Early intervention with newly identified infants and their families is a specialty area within deaf education. Not only does it draw upon knowledge of deaf education best practices, it requires a whole set of additional knowledge and skills that most university preparation programs simply don’t cover. This isn’t a personal gap, this is a systemic one.

You’re Not Alone and the Research Agrees With You

The gap between Teacher of the Deaf and Hard of Hearing preparation and early intervention practice isn’t something a few teachers quietly experience. It is documented in peer-reviewed research, national policy reports, and the position statements of major professional organizations.

Maryilyn Sass-Lehrer at Gallaudet University, one of the leading researchers in early intervention for deaf and hard of hearing children, has written that the growth of newborn hearing screening has created a surge in infants needing services, while the pipeline of specialists prepared to serve them has not kept pace. She notes that some families end up with providers “who do not understand the complex issues related to being deaf and who may inadvertently misguide” them – not out of carelessness, but out of a system that hasn’t prepared them. (Sass-Lehrer, Early Beginnings, Galludet/Laurent Clerc National Deaf Education Center)

A 2016 study published by the National Institutes of Health found that even among credentialed teachers of the deaf and hard of hearing working in early intervention, preparation levels were only weakly to moderately correlated with comfort providing specific early intervention (EI) skills particularly around supporting spoken language development in infants. In other words: a credential is not the same as preparation. (Factors Affecting Early Services for Children Who Are Hard of Hearing, PMC 4766183)

Dr. Harold Johnson, Emeritus Professor at Kent State University, said it plainly: “There is a gap between the preparation that deaf education preservice teachers receive and the roles thay are expected to fill.” (Hands and Voices, Fall 2019)

And the pipeline itself is shrinking. A 2025 study in the Journal of Deaf Studies and Deaf Education confirmed that teacher of the deaf and hard of hearing preparation programs have continued to close even as demand for qualified teachers grows. (Scott, Pagliaro, et al., 2025)

What Makes Infant and Toddler EI Different From What You Were Trained For

Happy loving family. mother and child girl playing, kissing and hugging at home

Before looking at what to do, it helps to name exactly what the early intervention context requires that may not have been part of your training. This is not a list of what you may have done wrong; it is a map of the terrain.

• Your primary “student” is the family, not the child.  In EI, you are working to build caregiver capacity. Your role is to help parents understand their child’s hearing difference, become confident communication partners, and learn how to weave language-rich interaction into everyday routines. This requires coaching skills, empathy for families in crisis, and comfort with a much more collaborative dynamic than the typical teacher-student relationship.
• The framework is family-centered, not child-centered. Under IDEA Part C, EI services are built around an Individualized Family Service Plan (IFSP) not an Individual Education Plan (IEP). The family sets the priorities. Your job is to support their goals within the rhythm of their daily life. This is a fundamentally different orientation than school-based services, and it takes intentional adjustment.
• You need 0-3 developmental knowledge.  Infant language acquisition, attachment and bonding, parent-infant interaction, and developmental red flags in babies are foundational to EI work. These topics are rarely covered in depth in K-12 TODHH preparation programs, and they matter enormously when you’re sitting across from a four-month-old and her parents.
• Communication modality decisions are immediate and emotionally loaded.  Families of newly identified babies are often making decisions about spoken language, ASL, or a bilingual approach within weeks of diagnosis, and sometimes with little information and a great deal of pressure from muliple directions. You need to be prepared to offer balanced, unbiased information across communication approaches, regardless of your own training emphasis.
• The home is your classroom. EI is typically delivered in the home or other natural environments. That changes everything: how you structure a visit, how you observe and coach in real time, how you embed learning into feeding, bathtime, and play. This is not a pullout session at a table with materials you prepared in advance.

What “Qualified” Actually Means for This Work

Several national organizations have issued clear guidance on what early intervention providers for DHH infants should know and be able to do. It is worth reading this list not as a judgment, but as an honest picture of what these families need.

According to the National Association of the Deaf (NAD), drawing on the Joint Committee on Infant Hearing (JCIH), early interventionists serving DHH infants should be able to:

• Provide families with information specific to their child’s hearing difference
• Offer information about family activities that facilitate language development
• Share information about the full range of communication approaches used by deaf and hard of hearing people
• Connect families to peer and language models – including Deaf community resources
• Help families understand their infant’s strengths and needs
• Promote the family’s confidence and ability to advocate for their child
• Build family support systems

The JCIH also specifies that all EI providers for this poulation should have training and expertise in auditory, speech, and language development across both spoken and signed language as well as child development in the 0-3 range. (JCIH Position Statement, 2007; Supplement 2013)

Practical Steps If You’re In This Situation Right Now

If you have a newly identified infant on your caseload and you’re feeling the weight of that responsibility, here is a grounded path forward. You don’t have to know everything before you walk in the door, but you do deserve support, and there are real resouces available.

1. Name the gap kindly, clearly, and in writing.  You are not refusing the work. You are being a responsible professional. Let your supervisor know that you want to serve this family well. That requires EI-specific training and support. Request mentoring, professional development, or consultation as part of taking on the caseload. Document the conversation. This protects you and the family.
2. Connect with your state EHDI program. Every state has an Early Hearing Detection and Intervention (EHDI) program. Many offer training, technical assistance, and connections to EI specialists. Find yours through the National Center for hearing Assessment and Management (NCHAM) – an invaluable hub for everything related to early intervention and DHH children.
3. Get grounded in the SKI-HI Model.  The SKI-HI curriculum, developed at Utah State University, is one of the most widely used evidence-based farmeworks for home-based EI with deaf and hard of hearing children. It is family-centered, communication-approach neutral, and practical. Available through NCHAM.
4. Reach out to your state’s Hands & Voices chapter.  Hands & Voices is a parent-led organization with state chapters across the country. Their Advocate Support Training (ASTra) program and regional networks can connect your with family support coordinators, Deaf mentors, and experienced EI professionals in your area.
5. Find a mentor, not just a manual.  Ask your state school for the deaf, regional DHH programs, or early intervention coordinators whether there is an experienced EI specialist who could serve as a consultant or mentor. Someone who has actually sat in living rooms with newly identified families brings a kind of wisdom no textbook can fully capture.
6. Consider specialized graduate-level training.  Gallaudet University offers a graduate certificate program in Deaf and Hard of Hearing Infants, Toddlers, and Families designed specifically to prepare professionals for this work. If early intervention is a regular part of your role (or likely to become one) it is worth exploring.

