Best of Hearing and Kids: Early Childhood Deafness – Past, Present and Future

This edition of Hearing and Kids, is written by David Luterman. David was my first audiology professor, he gave me my first job as an audiologist when he started the Thayer-Lindsey Nursery for Deaf Children, and he continues to be my mentor.  I attribute much of my success in pediatric audiology to David. When I first worked with David, I walked into his office and announced, “This child I am testing is untestable.” He said, “What you mean is you are unable to test this child. You will have to write in the report that you could not test the child.” He helped me understand that it could not possibly be the child’s fault that I could not test him, and I worked very hard for the next 40+ years to learn how to test so that  I did not have to write  in a report “I am unable to test this  child.”

Dr. Luterman is Professor Emeritus at Emerson College in Boston and Director of the Thayer Lindsey Family Centered Nursery for Hearing Impaired Children. He has dedicated his career to developing a greater understanding of the psychological effects and emotions associated with communication disorders so as to encourage professionals in the field to incorporate counseling strategies in their clinical interactions. He has successfully translated this understanding into a model of counseling that allows for content and affect exchange and has extended his model to include families.  He has lectured and written extensively on counseling and communication disorders throughout the United States, Canada and abroad. A fellow of the American Speech-Language-Hearing Association, he is author of many books and articles and frequently lectures.

By David Luterman

I started my clinical career as a diagnostic audiologist over 50 years ago in what I now consider the dark ages of education of deaf children. In 1965 I morphed from an audiologist to directing a family-centered program for preschool hearing-impaired children. My career has spanned a remarkable transformation in education of the deaf.

The future for a young deaf child in 1965 was rather grim:  Instruction was generally in a school for the deaf, often residential, and graduation with a third-grade reading level, mainly unintelligible speech despite years of oral instruction, and limited vocational opportunities. Amplification was provided by a body-worn hearing aid that had power but very limited flexibility for adapting to the child’s hearing loss and to ambient noise conditions; they were also underutilized in the educational programs.

Pedagogy in the schools was characterized by memorization, and children were taught the form of language without the substance. Consequently, they invariably failed any English linguistic competency test. Parents were marginalized, talked at but almost never incorporated into the education of their child. Because almost all children were educated in schools for the deaf there was limited exposure to normally hearing children and graduates were pretty much restricted to socializing within deaf communities. No wonder these were the dark ages!

The results of poor results of schooling

As the poor results of the schooling became known the methodology wars were reignited. Signing with deaf children became fashionable and several communication strategies were developed which tried to bridge the gap between oral education and American Sign Language. The 1970’s gave birth to the total communication movement which adapted ASL into a signed system using English grammar and syntax while at the same time promoting the use of amplification and encouraging oral language. The 80’s and early 90’s were also dominated by the Deaf community and their call for a role in education of the deaf child. They promoted a bilingual bicultural approach which mandated teaching ASL as the first language Unfortunately a huge amount of energy was devoted to fighting the war of methodology and little time and energy was devoted to fitting the method to the child; most often the child (and family) had to adapt to the method used by the school. Schools competed vigorously for children sure that they had the right method; consequently families were enlisted in the wars and were often confused by the competing claims.

The technology age

So where are we now? I would characterize us as being in the technological age; newborn screening, digital hearing aids and cochlear implants have transformed the educational landscape. Newborn screening has given us a chance to begin our therapeutic endeavors much earlier in the child’s development so that we are not remediating language as we would have to do with later detection. Early detection enables us to teach language development in a child directed, natural ways much as normally hearing children learn. Digital hearing aids have provided a remarkable flexibility in fitting so they can accommodate a wide range of hearing losses and ambient noise conditions for those children who can benefit from amplification.

I keep thinking hearing aids cannot get any better, and then they do. Cochlear implants are, from an audiological point of view, “Manna from Heaven.” In my diagnostic audiological days I used to dread seeing a profoundly deaf child because I had nothing to offer; now these children can achieve as well and sometimes better than hard of hearing children using hearing aids.

The technology has resolved, in the main, the methodology wars by clearly favoring an auditory/oral approach. I know the conflict still goes forward, but it is much more muted and I think basically a rear guard action. With the appropriate use of technology, embedded within a good early intervention program, we are turning out normally speaking hearing impaired children, certainly by kindergarten age and some by preschool. These children will be mainstreamed and the traditional school for the deaf, beyond the preschool years is becoming a repository for the deaf of deaf, the disadvantaged deaf and the multiply handicapped deaf.

