Coaching Parents to Use Natural Experiences for Listening, Language and Learning

Today's post is written by Ellie White, M.S., M.Ed., CED and

 Dorie Noll, MSDE, CED, LSLS Cert. AVEd


This article is simple yet full of wisdom regarding coaching parents in meaningful strategies for developing listening and spoken language for their child with hearing loss during natural, regular and common experiences including daily routines.

Great article - Way to go Dorie! 

I met Dorie Noll when we volunteered together in Vietnam with the Global Foundation for Children with Hearing Loss in July of 2014.






Recently, I was fortunate to present at the
10th Annual 2015 EDHI Early Detection of Hearing Loss & Intervention Day
in Chicago on March 20, 2015. 

Just a few days earlier this article was published and I highly recommended 
it as a "Must Read" to all those in attendance.
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This article can be found in the Volta Voices Magazine.
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Keeping It Real

Coaching Parents to Use Natural Experiences

 for Learning


by Ellie White, M.S., M.Ed., CED, and Dorie Noll, MSDE, CED, LSLS Cert. AVEd

Listening and spoken language professionals who deliver services to young children with hearing loss and their families—such as early intervention providers, speech-language pathologists, teachers of the deaf and hard of hearing, and Listening and Spoken Language Specialists (LSLS®)—have limited, precious time each week or month to do so. They are charged with using each visit or session to prepare those caregivers to take on a task that is unfamiliar to most people: teaching listening and spoken language skills throughout the day to a child with hearing loss. These professionals must use the limited time during visits as efficiently as possible to maximize the caregivers’ potential at teaching these skills to their child between visits.

Caregivers are faced with challenges and demands on their time no matter what. Moreover, caregivers who must explicitly teach a child with hearing loss to listen and talk have even more to accomplish in a day. The most efficient and effective approach to coaching caregivers on how to do this is to teach them strategies for improving their child’s listening and spoken language during natural, regular and common experiences, including daily routines. This allows caregivers to accomplish their daily caregiving duties while using those same activities to teach spoken language skills.

Get the Basics: Learn the Family’s Daily Routines


keeping it real baby feedingProfessionals must first help parents identify the language their child needs to learn, based on their specific routines, in order to communicate successfully in their home environment. This begins with the first session, during which the professional and the caregivers talk through the child’s routines. Caregivers identify parts of the day which are successful and other times that are a struggle. Sometimes, difficult parts of the day can be improved by focusing on the language the child needs to successfully participate in that routine. By focusing on the language surrounding daily routines, the child gains valuable skills that will help him/her communicate with his/her family, rather than learning a specified set of vocabulary words associated with a particular toy or game. This allows for more practice, embedded in routines that happen naturally and regularly, and provides the child with functional tools to communicate.

Diapers!

One daily routine that can easily be enhanced with language development strategies is diapering. This repetitive activity performed multiple times per day provides ample opportunity for the practice of meaningful language as well as face-to-face interaction from an ideal distance for listening. Optimally, diapering should occur in a quiet environment with minimal background noise. The caregiver can take a little extra time to narrate what she/he is doing as she/he does it.

“It’s time to change your diaper. Let’s walk over there to the changing table. I’m going to lay you down right here on the changing table. Oh, look at these cute little feet. I’m going to kiss those feet. Let’s unzip your jammies. Down, down, down it goes. Now let’s take this foot out – one kiss for this foot. And then let’s take this foot out – one kiss for this foot. Let’s take off this wet diaper. It’s all wet. I’m going to throw it away. Let’s get the wipes. Pull! I got a wipe. Feel the wipe. It’s cold. Brr, the wipes are cold! Okay, let’s clean you up. There we go. Now we need a new, clean diaper. Bottoms up! Time to put your feet back in your jammies. One foot. Two feet. Zip, zip, zip. Zip your jammies. Now you have a nice clean diaper and we’re all done! How about a hug?”