Resources:

• NCHAM – infanthearing.org – National Center for EHDI; EI curriculum library including SKI-HI Model, Colorado Model, IDEA Part C guidance, and more.
• Gallaudet/Clerc Center – clerccenter.gallaudet.edu – Early Beginnings (Sass-Lehrer); research and resources on EI for DHH children and families.
• NAD: EI Provider Qualifications – Position statement on what qualified EI providers should know and be able to do.
• JCIH Position Statement (2007; 2013 Supplement) – Joint Committee on Infant Hearing guidelines for EI for DHH infants; available through the American Academy of Pediatrics (AAP) and American Speech-Language-Hearing Association (ASHA).
• Hands & Voices – handsandvoices.org – ASTra advocacy program; state chapter connections; TODHH shortage resources and parent support.
• Sass-Lehrer, M. (Oxford University Press, 2015) Early Intervention for Deaf and Hard-of-Hearing Infants, Toddlers, and Their Families.
• Lenihan, S. (2010). Trends and challenges in teacher preparation in deaf education. The Volta Review, 110(2), 117–128. https://doi.org/10.17955/tvr.110.2.m.632
• Scott, Pagliaro et al. (2025) – Updates and current trends in deaf education teacher preparation programs. Journal of Deaf Studies and Deaf Education. pubmed.ncbi.nlm.nih.gov/40318217
• Pub Med Central 4766183 (2016) – Factors Affecting Early Services for Children Who Are Hard of Hearing – provider preparation and EI skill comfort data.
• Supporting Success for Children with Hearing Loss  – successforkidswithhearingloss.com – Resources, assessment tools, and professional development for teachers of the deaf and hard of hearing.

Article by Brenda Wellen, M.S. for Supporting Success for Children with Hearing Loss Bi-Monthly Update, March 2026

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What does it mean to have a baby with hearing loss? Help me understand.
I recently found out my baby has a hearing loss. I know he hears something. How can I understand what the hearing loss means to my child and my family?

• Questions Families Often Ask

• Early consistent hearing: building trust & confidence

• Tips for Parents

Facts for Parents

Why can’t we just wait awhile? We JUST found out!

We were just told that our child has a hearing loss. What’s the urgency? Why can’t we just enjoy our baby now and deal with the hearing loss later?

What should I be doing to help my baby?

I recently found out my baby has a hearing loss. How can I help him? Where do I start?

• 10 Things I Wish You Knew (From a special kid to special parents)

• Early Intervention – What’s that?

Are hearing aids really needed? How much will they help? I want my child with hearing loss to learn how to talk. I know he needs to wear hearing aids even though he has some hearing. How much does he really need to wear them? Will they make him hear normally?

What do people mean by Communication Choices? What do we need to decide? We just found out our child has a hearing loss. People are talking about communication choices and how we need to decide. What is this all about? We aren’t sure, but our child may have other needs too. How can this affect our choices?

How can we get started with the basics? It’s all so new!   Setting Lang in Motion: Family Supports and Early Intervention for Babies Who Are Deaf or Hard of Hearing. This resource was developed collaboratively between the Clerc Center and the Deaf and Hard of Hearing Program at Boston Children’s Hospital. With this resource, parents, educators, and professionals have free access to seven online modules which share information critical to promoting early language acquisition for young children who are deaf or hard of hearing. The topics covered in these seven modules include: early hearing screening and evaluating, understanding how the ear works, hearing aids, cochlear implants, using sign language for communication, communication at home, and parenting a deaf or hard of hearing child. Find out more here.

  What’s the big deal about unilateral hearing loss (learing loss in only one ear)? We just found out that our child has a permanent hearing loss, but it’s only in one ear. This doesn’t seem like a big deal. What should we know?

Will having ear infections impact learning? My son has had ear infections since he was a tiny infant. Now he doesn’t say his words clearly. Can this be because of the many ear infections he has had?

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Can face-to-face intervention

The centerpiece of Part C Early Intervention services is that they occur, to the maximum extent possible, in natural environments or settings that are typical for a same-aged infant or toddler without a disability. Having a parent at home full-time with an infant or toddler is no longer a societal norm. Early interventionists often struggle to find a time in the schedule of a busy family with working parents to provide early intervention services. In present times, with parents who are Millennials and widespread communication via media devices, there may be little familiarity in inviting someone into your home to exchange information.

Research² has clearly illustrated that young children have significantly better language scores at age 5 years when they have been enrolled early in intervention services AND when the family is highly involved in carrying out the strategies recommended by early interventionists. Many parents would feel the need to ‘make their home presentable’ before having someone outside their family circle come and visit. This on top of the demands of a young family and working parents often can lead to delayed or missed intervention appointments. If families do not feel comfortable having someone in their home then the success of early intervention may suffer, even with the most highly trained and dedicated interventionist.

Even as early as 2013³, research indicated that tele-intervention is a promising cost-effective method for delivering high quality early intervention services to families of children who are deaf or hard of hearing. In fact, even then the children who had families who received tele-intervention scored significantly higher on an expressive language measure as compared to the in-person group. A measure of Parent Engagement was also statistically better for families involved in tele-intervention.

A 2017 multi-state study⁴ that evaluated the benefits of early intervention via telepractice also found that children in the tele-intervention group scored significantly higher on language measures. Analysis of video recordings of tele-intervention versus in-person home visits resulted in higher scores for provider responsiveness and parent engagement. A 2018 review of 23 peer-reviewed studies⁵ found that 18 viewed the use of tele-intervention positively while the remaining 5 reported mixed conclusions and the need for more data. Current evidence in the literature indicates that tele-intervention can be an effective model for delivering family-centered early intervention for children who are deaf or hard of hearing.

The knowledge base to provide early intervention services, whether provided remotely or in-person, can be daunting as demonstrated by the following list of Areas of Knowledge and Skill.

