclusionsThe results indicate the need for lexical intervention for deaf students in the final years of primary school. The specialised support service for deaf learners should approach the intervention by targeting a specific type of vocabulary, making the semantic relationships between these words more transparent and promoting a deeper understanding of them.

The Impact of Hearing Loss on Diabetes Distress Among Adults With Type 2 Diabetes.

The purpose of this study was to assess the combined effects of type 2 diabetes (T2D) and hearing loss on the level of distress in individuals with diabetes. The 2021 National Health Interview Survey included 2633 adults (ages 18+) with T2D who reported perceived hearing loss, level of diabetes-related distress, household composition, and demographic characteristics. Logistic regressions evaluated these association between hearing loss and diabetes distress controlling for age, income, region of residence, marital status, rurality, educational attainment, insurance coverage, time since diabetes diagnosis, and household composition. Interaction effects examined differential associations between demographic groups. About 3.5% of adults with T2D in the sample reported hearing loss, and 70% reported diabetes-related distress. Results indicated that diabetes distress was significantly more likely among individuals with hearing loss (OR = 2.08) relative to their hearing counterparts. Additionally, females (OR = 1.50), low-income earners (OR = 1.84), middle-income earners (OR = 1.41), non-Hispanic Blacks (OR = 1.58), and Hispanics (OR = 1.75) with diabetes had higher odds of reporting diabetes distress. Interaction analyses indicated that non-Hispanic Blacks and Hispanics with hearing loss had a 37% and 19%, respectively, higher likelihood of diabetes distress relative to non-Hispanic Whites with hearing loss. Diabetes distress was more likely among individuals with hearing loss. These findings suggest the communication challenges of individuals with hearing loss may explain the observed differences in distress.

Investigating the impact of early deafness on learned action-effect contingency for action linked to peripheral sensory effects

Investigating peripheral visual processing in individuals with early auditory deprivation is a critical research area in the field of neuroscience, since it helps understanding the phenomenon of sensory adaptation and brain plasticity after sensory loss. Prior research has already demonstrated that the absence of auditory input, which is crucial to detect events occurring out of the central egocentric visual space, leads to an improved processing of visual and tactile stimuli occurring in peripheral regions of the sensory space. Nevertheless, no prior studies have explored whether such enhanced processing also takes place within the domain of action, particularly when individuals are required to perform actions that produce peripheral sensory outcomes. To test this hypothesis, we recruited 15 hearing (31 ± 3.3 years) and 15 early deaf adults (42 ± 2.6 years) for a neuro-behavioral experiment involving: 1) a behavioral task where participants executed a simple motor action (i.e., a button press) and received a visual feedback either in the center or in a peripheral region of the visual field, and 2) the electrophysiological recording of brain electrical potentials (EEG). We measured and compared neural activity preceding the motor action (the readiness potentials) and visual evoked responses (the N1 and P2 ERP components) and found that deaf individuals did not exhibit more pronounced modulation of neural responses when their motor actions resulted in peripheral visual stimuli compared to their hearing counterparts. Instead they showed a reduced modulation when visual stimuli were presented in the center. Our results suggest a redistribution of attentional resources from center to periphery in deaf individuals during sensorimotor coupling.

Vocal and early speech development in Korean-acquiring children with hearing loss and typical hearing

ABSTRACT This study investigated the vocal and early speech development of Korean-acquiring children with hearing loss (HL) who underwent early auditory amplification compared to their typical hearing (TH) counterparts. The research focused on phonological characteristics of child vocalisation based on samples collected from naturalistic home environments. One-day home recordings using a Language ENvironment Analysis (LENA) recorder were obtained from 6 children with HL and 12 children with TH who ranged from 17 to 23 months of age in Korean monolingual environments. Child volubility, canonical babbling ratio (CBR), consonant distributions, and utterance structures of vocalisations were evaluated through qualitative and quantitative analyses of vocalisation samples collected from LENA recordings. The findings revealed that children with HL displayed comparable vocalisation levels to children with TH, with no significant differences in volubility and CBR. In consonant and utterance shape inventories, noticeable quantitative and qualitative differences were observed between children with HL and those with TH. The study also suggested both universal and language-specific production patterns, revealing the early effects of ambient language on consonant distributions and utterance structures within their vocalisation repertoire. This study emphasised the role of auditory input and the importance of early auditory amplification to support speech development in children with HL.

