Technology

And Communication

Options for Children

With Hearing Loss

Opening Doors: Opening Doors:

S

U.S. DEPARTMENT OF EDUCATION

oon after Peter was born, the hospital screened

his hearing and found a possible hearing loss.

Peter was referred for more testing, which

showed that he did, indeed, have a hearing loss. Peter's

parents were shocked. First, they had no idea that

doctors could check a newborn's hearing, and second,

their son?

If you've recently found out that your child has a

hearing loss, this resource sheet is for you. Whether

your child is a newborn, a preschooler, or older, there's

help available. There are service systems in place to help

your child and your family, and there are many groups

with important information to share. This fact sheet

can help you connect with both.

Your Beautiful Child

Rejoice! You’re the parent of a newborn or young

child, and you have an incredible, wonderful journey ahead. The fact that your child has a hearing

loss is only one facet of the journey.

Still, hearing loss is a very important facet and

needs to be addressed. Even as a baby, your child is

learning and growing all the time. The sooner you

find help for your child, the better. Research has

shown that, with immediate and proper help, by

Photo reprinted with permission of NICHCY.

Technology

And Communication

Options for Children

With Hearing Loss

age 5 children with hearing loss can develop language skills comparable to those of children without

hearing loss. Two key factors are involved:

✓ early identification of the hearing loss, and

✓ appropriate early intervention services from

qualified providers.

Peter, the baby we just mentioned, is already well

on his way to developing the language and other

skills he needs to succeed in school and in life. His

hearing loss was detected early, the hospital

Continued on Page 2.
connected his family with nearby early

intervention services, and Peter received

services immediately. His family learned about

hearing loss and about communicating with

their newborn. They are exploring all sorts of

options for helping Peter to take advantage of

the hearing he does have (called residual

hearing) and to communicate visually. And

Peter—he’s wide open to the world and

learning, learning, learning all of the time.

Windows of

Opportunity

One of the most amazing things your child

will learn in his or her lifetime is language—

words, meanings and their use for communicating with others. The early years are a critical

time for learning language. Getting help for

your child as early as possible maximizes his or

her window of opportunity to learn language.

Research has shown that children who begin

receiving appropriate help before six months of

age are more likely to learn language at a pace

comparable to that of children whose hearing

is normal.1 So take advantage of the service

systems that exist to help your child and you.

Opening Doors: Technology and Communication Options for Children With Hearing Loss

1 Joint Committee on Infant Hearing. “Year 2000 position

statement: Principles and guidelines for early hearing

detection and intervention programs,” Audiology Today,

Special Issue, Reston, Va.: American Academy of Audiology,

August 2000. (Accessed on May 10, 2003 at

U.S. D

www.audiology.org/professional/positions/jcih-early.pdf.)

EPARTMENT OF EDUCATION

Opening Doors: Technology and Communication Options

for Children With Hearing Loss was produced for the

U.S. Department of Education under Cooperative Agreement

#H326N980002 between the Academy for Educational

Development and the Department’s Office of Special

Education and Rehabilitative Services (OSERS). The views

expressed herein do not necessarily represent the positions or

policies of the U.S. Department of Education. No official

endorsement by the U.S. Department of Education of any

product, commodity, service, or enterprise mentioned in this

publication is intended or should be inferred.

U.S. Department of Education

Margaret Spellings

Secretary

Office of Special Education and

Rehabilitative Services

John H. Hager

Assistant Secretary

Office of Special Education Programs

Alexa Posny

Director

Additional copies of this publication are available from:

ED Pubs

P.O. Box 1398

Jessup, MD 20794-1398;

1-877-4ED-PUBS (433-7827);

1-877-576-7734 (TTY/TDD);

301-470-1244 (fax);

edpubs@inet.ed.gov;

www.edpubs.org.

On request, this document can be made available in accessible

formats, such as Braille, large print, and computer diskette. For

more information, please contact the U.S. Department of

Education's Alternate Format Center at (202) 260-0852.

This report is also available on the

Department of Education’s Web site at:

www.ed.gov/about/offices/list/osers/reports.html.

Quick Facts

• Each year 24,000 children are born with

hearing loss in the United States.

• The great majority of these children are born

to parents who have normal hearing.

• Many states now require that hospitals

screen babies at birth for possible hearing

loss. This screening is painless, and only

takes a few minutes.

Continued on Page 3.

2

Photo reprinted with permission of NICHCY.

Continued from Page 1.
• Not all hearing loss is present at birth. Causes

of hearing loss later in childhood include

genetic factors, illness, and trauma.

