101 IDEAS for FA MILIES - Clarke Schools for Hearing and ... · Janice Gatty, Ed.D. Director of Child & Family Services Marian Hartblay, M.A.T., M.E.D. Director of Early Childhood

Janice Gatty, Ed.D.Director of Child & Family Services

Marian Hartblay,M.A.T., M.E.D.Director of Early

Childhood Services

101 IDEASfor FAMILIES

with INFANTS who are DEAF or HARD of HEARING:AN APPROACH TO LISTENING AND SPOKEN LANGUAGE

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Acknowledgements

We would like to express our appreciation to the people who helped develop this booklet.The content of the book is provided by the staff who work with families in the Infant-Toddler,Preschool, and Evaluation Programs at Clarke. The most insightful contributions have come,of course, from the parents and children with whom we work. With their trust, we share theirexperiences with you.

We also wish to recognize the administration of Clarke Schools for Hearing and Speechfor their expertise and for providing additional material and professional support. We extenda special note of appreciation to Maureen Uhlig and Jessica Appleby who helped us to makethese ideas presentable to you. J.G. and M.H., Northampton, MA

This booklet was made possible in part by a grant from The Grossman Family Foundation,whose generous support has also enabled Clarke to launch the innovative tVisit program thatprovides early intervention services to families of infants and toddlers with hearing loss in thecomfort and convenience of their home via the Internet. To learn more about the tVisit pro-gram, visit clarkeschools.org/tvisit or call 413.584.3450.

Preface

As a result of newborn screening programs, children with hearing loss are identified atyounger ages than ever before. For children who are deaf or hard of hearing, this has meantimproved outcomes and greater opportunities. For parents, however, learning about theirchild’s hearing loss this early can be an overwhelming experience. Parents are faced with hear-ing loss related decisions and responsibilities almost immediately — before they know any-thing about their child.

Our goal is to provide support and guidance for parents who are considering a listeningand spoken language approach to communicating with their child. Most families will have thesupport of an early intervention team of professionals (which can include a teacher of the deaf,speech pathologist, audiologist, early childhood educator, and/or a developmental specialist).The ideas in this booklet will help you and your team set goals for developing listening andspoken language skills as your child grows.

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DedicationThe 2014 edition of this publicationis dedicated to the memory ofCaley Larkin, whose family partici-pated in the Parent-Infant programat Clarke when her older brother,Ryan, lost his hearing due to menin-gitis. In a sense, the real authors ofthis booklet are family memberslike the Larkins who taught us mostof what we know about supportingand educating parents. The Larkin ’sgenerous gift has made it possibleto share this knowledge with fami-lies as they help their children growinto well-adjusted, capable, andconfident adults.

Thanks to a supportive family, and thewelcoming teachers and staff at SouthernBerkshire Regional School in Sheffield,MA, Ryan was mainstreamed in the localschool system from kindergarten throughhigh school.

Ryan was inspired by the entrepreneurialspirit of his extended family and, in 2003,started his own sign and auto detailingbusiness. Today his successful commer-cial sign business has grown to includelocal municipalities, hospitals, restau-rants, contractors, and retail businesses.

Ryan also acquired a taste for auto racingfrom his father and successfully raced forfive years. In his spare time, you will mostlikely find him on his boat or hitting thelinks.

Ryan and his bride, Jess, have just pur-chased their first home.

Clarke teacher Janice Gattyand Ryan in the Spring of 1984.

Caley and Ryan with theirparents Beth and Dickie

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Contents

Diagnosis is a Process (items 1-13) 1

Reducing Stress (items 14-27) 4

Deafness and Development (items 28-31) 6

Auditory Perception and Development (items 32-40) 8

Social-Emotional Development (items 41-49) 10

Cognitive Development (items 50-60) 12

Early Communication Spoken Language 14Examples of IFSP Goals

Auditory (items 61-72) 14Speech (items 73-79) 16Receptive Language (items 80-87) 16Expressive Language (items 88-94) 17

Motor Development (items 9 -100) 18

Movements of the Speech Mechanism 18

Conclusion (item 101) 19

Words from Parents 19

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and

1 Do not take your child for his or herhearing test by yourself. There will be

a lot of new information, concepts, andvocabulary presented during the hearingtest. It’s helpful to have another adult withyou to hear the results. If two parents areinvolved in making decisions, both par-ents should be present. If you must goalone, consider recording the consultationto share with your partner, extended fam-ily, or an invested friend.

2 Establish a relationship with a pediatric audiologist who has had

experience with deafness in young chil-dren. Some audiologists are experi-enced in diagnosing and treating olderpatients with hearing loss, but are lessexperienced in the developmental needsof infants and young children. You canask your pediatrician for referrals to

pediatric audiolo-gists, call a pedi-atric hospital, orcontact an educa-tional program forchildren with hear-ing loss to ask forrecommendations.Interview the audi-ologists. Ask themabout their experi-

ence working with young children and,particularly, their experience workingwith deaf children whose parents havechosen to use a listening and spokenlanguage approach to communication.

3Follow up on your referral for audi-tory brainstem testing (ABR) and

behavioral testing promptly. Gettingtesting done early is important. Sched-ule tests to evaluate your child’s hearingstatus every three months for the firstthree years. Observe the testing and dis-cuss observations with the audiologistafterwards.