Investigating the crowding effect on letters and symbols in deaf adults

Reading requires the transformation of a complex array of visual features into sounds and meaning. For deaf signers who experience changes in visual attention and have little or no access to the sounds of the language they read, understanding the visual constraints underlying reading is crucial. This study aims to explore a fundamental aspect of visual perception intertwined with reading: the crowding effect. This effect manifests as the struggle to distinguish a target letter when surrounded by flanker letters. Through a two-alternative forced choice task, we assessed the recognition of letters and symbols presented in isolation or flanked by two or four characters, positioned either to the left or right of fixation. Our findings reveal that while deaf individuals exhibit higher accuracy in processing letters compared to symbols, their performance falls short of that of their hearing counterparts. Interestingly, despite their proficiency with letters, deaf individuals didn’t demonstrate quicker letter identification, particularly in the most challenging scenario where letters were flanked by four characters. These outcomes imply the development of a specialized letter processing system among deaf individuals, albeit one that may subtly diverge from that of their hearing counterparts.

Neural adaptations to congenital deafness: enhanced tactile discrimination through cross-modal neural plasticity - an fMRI study.

This study explores the compensatory neural mechanisms associated with congenital deafness through anexamination of tactile discrimination abilities using high-resolution functional magnetic resonance imaging (fMRI). To analyze the neural substrates underlying tactile processing in congenitally deaf individuals and compare themwith hearing controls. Our participant pool included thirty-five congenitally deaf individuals and thirty-five hearing controls. All participantsengaged in tactile discrimination tasks involving the identification of common objects by touch. We utilized ananalytical suite comprising voxel-based statistics, functional connectivity multivariate/voxel pattern analysis (fc-MVPA), and seed-based connectivity analysis to examine neural activity. Our findings revealed pronounced neural activity in congenitally deaf participants within regions typically associatedwith auditory processing, including the bilateral superior temporal gyrus, right middle temporal gyrus, and rightrolandic operculum. Additionally, unique activation and connectivity patterns were observed in the right insula andbilateral supramarginal gyrus, indicating a strategic reorganization of neural pathways for tactile informationprocessing. Behaviorally, both groups demonstrated high accuracy in the tactile tasks, exceeding 90%. However, thedeaf participants outperformed their hearing counterparts in reaction times, showcasing significantly enhancedefficiency in tactile information processing. These insights into the brain's adaptability to sensory loss through compensatory neural reorganization highlight theintricate mechanisms by which tactile discrimination is enhanced in the absence of auditory input. Understandingthese adaptations can help develop strategies to harness the brain's plasticity to improve sensory processing inindividuals with sensory impairments, ultimately enhancing their quality of life through improved tactile perceptionand sensory integration.

Mapping the unique neural engagement in deaf individuals during picture, word, and sign language processing: fMRI study.

Employing functional magnetic resonance imaging (fMRI) techniques, we conducted a comprehensive analysis of neural responses during sign language, picture, and word processing tasks in a cohort of 35 deaf participants and contrasted these responses with those of 35 hearing counterparts. Our voxel-based analysis unveiled distinct patterns of brain activation during language processing tasks. Deaf individuals exhibited robust bilateral activation in the superior temporal regions during sign language processing, signifying the profound neural adaptations associated with sign comprehension. Similarly, during picture processing, the deaf cohort displayed activation in the right angular, right calcarine, right middle temporal, and left angular gyrus regions, elucidating the neural dynamics engaged in visual processing tasks. Intriguingly, during word processing, the deaf group engaged the right insula and right fusiform gyrus, suggesting compensatory mechanisms at play during linguistic tasks. Notably, the control group failed to manifest additional or distinctive regions in any of the tasks when compared to the deaf cohort, underscoring the unique neural signatures within the deaf population. Multivariate Pattern Analysis (MVPA) of functional connectivity provided a more nuanced perspective on connectivity patterns across tasks. Deaf participants exhibited significant activation in a myriad of brain regions, including bilateral planum temporale (PT), postcentral gyrus, insula, and inferior frontal regions, among others. These findings underscore the intricate neural adaptations in response to auditory deprivation. Seed-based connectivity analysis, utilizing the PT as a seed region, revealed unique connectivity pattern across tasks. These connectivity dynamics provide valuable insights into the neural interplay associated with cross-modal plasticity.

