Communication Methods And Suggestions

Many parents of a child with hearing loss question whether their child will ever be able to talk and how they will be able to talk to their child. A hearing impaired child’s speech ability depends on the degree of the hearing loss, the use of hearing technologies such as hearing aids and cochlear implants, and involvement in appropriate therapy. Most children with hearing loss can develop good speech and language when given the appropriate technology and support. The earlier a child has exposure to speech and language, the better the chance for normal speech and language development.

As discussed below, the communication method used has been shown to have a highly statistically significant association with good speech and language outcomes of children with hearing loss who use hearing aids and cochlear implants.


The auditory-oral approach stresses the teaching of spoken language. This method uses hearing aids or other hearing technologies, speech reading, facial expressions, body movement, and sometimes tactile cues. Signs are not used in the auditory-oral approach, but natural gestures that are used in typical conversation are included.


The auditory-verbal therapy (AVT) approach emphasizes the teaching of spoken language through hearing and using hearing technologies to the fullest. This approach requires that all daily events involve hearing and language exposure. Use of speech reading, facial expressions and body language are not stressed.

AVT is currently considered the preferred approach for children with hearing loss whose parents want them to achieve the best possible outcomes in speech and verbal communication ability while using modern hearing technologies. In combination with hearing aids and/or cochlear implants, AVT can produce remarkable speech and language results for children with hearing loss. At the Dallas Ear Institute we recommend certified Auditory-Verbal therapists for our children with hearing loss whose parents have this as their goal.

Manual Communication or Sign Language

There are many styles of sign language. American Sign Language (ASL) is a complete, complex language with grammar and sentence structure of its own. It consists of certain signs made with the hands combined with facial expressions and body movements. Signing Exact English (SEE) and Signed English (SE) consist of hand gestures, but the signs are in the exact word order of written and spoken English. Pidgin Signed English (PSE) and Conceptually Accurate Signed English (CASE) are methods that combine parts of English and ASL. Learning manual communication or sign language does not always mean that the child will not learn to communicate through spoken language, but if the goal is for a child with hearing loss to gain maximal proficiency in spoken language then sign language should take a very secondary role in the child’s early years.

Children exposed to spoken language have a greater probability of scoring higher on speech and language assessments than children exposed to some degree of either sign support or sign language (Percy-Smith et al., 2008). Data indicates that introducing sign language prior to cochlear implantation does not enhance outcomes compared to emphasis on spoken language alone and that use of sign language was detrimental for the development of spoken language for children identified with hearing loss after their first birthday (Nittrouer, 2008). Speech production, speech recognition, expressive language, complexity of utterances and syntax and narrative ability are better for children using a listening and spoken language approach than children using sign language via total communication (Moog & Geers, 2003).

Total Communication

Total communication uses sign language while talking and while using hearing technologies. The signs occur at the same time as the spoken word that matches the sign.

Cued Speech

Cued speech is a visual mode of communication that uses mouth movements of speech combined with certain hand gestures around the face to show each speech sound. Shapes of the hand represent consonant sounds. The place where the gesture is made near the mouth represents vowel sounds. Cuing was developed to help hearing-impaired children learn to read and make sense of spoken language by being able to “see” the sounds.

Practical Communication Suggestions

The following suggestions are things you can do to help your hearing-impaired child communicate with you or with other people:

1. Help your child to get in the habit of watching the speaker even if listening is not difficult so that he or she will get in the routine of paying close attention.
2. Instruct your child to ask the speaker to repeat if he or she did not understand everything that was said.
3. If your child does not appear to understand what is being said, rephrase rather than repeating the misunderstood words. Present the topic of conversation (For example, “We are talking about ______.”).
4. Include your child in all family conversations. Help your child learn about taking turns in conversations.
5. Help your child know that he or she may feel more fatigue after school since it will take a lot of effort to listen.
6. Encourage your child to keep his or her sense of humor.
7. Speak clearly and slowly within 3 to 6 feet of your child, or use a frequency modulation (FM) system in addition to amplification.
8. Speak to your child in a well-lit room to ensure visibility of lip movements, facial expressions and gestures. Do not speak to your child from another room.
9. For an older child, say his or her name before speaking.
10. Reduce or move away from background noise. Try to position background noise behind your child.
11. Do not over-articulate. Exaggerated mouth movements distort the quality of the speech and visual cues.
12. Closed captioning can help when watching television.

Suggestions to Enrich Speech and Language Skills

The following suggestions are some ways that parents can help promote a positive outcome for their child’s speech and language development:

1. Do not stop talking to your infant or child when you learn that he or she has hearing loss. 
2. Always speak to your child even if he or she does not seem to know what you are saying. Show your feelings by cuddling, touching and smiling. Use lots of facial expressions and gestures. 
3. Keep your language short and simple, but try to stay one level about your child’s current language skills.
4. Provide your child with a good language model and a setting filled with language. 
5. Talk about the things that you do and see and about common daily things.
6. Play with your child.
7. Read out loud to your child the same stories again and again. This will help your child catch words he or she may have missed before. Explain the story as needed. Talk about the stories you read. 
8. Act out stories.
9. Sing songs with your child.
10. Repeat the sounds your child makes and have him or her repeat the sounds that you make.
11. Teach your child words or signs for all sorts of feelings. Teach him or her feelings like sad, happy, mad, bored, afraid and confused.
12. Speak clearly.
13. Repeat key words again and again.
14. Make your voice go up and down in loudness and pitch to add meaning to what you are saying.
15. Give your child time to respond to what was said.