Resources for Skills and Strategies

NCHAM, or the National Center for Hearing Assessment & Management¹, is a centralized wealth of information for anyone who is starting to provide early intervention services, or to keep informed of the latest trends and research.

The NCHAM eBook, Chapter 18⁶: Early Intervention for Children Birth to 3: Families, Communities & Communication is a primer for the basics, and the nuances, of providing quality early intervention services.

The NCHAM Early Intervention Resource Pages include the following links:

• Early Intervention System Information
• Early Intervention Guidelines and Requirements
• Importance of Early Communication and Communication Options
• Hearing, Amplification, and Cochlear Implants
• Assessment Tools for Communication/Language and Auditory Development
• Early Intervention Curriculum and Training Materials
• Additional Early Intervention Materials, Web Sites, and Presentations

NCHAM also has a Practical Guide to the Use of Tele-Intervention in Providing Early Intervention Services to Infants and Toddlers Who are Deaf or Hard of Hearing⁷.  NCHAM established a tele-intervention learning community comprised of providers and researchers to share experiences, address challenges and systematically address relevant issues. Contact this thriving community by sending a message to Facebook.

References

1. 1. http://www.infanthearing.org/earlyintervention/
2. 2. http://depistageneonatal.be/pro_surdite/articles/Moeller.pdf
3. 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352990/
4. 4. https://journals.lww.com/iycjournal/toc/2017/04000
5. 5. https://doi.org/10.1177/1357633X18755883
6. 6. http://www.infanthearing.org/ehdi-ebook/2020_ebook/18%20Chapter18EarlyIntervention2020.pdf
7. 7. http://www.infanthearing.org/ti-guide/index.html

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The 2015 Outcomes of Children with Hearing Loss research² on children with permanent mild to severe hearing loss (25-75 dB) was a large-scale longitudinal study that followed children from six months of age to seven years old. There were 317 children who were hard of hearing and a comparison group of 117 children without hearing loss from 17 states. Almost all had permanent bilateral hearing loss and hearing aids. Three fourths were identified through newborn hearing screening. Assessment occurred every 6 months from age 6-24 months and annually thereafter to groups of children.

Summary of OCHL Findings:

In general, this collection of articles has now proven what experienced early interventionists know – for children who are hard of hearing, hearing aids need to be well fit and worn consistently and families need to know how to communicate effectively with their child to maximally develop spoken language. The richness of the parent’s talk with the child influences the child’s language outcome. This ‘formula for success’ for children who are hard of hearing is now supported by strong research.² To accomplish these ends requires very knowledgeable interventionists who have the time to provide continued support to families throughout early childhood and the involvement of someone with expertise in the educational impact of hearing loss once the child is in school.

The National Center for Hearing Assessment and Management (NCHAM) reports that detecting and treating hearing loss at birth for one child saves $400,000 in special education costs by the time that child graduates from high school.³ The amount saved can only be realized with the investment of early, appropriate services from experienced interventionists working to support families over time.

Early Intervention “Curriculums”

There is no single resource that will impart all the knowledge needed to adequately support families of young children with hearing loss. The interventionist must have a sufficient background in hearing loss, understanding audibility/speech perception, language development, the continuum of communication choices, and adult learning – as a start. The following are resources that have materials that can be easily shared with families to enhance intervention. The best intervention is reactionary, in response to the current concerns of the family, that builds skills over time in relation to the child and family’s needs. That said, it is very helpful to have resources at hand to draw from as you respond to different family learning styles and needs.

SKI*HI is perhaps the oldest and most recognized EI curriculum resource, especially for persons just starting to work with families of young children with hearing loss. The 2-volume, 2200-page resource includes information suitable to all degrees of hearing loss and exploration of and starting skill building in all communication choices. The visuals provided in the SKI*HI curriculum are something that interventionists use all the time!

EI Resources for Families Choosing to Use ASL

Gallaudet has some informational webcasts that will be of benefit to early intervention providers assisting families in learning sign language to use with their young children. Refer to the list of EI webcasts, online learning resources and publications here.

To learn any language, a child must be surrounded by fluent language users who dynamically involve the child in 2-way communication. Therefore, teachers of the deaf/hard of hearing who are highly skilled in the use of sign language and/or adults who have hearing loss and use sign language (Deaf Role Models) are the optimal choice for facilitating the family’s effective use of sign language.

Referencing sign language dictionaries such as Signing Fun, the Gallaudet Children’s Dictionary, and ASL Basics for Hearing Parents of Deaf Children is often very useful to families. It is important for EI providers to understand the developmental hierarchy for learning sign language. ASL developmental hierarchy information can be found at the end of this White Paper.

EI Resources for Families Choosing to Use Listening and Spoken Language

Listen Little Star is a tried and true resource from Australia that has 12 lessons for the family of infants (0-12 months). It is easy to use and has a DVD with professional grade video clips to accompany each lesson.

The Learn To Talk Around The Clock Toolbox is organized around a set of principles and provides hundreds of suggestions for natural practice in the family’s home or child care setting in an orderly presentation of skills known as “Signature Behaviors.” Author Karen Rossi, DHH teacher and LSLS, has an incredibly helpful website to support families, early interventionists, childcare and into preschool. The Language Development Knowledge Cards have many applications.

The Listening Room (Advanced Bionics AB4Kids) features three sections with content created specifically for age groups: Infants & Toddlers, Kids, Teens & Adults. Register to be able to see and download free activities and resources to support the development of speech, language, and listening skills. AB4Kids also offers the Baby Beats (video) app to develop listening and communication skills in young children. They also provide wonderful resources for preschool and school-aged children.

Cochlear Corporation has provided extensive, incredible resources with Sound Foundation for Babies and Sound Foundation for Toddlers. Designed for 12 months and up, the skills for babies start at a beginning auditory awareness level are applicable to children who are hard of hearing identified in the first few months along with those who are recently implanted. Babies Babble, Toddlers Talk, and Children Chatter are all videos that support the Listen, Learn, and Talk book. The Cochlear suite of materials is helpful to any interventionist or teacher working with children with useable residual hearing. There are also resource for parents of school-age children and could selectively provide some basic information for teachers. It is great to have this bank of resources videos at your fingertips.

