Strategies to Support Communication Development : Infants and Toddlers with Hearing Loss Mary V. Compton, Ed.D. Judy Niemeyer, Ph. D. CENTe-R EHDI Conference.

Strategies to Support Communication Development:

Infants and Toddlers with Hearing Loss

Mary V. Compton, Ed.D.Judy Niemeyer, Ph. D.

CENTe-R

EHDI ConferenceMarch 2005Atlanta, GA

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Early Relationships: The Context for Learning

• Interactions are opportunities for communication and language development.– Infant/toddler learns to relate/communicate.

• Responsive consistent care-giving nurtures reciprocal interactions– Caregivers provide auditory/visual input, pause

and wait for a response from baby.• Reciprocal interactions are the context for learning

– Early literacy development unfolds.

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Encouraging Infant Communication

• Create a language rich environment that includes novel materials and varied toys for interaction– narrate the infant’s world with expression

• Initiate frequent engaging interaction with infants– look for meaningful opportunities to initiate or respond

to baby’s interest

• Attract baby’s attention– tap on the toy/object that is the focus of communication

prior to initiation of interaction

• Make eye contact– position oneself and toys/objects in the infant’s visual

field when interacting

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Looking for Opportunities for Communication?

• Listen for the infant’s/toddler’s communicative responses/behaviors– What is the baby trying to communicate?

• Use observation to identify infant/toddler vocalizations, cues and signs– Does the baby need food, diaper change, or just want

to play?– How can I extend the interaction?

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Support Family Decision Making by…

• Recognizing family challenges at identification/diagnosis of hearing loss– Respond sensitively to feelings, respect family decisions

• Using a family-centered team approach to encourage family participation– Listen to learn parents’ priorities, interests, and concerns

• Providing unbiased information on communication approaches– Assist the family in exploring community resources to

learn about communication approaches

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Parents’ Questions

• How long before my child will understand what I am saying to him/her?

• Will my child talk?• How will I know my child’s needs are met

and development is on-target?• What is the best communication approach

for our child and family? • What kind of time and financial commitment

will be necessary to accomplish positive outcomes?

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Balanced Information:Is material for families….

• Inviting, jargon-less, and user friendly?

• Clear, concise, and appropriate?

• Supportive of parents rights and expertise?

• Considerate/respectful of families’ cultural heritage, community values and the Deaf community?

• Reflective of a collaborative team spirit?

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Balanced Information (cont’d)

• Available in multiple formats (multi-media and print), multiple reading levels, and different languages?

• Inclusive of local and national contacts?

• Reflective of current research and cited appropriately?

• Reviewed by a diverse group (families, professionals, individuals who are deaf/hard of hearing, cultural representatives)?

• Unbiased and balanced in representation of various communication options?

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Delivering Family-Centered Services• Respect the Family’s Values, Beliefs,

and Culture– Especially if they are different from your

own. Find out as much as you can about a family’s culture before visiting them.

• Trust the Family– As professionals, it is sometimes difficult to

set aside our own expertise in working with children. BUT, it is important to recognize the family as the true expert on their child.

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Delivering Family-Centered Services (cont’d)

• Become Partners with the Family– Involve the family in all decision-making

processes, and ask for their thoughts. – Work together with them to plan and deliver

services.– Invite family advocates to inservice training or

staff meetings to talk about what kinds of services are helpful and what aren’t.

• Relate to the family as people– Use a conversational approach rather than a

formal “clinical” approach.

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• Look at the whole family– Consider the child’s needs as part of the

family’s needs.– Think about their involvement in activities

such as church, sports, and participation in other community events.

• Be creative– Help the family find ways to incorporate

therapies into their typical family routines.

• Be Flexible– Respect the family’s priorities in setting goals

for their child, as well as in planning services and schedules.

Delivering

Family Centered Services cont’d

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Visual Communication Approaches

• Total Communication– Combined Approaches

• American Sign Language (ASL)– Bilingual/Bicultural

• Signing– Simultaneous Communication – CASE (Conceptually Accurate Signed English)

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Auditory-Oral Approaches

Auditory-Verbal Auditory-Oral Cued Speech

Acoupedics Aural-OralUnisensory Oral

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Auditory & Language Milestones

Newborn

2-3 months

4-6 months

6-12 months

12-18 months

• Cries, startles to loud sound• Laughs, forms sounds in back of

mouth (“goo”)• Turns head towards sound,

makes non-speech sounds- raspberries, squealing

• Babbles, gestures to communicate, knows his or her name

• Strings sounds together, says first word

• First words and 2 word utterances

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Roles of the Familyin Facilitating

Language Development

• Work with professionals with expertise in deafness and early childhood professionals to insure child’s success.

• Incorporate language development strategies at home.

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Strategies for Families

• Incorporate language into the daily routine.

• Make sure the child doesn’t get “left out” of family conversations.

• Inform teachers of strategies that work at home.

• Use strategies at home suggested by the teachers.

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Roles of the Early Childhood Teacher/Caregiver

• Collaborate with deaf education professionals to accomplish child’s IFSP/IEP goals.

• Partner with families to help them incorporate strategies at home.

• Create a language rich, natural environment.