4 Keep a notebook with records ofyour visits. A three-ring binder is a

good tool to organize test results, yourquestions (and their answers), andinstructional or educational materialsthat can help you understand the natureof your child’s hearing loss.

5 Ask about the differences betweenhearing tests. There are many dif-

ferent tests used to evaluate variousaspects of your child’s hearing, includingauditory brainstem responses (ABR),otoacoustic emissions (OAE), “real ear”measurements, bone conduction, sound-field testing, behavioral observation test-

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Diagnosis is a processDiagnosis is the process where we learn about a child’s hearing loss anddetermine what a child can and cannot hear, both with and without ampli-fication (such as hearing aids, FM systems, or cochlear implants). Thisprocess usually happens over a period of time, as opposed to all at once,and may consist of many tests. It is important for you, as a parent, tounderstand the nature of your child’s hearing loss and how it can affect hisor her development. Keep these tips in mind as you move through thediagnostic process.

What is a sensory aid?A sensory aid is adevice used tohelp a person withhearing lossaccess sound.Examples includehearing aids andcochlear implants.

?


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ing, visual reinforcement audiometry,conditioned play audiometry, and tym-panometry. Ask your audiologist toexplain these tests, their results, andwhat they mean for your child’s hearing.

7Ask questions. Although profes-sionals can help guide decisions,

decision-making is ultimately theresponsibility of the family. You shouldfeel comfortable asking questions andtaking an active role. Make sure you aregetting the information you need tomake an informed decision. No questionis too simple. Examples include:• Does my child need hearing aid(s)?• What does my child hear without hear-

ing aids? With hearing aids?• What does “degree of hearing loss”

mean?• Would my child benefit from a cochlear

implant?• Will my child be able to learn spoken

language?• Will my child’s hearing loss get better?

Will it get worse?• How might hearing loss in only one ear

(a unilateral hearing loss) affect mychild’s development?

• Should I be concerned if my child’shearing loss is only mild or moderate?

8Learn how to understand and readan audiogram. An audiogram is a

graph that shows the quietest sounds aperson can hear at different pitches orfrequencies. Ask what the audiogramresults mean in terms of your child’saccess to spoken language, both withand without a hearing aid.

9Ask the audiologist to put you intouch with older children or adults

who have a hearing loss similar to yourchild’s. Observing children at differentstages of development can offer parentsan important perspective on their child’sdevelopment. If your audiologist cannotdo this, a teacher of the deaf may beable to help.

10Ask to speak with other parentsof children who are deaf. Audiol-

ogists, speech and hearing clinics, pro-grams for the deaf, or early interventionagencies may have a list of parents whoare available to speak with you.

11 Establish full-time use of hearingaid(s). Children need consistent

exposure to sound to develop an under-standing of what different sounds mean.Full-time use of hearing aids (wearingthem during all waking hours) is essen-tial for your child to develop the foun-dations for listening and spokenlanguage. If you are considering acochlear implant, full-time hearing aiduse is an important step towards estab-lishing candidacy.

Ask about the dif-ferent types of hearing

loss and degrees of deafness.An audiologist and teacher of the

deaf can explain how the ear worksand what your child’s hearing lossmeans for his or her development.They can also help you understandthe different types of hearing loss,

such as a sensorineural hearingloss, conductive hearing loss,

or mixed hearing loss.

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12 Monitor your child’s responses.The capacity for a child to use

his or her residual hearing cannot bemeasured accurately until full-time useof sensory aids or amplification is estab-lished. Observe your child’s responsesto sound while wearing hearing aids inmany different settings, and reportthese observations to your audiologistand interventionist. These observationswill help your team assess your child’sdevelopment.

13 Learn about the causes of deaf-ness. Although hearing loss is not

typically a threat to overall health, it may

be important to you to know the specificcause of your child’s deafness. The primarycauses of deafness are genetic predispo-sition, illness, and trauma. Several genesassociated with hereditary deafness haverecently been identified. If illness or traumacaused the hearing loss, or if the hearingloss happened suddenly, your child’s over-all health should be evaluated. Thoughrare, there are some syndromes associatedwith deafness that have additional healthrisks. Ask your pediatrician if you haveother concerns, and find out if your childshould have further medical evaluations.Your pediatrician can provide referrals forscreenings and genetic testing.


14 Allow time for feelings associ-ated with the initial diagnosis.

These can include anxiety, anger, guilt,and even joy. Most parents experience arange of emotions related to their child’shearing loss and the changes in theirlives. Expect similar feelings to surfaceand acknowledge what you are feeling.Expect that these feelings might recur atthe beginning of each new stage of yourchild’s development.

15Get to know your child exclusiveof his or her hearing status. Relax

with your child. Enjoy holding him or her,looking at each other, and knowing eachother through everyday activities likefeeding, bathing, diapering, talking, andplaying together.

16 Understand that a portion ofyour time will be devoted to

learning more about deafness and yourchild’s development. Recognize yourchild’s need for individual attention andplan special activities that encourage hisor her strengths.