Care Partner Experiences in Supporting Deaf and Hard of Hearing Adults With Diabetes.

Care partners play an important role in diabetes management of people with diabetes. Although deaf and hard of hearing (DHH) adults experience diabetes at a higher rate than their hearing counterparts, there is a lack of information regarding the experience of care partners assisting those in the DHH community. There is a need to identify intentional support for this population. The purpose of this study was to explore how care partners of DHH people with diabetes provide helpful and unhelpful support, the care partner experience of providing support, and care partners' perceived diabetes self-management education, support needs, and recommendations. We engaged a community advisory board of care partners to DHH people with diabetes to explore how care partners provide support, their individual experiences in providing support, and their suggestions for diabetes self-management education. We used thematic analysis to analyze individual and collective responses. Three emergent themes were identified suggesting that care partners give support in a variety of ways, are often overwhelmed in meeting the demanding and ongoing needs of DHH people with diabetes, and have a multitude of suggestions for implementing a future diabetes care partner education program. We also identified some DHH population-specific challenges to diabetes care, including communication barriers with health care providers, inability to use hearing cues if a person with diabetes experiences a fall, and limited access to diabetes care education in sign language. These findings highlight a need to provide more support for care partners of DHH people with diabetes and to address the needs of DHH populations to ensure more equitable diabetes care. Further research is needed to adequately inform successful interventions for DHH people with diabetes and their care partners.

Tympanal ears mediate male-male competition, courtship and mating success in Bicyclus anynana butterflies.

The presence of intra-specific acoustic communication in diurnal butterflies is not well established. Here, we examined the function of the tympanal ear (Vogel's organ, VO) in the seasonally polyphenic butterfly Bicyclus anynana in the context of sexual signalling. We investigated how the VO and the flanking enlarged veins, which are suggested sound resonance chambers, scale with wing size across sexes and seasonal forms, and how disruptions to the VO alter courtship behaviour and mating outcomes. We found that males have VOs similar in size to females despite having smaller wings, and dry season (DS) male cubital and anal veins do not scale with the wing size. This suggests that the VO plays an important role in males and that cubital and anal veins in DS males may be tuned to amplify specific sound frequencies. Behavioural assays performed with deafened and hearing males of different seasonal forms, in pair and triad settings, showed that deafened DS males, but not wet season males, experienced lower mating success relative to their hearing counterparts. Our study documents a novel function for the wing tympanal membrane in mediating courtship and mating outcomes in diurnal butterflies.

Decoding auditory deprivation: resting-state fMRI insights into deafness and brain plasticity.

Deafness, as a profound manifestation of sensory deprivation, prompts a cascade of intricate cerebral adaptations. In this study, involving 35 deaf individuals and 35 hearing controls, we utilized resting-state functional magnetic resonance imaging (rs-fMRI) to delve into the depths of functional connectivity nuances distinguishing deaf individuals from their hearing counterparts. Leading our analytical approach was the application of multi-voxel pattern analysis (fc-MVPA). This advanced method provided a refined perspective, revealing amplified neural connectivity within the deaf population. Notably, regions such as the left postcentral somatosensory association cortex, the anterior and posterior corridors of the left superior temporal gyrus (STG), and the left mid-temporal lobe were identified as hotspots of heightened connectivity. Further, fc-MVPA shed light on intricate interaction effects, which became more pronounced when examining variables such as the duration of auditory deprivation and the extent of sign language exposure. These interactions were particularly evident in the premotor and left frontal mid-orbital regions. Complementing this, seed-based connectivity assessments illuminated pronounced coupling dynamics within the left STG spectrum. Concurrently, local correlation (LCOR) value analysis in the deaf group revealed significant shifts in the right superior STG and bilateral precuneus. In addition, amplitude of low-frequency fluctuation (ALFF) evaluations indicated modulations in the bilateral mid cingulum and left superior mid frontal gyrus. This comprehensive, fc-MVPA-driven exploration uncovers the multifaceted functional adaptations resulting from deafness, highlighting the profound plasticity of the human brain and its potential implications for targeted rehabilitative strategies.

