Communication methods for children with hearing loss

In the days and months ahead, your family will make decisions about how to help your child express his/her needs and interact with the world. It will be important to learn about a variety of ways to communicate with your baby. Early intervention providersor speech and language therapists can help you in this process. They can help you learn how to teach communication skills to your child in a way that works best for your family.

Communication choices

Children learn language early by experiencing the world around them with all their senses. They use both their eyes and ears to understand what someone is trying to communicate. Some children will learn to rely more on one sense. Some will rely mostly on their hearing with hearing aids or a cochlear implant. Other will rely more on their eyes. The method that is used to teach your child to communicate influences the way that your child learns to use his or her senses.

There are several methods for teaching your baby to communicate. Each method was designed to maximize a child’s self-esteem. These methods also maximize the child's ability to socialize with friends, family and community. Families are the most important factor in the success of any method. The family is the child’s first and most important teacher. Methods taught only to a child will isolate the child from the family. By including the family, language learning time increases to 24 hours a day, seven days a week. You and your child’s early intervention team will decide if you want to teach your child to talk, sign, or both talk and sign. Your early intervention team can help guide decisions about your child’s learning experiences. These methods are influenced by the culture of your community. They are also influenced by the service providers and the resources in your community.


The Auditory-Oral approach emphasizes teaching spoken language. Children are taught to use their hearing, lip reading and contextual cues to understand and use spoken language. The goal is to give your child the necessary spoken language skills to be enrolled in the typical public school and to function independently.

This method stresses the consistent use of hearing aids or cochlear implants. It also emphasizes oral language along with naturally occurring, conversational cues such as speech reading. Speech reading uses visual information from the face, body, and environment to help understand spoken words.

The philosophy is that oral language helps the development of reading and writing skills. Good reading and writing skills are critical to all academic areas. Small classrooms are used with daily individual instruction in oral language skills. Teachers provide spoken language instruction in all classroom activities.


The Auditory-Verbal (AV) philosophy is based on the premise that children with all degrees of hearing loss can develop the ability to listen and to use spoken communication.

This method is based on the normal neurological developmental model. It is based on the belief that the body and brain has been designed to use all five senses equally for learning. Technology is used to enhance and develop the hearing sense to receive information and to learn, within the “window of opportunity.” The auditory/verbal method follows a hierarchy of auditory development to teach sound awareness, detection, identification, and discrimination skills. AV therapists may be early interventionists, teachers of the deaf, audiologists, or speech-language pathologists and requires special training. Family members are active participants in therapy sessions.

Cued speech

Some sounds in the English language look alike on the lips. Look in the mirror and say the sounds /p/, /b/, and /m/. Cued speech uses hand gestures to supplement auditory and visual information. Hand movements are made near the speakers’ face to help cue the listener about specific speech sounds and to represent the English sounds visually. Family members learn the hand positions to help the child use lip reading skills and to help the child learn the difference between sounds when they look alike.

Cued Speech uses eight hand shapes in four different locations (known as cues) in combination with the natural mouth movements of speech to make all the sounds of spoken language look different. It is known as a sound-based visual communication system. Cued speech is used to facilitate language development, speech development, reading skills, and communication. This approach can be used with other approaches. It has been adapted for more than 55 languages and dialects. The use of Cued Speech focuses attention on the mouth, reinforces the sounds in a word or phrase, and integrates motor activity with the use of hearing and vision. More information can be obtained from the Cued Speech Foundation.

Simultaneous communication

Simultaneous Communication occurs when a person uses sign language and spoken English at the same time. The words that are signed and words that are spoken occur simultaneously. This method has been used to teach language to children who have Autism or Downs Syndrome as well as to facilitate the language development of normal hearing babies. If this method is chosen, it is important to consistently sign when you speak to your child. Sign language courses are routinely offered through the community, local colleges, adult education, etc.

Signing exact English

Signing Exact English (SEE) is a sign language system that was developed to make everything in the English language visible. It is a literal signed interpretation of English. Since American Sign Language (ASL) is a different language than English, it has different words and different word order. The purpose of SEE was to supplement the vocabulary of ASL so that children could clearly see what was said in English. SEE was developed in the early 1970’s. SEE is based on ASL signs and expanded with words, prefixes, tenses, and endings to give a clear and complete picture of the English language. Learning this sign language system may be easier for English speaking parents because they are familiar with the word order. During the 70’s there was a movement to add the use of sign language instruction in public schools to teach children with hearing loss. By 1978, SEE became the most widely used English sign system used in U.S. public schools.

Maximum use of residual hearing and speech reading is encouraged since the SEE signs match all of the parts of spoken English. SEE encourages the incorporation of ASL features to show intonation visually. This option is supported by the S.E.E. Center.

Total Communication

Total Communication includes the use of all modes of communication at the same time (i.e. speech, Signing Exact English, auditory training speech, speech reading, lip reading, and finger spelling). The child is provided information in both auditory and visual formats. This allows the child to use the information that best suits his/her needs.

The purpose of Total Communication was to provide a child with access to a visual language base and at the same time encourage development and use of spoken language. Some people were concerned that children were not able to develop a solid language base in either American Sign Language (ASL) or English (signed or spoken). Today, the term Total Communication is commonly confused with Simultaneous Communication (signing while talking).

Sign language

There are over 117 different sign languages around the world. Within each country, there can be different dialects of a sign language just like there is with spoken English. Exploring sign language systems can be very confusing because of the number of different systems and because of the variety of terminology.

For instance, there are a number of other systems of sign language that have been developed for use with spoken English. Collectively, these systems may be referred to as Manually Coded English (MCE), Sign Supported Speech (SSS), Sign Supported Systems (SSS) or Sign Supported they simply refer to systems that use both signs and speech for communication.

Ask your Early Intervention team or your speech therapist for more information on sigh language.

For more on how to communicate with your child click here.