A perspective on auditory skill development for children who are deafblind

Critical information in addressing the needs of children with hearing loss.

Jaimi Lard demonstrates using tactile sign language with the aid of her interpreter.

Instructional programming for children with complex profiles requires constant evaluation of priorities and on-the-spot decision making.  A child’s hearing loss may be overshadowed by other areas of need. In my role as a consultant to NEC I often work to help professionals recognize the importance of maximizing a child’s use of audition and to identify intervention strategies and goals that are functional and consistent with the child’s abilities and needs. Audition can help children to connect with people and activities, improve their ability to predict and act on their environment, and support communication development. 

Understanding the specifics about a child’s hearing loss can be challenging because hearing losses differ greatly in type and degree.  There are a number of variables to consider: degree of hearing loss (from minimal to profound); configuration; unilateral or bilateral; conductive, sensorineural or mixed; stable, fluctuating or progressive; congenital or acquired.  Children might be diagnosed with additional complicating auditory conditions, such as auditory neuropathy or tinnitus. They differ in their personal devices (hearing aids, cochlear implants, FM systems). They may or may not be effective users of their hearing devices.  All of these factors are important in determining goals for auditory skill development. With that in mind, you should receive and review audiological reports on your student. 

There are many misconceptions about teaching auditory skills. The following is my attempt to clarify information that I believe is critical as you address the needs of children with hearing loss:

  1. Audition should be exploited to the maximum degree possible so that it is functional and meaningful for the child.  In some cases, this may mean developing discrete skills in perception and discrimination, such as identifying familiar people, developing awareness of events or activities, and recognizing warnings and safety cues. Identifying and understanding auditory information are important for traveling safely and independently (Paths to literacy). For other children, audition will be a basic and important component of a multifaceted approach to communication, facilitating spoken language, social interactions, and literacy development. 
  2. Auditory skill development requires consistent use and effective monitoring of personal listening devices. Daily listening checks of hearing aids, cochlear implants and FM systems should be conducted by a staff member who is trained in that process. Support for troubleshooting and management of those devices should be a part of the child’s program and services, and should include the services of an educational audiologist.   
  3. Despite the advanced technology of hearing aids, cochlear implants and FM systems, the child’s hearing devices do not provide normal hearing.  Wearing the devices is not enough; they do not fix the problem. Developing listening skills requires well-crafted instruction and intervention that is based on a hierarchy of skills. Learning to listen cannot be left to chance. Instruction should follow a sequential auditory curriculum or guide, with consideration of where the child is in the acquisition of skills, and the goals that are appropriate and functional for him/her. Goals for listening should be consistently implemented across contexts. 
  4. Even a slight or mild hearing loss has an impact on speech perception.  Minimal hearing loss is not inconsequential (Flexer). That recognition has resulted in a relatively new category of slight or minimal hearing loss (ASHA). A slight hearing loss can be particularly problematic for children with multiple learning challenges because they are at increased risk for missing or mishearing verbal information presented at any distance and/or under less than ideal listening conditions.
  5. Hearing is different than understanding.  A child might hear a sound or speech but not necessarily know what it means. Understanding an auditory signal requires that a child distinguish it from other sounds in the environment.  Understanding speech requires that a child hear all the sounds clearly enough to know exactly what is being said. 
  6. Much learning takes place in noisy and reverberant classrooms, and noise and reverberation (echo) are significant barriers to hearing and understanding. Accommodations are intended to improve a child’s access to auditory information. An FM is an important accommodation because it provides the best access to speech. An FM reduces the negative effects of distance from the speaker, noise in the environment, and reverberation on the ability to hear and understand the important speech signal. For those reasons, I am a firm believer that all children with hearing loss should have the benefit of a personal FM system. In addition, auditory management requires controlling the acoustic environment to the degree possible: eliminate or reduce noise sources (blowers, pencil sharpening); cover bottom of chair legs that are not on carpet; add sound-absorbing materials to reduce reverberation; close doors to reduce hallway noise. Classroom set-up and placement of instructional groups should be carefully arranged because the more simultaneous groups/speakers occurring in instructional settings, the more challenging listening becomes.
  7. Do not underestimate the benefit of systematic auditory skill development for your students with hearing loss.