Chapter 1

 

Linguistic communication with the child with hearing impairment in group situations – how can we best understand each other?

 

Learning goals

In this chapter you will find out, with the aid of many clear examples, how communication with the child with hearing impairment can take place successfully. How should I talk to the child, what should I talk about, and how can I encourage the child himself to speak? As this course is designed for those working with children aged 0-3 years, it contains suggestions for communicating with children with hearing impairment who are in the initial phase of hearing and language acquisition.

 

1. How should I speak to the child with hearing impairment?

 

• In group situations, make contact with the child using eye contact and/or by addressing them by name when you want to speak to them. In this way, the child knows ‘you mean them’ and so can focus their listening on you. If you try to get their attention by suddenly touching them, you may startle them if they have not seen you approaching. They also need to learn how to speak to other children if they want something from them, instead of just tapping them on the arm or shoulder.
• Speak at normal volume – not too quietly and not too loudly. Amplifying the sound is not your job but that of the hearing aid or cochlear implant. And remember that speaking to the child more loudly will distort your facial expression and pronunciation.
• Don’t speak too fast or too slowly. If you slow down your speech, you change its intonation, stress and rhythm. These aspects of speech are known as ‘prosody’. For normal-hearing and children with hearing impairment alike, prosody can be laden with meaning, helping to make clear (for example) that you are giving praise, making a factual comment, confirming something or perhaps expressing impatience. Natural prosody is, therefore, very important. What’s more, it means we are giving the child a natural speech model and thus helping them to speak in a natural way themselves.
• Speak clearly, but avoid exaggerated movements of the mouth. These make lip-reading harder as the movements are distorted, and also affect the natural intonation of speech.

• Speak in a lively way, i.e. melodiously and stressing the important words. This involves contrasts of volume, as in, “Hey, great, you can already do that all by yourself!” or by elongating vowel sounds, as when playing ‘peekaboo’ hiding games with a 12-month-old child: “Wheeere’s Ben? Theeeeere he is!”
• Repeat the most important ‘carriers of meaning’, as you naturally do with all younger children, as in, “Look, Anna wants a go on the swings, too. Will you let her have a go on the swings?” These repetitions are very important in the initial phase of language acquisition, as a child with hearing impairment needs to hear words more often if they are to learn to understand their meaning. If, however, the child has already achieved a good level of linguistic understanding, so that they do not really need these repetitions, you need to make sure you use them less often. The child should, as a rule, learn to respond and to understand what is said when spoken to only once. If, however, they are used to having everything said several times, they will tend to listen to spoken language less and less attentively.
• Children with hearing impairment often have to piece together the message from individual bits they have understood. So, for important utterances, mix and match a choice of different words to get the main point across. For example, it is harder to understand if you just say, “Max, come along,” than if you say “Max, come along. We’re going outside into the garden. We wanted to collected chestnuts, remember?” With the second example, Max can glean from several different words what is about to happen. If he has not heard (or understood) the word ‘outside’, he can still piece together the message from the words ‘garden’ and ‘chestnuts’.
• Use lively facial expression and gesticulation. If your body language is natural, this makes communication natural and lively, and reinforces the message of your words.
• Speak in your own dialect, if this is the one spoken locally. Only an unfamiliar dialect that is not otherwise spoken within the group would confuse a child with hearing impairment.

 

1. What should I talk about with the child with hearing impairment?

 

• Let the child set the agenda. When they are a baby, this might take the form of happy kicking; when they are older, they might point to some object and later they use language, as in the questions of a child using their first two-word phrases: “Bear ouch?” But keep asking yourself: are you really talking about the same thing? It might be that you are focusing on the same object yet talking at cross-purposes. If a child is watching the marbles in a marble run, fascinated that they roll so fast all by themselves, and then suddenly drop into the next level, and you say, “Look, here comes the red marble – see, this one’s red!” then, while you may be playing with the same object, you are focusing on different things: you are talking about the colour of the marbles, whereas what interests the child is how fast they move. You can, of course, try to arouse the child’s enthusiasm for something else or for another aspect of the game, but if they don’t respond, you should switch back to the child’s own agenda.

