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contains information that encompasses the full range of options (Sackett et al., 1996). Every child and every family is different, and no single method of communication is appropriate for every child and family (Early Support, 2006). Parents making choices should be encouraged to consider which communication options are best for their child and their family (Marschark & Spencer, 2003). Conclusion Three-year-old Australian children with hearing loss and their families use a diverse range of languages and many of these children use sign as part or all of their communication system. More parents than children were multilingual, and children were more likely to be multilingual at home rather than in their early intervention setting. Parents in these studies reported that the following factors were influential in their decision-making about how their children with hearing loss would communicate: advice from professionals, children’s access to speech through audition, children’s intervention experiences, children’s future opportunities, practicalities of communication, and creating a sense of belonging for their children. Acknowledgements This research would not have been possible without the assistance of the children, families, teachers, speech pathologists, audiologists, researchers, and organisations that participated in and supported the LOCHI study. Co-investigators in the research described in this paper were Professor Sharynne McLeod (Charles Sturt University), Dr Teresa Ching (National Acoustic Laboratories), Associate Professor David McKinnon (Charles Sturt University) and Dr Loraine Fordham (Charles Sturt University). While conducting this research Kathryn Crowe was supported by a scholarship from the Department of Industry, Innovation, Science Research and Tertiary Education, and an Excellence in Research in Early Years Education Collaborative Research network scholarship from Charles Sturt University. Sharynne McLeod was supported by the Australian Research Council Future Fellowship (FT0990588). The LOCHI study was conducted at the National Acoustic Laboratories and supported by the HEARing CRC, established and supported under the Cooperative Research Centres Program – an initiative of the Australian Government. The LOCHI study was partly funded by the National Institutes of Health (R01DC008080), awarded to Dr Teresa Ching. References Australian Bureau of Statistics. (2012a). 2011 Census QuickStats . Retrieved from http://www.censusdata.abs. gov.au/census_services/getproduct/census/2011/ quickstat/0 Crowe, K., Fordham, L. A., McLeod, S., & Ching, T. Y. C. (2013). “Part of our world”: Influences on caregiver decisions about communication choices for children with hearing loss. Deafness and Education International . doi: 10.1179/1557069X13Y.0000000026 Crowe, K., McKinnon, D. H., McLeod, S., & Ching, T. Y. C. (2013). Multilingual children with hearing loss: Factors contributing to language use at home and in early education. Child Language Teaching and Therapy , 29 (1), 103–121. doi: 10.1177/0265659012467640 Crowe, K., & McLeod, S. (2012). A systematic review of cross-linguistic and multilingual speech and language outcomes for children with hearing loss. International

of the deaf told us not to sign”. However, other parents commented on the balanced advice they had received; for example “the teacher of the deaf provided unbiased information, not saying we should or should not use sign” (Crowe, Fordham et al., 2013).

Influences on parents’ decisions about multilingualism and using spoken English

Parents who had made decisions about whether or not to raise their children with hearing loss in a monolingual or a multilingual environment gave insight into what had been important in their decision-making process. These parents emphasised the importance in their decision-making of early access to hearing aids and early intervention, children’s future academic and literacy success, children’s abilities to form friendships, participation in mainstream Australian culture, communication with other family members, and the availability of intervention and education in English (Crowe, Fordham et al. 2013; Crowe, McLeod, McKinnon, et al., 2012). Few professionals were reported to advise against using English and there was a balance of recommendations for and against multilingualism (Crowe, Fordham et al., 2013; Crowe, McLeod, McKinnon, et al., 2012). Clinical implications The findings of this research can help professionals and organisations to develop information and services that cater for the languages and communication modes used by Australian children with hearing loss and their families, allowing families greater access to and engagement with intervention and education services. Knowing about some of the different characteristics, experiences, and perspectives that parents bring to the task of making decisions about their children’s communication can assist professionals better understand this process as they support families and their children. Future research needs Although much has been learned from this research, there is still more to learn about the way children with hearing loss communicate. Clinicians and educators need to know how the speech and language of children with hearing loss develops when children are speakers of a wide range of languages. Research describing speech and language development for children with hearing loss is available for only a small number of the languages which were reported to be used by children and families in these studies (Crowe & McLeod, 2012). The impact of communication mode on spoken language outcomes also needs to be considered carefully. Many research studies have reported that children who use sign to communicate have poorer spoken language outcomes. However, the findings of this research suggest that children’s use of sign to communicate may, in some cases, be a response to difficulties in their early speech and language acquisition. This means that in some cases the use of sign to communicate may be the result of difficulty acquiring spoken language, rather than the cause of difficulty acquiring spoken language. Parents should be encouraged by educators and clinicians to make informed choices about communication for their children with hearing loss, not just to make a choice. Making an informed choice means making a decision based on information that is comprehensive, without bias, and evidence-based, and

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JCPSLP Volume 16, Number 1 2014

Journal of Clinical Practice in Speech-Language Pathology