School is out. Summer is in. What does that mean for children with hearing loss? There is a lot of data which shows that many children lose skills over the summer – children with typical hearing and those with hearing loss. So what should families do to prevent children from losing skills over the summer, and to be sure that our children with hearing loss do not fall behind?


Reading lists and math activities for summer

Many public school programs send home assignments for kids to work on over the summer in the hope that they will not fall so far behind. If your school did send home a list, you need to schedule time each day for children to read or do other academic activities. If you did not get a list, go to the library and talk to the children’s librarian at your local library and ask for a list of books that would be appropriate for your child’s reading level. A good librarian will ask what your child is interested in and help you find books that will be both appropriate and interesting. Find the level of your child’s math skills and if your child’s classroom teacher has not giving you activities, search the internet and find math activities.


Monitor technology

Summer is an important time to check out equipment. Be sure that hearing aids or cochlear implants are working well and providing a clear crisp signal. Check that your school is sending FM systems back to the manufacturer to be reconditioned. (Close to end of summer, check that the equipment is back and in good working order.)


Managing technology around water

Some technology is waterproof but not all. For children who have technology that is not waterproof, not being able to swim with technology is frustrating. Many of the hearing impaired kids I know find not being able to hear in water to be one of their frustrations. It makes it difficult for them to fool around easily with friends at the swimming pool, by the lake or ocean. We need to talk to kids about this and be sure that they understand that their devices cannot get wet. Everyone also needs to know what to do if they do get wet. If a device falls into saltwater, rinsing it out quickly with fresh water may help prevent corrosion – but it may not. There are hearing aids and cochlear implants that can work in water or can be placed in an airtight sack which will prevent water coming in but the choice of technology cannot be made based on swimability alone. Ability to use hearing to learn has to be the primary goal.


Having backup technology

Whenever possible, it is good to have backup technology. If the technology gets wet, or stops working from sweat or just falls and breaks, we do not EVER want a child to be without technology. Not many people can afford to have back up technology but, in an ideal world, every child would have back up equipment. Families who use hearing aids should keep the last set of aids just so the child can hear something, until their primary technology can be repaired. Children with cochlear implants may have two devices and may be able to use their back up device while one is being repaired.


Language and learning

Summer cannot be time off with no work. Children with hearing loss can use summer time to catch up on things they are behind in at school, they can use the time to read ahead so as to be a bit ahead when school starts. Children who do not have language that is at age level, in every subtest of language evaluations, would benefit from therapy over the summer to build skills. And every child MUST read and read a lot during the summer to improve skills.


Talk to teachers before school is out

Parents should be communicating with teachers all the time so they know what areas need to be worked on. Ask this year’s teacher to give you some activities to work on with your child. If you can, try and talk with next year’s teacher. Discuss that you have a child with hearing loss and ask if you can borrow some textbooks over the summer to go over vocabulary to help your child be better prepared. Find out what is going to be studied. If they are going to study dinosaurs, take a trip to the Natural History Museum. If they are going to study Asia, find out where there are exhibits about Asia and go visit, and visit Asian restaurants and discuss food. Think how good your child will feel knowing more than her peers when school starts.


Camps for children with hearing loss

Everyone needs contact with peers. Children with hearing loss are frequently the only child with hearing loss in their class and maybe one of only a few in their school. If the school does not provide support groups so children can meet other kids with hearing loss and develop support systems, camps for children with hearing loss may be the perfect solution. It is important to find a camp with kids like yours – either mainstream kids or a signing program. Kids love being in contact with other kids. I know many who have developed lasting friendships in this way.


Make time for fun, too

It should not be all work. Kids need a break too so figure out how to get it all in. Schedule some time every day when work will be done but leave much of the day for fun. Enjoy!!

An article published last week in Pediatrics reports on research which will add critical information to the debate about using sign language and/or spoken language when educating children who are deaf and hard of hearing.

As we all know, 92% of children with hearing loss are born to families with normal hearing who do not know sign language. When they have a child who is born with a hearing loss, they are overwhelmed with information and decisions about how to make decisions for their child. Unfortunately, parents do not always have all the information they need when they are making decisions. The article published this week by Geers and colleagues will go a long way to adding actual data to this debate.


