Communication Modes

When a child is identified with hearing loss, parents have many questions.  One area of uncertainty is how they can encourage their child’s early and ongoing communication development. Parents will need more specifics about their child’s type of hearing loss, level of hearing, developmental needs and the potential benefit of listening devices (hearing aids and cochlear implants). Parents can gather information about communication approaches and make choices based on what they hope will work best for their child and family. Decisions may change over time, but it is essential for parents to strive to provide their child with full and early access to language.  In each of the approaches described below, children with hearing loss may use listening device(s) if suggested, to increase their awareness of sound and speech.   These brief descriptions summarize how an approach might be used by parents of children ages birth to five.

Auditory-Verbal   
An Auditory-Verbal approach stresses learning spoken language through listening. Parents become the primary facilitators of their child’s spoken language development and encourage listening, language and speech through everyday experiences. Parents actively participate with the child in therapy sessions with a LSLS Cert. AVT (Listening Spoken Language Specialist Certified Auditory Verbal Therapist). The goal is for the child to participate in a general education environment.

Auditory-oral
An auditory-oral approach emphasizes learning spoken language through listening but it may include visual techniques, too.  Parents encourage their child’s listening, language and speech through everyday routines.  Visual cues (gestures, expressions, lip movements) may be used as needed. The child could receive speech therapy with or without family involvement, but home activities are conducted to support language growth. There can be many similarities between educational programs using oral approaches.

Cued Speech
Cued Speech is a system that uses hand shapes and positions along with mouth movements to convey speech sounds. Cues visually supplement listening and support the development of speech-reading skills. Parents cue as they speak but, in many cases, the child speaks without cueing. Some families use cues to strengthen their child’s early speech and language and decide whether to continue it upon school entry. A child using cues could have a transliterator in school to cue what others are saying.

Total Communication
A Total Communication philosophy can involve a variety of methods but usually combines signing with spoken language. Total communication might mean parents supplement their spoken language with some signing or use mostly signs with some speech.  They might add pictures to their speech and/or signs. When every word is signed as it is spoken, it is called Simultaneous Communication. Total Communication is often used to help a child benefit from multiple strategies initially, with one specific communication approach being stressed later. Total Communication techniques vary from school program to program.

Formal Sign Language (American Sign Language (ASL) or Sign Language of other countries)
Sign Language is a visual, non-spoken language with its own distinct grammar and sentence structure.  If parents are Deaf and signing is their first language, they may choose this approach for their child and may or may not later encourage their child to also learn spoken language. When family members are hearing, they would aim to become fluent in signing to communicate fully with their child. In the U.S., Bilingual-Bicultural programs honor the culture of the Deaf community; stress ASL as a first language; and teach English for reading and writing. 

Choosing a Communication Approach
When parents are considering communication approaches for their child with hearing loss, they will need to explore why an approach would work for their child, who they can learn from, where there are programs, when services can start and what support they can receive.  This information can be gathered from multiple sources including service providers, the Internet, other parents, books, education systems, family organizations and  individuals who are Deaf and hard of hearing.  Learning about hearing loss and how to help their children develop language can be a major role for parents as they begin to develop advocacy skills. Five communication approaches are compared here in chart form and can be a helpful reference for families.

John Tracy Clinic offers information and distance courses for families of children with hearing loss ages birth to five. The focus is language development with ideas for learning through child play and family routines.  The expertise at John Tracy Clinic is in spoken language which is emphasized in onsite programs such as the Parent/Infant Program and Preschool, as well as via Distance Education for Parents, but many of the techniques can be used in any communication approach.  The key is to provide children with early and complete access to communication to help them fully develop their language skills.  Development of complex communication skills helps children be ready for school. There are no limits to what children with hearing loss can achieve.