Diapering also provides lots of opportunities to talk about body parts, items of clothing, or to play peek-a-boo or a tickle game. The caregiver can hang a small mirror on the wall next to the changing table and incorporate a few moments of mirror play. This simple activity can be enhanced to create a warm, language-rich interaction between caregiver and child, rather than a chore that must be rushed through many times a day.

Feeding

Feeding is another repetitive routine that can easily be enhanced to incorporate listening and spoken language strategies with an infant. As with diapering, the professional can encourage caregivers to feed their baby in a quiet environment, with minimal background noise. Cradling the baby in the arms creates an optimal distance for listening and meaningful interaction, whether breastfeeding or bottle feeding. By taking the time to interact warmly with their baby, caregivers are helping to create a secure attachment as well as a motivating time for listening.

“Oh, sweet baby, you are really crying! Are you hungry? I hear you! Here it is. Here’s your bottle! Mmm, there you go. It’s yummy! That’s better. Now your belly feels much better!”

During feedings, the caregiver can sing songs, talk about body parts, or just speak softly and warmly about the day. Using a standard cradle hold to feed a baby is very natural, but can be tricky for a baby with hearing aids because of potential feedback. By simply altering the baby’s position from a standard cradle hold to a football hold, the caregiver decreases the potential for feedback and can be confident the baby is prepared for a wonderful listening opportunity.

Out and About

Busy caregivers can even incorporate strategies while running errands to create meaningful listening and language experiences for their infants or toddlers. Putting the infant carrier or the toddler in the grocery cart, for example, is a good face-to-face interaction that can help minimize the distractions of a noisy environment at the grocery store. Professionals should encourage the caregiver to use self-talk as he/she chooses which apples to buy (“I wonder which apples I should get. I like the green apples, but the red apples are on sale. I think I’ll get the red apples today.”), or narration as they walk down the aisles and look for all of the items on their grocery list (“OK, we have the milk, the bread and the eggs. Next, we need to get cheese. Where is the cheese? Oh, here it is.”). These opportunities add to the baby’s listening and language exposure while allowing caregivers to accomplish the tasks of a busy day.

Playtime

keeping it real baby with blocksPlaytime is an important routine in which caregivers can enhance listening and language. For an infant, this may mean simply holding the baby face-to-face, without obscuring the hearing technology, and singing or talking to him/her. Caregivers can get down on the floor next to the baby and talk to him/her about the toys he/she is batting or activate a musical toy while cuing the infant to listen. Reading books is a valuable experience for every child, and caregivers can learn the value of reading books, using a rhythm while reading aloud and just talking about the pictures.

Infants and babies benefit from time spent every day interacting directly with their caregivers during play. Caregivers can use parallel talk to provide the valuable language of play. For example, “I see you are building a tower. I see a blue block, a red block and a yellow block. Up, up, up, dowwwwn! Uh oh! You knocked them down!” Caregivers can use language to help the child initiate play (“Let’s ask Daddy. Daddy, do you want to play?”), ask for help (“Oh no! You can’t get the lid off of the box. Do you need help? You can say, ‘help me.’”), and appropriately negotiate play (“Oh, do you want a turn? You can say, ‘my turn.’”).

Snack Time

Another way to enhance familiar routines is to teach the caregiver to make a snack together with the child. Caregivers may not realize how much language can be incorporated into this routine by simply extending it. Rather than giving the child the snack completely prepared, for example, the caregiver can cut up fruit with the child, for example, and use repetitive language such as “cut,” “take a bite,” “mmm, yummy” and “more.” If the child is eating crackers, the caregiver can prompt the child to ask for them, and then only give him/her a few at a time, so he/she has lots of opportunities to ask for “more crackers.”

Additionally, the professional can coach the caregiver to create a meaningful listening experience by listening for the microwave to beep indicating that the oatmeal is ready, and then encourage talking by expecting his/her child to verbally request “more” when he/she wants another bite. These simple extensions can turn snack and meal times into meaningful listening and language experiences, during which the practitioner can coach the caregiver to incorporate strategies such as wait time, withholding, narrating and sabotage. Meal time is usually very appealing for a young child, so caregivers can capitalize on that natural interest to create a motivating reason for communicating. Caregivers can be coached to incorporate sabotage by pretending to pour juice without taking the lid off so the child has to request that the lid be removed, withholding by only giving the child two or three crackers at a time so he/she has to repeatedly request more, narrating by describing the food preparation or talking about what the child is eating, and wait time by asking the child a question and waiting patiently and expectantly for a response.

