Opening Doors: Technology and Communication Options for Children with Hearing Loss

Information about Options Released from the
U.S. Department of Education, Spring 2005

Soon after Peter was born, the hospital screened his hearing and found a possible hearing loss. Peter was referred for more testing, which showed that he did, indeed, have a hearing loss. Peter's parents were shocked. First, they had no idea that doctors could check a newborn's hearing, and second, their son?

If you've recently found out that your child has a hearing loss, this resource sheet is for you. Whether your child is a newborn, a preschooler or older, there's help available. There are service systems in place to help your child and your family, and there are many groups with important information to share. This fact sheet can help you connect with both.

Your Beautiful Child

Rejoice! You're the parent of a newborn or young child, and you have an incredible, wonderful journey ahead. The fact that your child has a hearing loss is only one facet of the journey.

Still, hearing loss is a very important facet and needs to be addressed. Even as a baby, your child is learning and growing all the time. The sooner you find help for your child, the better. Research has shown that with immediate and proper help by age 5, children with hearing loss can develop language skills comparable to those of children without hearing loss. Two key factors are involved:

  • early identification of the hearing loss, and
  • appropriate early intervention services from qualified providers.

Peter, the baby we just mentioned, is already well on his way to developing the language and other skills he needs to succeed in school and in life. His hearing loss was detected early. The hospital connected his family with nearby early intervention services, and Peter received services immediately. His family learned about hearing loss and about communicating with their adorable newborn. They are exploring all sorts of options for helping Peter to take advantage of the hearing he does have (called residual hearing) and to communicate visually. And Peter-he's wide open to the world and learning, learning, learning all of the time.

Windows of Opportunity

One of the most amazing things your child will learn in his or her lifetime is language-words, meanings, and their use for communicating with others. The early years are a critical time for learning language. Getting help for your child as early as possible maximizes his or her window of opportunity to learn language. Research has shown that children who begin receiving appropriate help before 6 months of age are more likely to learn language at a pace comparable to that of children whose hearing is normal. So take advantage of the service systems that exist to help your child and you.

Quick Facts

  • Each year 24,000 children are born with hearing loss in the United States.
  • The great majority of these children are born to parents who have normal hearing.
  • Many states now require that hospitals screen babies at birth for possible hearing loss. This screening is painless, and it only takes a few minutes.
  • Not all hearing loss is present at birth. Causes of hearing loss later in childhood include genetic factors, illness, and trauma.
  • The degree of hearing loss can vary from mild to profound, including deafness. There also are different kinds of hearing loss: conductive (caused by diseases or obstructions in the outer or middle ear), sensorineural (where the delicate sensory hair cells of the inner ear are damaged), mixed (a combination of the two), and central (resulting from damage to the nerves of the central nervous system).
  • Many services are available to help children who have hearing loss, including deafness. For eligible infants and toddlers (birth through age 2), there's early intervention. For eligible children from 3 to 18 (and in some states through 21), there are special education and related services. These services can be very important to your child and your family. Use this fact sheet to learn more about, and connect with, these systems.

First Reactions

When parents find out that their beautiful child has a hearing loss, many may feel shocked, sad, and uncertain about what to do. As the shock fades, though, they usually begin a search for information. Information is one of your most powerful tools! It's very important to find out as much as you can about your child's hearing loss and what options and resources are available. If the information is hard to understand, there are specialists available who can help you.

Fortunately, there are many helpful resources. Four invaluable ones are listed below under "Where Do I Turn," and following is more information about the first two assistance options-state services such as early intervention and groups specializing in hearing loss and deafness.

Where Do I Turn?

Four valuable service systems available to you and your family are:

  • services such as early intervention (for eligible children up to the third birthday) and special education and related services (for eligible preschoolers and school-aged children)
  • organizations specializing in hearing loss and deafness that provide information and support
  • resource and information centers that can offer information about resources and educational rights
  • parent groups, in which you can talk with other parents who also have children with hearing loss.