17Be informed of the range ofoptions and opinions when mak-

ing decisions about communication. Askwhat options are available for the devel-opment of communication. Be wary ofsimplistic statements that may restrict

your child’s options. Observe differenteducational programs for children whoare deaf or hard of hearing, and talk toother parents regarding approaches todeveloping spoken language. Get in touchwith deaf adults who communicate in avariety of ways (spoken language, signlanguage, or some combination). Remem-ber that information on the Internet is notindividualized to your child or family.

18 Look for creative ways to organ-ize your schedule. Scheduling

appointments and testing along withother household responsibilities mayseem overwhelming. Think creatively;arrange for childcare or play dateexchanges with neighbors and friends,invite family or neighbors to help withsiblings while you go to appointments,and speak to your employer about flexi-ble scheduling.

19Make room for resources. Therewill be many new people in your

life, including audiologists, early inter-vention specialists, teachers of the deaf,speech-language pathologists, and audi-tory verbal therapists. Other resourcesmay include social workers, geneti-cists and other medical specialists,cochlear implant center staff, andeven occupational therapists and/orphysical therapists.

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Reducing StressAfter diagnosis, many family routines may change. Appointments for diag-nostic work, early intervention, and therapies can complicate day-to-daylife. Making decisions about communication choices and dealing with thepolitics of education and deafness can create anxiety for new parents. Thereare many ways to reduce stress during this adjustment period.


20Prioritize your time andresources. You may have more

opportunities for resources than time andenergy to use them. Decide who will bethe most helpful in addressing your child’sneeds and the needs of your family at thecurrent time. This may vary at differenttimes (such as illness or diagnosis).

21 Include as many family membersas possible. Don’t try to manage

things alone. Share responsibility andknowledge with family and friends.

22 Advocate for your child. Followyour gut instincts if something

does not seem right. Get help by askingfor meetings, evaluations, examinations,assessments, and services.

23Don’t expect everyone tounderstand your child’s hearing

loss. Many adults have never known achild who is deaf. Some may think thatyour child can hear nothing; others mayfind it hard to believe that your child hasa serious hearing problem because he orshe is so responsive to sound.

24 Find a special time for childrenin the family who are not deaf.

Many parents express concerns abouthearing siblings. Some siblings may take

on adult-like responsibility and feel aduty to “teach” their deaf or hard ofhearing brother or sister. Create specialtimes for your children together as wellas individually. Encourage siblings tocommunicate naturally and not to takeon too much responsibility.

25Ask your early interventionteam to review diagnostic

information. The initial diagnosis of yourchild’s hearing loss can be shocking. Theresponsibilities can be overwhelming.Ask for help in reviewing your child’s his-

tory and reports. Ask for (and expect)suggestions on next steps.

26Avoid pressure to be theteacher or professional. Chil-

dren with hearing loss have many teach-ers, therapists, and clinicians. They haveonly two parents. It’s an important job.Enjoy it.

27Take time for other family andadult relationships. Your child

will need special attention from youevery day. Remember to protect familytime. Build in a weekly break with grown-ups that is fun and restorative.

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Although hearing loss is not typically a threat to overall health, it may be important to you to know the specific

cause of your child’s deafness. The primary causes of deafness are genetic predisposition, illness, and trauma.

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28Become familiar with typicalbehaviors for all areas of devel-

opment. A range of behaviors isexpected of children at any given age forall areas of development (motor, social,emot iona l , cogni t ive , language) .Understanding the range and anticipat-

ing these behaviors will help you developappropriate expectations for your child.Your pediatrician, early interventionist,and teacher of the deaf can be a greatresource in these areas.

29Learn about legislation designedto help deaf children and their

parents. Federal law mandates interven-tion services for children with specialneeds from birth to three years of age. Part “C” of the IDEA Act, originallyPart “H” of P.L. 99-456, legislates earlyintervention services for all children whoare at risk for developmental delays. Inmany states, early intervention agenciesare charged with the task of providingservices to infants with hearing loss andtheir families. Such programs may be

staffed with a nurse, early childhood edu-cators, a special educator, a speech-lan-guage pathologist, a physical therapist,and an occupational therapist. Agenciesmay or may not have staff who are expe-rienced in working with children whohave hearing loss. In addition, some

teachers of the deaf are trained specifi-cally in sign language and may not beexperienced in addressing listening andspoken language. Many early interventionagencies will contract with providers whospecialize in deafness. You may requestto have a teacher of the deaf experiencedin maximizing listening and spoken lan-guage on your educational team.

30 The “naturalistic setting” ofchoice for an infant or young

child is the family. Current federal guide-lines mandate that early interventionservices should be provided in “natural-istic settings.” The naturalistic settingfor infants and young children is in thefamily. The goals and expectations of thefamily contribute greatly to the child’s

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Deafness and DevelopmentHearing is the dominant sense in learning to understand spoken language.Language gives human beings a way to communicate with others and is theprimary way that we interact socially. Children learn about their world anddevelop an understanding of concepts by socializing and using their sensesto explore. Early intervention techniques are used to help reduce the effectsof hearing loss on this development. The following ideas guide parents andprofessionals in addressing a child’s needs in ALL areas of development.

A holistic approach to intervention considers the global effects that hearing loss can have on development.

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social and emotional development. It isimportant that parents and extendedfamily learn how to adapt their commu-nication style to give the child access tothe family culture.