Household Chores

Caregivers can also be coached to use simple household chores to provide fun, meaningful language opportunities. By taking a little extra time to complete these chores, the caregiver can enrich the language associated with the chores in addition to taking advantage of a toddler’s natural desire to “help.”

For example, a caregiver can provide a toddler with a damp paper towel to wipe down the table or a dry one to help with dusting; or fill a squirt bottle with water and teach the child to “squeeze” and “wipe” the windows. The child can help the caregiver match socks, roll them into a ball, and throw them into the laundry basket, working on color words and sorting, sequencing (first, then), as well as simple vocabulary like “sock” and “throw.” Sorting laundry can become an auditory exercise as simple as “hand me the pants” or as complex as listening for two critical elements: “Give me the red shirt.” Caregivers can turn washing dishes into an engaging sensory experience, during which one can build vocabulary by naming items, work on counting and color words, and practice adjectives such as “hot,” “cold,” “wet” or “dry.”

Using Daily Routines

The most natural experiences a child has each day are based on the family’s daily routines. Daily routines are the single most important resource for activities to encourage listening and language development. After all, young children should be able to talk about the activities of their daily lives. Busy caregivers might go through these routines, such as eating breakfast or getting dressed, with the intention of accomplishing the task at hand quickly and efficiently rather than teaching the language.

Professionals can point out that these daily routines are big opportunities for language development with the child. During sessions, professionals can promote listening and language of daily routines by coaching caregivers through the activities. The practitioner can demonstrate how to talk about what the child is experiencing, label objects and incorporate songs while performing the task of the activity. Caregivers can practice enriching the language of these routines, while encouraging the child to listen, imitate and respond. Everyday routines provide ample opportunities for meaningful repetition and this repetition reinforces the language of daily activities often and naturally. Additionally, these daily activities are familiar to caregivers, so they feel more comfortable talking about what they are doing than they might with less familiar activities.

Avoiding the Toy Bag

Many professionals plan various craft activities and games to motivate young children to improve their language during home visits. However, the language of crafts or games that are only played during sessions is less useful for the caregiver and child on a regular basis, and therefore less “bang for the buck.” Materials brought in to be used in the session but not left with the caregivers only allow for infrequent and potentially less useful language practice. Caregivers may learn from their listening and spoken language professional strategies for using certain games and toys for language development, yet may not be able to generalize those strategies with their own toys or during routine activities. If the professional brings toys for visits and then leaves them for parents to use between visits, this allows for more practice time. Yet, this means caregivers must set aside additional time during their already busy day to play with these specific toys that they might not otherwise do. They may also feel less comfortable with the strategies or language associated with toys or games that don’t belong to them. It makes sense for children to understand and use the language of their daily routines and activities because that will be most meaningful to them. Helping caregivers enrich this language is the most efficient use of the professional’s limited time and resources.

Ultimately, practitioners work with parents through active and timely coaching to teach them how to use natural, everyday activities and proven techniques to prepare their infant with hearing loss to become a 3- to 4-year-old chatterbox whose daily life is filled with singing, reading, conversation and games with peers regardless of hearing ability in a variety of acoustic environments, so that children with hearing loss are ready for a mainstream school environment, self-advocacy and wholehearted participation in their community of choice. 
Ellie White, M.S., M.Ed., CED, is a teacher of the deaf at Central Institute for the Deaf in the pre-kindergarten/kindergarten department as well as a curriculum facilitator. She also serves as practicum coordinator and lecturer at Washington University’s School of Medicine Program in Audiology and Communication Sciences. White holds teaching certification in the state of Missouri in the areas of Deaf and Hearing Impaired and Early Childhood Education, as well as Missouri state principal certification. She holds professional certification from the Council on Education of the Deaf. White has published a number of articles and assessment tools related to instructing children who are deaf and hard of hearing. She can be reached at ewhite@cid.edu.