• Don’t tell the child what the objects are called: talk to the child about them. Not: “Look, these are Wellington boots. These shoes are called Wellington boots”, but, “Oh dear, your Wellington boots are really dirty,” or “Have you got new Wellington boots? They’re a lovely blue colour, aren’t they!” What objects, animals and people are like is far more interesting than what they are called. The exciting things about a tiger, for example, are that it has sharp teeth, bites and can run very fast. Interesting things about a cup might be that it is hot, it can break if it falls, it is dirty and has to go in the dishwasher, or that there is a picture of the child’s much-loved Pooh Bear on it.
• Repeat what the child says. It’s not how the child says something that is important, but what they mean. Show that you have understood the child by repeating what they say. Child: “Look, boken!” Adult: “Your pencil’s broken? Oh yes, the lead’s broken off. Come on, let’s get a pencil sharpener.” In this way, the child will feel understood and they hear the correct pronunciation, grammar and vocabulary without being directly corrected and getting the feeling that they have done something wrong.
• Make sure you don’t over-simplify your language. If you aren’t always a little ahead of the child in language level, they can’t progress. For example, they cannot learn ‘Wellington boots’ if you only ever say ‘shoes’, or learn ‘switch off’ if you always say ‘turn off’.
• It is important that you speak a lot with the child with hearing impairment. However, always be aware of how receptive the child is at any given moment. For example, is the child tired, over-stimulated or absorbed in an activity right now? Even children only a few weeks old clearly show whether they are in the mood to communicate or not. There is no point in overwhelming the child with language. This will only make them less willing and able to concentrate on listening, not more. Listening – and even speaking – must be interesting and worthwhile for the child.

 

1. How can I encourage the child to speak; to actively use language?

 

Elicit spoken language from the child, but don’t demand it! Guidelines such as “You can give the child what they want only when they try to name the object” are not helpful. If a child merely points and makes babbling/non-speech sounds, this shows it is still very difficult for them to express themselves more precisely using language. Speaking, communicating and being understood are fundamental needs for every human being. If a child is able to do so, they will apply their linguistic skills. Insisting on a response, however, generally leads to the child withdrawing into themselves or to a power struggle between the two interacting parties. For example, a child may be unable to carry out the request “Say: ‘An ice-cream, please!’”, and therefore they do not get what they want and start crying. One can easily imagine how the situation would escalate from there.

You can, however, elicit language from the child without actually insisting on it by using easy methods in day-to-day interaction:

 

