Communication opportunities for children who are

deaf or hard of hearing

DR. CARRIE OVERSCHMIDT, AU.D. , CCC -A

STATEWIDE AUDIOLOGY PROGRAM SPECIALIST

CHILDREN’S REHABILITATION SERVICE

DisclosuresRelevant Financial Relationships:

Salaried employee of Children’s Rehabilitation Service

Relevant Non-financial Relationships:

Alabama Academy of Audiology - President

Alabama Newborn Screening Committee - Advisory committee member; Audiology Task Force organizer

Alabama Newborn Hearing Screening Committee - Advisory committee member

Directors of Speech and Hearing Programs in State Health and Welfare Agencies (DSHPSHWA) -

American Speech-Language and Hearing Association (ASHA) Audiology Quality Consortium representative

Council of Organizations Serving Deaf Alabamians - member

ObjectivesBecome familiar with terms related to hearing loss and the effects that various degrees of hearing loss have on speech recognition ability.

Learn the four main communication outcomes for children who are deaf or hard of hearing and what it takes to be successful

Understand the main points to consider when counseling parents regarding communication outcomes

“Being deaf is not about hearing; being deaf is about communication”

-The Silent Garden (Ogden and Smith, 2016)

Language, Speech, and CommunicationExpressive Language:

◦ Signing, talking, writing

◦ Use words to describe objects, actions, etc.

◦ Use words to build a sentence

◦ Sentences turn into a conversation or concept

◦ Use of grammar so that it makes sense

Receptive Language:

◦ The ability to process and make sense of what is signed, heard, or read

◦ Understanding grammar structure

Language, Speech, and CommunicationSpeech:

◦ The ability to express ideas, feelings, concepts through articulating sounds

Communication:◦ the act of exchanging ideas, information or messages between two or more

people

◦ Words, signs, or symbols must be understood to both the parties

Communication OutcomesFor children with hearing loss, there are four primary communication outcomes, each tied to an approach to language:oAmerican Sign Language

oListening and Spoken Language

oTotal Communication

oCued Speech

American Sign LanguageVisual approach

ASL is a natural, visual/manual language

ASL is distinct with its own grammar and syntax

English is acquired by using teaching strategies for English as a Second Language

ASLGoals

◦ Age appropriate internal language

◦ Develop positive self image

◦ Provide access to Deaf community

◦ Foundation for learning writing and possibly spoken language

Receptive Language

◦ Developed using a visual approach

Expressive Language

◦ ASL and written English

◦ Code switch from ASL to English

ASL◦ Hearing

◦ Encourages individual choice about amplification

◦ Family Responsibilities

◦ Parents must be motivated to learn and use ASL consistently

◦ Literacy must be a priority

◦ Resources for families to interact in the Deaf community

◦ ASL is learned with connection to members of the Deaf community, classes (AIDB),and online resources

ASLAdvantages:

oEasiest to learn for child who is deaf

oEarly access to language

Disadvantages:

oNew language must be learned by family

oChild may not be able to communicate with larger society

Listening and Spoken Language (LSL)The desired outcome is spoken language

Two approaches

◦ Auditory Verbal - Auditory approach

◦ Auditory Oral - Combined approach

Goals:

◦ To develop the skills needed for mainstreaming successfully

◦ To be a part of the hearing community

LSLReceptive Language

◦ AV: Emphasis on listening to understand concepts

◦ AO: Develop language using speech reading and audition

Expressive Language

◦ Spoken and written English

Hearing

◦ Early and consistent use of hearing technology

◦ Ongoing audiologic follow up

LSLFamily Responsibilities

oParents are partners in therapy sessions

oParents learn how to promote auditory learning

oCarry over to daily activities

oCreate best possible listening environment

oProvide language-rich environment

oLearning through listening part of all experiences

LSLAdvantages:oFamily does not have to learn new language or mode of communication

oChild will be able to communicate with a larger society

Disadvantage:oChild must learn speech skills which may be difficult

Cued SpeechCombined approach

System of hand cues with natural mouth movements of speech

Specifies each sound of spoken language

Hand shape at a location cues a syllable

Cued SpeechGoals

◦ Provide clear communication in spoken language

◦ Develop phonemic language for conversation, reading, writing

◦ Support speechreading, speech and auditory skills

Receptive Language

◦ Early, consistent clear communication using cued speech, speechreading and hearing

◦ Cueing boosts auditory awareness, discrimination and understanding

Expressive Language

◦ Cued, spoken, and written English

◦ Over 60 cued languages

Cued SpeechHearing

◦ Early and consistent use of hearing technology

◦ Ongoing audiologic follow up

Family responsibilities

◦ Learn to speak and cue at all times

◦ Consistent use of cues and speech at all times

◦ System is taught in <20 hours

Cued SpeechAdvantages:o Easily combined with other modes

o Adapted to any spoken language

o Easier to learn than ASL

Disadvantages:

