Ages and Stages

By Maureen Plain

Effective communication is one of life’s greatest pleasures, and for those of us with typical hearing, we so often take this gift for granted. The process of verbal communication starts with being able to hear what is said. We then apply knowledge of the words we hear, so we can decipher its message.

When crafting a response, we must have the words in our repertoire of vocabulary readily available, so we can express our thoughts and then pronounce the words clearly enough to be understood by others. As we verbalize our response, grammatical markers for our words, intonation patterns, and understanding the social setting helps us share our thoughts effectively. This process of verbal communication begins in infancy with the use of eye contact, sounds, and body language, and continues throughout our lives. 

For those with hearing loss, all of this can be especially challenging.

Imagine the challenge for a 3-year-old girl who has just been diagnosed with a moderate to severe sensorineural hearing loss in both ears. For three years until diagnosis, she communicated entirely by reading body language and other physical cues. But how did this affect her ability to effectively communicate with others in the hearing world?

In the first couple years of life, caregivers (i.e. parents, nannies, and family members) are acutely aware of small children and often times face them when speaking. This girl’s caregivers did not realize she was solely dependent on reading body language and other physical cues, including lips, to communicate. As she got older, her mother noticed that when faced away, her daughter was unresponsive. After many misdiagnoses, this little girl and her family were told she had hearing loss.

Fortunately this child has a dedicated family that responded to her diagnosis with unwavering commitment, and immediately started designing a team of professionals to support the best learning possible, which included top-notch audiologists and a speech-language pathologist/auditory therapist. The school district provided great support and I was fortunate to be this child’s speech/language pathologist from the very beginning, working with her a few times each week from age 3 until she graduated from high school. 

Vocabulary growth and clear and proper pronunciation of words were always a crucial components of our therapy, as well as benchmarking and tracking progress. A toddler needs vocabulary to engage in play and to learn, just as a teenager needs vocabulary to navigate school and friendships.

At every age, building vocabulary with a person with a hearing loss is multifaceted and hard work. First we worked on hearing and saying each word until it became familiar enough to begin the process of developing listening for each word. We paid extra attention to words with syllables extremely difficult for her to hear, in this case those that are considered high-frequency (S-, SH-, CH-,TH-, -ECT.).

As the child grew older, she spoke intelligibly but would often leave off the ending syllables, such as a plural “s” because she was repeating only the sounds she heard. We worked on learning grammatical marker patterns so she would pronounce a plural “s” based on grammatical rules. Practicing the articulation for each sound component in a word is also very challenging, since a hearing loss makes it difficult to hear your own speech sound errors and correct them. We also used an oral motor approach to complement our work on sound production. We focused on how a sound felt when it was pronounced; where her lips, tongue and jaw belonged to articulate different sounds properly. We also practice oral vs. nasal air flow and practiced making sounds in front a mirror to see how it looked. Through this process, she developed speech that is clear and understood by all listeners, in addition to being able to use verbal cues and grammatical markers that she has been trained to watch for, but was otherwise unable to hear.

We also integrated speech therapy with auditory training exercises. Listening practice included her looking and listening when I was visible, and repeating the sounds she heard back to me. Once she mastered that, I then moved farther away from her sight to advance this skill. We then moved to improving listening without looking; while still facing her, I covered my mouth with a paper to develop better listening and discrimination of sound. As accuracy improved, I then would sit behind her and continually moved farther away until I was 6 feet away, with her back facing toward me. We also practiced listening to the word so it can be recognized in quiet and in noise.

Listening skills were paired with our work on vocabulary comprehension to enhance communication. Beyond pronunciation and listening, learning the definition of each word to build comprehension is crucial. Vocabulary shapes our conversation, and since mishearing words is a constant challenge for those with hearing loss, they must rely on their vocabulary knowledge to fill in the gaps for greater conversation participation and quality of life.

These are just a few of the many strategies that we used to improve speech, language, and listening during our 15 years together. To succeed she, as well as her parents and family, needed to fully trust the process and integrate these strategies into her everyday life. While therapy was only 2-3 hours a week, speech and verbal communication is a chosen part of her everyday life.

Therapy was a lot of hard work and sometimes frustrating for her, as not every milestone was easy. Until there’s a cure for her type of hearing loss, she will not have the ability to hear as seamlessly as those with typical hearing or have perfect speech. 

May is Better Speech and Hearing Month and serves as reminder that verbal communication is a shared pleasure that brings us laughter, learning, and love. We should take this month to treasure the gift of communication and celebrate the hard work and success of all individuals whose ability to communicate is challenged, for whatever reason.

Maureen Plain M.S., CCC-SLP, is a speech-language pathologist with 37 years of experience in the greater NY area. She is currently a Program Director for Sunny Days Consulting Services in New York.

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