MED-EL cochlear implant company also provides resources to purchase that will support listening and communication development.  Their free offerings include Ling Cards (set of 7 cards, 3” x 5”), Little Listeners comprehensive guide for preverbal speech, language and auditory development, Little Listeners in Spanish and other resources that can be ordered for free, or downloaded as PDFs.

Early Intervention Materials

Early Language Development Handouts and Activities with Bonus CD  This inexpensive resource provides 25 informational and activity-based handouts that will help you tell parents and caregivers at home how they can stimulate language development in their young ones. Copy the black and white handouts or print color versions from the CD.

Early Intervention Kit – Teaching Guide, Activities Book, Sign Language Cards While this is not a DHH-specific resource, this kit has the essential information and tools for successful early intervention services. Effectively address assessment, intervention, and documentation. The Activities Book is a gold mine of intervention objectives, goals, and specific suggested activities, for Pre-Linguistic Skills, Expressive Language Skills, Receptive Language Skills and Sound Production Development. 

Listen Little Star is for families of infants newly diagnosed with hearing loss. It is excellent for families to obtain and use independently as a supplement to their early services. It is even more effective when used as a family-friendly guide to early intervention whether used by a provider with limited background in DHH or a veteran early intervention DHH teacher. This colorful 160+ page guide is divided into 12 lessons and also includes an extensive Baby Response Checklist data gathering tool and other resource materials at the end.

A DVD with professionally recorded video lessons provides a description and video showing the lesson being done by a parent and child. It is an excellent way to teach the skill in the printed or digital guide.

Achieving Effective Hearing Aid Use in Early Childhood

The purpose of this guide is to further the understanding of children’s development, how developmental stages will affect hearing aid wear, and what families and early intervention teachers can do to achieve full-time hearing aid wear. By using the information in this guide, hearing aid retention accessories and specific age-appropriate strategies, it is hoped that families will be better prepared to manage their child’s hearing aid wear. The guide is 88 pages long and is available in digital or paper versions. Information written in this guide is directed toward parents, which makes it ideal to use as an intervention guide while providing services to families of infants, toddlers and transitioning preschoolers.

The Developing Child with Unilateral Hearing Loss

20%-30% of all infants diagnosed with hearing loss have unilateral hearing loss (UHL). The result is hundreds of

families of babies with unilateral hearing loss who are seeking assistance to understand what the hearing loss may mean to their child’s future and to receive direction on how they can best influence their child’s success.

The publication is a step-by-step guide to early intervention for children with UHL. It is available in digital and paper versions. The early intervention material is based on a 100-slide PowerPoint Presentation that explains what should be discussed at each of the first 5+ early intervention sessions along with family-friendly information to address each key point. Handouts have been drawn from the slide groups to serve as a summary of key concepts.

Social-Emotional Evaluation/Assessment Measure (SEAM)

The SEAM is an in-depth, easy-to-use tool, to reliably assess and monitor social-emotional development in

infants, toddlers, and preschoolers at risk for delays or challenges. The two-part SEAM™ assessment reveals

detailed qualitative information on children’s social-emotional competence – and identifies their caregivers’ strengths and areas of need. Easy to learn and implement, SEAM can be used by a wide variety of early childhood professionals, including those with little or no training in mental-health or behavioral interventions.

APPS!

There are literally thousands of apps available, with varying quality and effectiveness. Without any recommendations, the following are some resources regarding apps for babies/young children with hearing loss:

References

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Discovering how hearing loss impacts listening at home: Early Listening Function (ELF) Questionnaire – The ELF is a discovery tool for parents to systematically observe what it means to have a young child with hearing loss in the home environment. It shares 12 listening activities for you to do at home. Watch your child as you do the different sounds. Do them at different distances to find out the size of your child’s ‘listening bubble.’ Listen to the recordings below to better understand how distance from you and background noise will effect how your baby picks up language at home.

Importance of the role of parents! Parent Involvement : The Magic Ingredient in Successful Child Outcomes– This article was written for audiologists however it describes the discovery process that parents go through when they learn they have a child with hearing loss and how the ELF assessment can help.

Hearing loss types – what is going on in the ears/brain? Sorting Out the 4 Types of Hearing Loss – Not all hearing losses are caused by the same problem; some are permanent, some can be helped with medicine, – at first it can be very confusing to understand the differences. This 1-page summary provides some analogies that helps to understand what is going on with the auditory system to cause the different types of hearing loss (conductive, sensorineural, central/neural, mixed).

A mild hearing loss really is serious when it comes to keeping up with learning: Mild Hearing Loss with Simulations 20 dB (Slight) Loss 30 dB (Mild) Loss – The name ‘mild’ is an inaccurate description of just how a hearing loss from 25-40 dB can affect a child life long, if not addressed early in life, as described in this information.

What should I share with the child care provider? Welcoming the Child with Hearing Loss into Child Care

Ear infections sometimes can affect development: Ear Infections and Early Learning – Most children have one or more ear infections when they are young. If a child has many, over a long period it may affect hearing and the hearing loss can effect early learning.

Looking ahead at how hearing loss may impact listening and learning needs: Relationship of Hearing Loss to Listening and Learning Needs – 1 hearing loss per page (parent/teacher version)– This set of handouts is for families that know the dB level of their child’s hearing loss (i.e., 45 dB hearing loss in the better ear) and are wondering what that may mean in terms of future school success. The dB levels of hearing loss are used because the terms minimal (16-25 dB), mild (26-40 dB) and moderate (41-55 dB) hearing loss do not match the seriousness of these hearing losses regarding child development, listening and learning.

Demonstrations of Listening with a Hearing Loss and through Hearing Aids

Experiencing a hearing loss by listening to a simulation can be a powerful step toward understanding what it means to your child to have a hearing loss. Hearing aids make sound louder – both speech AND unwanted noise. Listen to the demonstrations to better understand how noise and distance will impact how your young child will be challenged to pick up language in these situations. Go to Demonstrations webpage

The post Understanding your Baby’s Hearing Loss first appeared on Supporting Success For Children With Hearing Loss.

Most states/local areas will have an early intervention option for families of infants and toddlers identified with permanent hearing loss.

