My name is Noralee, and I am a Speech-Language Pathologist who is living in Vancouver, Washington. I graduated from Utah State University in Logan, Utah with my Masters in Speech-Language Pathology as well as received additional training in auditory-verbal techniques. I took several additional classes as well as additional practicum focused on working with children with hearing loss. I am currently the Speech-language Pathologist at Tucker Maxon Oral School for the Deaf, which is dedicated to providing services and education for children who are deaf of hard of hearing who have amplification (cochlear implants and hearing aids) from birth (early intervention) to 5th grade. I am so excited and honored to be guest-blogger and I hope that I can bring some helpful information that I have found to be very useful in my profession.
Have you ever worked with a child with hearing loss? Maybe they were very young, in early intervention, or maybe in the schools. Maybe they have had therapy for years, or are newly diagnosed? Have you looked at their amplification devices, turned them on, practiced with trouble-shooting issues? What was your experience?
Many SLPs have limited to no experience with hearing loss. Many believe and have been taught that it is the job of an audiologist to see these children for “aural rehabilitation”. I am here to let you know that is simply not the case. Today, SLPs are becoming more familiar and interested in working with children with hearing loss, and more and more of those children are receiving the services that they need through trained professionals. However, there is still an extreme shortage of professionals that have the skills and knowledge needed to work with this special population. Let me tell you a little about the Auditory-verbal/Auditory-oral approach and what that entails.
The auditory-verbal/auditory-oral approach is a communication option parents choose when they want their children with hearing loss to use listening and spoken language to become independent members of mainstream society. The primary focus of this communication mode is on using hearing to develop speech without the use of sign language or total communication. Children use residual hearing, hearing aids and/or cochlear implants to support spoken language and auditory development. As early as possible, and with the help of parents and trained professionals, children learn to listen and make connections between sound and meaning that lead to spoken language. When this approach is combined with newborn hearing screening, modern hearing technology and appropriate early intervention, children with deafness and no other cognitive, social or emotional factors can develop spoken language skills comparable to those of same-age peers with normal hearing.
Children with hearing loss who begin intervention earlier have significantly better outcomes than children who begin intervention later. Most children who 1.) have parents who are good language providers and keep the hearing devices on them and in good working order and 2.) receive appropriate services from auditory-oral trained professionals progress at age-appropriate rates. In fact, children enrolled in auditory-oral programs have shown an average of one year of language growth for each year in the program(Tucker Maxon Oral School, 2012).
So why not supplement with sign language? Well-meaning professionals might tell parents that they need to sign with their baby to bridge the gap before the child learns to talk. This is simply not true! Using both signs and talking, while hoping for age-appropriate speech and language, is also misguided. In fact, it may hinder a child's chances of developing age-appropriate speech and language. Recent research shows that introducing sign language prior to cochlear implantation does not enhance outcomes compared to emphasis on spoken language alone. Deafness is a brain emergency. A baby's brain is born "wired" for language learning. If the auditory nerve in the brain is not stimulated by sound coming in, it withers away and the brain rewires itself to emphasize whatever sensory stimulus is going in, usually vision. This happens quickly. If parents sign with their baby who is deaf, they are not highlighting listening, and therefore, not helping the baby's auditory nerve to develop normally.
One of the best resources for parents of children with hearing loss is a Listening and Spoken Language Specialist (LSLS). A state listing of these certified professionals can be found at www.listeningandspokenlanguage.com. You can also find on this website on how to become a LSLS! There are also several other great resources online to research the oral communication method. These websites include www.agbell.org, www.oraldeafed.org, www.asha.org, and www.jtc.org which offer information on research, equipment, education, and parent support.
So, here is where you come in! Becoming more aware of the needs of children with hearing loss can help you become a more well rounded professional and also help you provide the best services possible. Although not all SLPs are considered professionals for listening and spoken language, there is one vital thing that all SLPs can do to provide support: listening checks.
When a child with hearing loss is on your caseload, or you know of one in your school, educate yourself and/or the teacher to complete a “listening check” on the child to ensure that their amplification equipment is working properly and is picking up frequencies needed for soft speech. This is for ANY child with a hearing loss with amplification, no matter their speech and language abilities. Remember the “Speech Banana” on the audiogram? If not, dig deep into your Intro to Audiology class textbook and find the diagram that explains the speech banana. We want to make sure that the amplification devices are picking up the range of frequencies on the speech banana that are needed for optimal listening and speech. The sounds to check are [mm, oo, ee, ah, sh, and ss].
There are many ways to do a “listening check” depending on the age and speech and language abilities of the child. I am going to focus on a child who is 3 and up with the ability to imitate. If you come across a child on your caseload, under the age of 3 or a child unable to imitate, please contact me and I will help you know how to do a listening check with that child (it IS possible!).
You want to have the child only listen to one ear at a time (have them take out their hearing aid or to take off the cochlear implant) and you will need to cover your mouth with your hand or have the child face away from you. Stand 3, 6, or 9 ft from the child. If the child can't hear you at 9 ft, then stand 6 ft, etc. DO NOT SHOUT OR RAISE YOUR VOICE. The point is to check that the child can hear the sounds at typical to soft speech sound levels. You will want a quiet environment. Say each of the 6 sounds, pausing in between to have the child repeat what was heard. If the child is able to repeat them all without difficulty, then move to the next ear. If the child says the wrong sound (oo for mm), then visually show the target sound, mix up the sounds, and start again. If the child continues to not say the sound, contact the child's audiologist. Don't try to play with the hearing aids or cochlear implant. Now, if the child does not say anything, you will want to make sure the device is on, change batteries if possible and contact the audiologist. You are important to this child to ensure that problems get identified and fixed as quickly as possible.
I know this is A LOT of information, probably too much, but I wanted to let you all know about something I love and give you a valuable tool that can help you in your career. I have attached two handouts, one is a “cheat sheet” for troubleshooting amplification devices and the other is the 6 sounds with pictures. I love using the pictures as visual cues for younger kids. I hope that you have found this information helpful! If you have any questions about what you have read, please feel free to contact me at firstname.lastname@example.org.
Simply click the links above to download the freebies.