The National Dissemination Center for Children with Disabilities (NICHCY) can help you connect with any of these systems. Contact NICHCY at: NICHCY 1825 Connecticut Ave NW,
Washington, DC 20009. Phone: 1-800-695-0285 (V/TTY). E-mail: Web site in English: Website in Spanish:

Early Intervention

The importance of early intervention has been mentioned several times already, but you may be wondering, "What is early intervention?"

"Early intervention" means getting started as early as possible to address the individual needs of a child with disabilities. This is done to enhance the infant or toddler's development, to minimize the potential for developmental delay, and to enhance the family's capacity to meet the child's needs. Early intervention is a system of services established by the states through grants from the federal government to help eligible children from birth until their third birthday.

If your child was born with a hearing loss or has developed a loss before turning 3, you may want to get in touch with personnel in the early intervention system in your area. The hospital staff may have already connected you with these services. If not, you may wish to ask your child's doctor or call your state's Parent Training and Information (PTI) center. They're sure to have this information.

Wondering where your PTI is located? NICHCY can provide you with the number for the PTI that serves your area and put you in touch with the early intervention system in your area. Give NICHCY a call at 1-800-695-0285.

Early intervention may be of help to your child and your family in many ways, including learning to communicate with each other. Under the federal early intervention program in your state, if your child is eligible, you'll be assigned a service coordinator to help you understand the intervention system and make sure that your child gets the services to which he or she is entitled. Note: Under the law, parents have the right to be part of the team that identifies the early intervention services their child needs.

Groups Specializing In Hearing Loss and Deafness

You'll be positively amazed at the number of groups in the United States that focus on deafness and hearing loss. Their information, advice, and perspectives can be a great help to you and your child over the coming years. To get you started, we've listed many such groups in the section entitled "Find Out More" at the end of this publication.

Breaking the Sound Barrier

The discovery of your child's hearing loss brings with it a lot of decisions to be made. One issue that is likely to come up is technology and how it can help children with hearing loss. You'll learn about two technologies in particular-hearing aids and cochlear implants. Both can give children access to spoken language and the other sounds around them. Let's take a look at these two technologies.

Hearing Aids

Hearing aids make sound louder in the ranges needed, which are dictated by the individual's hearing loss. They operate on very small batteries, collect sounds, make them louder, and then transfer them to the ear canal.

When a child has a hearing loss, many health-care providers believe that it's important to fit the child with hearing aids as early as possible. Why? Because children begin identifying sounds and learning language in their very first months of life. Hearing aids can give many children the opportunity to hear and learn language like children with normal hearing. Even babies 1 month old can wear hearing aids.

Each hearing aid is selected for, and fitted to, a child's individual hearing loss. That's because not all hearing losses are the same. One child may not be able to hear certain pitches or tones of sound, while another child may not be able to hear others. A professional trained in hearing loss (called an audiologist) will use tests to determine how much to amplify sound for each child. The tests don't hurt. They are used because very young children can't reliably tell us when sound is too loud, too soft, or unclear.

Once a child is fitted with hearing aids, it's very helpful for parents to work with the child's hearing health-care team and other professionals to identify the services the child will need to help him or her develop speech, language, hearing, and communication skills. For children under the age of 3, these services may be available through the early intervention system. When eligible children with disabilities are 3 and older, the public education system takes over and makes special education and related services available. (Contact NICHCY for information about accessing these systems of services. NICHCY's contact information was presented earlier, in the small section entitled "Where Do I Turn?")

This is just the briefest overview of hearing aids. They're complex devices, and there are many features to consider. To learn more, visit the Web sites we've listed in the section entitled "Find Out More" at the end of this publication.

Cochlear Implants

If a child has not benefited from hearing aids after wearing them for several months, he or she may be a candidate for a cochlear implant. This is a device that is surgically placed in the ear. Unlike hearing aids, a cochlear implant does not make sound louder. It bypasses the damaged parts of the ear and sends an electronic signal directly along the auditory nerve to the brain.