31 Work with an early childhoodeducator or early intervention

specialist who is familiar with deafness.A holistic approach to intervention con-siders all the ways that hearing lossaffects development. This approach

helps parents identify which behaviorsare age-appropriate (typical), whichare a direct result of the hearing loss(delays in speech and language), whichare a result of other issues secondaryto hearing loss (social or behavioral),and which may have other causes (cen-tral processing or perceptual disor-ders). Ask your team about thebehaviors you observe in your childand ways you can encourage orrespond to those behaviors.

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32Get comfortable with yourchild’s hearing aid (or other

sensory device). If you are uneasyaround your child’s hearing aids, yourchild may sense your discomfort andresist wearing them. Get familiar with thedevice: handle it, explore it from differentvisual angles, listen to it daily, and noticethe parts that move and can open or pullapart. Ask for an explanation of how itworks. As your child adjusts to wearingthe aids, he or she will notice your com-fort and familiarity.

33 Check the working condition ofthe sensory device(s) each day.

Ask your audiologist for a listening kitand instructions on care. The kit shouldinclude: a battery tester, a stethoscope, adry-aid kit, a blower, and an ear moldcleaner. Listen to the hearing aids dailyfor quality and consistency of sound, andcheck all pieces of the device for integrityand cleanliness. A cochlear implant cen-ter will provide maintenance and a trou-bleshooting kit for the processor.

34 Ensure consistent auditoryinput. The brain relies on con-

sistent, steady, and reliable sensory inputfrom the sensory receptors (eyes, ears,nose, mouth, and skin) to develop anunderstanding of sound.

35 Establish full-time use of hear-ing aids. Full-time use means

that a hearing aid or CI is worn when-ever your child is awake. Infants andyoung children may pull hearing aidsout of their ears repeatedly in the begin-ning. If your child has difficulty with this,you can start slowly and increase thetime the aids are worn each day. Haveclear and consistent expectations. Foryoung children, use a doll to explainhow your child should wear the hearingaids. Smile and praise your child whenhe or she wears them. If your child pullsout the hearing aids, acknowledge theevent and calmly put the hearing aidsback into his or her ears.

36Monitor your child’s use of sen-sory devices. Hearing aids

should be set high enough for your childto hear, but not so high that the sounds

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Auditory Perception andDevelopmentHearing children respond to sound in the womb. The process of under-standing what sound means, however, begins after a baby is born. It isa process that involves not just hearing and vision, but all of the senses.For children with typical hearing, this process takes place naturally with-out any special instruction. When a child is deaf or hard of hearing, theprocess of auditory development begins when he or she is providedwith access to sound, typically through a sensory aid (such as a hear-ing aid or cochlear implant).


could damage residual hearing. Per-formance with the hearing aids shouldbe measured through hearing tests.Ask your team about cochlear implan-tation if hearing aids do not provideenough benefit.

37 Maintain health and function ofthe middle ear. The purpose of

the middle ear is to conduct sound fromthe outer ear to the cochlea. Conditionsinvolving the middle ear, such as aretracted eardrum (negative tympanicpressure), middle ear fluid, or ear infec-tions, are easily detected and usuallytreatable. These conditions can preventthe child from receiving the full benefitof a hearing aid. Your child’s middle earfunction should be checked at leastevery three months or more often ifcolds or allergies seem to affect the abil-ity to hear.

38Be aware of sounds and drawattention to them. Hearing peo-

ple quickly “tune out” environmentalsounds, such as a loud air conditioner, topay attention to more important sounds,such as a person speaking. When helpinga young child learn to use amplification,adults need to be aware of even mun-

dane sounds in the environment and callattention to them. Be aware that back-ground sounds such as dishwashers,fans, radios, and televisions will competefor your child’s attention. Control thechoice of sounds and background noisein your home to make it easier for yourchild to listen.

39Develop a rich model of theworld of sound. Expect your

child to be aware of and respond tosound. Look for changes in your child’sbehavior in response to sound (such aslooking for the sound, turning toward thesound, pointing to the ear, or babbling).Acknowledge his or her response to rein-force the meaningfulness of the sound.

Reinforce bab-bling. Smile, imi-

tate or talk to yourchild in response tohis or her babbling. This helpschildren develop an aware-ness of their ability to

produce sound.

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41Ensure face-to-face communica-tion. Non-verbal behaviors such

as eye contact, facial expressions, andgestures communicate important infor-mation. Being face-to-face with yourchild shows interest and attention. Capi-talize on your child’s ability to use thisinformation. Position your child in frontof you or kneel down so that he or shecan look at your face as you speak.

42 Play games that require turntaking. Turn taking is natural

and necessary for dialogue or conversa-tion. Verbal and non-verbal games thatinvolve turn taking, such as peek-a-booor building blocks, can be fun, relaxing,and very engaging and can give childrenan opportunity to communicate.

43Let toddlers be toddlers. The“terrible twos” are not terrible

from the two-year-old’s perspective! Withincreased mobility, the world of a two-year-old expands greatly. Toddlers aremotivated by their new abilities. “No!” is apowerful word and sentence for any tod-dler. Keeping your child physically safeduring this time of exploration and exper-imentation is important. Respecting chil-dren’s attempts at autonomy andindependence is important for their socialand emotional growth. Make sure that

your child has opportunities to asserthimself or herself with authority andhonor those attempts when appropriate.

