Speech Services for Hearing Impairment :: Nationwide Children's Hospital

Speech Services for Hearing Impairment

The Hearing Program at Nationwide Children's Hospital offers many speech services to meet the individual needs of your child and family. Services are based on your choices.

Types of Treatment

1. Listening and Spoken Language Therapy (“Auditory-Verbal Therapy”): This treatment helps your child to develop listening skills. When children can process what they hear they can learn to speak clearly.

The goals of Listening and Spoken Language therapy:

  • Early diagnosis of hearing loss; treatment beginning as young as 3 months of age
  • Full time use of hearing devices
  • One- on-one speech therapy to meet your child’s needs
  • Parents and caregivers participate in treatment
  • Sign language and other visual methods of intervention are not used
  • Hearing aids and cochlear implant(s) are the child’s link to the hearing-speaking world
  • Children may be in a regular classroom with classmates who can hear and speak
  • Children learn independence and self-advocacy
  • Hearing is a part of the child’s personality.

The Principles of LSLS Auditory-Verbal Therapy and Principles of LSLS Auditory-Verbal Education are followed in this intervention approach.

2. Auditory-Oral or Auditory-Based Speech Therapy: makes the most of Auditory-Verbal plans to optimize listening development but also includes: lip reading

The goals of Auditory-based therapy include:

  • Full-time use of hearing devices
  • Speech pathologist may stress lip-reading and visual cues by “watching” to learn language
  • Sign language is not used
  • The hope is to close the gap between the child’s actual age and performance
  • The child is urged to develop oral skills so he or she can function in a hearing community.
  • Early diagnosis and intervention is critical to this method
  • The family participates in speech therapy sessions.
  • Your child often attends an oral educational program specific for children with hearing loss or a mainstream educational setting.

3. Total Communication Speech Therapy: a combination of sign and spoken communication.

The goals of Total Communication speech therapy include:

  • Encourage full time use of hearing technology
  • Speech pathologist supports the child’s language, listening, and speech development through use of picture symbols on devices such as IPads, as well as sign language, visual cues, and spoken input
  • Use every and all means to communicate with a child who has hearing loss
  • Exposure to sign language, natural gestures, and speech reading
  • **At least one, but preferably all family members should learn sign language to communicate fully with a child using this system.
  • Parents must always sign while speaking

How to Choose a Communication Option:

  • Families often choose a communication option based on their child’s needs and their family dynamic.
  • Professionals can guide and coach a family based on the following factors:
    • Age at diagnosis: age when therapy services were started
    • Cochlear anatomy
    • Does the child have any other developmental disabilities or delay
    • Does the child have the ability to use his or her hearing technology all waking hours?
    • What is the family’s plan for educational environment: immediate and long term needs are considered
    • What is the family’s ability to use the desired communication method?
    • Does the family have the appropriate resources and support?
    • What are the family’s goals for their child: long and short term goals are considered
  • Additionally, this chart is used to help guide the family in their decision.

Speech Treatment

  • Speech therapy typically starts after the child has been fitted with appropriate hearing technology
  • Hearing impaired speech treatment sessions typically last 1 hour
  • Your child must arrive with his or her hearing technology on and in good working order.
  • Your child will be scheduled with a therapist based on his or her ability to communicate.
  • The primary caregiver should sit in during the session and join in as guided by the speech pathologist.
  • The speech pathologist will give your child goals and targets to work on at home.
  • During the session the caregiver should take notes to know what to work on for the following week. The carry-over of goals into the home setting is essential for your child’s progress.
  • Lesson plans are. created for your child’s individual level and needs.
  • You will know how your child is doing during each session.
  • Goals are created to address your child’s speech, language, listening, cognitive, and literacy development
  • Materials are often provided for home practice and carry-over

Early Intervention

Today’s children with hearing loss are expected to develop listening and spoken language skills. Research has shown that, “With early detection, early amplification and effective individualized therapy with parent participation, up to 80% of children born deaf can potentially be successful in mainstream education and society” (Lim & Simser, 2005). The new millennium has brought about advancements in hearing technology, early identification, and intervention. The Universal Newborn Hearing Screening Program has led to early detection and amplification taking advantage of the “critical period” (Birth-3 years) for developing the auditory pathways. The goal for today’s children identified with hearing loss is to follow a developmental model of intervention versus a remedial model (Flexer & Cole, 2007).

Hear the Beat: Early Intervention Speech Group with Music Therapist

Hear the Beat is a group of Nationwide Children’s Hospital’s Speech Pathologist Hearing Impaired Specialists. The group works with young children with hearing loss and their caregivers. They focus on speech, language, hearing, learning, and emotional development through music and movement.

Who: Families with children with hearing loss, ages birth through 12 months. Families are encouraged to attend both before and after receiving either hearing aids or cochlear implants.

When: The group meets once a month on Fridays for 3 consecutive months.

Where: Nationwide Children’s Hospital Main Campus Outpatient Speech Therapy - Outpatient Building 6th floor.

Why: To help families and caregivers to develop early communication skills with their child with hearing loss.