Dorie Noll, MSDE, CED, LSLS Cert. AVEd, is a parent educator in the Central Institute for the Deaf (CID) Joanne Parrish Knight Family Center. She also serves as lecturer at Washington University’s School of Medicine Program in Audiology and Communication Sciences. She has served as teacher in the CID Nursery Class, facilitated the CID Nursery Class program and provided early intervention services to families in the home. She holds teaching certification in the state of Missouri in Deaf and Hearing Impaired and is credentialed with the early intervention programs in both Missouri and Illinois. Noll is also a certified parent educator with the Parents as Teachers program in Missouri and holds professional certification from the Council on Education of the Deaf. Noll is the mother of a smart, successful, flourishing, 16-year-old son with profound hearing loss and a cochlear implant. She can be reached at dnoll@cid.edu.

"What is An Auditory Verbal Therapist?" - A Real Conversation Starter!

Today’s blog is written by  Elizabeth Rosenzweig MS CCC-SLP LSLS Cert. AVTwho is a speech language pathologist and a certified auditory verbal therapist in private practice. You can read more of her work at http://auditoryverbaltherapy.net

Elizabeth answers many of the same questions that I am frequently asked about Auditory Verbal Therapy and Hearing Loss. So, rather than reinventing the wheel...

Source

Elizabeth writes, "When you meet someone new, one of the first questions we tend to ask is, “What do you do?”  When I tell people that I teach children with hearing loss to listen and speak, it’s a real conversation starter.  Here are some of my most frequently asked questions about hearing loss, hearing technology, and Auditory Verbal Therapy.  What are yours?

What do you do?
I’m a Listening and Spoken Language Specialist, Certified Auditory Verbal Therapist.  The LSLS Cert. AVT designation means that I’m a speech-language pathologist* who has training above and beyond basic SLP certification specializing in guiding and coaching parents and caregivers to teach children with hearing loss to listen and speak without the use of sign language.  Here is more information about the Principles of Auditory Verbal Therapy.
*Members of other speech and hearing science-related professions (audiologists, teachers of the deaf) can also apply for LSLS certification.  I just happen to be an SLP by training.

So… you teach lipreading?
No, I don’t teach lipreading.  Here’s why.

So… you use sign language?
No.  The families I serve have chosen listening and spoken language for their children’s communication mode.  In fact, more than 85% of parents of children with hearing loss choose for their children to learn to listen and talk (Brown, 2006).  Oral communication gives their children access to the broader world, independence, improved literacy and phonological awareness, and even the ability to learn to communicate orally in more than one spoken language.  Learning to listen means a person with hearing loss — even profound hearing loss — can enjoy music, learn to use the telephone, and understand speech without visual cues.

What causes that [hearing loss]?
There are many different reasons that a person could be deaf or hard of hearing.  Some hearing loss is genetic — it can occur on its own or be part of a larger syndrome that causes other symptoms as well.  (For example, Connexin 26 deafness is caused by a mutation of the GJB2 protein which effects the hair cells of the inner ear but causes no other issues, while Usher Syndrome causes hearing loss but is also associated with vision loss).  Other hearing loss is the result of illness, injury, or age (age-related hearing loss is called presbycusis and is a natural part of the aging process).  There are genetic tests available to determine the cause of hearing loss, but remember that even if the genetic testing does not determine a cause for your/your child’s hearing loss, that does not necessarily mean it is not genetic in nature, just that we have not yet identified that particular genetic variant.  While we are often able to identify the cause of hearing loss, there are times that the cause is idiopathic (basically, medical speak for “we don’t know”).

