If immediate communication is important or the communication demands are limited, communication may be accomplished by writing. Though this may be necessary in emergencies and acceptable for brief contacts, it is rarely as effective and efficient as spoken communication or communication through a qualified sign language interpreter. In addition, many individuals who were born deaf or who became deaf at an early age may have difficulty with English and be unable to communicate effectively in writing. Their primary language is a sign language. This is not to say that individuals who are deaf simply use a different language. Deafness is a complex disability and communicating with individuals who are deaf often requires special skill and training.