hearing impairment often have some degree of speech and/or language delay.
There are a number of different approaches to facilitate speech and language in
these cases, and these depend on several factors:
impaired is the child?
What are the
wishes of the parents?
child's first language (sign or spoken)?
Does the child
have hearing aids or a cochlear implant?
What type of
school the child attends (deaf or hearing)?
If the child
is part of the deaf community and/or his parents are also deaf, it is possible
that he may not follow an “oral / aural” route of language development and will
use sign language. Sign language is a recognised language encompassing a wide
vocabulary, grammatical structure and also involving facial expression.
Individual countries have their own sign languages and often areas within a
single country will have some regional differences (like having a local dialect
with hearing aids or cochlear implants may follow an oral / aural route and
have auditory training and learn speech sounds. There are different approaches
to help with speech and language development. An effective habilitation and
treatment for many cochlear implant wearers is Auditory-Verbal Therapy (AVT). This approach focuses on listening and sound
awareness, as this is the most natural and efficient way that children learn
speech. With AVT every possible opportunity to listen and learn is used through
the day, using the child's environment as a learning tool.
mild to moderate hearing loss and conventional hearing aid users may require
more conventional speech therapy, but will still benefit from sound awareness
and discrimination work. Although signing is not encouraged with AVT, some
children with severe hearing loss and conventional hearing aids, may also use
sign language alongside their speech work.
Speech Therapy for conventional hearing aid users
The success of
speech therapy with conventional hearing aid users will depend on the extent of
their hearing impairment, their motivation to communicate with speech, the
dedication of the team around the child (including parents and care-givers),
and whether they want to follow the signing or speaking (or both) route.
A lot of
speech work will involve listening activities and getting the child to
discriminate sounds. This may initially be just simple everyday sounds or
words, accompanied by pictures.
who learn language with sign acquire vocabulary at a similar rate to hearing,
speaking children, but deaf children who are exposed to only oral language,
will develop spoken language vocabulary more slowly. They also find it harder
to develop grammatical skills.
deaf babies often mis-gauge their child’s language level, and pitch their level
inappropriately, this makes the language environment less natural and can delay
the development of the child’s language skills. It is also very important to
give the child feedback and acknowledgement when they attempt any form of
communication, otherwise they may become frustrated and start to give up
Assessment and management
Language Pathologist/Therapists need to have an holistic view of assessment and
therapy and move away from the medical model (which looks at a child’s
impairments to explain their difficulties), and follow a more social model
which aims to remove the obstacles that are causing the child difficulty. To
remove the barriers rather look at the deficits, we need to keep the hearing
impaired person, their team and the family at the centre of the process.
assessment means examining a range of skills and then developing a
comprehensive program that focuses on all areas of communication throughout the
Pragmatics, social skills and conversational skills
use of language in context, turn taking, attention getting, initiating,
responding, repairing, topic maintenance, shared knowledge and inference,
facial expression, eye contact, proximity and touch. The important point here
is, don’t let the deaf child be a passive participant, we want them to learn to
turn-take, respond and share their thoughts and feelings. Videoing the hearing
impaired individual interacting is a good way to highlight certain skills to
them and their parents.
impaired children are often unable to learn language in a natural way and so
have to be taught about grammar and syntax. Teaching these language skills can
be very difficult, and we also have to be aware that auditory memory skills and
comprehensive language may be delayed. The use of sign can develop language
skills, but some programs (such as Auditory Verbal Therapy) tend to discourage
signing and lipreading because they are trying to promote listening
development,which will in
turn facilitate speech and language.
Speech development and expressive communication
development can also be a difficult skill to cultivate with a hearing impaired child.
Much of the success will depend on their level of residual hearing, how well they
are aided and their motivation.
considering speech development, we must be aware of a number of elements:
- Phonological awareness and letter sound knowledge
- Articulation of speech sounds.
- Prosody and intonation (sign language does not have this, but the
use of facial expression adds emphasis to meaning)
- Voice quality is another aspect of speech that is sometimes an
issue for hearing impaired children. Children with hearing impairment are often
not able to monitor their own voices effectively and may speak too quietly or
loudly. They may also have to be made aware of breath control when talking.
Changing the communication environment at home and school
As well as
helping the deaf child to communicate, everyone around the child must also have
a heightened awareness of their own communication and the communication
environment. As communicators with deaf children we must be aware of a number
of our own behaviours, including facing the hearing impaired child when communicating,
talking clearly so they can see our lip patterns, and when needed, using
gesture, sign or visuals to help (with Auditory-Verbal Therapy, you may not follow
some of these processes, as you are trying to teach the child to listen and discriminate).
We must also pay attention to the physical environment and communicate in an
area that is well lit and where there is less background noise.
Things to remember when communicating with a deaf child
- Always face, or be on the hearing aided side of the person when
you talk to them
- Think about the environment - lighting, clothing, background noise
- Use facial expression and gesture to add meaning
- Repeat and rephrase your communication
- Request confirmation from the hearing impaired individual
- Don’t over articulate, but don’t mumble either
- Think about your own volume and rate when you speak
- Set the context to help the person understand
- Write things down or draw a picture if you cannot communicate your
message with speech or sign
- Always respond
- Reward with a smile
Be aware that
hearing children in the pre-verbal stage get feedback from an adult when they
look at things, like a running commentary. This obviously is more difficult for
a hearing impaired child as the child has to look at the adult and the object.
