Strategies to Support Communication Development : Infants and Toddlers with Hearing Loss Mary V. Compton, Ed.D. Judy Niemeyer, Ph. D. CENTe-R EHDI Conference March 2005 Atlanta, GA

©CENTe-R 2005 Early Relationships: The Context for Learning Interactions are opportunities for communication and language development. –Infant/toddler learns to relate/communicate. Responsive consistent care-giving nurtures reciprocal interactions –Caregivers provide auditory/visual input, pause and wait for a response from baby. Reciprocal interactions are the context for learning –Early literacy development unfolds.

©CENTe-R 2005 Encouraging Infant Communication Create a language rich environment that includes novel materials and varied toys for interaction –narrate the infants world with expression Initiate frequent engaging interaction with infants –look for meaningful opportunities to initiate or respond to babys interest Attract babys attention –tap on the toy/object that is the focus of communication prior to initiation of interaction Make eye contact –position oneself and toys/objects in the infants visual field when interacting

©CENTe-R 2005 Looking for Opportunities for Communication? Listen for the infants/toddlers communicative responses/behaviors –What is the baby trying to communicate? Use observation to identify infant/toddler vocalizations, cues and signs –Does the baby need food, diaper change, or just want to play? –How can I extend the interaction?

©CENTe-R 2005 Support Family Decision Making by… Recognizing family challenges at identification/diagnosis of hearing loss –Respond sensitively to feelings, respect family decisions Using a family-centered team approach to encourage family participation –Listen to learn parents priorities, interests, and concerns Providing unbiased information on communication approaches –Assist the family in exploring community resources to learn about communication approaches

©CENTe-R 2005 Parents Questions How long before my child will understand what I am saying to him/her? Will my child talk? How will I know my childs needs are met and development is on-target? What is the best communication approach for our child and family? What kind of time and financial commitment will be necessary to accomplish positive outcomes ?

©CENTe-R 2005 Balanced Information: Is material for families…. Inviting, jargon-less, and user friendly? Clear, concise, and appropriate? Supportive of parents rights and expertise? Considerate/respectful of families cultural heritage, community values and the Deaf community? Reflective of a collaborative team spirit?

©CENTe-R 2005 Balanced Information (contd) Available in multiple formats (multi-media and print), multiple reading levels, and different languages? Inclusive of local and national contacts? Reflective of current research and cited appropriately? Reviewed by a diverse group (families, professionals, individuals who are deaf/hard of hearing, cultural representatives)? Unbiased and balanced in representation of various communication options?

©CENTe-R 2005 Delivering Family-Centered Services Respect the Familys Values, Beliefs, and Culture –Especially if they are different from your own. Find out as much as you can about a familys culture before visiting them. Trust the Family –As professionals, it is sometimes difficult to set aside our own expertise in working with children. BUT, it is important to recognize the family as the true expert on their child.

©CENTe-R 2005 Delivering Family-Centered Services (contd) Become Partners with the Family –Involve the family in all decision-making processes, and ask for their thoughts. –Work together with them to plan and deliver services. –Invite family advocates to inservice training or staff meetings to talk about what kinds of services are helpful and what arent. Relate to the family as people –Use a conversational approach rather than a formal clinical approach.

©CENTe-R 2005 Look at the whole family –Consider the childs needs as part of the familys needs. –Think about their involvement in activities such as church, sports, and participation in other community events. Be creative –Help the family find ways to incorporate therapies into their typical family routines. Be Flexible –Respect the familys priorities in setting goals for their child, as well as in planning services and schedules. Delivering Family Centered Services contd

©CENTe-R 2005 Visual Communication Approaches Total Communication –Combined Approaches American Sign Language (ASL) –Bilingual/Bicultural Signing –Simultaneous Communication –CASE (Conceptually Accurate Signed English)

©CENTe-R 2005 Auditory-Oral Approaches Auditory-VerbalAuditory-Oral Cued Speech AcoupedicsAural-Oral UnisensoryOral

©CENTe-R 2005 Auditory & Language Milestones Newborn 2-3 months 4-6 months 6-12 months months Cries, startles to loud sound Laughs, forms sounds in back of mouth (goo) Turns head towards sound, makes non-speech sounds- raspberries, squealing Babbles, gestures to communicate, knows his or her name Strings sounds together, says first word First words and 2 word utterances

©CENTe-R 2005 Roles of the Family in Facilitating Language Development Work with professionals with expertise in deafness and early childhood professionals to insure childs success. Incorporate language development strategies at home.

©CENTe-R 2005 Strategies for Families Incorporate language into the daily routine. Make sure the child doesnt get left out of family conversations. Inform teachers of strategies that work at home. Use strategies at home suggested by the teachers.

©CENTe-R 2005 Roles of the Early Childhood Teacher/Caregiver Collaborate with deaf education professionals to accomplish childs IFSP/IEP goals. Partner with families to help them incorporate strategies at home. Create a language rich, natural environment.