But how do you teach a deaf person to listen if they can’t hear?
Access to hearing is crucial for learning to listen and speak naturally.  We [people with typical hearing] learned to talk because we spent our first months of life (even in utero, starting 20 weeks before we were born!) listening to the sounds of language around us.  Helping children with hearing loss gain access to sound is the first critical component of our task if we want to help them learn to talk as well.  This is why it is so, so important for people with hearing loss to be fitted immediately with the appropriate technology (hearing aids, Baha, or cochlear implant, depending on their level and type of hearing loss).  Unlike glasses, though, you don’t just put the hearing device on and your hearing issue is suddenly corrected.  It takes time and therapy to train the brain to listen.  It’s all about the brain.  

How old are the children you work with?
Thanks to newborn hearing screening, the majority of the children on my caseload were identified with hearing loss at birth.  Because I serve families from around the world, though, where newborn hearing screening may not be possible, I do have some children whose parents only discovered their hearing loss as toddlers when they were not meeting the expected speech, language, and listening milestones.  Other children on my caseload were born with hearing but lost it as a result of illness or injury.  I also work with teens and adults — either those who have had hearing loss their whole lives or those who lost their hearing after learning language and are looking to get back up to speed with new hearing technology (a hearing aid, Baha, or cochlear implant).

They’re identified at birth?  How can you tell that a baby can’t hear?
Newborn hearing screening is done one of two ways, either ABR (Auditory Brainstem Response) or OAE (OtoAcoustic Emissions) testing.  Both of these tests measure physiological responses to sound stimuli that do not require the baby to do anything to respond.  By measuring the brain’s response to sound (ABR) or the natural sounds emitted by a typically functioning ear (OAE — and yes, your ear is emitting sounds, even if you can’t hear them!), we can determine whether or not an infant (or any other unresponsive patient) is in need of further hearing testing.

But how do you do therapy with a child that young?
Early intervention is the key to success for children with hearing loss.  Here’s why.  The bulk of my work focuses on guiding and coaching the parents, supercharging their interactions with their child to help them facilitate the growth of language and listening skills from the very start.  If the child sleeps through the entire session, the parents and I are still learning together.  I just love working with infants and young children and their parents, helping them to build the foundation for a lifetime and language and listening success!

How do you work with clients around the world?
I use videoconference technology to provide teletherapy services to clients from all over the globe.  It’s like Skype or FaceTime, but more advanced to be compliant with HIPPA and other patient-privacy laws.  Curious about what atypical teletherapy session looks like or the benefits of teletherapy?  Check out my Teletherapy FAQs!

How do you do therapy without being physically present?
Many people think that “speech therapy” involves hands-on treatment (put your lips here, but your tongue here, etc.).  Auditory Verbal Therapy focuses on learning to listen and talk using a developmental, not remedial, approach.  My job is to coach the parents in how to infuse everyday activities and interactions with opportunities for listening, language, speech, and cognitive growth.  Not being present for teletherapy can actually be an advantage over in-person treatment because I can’t jump in.  I have to empower the parents to be their children’s first and best teachers, and that is key!  One hour of therapy a week is not enough.  For children to truly succeed, parents need to have the skills and confidence to implement AV techniques throughout the week.

How long does this therapy take?
There are many factors that affect a person’s outcome with a cochlear implant.  Let’s take a child who is identified early, fitted with appropriate technology, and has access to a Listening and Spoken Language Specialist and strong family support and commitment to the AV lifestyle.  For the children like this on my caseload, they usually don’t need me by the time they are 3-5 years old.  Basically, if everything goes well, they’re reading to mainstream from day one of preschool or kindergarten, with age-appropriate skills and minimal support.  For other children, perhaps those identified later or who have additional disabilities, progress may be slower and the timeline extended.  For teens and adults, therapy usually is shorter-term in nature, focused on building specific skills or re-learning how to hear with a new device.
Success is not an accident.  It takes lots of hard work, but incredible results are achievable.

