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Hello!
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.
Auditory-verbal/Auditory-oral Approach
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 noralee.jones@gmail.com.
Simply click the links above to download the freebies.
This is a nice post with some great advice. I will definitely remember your listening check! However, I feel that you have implied that 'well-meaning professionals' that recommend the use of sign language are doing it wrong. I, and many others, think that a child who is deaf has the right to be a part of the deaf community which includes using sign language. I certainly understand why some parents choose to take the auditory verbal route but I think a total communication route is just as valid an option and the choice between the two is dependant on a family's preferences and needs, not automatically the auditory verbal route. We have a similar organisation here that also emphasises auditory verbal therapy and I understand that these specific organisations are focused on it, but I just didn't want anyone to think it was the only option for a child who it deaf.
ReplyDeleteAnonymous - Thank you for your comments. Of course there are other options and no where in my post did I say that AVT was the only option. When I talked about professionals recommending ASL, if you read the entire section, you will see that I was referring to the recommendation of sign language while also wanting typical developing speech and language as a way to "bridge the gap". This is not referring to a Total communication option.
ReplyDeleteResearch has shown that TC, although completely appropriate for some families, does not have the same results as compared to emphasis on spoken language alone. This is not to say that some families would not like to have their child still learn sign language or to get in touch with deaf culture. However, for most parents who choose AVT, there is no hearing loss in their family and 90% of children who are deaf are born to hearing parents who do not know sign language.
I work with a family currently, who both parents were born deaf and use ASL, but have enrolled their children in the school in order for their children to have spoken language and give their children more options in a "hearing world". They are still deaf and embrace the deaf culture, however, these parents see the importance and benefit of AVT for their children.
All parents have the ultimate right to choose the option for their child. I simply have described one of the options.
I am an SLP in a bicultural/bimodal program in WA myself. I minored in Audiology and have had a strong connection with Deaf culture since I was a teen. I strongly, but respectfully, disagree with your statements. Actually, research suggests that having a strong foundation in any language supports further language acquisition. For deaf individuals, a visual language (such as ASL) is typically the easiest to learn. It is logical (and supported by significant research) to suggest that deaf/Deaf children first learn ASL, then verbal English if so desired by their parents. Hearing aids and cochlear implants are currently an imperfect science and do not allow children unrestricted and consistent access to verbal speech. This essentially sets a child up for a language disorder, not to mention the fact that it inhibits their learning in all other academic areas!
ReplyDeleteBecause of the drastic difference in our philosophies, I also have to say that we may have different viewpoints on what a good outcome looks like. To me, a successful student with hearing loss is one who has a strong base language (whether it be ASL, SEE or English), age/grade level appropriate academic skills, self advocacy skills and a supportive network of peers and adults who he/she can easily and effectively communicate with. I do not see verbal English as being necessary for any of this.
Also, deaf refers to a person with hearing loss while Deaf refers to a person who is culturally Deaf. It's important to be aware of the difference. I also hope that you are aware of the fact that American Sign Language is a fully developed language with a grammar structure independent from any other language. The fact that you referred to ASL as "sign language" made me wonder how familiar you are with ASL and Deaf culture as a whole. What background do you have in these areas?
Wow, I had no idea this would spark so much discussion! Thank you everyone for sharing your opinions. Please remember that Noralee is simply sharing one aspect of working with individuals who are deaf or hard of hearing. She is by no means saying that the Auditory-verbal/Auditory-oral approach is the ONLY approach. And yes, I am sure she is well educated in the difference between Deaf and deaf, as I am sure most of us know and understand that difference as well.
ReplyDeleteBrea - Thank you for your support and obvious understanding of my intent with this post. I love your blog and hope to be able to be a resource in the future. :)
ReplyDeleteHannah - Obviously, it upset you that I have discussed one method of language for those who are deaf/Deaf, as well as my typos of capitalization. This does not mean that I am not well and diversely educated on the subject matter or am not a professional. Brea's blog is not really the appropriate place to be making judgments, assumptions and accusations. Regardless, I would love to see the research that supports the claims you have made. I am happy to read it and continue this discussion more privately (through email). Thank you for your time.
Noralee - I'm a SLP with MECP, and I serve the hearing-typical kids at TMOS. We've probably bumped into each other without realizing it. I think we even share a kiddo. Perhaps I can get someone to introduce us at some point. :)
ReplyDeleteNoralee,
ReplyDeleteI am sorry that you were offended by my previous comment. I was genuinely trying to find out what you were familiar with regarding Deaf culture. If I had a dime for every time a fellow SLP expressed a complete lack of awareness of Deaf culture, I would be rich! Sometimes tone is not conveyed accurately in writing, particularly in a quick comment on a blog.
I am also choosing to post this publicly because I do not want others to think I was attacking you, when I was strongly disagreeing with you. I also would like others to have access to this excellent resource regarding the positive correlation between ASL fluency and English academic development. Please take a few minutes and look at this: http://www.gallaudet.edu/documents/cummins_asl-eng.pdf