Behavioural evidence for enhanced olfactory and trigeminal perception in congenital hearing loss.

Sensory deprivation, especially hearing loss (HL), offers a valuable model for studying neuroplasticity in the human brain and adaptive behaviours that support the daily lives of those with limited or absent sensory input. The study of olfactory function is particularly important as it is an understudied aspect of sensory deprivation. This study aimed to compare the effects of congenital HL on olfactory capacity by using psychophysical tasks. Methodological concerns from previous studies regarding the onset of HL and cognitive assessments were addressed. We recruited 11 individuals with severe-to-profound sensorineural HL (SNHL) since birth and 11 age- and sex-matched typical hearing non-signers. We used standardized neuropsychological tests to assess typical cognition among participants with SNHL. We evaluated olfactory functions by assessing olfactory detection threshold, odour discrimination and odour identification. Hearing-impaired participants outperformed their typical hearing counterparts in olfactory tasks. We further evaluated the accuracy and response time in identifying and localizing odours to disentangle olfactory sensitivity from trigeminal system sensitivity. Participants with SNHL demonstrated higher sensitivity to both the identification and localization tasks. These findings suggest that congenital SNHL is associated with enhanced higher-level olfactory processing and increased trigeminal sensitivity.

Cancer Worry and Fatalism at the Intersection of Race and Hearing Status.

The deaf and hard of hearing (DHH) community experiences lower cancer screening rates than the general population. Cancer worry and fatalism can influence cancer screening, along with race, and the interaction of intrinsic factors with DHH health behavior needs to be investigated. The study examines the association of the intersection of race and hearing status with cancer worry and fatalism. This study analyzed cross-sectional survey data from NCI HINTS-ASL (for DHH adults) and NCI HINTS (for hearing adults). Multivariable logistic regression models were used to assess (i) the association of race-hearing status intersection with cancer worry and fatalism, as well as (ii) the relationship between hearing status and outcomes within each race. The study found that the overall interaction between race and hearing status was significantly associated with both high cancer worry and fatalism, with African American (AA)/Black and Asian/Other having higher odds of worry [1.17 (0.83, 1.64); 1.19 (0.85, 1.66), respectively] and other groups having lower worry than White hearing (P < 0.0001), and all deaf having less concern about cancer fatalism (P < 0.0001). Within each racial group, White DHH respondents had lower odds of cancer worry [aOR (95% CI): 0.72 (0.58, 0.91); P < 0.01] and fatalism [0.55 (0.46, 0.67); P < 0.0001] compared to White hearing respondents, while DHH AA/Black [1.89 (1.06, 3.37); P = 0.03], Asian/Other [2.39 (1.06, 3.37); P = 0.03], and Hispanic [1.95 (1.18, 3.22); P < 0.01] respondents had significantly higher odds of cancer worry and lower odds of cancer fatalism [Black: 0.50 (0.23, 1.09); P = 0.07; Asian/Other: [0.68 (0.42, 1.09); P = 0.10]; Hispanic: [0.69 (0.40, 1.17)]; P = 0.16] compared to their hearing counterparts. DHH individuals have different odds of experiencing cancer worry and fatalism compared to their hearing counterparts. Inclusion of individuals with sensory disabilities in a larger cancer study sample enriches the diversity of perspectives, ensuring that the findings reflect a broader range of experiences and needs. More research into contributory factors in the signing DHH population is needed.

