Hello, in this lecture, we're going to discuss communication options for children who are deaf or hard of hearing. And if you're not well versed in the area of hearing loss and communication options, you may not realize that this can be a very controversial topic. People feel very passionate about particular options. But our mission here today is to go through these options and look at what each option involves. The key that overrides all the options is the fact that hearing loss affects communication. If we look at what are typically considered to be the five most common options, you see that they run a gamut from mostly relying on auditory input to almost exclusively relying on visual input, and a combination of the two senses in between. On the far left, you have the auditory verbal approach, which is an early intervention approach that relies on teaching, listening, and spoken language and the use of technology. The auditory oral approach also heavily relies on hearing and using technology, but may include some lip reading instruction. And where the auditory verbal approach focuses on teaching the parent to be the primary teacher of the child's listening and language. The auditory oral approach typically involves a teacher of the deaf or hard of hearing instructing the child. The total communication option can look a variety of different ways. You're going to have some visual input and some auditory input, and which sense is used predominantly may vary. There is often an effort to speak and sign together at the same time. But because a true signed language and a spoken language don't line up one to one, it's not possible to truly give both equal weight. So one or the other is going to take precedence. The other place where total communication comes into play may be if the child has another significant disability, such as cerebral palsy, in addition to hearing loss. In this case, a total communication approach or using any method available to access and promote communication may come into play. So you may have a child who is listening, but is using a dedicated voice output computer system to respond back. Cued speech, or cued American English, if it's used in the United States, is a modality that provides visual access to all the phonemes of the language. Where we know lip reading can provide only 30% of the information visually of spoken language. Cued speech is able to add hand shapes placed around the mouth to make all the sounds visible to the person who is receiving the communication. There are many signed languages across the world, American Sign Language being the one that's used in the United States. And it's important to understand that these languages are truly languages distinct from a spoken language. They have their own grammar, they have their own word order, and they take advantage of the fact that this language is three dimensional. They're able to use space to express things that in a spoken language would be expressed by a different word. For instance, in English, you might say big, but if something was really big, you might say enormous. But when that is signed, it would be signed based on the space. So it might be big or enormous, but the word would not change. It's the dimensions in space that make the sign different to express that meaning. All of these options have been around for more than 50 years. None of them are experimental or new. They've all had research done to discuss their impact and their viability. Sign language would be the oldest, with American Sign Language having its roots in French sign language in the early 1800s. This was followed not too much later by the auditory-oral approach in the 1840s. With technology, hearing aids becoming an option, the auditory-verbal method came about. The 1960s saw rise to both total communication, the idea that we should take advantage of both senses. And cued speech, which was developed in an effort to improve literacy among users of American Sign Language. Each of these options is inherently different to our approaches. The auditory-verbal approach and auditory-oral approach use techniques and strategies to maximize the development of listening and talking. The goal in these approaches is to facilitate the development of listening and talking. The total communication option is a philosophy. Its belief is that we should use everything available to facilitate communication, whatever form that may take. Cued speech is a modality overlaid on top of a spoken language, using hand shapes placed around the face to indicate certain phonemes and vowels and consonants both to aid the individual with a hearing loss in communicating and understanding what is being spoken. Sign language is a language, American Sign Language is a distinct language. As we've already discussed, it has its own grammar, it has its own rules, and therefore its own culture. Communication is what bonds families. When communication is not successful, these bonds can be weakened. So it's important that a parent who has a child born with a significant hearing loss understands what their options are, has the information needed to make the best choice for their situation and their family. It's important that parents and others understand that there's no easy option. The critical period for language learning is zero to five. So it's time-sensitive, and we need to act early and effectively to habilitate language. It takes approximately five years to become fluent in a language. This becomes important if a family who is not versed in a signed language chooses that option. Because they'll need to understand the need for commitment in an ongoing sense to acquiring language fluency in ASL or whatever the signed language is. 95% of children with hearing loss are born to parents who are hearing. So it's not uncommon for a child who is born congenitally with a severe to profound hearing loss to have parents who have never dealt with hearing loss before. Immersion in a language is always going to yield the best results. And this is true whether we choose a signed language or a spoken language. And in the event that we're dealing with more than one spoken language, we want to discuss that and be sure that there's immersion into languages, if that's the goal. Or that we have a significant focus on one language or the other. Audiologist Dr. Carol Flexer has reminded us that the ears are just the doorway to the brain, and you actually hear with your brain. So during this first five years of life, we want to, if a child is going to use listening and spoken language, build the auditory pathways and connections in the brain to make that a viable option. Listening and talking requires early use of appropriate hearing technology for a child with a hearing loss. We know that the brain will reorganize to use auditory centers for vision if they're not used for hearing. So again, we're in a time-sensitive situation for the development of the language and for the development of the various centers in the brain for maximal use and the best outcome in the chosen option. The question comes about as to why there are different options. And offered options really differ in the primary sense that they use. And like all people, people with hearing loss are unique and their communication needs vary. And if you look, we have some factors bulleted here that give reasons why one option over another might be chosen. For instance, the family environment. If the family is well versed in a signed language, it may make good sense to immerse the child in that language. If a family knows no sign language and is not familiar with that, it may make more sense to pursue a listening and talking outcome. Physical limitations may come into play when choosing options. An individual that does not have good motor control of their hands and arms is going to have some limitations in terms of how they might be able to sign. This may make listening and talking a preferable option. Vision comes into play. If there is a significant vision loss, that needs to be considered when choosing options. This may push a family towards an option that is more auditory-based. Inner ear anatomy may also be a decision factor. If the ear is abnormal and not able to support a cochlea implant and provide good access to sound, then an option that is more visual may be indicated. For professionals, it's important to recognize that professional guidance has a huge ability to sway a family in one direction or another. And it's often the professional that first encounters the family that has the most weight. So when giving families guidance, we need to be cognizant of the factors that go into a choice and what the family's personal beliefs and desires are. That concludes the lecture on communication options. I hope that you'll join us again for some of our other lectures.