Strategies to Support
Infants and Toddlers with Hearing Loss
Mary V. Compton, Ed.D.
Judy Niemeyer, Ph. D.
EHDI Conference
March 2005
Atlanta, GA
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.
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Infant Communication
• Create a language rich environment that includes
novel materials and varied toys for interaction
– narrate the infant’s world with expression
• Initiate frequent engaging interaction with infants
– look for meaningful opportunities to initiate or respond
to baby’s interest
• Attract baby’s 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 infant’s visual
field when interacting
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Looking for Opportunities
for Communication?
• Listen for the infant’s/toddler’s
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?
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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
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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 child’s 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
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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
• Reflective of a collaborative team spirit?
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Balanced Information (cont’d)
• Available in multiple formats (multi-media and
print), multiple reading levels, and different
• Inclusive of local and national contacts?
• Reflective of current research and cited
• 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?
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Family-Centered Services
• Respect the Family’s Values, Beliefs,
and Culture
– Especially if they are different from your
own. Find out as much as you can about a
family’s 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.
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Family-Centered Services (cont’d)
• 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
– Invite family advocates to inservice training or
staff meetings to talk about what kinds of
services are helpful and what aren’t.
• Relate to the family as people
– Use a conversational approach rather than a
formal “clinical” approach.
©CENTe-R 2005
Family Centered Services cont’d
• Look at the whole family
– Consider the child’s needs as part of the
family’s 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 family’s priorities in setting goals
for their child, as well as in planning services
and schedules.
©CENTe-R 2005
Visual Communication Approaches
• Total Communication
– Combined Approaches
• American Sign Language (ASL)
– Bilingual/Bicultural
• Signing
– Simultaneous Communication
– CASE (Conceptually Accurate Signed English)
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Auditory-Oral Approaches
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Cued Speech
Auditory & Language
 Newborn
 2-3 months
 4-6 months
 6-12 months
 12-18 months
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• Cries, startles to loud sound
• Laughs, forms sounds in back of
mouth (“goo”)
• Turns head towards sound,
makes non-speech soundsraspberries, squealing
• Babbles, gestures to
communicate, knows his or her
• Strings sounds together, says
first word
• First words and 2 word
Roles of the Family
in Facilitating
Language Development
• Work with professionals with expertise
in deafness and early childhood
professionals to insure child’s success.
• Incorporate language development
strategies at home.
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Strategies for Families
• Incorporate language into the daily
• Make sure the child doesn’t get “left
out” of family conversations.
• Inform teachers of strategies that
work at home.
• Use strategies at home suggested by
the teachers.
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Roles of the Early Childhood
• Collaborate with deaf education
professionals to accomplish child’s
IFSP/IEP goals.
• Partner with families to help them
incorporate strategies at home.
• Create a language rich, natural
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Strategies for Everyone
• Follow the lead of the infant
– respond to and extend engagement in
interesting toys/objects
• Speak in parentese
– draw the infant’s 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 child’s
visual field
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More Strategies
• Use a variety of language features.
– Intonation
– Pitch
– Rhythm
– Volume
– Pausing
• Allow wait time for child to
listen/watch, process, and respond.
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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: “ It’s hot in here too.”
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Expanding and Describing
• Adding to what the child has said
– Child says: “Snowing outside.”
– Adult says: “Yes, it’s 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.”
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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: “You’re bouncing the ball.” or
“Jose is bouncing the ball. The ball is
bouncing up and down.”
– Use “you” or say the child’s name.
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Labeling & Answering
• Labeling - Use labeling or explaining phrases
or statements
– Adult says: “That’s a big blue beach ball.” or “That
dog is a poodle.”
• Answering the child’s question
– Child says: “Gampa’s?”
– Adult says: “Yes, we are going to Gampa’s now.”
©CENTe-R 2005
Expansions & Extensions
• Expansion - Repeating child’s utterance the
way an adult would have said it
– Child says: “Doggy run”
– Adult says: “Yes, the doggy is running.”
• Extension - Expanding the child’s response
to an adult sentence, then adding an
additional related comment.
– Child says: “Car go”
– Adult says: “The car is going. It’s 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
– ‘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
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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 father’s 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?
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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
– How will you approach the family?
– Do you immediately proceed to schedule visits in
various community settings representative of
communication options?
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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 daughter’s communication.
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Strategies Demonstrated
• Adults in the videos provide excellent
examples of ways to support the language
development of infants and toddlers
Eye contact
Facial expression
Pointing to objects
Getting on child’s level
Restating words or phrases
Narrating what is happening
Attending to the child’s communication
Giving auditory input and waiting for response
©CENTe-R 2005
Alexander Graham Bell
Association for the Deaf and
Hard of Hearing
Auditory-Verbal International,
National Cued Speech
Oral Deaf Education
LeClerc/Gallaudet University
American Society for Deaf
©CENTe-R 2005
Deafness Research
Beginnings for Parents of
Children Who are Deaf or
Hard of Hearing
National Institute on Deafness
and Other Communication
National Dissemination
Center for Children with
Raising Deaf Kids
My Baby’s Hearing
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
For Parents of Children Who Are Deaf or Hard of Hearing
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…
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My Baby’s Hearing
Sponsored by
Boys Town National Research Hospital and NIDCD (National
Institute on Deafness and Other Communication Disorders)
This organization provides information for new
parents related to newborn hearing screening,
hearing and amplification, early intervention and
language development, and valuable parent-toparent types of support.
©CENTe-R 2005
The CENTe-R’s 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.
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Explore Modules
Content designed as
Reusable Learning Objects (RLOs)*
to scaffold information
CENTe-R Online Modules
• *=Cisco System’s
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Contact Us!
• 336-256-0524
The University of North Carolina at Greensboro
316 Curry
PO Box 26170
Greensboro, NC 27402
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Strategies to Support Communication Development: …