Did our cochlear implant program make any difference in the lives of our patients? Achievements of 30 patients with long term follow-up averaging 20 years after cochlear implantation

Background Cochlear implants are standard of care for the patients with sensorineural hearing loss not benefited from hearing aids Aims Evaluate qualitatively the impact of cochlear implantation in the long-term. Materials-methods Thirty middle-class patients with similar patterns of loss and social environment averaging 20 years post-implantation responded to 52 questions that evaluated psychosocial benefits from cochlear implantation. Results All completed secondary education and 93% had postgraduate studies. Educational and workwise they are at the same level as their hearing counterparts. All use their cochlear implants and would recommend one to people who need it. They attribute their success to the implant, the rehabilitation program, their family, and a stimulating social environment. Despite their success, most experience difficulties relating with others (socially and at work) due to their hearing condition. They manage but work much harder than their hearing peers to achieve the same. Conclusions We made a difference in the lives of these patients, however, there is more to be done. Significance Early intervention, rehabilitation, plus family, and stimulating-environment are crucial in children with sensory deficits.

Differential language performance of Mandarin-speaking children with and without hearing loss

ABSTRACT The current study investigated the differential item functioning (DIF) on language assessment between Mandarin-speaking children with and without hearing loss (HL). Particularly, it explored the differences between the children in specific linguistic aspects. A total of 253 Mandarin-speaking children, aged three to six years old, participated, including 140 children without HL and 113 with HL. All children took the Revised Preschooler Language Assessment (RPLA) to assess their language ability. The RPLA items were categorized into different linguistic aspects, including semantics, syntax and pragmatics. The DIF analysis was conducted and the results revealed several statistically significant DIF items favouring children with and without HL, showing both the advantages and difficulties faced by children with HL. Items that favoured children with HL included directional words (semantics), comparative sentences (syntax), analogies (semantics), producing complete sentences (pragmatics/syntax), and retelling stories (pragmatics). Items that favoured children without HL included wh-questions (semantics), sentences containing connectives (syntax), logical words (semantics), comprehension of long paragraphs (semantics), and identifying semantic features (semantics). The results shed light on the advantages, which may benefit children with HL due to early intervention. In addition, suggestions on the difficulties were also provided, which these children may encounter compared to their hearing counterparts.

Mask your word, mask my world: mask wearing behavior in Chinese deaf people during the COVID-19 pandemic

Community mask wearing can effectively reduce the spread of the novel coronavirus disease (COVID-19). However, it may also hinder face-to-face interpersonal communication, particularly for deaf individuals who depend on non-manual articulations to convey and comprehend various types of meanings. The current research, for the first time in the literature, quantitatively assessed the hypothesis that deaf individuals are less likely to comply with mask policies during the pandemic than their hearing counterparts because face coverings negatively impact their everyday communication. Across two studies, Chinese people exhibited lower adherence to mask wearing in their self-report and actual behavior than typical-hearing individuals. It may be that taking off face masks can facilitate communication among people with hearing loss. These findings have important implications for both everyday communication and public health preventive measures for hearing-impaired populations.

Utilization of acoustic cues to identify emotional prosody: Results in adults with normal hearing or cochlear implants

Emotional prosody is a dominant source of information about a talker’s intended emotion. Multiple acoustic cues contrast different emotions. Voice pitch is a dominant acoustic cue for prosody, but individuals with cochlear implants do not have adequate access to this cue. Previous work has suggested that older individuals with normal hearing also have limited access to dynamic voice pitch contour cues. We are developing a cue-weighting method to estimate perceptual weighting of different prosodic cues in emotion identification by listeners with cochlear implants or normal hearing. Initial analyses indicate that in adult normally hearing listeners, increasing age reduces their weighting of voice pitch cues to emotion, but not their weighting of the secondary cue of duration. The perceptual weight for voice pitch is reduced when normally hearing listeners are attending to spectrally degraded (noise band vocoded) stimuli. Consistent with the latter observation, cochlear implant patients showed reduced weighting of voice pitch cues compared to normally hearing counterparts when both are attending to original (clean) stimuli. Taken together, these results suggest that increasing age and spectral degradation both reduce listeners’ ability to utilize voice pitch cues to emotional contrasts.

Sex-Specific Interactions Between Hearing and Memory in Older Adults With Mild Cognitive Impairment: Findings From the COMPASS-ND Study.

