Our experience is that some professionals look at an audiogram and decide as a result on that child’s possible access to spoken language. They assume that there is a cut off point, that beyond a certain level of deafness, spoken language is not a possibility.
Though they do it with the best of intentions, of helping parents come to a, in their view, realistic understanding of their child’s future, they are frequently out of touch with what is now possible.
Their expertise is in their medical specialism, not current hearing aid technology, childhood language acquisition, acoustic phonetics, or any of the other disciplines on which the Natural Aural Approach draws.
We know of many parents whose deaf children are now chattering away who were told by such professionals that their child would never talk.
Digital hearing aids can be fine tuned to meet his very specific needs. As he is a baby and new to sound he may have been set up quite conservatively to start as they gather more information about his reaction to sound. You are the person who will know him best and see his reactions and responses as you talk to him and take him out and about and in different situations in the home at different times of the day. See how he responds and how he engages to you as you speak and his reactions to sudden noise or loud noise.
• He will turn to your voice
• He may start cooing as he hears your voice; he may calm to a soothing voice or song
• He may start to anticipate events as he hears familiar sounds that are associated with this
• He may start to rock or clap as he hears a familiar rhyme or tune
• He may just still; stop sucking or stop what he is doing to voice or noise.
• In time his vocalisations will change:
• As you respond to his vocalisations he will engage with you for longer
Talk back and encourage him, smiling and commenting that he did notice these sounds and bring him closer to them. Engage with him and talk and smile and show him what he noticed.
• He may cry to voice or sounds as if they are too loud.
• May pull then out.
• He may blink as you talk or blink to environmental sounds
• He may just not react to voice and may startle as if you appeared unexpectedly
Tell your Teacher of the deaf and audiologist about your concerns and when and where and how he reacted. Ask for an immediate hearing aid review. Blinking and crying may indicate that he is over amplified and the hearing aids are set too loud. I would remove the hearing aids and control the loud sound coming in.
If he didn’t seem to notice any sound, first check the hearing aids are on and working:- battery( in the right way around; battery is new; mould isn’t blocked by (wax; moisture or tubing isn’t squashed or only half way down the mould tip)
Then try bringing him much closer using gentle soothing tones. Make sure he sees your face. Gradually raise your voice keeping a friendly smiley face and tone. Check that he is aware you are talking to him. It might be that the hearing aids are not set up enough for him. Notify your Teacher of the Deaf and Audiology and ask for an immediate hearing aid review.
The noise you describe is probably feedback –
1) Check the earmould is in your child’s ear properly.
2) Check the earmould fits well, there should not be a gap between the mould and the ear, as this allows the sound to escape from the hearing aid. If the earmould is not a good fit make an appointment to have new earmoulds made.
3) Occasionally the tubing has a hole or crack in it which allows the sound to escape. Retubing the earmould can solve this.
Many children go through a phase of pulling off their Cochlear Implant or hearing aids, this does not mean that they don’t like it, but that they are exploring the equipment. It is important to stay positive and encourage them ‘Oh yes that’s your Implant, it helps you hear ‘lets put it back on’ It can help to positively reinforce the sounds they can then hear, maybe by singing a favourite song, or playing a game.
All the time. Hearing aids provide access to everyday language, which is how he will develop his language and listening skills.
Get into a routine. First thing in the morning before you get him dressed. Wake him up with a smiley face and a positive voice telling him you can hear him and you do so like his hearing aids. He needs to hear from the start. Sound is important to all of us don’t deny him this pleasure. Giving him a ‘break’ from the hearing aids; means he is without sound which means he is missing out.
During the day if he naps. Let him nap with them in. He will then get used to having something in his ears and he will have access to sounds around him. As he starts to stir he can hear your soothing voice, rather than waking him up by you fiddling with his ears as you reinsert the aids.
In the bath if his head remains dry he can wear one ( I would stick to one- keeps the other safe in case of accidents). After bathtime, dry ears and replace the hearing aid- even if it is just before bedtime. There are so many language opportunities that you can’t afford to miss especially if they are about fun things he is doing.
At night he will have to have them out. Make it the last thing you do or even once he has fallen asleep.
Because she can. She has learnt a new skill, just like she will be able to pull a hat off or her socks.
You need to keep those hands busy. Socks on hands also help. This is a time to put a safety lead on the aids and pin to clothing as when out and about you could lose them.
Make sure they sit well on her ears so that the microphone is naturally pointing forward and the aids sit securely. Check tubing is the right length and not twisted, hasn’t moved up inside the mould and isn’t twisted. (If the tubing has moved up inside the mould, push it back down flush with the tip of the mould.) Ask for the medium to thick walled, wide bore double bend tubing, as it sits the aid better on the ear than the single bend tubing . For those who get frequent condensation in the tube, ask for stay dry tubing, thought this only comes with a single bend. Use toupe tape on the side or under the arch of the aid to stick it behind the ear.
A gentle ‘no’ and bring her hands down and put something in them and engage in a song or chatty interaction that distracts her away from the aids.
Always do the most exciting, musical and conversational activities with hearing aids in. Do the opposite when she hasn’t them in.
Speech spoken at a normal speed is full of rhythm and intonation. We now know that it is the rhythm and intonation that children find easiest to hear and learn.
There is more information and expression when words are spoken in groups. The tone of your voice holds the child’s interest and provides meaning to what you are saying.
Singing is especially interesting and easy to recognise. Groups of words and ‘running speech’ hold interest and have meaning with their tone.
“There, there, let me kiss it better”
“Wow, look at that!”
“What are you doing?”
“Good boy/girl, you are clever.”
“Night, night, sleep tight, I love you.”
These expressions are repeated often and become recognisable and are anticipated in daily routines and events.
