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Communication Modes
Communication Options For Hearing Impairment and Deafness
The State of Arkansas is an active participant in the Universal Newborn Hearing Screening Program. This program requires that all babies born in Arkansas receive a hearing screening prior to discharge from the hospital. Newborn hearing screenings are also available at ACENTA from our audiologists if your child misses or fails the initial screening in the hospital. This program was developed with the aim of lowering the age of diagnosis so that appropriate intervention can begin as early as possible. Research and clinical experience clearly show that the earlier the intervention, the better the outcome for the child in terms of communication development and overall social, academic and vocational achievement.

If your child is diagnosed with a hearing loss or total deafness, there are several options to consider concerning how your child will communicate and function in society. Our ACENTA Audiologists will counsel you about the type and degree of hearing loss and the various communication options available for you and your child. We will give you a shoulder to lean on and plenty of information about each of the options as you consider the pros and cons of each alternative. We will also encourage you to do additional research on some of the options through pamphlets, videos, websites, etc. We will meet with you after you have had a chance to consider some of your choices in order to answer your questions and provide any additional information that you need. As a parent, you will have the task of deciding which option is best for your child. It is important that you fully consider the pros and cons of each choice and make your own decision, not allowing advocates for any particular position to sway your opinion or compromise your objectivity. It is equally important to keep your focus on the dreams and goals you have for your child and what you feel would best meet your family's needs and aspirations. You will also need to consider practical factors such as how available or accessible each particular option is and how much family support and commitment are available to supplement the process of investing in various options.

Here is a discussion of the most common options that are available. This somewhat brief discussion does not attempt to cover the full range of factors to consider when looking at each communication method. We would be glad to provide additional counseling and information about any of these options and also suggest that you visit the AG Bell webpage at

Auditory-Oral (or Aural/Oral)
This approach emphasizes the use of hearing aids, auditory trainers and/or cochlear implants to capitalize on any available hearing that a child might have. Speech reading (lip-reading) and talking are encouraged, while use of sign language is typically not allowed. Children involved with this rehabilitation approach are often placed in the regular classroom setting (mainstreamed) with the philosophy that these children can succeed academically and socially in a hearing society. This approach is recommended for children with cochlear implants because it emphasizes the hearing abilities provided by the implant. The goal for these children is to be mainstreamed and to live and work in the hearing world. For more information go to

This approach is very similar to the Auditory-Oral approach with the exception that speech reading is not supported in order to facilitate optimal training of listening skills. Learning auditory skills on a one-on-one teaching basis is stressed. These children are also typically mainstreamed, with the goal of functioning in a hearing world. The auditory-verbal approach can be successful with even profoundly deaf children who are getting minimal auditory information through their hearing aids. This approach is recommended for children with cochlear implants because a cochlear implant emphasizes the hearing abilities provided by the implant. The goal for these children is to be mainstreamed and to live and work in the hearing world. For more information go to

American Sign Language (ASL)
This approach is recognized as a true language much like Spanish or English and involves signs and gestures made with the hands. These symbols with the hands do not follow the grammatical structure of the English language. This method is usually introduced as the child's primary language with English as a second language. This method capitalizes on the most easily used communication channel for the deaf child, the visual sense, and is widely used by members of the Deaf Community. The predominant Deaf Culture viewpoint is that deafness is not a disability, but rather just a physical or personal trait just like having blue eyes or blonde hair. Persons in the deaf community view themselves as having a separate identity and culture from "mainstream society." Traditionally, supporters of Deaf Culture have been strongly against the use of hearing aids and cochlear implants, because, as mentioned above, deafness is not seen as a handicap or disability but rather a way of life and therefore there is no reason to improve or correct the deafness. This culture seems to be undergoing some changes, however, as small but increasing numbers of its members are getting or considering cochlear implants. Some individuals wish to be a part of both the hearing culture and the deaf community, and are comfortable using hearing aids or cochlear implants as well as American Sign Language. Hearing parents of deaf children who are considering this communication method should be aware that because English is the second, less-used language, the skills of reading and writing typically tend to be underdeveloped. This may affect educational and vocational choices. Typically with this approach children attend a school for the deaf and their signing skills will far surpass those of their parents. Hearing parents who are not immersed in the deaf culture as their primary culture will fall far behind their ASL-using children. In time this can lead to a communication gap between parent and child as the child identifies more and more with the deaf community.

Signed English
This form of sign language, often referred to as Signing Exact English (SEE), is often used in educational settings. It follows exact English grammar and English sentence structure. This means that each word is signed in the exact same order as spoken words.

Finger Spelling
This is not typically an approach by itself, but acts as a supplement to the use of spoken English by providing a manual sign for each letter of the alphabet.

Cued Speech
This visual method is used as a supplement to speech reading and involves the use of eight hand shapes and four hand positions near the mouth while speaking to represent different speech sounds. This helps with the identification of sounds that are not easily seen on the lips or sounds that appear identical when lip-reading, such as "k" and "g" or "p" and "b." Although the hand shapes are manual, this method is an oral approach and is dependent upon speech reading spoken language. Cued speech may be used in addition to other communication approaches. The availability of this method varies in different regions of the country. For more information go to

Total Communication
This approach incorporates multiple communication methods to ensure that the child is receiving maximum access to learn language or communicate in any given situation. Amplification, assistive listening devices and cochlear implants are used in conjunction with Signed English, finger spelling, talking, ASL and sometimes cued speech. Because visually-based communication methods, such as ASL, are typically easier to learn for deaf children, use of this approach tends to de-emphasize the learning of listening and speaking skills. Parents should be aware that manual signing generally takes precedence over less easily learned skills in spite of educators' best efforts to provide balanced learning using all of the above communication methods. If parents hope to mainstream their children and equip them to function independently in the hearing world, this approach may not be the best option. This approach is not recommended for children who receive a cochlear implant at a young age because it will not fully stimulate and maximize the hearing abilities that the implant provides.

Note: Some of this material is taken from the informative booklet titled "So Your Child Has a Hearing Loss: Next Steps for Parents" by Alexander Graham Bell Association for the Deaf and Hard of Hearing (AGBell).

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