44 Acknowledge your child’smessage and emotional

intent. Label feelings (such as “You’resad!”) so your child’s frustration canfocus on an event instead of a break-down in communication (for example,“You threw the sandwich on the floor. Iknow you do not want the sandwich butyou may not throw food!”).

45 Encourage your child to learnwords that express his or her

needs. Some early words are meaningfuland powerful because they give childrenan opportunity to control their environ-ment through language. First words suchas “yes,” “no,” “open,” “up,” “mine”,“more,” “push,” “pull,” and “bye-bye” giveyoung children an opportunity to expe-rience the power of language.

46Use language to help childrenlearn how to delay gratifica-

tion. At two years of age, hearing chil-dren are beginning to be able to regulatetheir needs through the use of language.Language such as “Wait a minute!” or “I’llbe right back!” is often accompanied bya natural gesture and is part of a two-

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Social-Emotional DevelopmentLanguage is learned in a social context. Children learn their native lan-guage by interacting with fluent users. Later in development, languagefacilitates social interaction. When language is truly reciprocal, it becomesa means of learning about others and one’s self. Therefore, language isimportant for the development of a sense of self and cultural identity.

These tips will help you address the social and emotional needs ofyour child.


year-old’s vocabulary. This language mayneed more formal demonstration with achild who is deaf or hard of hearing.

47Daily routines and activitiescan provide a structure for a

child with limited language and helphim or her to feel included in events.Children with limited access to soundand language may perceive the world aschaotic and unpredictable. Languagecan make a young child’s world, overwhich they have very little control, seem

more predictable. Daily routines andactivities will give your child a sense ofconfidence and familiarity.

48Allow and help your child todevelop an identity as a child

who has a hearing loss. Most childrenwho are deaf (over 90%) are born tohearing parents. Hearing parents greatlybenefit from connecting with deaf adultsand children. It is also helpful for evenvery young children to see and interactwith peers who also wear sensory aidsand communicate in a similar style.Establishing a healthy social identityhelps children to know that they are part

of a group with whom they share com-mon characteristics.

49Your pace or mine? Childrenexperience life at a different

pace from adults. Young children needtime to stop to smell the flowers and feelthe water. Children who are deaf needeven more time for exploration becauseof the reduced sensory input imposed byhearing loss. Rushing them through atransition, routine, or activity is likely tocause frustration and anxiety. Here are

some examples of how to set a pace thatis comfortable and geared to languagelearning.• Point to your ear and tell your infant

that you heard the telephone; take himor her with you to answer it.

• Go for “sound walks” and help yourchild listen and see what is makingsound in the house or outside.

• Talk to your child about what he or sheis exploring—the way that soap bubblesup while they wash their hands, themark a stick makes in the dirt, or thewheel that spins around and around.

• Show and tell your child that your coffeecup is empty and you’re going to fill it.

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50Establish routines for dailyactivities. Day-to-day activities

and transitions can seem unpredictableto a child who is deaf. Having set rou-tines around daily events can make theenvironment more predictable. Daily rou-tines include waking up and putting onthe hearing aids, going to the changingtable or bathroom, nursing or breakfast,bathing, dressing, and planning the day.

Each of these events involves a repeatedset of activities and language.

51 Prepare children for transitionsthat they cannot predict by

“overhearing.” Sounds allow hearing chil-dren to prepare for upcoming changes inthe environment. For example, a hearingtoddler may overhear her mother talkingon the telephone. After the mother says“good bye,” the toddler hears a rattle ofkeys and the opening and closing ofcloset doors. Mom appears in the tod-dler’s room wearing her coat, with thetoddler’s coat in hand. This toddler is notsurprised to be told that she and hermother are going out. A child with hear-ing loss does not have access to these”clues” and may feel surprised or unpre-

pared. You can help prepare your toddlerby including him or her in the preparationfor an event (such as looking for the keysand coats together before going out).

52Use symbolic materials to helpyour child understand lan-

guage. Language allows us to talk aboutthe past, prepare for the future, and referto things we cannot see. This is a chal-

lenge for young children with hearingloss. Use toys, pictures, photographs, andbooks to help relate language to ideas.

53Provide your child with a vari-ety of symbolic play materials.

Symbolic materials are objects or toysthat can be used to represent people,objects, or events. Playing with symbolicmaterials allows young children toexpress ideas and understanding of theworld even when language is limited.Here are some examples of toys that canenrich your child’s play.• Doll house with extended family of dolls• Dolls with hearing aids and cochlearimplants

• Vehicles (such as fire engines, trucks, ora school bus)

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Cognitive DevelopmentChildren who are deaf or hard of hearing who have hearing parents are atrisk for learning to listen and talk using the family’s native language. How-ever, imperfect access to sound does not have to result in cognitive delays.Here are some ideas to help parents feel confident that they are meetingtheir child’s intellectual needs during early language development.