It is important to let the hearing child explore and control their environment,
but the adult can help by sitting with, or opposite the child, having a joint
focus. As an adult with a hearing impaired baby, try and respond as often as
possible and try to follow your babies focus. Remember, even young babies can
be aided from an early age to make the most of their residual hearing during
that critical period of speech and language development.
training is a great way to test and train the acuity of a child’s hearing using
their hearing aids. Auditory training also facilitates speech and language development.
The type of auditory training will depend on the hearing ability and developmental
level of the individual.
There is a
hierarchy of treatment with auditory training, and if you are starting at the beginning
with a child that has only recently been aided or implanted, the initial auditory
work will just be getting the child to discriminate between sound and no sound.
When the child can react to the difference between sound and no sound we work
through a number of steps:
- Discrimination between long and short sounds
- Discrimination between 2 different sounds. Discriminating vowel
sounds can be difficult so we must use sounds that are not only different, but
also have different formant frequencies
- Differentiating between one and two syllable words/nonsense words
- Discriminating between words containing different vowels (e.g pot
- Discriminating between words with different initial or final sounds
(e.g. day/pay or hearse/herd
- Discriminating words in closed set word lists and open set word
lists. Closed set word lists may be a smaller set of words that are familiar to
the listener and initially quite different in sound. Open set word lists
introduce new words and might be more complicated because it introduces more
words that are in the same category or sound similar.
Examples of a
Closed Set word list -
(this group of words has different
initial sounds, different vowel sounds, and pyjamas has more syllables). A much
harder closed set would be -
mat, mouse, house, rat
(this group is more difficult as
some initial and vowel sounds are the same, there is rhyme, and there are also
words with close semantic links e.g. Mouse/rat).
An Open Set
word list can have an endless list of choices and exposes the child to new words,
these tasks are much more difficult.
discrimination tasks might require a child to listen to sets of words, but spot
the differences between each set e.g. “are these 2 sets the same, or different?”
- pot pot pot pot pot pot pot pet
- tap tap tap
tap tap tap tap tap
child to discriminate words in phrases and words with background noise will
also facilitate their listening development. Finally, to promote their word knowledge,
we offer choices with questions (e.g. “Which one do you write with”), so their auditory
comprehension is developed further.
What to be aware of when carrying out auditory training:
- Are aids on and set up (volume correct) and working?
- Are you close enough to the child?
- Are you on the right side (the aided side) or facing the child?
- Check environment for noise and visual distractions
- Has the child got a cold/ear infection (this can impact on hearing
- Make sure the child is actually listening and not reading lips
- Be aware of the child’s language level and developmental level
- Use visual prompts to cue and help the child understand
- Have you carried out a “Ling Sound Test”
hearing impaired children, listening is not going to be their major source of receiving
communication and they are going to rely on sign, gesture and lipreading.There is a
difference between lipreading and speech-reading. Lip reading relies on lip movement
and facial expression, whereas speech reading uses lips, facial expression,
gesture and sound. Lip reading training involves becoming familiar with eye contact,
facial expression, and lip shapes. Lip readers will then learn to match lips shapes to
sounds, learn to identify words and common phrases, and as they become more
proficient, short then long sentences.
and story retell are good ways to teach both lip-readers and to develop
auditory comprehension. Barrier games involve facing the hearing impaired listener, but
have a barrier between you so they cannot see what is in front of you, or what you are
writing or drawing. If you are testing auditory comprehension cover your lips so
that the listener cannot get clues by lipreading. Try having a series of corresponding
pictures in front of both of you. Name a picture, then see if the listener can listen,
discriminate and understand what you have said, and name or point to their
corresponding picture. You can do all sorts of games using the barrier such as map reading or
picture drawing. Give the listener instructions to follow on a map and see if they
end up at the same location. Draw a picture and describe it as you draw, and at the
same time encourage the listener to draw the picture you are describing, then see if
both pictures match at the end.
- Hearing Impairment, Auditory Perception and Language Disability by John Bamford and
- Children With Hearing Loss: A Family Guide by David Luterman
- Auditory-Verbal Therapy for Parents and Professionals by Warren Estabrooks
- A Journey into the Deaf-World by Harlan L.
Lane, Robert Hoffmeister, and Ben Bahan
- Inside Deaf Culture by Carol A. Padden
and Tom L. Humphries
- Rebuilt: My Journey Back to the Hearing World by Michael Chorost
- Hearing AIDS by Harvey Dillon
- Hearing Aid Handbook: 2008-2009 by Jeffrey J. DiGiovanni
- The Hearing Aid Decision: Answers to Your Many Questions by Randall D. Smith,Jerome G. Alpiner,
and Megan Mulvey
- Digital Hearing Aids by Arthur Schaub
- Advances in the Spoken-Language Development of Deaf and
Hard-of-HearingChildren (Perspectives on Deafness) by Patricia Elizabeth Spencer and Marc Marschark
- Helping Deaf and Hard of Hearing Students to Use Spoken Language:
A Guide for Educators and Families by Susan Easterbrooks
and Ellen L. Estes
Disclaimer: This website is for general information only and is not intended as a substitute for independent professional advice.