July 5, 2011 Audiology

Parent Engagement in Audiologic Habilitation

Increasing Positive Outcomes for Children With Hearing Loss

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Recent advances in universal newborn hearing screening, early diagnosis and intervention, and hearing technology have led to improved communication and academic outcomes for young children who are deaf or hard of hearing. For more than a decade, studies have demonstrated that diagnosis and intervention delivered early—before the child is 6 months old—often lead to age-appropriate communication outcomes by the time the child enters kindergarten or first grade (Yoshinaga-Itano et al., 1998; Calderon & Naidu, 2000; Moeller, 2000). More importantly, when children with hearing loss enter first grade with age-appropriate language abilities, they are more likely to be enrolled in mainstream educational environments and achieve higher rates of literacy.

Beyond Early Identification and Technology           

Although early identification of hearing loss and use of hearing technology are critical first steps, obtaining auditory access does not automatically result in improved language abilities, especially spoken language. There is growing evidence that early intervention services that facilitate parent engagement in the child's habilitation often result in improved language acquisition (DesJardin & Eisenberg, 2007; Moeller, 2000; Zaidman-Zait & Young, 2007). The important role of parents and caregivers—and by extension, families—in the habilitation of children with hearing loss cannot be overemphasized, regardless of the degree of hearing loss or the type of technology employed (e.g., hearing aids, cochlear implants, or FM systems).

When parents learn that their infant or toddler has hearing loss, communication may become even more strained. For more than 40 years, concerns have been raised about parents speaking less to their child after a hearing loss is diagnosed (Gross, 1970). Furthermore, as Easterbrooks and Estes (2007) point out, parents may feel distanced from their infant with hearing loss when he or she is noncommunicative and may become frustrated with the intervention or habilitation process.

Conversely, when parents actively participate in the child's habilitation, they assume the natural role of the child's first and primary language models. Learning strategies that facilitate language and communication allows parents to integrate goals for language expansion during regular routines throughout the day or when the family is together. With this level of support, feelings of frustration can be replaced by observable progress in the child's communication development. For parents to achieve this level of engagement, however, early interventionists and other service providers must have the knowledge and skills to encourage, facilitate, and include parents in the child's habilitation.

Fleming, Sawyer, and Campbell (2011, p. 234) describe a model of parent participation as "providers directly teach[ing] caregivers how to embed learning strategies within a family's naturally occurring activities and routines by maximizing already existing learning opportunities or creating individualized learning opportunities, including using adaptations and assistive technology. In participation-based services, the provider takes on a role of caregiver educator by teaching and supporting the caregiver to interact with the child using strategies to promote learning."

Reluctance to Engage Parents 

Despite research that supports parents' engagement and participation in providing intervention to their child, few professionals actually structure their habilitation with the goal of involving the parents or other family members. Several studies demonstrate that early interventionists continue to spend a majority of their time delivering traditional child-centered services and focus less on parents' involvement or participation in the activities (Campbell & Sawyer, 2007; Peterson et al., 2007). Fleming, Sawyer, and Campbell (2007) review several "internal" barriers related to providers that may prevent greater parent participation: limited confidence or experience working with families, lack of formal training, and varying beliefs about the importance of caregiver involvement.

Engaging Parents to Foster Success 

Audiologists and speech-language pathologists providing audiologic habilitation services to young children with hearing loss and their families should embrace parent participation as a key element of intervention. Practitioners may have less experience with this model of intervention/habilitation, but failure to recognize the crucial role of parents could affect the child's potential for communication success. Child-centered approaches, which support only passive involvement by the parents, are no longer considered adequate. To increase the communicative success of the child, parents must become the primary consumers of the intervention and habilitation. After parents are given opportunities to participate in habilitation activities, they should practice the language-facilitating strategies with their child under the observation and guidance of audiologists and SLPs.

Advances in newborn hearing screening, early fitting of hearing technology, and enrollment in intervention and/or habilitation services have created significant opportunities for communication success for children with hearing loss. Parents know their children better than anyone else, but may not have the knowledge and experience to be strong language facilitators without encouragement and training from qualified providers. Audiologists and SLPs should be the qualified providers to whom parents look for support, and we need to be prepared to provide that essential aspect of their children's intervention and habilitation.  

K. Todd Houston, PhD, CCC-SLP, is an assistant professor at Utah State University. His interests include listening and spoken language acquisition in children with hearing loss. Contact him at todd.houston@usu.edu.

Tamala S. Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management at Vanderbilt Bill Wilkerson Center, and the coordinator of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. Contact her at tamala.bradham@vanderbilt.edu.

cite as: Houston, K. T.  & Bradham, T. S. (2011, July 05). Parent Engagement in Audiologic Habilitation : Increasing Positive Outcomes for Children With Hearing Loss. The ASHA Leader.


Calderon, R. (2000). Parental involvement in deaf children's education programs as a predictor of child's language, early reading, and social-emotional development. Journal of Deaf Studies and Deaf Education, 5(2), 140–155.

Calderon, R., & Naidu, S. (2000). Further support for the benefits of early identification and intervention for children with hearing loss. The Volta Review, 100(5), 3–84.

Campbell, P. H., & Sawyer, L. B. (2007). Supporting learning opportunities in natural settings through participation-based services. Journal of Early Intervention, 29, 287–305.

DesJardin, J. L., & Eisenberg, L. S. (2007). Maternal contributions: Supporting language development in young children with cochlear implants. Ear & Hearing, 28(4), 456–469.

Easterbrooks, S. R. & Estes, E. L. (2007). Helping deaf and hard of hearing students to use spoken language. Thousand Oaks, CA: Corwin.

Fleming, J. L., Sawyer, B. L., & Campbell, P. H. (2011). Early intervention providers' perspectives about implementing participation-based practices. Topics in Early Childhood Special Education, 30(4), 233–244.

Gross, R. (1970). Language used by mothers of deaf children and mothers of hearing children. American Annals of the Deaf, 115, 93–96.

Moeller, M. P. (2000). Early intervention and language development in children who are deaf and hard of hearing. Pediatrics, 106, 1–9.

Peterson, C. A., Luze, G. J., Eshbaugh, E. M., Jeon, H. J., & Kantz, K. R. (2007). Enhancing parent-child interactions through home visiting: Promising practice or unfulfilled promise. Journal of Early Intervention, 29, 119–140.

Yoshinaga-Itano, C. Sedey, A. L., Coulter, B. A., Mehl, A. L. (1998). Language of early- and later-identified children with hearing loss. Pediatrics, 102, 1168–1171.

Zaidman-Zait, A., & Young, R. A. (2007). Parental involvement in the habilitation process following children's cochlear implantation: An action theory perspective. Journal of Deaf Studies and Deaf Education, 13(2), 195–214.


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