What’s the difference between a cochlear implant and a hearing aid?
Here’s my simple explanation on hearing loss and hearing technology:
Sensorineural hearing loss (sometimes called “nerve deafness”) occurs when the cilia (hair cells) of the inner ear (the cochlea) do not function properly.  In an undamaged ear, the pressure from sound waves goes into your pinna (the outer ear, the part you can see), makes the eardrum move back and forth, is passed along the small bones of the middle ear (the smallest bones in your body!), and then transfers to the middle ear, where those sound waves cause actual waves in the fluid-filled cochlea.  The waves of fluid cause the hair cells to move.  This sets off a beautiful chemical chain reaction, which ultimately causes stimulation of the auditory nerve (cranial nerve VIII), which sends the sensation of “sound” to the brain.  The hair cells in the cochlea are tonotopically arranged, meaning that each region corresponds to different tones, going from high frequency sounds at the basal end to low frequency sounds at the apex of the cochlea, which looks like a snail shell.  Think of a piano keyboard that has been rolled into a spiral, except that the keys go from high to low, unlike a regular piano.
A hearing aid simply pushes more (louder) sound into this system.  If the sound is louder, it makes bigger waves in the cochlear fluid and stimulates those hair cells to say, “I heard that!”  It’s pushing more sound through the damaged system.  For some peoples’ degree of hearing loss, a hearing aid is enough to provide access to the full spectrum of speech sounds.
A cochlear implant replaces the damaged system altogether, and works for patients when a hearing aid is not enough to give adequate access to sound.  A cochlear implant consists of an internal electrode array (like a wire with various electrodes, points of contact, that is threaded through the cochlea to take the place of the damaged hair cells), and an external processor.  Sound goes into the CI microphone, then the processor (think of it as the “brain” of the CI) says, “Okay, to replicate this natural sound coming in with our electrical system, we need to stimulate electrodes #1, #5, and #12 in this order, in this pattern, at this rate.”  That message travels up the wire to the magnet/headpiece/coil on the outside of the CI users’s head, and FM waves transmit that information to the internal implant.  The proper electrodes of the internal array in the cochlea) are fired, and this message stimulates the auditory nerve, and the brain hears.
This is all a very simplified explanation of an exquisite process, but I think it gives enough information for a layperson to have a good working knowledge of the system — not too simple (so it seems like magic), not too complex (so it seems like mystery).

Can everyone benefit from a cochlear implant?
For some people with hearing loss, a hearing aid is enough to give them access to sound needed for brain development and the development of speech, language, and listening skills.  When a hearing aid is not providing enough access, it’s time to consider a cochlear implant.  In almost all cases of sensorineural deafness that is severe-profound (and we’re even creeping up to moderate loss in the case of borderline candidates), the patient can benefit from a cochlear implant.  Cases where a person who has sensorineural hearing loss severe enough to need a CI but cannot have one would include: lack of a cochlea (a very rare anatomical anomaly), lack of an auditory nerve (also very rare, in which case the person would be more of a candidate for an ABI, Auditory Brainstem Implant), ossified cochlea (for example, someone who had had meningitis years ago, and the cochlea has ossified [basically, "turned to bone"] to the extent that an electrode array cannot be put in), or other health conditions that preclude surgery.
There are also people who have conductive, not sensorineural hearing loss.  Here, the issue is not with the hair cells of the cochlea but with the outer or middle ear.  The cochlea works, we just can’t get the sound in.  These people benefit from bone conduction devices, like the Baha (or, in some cases, a traditional hearing aid).
HERE is more information on the cochlear implant process.

How much does that cost?
There is no set “off the shelf” price for a cochlear implant.  The cost varies based on a number of factors: the insurance system (does the patient have private insurance or do they live in a country with nationalized healthcare?), the surgeon and hospital fees, etc.  Most nationalized healthcare systems do include cochlear implants in their coverage.  In the United States, cochlear implants are covered by most private insurers as well as Medicare and Medicaid.  Unfortunately, coverage for hearing aids seems to lag behind, and though some families are able to receive hearing aids through early intervention or
See these articles for information on how to successfully argue for cochlear implant surgery or processor upgrades.  You can also find more information on sources of funding for hearing technology and sources of funding for auditory verbal therapy.

