Home Audiology Make Communication the Focus for Parents of Children Newly Identified With Hearing Loss

Make Communication the Focus for Parents of Children Newly Identified With Hearing Loss

by Tina Childress
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a baby's ear

a baby's ear

“The most important role for the family of an infant who is deaf or hard of hearing is to love, nurture and communicate with the infant.” –Joint Committee on Infant Hearing

Parents of children newly identified with hearing loss—especially infants identified at birth—must deal with the diagnosis, follow-up care and amplification recommendations. Eventually, they realize they need to use an alternate method of communication with their child. They probably turn first to their pediatric audiologist. As the family goes through the process of additional tests, confirming hearing levels and picking out hearing aid(s) or cochlear implant(s), the audiologist also usually provides counseling on communication options, as covered in this month’s ASHA Leader magazine cover story, “Refocusing on Choices.”

I’m not going to go in-depth about the communication options, but my experiences as an educational audiologist and late-deafened adult with bilateral cochlear implants influence my view on communication choices. Most of us probably lean one way or another, but we need to admit any biases to ourselves and understand how they affect our presentation of information to parents.

How to communicate with and educate a child with hearing loss has been a controversial topic since … forever, it seems. Remember the Milan Conference of 1880? Professionals often refer to this dilemma in terms of a pendulum, swinging back and forth between visual/manual and auditory/spoken modes. With the advent of the cochlear implants in young children, the pendulum is currently entrenched in the auditory/spoken modes.

Recently, social media is buzzing with accomplishments of Deaf individuals—starring on television, in theater and even in the White House and Supreme Court.  This has led to a more visible and renewed surge of individuals advocating for using ASL. Again, it’s what’s right for the individual families.

We need to remember it’s all about respect and support. We don’t want parents to feel like they failed if one approach doesn’t work and they switch to another. No one—especially a parent—wants to hear they made a wrong choice. Plus, if parents already made a decision, it’s not necessarily our place to second-guess them. Granted, parents might form unrealistic expectations—like talking on the phone with their child who wears a CI only two hours a day—but we can help them understand and manage those expectations.

Have you ever had a parent ask you, “What would you do if this were your child?” The first time I was asked this question, I remember thinking to myself, “What if I tell them something and I’m wrong or it doesn’t work? They’re going to blame me!”

In talking to scores of parents over the years and guiding them through the process to make their communication decision, they express the same fear: “What if I choose the wrong path and my child is not as successful as he/she can be?”

When I teach my pediatric audiology class, I tell my students it’s imperative to let parents know that the language-path choice they make isn’t set in stone and they can change course. It is important, however, to commit fully to their first choice before seeking another option. Becoming fluent in ASL takes time, as does learning how to use residual hearing to listen and talk. It’s up to us—clinicians and educational professionals—to set benchmarks and monitor progress.

Further, we should explain to families how situations and expectations can change. I treated children who started out as signers, but switched to listening and spoken language once they could benefit from their CI. I also worked with students who learned how to sign simultaneously while developing their listening and spoken language skills. I also have adult friends who wished they’d been exposed to ASL sooner—as well as adult friends who wish their speech was more intelligible or that they’d received a cochlear implant when they were younger.

Ethically, our goal isn’t to choose a communication methodology for the parents we serve, but provide them with information and resources so they can make an informed choice. What resources do you keep you in your office to help them make an informed choice?

Essentials for me include:

  • Websites and social media sites that support the selected methodology.
  • Printed materials and age-appropriate toys, because we’re working with children.
  • Contact information for connecting with other families and mentors—we understand hearing loss, but we may not understand all of the issues related to parenting a child with hearing loss. My favorite source for this is Hands & Voices, a nonprofit organization for families of children who are deaf or hard of hearing.

At the end of the day, it comes down to language. If a family chooses ASL, they must immerse themselves in ASL in the same way they might immerse themselves in Mandarin if they were moving to China. If the family chooses listening and spoken language—even though they’re likely already fluent—it’s easy to get complacent and think time spent in front of a passive screen provides the same result as time spent in interactive conversations.

Remember, it’s not important how you communicate, just that you communicate!

The cover story for The Leader’s May issue focuses on language choices for children who are deaf or have hearing loss.


Tina Childress, MA, CCC-A, is an educational audiologist for the Urbana (Illinois) School District, a consultant/trainer and cochlear implant outreach specialist at the Illinois School for the Deaf, and a visiting lecturer at the University of Illinois and Illinois State University. Childress is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.  Tina.Childress@gmail.com.

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Becky Clem May 3, 2016 - 12:01 pm

Thank you Tina for your comments about the need for families to immerse themselves in whatever choice they make for their child. Overall, what are the outcomes they want for their child? Whatever outcome they choose, 1000% commitment to the communication for that outcome is critical.

Tina Childress May 5, 2016 - 12:30 pm

Yes! We know that parents and caregivers are the KEY to communication.

RZ May 4, 2016 - 2:09 am

It is so nice to see the ASHA community finally changing perspective to appreciate the richness of communication options (including ASL!) for Deaf and hard of hearing children, rather than focusing solely on listening and spoken language. I hope we can continue to make sure to be on the right side of history with this topic.

Tina Childress May 5, 2016 - 12:31 pm

The goal of this article was to highlight ALL the possibilities so I’m glad that you pull this out. As we know, equal audiograms do not equal functioning so it’s important for parents to have realistic expectations and know what’s available and what works for their family dynamics.

KIM Livingston May 4, 2016 - 8:23 am

Why aren’t we pushing for more bilingual teaching and emphasizing the language deprivation many children have entering school who have not received bilingual teaching? Also, the fact that this article focused the photo on the ear versus the eyes/hands/mouth and ears shows the bias and is negligent and only continues the audism surrounding the issue.

Tina Childress May 5, 2016 - 12:41 pm

In retrospect, I could have been more clear about the fact that if a family chooses ASL as their mode of communication and the fact that 90+% of the parents are hearing, it is inherent that they will be exposed to language in mostly a bilingual fashion. If they are born into a family with native ASL users, ASL will be their primary language and English will be their second language since they will still need a background for being able to read and write. Thanks for giving me an outlet to make this a little more evident.

I believe the picture that was shown was chosen to represent the fact that it is the functioning or non-functioning of the ear that is the basis for needing to have this discussion in the first place. It was NOT intended to make a statement that this is all that matters. As speech, language and hearing professionals, our job is to support the family and provide parents with guidance and information, as needed. Our expertise is speech, language and hearing – in whatever modality that includes – so that is what we concentrate on.

Donna May 4, 2016 - 10:22 pm

I am not sure that this sentence encourages families to be open to all possibilities; I think it implies that one mode will hurt the other. “It is important, however, to commit fully to their first choice before seeking another option.” It’s an exclusive statement implying using two options is worse.

Tina Childress May 5, 2016 - 12:45 pm

Great point – they don’t have to be mutually exclusive nor imply that one is necessarily better than another! As cited in the article, the point of this article was not to go into communication methodologies per se (it is referenced in a separate article) but rather discuss what parents need in terms of support for making this decision about communication. There is definitely a continuum and it is possible to be bilingual.

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