Choosing a Communication Methodology

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Speech Processor	Listening	Resources	Versión en Español

By Debra Nussbaum, M.A., CCC-A

"Children may benefit from using cochlear implants regardless of the communication strategy/teaching approach employed by their school program...Recommendations concerning educational programming should be made in partnership with parents, with the individual child's unique status in mind…"

Connor, C. M., Hieber, S., Arts, H.A., Zwolan, T. Speech, vocabulary, and the education of children using cochlear implants: Oral or total communication? Speech, Language, and Hearing Research, vol. 43, October, 2000.

There are many misconceptions and much confusion surrounding communication methodology choices for deaf children. These choices become even more complex when a cochlear implant is added to the picture. Determining a methodology to use for implanted children usually centers on which approach will best support the acquisition and use of spoken English. While development of spoken language skills is the goal for all students with cochlear implants, the road to achieving the outcome of full use of spoken language for communication and learning will vary for each child. (See Factors Influencing Performance with a Cochlear Implant.)

As each implanted student and family is unique, communication choices should be made taking into consideration a range of communication, academic, and social/emotional goals.

While development of spoken language skills should be central to whichever communication approach is utilized, use of an approach that provides a student with support through visual modalities in addition to spoken language should also be considered (i.e., Sign Supported Speech, bilingual programs encouraging both ASL and spoken English, Cued Speech). As discussed in the NAD position paper on cochlear implants, as a communication methodology is chosen, it is important to keep in mind that "language and communication are not the same as speech, nor should the ability to speak and/or hear be equated with intelligence, a sense of well-being and lifelong success." Communication and cognition are vital ingredients of every child's development, regardless of the mode in which it is expressed (i.e., visual or auditory).

Bilingual approach: A bilingual approach supports development of ASL as a child's first language, with development of English as a second language through reading, writing, and spoken language (specific to each child's potential and needs).

Total Communication: Total Communication (TC) includes use of all modes of communication—sign language (ASL or manually coded English), spoken language, mime, facial expression, gestures, etc., to facilitate language development and communication. Its intention is not that all modalities be equally weighted and utilized for all children. The most common embodiment of TC, however, has become simultaneous communication. Simultaneous communication is the use of the spoken word simultaneously with the signed version of all or part of the spoken utterance with the signs attempting to approximate the spoken message.

Cued Speech: Cued Speech is a system utilized to assist in clarifying speechreading information. Hand-based cues are provided to help a child differentiate the various phonemes of speech that look similar on the lips. The system includes eight handshapes, representing groups of consonant sounds and four locations of the handshapes near the face, each representing a group of vowel sounds. A combination of these hand configurations are coordinated with the natural movements of speech.

Oral Approach: The oral approach supports development of spoken language through use of a child's residual hearing. Appropriate, consistently functioning hearing aids or other listening technology is integral to the success of this approach. Using this approach, the child is also trained to obtain as much information as possible from speechreading. Speechreading is the ability to watch the lips and face of a speaker to obtain information.

For more information, see: Communication Choices with Deaf and Hard of Hearing Students.

Issues to Keep in Mind

Deciding which methodology to use is dependent on a complex interaction of factors individual to each child and family. There is no one "right" decision for any child with a cochlear implant. While it is beyond the scope of this document to fully detail the issues related to choosing one methodology over another, the following issues should be kept in mind as decisions are made:

• a one-size-fits-all approach will not meet the needs of all children with cochlear implants,

• the communication methodology the child has used up until implantation should be considered in the decision-making process,

• the methodology chosen should not be frustrating to the child, and

• considerations for a young child obtaining a cochlear implant before language has been established will be different than those for a child obtaining an implant when he or she is older and at a later stage of language development.

Communication Environment

For more information on communication options:

Beginnings for Parents of Children Who Are Deaf or Hard of Hearing

Oral Deaf Education

Where Do We Go From Hear?

Communication Choices with Deaf and Hard of Hearing Students

National Cued Speech Association

Auditory-Verbal International, Inc.

My Baby's Hearing

American Sign Language: Quick Facts (NIDCD)

Regardless of methodology, it is important to provide a communication environment that:

• is driven by individual communication goals/strengths/style,

• assures language accessibility while spoken language skills are developing,

• focuses on a child's communication strengths to facilitate cognitive and academic development,

• provides access to mature and fluent language models,

• provides opportunities to develop spoken language skills in meaningful ways during both structured and natural activities,

• acknowledges that language modality may change for students as they progress following implantation,

• acknowledges that student skills and preferences are important in making communication decisions,

• is structured to facilitate language/communication development and, at the same time, takes into consideration a child's overall educational and social needs,

• is child-centered with the child providing the lead in demonstrating communication preferences,

• does not allow the child to fall behind academically at the expense of focusing on spoken language development,

• provides the child with efficient communication for interacting with peers, and

• expects the deaf child to acquire language at the same rate as his or her hearing peers.