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Communication Considerations for Children With Hearing Loss

by Kirsten Marconi


When a child fails a hearing screening and follow-up testing reveals a hearing loss, parents often experience a roller coaster of emotions. During this time, parents might get overwhelmed by making decisions that will affect the rest of their child’s life. However, as professionals, we must convey the importance of early intervention on future outcomes. Early exposure to language, in any form, lays the foundation for future communication skills.

We also must come to the table with unbiased information. Allow parents to review all options and choose a path to communication they feel best fits their child and family. As speech-language and hearing professionals, we must put aside our own biases and assist these families on their journey to communication, helping them to understand that this is a marathon, not a sprint.

As an educational audiologist, I work with children who communicate and are educated using a in a variety of different methodologies I see, first hand, how these decisions affect them in terms of communication, as well as academically and socially. For the purpose of this blog, I concentrate on four communication options, as identified by AG Bell’s Listening and Spoken Language Knowledge Center.

I use the term “outcomes” because I think parents should ask themselves: “What do I want for my child? How do I want them to learn and communicate with others? What is my ultimate goal for them?” Then they should pick a methodology to support those outcomes.

Below, I explain each outcome along with key points to consider when offering parents these choices:

  1. Listening and spoken language: This methodology is based on the belief that with early identification, early intervention and consistent use of technology, children can learn to listen and speak. It incorporates the “1-3-6” rule: identification of hearing loss by 1 month of age, appropriate amplification fit by 3 months of age, and family-centered early intervention services supporting the development of listening and spoken language by 6 months of age. For children to become successful, parents must understand the importance of technology. Hearing aids and/or cochlear implants must be worn during all waking hours, even during those first few months, when the little ones are pulling and tugging them off. They must put them back on. Also, regular audiologic assessments are critical to monitor for changes in hearing and hearing aid/cochlear implant function.
  2. Cued speech/language: The National Cued Speech Association defines cued speech as “a visual mode of communication in which mouth movements of speech combine with cues to make the sounds (phonemes) of traditional spoken languages look different.” Cued speech makes sounds visible through the use eight handshapes in four placements around the face. This intended to improve speech reading and is believe to improve literacy. I never worked with a student on my caseload who used cued speech as a communication methodology. I have seen it used in treatment and can see the benefits.
  3. American Sign Language/English bilingual-bicultural: American Sign Language (ASL) is a complete, complex language. It uses signs made by moving the hands, facial expressions and changes in body posture to convey a message. It’s a separate and distinct language from English, with its own rules for pronunciation, word order and grammar. A bilingual-bicultural approach involves using ASL, the natural first language for the primary method of communication, while encouraging the development of spoken or written English as the second language.. If a family chooses ASL—and aren’t part of the Deaf culture—they must make it a priority to learn sign language themselves and expose their child to Deaf culture as much as possible. Being the only child in a school who signs can feel isolating and frustrating, thus Deaf peers are important.
  4. Total communication: Total communication (TC) incorporates all means of communication: signs, natural gestures, fingerspelling, body language, facial expressions, listening, lip reading and speech to optimize language development. Children in TC programs typically wear amplification, whether it be hearing aids or cochlear implants. TC will and should look different for each child. Some children rely heavily on sign language, while others do not. The TC philosophy adapts to the individual needs of the child in order to facilitate understanding, learning and language development. Families should work cooperatively with the education team to ensure their child receives the best instruction fitting their needs.

The May issue of The ASHA Leader focused on language choices for children with hearing loss

Making a life-long decision for a child is never easy, especially after dealing with a possibly unexpected diagnosis of a hearing loss. Each communication approach requires dedication from everyone involved with the child in order to work. Parents, siblings, early interventionists and school personnel should all work together to help the child become an effective communicator.

Additionally, mastery of any communication approach won’t happen overnight. It’s important for families to stick with a choice long enough to really get an idea if it works for their child. It also helps to provide and encourage families’ opportunities to meet with other families already using a communication outcome. This allows them to ask questions and get answers from people who experienced the process of choosing, and now living, with a particular option.

Kirsten Marconi-Hutkay, AuD, CCC-A, is an educational audiologist for Stark County Educational Service Center in Canton, Ohio, where she serves children ages 3 to 21.



American Sign Language (ASL)

Listening and Spoken Language Development

Cued Speech

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