Hearing problems for your child?

            Children with hearing loss have the option to use three main systems for communication. First, there are systems emphasizing listening and spoken language (LSL). The most common of these systems include the auditory-oral approach and the auditory verbal approach. Next, there are manual-visual systems for communication. Manual-visual systems include American Sign Language (ASL) and Signing Exact English (SEE). These are non-verbal systems that include communication with only visual information present. Finally, there are systems combining visual and auditory information. The most commonly used visual-auditory systems include the Total Communication approach (TC) and the Cued Speech approach. There are many similarities and differences between the three communication methods for children with hearing loss. The following will define these approaches as well as explain the similarities and differences between them (Schow & Nerbonne, 2013). 

              In order for a child to use a listening and spoken language system, he or she must have some residual hearing left. These systems use hearing aids, cochlear implants, and FM systems to maximize language development and establish spoken language in the child. A child that receives therapy using an auditory-oral approach will be educated with other children with hearing loss and therapy will target speech, language, and hearing development while parents are given activities to do at home for more practice with their child. Speech reading is not emphasized during an auditory-oral approach (Schow & Nerbonne, 2013). An auditory-verbal approach is similar to an auditory-oral approach in that they both rely on the use of residual hearing, hearing aids, cochlear implants, and amplification systems. However, auditory-verbal approaches focus more on auditory skills instead of visual cues. An auditory-verbal approach will teach parents how to incorporate spoken language activities into daily life (Schow & Nerbonne, 2013).

              In a manual-visual system, only visual cues are used. American Sign Language (ASL) and Signing Exact English (SEE) are most effective with at least one parent that signs in the home to ensure carryover and practice. In order to implement these systems, ASL must first be established as the first language in the home (Schow & Nerbonne, 2013). The child must maintain access to fluent speakers of ASL and the use of amplification when using this is optional since few auditory cues will be used. English is often developed later after ASL has been established and the child becomes fluent in the signing system (Schow & Nerbonne, 2013).

              Systems combining visual and auditory information include the Total Communication (TC) approach and the Cued Speech approach. Total Communication uses manually coded English (SEE), fingerspelling and gestures in addition to residual hearing and speech to maximize language learning for children with a hearing impairment (Schow & Nerbonne, 2013). Like LSL approaches, the use of amplification and hearing aids or cochlear implants is encouraged during a Total Communication approach. During a Total Communication approach, adults that work with the hearing impaired child would use speech at the same time as they use manually coded English and fingerspelling (Schow & Nerbonne, 2013). The Cued Speech is similar to the Total Communication approach in that visual cueing and speech happens simultaneously. They are also similar in that they maximize the use of residual hearing. However, adults that use this approach with hearing impaired children use a set of hand shapes and movements that they learn previously to working with the child. The hand shapes are used to differentiate sounds that look similar when coming from the lips (Schow & Nerbonne, 2013). Both of these approaches require commitment from the family to help carry over what has been learned from the therapist and at the child’s school.

              Over 90% of babies born with hearing loss are born to hearing parents that don’t consider themselves culturally Deaf or part of the Deaf community (Schow & Nerbonne, 2013). Because of this, many families are likely to include an approach that emphasizes spoken language. It’s also important that families be realistic in their expectations for their child and their own language-learning abilities. If ASL is not going to be used in the home it will only negatively affect a child with hearing loss. However, if a child does not have any residual hearing and must rely on visual cues for communication, it is essential that someone in the family learn a manually coded system so that the child doesn’t fall further and further behind in his or her language development. The approach chosen should really be a decision of comfort, ease of use, and what is the right fit for the child.

Source: Schow, R.L., & Nerbonne M.A. (2013). Introduction to Audiologic Rehabilitation. Upper Saddle River, NJ: Pearson Education, Inc.