Spoken Language and Sign Language and the Effect of Language and Literacy


Everyone seems to be sure that they know exactly what is the best method to educate children with hearing loss. The problem is that everyone has a different answer. Obviously, the same answer is not the same for every child and for every family but that has not prevented us from acting as if there was only one right answer. Each of us will provide the best possible language modeling for our children if we communicate in the language we know well. Each child is different and what works for one will not work for all. Children born into families with deaf parents who are fluent signers are in a different situation than children born to families with normal hearing parents who do not know sign language at the time of diagnosis. While families who are fluent signers will be able to provide their children with good language, families who don’t sign will not. Think about how it is to learn a new language. I am trying to learn Italian. I feel sorry for any child who has to learn Italian from me.

But there is an additional issue and that is literacy. Language learning is critical for developing literacy. Children who do not have good language  and phonologic will not have good literacy. And, if you want a child to learn to read in English, they need to have good English language skills. ASL skills do not necessarily transfer to English literacy skills.


The Geers et al study


Ann Geers is a well respected clinician and researcher as are her co-authors. Geers has published extensively. Her most recent paper was just published in Pediatrics. She evaluated the relationship between early sign language exposure and cochlear implant benefits. The article reports that most children with hearing loss learn spoken language and that most children with hearing loss are born to parents who have normal hearing and do not know sign language. The debate that has been raging for as long as I have been in this field (more than 50 years) is whether parents should be encouraged to learn sign language and to teach their deaf children to sign. This study evaluated parents use of sign language before and after cochlear implantation and the influence of parents sign language use on speech recognition, speech intelligibility, spoken language, and reading outcomes.

Three groups of children with CI’s from a national data base who were matched for demographic, auditory and linguistic characteristic but differed in duration of early sign language exposure provided in their homes were compared through elementary school grades.

Children without early sign language exposure achieved better speech recognition skills over the first three years after implantation and were statistically significantly better in spoken language and reading near the end of elementary school then children who were exposed to sign language. Over 70% of children who had no sign language exposure had age appropriate spoken language compared to only 39% of those exposed to sign language for 3 or more years. Early speech perception predicted speech intelligibility in middle school years.




All three groups received reading comprehension scores similar to hearing peers in early years but those without sign language exposure exhibited a statistically significant reading advantage over the long term sign subjects. For children with no sign language exposure only 11% were delayed in early elementary years increasing to 23% in late elementary years. For children exposed to sign language in early years, the percentage of children with less than average reading scores increased from <20% in early elementary years to >50% in late elementary years.


Study discussion


This article clearly provides the most compelling evidence that there is no advantage to early sign language use. Children who’s families used spoken language only, had better auditory speech recognition and more intelligible speech than children who’s families used sign language. Even short term sign use resulted in poorer speech intelligibility in elementary school. Even children whose families who used sign language minimally had poorer outcomes then children not exposed to sign language.


My conclusions


Most parents of children with hearing loss do not know sign language and the process of learning sign language, just like learning any other language, is long and arduous process meaning that they will not be exposing their children to good language models during the early years. The children who are listening exclusively to spoken language have the opportunity to hear good spoken language models and incorporate this into their speech recognition and spoken language. Children with poor reading skills have limited employment opportunities.Very significantly, the reading results alone  make a case for using spoken language exclusively by parents.


THE WORLD HAS CHANGED. Newborn hearing screening and improvements in technology have changed the world for children with hearing loss. When I started in this field children where identified with hearing loss at age 2-3 years and if they had severe to profound hearing loss they did not do well with hearing aids. They lost lots of time and many never successfully learned spoken communication but NO MORE. Babies are now identified at birth and fit with technology in early months. As soon as they receive technology they are hearing their families speak to them and learning language.

Children who have good listening and spoken language and good literacy skills have opportunities in life that those who do not have those skills just don’t have. Learning sign language later is always an option but learning it early destroys possibilities. That is the point – it only works if children have early exposure to spoken language.

It is unfair to be making decision for today’s children based on results of children who did not have the same opportunities – who were identified later and had technology that did not provide sufficient gain. Please let’s stop doing it.