Sometimes the model of early intervention means that your family will be served by someone who does not specialize in the early learning of children with hearing loss. This resource specifies why this is very important to the early (and lifelong) outcomes of your child. Even when your family receives services from a teacher of the deaf/hard of hearing, sometimes the services of a speech-language pathologist is denied – even if you have made it clear you want your child to learn to listen and speak. Why Your Young Child with Hearing Loss Needs Speech Services will help you understand the issues and why it is important to insist that a speech language pathologist be an active part of your early intervention team.

Sound Foundation for Babies and Toddlers  Cochlear Corporation has a suite of resources to assist with listening and language development from birth to 6 years of age. Free download! The Sound Foundation resources, by Nancy Caleffe-Schenck, offer week by week activities. Each week includes a video tutorial and attention specific to audition, receptive/expressive language, speech, songs, rhymes, etc.

There is much information available from many sources on early learning and early services for children with hearing loss. Below are just a few of these:

Speech Goals at Home – Ideas for Parents  is a 2-page article written by a parent who describes her struggles and successes in supporting her daughter’s speech and language development in the early years. My thanks to AG Bell for allowing the inclusion of this article. Key areas presented are:

What do you talk about?

Your personal technique

Adjust daily practice

Repeat target words and sounds

Maintain consistent and appropriate amplification

“With patience, perseverance, creativity and consistent amplification, you will find what everyday activities your child will respond to and feel confident in your contribution to the child’s speech and language development.”

Equal Voice for Deaf Children is non-profit and freely provides ‘how to’ lessons via their website. For families who live remote from service providers or those who have service providers available to them with limited expertise in supporting the development of young children with hearing loss, this is a viable option to explore.

Public Service Video on Communication Development in Early Childhood

The John Tracy Clinic has been providing distance learning options for families of children who are deaf or hard of hearing for decades! Distance learning courses are available in English and Spanish. The Baby Course is a great place to start learning about how to develop your baby’s language as you feed, play, change and do other things with him day-by-day.  Other resources and supports are also available for distance learners. Services in general are at no cost.

Again, these are just a few of the many resources available! If you are a parent with a recently diagnosed child with hearing loss it is often overwhelming to think of all you have to learn!  It is easiest to do so if you are in touch with another parent who has gone through all of the feelings that you are having and has also spent many hours of worry about their child’s future and how to best help him or her. Do not hesitate to contact Hands & Voices, a national group who can help you connect with people in your state. They have chapters in some other countries too!

Information posted on Supporting Success for Children with Hearing Loss, August 2013, October 2014.

The post Speech & Language Development at Home first appeared on Supporting Success For Children With Hearing Loss.

What is universal to children with hearing loss is that they have a reduced listening bubble, meaning that they are unable to overhear conversations going on around them beyond a few feet. Hearing aids have a very small microphone and pick up sound best in a quiet room when the speaker is within 3-6 feet. The distance between the ears of a child sitting on the floor near a standing parent is often further than 3-6 feet.

Along with fewer words learned, children with hearing loss are at high risk for not learning what typically hearing age mates know about social communication, or pragmatic language use.

Summary of the Need for Children with Hearing Loss to Develop Pragmatics

Pragmatic language skills are the most abstract and complex of all language skills. Even when the child has age-appropriate vocabulary and syntax (grammar) skills, she or he may not yet have learned how to use these skills in a socially appropriate manner for specific social purposes.

Young children with typical hearing acquire these skills rapidly between 3 and 4 years of age and are able to use these pragmatic language skills using complex language. Children with hearing loss acquire these skills much more slowly even when provided early intervention and preschool services. Even at the age of 7, typical children with hearing loss have the pragmatic language skills similar to a 3-year-old.

Without mastery of these skills, children will encounter significant challenges with literacy, written communication, and abstract conversational communication – all of which effects success in school and in getting along with peers. Being “socially awkward” and “not fitting in” all relate to pragmatic language skills and theory of mind.

The area of social cognition, or the ability to recognize emotional state in others, appears especially weak in children with hearing loss, with 7-year-olds having the ability to identify and explain feelings in a manner that is typical of a 3-year-old. This is why it is imperative to address social cognition specifically when a child has a hearing loss. (See intervention products below for intervention ideas).

How do we know this?

A 2012 study asked parents to complete a 45-item checklist about how their child uses social communication skills. It was completed by parents of 109 children with typical hearing  and parents of 126 children with hearing loss of all degrees between age 2-7 years. For each of the 45 items the parents had to decide if the child did not use any communication (not present), used no words (point, yank, other preverbal gestures), used 1-3 words to express the communication in the item or was able to use complex language.

Results for average number who were considered to have ‘mastered’ the item, meaning they used complex language (mastery = 75% of the age group being able to communicate using complex language)

• Average results for 109 children with typical hearing:
  • 3 years = 20 of the 45 items
  • 4 years = 43 of the 45 items
  • 5 years = 44 of the 45 items
  • 6 years = all of the items
• Average results for 126  children with hearing loss of all degrees:
  • 3 years = 6 of the 45 items
  • by 7 years = only 31 of the 45 items

Even children with “mild” degrees of hearing loss (26-40 dB) had substantial developmental delays in the area of social communication.

What should we do?

Assess specifically in the area of pragmatics.  With 80% or more children with hearing loss being educated mainly in the mainstream, the ability to interact socially is crucial to their full participation in the classroom and acceptance by their peers.

In order to identify deficits in social communication we must expand the scope of a comprehensive oral language evaluation to include daily pragmatic language behaviors. Most standard instruments used to assess language do NOT provide a norm-referenced, valid or reliable measures of social communication and therefore substantially miss or underestimate this important area of development (i.e., TOLD, OWLS).

Although the CELF-4 contains a Pragmatic Profile, it provides no normative data or standard scores (CELF-5 does have a teacher-completed Pragmatic Profile). The extensive CASL does tap into pragmatics, but it measures a student’s knowledge of pragmatics rather than actual use in school and social situations. It is up to the parents and professionals who specialize in supporting students with hearing loss to advocate for appropriate measures of pragmatic language use.

What assessments should be used?