Read picture books together and talk about and point to what you see, modeling so that your child

eventually points to the picture as you talk about it.84


• Animals (pets, farm, wild, zoo, birds,bugs, or fish)

• Building materials (blocks, LEGOs, orLincoln Logs)

55Picture books are an example ofsymbolic materials that can be

used to help children understand anddevelop spoken language. Create yourchild’s own books with digital photos orcut-outs from magazines. A small, inex-pensive photo album works well in littlehands and is very motivating when itcontains your child’s pictures. Examplesof books include:“Who Book” pictures of familiar people

in the child’s world “What Book” pictures of familiar things

(toys, food, or clothing)“Where Book” pictures of familiar

places in the child’s world (home,grandma’s, school, or the library)

“Sound Book” pictures of objects orevents associated with familiar soundpatterns in the child’s environment (atelephone or a musical toy)

“Event Book” designed to prepare forand/or review a routine event thatmight happen repeatedly in a child’slife but is not part of his or her every-day experience (going to the doctor, atrip to the library, or holidays)

56Talk about “Same” and “Differ-ent”: Even very young children

can understand the concepts of similar-ity and difference: Are these colors thesame or different? Do these letters lookthe same or different? Do they sound thesame or different? Are these quantitiesthe same or different? Making childrenaware of similarities and differences canhelp them “organize” the world, and pre-pare for school settings.

57Allow time for your child torespond. Children need more

time than adults to take in sensory infor-mation (listen, see, touch) and respond.Be patient and give your child time forthis process.

58Observe your child’s behaviorover time. You will learn about

your child’s needs as they emerge andchange. If possible, videotape your childperiodically to document these changes.

59Notice how your child learnsabout the world. Children have

different ways of learning about theworld. Some children need more time toobserve. Others may need to exploreactively by touching and moving objects.Notice how your child approaches newexperiences. Understanding your child’slearning style can help you increaseopportunities for learning.

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Provide “realand direct” experi -ences with a varietyof activities. All chil-

dren learn by interacting with theworld around them. It is especially

important for children with languagedelays to interact with a variety ofpeople and objects and have experi-ences to enrich and complete theirmodel of the world. Take your childwith you to close the door, get themail, or visit the store. Value the

richness of baking cookies,planting flowers in a garden,

and tightening a loosescrew.

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them

60Read to your child. National sta-tistics indicate that the reading

level of children who are deaf is wellbelow the national average, but this doesnot have to be so. Reading with your childfrom a very early age can facilitate lan-guage development, and later, literacy.When you and your child look at a booktogether, your child will be close to you,usually in your lap. This is a great listening

position. You can look at picturestogether and ask your child questionsabout the pictures. Just talking about thepictures is an important part of reading.Reading picture books and stories to chil-dren, even in infancy, helps to developsymbolic meaning, vocabulary, andwidens and confirms their experiences.Make reading together part of your every-day routine!

Your child’s initial evaluation with theearly intervention team will result in anIndividualized Family Service Plan (IFSP)that will be updated periodically. Thegoals that you have for your child will bewritten and described in general terms.Here are a few examples (items number61–94) of the early skills needed fordevelopment of spoken language, fol-lowed by ways you can help facilitatethese behaviors.

You will know your child isdeveloping auditory skills(items 61–72) when he or she:

61Responds with increasing consis-tency to voice and environmental

sounds. Responses can include frowning,eyes widening, stopping a movement oractivity, turning to the source of thesound, turning to his or her name beingcalled, moving towards the door when heor she hears a knock, or looking at thephone when it rings. Explore sounds in all

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Early Communication and Spoken LanguageAs a parent using a listening and spoken language approach with your child,one of your goals will be for your child to learn to talk. Children who aredeaf learn to communicate using spoken language when careful and con-sistent adaptations and accommodations are made in all environments.Your early intervention team and teacher of the deaf can help you workthese accommodations into daily life.


environments with your child: identify thesource of the sound and talk about howthe sound stops and starts.

62Asks for his or her hearing aidsor sensory device. This lets you

know that your child is accepting his orher hearing aids. Praise your child withclapping, smiling, and firm but pleasantexpectations each time the hearing aidsare put in. Continue the praise when yourchild cooperates by turning his or herhead for insertion of the aids, or points tohis or her ear for the aid.

63Searches for the source of asound. When a sound occurs,

such as a doorbell or a television turningon, encourage your child to look for thesource of the sound.

64Listens to sounds in the house.Your child should respond to the

onset of sounds such as: the telephone,the doorbell, running water, the dish-washer, the garbage disposal, or a timer.Identify these sounds as they occur.

65Listens to sounds outside. Yourchild should notice the presence

and absence of outside sounds like air-planes, engines, sirens, animal sounds,the wind, thunder, or cars. Identify andexplain these sounds.

66Listens to music and songs. Chil-dren should be able to differenti-

ate music from other sounds in theenvironment early in development. You cancall attention to these differences by yourresponses to music. If you move in a par-ticular way in response to the rhythm(sway, tap your foot, or wave your hand)your child is more likely to attend to thesound patterns of the music or song andassociate the movements with the music.

67Discovers the ability to makesounds. A spoon on a cup, the lid

on a pot, sound toys such as push buttonboxes, and your child’s voice are all excel-lent tools for making sound.

68Looks at the face of the speakerand maintains eye contact. Your

child should be able to maintain eye con-tact with someone who is talking. Youcan encourage this by using animatedfacial and vocal expressions.

69Understands the direction fromwhich a sound comes (local-

izes) in familiar situations. You canencourage this understanding byextending the duration of the sound(such as letting your telephone ring) andencouraging your child to investigatewhere the sound is coming from.