• Wait a moment, and take a break from speaking, so that the child has time to muster their thoughts and say something themselves. In a natural dialogue, the speaker and listener take turns. If you insert pauses, this sends a signal to the child that they can now assume the role of the speaker. You can, for example, after turning over the page in a picture-book, first wait and see if the child points to something on the new page or comments on it using spoken language.
• Natural opportunities/reasons for using language often arise when something does not happen as expected. An example: try, from time to time, briefly delaying an action that the child expects. If something does not happen in the way the child anticipated, they will make eye contact with a questioning look and perhaps say something. If, for example, you are rolling a ball back and forth to each other and briefly hold onto the ball, the child will take notice and may say “My ball!” If everything happens as expected, it is not usually necessary to say anything – natural opportunities and reasons for using language do not arise. If, however, the predicted action does not materialize, or a person or an object is not there and needs to be looked for, or something is broken, or if the child needs help, or if they cannot reach something they want, then communication really is necessary. For example, a child cannot be expected to name their drinking bottle without a good reason. However, if the bottle is packed away and the child looks around for it, this provides a natural reason and opportunity for using language, and the child may say “Bottle?”
• A child’s first words are often associated with strong emotions: maybe Mummy has disappeared from view, making the child anxious so that they call out “Mummy!” Or a toy car has rolled under the sofa and the child cannot retrieve it unaided, gets annoyed and calls for Grandma’s help: “Grandma car!” Or a box or a bag is – against expectations – empty and, on opening it, the surprised child exclaims, “Empty” or “Gone!” Or a child is playing with the light switch, enjoys making the light come on or go out and comments enthusiastically, “Off!” Or a teddy bear is provided with a sticking plaster and the child declares with a serious expression, “Teddy ouch!” The child is solemnly warned that the candle’s flame is hot and, impressed, repeats “Hot!”
• Ask questions, for example, when looking at a picture-book: “Who’s that hiding there?” or “I wonder what the tiger’s going to do next; what do you think?” But avoid asking the children obvious test questions like “What’s he called?” or “What’s he doing?” Children are able to notice from a very early stage whether they are being asked real questions or whether the other person is just testing to see if the child can produce the hoped-for answer.
  • Ask ‘alternative questions’. If, for example, the child points to the table and says “Ah!” or “Drink”, you can ask: “What would you like to drink? Tea or juice?” Even if you already know what the child usually wants, this is a good opportunity to model the right words to the child (‘drink, tea, juice…’). In this way, the child hears the words and will soon be able to use them themselves. Even if the child does not yet specifically answer, or they point again and respond only with “Yes,” it is still worthwhile, by means of an alternative question, providing a model for a possible reply. This model serves as an aid in the initial phase of speech acquisition, but as it predefines (and thus restricts) the content of the answer, it is important to later scale back the use of these alternative questions, too.
  • If the child is further on in their development, then ask open questions: “What would you like to drink?” After a visit to the zoo, the question, “What animals did you see?” is far more restricting than the question, “Which animal did you like best?” The first question is more likely to result in a list, and the second in a conversation, with a real information gap – the child is telling me something I genuinely don’t know and which interests me.
• Comment on your own actions and those of the child. If, for example, you are playing together in the sandpit, say, “That’s a deep hole you’re digging. That’s going to take an awful lot of digging, isn’t it! I’ll just go and borrow Lisa’s bucket and spade, shall I?” If the child in the picture-book points to a child jumping in a puddle, say: “She’s having fun! Splish, splosh! I think this girl’s trousers are getting really wet. Do you like jumping in puddles?” In this way, the child will hear the right words and phrases for this context and will be encouraged to make their own utterances.
• When playing and looking at picture-books or telling stories, use direct spoken language. If you use different voices for the different characters, you are providing new listening experiences. The mouse might speak quickly in a high-pitched voice, and the bear in a slow, deep voice. These touches bring games and picture-book sessions to life and encourage the child to spontaneously imitate you. The mouse in the story might say to its 14 mouse children, “Night night, sleep tight!” or the bear might warn another animal and say “Watch out!” Animal noises like “Moo” or “Woof” are direct spoken language too and encourage imitation. However, don’t overdo these animal sounds.
• Songs, verses, finger games and singing games are a good way of developing language skills, containing as they do natural repetition. Young children love repeating what they know. Their vocabulary is expanded, and their feeling for language fostered, by rhymes and the like; among the many benefits, their memory for language, melodies and sequences of movements is stimulated. Verses and songs with a ‘fun finish’ are especially popular with babies and small children. They wait very eagerly and attentively for the ending, listening very carefully right until this part comes: “Shake the blanket, shake the blanket, shake the blanket … over!”
• If the child does not yet say much, you can elicit spoken language by letting them finish a verse, a line of a song or a sentence: “Jack and Jill went up the…” “hill!” “Humpty Dumpty sat on a … wall!” “Tell Daddy who we saw in the garden today.” “A tiny little…” “Kitten!” “What do we need to lay the table? Spoons, plates and…” “Cups”!
• Linguistic awareness is enhanced by hands-on experience. Children with hearing impairment do not learn the meaning of words from picture cards. Active (spoken) vocabulary does not develop at first through images either, but in actual everyday and play situations. Children learn by continuously having new experiences in day-to-day life and play, by physically connecting with things in their world – taking hold of, holding onto and feeling things, seeing, climbing, running, hopping etc. – and through the language they hear while doing so. Give the child plenty of opportunities for movement and to actively experience the world around them. A book about a building site is no substitute for the multi-sensory experiences a child can enjoy if together you go and watch all the goings-on where a real house is being built, or if the child plays ‘building sites’ with other children in the sandpit. Books are, initially, a valuable addition to actually experienced situations; later, children will, of course, also learn about new concepts from books.

 

Even if the child is progressing well in their hearing and their spoken language development, it must not be forgotten that hearing and listening – and thus everyday life in general, throughout the day – ‘take more out of’ these children than their normal-hearing peers. You will, therefore, find that the child often does not respond when spoken to. Be patient, wait a moment and then, simply repeat – but not in a reproachful way – what you’ve said. If the child still does not react, try to rephrase what you want to say. You might, for example, say: “Kim, would you like to help me lay the table?” If the child still does not respond after you have repeated this, you might say: “Do you want to fetch the plates and spoons and bring them to the table?” Don’t tell the child off if they do not listen or respond. Hearing needs to be something positive and rewarding for the child. There will always be days or phases where they are more – or less – switched on to listening, and there may be many reasons why a child with hearing impairment sometimes does not respond (although, of course, it’s necessary to check that the hearing aids or cochlear implants are working properly): They might be absorbed in an activity, or tired, or distracted, or do not yet understand the meaning of the words you are using, or it might be noisy there, or the child just doesn’t feel like listening – like any normal-hearing child at times. Moreover, children fitted with hearing aids often do not hear as well when they have a cold, as their inner-ear hearing disorder is maybe compounded by a middle-ear problem (i.e. conduction hearing loss).

If you fully commit yourself to the child with hearing impairment; if you give yourself and the child time to get to know each other and try to get talking with them, even though they are only just setting out on the journey of hearing and spoken language development, then you will find that interaction can prove successful – even with this child.