Disadvantages:o Lack of public awareness

o “Neglected stepchild” of deaf education

o Number of trained professionals is small

Total Communication (TC)Combined Approach

Educational philosophy, not a methodology

English-based

“Whatever works”

May include:◦ Speech

◦ ASL

◦ Auditory training

◦ Visual aids

◦ Simultaneous Communication (Sim-Com)

TCGoal:

To bridge the gap between strictly oral or manual approaches

Receptive Language:◦ Speech reading

◦ Listening

◦ Speech and sign-based systems in English order

Expressive Language: oSpoken English using sign language in English word order

oWritten English

TCHearing◦ Consistent and appropriate use of hearing technology (hearing aids, cochlear implant(s), FM

system) is strongly encouraged.

Family Responsibilities

◦ Families are expected to learn and consistently use the chosen English-based sign language system.

◦ Parents need to work with the child’s teacher(s) and/or therapist(s) to learn strategies that promote language expansion.

TCAdvantages:

Flexible

Disadvantages:

Focus on “lowest common denominator”

Does not encourage children to realize potential

Speech Banana

Relationship of Hearing Loss to Listening and Learning Needs (Anderson & Matkin, 2007)Possible Impact on the Understanding of Language and Speech

Possible Social Impact

Potential Educational Accommodations and Services

“Minimal” or Mild Hearing LossChild may have difficulty hearing faint or distant speech

Mispronunciation of sounds

At risk for academic delays

Usually very successful with amplification

Moderate Hearing LossEven with hearing aids, child can "hear" but may miss much of what is said

Listening “bubble” of 3-5 feet

Can miss 50-80% of speech depending on dB loss

Child is likely to have:

◦ Delayed or disordered grammar

◦ Limited vocabulary

◦ Articulation (pronunciation) errors

◦ Flat voice quality

If the child is very language delayed and/or has additional disabilities, visual communication may be needed to supplement speech

Moderately-Severe Hearing LossDifficulty even in quiet, one-on-one environment

Without amplification, conversation must be very loud to be understood

Child is likely to have:

◦ Delayed language

◦ Poor grammar

◦ Reduced speech intelligibility

◦ Flat voice quality is likely

If the child is very language delayed and/or has additional disabilities, visual communication may be needed to supplement speech

Use of a personal FM system will reduce the effects of noise and distance to allow increased auditory access to verbal instruction

Severe to ProfoundWithout amplification, listening “bubble” of one foot

Even with hearing aids unable to perceive all speech sounds

The child with severe to profound hearing loss may be a candidate for cochlear implant(s)

The child with profound hearing loss will not be able to perceive most speech sounds without cochlear implant(s).

Family members must be involved in child’s communication mode from a very young age

If the child is very language delayed and/or has additional disabilities, visual communication may be needed to supplement speech

Hearing Loss Simulation

https://www.starkey.com/hearing-loss-simulator

Factors to consider when counseling parentsParents are the “experts” of their child

At a vulnerable time, parents have to make a lot of decisions quickly

These decisions are often life-altering

Assume that parents know and want what is best for their child

Do not make assumptions based on parents being hearing, deaf or HoH, or Deaf

Parents must be informed of ALL options.

ALL options presented in an unbiased and culturally sensitive manner

FAMILIES NEED TIME to make well informed decisions

Questions to askHow do you want your child to learn and communicate with others?

What do you want for your child?

What is your ultimate goal for your child?

Do you understand all test results?

What have other professionals told you?

Have you been told what the communication outcomes are for your child?

Do you understand the various outcomes?

Have you decided on which outcome is best for your child and your family?

Would you like to see the teaching approach in practice?

Have you been provided contact information for other parents or support groups?

How much time do you have to learn the methodology?

Factors for the family to considerIn the end, parents choice becomes child’s choice

Child may choose differently when they get older

No right way to decide

Consider rational, emotional, and creative approaches

Hands & Voices suggests parents “pack a bag” that includes:o Encouragement to take time needed

o Support from good listeners and other parents

o A bias detector

Factors for the family to considerCan your family meet the requirements?

Are there resources in the community?

Will your desired outcome for your child be met with the approach?

ReferencesKaren Anderson & Noel Matkin (2007). Relationship of Degree of Long-term Hearing Loss to Psychosocial Impact and Educational Needs.

Luterman (2009) From Diagnosis to Action. Volta Voices.

Mitchell & Karchmer (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing sutdents in the United States. Sign Language Studies 4(2):138-163.

North Carolina Beginnings Reference Chart. Retrieved from ncbegin.org on 7/6/18.

Ogden & Smith (2016). The Silent Garden. Gallaudet University Press: Washington D.C.

Maddell & Flexer (2014). Pediatric Audiology: Diagnosis, Technology, and Management. 2nd

edition. Thieme: New York.

Winefield (1987). Never the Twain Shall Meet. Gallaudet University Press: Washington D.C.