Ten Tips

In 2008 I gave a talk at Cook Children’s Hospital in Ft Worth TX. Becky Clem, the director of the Speech and Hearing, had asked me to put together 10 Tips for Professionals. I had forgotten about it until someone recently reminded me. I decided this might be a good place to update them so here you go.


Check Technology

Technology is the way kids connect with the world. It is absolutely critical that technology be working well every day. Kids are not good at reporting problems, certainly not before high school, so the adults need to monitor. Parents need to check technology every morning. Someone at school needs to check during the school day.


Make sure the FM is on and working

Classroom teachers need to check daily that the system is working. Kids do not want to have attention called to them so some system needs to be developed that will not be disruptive. The teacher can quietly talk into the FM and ask “What color is my shirt?”, or “How many people have red shirts?” If the child answers the questions we can assume the FM is working. If not, either the FM is not working or the child does not understand the question. In either case, we need to solve the problem.


Every child needs speech perception testing frequently

The reason we fit technology is so that people with hearing loss can hear and understand speech. So it makes sense (at least to me) that we need to check to see if a child is hearing and understanding speech. We can set hearing aids appropriately and that will tell us what is reaching the child’s eardrum, but not whether speech is clear and understandable. EVERY CHILD WITH HEARING LOSS NEEDS SPEECH PERCEPTION TESTING. And we do not only want a score. We need to know what the specific perception errors are. By knowing the errors we can modify hearing technology. For example, if a child is misperceiving the phoneme /s/ it indicates that he is not hearing at 5000-6000 Hz. The audiologist should use that information to modify settings and then check that perception has improved.


Everyone needs to monitor performance

If you don’t test, you do not know what the child is hearing, but more importantly, what the child is not hearing. It is everyone’s job to monitor speech perception. Parents, SLP’s, TOD’s, auditory-verbal clinicians and classroom teachers need to be the listening police. In what situations is the child hearing well. In what situations is a child having difficulties. What specific phonemes are being misheard. Are they being misperceived in all conditions or just at a distance. Information should be recorded and sent to the audiologist who should change technology settings to improve performance.


As kids get older, we need to educate them about hearing loss

When hearing loss is identified we educate parents about hearing loss. We discuss causes of hearing loss, help them understand about different forms of technology, understanding audiograms etc. As kids get older they need the same information. It is their hearing loss and they need to understand. Starting at about 7 or 8 years I start explaining the audiogram to kids. “ This is your hearing loss.” This is where normal hearing is.” “ This is how you are hearing with your hearing aids.” “This is how much you understand speech with your hearing aids at normal conversational levels, at soft conversational levels, and in noise.”


This kind of counseling opens the opportunity for kids to ask questions. The most common is “Will I always have to wear hearing aids?” The information from testing is also a good way to inform about why we need FM systems in school.


Everyone misunderstands sometimes

It is important for kids to understand that everyone misunderstand sometimes. It is not just people with hearing loss. So, it is okay to ask for repetition if you missed something, or to ask for clarification if what you think you heard does not make sense. This is an advocacy issue and everyone working with a child needs to work on this.


Meeting other kids with hearing loss

Mainstreaming is terrific. It offers kids opportunities that would not be available in most schools for the deaf. However, one disadvantage is that kids do not have the opportunity to meet with other kids with hearing loss. Ideally, the kids are attending schools that have other kids with hearing loss. But, if not, both families and schools need to arrange for social and support groups where kids with hearing loss can meet other kids with hearing loss. School districts can arrange a support group lunch once a month were kids from different schools can meet up. Families can take kids to either local or national AGBell conferences where there are opportunities to meet other kids with hearing loss. Teens can join the LOFT program at AGBell where they have the opportunity to be mentored by older kids with hearing loss. What a treat!!


Keep an eye on new technology

Technology keeps improving (what a good thing!!). Even if a child is doing fairly well with technology, could he do better with improved technology? Do newer hearing aids offer something that the older hearing aids do not? Would speech perception be better with newer technology? Is it time to consider a cochlear implant? Is it time to look at new cochlear implant speech processors? For children, who are depending on listening to learn, and for whom learning will determine who they are in the future, is “good enough” sufficient? Not in my mind. Good enough is not good enough for kids with hearing loss. Only excellent is good enough.


Parents and caregivers need to be involved

We cannot leave our kids at the door of audiological evaluations, of school, of therapy. Parents need to be involved. From an audiological evaluation, they need to know exactly what a child is hearing, what he is missing, and what they need to do about it. Is he hearing at the string bean? If not what does has to happen to help he hear at the string bean? If he is hearing at the string bean but is not understanding what has to happen in therapy? What is happening in therapy? What is happening in school? What do parents need to do to keep things going in an upward direction? What do parents need to tell teachers to help them understand about hearing loss? Parents are really in charge. The more they know about what is happening, the better kids will do.



Everyone working with a child with hearing loss is part of a team that makes for success. The AVT and SLP needs to tell the audiologist how the child is doing before each evaluation. It is helpful if they can tell the audiologist what the child is hearing and what she is missing. The more specific the better. What phonemes is a child hearing and what is she missing, and in what situations. What is the child’s language level – so the audiologist knows what speech perception test to use. The audiologist needs to tell the AVT and SLP if speech perception is not good enough. If aided thresholds are good enough (and only if aided thresholds are in the string bean, poor speech perception indicates that therapy is needed to improved skills. The audiologist should point out if speech perception in one ear is poorer than the other, indicating that some listening work in the poorer ear alone, and practice listening for a couple of hours a day with the poorer ear alone is a good idea. By communicating with each other, and really listening and respecting each other, we can improve a child’s success.


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.


  1. Hello, We 3 West coast Ed. Auds. are not familiar with the term “string bean”. Are you substituting the term for ‘speech banana’? Also, you may want to check your wording in that section; there are quite a few errors that make it difficult to understand.



    1. Thanks for your comment. If you look at the drawing next to the paragraph you will see that what I mean by the String bean. It is the top of the speech banana. Children need to hear at the top of the speech banana if they are to hear all the phonemes, not somewhere or anywhere within the speech banana. I hope this makes it more clear. Please let me know if you have any questions.

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