For a hierarchy of expectations for the development of pragmatic language and Theory of Mind skills for ages 6 months through 7 years access the Summary of Social Interaction (Pragmatic) Development / Theory of Mind handout (in Teacher Tools).

We should use assessments that provide a valid, normative comparison between the student with hearing loss and his or her typically hearing age peers. An internet search can provide a list of assessment instruments for clinicians to review. An expansive list will not be included on this site. The assessments vary greatly in validity, administration time, practicality and expense. Below are recommendations:

 Early Intervention through Preschool 

The Language Use Inventory is completed by families for children ages 18-47 months. It has great norms and validity. The downside is the expense of the test and the length of the protocol that must be completed by families. If your agency will pay for it and your families will complete all of the pages, you will end up with a clear trajectory of pragmatics language learning as children transition from early intervention and eligibility for specialized instruction is considered. The reality is that the expense and parent completion really can be very significant issues.

Most growth of pragmatic language skills occurs between 30-48 months. We really need a snapshot as to whether a child seems to be ‘on target’ at the time of eligibility from early intervention and for planning/monitoring during preschool. The Pragmatics Checklist, used in the study described above has been included free for use by teachers/clinicians in their work with families of young children with hearing loss.A computer fillable version of the Pragmatics Checklist is also available. It fits on one page and can be completed individually by the parents or as part of an interview dialogue with the early interventionist. The majority (75%) of children will be able to use complex language (full expressions of more than 3 words) per the following: Age 3: 20 of 45 items; Age 4: 43 of 45 items; Age 5: 44 of 45 items; Age 6: 45 items. Therefore, at transition, a child should have mastered 20 of the items using complex language. By entry into kindergarten, all items can be expected using complex language. Based on the results of the study however, it is more likely that the child with hearing loss will exhibit challenges in some or most of the areas listed above as pragmatic skill areas of weakness.  To provide further specificity of expected attainment of each of the skills, refer to the Pragmatics Checklist Interpretation which provides the age of mastery in months (75% of the age group can perform using complex language) and when emergence using 1-3 words and using complex language can be expected.

RECOMMENDATION:  The Pragmatics Checklist will be completed by families at least annually for all children with hearing loss ages 3, 4, and as part of planning for kindergarten readiness.  Hierarchy of skill development for children ages 6 months to 8 years = Summary of Pragmatic Development + Theory of Mind (in Teacher Tools). Download the resource Teaching Your Child to Identify and Express Emotions and share it with families.

Kindergarten through grade 2

Because the normative results for The Pragmatics Checklist included children with hearing loss up to age 7, it is appropriate for use through grade 2 as a parent-completed checklist. For ages 5, 6, 7 it is desired for the parents to identify any of the items in which the child is able to only use a few words to express themselves, especially for the 17 items that mastery is achieved between 48-54 months and the 1 item of mastery between 54-60 months. If the checklist has been completed by the families before and they have already checked that the earlier skills were mastered, it would be appropriate to just circle the items of interest (non mastered and/or most age-appropriate). Interpretation guide shown is available in Teacher Tools.

For a norm-referenced diagnostic tool the Pragmatic Language Skills Inventory (PLSI) is for students age 5.0-12.11 years. This checklist has 45 items that can be completed by the teacher in 10-15 minutes. It has three subscales: Personal Interaction Skills, Classroom Interaction Skills and Social Interaction Skills. The PLSI has strong psychometrics to be able to clearly identify issues, even for children as young as kindergarten.

Another, or additional option, that may be useful for monitoring development or program planning is Checklist of Socio-Pragmatic Language Behaviors for Students with Sensory Impairment.  This checklist was found on the internet authorless, and was reformatted to fit on one page. It  has been included free for use. It includes many of the items from the Pragmatics Checklist in a manner more appropriate to school-age (K+) students. It is NOT normed or validated in any way but could be useful for planning or monitoring progress.  If you developed this material please contact me so your name can be specified as author.

An excellent norm-referenced test to use is the Social Language Development Test, which can be administered starting at age 6. It has four subtests: making inferences; personal negotiations; multiple interpretations, and supporting peers. The test assesses students’ language-based responses to portrayed, peer-to-peer situations which is unlike other tests which rely on observation forms, like the PLSI or PLOS.

There are tests specific to pragmatic language development that are appropriate starting at kindergarten age, however expense and time commitment to complete should be carefully considered. Regardless of the instrument, the person completing the checklist needs to be very, very familiar with the child’s behavior and what is typical for age peers.

RECOMMENDATION:  Every student with hearing loss should be tested for pragmatic language deficits. The 18 older age (4-5 years) items of the Pragmatics Checklist can be completed as a screening measure by families for children with hearing loss ages 5, 6 and 7 (kindergarten through grade 2) prior to school entry or in the first couple of weeks of school. Once the classroom teacher has observed the student 6 weeks or longer, the PLSI can be given to determine pragmatic language behavior issues.  If a child is identified as having pragmatic language behavior issues in the classroom, the SLDT can be given to define the pragmatic language deficit.  In addition, the teacher of the deaf/hard of hearing can consider the social communication skills represented on the Checklist of Socio-Pragmatic Language Behaviors for Students with Sensory Impairment for student planning and monitoring of progress. Share Improving Your Child’s Social Skills with families.

Grades 3 – 12

Again, there are tests that tap into pragmatics skill development for this age group (refer to list of assessment instruments). Most students with hearing loss are educated in the regular education mainstream classroom and have a classroom teacher who has observed their behavior over the course of many days and many situations. To initially explore pragmatic language skills, what seems most practical to obtain a snapshot as to whether a student seems to be ‘on target’ is a checklist that can be quickly completed by the classroom teacher and is also a valid measure of the student’s use of spoken language in school and social situations. The Pragmatic Language Skills Inventory (PLSI) has 45 items for the teacher to complete for students ages 5.0 – 12.11 years. Cut-off scores are provided for determining whether the student exhibits characteristics of a pragmatic language disorder. Guidelines are provided to assist the examiner in interpreting the results.The Pragmatic Language Observation Scale (PLOS) has 30 questions that are rated by classroom teachers in a 5-point scale from below average to above average. It is designed for use with students age 8 through high school.  Scoring the PLOS teacher checklist results in a percentile rank and a Pragmatic Language Observation Index (PLOI), which should relate to the total composite scores provided by most comprehensive oral language test batteries. There is also a descriptive term score (above average, average, below average, poor, very poor).

