Ensuring Access to Communication for Young Children with Hearing Loss: Auditory Learning and Spoken Language

Speech Perception in Typical Hearing Children

Children with typical hearing are born with highly specialized speech perception abilities. For example, newborn infants can show preferences for the human voice and even identify the voices of their parents as measured through physiological reactions that occur when mom or dad speak to them (Gopnik, Meltzoff, & Kuhl, 1999). Newborns with intact hearing also can show preferences for human speech over environmental noises. Research also indicates that by 6 months of age, infants with typical hearing begin to refine the categorical perception of their native language (Kuhl, Williams, Lacerda, Stevens, & Lindblom, 1992), or more commonly stated, the language that is spoken in their homes. Categorical perception allows the infant to discriminate the speech sounds (i.e., phonemes) of their native language, a critical skill that is necessary for phonemic awareness, ongoing spoken language acquisition, and literacy.

Children with Hearing Loss Are at a Disadvantage

For newborns identified with hearing loss, their early speech perception is delayed. The auditory cortex and closely associated language centers have not received the same amount of stimulation as compared to their hearing peerseven as newborns. Because the auditory pathways are formed prenatally at approximately 5 months gestation, the newborn with typical hearing has been "listening" for about 16 weeks at birth. That is, the newborn that is delivered after a full-term pregnancy, auditory brain development has been occurring for approximately 4 months, and the auditory pathways that are necessary for speech perception are well on their way to being formed. The child with hearing loss, however, remains at a disadvantage. The prenatal experiences have not been the same, and the child's ability to respond to random sounds in the environment or to his or her parents' voices is severely impaired. Because hearing loss is often described as the "invisible disability" (Shohet & Bent, 1998), children that appear normal in every other physical aspect will fail to make progress in their speech and language development. In fact, most children with unidentified hearing losseven those in the severe or profound rangewill begin to vocalize just as any infant. In these cases, the infant is receiving tactile stimulation from vocalizing. Additionally, the infant's parents also are responding positively to each vocalization, and this reinforces the behavior in the child. However, at around 6 months of age, research indicates that most children with unidentified hearing loss will drastically reduce the amount of vocalizing they are exhibiting (Carney & Moeller, 1998). For parents, this is often one of the first "red flags" that will occur indicating that something is out of the ordinary.

A Changing Landscape: Universal Newborn Hearing Screening

Prior to universal newborn hearing screening (UNHS), parents often would suspect that their child had a hearing loss an average of 12 months before receiving a confirming diagnosis (Thompson, 1991). This delay led to an average age of diagnosis of 2.5 years of age (Commission on Education of the Deaf, 1988; White, 2007) for most children identified with hearing loss. Because of this later diagnosis, practitioners (especially speech-language pathologists and early interventionists) faced a considerable challenge in developing the child's spoken language abilities. While many children could be successful in their communication development with appropriate hearing technology, few children had access to the services that were necessary to achieve intelligible spoken language.

Communication Approaches

Because most children with hearing loss today can achieve communication outcomes that are comparable to their same-age hearing peers by the time they reach kindergarten or first grade (Yoshinaga-Itano et. al, 1998), it is important to understand the range of communication options that are now available to parents. For children with hearing loss under the age of 3, federal law requires that family-centered services be implemented, and speech-language pathologists should be prepared to discuss the various communication approaches with relative detail.

Discussing the type of communication approach that parents wish to implement can be a sensitive topic, and parents should be allowed to arrive at an informed decision that is based on their desired outcomes (Joint Committee on Infant Hearing, JCIH; 2007) for their child. The discussion can be driven by the parents' long-term goals, expectations, and how they wish to communicate with their child. Most importantly, parents should have access to unbiased information about each communication approach, and they should understand the benefits and challenges that are inherent with each methodology. Once these discussions have occurred, the speech-language pathologist can explain the communication approaches and the range of support services that should be available in the local community.