For more information please contact: Shana Lucius: shana.lucius@nationwidechildrens.org


Your child should see a hearing team Speech Pathologist every year:

  • To make sure the child is meeting his or her listening, speaking, and learning goals
  • To manage services with school specialists (Individualized Educational Plan (IEP), School
  • Accommodations)
  • To know how your child is doing compared to other children the same age who can hear and
  • speak

During the evaluation you and your child will receive:

  • Specialized care from speech pathologists who work with children who have hearing loss
  • A complete evaluation checking pronunciation, vocabulary, listening, auditory-memory, and language
  • A full report with specific listening and speech goals and advice for home and classroom
  • The hearing team speech pathologist will work closely with your child’s audiologist to ensure your child is hearing to the best of his ability.

Cochlear Implant Candidacy Speech Process:

Once the cochlear implant candidacy process has been started, a there will be a speech evaluation. The speech pathologist will check your child’s abilities with hearing aids on.

This evaluation is important because it helps decide your child’s current level of hearing and speaking abilities. It also serves as a “baseline” to measure your child’s progress over time.

The speech pathologist will discuss your goals for your child in terms of communication options and educational placement.

What to Bring:

  • Working hearing aids
  • Most recent copy of your child’s IFSP or IEP

What to Expect After Cochlear Implant Surgery:

  • Your child will be scheduled for speech therapy after his cochlear implant is turned on. This will be decided based on the communication option you have chosen for your child.
  • Bi-Monthly to Weekly speech therapy is necessary for at least the first year after your child’s cochlear implant is turned on; the frequency of therapy often depends on your child’s age, prior hearing experience, and progress with goals.
  • Speech development expectations: (See Roadmap)

Speech Roadmaps:

Factors that influence your child’s progress with a cochlear implant include:

  • The younger the child, the greater the potential for developing skills more like typically developing peers.
  • The greater benefit the child had with hearing aids and access to sound prior to cochlear implantation the more likely the child will progress more like typically developing peers.
  • The consistent, all waking-hour use and bonding with the cochlear implant(s) will affect communication outcomes.
  • The family and caregivers’ involvement and carry-over of goals into the home setting
  • The follow-through for appointments including: audiology, speech, and ENT The family’s commitment to communication modality
  • Other developmental diagnoses
  • Cochlear anatomy

The Ling Six Sound Check

What is the Ling Six Sound Check?

A behavioral listening check that uses six sounds to decide the effectiveness of a cochlear implant or hearing aid. This check can be used to decide what sounds the child is able to detect, discriminate,
and identify.

Six-Sound Speech Test Instructions

  • Stand four feet away from the child and ask him or her to “listen.”
  • If this is the first time the child has completed the task, show him what is expected.
  • Using a normal conversational level, present each of the six sounds through listening alone. You may repeat a sound if the child misses it. To avoid lip-reading, place a thin piece of paper in front of your mouth or stand behind the child.
  • Occasionally say nothing while doing the test. This way a listener learns that it is okay to say he or she does not hear anything. Remember to present the Ling Sounds in a random order so the child does not learn the pattern.
  • If the child is able to detect the sounds, progress to having him or her point to the correct picture and then naturally repeat the Ling Sound.

Ling Six Sounds

  • ah
  • eeee
  • ssss
  • oo
  • sh
  • mmm

Ling Six Resources

Learning to Listen

There are many strategies that you as parents can use to add listening into everyday activities. This section describes a number of important rules that should be followed during the learning to listen process.

  • Reducing background noise - You will have greater success in communicating with your child if there are no other activities (other people talking, TV, radio, dishwasher, etc.) competing with you.
  • Pausing and Repeating - Waiting for your child to respond can be one of the hardest techniques to use. However, it is critical to allow the child time to process and respond correctly.
  • Auditory closure - Give your child some of the information he needs. For example, say “The dog is in the ____,” and allow him or her to fill in the missing piece.
  • Auditory input first - Your child must hear spoken words, phrases and sentences before any visual cues are given. This is the most effective way of learning spoken patterns.
  • Importance of play and out-of-home experiences – Play and providing a variety of experiences, such as visiting the zoo, store, park or museum, are effective ways to help your child develop language and cognition. These experiences allow children to learn about the world outside their immediate environments.
  • Ongoing audiological management – Constant use, maintenance and education of hearing devices is essential to your child’s hearing impairment. Good management involves learning about well-fitted earmolds, keeping ear canals clear and healthy, understanding audiograms in relation to your child’s impairment and having regular hearing tests.
  • Listening should be fun - It is important that learning to listen is enjoyable and meaningful. The more your child is engaged in listening, the greater the possibility for the development of spoken language. Listening experiences should be appropriate to your child’s age, ability, and interests. As your child matures, it is important to change the toys, games and language accordingly.
  • Team effort – In auditory rehabilitation, the partnership between parents and professionals is essential to guide and support your child. Therapists will provide you with skills to develop your child’s spoken language and, in turn, you will provide valuable feedback to the therapists about your child’s development at home and outside of therapy.
  • Implementing therapy at home – It is crucial for parents to continue therapy goals and implement techniques outside of therapy sessions. The therapist can provide information and instruction of at home activities for parent s to work on with the child.

Developmental Milestones Checklist

It’s important to know what milestones your child should be reaching in his or her development. There are specific behaviors we expect to see in typically-developing hearing infants and toddlers, up to age 5. Click here for more information.

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Braxton turns four today. He received the best birthday gift anyone could get, the gift of hearing.
This video is posted to showcase the talent, innovation and advanced skill of the Hearing Program. Its purpose is not to recruit patients or promote services.

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