Children learn language by being exposed to it. Children who hear Russian learn Russian. Children who hear French learn French. Children who hear English learn English etc. There has been a lot of research that shows that the amount of exposure they receive significantly affects their language.
Exposure to language
Hart and Risley (Hart, B, and Risley, T.T (1995) Meaningful differences in everyday experiences of young American children. Baltimore; Paul H. Brookes Pub. Co.) showed that children in welfare families heard significantly fewer words per day than children from families in which parents were professionals resulting in significantly smaller vocabularies and lower IQ scores.
Hart and Risley reported that children from welfare families heard an average of 8,624 words in a 14 hour day, and at age 3 had an average vocabulary of 525 words and an IQ of 79 while children from professional families heard an average of 30,142 words in a 14 hour day and at age 3 had a vocabulary of 1,116 words and an IQ of 117.
Kraus and Anderson (Kraus and Anderson) have demonstrated that low socioeconomic states is linked to impaired auditory processing. They report that low socioeconomic status appears to affect neural mechanisms important for developing literacy skills.
An article in the Wall Street Journal dated 9/24/14 reported that English proficiency is a strong predictor of economic standing. They reported that the top careers for adults with limited English proficiency are building and grounds maintenance/cleaning, production, construction and extraction, food preparation and serving, and transportation and material moving. While people may be proficient in another language, proficiency in English is a critical predictor of economic standing.
What does this all mean for children with hearing loss?
We know that hearing loss is a doorway problem. Hearing loss prevents children from accessing auditory information which results in reduced auditory brain development, decreased language and decreased literacy skills. But does it have to be this way? NO!!!
Those of us who work with children and families affected by hearing loss know that it absolutely does not have to be this way. What does it take? Exposure to speech and language requires more work for a child with hearing loss.
What does it take to provide good access to language if you have a hearing loss?
First and foremost we have to provide access to speech and language. I have talked about this a bunch of times in this blog but here we go again. With today’s technology, every child who has an auditory nerve, regardless of degree of hearing loss, will be able to have access to speech and language. With today’s hearing aids and cochlear implants we can provide good access.
What does good access mean? It means that with the child’s technology they are hearing at the level of the speech string bean through 8000 Hz (The Speech Bean) (https://hearinghealthmatters.org/hearingandkids/2015/the-speech-string-bean/) – in other words, at the top of the speech banana. Only by hearing throughout the speech frequencies (through 8000 Hz) will they have access to all conversational speech. Children need to hear speech that is clear and they need to hear people talking who are standing next to them and those who are standing 10 feet away. Typical hearing children learn much of what they know by overhearing conversations that are not directed specifically to them. So they need to hear soft speech so that they can participate in incidental learning.
Speech and language
Once we are sure that children are hearing speech at a sufficiently soft level (in the string bean) we also need to be sure that they are hearing speech that is clear so that they can use it to learn. We need to talk to they directly, we need to turn off as much noise as we can, and we need to talk talk talk talk.
Educating parents from all socioeconomic status’s about talk talk talking
We absolutely know that deaf kids can succeed and be anything they want to be. Kids who’s hearing loss I identified when they were young (before newborn hearing screening) are now physicians, lawyers, accountants, musicians, psychologists, audiologists, engineers, a rabbi etc. How did they get there?
- Appropriately fit technology (and not as good as if available today)
- Using technology every waking minute
- Lots of therapy
- Parents who talk, talk, talked
While many of these young people came from families who were professionals not all did. Some of the kids who succeeded came from families where no one had graduated from high school, much less college. They had a lot to learn but that does not mean that we can not help these families succeed. In fact, it is our responsibility to help these families succeed.
What should we be telling families?
- We need to help families understand that hearing loss is a neurologic emergency and that children need to be treated as quickly as possible.
- They need to understand the need for auditory access. They need to understand that if children wear hearing aids 4 hours a day it will take that child 6 years to hear what a typical child hears in one year. Keep hearing aids on!!!
- Turn down the noise.
- Therapy needs to demonstrate talking and expanding language so families can learn to build skills. Talk about what you are doing, where you are going, what you see and hear.
- Parents need to read 10 books a day every day (Reading aloud t0 children is the single best predictor of a child’s literacy.)
- Sing songs
- Expect children to listen and talk.
What do we need to do as professionals?
Our jobs are much easier when we are working with families who already have high expectations for their children and who, when we see them, have researched everything there is to know about deaf kids. Great. Those families take less work. But kids from low socioeconomic families have just as much of a right to succeed. And we need to make it happen. We need to model expanding language, make sure they understand all they need to do, help them learn to find books to read in the library etc.
Audiologists have to make sure that technology is working well, that children are hearing in the string bean, and that the technology is clear and not distorted. We need to monitor speech perception. We need to know that the child is receiving appropriate auditory based therapy and that parents are participating. If a child is not receiving appropriate therapy we need to help families find appropriate therapy.
Speech-language pathologists and listening and spoken language specialists need to be sure that therapy is auditory based, is developmentally based and that families understand and participate.
Everyone needs to monitor progress. If a child is not making appropriate progress we need to all talk together about what needs to be done and get it done. We cannot work in silo’s. We need to work together to provide children with whatever they need to succeed. Our jobs are bigger than our individual clinical responsibilities. Those of us who have chosen pediatric audiology are responsible for helping families succeed. And we can do it.!!!