• The degree of hearing loss can vary from mild

to profound, including deafness. There also

are different kinds of hearing loss: conductive

(caused by diseases or obstructions in the

outer or middle ear); sensorineural (where the

delicate sensory hair cells of the inner ear are

damaged); mixed (a combination of the two);

and central (resulting from damage to the

nerves of the central nervous system).

• Many services are available to help children

who have hearing loss, including deafness.

For eligible infants and toddlers (birth

through age two), there's early intervention. For

eligible children from three to 18 (and in

some states through 21), there are special

education and related services. These services

can be very important to your child and your

family. Use this fact sheet to learn more

about, and connect with, these systems.

First Reactions

When parents find out that their

child has a hearing loss, many

may feel shocked, sad, and uncertain about what to do. As the

shock fades, though, they usually

begin a search for information.

Information is one of your most

powerful tools! It’s very important to

find out as much as you can about

your child’s hearing loss and what

options and resources are available.

If the information is hard to

understand, there are specialists

available who can help you.

Fortunately, there are many helpful

resources. Four invaluable ones are

listed in the box at the right, and

following is more information about

the first two assistance options—

state services such as early intervention and groups specializing in

hearing loss and deafness.

Early Intervention

The importance of early intervention has been

mentioned several times already, but you may

be wondering, “What is early intervention?”

“Early intervention” means getting started as

early as possible to address the individual

needs of a child with disabilities. This is done

to enhance the infant or toddler’s development, to minimize the potential for developmental delay, and to enhance the family’s

capacity to meet the child’s needs. Early intervention is a system of services established by the

states through grants from the federal government to help eligible children from birth until

their third birthday.

If your child was born with a hearing loss or

has developed one before turning three, you

may want to get in touch with personnel in the

early intervention system in your area. The

hospital staff may have already connected you

with these services. If not, you may wish to ask

Where Do I Turn?

Four valuable service systems available to you and your family are:

❒ state services such as early intervention (for eligible

children up to the third birthday) and special education and

related services (for eligible preschoolers and school-aged

children);

❒ organizations specializing in hearing loss and deafness that

provide information and support;

❒ resource and information centers that can offer information about national and state resources and education

rights; and

❒ parent groups, in which you can talk with other parents who

also have children with hearing impairments or deafness.

The National Dissemination Center for Children with

Disabilities (NICHCY) can help you connect with any of these

systems. Contact NICHCY at: NICHCY, P.O. Box 1492,

Washington, DC 20013. Phone: 1-800-695-0285 (V/TTY).

E-mail: nichcy@aed.org. Web: www.nichcy.org.

U.S. DEPARTMENT OF EDUCATION

3

Opening Doors: Technology and Communication Options for Children With Hearing Loss

Continued from Page 2.

Continued on Page 4.
advice, and perspectives can be a great help to

you and your child over the coming years.

We’ve listed many such groups on Pages 7 and

8 to get you started.

Breaking the

Sound Barrier

The discovery of your child’s hearing loss brings

with it a lot of decisions to be made. One issue

that is likely to come up is technology and how

it can help children with hearing loss. You’ll

learn about two technologies in particular —

hearing aids and cochlear implants. Both can

give children access to spoken language and the

other sounds around them. Let’s take a look at

these two technologies.

Hearing Aids

Hearing aids make sound louder in the ranges

needed, which are dictated by the individual’s

hearing loss. They operate on very small batteries, collect sounds, make them louder, and then

transfer them to the ear canal.

When a child has a hearing loss, many

health-care providers believe that it’s important to fit the child with hearing aids as early

as possible. Why? Because children begin

identifying sounds and learning language in

their very first months of life. Hearing aids

can give many children the opportunity to

hear and learn language like children with

normal hearing. Even babies one month old

can wear hearing aids.

Each hearing aid is selected for, and fitted to, a

child’s individual hearing loss. That’s because

not all hearing losses are the same. One child

may not be able to hear certain pitches or

tones of sound, while another child may not

be able to hear others. A professional trained in

hearing loss (called an audiologist) will use tests

to determine how much to amplify sound for

each child. The tests don’t hurt. They are used

because very young children can’t reliably tell

us when sound is too loud, too soft, or unclear.

Opening Doors: Technology and Communication Options for Children With Hearing Loss

U.S. DEPARTMENT OF EDUCATION

4

Continued on Page 5.

your child’s doctor or call your state’s Parent

Training and Information (PTI) center.

Wondering where your PTI is located? NICHCY

can provide you with the number for the PTI

that serves your area and put you in touch with

the early intervention system in your state. Give

NICHCY a call at 1-800-695-0285.

