Hearing loss is the most common sensory impairment in the United States, affecting about 1 in 1,000 people at birth and 2-3 in 1,000 newborns. Prelingual deafness refers to deafness that occurs before acquiring a first language, including at birth through age 3. There is a distinction between lowercase "deaf" referring to the audiological condition of not hearing, and uppercase "Deaf" referring to a cultural group who share American Sign Language and a collective identity. While sign languages were once viewed as inferior to spoken languages, they are now recognized as full natural languages used by linguistic communities of deaf signers.