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Evaluating Communications Options for Your Child

Historically, teachers, doctors and other professionals talked with families about a child’s communications “options.” Today, the word “options” has been replaced with “outcomes” as a reflection of the hearing loss community’s focus on the success of the child.

For children with hearing loss, there are four primary communication outcomes, each tied to an approach to language:

Listening and Spoken Language
Cued Speech/Language
American Sign Language/Bilingual-Bicultural
Total Communication Method

Mastering a communication outcome requires hard work and dedication on the part of the child and family. A child’s brain is ready to learn language at an early age, even though he or she will not be able to understand or communicate back right away. Remember that you are laying the foundation for communication proficiency from day one. It is important to stick with one option for long enough to determine that it is the right one for your child and your family.

Listening and Spoken Language

The Listening and Spoken Language approach to language development teaches infants and young children with hearing loss to listen and talk with the support of hearing technology such as hearing aids, assistive listening devices (such as an FM system) or cochlear implants.

Hearing technology provides auditory stimulation and sets the stage for the development of listening while spoken language therapy teaches the child how to “listen” with the device and to translate what he or she is hearing into spoken language. In nearly every case, a child needs hearing technology that is appropriately fitted and worn 100 percent of his waking hours in addition to listening and spoken language therapy to develop an outcome.

The earlier the infant has access to auditory stimulation, the earlier he or she can take advantage of the benefits of “hearing,” or listening, and learn to talk, thus learning spoken language.

Parents and caregivers receive counseling and support in their role as the child’s most important teacher of language, learning how to stimulate their child’s speech and language production. The goal is for the child to attend his local school and learn in the general (regular) classroom, like other children his or her same age.

Cued Speech/Language

Cued Speech is a visual communication system that is used to demonstrate phonetic information for children who may not be able to learn entirely though amplified hearing.

Designed to enhance lipreading ability, cued speech combines the natural mouth movements of speech with eight hand shapes (cues) that represent different sounds of speech. For example, the hand shapes help the child distinguish sounds that look the same on the lips, such as "p" and "b". In addition to the eight hand shapes, there are four positions around the mouth, each of which represents several vowel sounds. Some children who use Cued Speech also enroll in programs that emphasize listening and spoken language development.

For more information, contact the National Cued Speech Association.

American Sign Language

American Sign Language is a manual communication language taught as a child's primary language, with English taught as a second language. American Sign Language uses hand symbols and gestures combined with facial expressions to communicate language. American Sign Language is recognized as a true language in its own right and does not follow the grammatical structure of English. This method is used extensively within the Deaf community, a group that views itself as having a separate culture and identity from mainstream hearing society.

For information about AG Bell's position on American Sign Language, please read our Position Statement on American Sign Language.

For more information, contact the National Association of the Deaf or the American Society for Deaf Children.

Total Communication

Total Communication (TC) is a philosophy that includes various types of sign (i.e., ASL, Signing Exact English/S.E.E., and contact languages such as Pidgin Sign English or PSE), finger spelling, speech reading, speaking, and the use of amplification. Simultaneous communication (also referred to as SimCom or SC, and, more recently, manually-coded English; MCE) is TC in which speaking and signing occur at the same time. SC can include contact language (e.g., Pidgin Sign English; PSE and Conceptually-Accurate Signed English; CASE), grammatical forms of English (i.e., Morphemic Sign or MSS; Signing Exact English, S.E.E.) and ungrammatical ASL and English (e.g., Signed English, Sign Supported Speech, Sign Supported English). For more information see https://digitalcommons.usu.edu/jehdi/vol3/iss2/5/.