A child using a cochlear implant will need help developing language, just as children using hearing aids do. He or she will need to be trained to interpret and use the sounds that are perceived via the implant. With this training, a child who is an appropriate candidate and who receives a cochlear implant early will likely learn spoken language at a level close to that of children who have normal hearing.

Cochlear implants are approved by the Food and Drug Administration for appropriate children 12 months of age or older. What makes a child a good candidate for a cochlear implant? The following factors are usually considered:

  • The severity of the hearing loss. For children aged 12 months to 2 years, the hearing loss should be sensorineural and profound. (Sensorineural hearing losses involve damage to the delicate sensory hair cells of the inner ear.) For children over 25 months, hearing loss should be sensorineural and severe to profound.
  • The level of benefit from hearing aids. When a child has received little or no benefit from wearing hearing aids, the possibility of a cochlear implant may be discussed.
  • The level of the family's motivation about the child receiving a cochlear implant. For cochlear implants to be successful, family members need to be fully committed to making sure that the child receives follow-up services.

These follow-up services may include speech, audiology, and other services, which are intended to help the child learn to listen with a cochlear implant. These services are provided by qualified individuals and may be available under various programs, including early intervention services or special education and related services. Parents play a part in identifying the services and seeing that their child receives them. The child and his or her family should be prepared to actively pursue a program of learning to listen with the cochlear implant.

Detailed information about this technology and what families can expect is available at the Web sites and in the publications listed in the section entitled "Find Out More" toward the end of this document.

Exploring Communication Options

Communication is at the heart and soul of our lives. Children with hearing loss may build their communication skills using one or more of the communication options described in this section. To help you get started learning more about these, let's take a look at each one.

American Sign Language (ASL)

American Sign Language (ASL) is a fully developed, autonomous, natural language with distinct grammar, syntax, and art forms. Sign language can perform the same range of functions as a spoken language. “Listeners” use their eyes instead of their ears to process linguistic information.  “Speakers” use their hands, arms, eyes, face, head, and body.  These movements and shapes function as the “word” and “intonation” of the language. If parents are not deaf, intensive ASL training is necessary in order for the family to become proficient in the language.

Auditory-Oral (AO)

This method of teaching spoken language stresses the use of amplified residual hearing, speech and oral language development. Additionally it places emphasis on speech reading and visual clues from the face or body. Tactile methods may also be used to encourage the child to feel the sounds of speech.  Parents need to be highly involved with child’s teacher and/or therapists to carry over training activities to the home and create an optimal “oral” learning environment.

Auditory-Verbal (AV)

This approach to teaching spoken communication concentrates on the development of listening (auditory) and speaking (verbal) skills.  It emphasizes teaching the child to use his or her amplified residual hearing and audition from listening devices (like hearing aids or cochlear implants) to the fullest extent possible.  A high degree of parent involvement is necessary as parents learn methods to integrate listening and language throughout daily routines.  May include: Natural Gestures, Listening, Speech (Lip) Reading, Speech

Cued Speech

This system is designed to clarify lip reading by using simple hand movements (cues) around the face to indicate the exact pronunciation of any spoken word. Since many spoken words look exactly alike on the mouth (e.g. pan, man), cues allow the child to see the difference between them.  Cued speech can be learned through classes taught by trained teachers or therapists.  A significant amount of time must be spent using and practicing cues to become proficient.

Simultaneous Communication

Simultaneous communication occurs when a person uses sign language and spoken English at the same time.  The signs used may be an exact match to the spoken message (Signed Exact English). Or, a person may sign some, but not all, of the words in the spoken message (Pidgin Signed English).  The words that are signed and the words that are spoken occur simultaneously. Parents must consistently sign while they speak to their child.  Sign language courses are routinely offered through the community, local colleges, adult education etc.

Total Communication (TC):

The term Total Communication was first defined as a philosophy which included use of all modes of communica­tion (i.e. Speech, sign language, auditory training, speech reading and finger spelling). Today the term Total Communication is commonly interpreted as Simultaneous Communication (signing while talking). This philosophy led to the formation of manual systems (e.g. Signing Exact English - Signed English) that attempt to represent spoken English.

