Child Aural/Audiologic Habilitation
With infants and children, audiologic (hearing) rehabilitation services are sometimes called “habilitative” rather than “rehabilitative.” The term “rehabilitation” focuses on restoring a skill that is lost. In very young children, a skill such as talking may not be there in the first place, so it has to be taught—hence, the services would be habilitative, not rehabilitative.
Hearing loss can have a major impact on a child’s development, so these services are critical. The services provided will depend on each child’s individual needs and are based on the following factors:
- Age of the child
- Age of onset of the hearing loss
- Age when hearing loss was discovered
- Degree of hearing loss
- Type of hearing loss
- Age of child when hearing aids were first used
The audiologic habilitation plan for children is guided by the type of communication method the family is using with the child. A variety of communication methods are available. The family should select a method based on their needs and the needs of the child. Communication methods include:
Listening and spoken language (also referred to as auditory-verbal or auditory-oral): The infant or young child is fitted with hearing assistive devices. The child is then exposed to the language of the home through listening and talking, leading to spoken language in the home, school, and among peers.
Cued speech or cued language: This method utilizes specific hand shapes and placements around the face to clarify the ambiguity of lipreading.
American Sign Language (ASL): The infant or young child is exposed to language through vision, which leads to signed language in the home, school, and among peers. ASL’s grammatical structure is different from that of spoken English.
Total communication: This method represents the simultaneous use of spoken language and English-based signed language.
Early detection of hearing loss and early use of hearing aids or cochlear implants are critical for the development of speech, language, and communication skills in children with hearing loss. In fact, infants identified with a hearing loss by 6 months of age who received a hearing aid or cochlear implant and habilitation services have been shown years later to have language skills similar to those of children of the same age who have normal hearing.
Habilitation/rehabilitation services for children with hearing loss involve the services of both audiologists and speech-language pathologists. In addition to offering the services described earlier, these professionals may focus on other, more specialized skills when working with children:
Developing language. Adults who gradually lose their hearing over time already understand language and have speech. Infants and young children have not yet learned these skills. In young children with hearing loss, speech and language development can be delayed. Speech-language pathologists work with families to help their children with hearing loss develop language understanding (reception) and language use (expression).
Training in listening. Children with hearing loss need training to learn to listen well while using a hearing aid or hearing assistive device. One of the first things they learn is to be aware of the sound of their parent’s voice and other interesting things in their home environment. Very quickly, they learn that sounds have meaning. Parents can help by naming different sounds for them. For example, “Listen, I hear the dog. He is barking, woof.” As they get older, they will be taught to “discriminate” between different sounds of speech (e.g., “b” sounds different than “th”).
Proper use of hearing aids and hearing assistive devices. Young children and infants will need help with their hearing aids or cochlear implants. For this reason, family members and/or caregivers must be trained in the care and consistent use of this equipment. This training includes proper daily care and adjustments of the device to maximize performance. As children get older, it is important for them to gradually become responsible for caring for their own devices and communication needs.