Communication

Options:

A Discussion with

ParentsAmy Peters Lalios, MA,CCC-A, LSLS Cert. AVTDirector, Therapy Services

alalios@hearwi.org

EHDI 2016

San Diego,CA

Christine Kometer, M.Ed, LSLS Cert. AVEdDirector, Education Services

ckometer@hearwi.org

Options are not necessarily common

knowledge!

� “Families should be made aware of all communication options and available hearing technologies in an unbiased manner.”

� “Information…..communicated in culturally sensitive and understandable format.”

� “Informed family choice and desired outcome should guide the decision making process.”

American Academy of Pediatrics’

Joint Committee on Infant Hearing (2007)

Many parents do not get information about options from their audiologist and medical team

Matthews, et al., 2009;Berg et. al., 200)

Why Discuss?

� Family decision

Parents in control –

92% report they are happy with their decision

Professionals in control-

7.7% report they are happy with the decision

*61.5% report they “Don’t know”

~Lisa Crawford, Texas H&V (EHDI 2009)

Shared priority:All families deserve unbiased, complete information about communication/ language / education options

� Alexander Graham Bell

� American Society for Deaf

Children

� Gallaudet University/ Clerc

Center

� Hand & Voices

� Joint Commission on Infant

Hearing

� National Association of the

Deaf

� National Cued Speech

Association

� NCHAM/ EHDI

Complex Issue

� Age of Identification

� Onset of Hearing loss

� Degree of Hearing loss

� Benefit from Hearing Aids

� Family Dynamics:

� Siblings & Extended Family

� Lifestyle

� Bilingual issues

� Culture & Values

� Attitude & Commitment

� Finances

� Multiple Issues or Labels

� Family Support System

� Urban or Rural

� Availability of Resources

� Technology

� Parents can choose sound

� Validity of testing

� Society issues

� Beliefs about Disability

� Social Isolation

� Child’s Innate Abilities: learning style, personality, development, inclinations

� Peers & Social Outlets

� Educational Options

� Long term Goals

� Validity of information

� Flexibility and fluidity of choice-making process

Let the child leadCopyright © 2006 Hands & Voices

Where we begin…

Images: biographixmedia.com Image: http://Georgetown.edu

� Brain Architecture video (1 minute , 57 seconds)

- Center on the Developing Child

Harvard University

https://www.youtube.com/watch?v=VNNsN9IJkws

� Animation depicting synapses in the brain and the basis for neural pathway development. This process is important for all senses

Hearing Loss =

Neurodevelopmental 911!

• Experience Dependent Plasticity!

• Take advantage of neuro developmental synchrony so that children can become morphosyntactically competent language users.

Early Experiences Matter!

Source: Corel, JL. The postnatal development of the human cerebral cortex. Cambridge, MA: Harvard

University Press; 1975. http://www.urbanchildinstitute.org/why-0-3/baby-and-brain

Use it or lose it

�Connections frequently activated are

reserved, strengthened & more efficient

�Connections not consistently activated

are naturally repurposed or pruned

allowing active connections to strengthen

and grow

� “Windows of opportunity” are present at birth

� “The [cerebral] cortex matures in stages/columns and the level of maturity depends on the richness of exposure and experience.” 1

� Stimulation with sound should occur as early as possible to take advantage of critical periods of neurological and linguistic development 2 ,3

1. Merzenich, 2010 ; 2. Lennenberg, 1967; Marler, 1970; Clopton and Winfield, 1976; Johnson and Newport, 1989; Newport, 1990: 3. Sharma and Nash, 2009

Early experiences

can have a

profound effect on

brain development!