70Recognizes differences betweensounds (such as the doorbell and

the telephone). Point out when a sound isabsent as well as where it is coming from.

71Imitates familiar phrases withoutbeing prompted. This means that

your child should be able to repeatwords and phrases independently. Youcan encourage this skill by speaking nearyour child’s ear while playing, cleaning,or eating. Be sure to pause to allow yourchild to imitate you.

72Responds to speech soundsvarying in pitch or frequency

(ah, oo, ee, s, sh, or m) by producing thesame speech sound. You can encouragethis skill by making speech sounds forspecific toys or movements.

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You will know your child isdeveloping control of thespeech mechanism (items73–79) when he or she:

73Imitates facial expressions.Babies will imitate a parent’s

smile, open their mouth, stick out theirtongue, put their lips together, blow rasp-berries, and make other facial movementsduring play. All of these are examples ofthe motor behaviors that precede speech.

74Produces reflexive sounds. Yourbaby will coo and babble. Rein-

force these sounds by responding tothem and imitating them.

75Imitates vocal patterns preserv-ing the melody (rhythm and

intonation) of a model. Your baby willbegin to imitate your voice. Examplesrange from early imitation of “ahh,” and “a-goo,” to imitations of speech patterns(hop-hop-hop) or the melodies of songs.Encourage your baby to imitate thesesounds.

76Begins to develop breath con-trol by blowing bubbles, blow-

ing a light object (like a cotton ball)across the table, or vocalizing on a singleopen vowel using one breath for two tothree seconds or more. Play blowinggames or reinforce vocalizations by smil-ing, clapping or imitating the baby.

77Vocalizes on exhalation contrast-ing long and short utterances.

Show your baby how you take a breathbefore speaking and gesture to show howyou breathe out while vocalizing.

78Babbles at a rate of four or fivesyllables per second. Pair motor

movements with the number of syllables.

Raise your hand incrementally as you say,“The airplane (toy) goes up-up-up-up-up.”

79Contrasts long versus shortvowels. You can model this for

your child by saying the word, “uh-oh,”and emphasizing the short “uh” soundand the long “oh” sound.

You will know your child isunderstanding spoken lan-guage (items 80–87) whenhe or she:

80Responds to the presence ofothers. Infants may look around

a room for familiar faces, imitate smiles,turn toward voices, and smile in response

81Responds to his or her name. Toencourage this, call your child’s

name frequently, and smile when he orshe turns in response.

82Attends to finger plays (repeti-tive songs supported by ges-

tures) and begins to imitate some handmovements. Sing songs along withfamiliar routines or finger play activitiessuch as Twinkle, Twinkle Little Star,Eensy Weensy Spider, Que Linda Manita,or The Wheels on the Bus.

83Recognizes and responds tosocial routines with appropri-

ate movements. This can mean wavingbye-bye, moving towards the door, orreaching for a coat. Identify these as theyhappen and repeat them daily.

84Responds to “Where” ques-tions (Where’s your hat?

Where is Daddy?) by searching for and

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,

to gestures.

pointing to an object, person, or pic-ture. Begin by asking the whereabouts offamiliar family members and follow withfavorite toys, objects, or things to eatthat are not within view. Read picturebooks together and talk about and pointto what you see, modeling so that yourchild eventually points to the picture asyou talk about it.

85Follows simple one-step direc-tions (Go get your diaper. Take

off your shoe. Throw this in the trash).Narrate routine activities and expectyour child to listen and look at your faceas you speak. Repeat these routines fre-quently and demonstrate the meaning ofthe direction you are giving.

86Identifies three or four bodyparts by pointing to them. Point

to your eyes and your child’s eyes. It canbe helpful to look in a mirror as you talk.

87Identifies common objects froma set of four things by pointing or

reaching for the object. You can use com-mon household objects, like a ball or apple,to practice identifying objects.

You will know your child isdeveloping expressive lan-guage (items 88–94) when heor she:

88Communicates behaviorally. Aninfant or toddler will let you

know his or her needs and interests withintentional behaviors, such as lookingyou in the eye, imitating facial expres-sions, reaching, pointing, and nodding orshaking his or her head. These are allexamples of behaviors that provide afoundation for language.

89Vocalizes for attention consis-tently. Your child will learn that

vocalizing and babbling are meaningfulif you respond immediately. Play turn-taking games that require voicing, suchas Peek-a-boo or Uh-oh!

90Varies duration (length), inten-sity (loudness) and prosody

(intonation) of his or her voice to con-vey emotion. Imitate your child’s vocal-izations to show that you understandwhat your child is feeling.

91Imitates single words accompa-nied by a natural gesture. Model

gestures for “bye-bye” and “all gone” withyour child.

92Uses “doing” words (more, up,help). Throughout daily rou-

tines, be sure to talk with your child anduse words that your child can learn anduse. Make sure your child can hear andsee you during routines. Be sure to pauseto give your child time to initiate orrespond vocally.

93Uses single words (mama, hi,up) and word-chunks (all

gone, bye-bye, thank you) associatedwith social routines. Routines providegreat practice because they happenover and over again. How many timeswill you change your child’s diaper?Prepare a meal? Talk throughout theroutine, and give your child opportuni-ties to imitate.

