Words Create Worlds: Guest Post from the Children’s Cochlear Implant Center at UNC

The Children’s Cochlear Implant Center at UNC is a world-renowned pediatric cochlear implant program, staffed by 4 full time audiologists and 6 full time Listening and Spoken Language certified speech and language pathologists. The Children’s Cochlear Implant Center provides individualized therapy for children with all levels of hearing loss, and learning opportunities for hearing care professionals through mentorships and continuing education programs. They serve children with hearing loss from birth to 21 years of age.

Hannah Eskridge, the Director of the Children’s Cochlear Implant Center and Lillian Henderson, the Clinic Manager wrote the following guest post for us about how children who are deaf and hard of hearing may learn spoken or written language, if those are modes of communication that their family chooses to pursue. 

Lillian Henderson


Hannah Eskridge


“Words create worlds.”   

-Abraham Joshua Heschel

For readers, there is nothing more satisfying and at the same time heart breaking as when you have finished reading a good book. How can a bunch of words, scrambled on a stack of papers transport a person into worlds they never imagined entering? And how did we learn what all those words meant to begin with? Without understanding the words, we would not be able to understand the first sentence of the book much less be delivered to worlds we never knew existed. 

Typically developing children learning spoken language usually learn and use words (vocabulary) at the rate shown in the chart below. During the first four years of a child’s life, vocabulary growth is rapid. As the child enters kindergarten, they will have a receptive vocabulary (words the child understands) of 2500 to 2800 words and a productive vocabulary (words the child speaks) of 1500 to 2000 words, which they use to construct sentences that are five to eight words long. Vocabulary development continues with the child learning another 2000 to 3000 new words each year. By the time the child is in fifth grade they have a vocabulary of 20,000 words. If the child continues to have exposure to new words through diverse reading materials and new and varied experiences, they will know 80,000 words by age 17. For typically developing children, natural language exposure through conversations and experience in the world provide enough scaffolding to expand a child’s vocabulary throughout childhood. That is to say, language is not typically taught, but rather acquired with little effort.

Age  Vocabulary  Syntax
12 months  1st word emerges  One word
18 months  50 words  Maybe 2-word combinations
2 years  300 words  Average 2-word phrases
3 years  900 words  Average 3- to 4-word sentences
4 years  1500 to 1600 words  Average 4- to 5-word sentences

For children who are deaf and hard of hearing who may be behind in vocabulary acquisition, an excellent way to give them access to the magic of reading is to deliberately teach vocabulary and world knowledge (cultural and historical knowledge that contributes to deeper understanding). As speech therapists, we use a teaching hierarchy to teach vocabulary and other language concepts. The hierarchy begins with input of a new word, moves to checking for understanding, then to imitation, and finally to the child spontaneously using the word. While this may seem like a lot of work for one word, once children begin to learn a few words, this process can happen rapidly. 

For input, an adult engages the child in a meaningful, developmentally appropriate interaction or activity while the adult abundantly uses the new vocabulary word. In order to check for understanding, an adult asks the child to find or act out the target word. This may look different depending on the part of speech of the word. For a noun, asking the child to select an object from a set of objects is a quick comprehension check. For verbs, the child can show their understanding by performing the action requested. For descriptions, the child is given several objects that are similar but have different characteristics for the child to show comprehension of the descriptive being asked.

Comprehension checks can be tricky for some words. For instance, if you give the child scissors and say, “cut” there is no other option but for the child to cut with the scissors. However, if you give the child options of scissors, crayons, glue and paint, you may have a better idea if the child comprehends “cut”. Asking for imitation should only happen after a child has shown comprehension of a word. In order for the child to get plenty of practice using the word, the adult asks the child to repeat the word after the adult. This can be done either immediately after the adult models the word, or after a several second delay. For instance, the adult might say, “Repeat after me: ladybug,” or the adult might model the word in a sentence containing more linguistic information than just the target word, like “This is a ladybug. It has a red body and black polka dots. What is it?” Once the child has had repeated practice imitating the word in a meaningful activity, spontaneous use of the word will likely occur. 

While the process of language learning may look different for children who are deaf and hard of hearing, with the help and cooperation of parents, teachers and therapists, deaf and hard of hearing children successfully learn to communicate just as hearing children do using spoken, written, and/or signed language. Vocabulary learning and teaching are best when both parent, therapist and child are having fun!



Dr Karen. (2020, February 22). Vocabulary Development in the School-Age Years. https://drkarenspeech.com/vocabulary-development-school-age-years/  

Hirsch, E. D. (2010). Teaching Content Is Teaching Reading. Principal, 10–14. doi: http://www.naesp.org/sites/default/files/Hirsch.pdf

Lund, E., & Douglas, W. M. (2016). Teaching Vocabulary to Preschool Children With Hearing Loss. Exceptional Children, 83(1), 26–41. doi: 10.1177/0014402916651848 

Merritt, D. D. (2012). Typical Speech and Language Development: A Checklist for School Nurses. https://ctserc.org/documents/resources/SpeechLanguageDev.pdf

Polloni, A. (n.d.). Semantics-the meaning behind it all. Retrieved from http://everydaylanguage.qwriting.qc.cuny.edu/2014/05/13/semantics-the-meaning-behind-it-all/

Willingham, D. (n.d.). Teaching Content Is Teaching Reading. Retrieved from https://www.youtube.com/watch?v=RiP-ijdxqEc