What it Takes: Communication & Language Development

Children learn language most easily when actively engaged in relaxed, meaningful interactions with supportive parents and caregivers

Kretschmer & Kretschmer, 1978; Lennenberg, 1967; Leonard, 1991; Ling, 1989; MacDonald & Gilletter, 1989; Menyuk, 1977; Ross, 1990; Estabrooks, 1994

What it Takes: Communication & Language Development

Sensory Pathways�Visual / Auditory

�Options for amplification technology

�Sustained effort towards development

What it Takes: Communication & Language Development

Language Input

�Complete, fluent language

�Meaningful, relevant� Abundant

�Contextual

� Repetitive

� Intentional

� Developmentally appropriate

What it Takes: Communication &

Language Development

Consistent�Use

�Meaningful repetition

�Expectation(s)

�Access to other users of the language

�Developmental appropriateness

Underlying Assumptions

� Anything is possible

� Every option is open to almost every child and family

� Parents as decision-makers: “Captain of the ship”

� Team is the “crew”: help you meet your goals for

your child and family

� Preferred Option may change

�Child’s skills and functional abilities can be positively

influenced by intentional interaction

Receptive Communication Continuum

AVA VA AvV

Nussbaum, D., Scott, S., Waddy-Smith, B., Koch, M. (2006, abril). Spoken Languageand Sign: Optiminzing Learning for childrenwith Cochlear Implants. Paper presentedat Laurent Clerc National Deaf EducationCenter, Washington, D.C.

Fully VisualCommunicator

Mostly VisualCommunicator

Mostly

AuditoryCommunicator

Fully AuditoryCommunicator

Receptive Communication• V Depends on visual information from signs / ASL

• VA Depends on signs / ASL; gets some benefit from auditory information• VA Able to understand both signs / ASL and spoken language at high levels of fluency

• Av Depends on spoken language with some signs or gestures (often for larification)

• A Depends on auditory information through spoken language

Expressive Communication Continuum

OSo SO OsS

Nussbaum, D., Scott, S., Waddy-Smith, B., Koch, M. (2006, abril). Spoken Languageand Sign: Optiminzing Learning for childrenwith Cochlear Implants. Paper presentedat Laurent Clerc National Deaf EducationCenter, Washington, D.C.)

Fully SignCommunicator

Mostly SignCommunicator

Mostly Oral Communicator

Fully Oral Communicator

Expressive Communication• S Uses signs / ASL only

• So Uses signs / ASL with some oral communication• SO Able to use both sign and oral communication at high levels of fluency

• Os Uses spoken language with some signs or gestures (often for clarification)

• O Uses spoken language only

Initial Considerations for Parents

� How does your child communicate now?

� How do you envision your child

communicating in the future?

�Movement on the continuum is possible.

Functioning can be positively influenced

by intentional interaction

Considerations for Parents

�What are your long-term goals for your

child/family?

�Do you know anything about any of the

communication options?

�What kind of school experience do you

want for your child?

American Sign Language (ASL)

and English as a 2nd Language

Cued Speech Total Communication Auditory Oral Auditory Verbal

“Listening and Spoken Language”

Also known as Bilingual / Bicultural

“Bi – Bi”

Simultaneous Communciation

“SimCom” or “TC”

“Oral” “AV Therapy”

DEFINITION •ASL is the language of the Deaf community and an important part

of their culture and identity

•ASL has its own distinct grammar

and does not match spoken English

•ASL is a fluid, rich language with

slang, idioms, etc.

• A sound-based hand

supplement to speech

reading

• 8 handshapes used in 4

locations (“cues”)

• Cues are used

simultaneously while

speaking to make help

distinguish sounds that

look the same on the

mouth of spoken

language look visually

different

• A philosophy using a

combination of methods

including: sign language system,

finger spelling, body language,

speech, speech reading, listening

and amplification.