Early intervention may be of help to your child

and your family in many ways, including learning to communicate with each other. Under the

federal early intervention program in your state,

if your child is eligible, you’ll be assigned a service

coordinator to help you understand the intervention system and make sure that your child gets

the services to which he or she is entitled. Note:

Under the Individuals with Disabilities Education

Act (IDEA), parents have the right to be part of

the team that identifies the early intervention

services their child needs, called the Individualized Education Program (IEP) team.

Groups Specializing

In Hearing Loss and

Deafness

You’ll be positively amazed at the number of

groups in the United States that focus on

hearing loss and deafness. Their information,

Photo reprinted with permission of Cochlear Americas.

Continued from Page 3.
Once a child is fitted with hearing aids, it’s very

helpful for parents to work with the child’s

hearing health-care team and other professionals

to identify the services the child will need to help

him or her develop speech, language, hearing,

and communication skills. For children under the

age of three, these services may be available

through the early intervention system. When

eligible children with disabilities are three and

older, the public education system takes over and

makes special education and related services

available. (Contact NICHCY for information

about accessing these systems of services. See

contact information on Page 3.)

This is only the briefest overview of hearing aids.

They’re complex devices, and there are many

features to consider. Visit the Web sites we’ve

listed on Pages 7 and 8 to learn more.

Cochlear Implants

If a child has not benefited from hearing aids

after wearing them for several months, he or she

may be a candidate for a cochlear implant. This is

a device that is surgically placed in the ear.

Unlike hearing aids, a cochlear implant does not

make sound louder. It bypasses the damaged

parts of the ear and sends an electronic signal

directly along the auditory nerve to the brain.

A child using a cochlear implant will need help

developing language, just as children using

hearing aids do. He or she will need to be

trained to interpret and use the

sounds that are perceived via the

implant. With this training, a child

who is an appropriate candidate and

who receives a cochlear implant early

will likely learn spoken language at a

level close to that of a child who has

normal hearing.

Cochlear implants are approved by

the Food and Drug Administration

for appropriate children 12 months

of age or older. What makes a child a

good candidate for a cochlear implant? The following factors are

usually considered:

• The severity of the hearing loss. For children aged

12 months to two years, the hearing loss

should be sensorineural and profound. For

children over 25 months, hearing loss should

be sensorineural and severe to profound.

• The level of benefit from hearing aids. When a

child has received little or no benefit from

wearing hearing aids, the possibility of a

cochlear implant may be discussed.

 • The level of the family’s motivation about the

child receiving a cochlear implant. For cochlear implants to be successful, family

members need to be fully committed to

making sure that the child receives followup services.

These follow-up services may include speech,

audiology, and other services, which are

intended to help the child learn to listen with a

cochlear implant.

Services are provided by qualified individuals

and may be available under various programs,

including early intervention services or special

education and related services. Parents play a

part in identifying the services and seeing that

their child receives them. The child and his or

her family should be prepared to actively

pursue a program of learning to listen with the

cochlear implant.

U.S. DEPARTMENT OF EDUCATION

Opening Doors: Technology and Communication Options for Children With Hearing Loss

5

Photo reprinted with permission of Oticon.

Continued from Page 4.

Continued on Page 6.
Detailed information about this technology

and what families can expect is available at the

Web sites and in the publications listed on

Pages 7 and 8.

Exploring

Communication Options

Communication is at the heart and soul of our

lives. Children with hearing loss may build

their communication skills using one or more

of the communication options described in

this section. To help you get started learning

more about these options, let’s take a look at

each one.

Auditory-Oral

This approach encourages children to make

use of the hearing they

have (called residual

hearing) using hearing

aids or cochlear implants. Speechreading,

sometimes called lipreading, is used to

supplement what’s

detected through residual hearing. In this

approach, children learn

to listen and speak but

do not learn sign language (described below).

Auditory-Verbal

A key element of this approach is teaching

children to make effective use of their residual

hearing—either via hearing aids or a cochlear

implant. Therapists work one-on-one with the

child to teach him or her to rely only on listening

skills. Because parent involvement is an important part of the auditory-verbal approach, therapists also partner with parents and caregivers to

provide them with the skills they need to help the

child become an auditory communicator. In this

approach, neither speechreading nor the use of

sign language is taught.

Opening Doors: Technology and Communication Options for Children With Hearing Loss

U.S. DEPARTMENT OF EDUCATION

6

Cued Speech

In this system, children learn to both “see” and

“hear” spoken language. They focus on the

movements that the mouth makes when we talk.

This is combined with: (a) eight hand shapes

(called cues) indicating groups of consonants, and

(b) four positions around the face, indicating

vowel sounds. Some sounds look alike on the

lips—such as “b” and “p”—and others can’t be

seen on the lips—such as “k.” The hand cues help

the child tell what sounds are being voiced.

