By Elizabeth B. Cole and Carol Flexer, author of Children With Hearing Loss: Developing Listening and Talking, Birth to Six, Third Edition
Spoken language is acoustically based. When the expectation is that a child will learn spoken language, hearing loss presents a critical spoken language-information-accessing obstacle to the child’s brain. When, through the miracle of modern technology and expertise, the audiologist provides the child’s ears with appropriately selected and programmed hearing aids or cochlear implants, the child’s brain now has access to the acoustic information encoded in spoken language. Looking at it this way, for the child who is learning spoken language, untreated hearing loss presents not only an ear problem, but also a brain access problem. Luckily, given sufficient acoustic access to spoken language in meaningful, varied-but-repetitive contexts, the child’s brain learns to make sense of the auditory input and learns to understand and produce spoken language. That process can be described in just one sentence, but is far from simple. The process of helping a child with hearing loss learn to listen and talk fluently requires a great deal of time, commitment, and sustained effort from all those who care for the child.
In recent years, there has been a veritable explosion of information and technology about testing for and managing hearing loss in infants and children, thereby enhancing their opportunities for auditory brain access. The vanguard of this explosion has been newborn hearing screening. As a result, in this day and age, we are dealing with a vastly different population of children with hearing loss, a population that we’ve never had before in our history. With this new population whose hearing loss is identified at birth, we can facilitate access of enriched auditory/linguistic information to the baby’s brain. The miracle is that we can prevent the negative developmental and communicative effects of hearing loss (such as delayed speech, language, reading and social skills) that were so common just a few years ago. With these babies and young children, we can now work from a neurological, developmental, and preventative perspective rather than a remedial, corrective approach. As we implement brain-based science, the effects on the field of hearing loss are truly revolutionary.
The following are some suggestions for families and practitioners who want to grow the baby/child’s brain for listening and spoken language. Many of the suggestions describe things that any devoted parent would likely do with a child. Beyond the technology, what is different for the parent of a child with hearing loss is the requirement for constant vigilance for decreasing noise and distance, and the requirement for sustained effort at increasing appropriate and meaningful verbal interactions with the child. These are the so simple, yet so difficult, keys for successfully laying the spoken language foundation that the child needs for the rest of his or her life. The authors take their hats off to all of the thousands of parents who have internalized all of the strategies and accomplished just exactly that!
- Your child must wear his or her hearing aid or cochlear implant every waking moment and every day of the week—“eyes open, technology on” (even when bathing or swimming, use technology that is water resistant/proof). The brain needs constant, detailed auditory information in order to develop. The technology is your access to the brain and your child’s access to full knowledge of the world around him or her. If your child pulls off the devices, promptly, persistently, and calmly replace them.
- Check your child’s technology regularly. Equipment malfunctions often. Become proficient at troubleshooting.
- The quieter the room and the closer you are to your child, the better you will be heard. The child may have difficulty overhearing conversations and hearing you from a distance. You need to be close to your child when you speak, and noise in the environment (especially from nonstop TV or other electronics) needs to be greatly reduced or eliminated. Keep the TV, computer/tablet, and CD player off when not actively listening to them.
- Use an FM system at home to facilitate distance hearing and incidental learning. An FM system can also be used when the child is reading out loud to improve the signal-to-noise ratio and to facilitate the development of auditory self-monitoring. Place the FM microphone on the child so that he or she can clearly hear his or her own speech, thereby facilitating the development of the “auditory feedback loop.”
- Focus on listening, not just watching. Call attention to sounds and to conversations in the room. Point to your ear and smile, and talk about the sounds you just heard and what they mean. Use listening words such as “You heard that,” “You were listening,” and “I heard you.”
- Maintain a joint focus of attention when reading and when engaged in activities. That is, the child should be looking at the book or at the activity while listening to you so that he or she has a chance to gain confidence in his or her ability to listen and understand without watching.
- Speak in sentences and phrases, not single words, with clear speech and correct grammar using lots of melody. Speak a bit slower to allow the child time to process the words, but be careful not to exaggerate your mouth movements. Many adults speak faster than most children can listen.
- Read aloud to your child daily. Even infants can be read to, as can older children. Try to read at least ten books to your baby or child each day. You should be reading chapter books by preschool.
- Sing and read nursery rhymes to your baby or young child every day. Fill his or her days with all kinds of music and songs to promote interhemispheric transfer. Singing is a whole brain workout!
- Constantly be mindful of expanding your child’s vocabulary. Deliberately use new words (in appropriate phrases and sentences) with the child for objects, foods, activities, and people as you encounter them in the environment during daily routines.
- Talk about and describe how things sound, look, and feel.
- Talk about where objects are located. You will use many prepositions such as in, on, under, behind, beside, next to, and between. Prepositions are the bridge between concrete and abstract thinking.
- Compare how objects or actions are similar and different in size, shape, quantity, smell, color, and texture.
- Describe sequences. Talk about the steps involved in activities as you are doing the activity. Sequencing is necessary for organization and for the successful completion of any task.
- Tell familiar stories or stories about events from your day or from your past. Keep narratives simpler for younger children, and increase complexity as your child grows.
Above all, love, play, and have fun with your child!
Please read Dr. Cole and Dr. Flexer’s Children With Hearing Loss: Developing Listening and Talking, Birth to Six, Third Edition for detailed information about audiology, technology, parent coaching, and listening and spoken language development.