The contemporary educational and clinical scene

I have some concerns about the contemporary educational and clinical scene. There are problems with newborn screening that need to be addressed. The false positive rate is very high and there is a compliance issue as well; nearly half of families with a child who has failed screening do not return for further testing. I think it is a function of testing too early: Parents are emotionally vulnerable and not able to assimilate possible bad news. The child may have debris in the ear canal from the birth process causing a temporary conductive loss that spontaneously clears up if the child is tested later, hence the large number of false positives. I think early detection, in conjunction with a family-centered therapy program, is a key component of a successful outcome. I just wish we could test somewhat later than at birth and allow mother and child some time to recover from the birth process; then I think we would then have more compliant families and many fewer false positives.

The demise of total communication

I worry about the demise of the total communication programs. I think we need diversity in our educational approaches. There are children who are visual learners who do not do well in auditory-only programs and we need to identify these children early and provide them a suitable communication modality. Unfortunately, I have seen these children labeled aural failures and/or parents castigated for not following through. We have also found in our program that introducing some signing very early in the therapeutic process has beneficial results. It reduces some parental stress as some communication is established and it also teaches the child about the value of communication. When aural/oral abilities begin to develop the signing is dropped and does not seem to have any negative impact on the developing aural skills. Methodology needs to be seen as a tool; as a means to an end and to do any given job we need a variety of tools.

Mainstreaming

I also have concerns about mainstreaming as it’s currently practiced. Placing a hearing impaired child in a local school system that is not supportive of the child’s needs often results in a socially isolated and unhappy child. While the children have adequate academic and linguistic skills, they often lack the social skills necessary to thrive in a normally hearing environment. They also do not have the professional support or the acoustic environments that are necessary for their success. This is not a good mainstreaming model, but it seems to be the prevailing one. I much prefer a program for hearing impaired children that is integrated within a school for normally hearing children. I think this is the wave of the future and is already practiced in several communities .We need to start the mixing of hearing impaired and normally hearing very early and maintain this all through the child’s education.

The role of parents

I think there is currently more recognition of parental importance than there has been in the past, but this seems not to be honored in practice. I still see too many programs where parents have a passive and marginal role in the school and not the collaborative role that I would love to see and one that I think insures a better outcome. I think the problem lies in the professional training programs in which there is limited experience in a family centered model.

Hope for the future

So where are we going? I am not sure these are predictions as much as hopes. Cochlear implants will certainly get better as we are still in the early stages of development. Binaural implantation will be commonplace and I suspect implants will supplant hearing aids in the not too distant future as the preferred method of aiding a child with hearing loss. There is increasing recognition on the part of professionals need to incorporate parents in the therapeutic process. Hopefully this can be addressed by increased inservice to existing programs and better prepared instructors at the college level.

Parents at the center

What is needed is a paradigmatic shift that puts the parents in the center of our educational endeavors. I think the programs of the future will enlist parents as collaborators and utilize their skills and knowledge fully. I think the school of the future will be fully integrated within the educational mainstream in which there is a maximum use of technology embedded in a family-centered model. We already have on hand all the necessary tools to mitigate the negative effects of early childhood deafness. By extending and polishing what we already know we will be able to educate increasing numbers of children to fully compete in the hearing arena and the deafness will have minimal impact on the child’s success. While doing this we can wait for stem cell research to grow hair cells and cure deafness, at which point we will all need to seek other employment.

 

 David Luterman D. Ed, is Professor Emeritus Emerson College. His e-mail address is dmluterman@aol.com.

About Jane Madell

Jane Madell has a consulting practice in pediatric audiology. She is an audiologist, speech-language pathologist, and LSLS auditory verbal therapist, with a BA from Emerson College and an MA and PhD from the University of Wisconsin. Her 45+ years experience ranges from Deaf Nursery programs to positions at the League for the Hard of Hearing (Director), Long Island College Hospital, Downstate Medical Center, Beth Israel Medical Center/New York Eye and Ear Infirmary as director of the Hearing and Learning Center and Cochlear Implant Center. Jane has taught at the University of Tennessee, Columbia University, Downstate Medical School, and Albert Einstein Medical School, published 7 books, and written numerous books chapters and journal articles, and is a well known international lecturer.