Hearing loss today is not what it was when I started in this profession 45 years ago. (And, believe me, that’s a good thing!) It is not the same as it was 20 years ago, or even 10 years ago. People with hearing loss have more options now than they did in the past. Technology has improved so dramatically that we can really tell parents that almost every child identified with a hearing loss can learn to listen and talk. That was not the case when I started in this profession. Twenty years ago, kids with severe and profound hearing losses could not be expected to learn by listening. They could learn to speak but they were going to have to rely on looking using lipreading and other visual cues. They could do it, but it was going to be difficult. In school, they could not pay attention to the teacher (looking at her face, and listening) and take notes at the same time. If the teacher turned away, they were going to miss what was being said. Because they had less exposure to speech and language, it took longer for them to learn.
THINGS HAVE CHANGED
Fortunately, things have changed. First, babies are being identified at birth and fit with technology within the first few months of life. As a result, they do not have a period of time when they are auditorily deprived. Second, technology is different today. Hearing aids are more powerful, and cochlear implants are now available for kids who do not hear with their hearing aids. In other words, we can do things to make sure kids can hear. Third, therapy is different. Back in the “old days” therapy focused on using visual cues. Kids had to lipread, many kids used sign language to understand. Now, because technology is so good, kids can focus on listening and with appropriate auditory therapy, they can build auditory brain skills and can learn to listen and speak in the same way as their peers. Is it just as easy as it is for a typically hearing child? Of course not, but they can do it. Here is how much things have changed. As reported by Teresa Caraway, PhD, at a recent pediatric audiology conference in New York City, in 1995 40% of families chose a spoken language out come for their child and 60% chose sign language. In 2005, Carolyn Brown reported that 85% of families chose a spoken language outcome for their child and 15% chose sign language. In 2010, between 89% and 95% of families are choosing a spoken language outcome (Caraway 2012).
Ten or 15 years ago, when we identified a baby with a hearing loss we talked with parents about the educational options for their child. Choices were oral communication (which usually meant looking and listening), sign language, or total communication (where children were taught to both sign and speak.) Cued speech, using hand gestures close to the mouth was another option for children using oral language to help them understand things they could not get from lipreading alone.
As things have changed, listening has become an excellent option for developing speech, language and literacy. With the right technology, kids can learn to listen with almost any degree of hearing loss. So the question we ask parents now is different. The question we ask now is less about options, and more about outcomes. The question I now ask is “What is your goal for your child? Where to you want your child to be at age 5, 10, 20?” The way we plan treatment, depends on this goal. Since 95% of children with hearing loss are born to parents with normal hearing, most parents want their children to be part of their hearing world. If parents want their kids to attend school with their sibs, go to college etc, they usually choose to have their children develop spoken language skills.
Typical preschool children learn a new word every 90 minutes – about 10 new words a day. Those of us, fortunate enough to spend time with preschoolers see this. It is so exciting. We know their auditory brains are developing and they are using this to learn. As professionals working with children with hearing loss, we need to be sure that we are providing this current generation of children with hearing loss with everything they need to learn the way their peers learn. They need well fit technology, auditory based therapy that is parent centered so the parents can be the primary teachers 24/7, and all of us need to have high expectations about what is possible for today’s deaf child. It is a whole new world.
Brown, C (2006) Early intervention: Strategies for public and private sector collaboration. Paper presented at the 2006 convention of the Alexander Graham Bell Association for the Deaf and Hard of Hearing, Pittsburgh, PA
Caraway, T (2012) Play it by Ear. Controversial Issues in Pediatric Audiology, NYC February 2-3.
Caraway, T and Madell, J. R. (Produced by ASHA) (2012) Current Trends in Pediatric Cochlear Implantation: Creating Auditory Opportunities. (Web Workshop).