Find Out More

The organizations and websites listed alphabetically below are just some of the many sources of information on hearing loss and deafness. Each will lead you to more.

Alexander Graham Bell Association for the Deaf and Hard of Hearing
1-866-337-5220; 202-337-5220 (V); 202-337-5221 (TTY)
Look for information such as: Next Steps for Parents and Knowledge Center

American Academy of Audiology 1-800-222-2336; 703-790-8466
Look for information such as: Fact Sheets, Publications & Resources, and How’s Your Hearing Consumer Website

American Academy of Otolaryngology-Head and Neck Surgery
Look for information such as: Overview Cochlear Implant, Hearing Aid, Hearing Health, and Fact Sheets

American Society for Deaf Children
1-800-942-2732; 202-644-9204 (VP)
Look for information such as: Advantages of Early Visual Language and Language Rights

American Speech-Language-Hearing Association
1-800-638-8255; 301-296-5650 (V/TTY)
Look for information such as: Hearing Loss, Screening & Assessment, and Health Insurance

Laurent Clerc National Deaf Education Center
202-651-5051 (V/TTY)
Look for information such as: Information from Infancy to Transition to Adulthood, Assistive Technology, Cochlear Implant Education Center, Laws, and Publications

National Dissemination Center for Children with Disabilities (NICHCY)
1-800-695-0285 (V/TTY)
Web in English:
Web in Spanish:
Look for information such as: Contact information for the early intervention system, parent groups, disability groups, and PTI in your state

National Early Childhood Technical Assistance Center (NECTAC)
919-962-2001 (V); 919-843-3269 (TTY)
Look for information such as: Contact information for early intervention systems, Early Childhood Resources

National Institute on Deafness and Other Communication Disorders (NIDCD)
1-800-241-1044 (V); 1-800-241-1055 (TTY)
Look for information such as: Health Information, Communication Considerations

Hearing Loss Association of America (HLAA)
301-657-2248; 301-657-2249 (TTY)
Look for information such as: Hearing Assistive Technology, Online Community

Other web sites

*The U.S. Department of Education has neither reviewed nor approved the information listed on the Web sites noted in this document, which are not part of the Department's Web site. No official endorsement by the U.S. Department of Education of any product, commodity, service, or enterprise mentioned on these resource pages or in this publication is intended or should be inferred.


Opening Doors: Technology and Communication Options for Children With Hearing Loss was produced for the U.S. Department of Education under Cooperative Agreement #H326N980002 between the Academy for Educational Development and the Department's Office of Special Education and Rehabilitative Services (OSERS). The views expressed herein do not necessarily represent the positions or policies of the U.S. Department of Education. No official endorsement by the U.S. Department of Education of any product, commodity, service, or enterprise mentioned in this publication is intended or should be inferred.

U.S. Department of Education
Margaret Spellings
Office of Special Education and Rehabilitative Services

John H. Hager
Assistant Secretary
Office of Special Education Programs

Patricia Guard
Acting Director

Additional copies of this publication are available from:
ED Pubs 
P.O. Box 22207
Alexandria, VA 22304
1-877-4ED-PUBS (433-7827)
1-877-576-7734 (TTY/TDD)
703-605-6794 (fax)

This publication is available upon request in alternate formats such as Braille, large print, audiotape, or computer diskette. For more information, contact the Department's Alternate Format Center at 202-260-9895. This report is also available on the Department of Education's Web site at:

Confused? Overwhelmed? Wondering how in the world you're supposed to decide which approach to use with your child? Well, that's normal! There's a lot to know about each of these methods. To learn more, take a look at the publications and Web sites above or the ones we've listed on our links page. Read, ponder, and talk with other parents, your child's audiologist, and other hearing health-care and education professionals.

Footnote 1:
Joint Committee on Infant Hearing. "Year 2000 position statement: Principles and guidelines for early hearing detection and intervention programs," Audiology Today, Special Issue, Reston, Va. : American Academy of Audiology , August 2000. (Accessed on May 10, 2003 at

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