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Strategies for Everyone• Follow the lead of the infant

– respond to and extend engagement in interesting toys/objects

• Speak in parentese– draw the infant’s attention to the rhyme and rhythm

of language

• Pause within interactions– allow time for the infant to process information and

respond

• Use brief sentences– reference or point to objects in the child’s visual field

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• Use a variety of language features.– Intonation– Pitch– Rhythm– Volume– Pausing

• Allow wait time for child to listen/watch, process, and respond.

More Strategies

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Repeating & Repeating Plus

• Repeating what the child says– Child says: “Juice all gone.”– Adult says: “Juice all gone.”

• Repeating and Adding to what the child has said– Child says: “Hot out there.”– Adult says: “ It’s hot in here too.”

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Expanding and Describing

• Adding to what the child has said– Child says: “Snowing outside.”– Adult says: “Yes, it’s snowing all over.”

• Describing what you are seeing, hearing, doing as you do it - Self Talk– While washing dishes, adult says: “Wash the

dish and now we rinse the dish.”

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Parallel Communicating

• Talking or signing about what the child is doing (or maybe thinking or feeling) - Parallel Talk

– Child is bouncing a ball;– Adult says: “You’re bouncing the ball.” or

“Jose is bouncing the ball. The ball is bouncing up and down.”

– Use “you” or say the child’s name.

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Labeling & Answering

• Labeling - Use labeling or explaining phrases or statements– Adult says: “That’s a big blue beach ball.” or “That

dog is a poodle.”

• Answering the child’s question– Child says: “Gampa’s?”– Adult says: “Yes, we are going to Gampa’s now.”

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Expansions & Extensions• Expansion - Repeating child’s utterance the

way an adult would have said it– Child says: “Doggy run”– Adult says: “Yes, the doggy is running.”

• Extension - Expanding the child’s response to an adult sentence, then adding an additional related comment.– Child says: “Car go”– Adult says: “The car is going. It’s a red car.”

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“Education and Care: Two Sides of the Same Coin”

(Rebecca Parlakian, 2004) • Caregiver provision of continual and frequent

language input and expression…..– encourages child initiation of communication and

engagement– ‘sets the stage’ for literacy development

• Infant/Toddler early literacy behaviors emerge…. – carrying books, turning pages, chewing on them – pointing to pictures– bringing a book to an adult to read– Imitating and vocalizing with an adult who is reading

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Discussion Question from “Early Relationships” module

•  You have been working with a single father who takes his child for auditory oral services but he has been absent for 3 weeks. You call to check on them and find the father’s work demands have escalated and he is no longer able to bring his son for appointments. He understands the importance and yet is unable to follow through. – How do you respond to this father? – What are your goals as the interventionist in

addressing this issue?

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Discussion Example

• You are working with a family that has a newly identified infant with hearing loss. The infant is 5 months old and the family is finally adjusting to a new baby being in the house but the hearing loss diagnosis continues to be overwhelming for the parents.

– How will you approach the family? – Do you immediately proceed to schedule visits in

various community settings representative of communication options?

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Video Clip Study Questions

Discovering Sound• Describe the role early interventionists

take during their home visit.

• Identify methods the mother is using to increase the daughter’s communication.

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Strategies Demonstrated• Adults in the videos provide excellent

examples of ways to support the language development of infants and toddlers including:

– Eye contact– Facial expression– Pointing to objects– Getting on child’s level– Restating words or phrases – Narrating what is happening – Attending to the child’s communication– Giving auditory input and waiting for response

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WEBSITES• Alexander Graham Bell

Association for the Deaf and Hard of Hearing

www.agbell.org• Auditory-Verbal International,

Inc.

www.auditory-verbal.org• National Cued Speech

Associationwww.cuedspeech.org

• Oral Deaf Educationwww.oraldeafed.org

• LeClerc/Gallaudet Universityhttp://clerccenter2.galluadet.edu

• American Society for Deaf Children

www.deafchildren.org

• Deafness Research Foundationwww.drf.org

• Beginnings for Parents of Children Who are Deaf or Hard of Hearing

www.ncbegin.org• National Institute on Deafness and

Other Communication Disorderswww.nidcd.nih.gov

• National Dissemination Center for Children with Disabilities

www.nichcy.org• Raising Deaf Kids

www.raisingdeafkids.org• My Baby’s Hearing

www.babyhearing.org• CENTe-R

http://center.uncg.edu

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Hands and Voiceswww.handsandvoices.org

Hands & Voices is a non-profit, parent-driven national organization dedicated to supporting families of children who are deaf or hard of hearing.. The organization consists of parents of ASL signers, cued speech users.... parents of children with cochlear implants or total communicators... And professionals who work with these families.

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Beginnings www.beginningssvcs.com

This non-profit organization was established to provide emotional support and access to information as a central resource for families with deaf or hard of hearing children, as well as for deaf parents who have hearing children. BEGINNINGS is also committed to providing technical assistance to professionals…

For Parents of Children Who Are Deaf or Hard of Hearing

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My Baby’s Hearingwww.babyhearing.org

This organization provides information for new parents related to newborn hearing screening, hearing and amplification, early intervention and language development, and valuable parent-to-parent types of support.

Sponsored by

Boys Town National Research Hospital and NIDCD (National Institute on Deafness and Other Communication Disorders)

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The CENTe-R’s mission is to inform and support graduate-level professionals serving families with infants and toddlers who are deaf/hard of hearing through web-based training modules.

http://center.uncg.edu

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• http://center.uncg.edu

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