We now know that deaf children can learn well through listening with good quality hearing aids or cochlear implants. To help children develop good listening, we need to make listening a part of everyday life. Many children with the right aids don’t need to use their eyes to know what is being said – we can even talk to them when they are not looking.
However, to get a child’s attention when we want to talk to them, we make sure that they can see us. This helps them to understand that we are interested in them and that we are ready to listen to what they have to say. Our expressive face helps them to make sense and gives meaning to what we are saying.
We don’t put pressure on them to read our lips, as this makes the person talking, over emphasise their lip pattern which would distort their speech, but we don’t hide our mouths as we want the interaction to flow naturally. During the interaction, we are always checking that we are talking about the same thing and letting the child know that we are interested in what they are saying and doing by our facial expressions.
Once children know something about sound and language, lipreading can be a very useful extra aid when things are difficult – when there is a lot of background noise, for example, which is when we all use it. The children themselves will tell you when they need to see you.
Research into how children learn to talk has shown us that teaching children words and sentences is not the best way – it leaves children confused about how to use words and muddles their sentences.
Children learn words and language themselves, as they listen to and talk to the people in their lives. They find they need words and sentences to say what’s in their minds. It’s as natural as learning to walk, once you can hear, even if you don’t hear exactly the same as other people.
It takes a normally hearing child about a year to produce her first word – a year of listening. We should expect a deaf child to need at least a year of listening through the aids before she starts to talk.
During that year of listening, children play with their voices, learn to get attention and learn to recognise a few regularly used sayings, ‘Daddy’s coming’, Where’s teddy?’, ‘It’s bath-time’. ‘Let’s go to the park’. ‘You need your coat and wellies’.
Children learn first the words which are most important to them, not the ones which we think are easy, or the ones they hear most often. Their first words are likely to be words like ‘more’, ‘no’, ‘gone’, ‘down’, because these words make something happen in their lives.
Because children can hear themselves, they can match their speech to what they hear others say. Their speech develops natural rhythms and intonation patterns and is usually quite easy to understand and becomes clearer as they develop – the more they talk, the better they become.
Adults need to be good listeners. Instead of correcting, it is more helpful to pick up on what the child is saying and meaning and return it correctly.
e.g. the child says “drink”,
Mum says “oh, you want a drink, are you thirsty?”
Child repeats, “drink”.
Mum says, “What do you want, juice or milk?”
Child say, “Milk.”
Mum says, “You want a drink of milk, let’s find your cup.”
Child points and Mum says, “Ah, there it is, now how much do you want. Tell me stop………….
All this is about following the child’s meaning, introducing new language, holding a conversation and taking turns. This makes listening and talking, fun and meaningful.
Children don’t need to be taught to speak. Expecting correct pronunciation before they are speaking fluently can interfere with the natural sound of their speech. It can also make them feel self-conscious about talking. Children need to enjoy talking without worrying about how its said. If you don’t understand them, be patient, they will try again.
Running speech is a continuous stream of constantly changing patterns of sound. These patterns are very subtle and fleeting. When signing is constantly used at the same time as speech, these subtle patterns are changed, often quite radically. This makes it much more difficult, if not impossible, for the deaf child to “tune-in” to the patterns that are inherent in normal speech, since sign distorts them.
It is virtually impossible for sign to be used in complete synchrony with speech. It is very difficult to pay attention to two sensory inputs at the same time particularly when one claims so much more attention than the other
What does not work for anyone, parents or children, are eclectic compromises which result in the child having no access at all to a functional language. There are some authorities who suggest that a deaf pre-school child who is being encouraged to talk at home should attend a signing nursery “just in case”. This sort of halfway house just serves to confuse and delay the child’s development.
But natural gesture is an important part of getting to know what talk is about.
The facial expressions and gestures which people use every day, play an important part in children learning to make sense of the sounds they hear. They help children to know what sounds mean and give important clues about how people think. It is important that children benefit from their use.
Some experienced mothers with both hearing and deaf children will tell you that their deaf children were no more frustrated as toddlers than their hearing children. All young children experience periods of frustration.
There is also no evidence to suggest that deaf children who use sign are any less subject to bouts of frustration than children who are being brought up using an auditory oral approach.
There are some suggestions about how to help dealing with difficult behaviour in ‘Just like every other child‘.
Sign language is the natural language for deaf children only when it is the natural language of the home, i.e. where it is used for daily communication between family members. Otherwise it is no more natural than any other language.
Since most deaf parents have hearing children (about 85%), very, very few severely or profoundly deaf children are born each year into homes where sign language is the natural language. Probably no more than 20 – 25 children such children per year.
Sign language, which uses movement and vision to convey meaning is organised in a way which is fundamentally different to spoken languages. It is difficult for hearing people, whose language developed through listening, to fully master sign language, unless they were exposed to it as a young child – hearing children of sign using deaf parents for example. Deaf children would need to be surrounded at an early age by fluent sign language users if they were to develop vision and movement as the basis of their language. The parents and family of a deaf child are not normally fluent sign language users, and are unlikely to become so during the early years that are vital to language acquisition.
There is no evidence for this. It seems likely that deaf children will be better adjusted if they are able to mix naturally with their family and community and fulfil their educational potential. This makes it more likely that children educated through spoken language will become well adjusted.
Recent research shows that children who follow the natural aural approach and have not used sign language, have better communication skills.
Ann E Geers’ study provides the most compelling support yet available in CI literature for the benefits of spoken language input for promoting verbal development in children implanted by 3 years of age.
This is an issue of parental choice for their children. The absence of spoken language in the home makes it more difficult for such children to learn to listen and talk but it remains a feasible alternative. In order to achieve spoken language these children need to receive their education in a spoken language environment not involving the use of sign and other family and friends need to provide as much spoken language for the child in the home as possible.
Yes it can!