Sign Language

There are two basic types of sign language:

(a) SEE, which stands for Signed Exact English,

and (b) ASL, or American Sign Language. SEE

is an artificial language

that follows the grammatical structure of

English. ASL is a language that follows its

own grammatical rules.

It is often taught as the

child’s first language.

English may then be

taught as a second

language.

Total Communication

In this communication

system, methods are

combined. Children learn a form of sign communication. They also use finger spelling,

speechreading, speaking, and either hearing aids

or cochlear implants.

Confused? Overwhelmed? Wondering how in

the world you’re supposed to decide which

approach to use with your child? Well, that’s

normal! There’s a lot to know about each of

these methods. To learn more, take a look at

the publications and Web sites we’ve listed on

Pages 7 and 8. Read, ponder, and talk with

other parents, your child’s audiologist, and

other hearing health-care and education

professionals.

Continued from Page 5.

Photo reprinted with permission of Cochlear Americas.
Alexander Graham Bell Association for the

Deaf and Hard of Hearing

1-866-337-5220; 202-337-5220 (V); 202-337-5221 (TTY)

E-mail: info@agbell.org

Web: www.agbell.org

American Academy of Audiology

1-800-222-2336; 703-790-8466 (V)

Web: www.audiology.org

American Academy of Otolaryngology–

Head and Neck Surgery

703-836-4444 (V)

Web: www.entnet.org

American Society for Deaf Children

1-866-895-4206; 717-703-0073 (V/TTY)

E-mail: asdc@deafchildren.org

Web: www.deafchildren.org

American Speech-Language-Hearing Association

1-800-638-8255; 301-897-5700 (V/TTY)

E-mail: actioncenter@asha.org

Web: www.asha.org

U.S. DEPARTMENT OF EDUCATION

Visit the AG Bell Web site to learn

about hearing loss, hearing

technology and spoken language

education opportunities.

Hearing Loss and

Hearing Screening and Assessment

Online overview of the

cochlear implant

Continued on Page 8.

7

Consumer guides, including:

Early Infant Hearing Screening and

Intervention and Frequently Asked

Questions About Hearing Aids

In Spanish, too!

* The U.S. Department of Education has neither reviewed nor approved the information listed on the Web sites noted in

this document, which are not part of the Department’s Web site. No official endorsement by the U.S. Department of

Education of any product, commodity, service, or enterprise mentioned on these resource pages or in this publication is

intended or should be inferred.

Opening Doors: Technology and Communication Options for Children With Hearing Loss

The organizations and Web sites listed alphabetically below* are just some of the many sources of

information on hearing loss and deafness. Each will lead you to more.

ASDC Snapshots such as I

Suspect My Baby Has a Hearing

Loss and Cochlear Implants

M M Find Out More Find Out More M M

Look for

information

such as ...
Look for

information

such as ... Hearing Loss Association of America

301-657-2248 (V); 301-657-2249 (TTY)

E-mail: info@hearingloss.org

Web: www.hearingloss.org

Laurent Clerc National Deaf Education Center

202-651-5051 (V) , 202-651-5052 (TTY)

E-mail: Clearinghouse.Infotogo@gallaudet.edu

Web: http://clerccenter.gallaudet.edu/InfoToGo

National Dissemination Center for Children

with Disabilities (NICHCY)

1-800-695-0285 (V/TTY)

E-mail: nichcy@aed.org

Web: www.nichcy.org

National Early Childhood Technical Assistance

Center (NECTAC)

919-962-2001 (V); 919-843-3269 (TTY)

E-mail: nectac@unc.edu

Web: www.nectac.org

National Institute on Deafness and Other

Communication Disorders

1-800-241-1044 (V); 1-800-241-1055 (TTY)

E-mail: nidcdinfo@nidcd.nih.gov

Web: www.nidcd.nih.gov

Continued from Page 7.

Hearing Aids

and Cochlear Implants

Visit the Hearing Loss Association of

America’s National Center for Hearing

Assistive Technology and learn about

hearing aids, cochlear implants, and more

8

Contact information for

the early intervention

system, parent groups,

disability groups, and PTI

in your state

Contact information for

the early intervention

system in your state

And you may wish

to try these

Web sites,

too!

www.infanthearing.org

www.babyhearing.org

www.ncbegin.com

www.nad.org

Hearing Aids and Other Assistive

Devices: Where to Get Assistance

and visit the Cochlear Implant

Education Center

U.S. DEPARTMENT OF EDUCATION

Spring 2006

M MFind Out More Find Out More M M