Rationale: Current Trends in the United States
In the first decade of the 21st century, children with even severe and
profound hearing loss have more opportunities to be successful with
spoken language than ever before.
Today, more than 94% of newborns in the United States are screened
for hearing loss prior to leaving the hospital or birthing center. For those
children who fail their hearing screening, immediate diagnosis is
possible, and the fitting of digital hearing aids can occur by the time the
child is four weeks of age.
In most states, enrollment in early intervention services can occur, and
the infant can begin to use their amplified residual hearing to learn to
listen and talk. If the child doesn’t make satisfactory progress within a
few months due to his or her severe or profound hearing loss and
limited benefit from hearing aids, cochlear implantation may be
considered.
By identifying hearing loss early, fitting the child with appropriate
hearing technology, and enrolling them in early intervention programs
that emphasize auditory learning, often these children can achieve
spoken language that meets or exceeds their hearing peers by the time
they reach kindergarten or first grade.
Because approximately 95% of parents of children with hearing loss
are hearing themselves, most parents want their children to maximize
their ability to develop spoken language and to use the mode of
communication found commonly within the home and used with other
family members. In fact, some states – such as North Carolina – are
reporting that parents are choosing spoken language options for their
children with hearing loss more than 85% of the time, especially when
they know spoken language is a viable and realistic outcome for their
child. And, these parents are typically selecting one of the two most
common spoken language approaches, Auditory-Verbal or Auditory-
Oral, without ever initiating visual communication systems, such as sign
language.
Due to advances in newborn hearing screening, early identification of
hearing loss, the fitting of advanced hearing technology such as digital
hearing aids, cochlear implants, and FM systems, and the availability of
appropriate early intervention, most children with hearing loss can be
successful with either an Auditory-Verbal or an Auditory-Oral approach.
Parents must choose the approach that is right for their child and family.
However, prior to making that decision, parents should speak with other
parents about their experiences, get first and second opinions from
professionals who are highly trained and knowledgeable, observe
programs and/or schools first-hand, and ask very tough questions about
each program’s outcomes. That is, parents should know how many
children in the school or educational program are using age-appropriate language, how many are beginning to read, and how many
leave the program and are ready to be mainstreamed with hearing
peers. Once the parent(s) has obtained a range of information about
the available options, they can make an informed decision about the
services and intervention or educational placement they desire for their
child with hearing loss.
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Definition of Communication Methodologies
Auditory-Verbal: The Auditory-Verbal approach has been in existence
since the early 1900s, but the practice has gained significantly more
popularity since the introduction of cochlear implants in children in the
early 1990s. In the typical Auditory-Verbal model, the use of audition or
listening is the primary mode of input for the child. Visual cues, such as
speechreading, are not emphasized. Most sessions occur once or
twice each week with a certified therapist (Cert. AVT), parent(s), and
child, and the parent(s) is the primary consumer of the approach. That
is, the goal is to teach the parent how to facilitate speech, language,
and cognition through listening and how to integrate these strategies
and techniques into the daily routines of the home and the child. The
ultimate goal is for the child to develop age-appropriate language
abilities and to be mainstreamed with other typical hearing children as
early as possible.
Auditory-Oral: Similarly, the Auditory-Oral approach maximizes the
child’s use of amplified residual hearing and seeks to educate the
parent about appropriate strategies to integrate listening, speech and
language into daily routines. The basic philosophy of Auditory-Oral
education – that children with hearing loss can learn to speak with
proper training – has been around for centuries. More recently,
because of advances in hearing technology (e.g., digital hearing aids,
cochlear implants, and FM systems), most children who are deaf or
hard of hearing can now be successful. With the Auditory-Oral
approach more visual cues, such as speechreading, may be used as a
teaching technique, and children with hearing loss may be grouped
together in their intervention program or school. The long-term goal is
for these children to be mainstreamed with typical hearing peers in their
neighborhood school.
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Serving Children with Hearing Loss in Costa Rica
Dr. Sebastian Malek Quesada, in cooperation with the Costa Rican
Social Security Administration and the Ministry of Health, is working
toward implementing the Early Neonatal and Infant Deafness Detection
and Intervention Program in his country. The primary, long-term goal of
this program is to establish universal newborn hearing screening in all
hospitals and birthing centers throughout Costa Rica. Currently, a pilot
hearing screening program is being planned for two major birthing
hospitals in San Juan, Costa Rica.
However, in planning for newborn hearing screening and early
diagnosis with sensorineural hearing loss, Dr. Malek also realizes that a
comprehensive early intervention system must be developed to meet
the communicative and educational needs of each child. Costa Rica
does not have educational programs for children with hearing loss that
can teach them to listen and talk.
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Objectives and Goals of the September 2007 Visit
In September (9th-14th), Dr. Malek will lead a small delegation of
educators and government officials to visit several “model” centers and
educational programs in Mexico and the United States. The delegation
is scheduled to visit Auditory-Verbal Mexico (Mexico City), the John
Tracy Clinic (Los Angeles, CA), Saticoy Elementary School (Los
Angeles Unified School District), and the Hearts for Hearing Foundation
(Oklahoma City, OK). These centers or educational programs are
considered to be examples of current best practice in the early
intervention and habilitation of young children with hearing loss and their
families. By visiting each of these facilities, the delegation will have the
opportunity to observe the following:
- diagnostic procedures in speech, language and hearing;
- educators, speech-language pathologists, and audiologists who
are trained to maximize listening and spoken language in young
children with hearing loss;
- Auditory-Oral classrooms;
- individualized, one-on-one therapy sessions (Auditory-Verbal
Therapy);
- audiological follow-up, including hearing aid fitting and cochlear
implant mapping;
- parent counseling and family-centered practices;
- cochlear implant surgeries;
- state-of-the art facilities with appropriate acoustical treatments to
maximize learning; and
- a variety of educational materials and curricula used to teach the
children.
Throughout the week-long visit in September, the delegation will be
drafting an action plan that will guide them in establishing at least one “model” pilot program in Costa Rica.
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Additional Resources
For more information about these spoken language options and other
related topics, please visit the following websites:
AG Bell Academy for Listening and Spoken Language www.agbellacademy.org
Alexander Graham Bell Association for the Deaf and Hard of
Hearing (AG Bell)
www.agbell.org
American Speech-Hearing-Language Association (ASHA)
www.asha.org
BEGINNINGS for Parents of Children Who are Deaf or Hard of
Hearing, Inc. www.ncbegin.org
Hear and Now
www.hearandnow.org
National Center for Hearing Assessment and Management
(NCHAM) www.infanthearing.org
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