RECOMMENDATION:  That the classroom teacher annually complete the Pragmatic Language Skills Inventory for children in grades 3-6 or the Pragmatic Language Observation Scale for students in grades 3-12. The Social Language Development Test can be used to further diagnose the pragmatic language deficit that has been identified by these teacher checklists. An increasing number of students with hearing loss are not being identified as eligible upon school age, using a standard battery of language assessments. The results can also be used to support the referral of a student with hearing loss for educational assessment who was found to be previously ineligible. As part of that assessment an instrument specific to evaluating pragmatic language and valid comparison of results to normative performance can/should be performed.

Planning and Intervention

Planning: A pdf of a 2012 PowerPoint presentation on Pragmatic Puzzle PPT_Practical Solutions for Evaluation and Treatment – Fleckenstein, Mary Michelle presents an overview of pragmatic language, choosing tests to determine pragmatic disorders, report writing for pragmatic disorders (includes detailed example), samples of goal writing, and a summary of intervention tools available.

Intervention: 

• Teaching the Basics of Theory of Mind (much overlap with teaching pragmatics including social cognition, emotions, nonverbal language)
• What’s Up? Game of Social Language  (for teens gr 7-11)

One resource that suggests intervention for pragmatic language development, especially for young children, is available for consideration (The Missing Link in Language Development of Deaf and Hard of Hearing Children: Pragmatic Language Development).

An interesting British study researched the effectiveness of different interventions for children aged 6-10 years with pragmatic language deficits after 8 weeks of treatment (1 hour 3 times/week). Areas of intervention were:  a) pragmatic rules in discourse and conversation; b) turn-taking; c) meta-pragmatics; d) social understanding and social role-playing; e) formulation of conversation and narrative; and f) inferential understanding. All children showed positive change, some more than others.  Authors are careful to say that this intensive treatment schedule lacks evidence to show it is needed for every student, they do indicate addressing the above areas will result in improvement in student’s social communication behavior.  Use this link to refer to another study that provides information on successful intervention.

There are a wide variety of intervention materials available for pragmatic communication learning, especially with the rise of students on the Autism Spectrum (see suggested tools at the end of the PowerPoint presentation mentioned under Planning).

Information compiled by Karen L. Anderson, PhD, September 2013 for Supporting Success for Children with Hearing Loss.  Updated March 2017.

The post Social Communication – PRAGMATICS first appeared on Supporting Success For Children With Hearing Loss.

“Interpreting services, as used with respect to children who are deaf or hard of hearing, includes oral transliteration services, cued language transliteration services, and sign language interpreting services.” IDEA Sec. 300.34 (b) (4)

What is Cued Speech?

The National Cued Speech Association (NCSA) defines Cued Speech as a mode of communication that uses hand shapes to represent consonant phonemes and hand placements to represent vowel phones, building blocks of a language, along with natural mouth movements to remove the ambiguity of lipreading, and to clearly show spoken information through vision alone.

Dr. R. Orin Cornett developed the Cued Speech system in 1965-1966 with the primary goal of improving reading comprehension and to promote literacy for deaf children.

Cued Speech Facts

• Cueing provides access to accents, dialects, rhymes, and fun or nonsense words.
• Using the language of the home, parents are able to communicate naturally with their children while cueing.
• Since American English is the language of instruction in the US, cueing provides access to that language.
• Cued Speech is not a language, but a visual mode to provide access to a spoken language.
• Cued Speech has been adapted to more than 67 languages and major dialects.
• Cueing can be used to make foreign language learning an attainable goal.
• Cueing is not based on spelling. It shows pronunciation and it can be used to correct one’s pronunciation.
• Cueing does not interfere with auditory processing and validates the auditory message.

Applications/ Multiple uses for Cued Speech

• As a mode of communication at home and at school.
• To validate target sounds during speech and language therapy.
• To assist children with special needs (such as children with Autism and Auditory processing disabilities).
• To provide children who are deaf and hard of hearing with a Bilingual education: Cued American English and American Sign Language.

Language Acquisition and Cued Speech

Providing an early and natural language model for deaf children who are born to hearing families is essential to language acquisition. With Cued Speech and through natural communication with those around them deaf children develop phonemic and phonologic awareness of language that is vital to language acquisition. Cued Speech provides access to the building blocks that form the foundation of language and the rules for assembling them. This acquisition of phonology through Cued Speech allows for the natural development of the English language. It also provides an unparalleled foundation upon which literacy and speech production may be learned. If deaf children are exposed to English visually via cueing in everyday interactions, they will develop the phonologic and phonemic awareness to internalize the language in a similar manner to hearing children, (Leybaert, and Charlier, 1996; LaSasso, Crain and Leybaert, 2003.)

Perspectives from a late cuer:  https://cuedspeech.org/our-stories/tiffany-matthews/

Cued speech for Professionals  http://www.youtube.com/watch?v=B8NjRDmVsmQ

Learning to Cue

Parents, who cue consistently to their deaf children at an early age using the language of the home, provide a visually rich environment. These children learn language the same way hearing children do.

Adults and hearing parents could learn Cued Speech in 15-20 hours.  Adults would learn to apply the Cued Speech system to a language they already know. The time it takes to achieve proficiency varies by individual and consistent use.

Cueing classes are offered at Cue Camps (weekend retreats) and workshops throughout the country. Teachers of Cued Speech are certified by the National Cued Speech Association to ensure uniform teaching methods.