• Signs used are not ASL but rather

signs borrowed from ASL layered

over English to follow English

grammar and word order

• A therapy approach

emphasizing teaching child to

use his/her hearing, speech

reading and visual cues to

understand and use spoken

language

• A therapy approach which

guides and coaches parents to

teach their child spoken

language through maximal

development of listening skills

• Uses natural developmental

patterns of language learning,

listening and cognition

• Requires a certified Auditory

Verbal Therapist or Auditory

Verbal Educator

GOALS &

OUTCOMES

• The child learns ASL as his/her

primary language and learns

English as a second language

through reading

• To appreciate the differences

between the hearing & Deaf

communities

• Richer understanding of and

participation in Deaf culture

• To access the basic,

fundamental properties of

spoken languages

through the use of vision

• Has been adapted to 60+

languages and dialects

• To use any available tool to help

the child communicate

depending on the situation and

conversational partner

• To develop listening and

spoken language skills to the

child’s best potential

• To integrate listening and

spoken language into all

aspects of the child’s life

• To promote education in

neighborhood schools with

typically-hearing peers

HOW LANGUAGE

IS UNDERSTOOD

•Child interacts with other ASL users

and develops understanding of ASL

through rich language exposure

• English is taught as a second

language after child has strong

foundation in ASL

• Child learns to understand

language using

amplification and “read”

speech through cues

which represent different

sounds

•Child learns to understand

language (spoken, signed or

both) through rich language

exposure to spoken language, a

formal signed system and speech

reading

• Child learns to understand

spoken language through

(aided) listening and speech

reading

• Child learns to understand

spoken language through

(aided) hearing

• Does not rely on speech

reading or visual cues for

understanding

HOW LANGUAGE

IS EXPRESSED

•ASL

•Written English (or other)

•Varying proficiency may occur

within both language systems

• Spoken language (with

cues)

• Written English (or other)

• Spoken language

• Sign language (not ASL)

• Fingerspelling & written English (or

other)

• Varying proficiency may occur

within both language systems

• Spoken language

• Written English (or other)

• Spoken language

• Written English (or other)

AMPLIFICATION(HEARING AIDS, COCHLEAR

IMPLANTS, FM SYSTEMS, ETC.)

•Use of amplification is not a

requirement for success

• Maximal use of remaining

hearing is strongly

encouraged

• Maximal use of remaining

hearing is strongly encouraged

• Early and consistent and

maximal use is critical

• Early, consistent and maximal

use is critical

WHAT IT TAKES • Parents and family must become proficient in ASL if they are not

already

• Access to Deaf and/or hearing

adults fluent in ASL

• Parents and family are the

primary teachers of cued

speech to their child

• Parents must cue at all

times while speaking

• Must learn to cue fluently

• Parents and family must learn the

sign system

• Parents must encourage full-time

use of amplification

• Families should consider a

language plan to ensure

adequate exposure to both

signed and auditory systems

• Parent and family must

integrate therapeutic

techniques and strategies into

daily routines

• Parents must encourage full-

time use of amplification

• Parents and family must

integrate therapeutic

techniques and strategies into

daily routines

• Parents must encourage full-

time use of amplification

SCHOOL – AGE

CONSIDERATIONS

• Bilingual-bicultural approaches are

most commonly found in residential

schools for the Deaf

• Child may require a

transliterator: a proficient

cuer who cues what the

teacher(s) and peers say

• Placement options vary by district

• Class would typically be taught

by Teacher of the Deaf & HOH

• Placement options vary by

district

• Class would typically be

taught by Teacher of the

Deaf & HOH

• Ultimate goal is mainstream

classroom setting with typically

hearing peers

• May continue to receive

support in and out of classAdapted from NC Beginnings (www.ncbeginorg)

Receptive Communication Continuum

AVA VA AvV

Nussbaum, D., Scott, S., Waddy-Smith, B., Koch, M. (2006, abril). Spoken Languageand Sign: Optiminzing Learning for childrenwith Cochlear Implants. Paper presentedat Laurent Clerc National Deaf EducationCenter, Washington, D.C.