©CENTe-R 2005 Strategies for Everyone Follow the lead of the infant –respond to and extend engagement in interesting toys/objects Speak in parentese –draw the infants attention to the rhyme and rhythm of language Pause within interactions –allow time for the infant to process information and respond Use brief sentences –reference or point to objects in the childs visual field

©CENTe-R 2005 Use a variety of language features. –Intonation –Pitch –Rhythm –Volume –Pausing Allow wait time for child to listen/watch, process, and respond. More Strategies

©CENTe-R 2005 Repeating & Repeating Plus Repeating what the child says –Child says: Juice all gone. –Adult says: Juice all gone. Repeating and Adding to what the child has said –Child says: Hot out there. –Adult says: Its hot in here too.

©CENTe-R 2005 Expanding and Describing Adding to what the child has said –Child says: Snowing outside. –Adult says: Yes, its snowing all over. Describing what you are seeing, hearing, doing as you do it - Self Talk –While washing dishes, adult says: Wash the dish and now we rinse the dish.

©CENTe-R 2005 Parallel Communicating Talking or signing about what the child is doing (or maybe thinking or feeling) - Parallel Talk –Child is bouncing a ball; –Adult says: Youre bouncing the ball. or Jose is bouncing the ball. The ball is bouncing up and down. –Use you or say the childs name.

©CENTe-R 2005 Labeling & Answering Labeling - Use labeling or explaining phrases or statements –Adult says: Thats a big blue beach ball. or That dog is a poodle. Answering the childs question –Child says: Gampas? –Adult says: Yes, we are going to Gampas now.

©CENTe-R 2005 Expansions & Extensions Expansion - Repeating childs utterance the way an adult would have said it –Child says: Doggy run –Adult says: Yes, the doggy is running. Extension - Expanding the childs response to an adult sentence, then adding an additional related comment. –Child says: Car go –Adult says: The car is going. Its a red car.

©CENTe-R 2005 Education and Care: Two Sides of the Same Coin (Rebecca Parlakian, 2004) Caregiver provision of continual and frequent language input and expression….. –encourages child initiation of communication and engagement –sets the stage for literacy development Infant/Toddler early literacy behaviors emerge…. –carrying books, turning pages, chewing on them –pointing to pictures –bringing a book to an adult to read –Imitating and vocalizing with an adult who is reading

©CENTe-R 2005 Discussion Question from Early Relationships module You have been working with a single father who takes his child for auditory oral services but he has been absent for 3 weeks. You call to check on them and find the fathers work demands have escalated and he is no longer able to bring his son for appointments. He understands the importance and yet is unable to follow through. –How do you respond to this father? –What are your goals as the interventionist in addressing this issue?

©CENTe-R 2005 Discussion Example You are working with a family that has a newly identified infant with hearing loss. The infant is 5 months old and the family is finally adjusting to a new baby being in the house but the hearing loss diagnosis continues to be overwhelming for the parents. –How will you approach the family? –Do you immediately proceed to schedule visits in various community settings representative of communication options?

©CENTe-R 2005 Video Clip Study Questions Discovering Sound Describe the role early interventionists take during their home visit. Identify methods the mother is using to increase the daughters communication.

©CENTe-R 2005 Strategies Demonstrated Adults in the videos provide excellent examples of ways to support the language development of infants and toddlers including: –Eye contact –Facial expression –Pointing to objects –Getting on childs level –Restating words or phrases –Narrating what is happening –Attending to the childs communication –Giving auditory input and waiting for response

©CENTe-R 2005 WEBSITES Alexander Graham Bell Association for the Deaf and Hard of Hearing Auditory-Verbal International, Inc. verbal.org National Cued Speech Association Oral Deaf Education LeClerc/Gallaudet University edu American Society for Deaf Children Deafness Research Foundation Beginnings for Parents of Children Who are Deaf or Hard of Hearing National Institute on Deafness and Other Communication Disorders National Dissemination Center for Children with Disabilities Raising Deaf Kids My Babys Hearing CENTe-R

©CENTe-R 2005 Hands and Voices Hands & Voices is a non-profit, parent-driven national organization dedicated to supporting families of children who are deaf or hard of hearing.. The organization consists of parents of ASL signers, cued speech users.... parents of children with cochlear implants or total communicators... And professionals who work with these families.

©CENTe-R 2005 Beginnings This non-profit organization was established to provide emotional support and access to information as a central resource for families with deaf or hard of hearing children, as well as for deaf parents who have hearing children. BEGINNINGS is also committed to providing technical assistance to professionals… For Parents of Children Who Are Deaf or Hard of Hearing

©CENTe-R 2005 My Babys Hearing This organization provides information for new parents related to newborn hearing screening, hearing and amplification, early intervention and language development, and valuable parent-to- parent types of support. Sponsored by Boys Town National Research Hospital and NIDCD (National Institute on Deafness and Other Communication Disorders)

©CENTe-R 2005 The CENTe-Rs mission is to inform and support graduate-level professionals serving families with infants and toddlers who are deaf/hard of hearing through web-based training modules.

©CENTe-R 2005 Explore Modules Content designed as Reusable Learning Objects (RLOs)* to scaffold information CENTe-R Online ModulesOnline Modules *=Cisco Systems

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