94Is ready to use two-word utter-ances. Put the child’s single

words (“more”) into the context (suchas “snack time”) of a phrase (“Morejuice?”) and sentence (“Do you wantmore juice?”).

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95Observe your child’s oral motorskills. Oral motor skills are

those movements that we need to eat,swallow, and speak. Weak oral motorskills can make speaking difficult. Eatingor chewing difficulties, avoidance of cer-tain food textures, excessive drooling,and limited control of the tongue or lipscould mean weakness in the oral motormechanism. Ask your doctor and/orspeech pathologist to assess your child’soral motor function and make recom-mendations if he or she needs help.

96Encourage your child to be imi-tative. Imitate the movements of

your child’s body and mouth (and voice)to encourage imitation.

97Get moving with your child!Moving gets the breathing

mechanism ready for vocalizing. Walk,run, and jump with your child!

98Movement can provide pho-netic cues. Call attention to the

motor movements of speech. Slidingdown a slide lends itself to producingextended, uninterrupted vowels like“Whe-e-e-e-!” Climbing up the slidelends itself to shorter, interrupted soundslike “Up-up-up-up-up!” Be aware of yourchild’s movements and the speechsounds that accompany them.

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Motor DevelopmentChildren experience and explore their environment through movement.Motor behavior, or physical movement, is a driving force behind infantdevelopment. During the first two years, children actively build an under-standing of the world by moving. Limited motor ability can put cognitivedevelopment at great risk. There are many ways you can encourage greatermotor activity in your child.

MOVEMENTS OF THE SPEECH MECHANISM

Vocal sounds are generated by movements of the tongue, lips, teeth, lungs, and soft palate.The sound of the voice is controlled by the sensory (auditory) feedback from the movementsof the speech mechanism.

For some children, assuming a sedentary or quiet position may be good for attentionalaspects of communication, but may not be conducive to vocal output. The act of engagingvery young children in physical activities can help them to vocalize.

If gross or fine motor delays are suspected, an evaluation by a pediatrician and an occu-pational and/or physical therapist should be performed.


99Support communication withnatural gestures. Gestures con-

tribute to the development of early lan-guage in hearing children. In most cultures,language is accompanied by natural ges-tures or facial expressions (pointing, wav-ing “good bye,” shaking the head “no,”nodding the head “yes,” putting the fore-finger to the lips to quiet someone with“sh,” thumbs up, or clapping for praise).Include them when you speak.

100Provide opportunities foryour child to explore the

effects of movement. Children learn bydoing. Banging on pots and pans createsa loud noise. Splashing in the water makesa noise and the child usually gets all wet.Painting requires movement of a brush onpaper that creates a colored visual pattern.All of these experiences provide directfeedback. Talk with your child about theseexperiences.

101Simply enjoy your child withoutthe pressure of a hundred

ideas! Parenting is often referred to aslife’s most challenging and most rewardingwork. When a child has a hearing loss, thedemands may multiply, but the joys of par-enting hold true. As teachers and parents,we recognize the commitment that isrequired to ensure access to communica-tion and fully include a child who is deafinto our own culture. There are variationsof “deaf cultures.” Some use sign languageas the primary mode of communicationand others, such as “oral deaf culture,” usespoken language as the primary commu-nication mode. In all cases, the culture isdefined by inclusion and accessibilitythrough communication. The choices a

family makes are personal and have a pro-found effect on family life, as well as thechild’s development.

Our hope is that this booklet will pro-vide guidance and support to familieswho are beginning to explore listeningand spoken language with their child.

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Conclusion

ADVICE FROM PARENTS

“Start early.” “Exploreoptions.” “Prioritize.” “Get your child to wear

hearing aids.”

“Talk to other parents.”“Join a parent group.”“Cry, talk, get help.”

“Reserve the right tochange your mind.”

“Stay in the moment. Lettomorrow come tomorrow.”“Take one day at a time.”“Persevere; don’t give up,the rewards are worth it.”

“Take a break!’

“Don’t forget to enjoy your child.”

“Live life fully!”


“Go with your instincts.”

At Clarke, we help children — from infancy through their teen years — who are deaf and hard ofhearing learn to listen and talk. Children served by Clarke use advanced technologies includingcochlear implants and hearing aids to maximize their access to sound. Our teachers of the deaf,audiologists, and speech-language pathologists have the background, training, and experienceto prepare children academically and socially for a world of limitless possibliities.

Clarke children listen and learn in the classroom, run and laugh with their friends on theplayground, and have lives filled with music, sports, family, and community. Many children whocome to Clarke are ready to attend their neighborhood mainstream schools by kindergarten.

Clarke has center-based locations in Boston and Northampton, MA; Bryn Mawr and Philadelphia,PA; New York, NY; and Jacksonville, FL. We also provide services to families, school districts, andprofessionals throughout the country, so call us at 413.584.3450!

There are many agencies, organizations, and publications that can provide more informationabout using a listening and spoken language approach with your child with hearing loss. Formore information contact:

45 Round Hill RoadNorthampton, MA [email protected] clarkeschools.org


Documents

101 IDEAS for FA MILIES - Clarke Schools for Hearing and ... · Janice Gatty, Ed.D. Director of Child & Family Services Marian Hartblay, M.A.T., M.E.D. Director of Early Childhood