Hearing loss (HL) in older adults is associated with a decline in performance on cognitive tasks and the risk of developing dementia. However, very few studies have investigated sex-related effects on these associations. A previous study of cognitively healthy older adults showed an association between HL and lower cognitive performance in females only. In the present study, we examined the effects of sex and hearing on cognition in individuals with mild cognitive impairment (MCI). We predicted that females with HL would be more likely to show poorer performance on the cognitive measures compared to females with normal hearing (NH), while cognitive performance in males would not depend on hearing. We further predicted that these auditory-cognitive associations would not depend on test modality, and would thus be observed in females for both auditory and visual tests. Participants were 101 older adults with amnestic MCI (M = 71 years, 45% females) in the Canadian Consortium on Neurodegeneration in Aging (CCNA) COMPASS-ND study. Performance on the Montreal Cognitive Assessment (MoCA), Rey Auditory Verbal Learning (RAVLT), and Brief Visuospatial Memory Test-Revised (BVMT-R) was analyzed to investigate sex-related differences and/or hearing-related differences. Participants were categorized as having NH or HL using two different measures: pure-tone hearing screening results (normal based on a pure-tone threshold < 25 dB HL at 2000 Hz in the worse ear) and speech-in-noise speech reception thresholds (SRTs; normal < -10 dB SNR on the Canadian Digit Triplet Test [CDTT]). Males and female groups did not differ in age, years of education, or other relevant covariates. Yet, females with better hearing on either pure-tone or speech-in-noise measures outperformed their worse hearing counterparts on the MoCA total score. Additionally, females with better hearing were more likely to recall several words on the MoCA delayed recall trial relative to those with worse hearing. Females with NH showed significant correlations between CDTT SRTs and both MoCA and RAVLT scores, while no correlations were observed in males. In contrast, males but not females showed an effect of hearing group on BVMT-R test status. There were sex-specific differences in auditory-cognitive associations in individuals with MCI. These associations were mostly observed in females and on auditory tests. Potential mechanisms and implications are discussed.

Researching relations between hearing Sign Language interpreters and their deaf clients: Methodological considerations on empirical data collection with prelingually Deaf participants

The present paper discusses necessary adaptations in research methodology to include Deaf Sign Language users in a survey on Sign Language interpreting. Prelingually Deaf Sign Language users have, on average, lower literacy levels than their hearing counterparts. Many of them disfavour reading and writing texts and prefer to be addressed with, and communicate in Sign Language. The present paper reports on a survey among hearing Sign Language interpreters and Deaf Sign Language users that included qualitative expert interviews and a questionnaire with multiple choice as well as free text answers. In total, the questionnaire was processed by 771 participants, 325 of whom are hearing Sign Language interpreters and 446 Deaf Sign Language users. The paper reports on how the data was collected among the Deaf participants including the use of Sign Language and Sign Language oriented Easy Language Plus in order to meet their communicative preferences. The paper is a contribution to the current efforts in Accessible Communication research to adapt methodology according to the participant’s communicative needs.

Assessments of Sign Language Development

Since the late nineties, several assessments to track and assess sign language acquisition in deaf and hard of hearing (DHH) children have been developed and standardised for some sign languages (Herman, Rowley, Mason, &amp; Morgan, 2014; Rosenburg, Lieberman, Caselli, &amp; Hoffmeister, 2020). These assessments have provided important insights into how DHH children acquire sign language and how acquisition can be impacted by developmental or acquired disorders (Mason et al., 2010; Quinto-Pozos, Forber-Pratt, &amp; Singleton, 2011). Moreover, the development of sign language assessments has enabled research studies to show associations between language, cognitive skills and literacy (Botting et al., 2017). The availability of sign language assessments has confirmed that DHH children from DHH, signing families achieve similar milestones in sign language as their hearing counterparts in spoken language. Yet the measures developed to date are insufficient for tracking bimodal bilingual development in DHH children, particularly as children progress through the later school years. This article reviews hitherto mentioned and new issues in test development and standardization related to the status of sign language research, the size and nature of the population of DHH signers, and tester issues with a specific focus on assessments used by practitioners rather than those designed for research purposes. References are made to the reasons why DHH children are at risk for language delay. A selection of different types of sign language test is presented. In the UK and elsewhere, many of the tests developed to date have focused on the earlier stages of language development. We therefore include a description of a UK project that is adapting an assessment for adolescent signers.