Having an instructor is the best way to learn to monitor correct execution of cues and to help avoid building bad habits and incorrect cueing posture.  However, other ways to learn Cueing is from a DVD, Skype lessons  or materials available at Cued Speech Discovery (www. cuedspeech.com).  Cueing charts available at links below:

https://cuedspeech.org/wp-content/uploads/2021/02/Cue-Chart-American-English.pdf

https://cuedspeech.org/wp-content/uploads/2021/02/CS_Charts_Standard-IPA.pdf

Research on Cueing

A small selection of research on cueing shows:

• Children who grew up with consistent exposure to cueing had similar reading comprehension levels to their hearing peers (Wandel, J., 1989)

• Children who cue at home outperform others on rhyme judgment and measured reading achievement  (Leybaert, J. & B. Charlier, 1996)

• Young adults from Cued Speech backgrounds demonstrated phonological awareness skills and reading comprehension similar to hearing peers and superior to those from non-Cued Speech backgrounds (LaSasso, C., Crain, K. & Leybaert, J., 2003)

• Cued Speech is effective for Enhancing Speech Perception and First Language Development of Children With Cochlear Implants (Leybaert, J. LaSasso, C., 2010)

Information complied by: Suhad Keblawi, Director of Outreach. skeblawi@cuedspeech.org                      

National Cued Speech Association (NCSA)   www.cuedspeech.org

Information Posted September 30, 2014

The post Cued Speech Information first appeared on Supporting Success For Children With Hearing Loss.

WHO FUNCTION AS DIFFERENT TYPES OF COMMUNICATORS

Listed in Developmental Sequence

Adapted from: INSITE

DOWNLOAD PDF OF THIS CHART

Adapted by Karen L. Anderson, Audiology Consultant, Florida Early Hearing Loss Detection and Intervention Project, January 2002

The post Characteristics of Children as Communicators first appeared on Supporting Success For Children With Hearing Loss.

Guide to the ASL Development Observation Record
is a 12-page detailed observation that includes the 2-page list of stages.

These materials were developed by the Early Childhood Education program at the California School for the Deaf in Fremont to document the ASL language development of deaf children from the time they enter early intervention/early childhood to kindergarten.

The goal is to identify the language strengths and needs of each child and to document progress over time. It also serves as a criterion-referenced hierarchy to guide teacher in assessing their own role as language models and how they use language with children. Kudos to CSD for a wonderful assessment and planning resource!

K-12 ASL Content Standards
developed by the Clerc Center at Gallaudet University. The ASL Content Standards help for planning and monitoring ASL development in children who are deaf or hard of hearing visual communicators.

A Good Start: Suggestions for Visual Conversations with Deaf and Hard of Hearing Babies and Toddlers
suggests research-based techniques for communicating with young children with hearing loss. Deaf children of Deaf mothers typically have age appropriate language levels at 18 months as compared to children with hearing loss who have hearing parents. This study considered what the Deaf parents are doing that results in these higher outcomes. Primary differences related to the
way that parents got the attention of their infant/toddler before communicating. These attention getting techniques can be of benefit to any family of a child with hearing loss, regardless of the communication option used.

Through Deaf Eyes
is an almost 2-hour video that portrays the history of deaf education and views of people who themselves are deaf. This video, or viewing portions with your students, may be valuable in Deaf culture studies and self-advocacy considerations.

Setting Lang in Motion: Family Supports and Early Intervention for Babies Who Are Deaf or Hard of Hearing.
This resource was developed collaboratively between the Clerc Center and the Deaf and Hard of Hearing Program at Boston Children’s Hospital. With this resource, parents, educators, and professionals have
free access to seven online modules which share information critical to promoting early language acquisition for young children who are deaf or hard of hearing. The topics covered in these seven modules include: early hearing screening and evaluating, understanding how the ear works, hearing aids, cochlear implants,
using sign language for communication, communication at home, and parenting a deaf or hard of hearing child. Find out more
here.

Early Intervention Network: Supporting Linguistic Competence for Children Who are Deaf or Hard of Hearing

This free online network is designed especially for early intervention professionals. It provides one centralized place to access evidence and recommendations to guide your practice in supporting language and communication development for young children who are deaf or hard of hearing. The network also provides an opportunity to see what early intervention providers are doing to implement these recommended practices.

Visit the network and find out about the 5 evidence-based factors identified as critical to early language acquisition.

Gain the knowledge and skills you need to effectively promote linguistic development for young children who are deaf and hard of hearing.

Webinar: Maximizing Language Acquisition – ASL & Spoken English
Provided at no cost by Gallaudet’s Laurent Clerc National Deaf Education Center,
Maximizing Language Acquisition provides an evidence based rationale for supporting language acquisition in both American Sign Language and spoken English for young children who are deaf or hard of hearing. The webinar describes the results of research on language acquisition and clarifies misconceptions in deaf education. To learn more about the webcast click
here.

Signing with Babies and Children : A Summary of Research Findings for Parents and Professionals.
By Claire Vollotton, PhD, commissioned by Two Little Hands Productions (2011). As they state:
‘This white paper is for you – the many parents, teachers, health professionals, social workers, students, and writers who have asked us for unbiased information that can be used to inform practices and shape professional opinions. We are pleased to be sharing this paper with you and we encourage you to pass it along to anyone you think may benefit from it.’

Information about an App to Learn Sign Language: Sign language is the preferred choice for some families and/or the best mode to learning for some children. It isn’t always easy to learn though within a busy family’s schedule. The information about the

Baobob App
designed by Gallaudet University. It is the first of a series of three bilingual storybook apps, developed to help language acquisition and reading in all young children; in particular for those who are deaf and hard of hearing. This app is unique in the world since it was built upon findings of extensive research done on both hearing and deaf bilinguals. Past research demonstrated that early visual language experience with ASL aids reading acquisition in English and offers other important advantages for a deaf child’s linguistic, communicative, cognitive, academic, literacy, and psychosocial development.

ASL Development Tools from Departments of Education and Other Resource Sites

• Developed by West Virginia Department of Education
• Developed by Wyoming Instructional Network
• Center for Deaf and Hard of Hearing Education, Indiana
• ASLCIA – American Sign Language Curriculum, Instruction, Assessment
• Assessment Toolkits from Gallaudet University
• ASL Education Center
Website resources for learning, practice and fun
• Pictures of ASL signs
• Type in word for video of sign
• Practice for fingerspelling
• Stories in ASL with subtitles
• Curriculum (ASL University)
• Music videos by children using ASL
• Uplifting, inspiring and great to share with peers, families, teachers!See apps and other sign language learning resources
  here.

 

Updated January 2024.

The post ASL Development first appeared on Supporting Success For Children With Hearing Loss.

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