Support Services Handout Series
Number 4002 Communication Sheet
Frequently Asked Question: Number 1

Meeting Individual Needs

There is not one right answer for all children. It is necessary to look at each child individually when making decisions about hearing aid use and auditory and speech development. Planning should involve a team approach including family members, audiology and speech professionals, teachers, and other specialists involved in the child's educational programming. Family education is essential to help families understand the impact of hearing aids and auditory and speech development. Development of a child's auditory and speech skills should be addressed within the context of his/her overall visual and spoken language development and educational program. Opportunities should be provided for trial use of a hearing aid and observation of a child's responses and progress in listening, and speech development to assist in determining how this area of development will realistically benefit a child. The degree of focus placed on auditory and speech training for children will vary based on indicators suggesting potential for developing listening and speech skills ( i. e. degree of hearing loss, consistent use of amplification, ongoing progress in this area of development). The amount of emphasis placed on development of auditory and speech skills should be proportionate to each child's potential and interest for developing these skills.

The Role Of Early Intervention

Our experiences suggest that hearing aid fitting and development of auditory and speech skills should be addressed as early as possible. This may be as early as infancy. There is evidence that a window of opportunity exists from birth to age 5, when it is easier for a child to develop skills such as listening, speechreading, use of voice and use of mouth movements in an appropriate manner. When a child has the opportunity to incorporate auditory and speech skills into early development, use of these skills may more readily become a part of his or her communication repertoire. There also may be less of a chance that the child will develop habits such as lip smacking, vocalization for tactile stimulation and use of inappropriate voice intensity. When a child is using ASL as his or her primary language, amplification and auditory and speech development may provide another avenue for the acquisition of information and development of overall communication skills.

What About Hearing Aids?

Auditory and speech development may be facilitated by the use of a hearing aid. However, for children who do not benefit from a hearing aid, developing functional communication skills, enhances overall communication abilities. For example, children who do not use hearing aids can develop an understanding that a) mouth movements and speech reading facilitate communication, b) sound has a purpose in the environment and c) most people communicate via sound and speech. Children can also develop speech reading skills, use of mouth movements, appropriate use of vocalization, conversational strategies, facial expression and body language, to facilitate communication.

Determining if and how much a child benefits from a hearing aid involves ongoing formal evaluation of hearing aid benefit, as well as observation of the child using a hearing aid in their everyday environment. There are varying degrees of possible benefit from a hearing aid, ranging from awareness of sound in the environment and voice monitoring, to a sophisticated understanding of spoken language. To what degree a child will benefit from a hearing aid is not always clear cut. Some children automatically demonstrate their benefit from a hearing aid. For these children, making a decision regarding continued use of a hearing aid may be easy. Other children may require intensive instruction before their benefit or lack of benefit from a hearing aid becomes apparent. Some children, demonstrate limited benefit from a hearing aid on formal testing or in the environment yet they may still accept, use, or request their hearing aid on a consistent basis. This behavior may indicate that the child is obtaining benefit from the aid that can not be measured formally or observed by others. Children should have an opportunity to experience the use of a hearing aid to determine possible benefit. While we advocate early amplification fitting, there are times when hearing aid use may not be a priority for a child at a given time or at all. For example, there may be situations here focus on hearing aids may be secondary to a child's other medical, physical, cognitive, and family needs. Hearing aid use then may be postponed while other more immediate issues are addressed, with hearing aid use revisited at a later time . There also may be situations where after continued use and evaluation of a hearing aid, no benefit can be measured or observed by the child or others. For these children, it may be recommended that hearing aid use be discontinued. Professional recommendations regarding hearing aid use may be in opposition to the values of the family. (i.e. family may feel that use of an aid is not necessary because the child will be communicating via sign language, family may not accept that the child has a hearing loss and may need a hearing aid). In such situations, sensitivity and respect by professionals should be demonstrated. Sometimes a hearing aid may cause interference to a child. Some children have problems related to sound intolerance, tinnitus (ringing in the ears), or distortion in their auditory system that may make hearing aid use a hindrance rather than a help. For all of these reasons, decision making regarding hearing aid use must be an ongoing process involving both family and professional input.}

Considerations for Planning

There are a variety of issues regarding use of amplification and training related to auditory and speech development at an early age that should be taken into consideration. It is important to remember that no decision is final. Programming for auditory and speech development should be re-evaluated as needed based on a child's performance and interest in this area, maturation, improvements in technology, revisions in family goals, etc. Listed below are some considerations related to hearing aid use and establishing an early auditory and speech development program when American Sign Language is the primary language used in the educational setting.

• Early amplification and training help facilitate speech and auditory skill development. Early intervention provides the opportunity for children to be exposed to the concept that information in the environment can be received and transmitted through talking and listening as well as through ASL. When auditory and speech development is addressed at an early age, the family may better see how and to what extent these skills are going to fit , or not fit into their child's overall language development and communication functioning. When auditory and speech training is not provided at an early age, the opportunity for maximum development of potential in this area may not be realized. Auditory and speech skill development can be addressed at an early age while visual language is also emerging. American Sign Language (ASL) should be developed and utilized separate from spoken language. Concepts and linguistic skills a child has developed in ASL can be used to facilitate development of auditory and speech skills.
  
  The use of sign supported speech (simultaneous communication) may be a useful tool for the purpose of training auditory and speech skills and for meeting specific communication needs. (e.g. hard of hearing children) In these situations, sign supported speech provides a child with visual input to supplement possible gaps the child may experience when provided with only auditory/speechreading information.
  
  
• It is important to consider the amount of emphasis placed on development of auditory and speech skills with a child's potential. Factors including a child's hearing level, progress, and interest should be evaluated routinely in monitoring a student's goals in this area of development.

Response developed at Kendall Demonstration Elementary School by: Debra Nussbaum, Audiologist, Bettie Waddy-Smith, Communication Specialist/Speech, Stephanie Marshall, Audiologist, March, 1998.

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