Children with Hearing Loss: Developing Listening and Talking Birth to Six
RATING: (3 of 5 ears)
AUTHORS: Elizabeth B. Cole and Carol Flexer
PUBLISHERS: Plural Publishing
REVIEWER: Dale L. Lisonbee, MS, Teaching Fellow, Kent State University, Kent, Ohio
SYNOPSIS: Children with Hearing Loss: Developing Listening and Talking Birth to Six by Elizabeth B. Cole and Carol Flexer was written to provide a framework for those who help children with hearing loss develop listening and talking skills. The text is easy to read and written in two sections. Section One, consisting of the first five chapters, reviews the foundation for talking and listening, providing a functional explanation of audition, diagnosis, and audiological management. Section Two, made up of chapters six through ten, includes important aspects of intervention through the use of auditory input. Parent involvement and natural settings are keys to this intervention. Finally, an appendix provides helpful tools to the professional managing infants and young children with hearing loss.
REVIEW: Educators of infants and children with hearing loss have a daunting task ahead of them: teaching both listening and language skills to children who have difficulty accessing auditory information and immature auditory learning systems. Not only does the child need access to auditory information, but that information has to be constant, as well as consistent. Children should have a multidimensional support system, including accurate diagnosis, optimal amplification, emersion into auditory input, and constant intervention to be successful language learners. Even a child with a minimal hearing loss requires significant support. In Children with Hearing Loss: Developing Listening and Talking Birth to Six by Elizabeth Cole and Carol Flexer, the mystery of language acquisition, and the subsequent intervention strategies for children with hearing loss, are explained in a complete easy to read format.
The authors emphasize that listening is a function of the brain, not the ear. The auditory system, which provides the brain with input, is functional as early as 20 weeks gestation. This means that newborn infants have 20 weeks of experience with “listening learning“ behind them when they emerge into this auditory rich world. A mother’s voice is a sound already familiar and comforting to the newborn. Speech and other sounds provide the infant with vital signal information to monitor the environment. The authors explain that when sounds are transmitted adequately, a flexible neural system matures and meaning is assigned to sound. Neural maturation occurs over the course of many years with the first three years of life being the most important for language development. When sound is not transmitted through the auditory system, the brain cannot listen. Children with congenital and early onset hearing loss miss out on this maturation process if not maximally amplified soon after birth.
Chapter Four outlines diagnostic tests frequently used for infants and children, and emphasizes the importance of universal newborn hearing screening as a means for early diagnosis of hearing loss after birth. This chapter also includes a detailed overview of age appropriate standard test batteries such as behavioral observation audiometry, visual reinforcement audiometry, conditioned play audiometry, acoustic immittance, and speech perception testing to increase the accuracy of diagnostic measures. Included at the end of this chapter are reference tables, which provide an overview of diagnostic tests and age appropriate responses.
The next section of the book focuses on optimizing “detection of the complete acoustic spectrum,” once hearing loss has been diagnosed. The audiologist must first determine the integrity of the learning environment with the following in mind:
Is this environment sound friendly?
Is there significant distance between the signal and the child?
Is there a speech-to-noise ratio of +15 dB or better?
These are all questions that must be addressed before the most favorable listening can take place. In Chapter Five, there is a detailed discussion of amplification in the form of behind the ear hearing aids, cochlear implants, FM, and IR assistive listening devices. The authors emphasize that intervention should be based on through, precise evaluation, observation, and inquiry by the audiologist.
When the brain is able to receive sound through amplification, then intervention is appropriate. Chapter Six includes intervention strategies and differentiates among intervention programs for the caregivers. This section of the book also provides parents with acoustic dimensions of speech, how to facilitate listening and language development, recognizing auditory and linguistic targets, and speech acquisition. Parents can assist in language learning through vigilantly following four main steps. First, the child’s amplification must be maintained and worn during all waking hours. Second, parent must be aware of the speech to noise ratio and make provision to increase the speech and reduce the noise. Third, parents control for distance between speaker and child. Fourth, parents learn and use good communication strategies with auditory information as the main source of information.
Interventionists teach caregivers how to recognize opportunities to enrich communication and provide knowledge to facilitate developmentally appropriate communication. They also provide preplanned meaningful activities for the parent to use that will address omissions or gaps in the child’s development. Included in this book is a framework for maximizing caregiver effectiveness in promoting auditory/linguistic development, and concrete examples for providing children of all ages with auditory rich experiences.
CRITIQUE: Cole and Flexer accomplish the goal of “providing a framework for the professional practicing and in training, as well as families who want to develop listening and talking in their babies and young children who are deaf or hard of hearing.” Children with Hearing Loss: Developing Listening and Talking Birth to Six is a great resource for any audiologist working with a pediatric population.
Flexer remains true to her passion; assistive listening devices (ALD) and sound field amplification. Yet, a detailed discussion about the types of ALDs and prescribing the appropriate ALD for the degree of hearing loss is lacking. A significant portion of the text is devoted to cochlear implants and their growing use with infants and children. However, little reference to research is provided within the text. A discussion of the history of newborn hearing screening, as well as Marion Downs’ prompting of newborn hearing screening in 1960 was informative. However, further discussion about assessment techniques, such as auditory brainstem response and otoacoustic emissions, making possible the current status of newborn hearing screening, could have given clarity to the delayed development of universal newborn hearing screening. Discussion of the configuration of hearing loss was especially worthwhile for those needing a basic knowledge of hearing loss or in training. Aural intervention strategies were well warranted, and provide a strong base for language development. Professionals in early intervention could read this book and be prepared to apply the intervention strategies.
All in all, Children with Hearing Loss: Developing Listening and Talking Birth to Six would and should be part of every educational audiologist’s library as a valuable resource to share with professionals who work with hearing-impaired children.