Is it as good as real hearing?  What does it sound like to them?
Asking what a cochlear implant sounds like to a person with hearing loss is like asking, “What does red look like to you?”  We are all limited by our own perceptions, and any simulation that we hear is just that: a simulation, based on our best knowledge of how the device’s algorithm processes sound, and then re-filtered through our own ears and brain as the listener.  This is not to say, however, that hearing loss simulations are inaccurate (learn more about why this is so, and how to understand hearing loss research, HERE).  We hear as well as we speak, and the fact that cochlear implant users are able to achieve very natural-sounding speech shows the remarkable capability of the brain to take electronic sounds and make them into clear, usable hearing.  For more on how hearing loss sounds, see this article.
Audiological results show that it is very possible for a person with hearing loss (who is appropriately amplified and has received good listening and spoken language instruction), to have hearing thresholds from 15-20dB across the board to 6000Hz and speech discrimination scores (in quiet and loud speech and speech in noise) in the 90% range.  This is comparable to how someone with unimpaired hearing might score.  Of course, even thousands of dollars of the best hearing equipment available cannot match the priceless gift of natural hearing, but in terms of actual results in practice, people with CIs and HAs can do remarkably well.  Why?  The brain is incredible.  

Does it work?
Again, the outcomes literally speak for themselves.  Decades of research on the outcomes of children with cochlear implants and/or those raised with Auditory Verbal Therapy show that, by and large, these children are learning to listen, talk, and read at levels commensurate with their hearing peers.  They are thriving in the mainstream, attending college, gainfully employed, and living lives that are as “normal” as anyone else.  For a great overview of research on this topic, see this collection from Utah State University.

How do the children do socially?
Social competence is often predicated on language success.  If you have the language and listening skills to keep up with your peers, socialization will be that much easier.  All children go through bumps in their development, butresearch shows us that children with cochlear implants generally report levels of self-esteem comparable to their hearing peers. 

How well do they hear music?
When cochlear implants were first developed, the external device was called a “speech processor,” not a “sound processor” like they are sometimes called today.  Why?  In the beginning, just the thought that a profoundly deaf person would be able to hear speech seemed too fantastic for words.  If that could be achieved, any access to additional sounds would just be icing on the cake.  Speech — and the communicative independence that came with it — was the goal.  Now, cochlear implant users can hear speech, music, and more!  Though cochlear implant users’ enjoyment of music varies (as does typically hearing peoples’, I might add), research shows us that cochlear implant users do have the capability to hear the difference between a wide range of pitches, and that practice and exposure can significantly increase CI users’ music enjoyment.  People with hearing loss who have good amplification and a strong AV foundation can even learn to play an instrument, participate in a choir, or take dance lessons.  HERE is more information on the latest research on CI/HA users and music.

How well do they hear in noise?
Hearing in noise can be tricky for anyone, but even more so for a person with hearing loss.  Our brains are trained to pick up the important signal (the person talking to us) and filter out the rest (the background noise), while still being attentive to certain sounds in the environment (a siren, an oncoming car, or someone calling our name from across the room).  It’s pretty impressive!  If a person with hearing loss has not had that auditory experience (and remember, this experience starts before you even take your first breath), it’s tough!  Auditory training, combined with the ability to today’s hearing technology to use a “computer brain” to identify and filter out background noise, can help a lot.  So can adaptive technology like FM and soundfield systems, and smart communication techniques.

Can people with hearing loss drive a car?  Talk on the phone?  Go to college?  Get married?  Listen to music on an iPod?  Learn a foreign language?  Play sports?

These questions may sound silly, but remember, most people have little to no everyday interaction with people with hearing loss.  The answers to all of these questions?  YES!
Yes, people with hearing loss can drive a car.  Yes, they can talk on the phone.  Yes, they can go to college (check out the Ultimate College Guide for Students with Hearing Loss for more info and tips!).  Yes, they can listen to music on an iPod (often linking it right to their hearing device, or, with even newer technology, streaming via bluetooth!).  Yes, people with hearing loss get married (to partners with and without hearing loss, read some stories HERE).  Yes, people with hearing loss can learn multiple oral languages.  Yes, people with hearing loss can play sports.  So much is possible!"