Fully VisualCommunicator

Mostly VisualCommunicator

Mostly

AuditoryCommunicator

Fully AuditoryCommunicator

Receptive Communication• V Depends on visual information from signs / ASL

• VA Depends on signs / ASL; gets some benefit from auditory information• VA Able to understand both signs / ASL and spoken language at high levels of fluency

• Av Depends on spoken language with some signs or gestures (often for larification)

• A Depends on auditory information through spoken language

Expressive Communication Continuum

OSo SO OsS

Nussbaum, D., Scott, S., Waddy-Smith, B., Koch, M. (2006, abril). Spoken Languageand Sign: Optiminzing Learning for childrenwith Cochlear Implants. Paper presentedat Laurent Clerc National Deaf EducationCenter, Washington, D.C.)

Fully SignCommunicator

Mostly SignCommunicator

Mostly Oral Communicator

Fully Oral Communicator

Expressive Communication• S Uses signs / ASL only

• So Uses signs / ASL with some oral communication• SO Able to use both sign and oral communication at high levels of fluency

• Os Uses spoken language with some signs or gestures (often for clarification)

• O Uses spoken language only

American Sign Language (ASL)

� ASL is a full, complete language with its own syntax

and grammar system

� Provides access to the Deaf community

� Requires parental knowledge of and fluency in ASL

� No written form

� ASL users learn written English as a second language

� Bilingual / Bi-Cultural specialized programs exist, including most state schools for the Deaf

Total Communication /

Simultaneous Communication

� Philosophy involving the use of a signed language system and spoken English simultaneously

� Requires parental knowledge of and fluency in signed system

� Child asked to process two sensory stimuli simultaneously

� May provide the child the opportunity to be bilingual

� In school:

� Variability exists in implementation of TC/SimComprograms

� Classmates generally have hearing loss and use same mode

Cued Speech

� Handshapes are used as symbols to clarify phonemes that look the same on the mouth when produced

� Not a language but rather a symbolic system of speech phonemes

� Requires family members learn to cue� Can be a supplement to residual hearing and use of amplification

� Widely used in some areas of the country and hardly used in others

� In school:� May need staff who can cue to facilitate comprehension in classroom

� Peers and classmates may or may not cue for themselves

Auditory Oral Approach

� Promotes listening skills and spoken language

� A therapy approach emphasizing teaching child to use his/her hearing, speech reading and visual cues to understand and use spoken language

� Speech reading, natural gestures and facial expressions are also promoted

� In school

� AO classrooms promote listening skills and spoken language; classmates often also have hearing loss

� Teachers of the Deaf and Hard of Hearing

Auditory-Verbal Therapy

� Promotes development of spoken language and communication skills through listening

� Uses optimal amplification to guarantee access to sound

� A developmental, comprehensive therapeutic approach coaching caregivers / parents

� Parents become the primary facilitators of their child’s spoken language development

� Providers hold LSLS certification designated as

LSLS AVT or LSLS AVEd

� In school:

� Goal: mainstream classroom with typically hearing peers

Complex Issue

� Age of Identification

� Onset of Hearing loss

� Degree of Hearing loss

� Benefit from Hearing Aids

� Family Dynamics:

� Siblings & Extended Family

� Lifestyle

� Bilingual issues

� Culture & Values

� Attitude & Commitment

� Finances

� Multiple Issues or Labels

� Family Support System

� Urban or Rural

� Availability of Resources

� Technology

� Parents can choose sound

� Validity of testing

� Society issues

� Beliefs about Disability

� Social Isolation

� Child’s Innate Abilities: learning style, personality, development, inclinations

� Peers & Social Outlets

� Educational Options

� Long term Goals

� Validity of information

� Flexibility and fluidity of choice-making process

Let the child leadCopyright © 2006 Hands & Voices

Parent / Family Opportunities

� FamilyLink Activities

� Monthly outing

� Pizza Party Orientation

� Community Partnerships

� Annual Events for current and past families

� Program Specialists

� State GBYS

� State Deaf Mentor Program

� Wisconsin Families for Hands & Voices

� Wisconsin chapter of AG Bell

� Wisconsin Statewide opportunities via WESPDHH Outreach

Ultimate Goal for ALL

Children

� Well-adjusted, self confident child who uses

language to successfully interact with others

� Child with the necessary foundational skills to be

ready to learn at school entry