ehdi 2016 san diego,ca · communication options: a discussion with amy peters lalios, ma,ccc-a,...
TRANSCRIPT
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Communication
Options:
A Discussion with
ParentsAmy Peters Lalios, MA,CCC-A, LSLS Cert. AVTDirector, Therapy Services
EHDI 2016
San Diego,CA
Christine Kometer, M.Ed, LSLS Cert. AVEdDirector, Education Services
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Options are not necessarily common
knowledge!
� “Families should be made aware of all communication options and available hearing technologies in an unbiased manner.”
� “Information…..communicated in culturally sensitive and understandable format.”
� “Informed family choice and desired outcome should guide the decision making process.”
American Academy of Pediatrics’
Joint Committee on Infant Hearing (2007)
Many parents do not get information about options from their audiologist and medical team
Matthews, et al., 2009;Berg et. al., 200)
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Why Discuss?
� Family decision
Parents in control –
92% report they are happy with their decision
Professionals in control-
7.7% report they are happy with the decision
*61.5% report they “Don’t know”
~Lisa Crawford, Texas H&V (EHDI 2009)
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Shared priority:All families deserve unbiased, complete information about communication/ language / education options
� Alexander Graham Bell
� American Society for Deaf
Children
� Gallaudet University/ Clerc
Center
� Hand & Voices
� Joint Commission on Infant
Hearing
� National Association of the
Deaf
� National Cued Speech
Association
� NCHAM/ EHDI
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Complex Issue
� Age of Identification
� Onset of Hearing loss
� Degree of Hearing loss
� Benefit from Hearing Aids
� Family Dynamics:
� Siblings & Extended Family
� Lifestyle
� Bilingual issues
� Culture & Values
� Attitude & Commitment
� Finances
� Multiple Issues or Labels
� Family Support System
� Urban or Rural
� Availability of Resources
� Technology
� Parents can choose sound
� Validity of testing
� Society issues
� Beliefs about Disability
� Social Isolation
� Child’s Innate Abilities: learning style, personality, development, inclinations
� Peers & Social Outlets
� Educational Options
� Long term Goals
� Validity of information
� Flexibility and fluidity of choice-making process
Let the child leadCopyright © 2006 Hands & Voices
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Where we begin…
Images: biographixmedia.com Image: http://Georgetown.edu
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� Brain Architecture video (1 minute , 57 seconds)
- Center on the Developing Child
Harvard University
https://www.youtube.com/watch?v=VNNsN9IJkws
� Animation depicting synapses in the brain and the basis for neural pathway development. This process is important for all senses
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Hearing Loss =
Neurodevelopmental 911!
• Experience Dependent Plasticity!
• Take advantage of neuro developmental synchrony so that children can become morphosyntactically competent language users.
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Early Experiences Matter!
Source: Corel, JL. The postnatal development of the human cerebral cortex. Cambridge, MA: Harvard
University Press; 1975. http://www.urbanchildinstitute.org/why-0-3/baby-and-brain
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Use it or lose it
�Connections frequently activated are
reserved, strengthened & more efficient
�Connections not consistently activated
are naturally repurposed or pruned
allowing active connections to strengthen
and grow
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� “Windows of opportunity” are present at birth
� “The [cerebral] cortex matures in stages/columns and the level of maturity depends on the richness of exposure and experience.” 1
� Stimulation with sound should occur as early as possible to take advantage of critical periods of neurological and linguistic development 2 ,3
1. Merzenich, 2010 ; 2. Lennenberg, 1967; Marler, 1970; Clopton and Winfield, 1976; Johnson and Newport, 1989; Newport, 1990: 3. Sharma and Nash, 2009
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Early experiences
can have a
profound effect on
brain development!
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What it Takes: Communication & Language Development
Children learn language most easily when actively engaged in relaxed, meaningful interactions with supportive parents and caregivers
Kretschmer & Kretschmer, 1978; Lennenberg, 1967; Leonard, 1991; Ling, 1989; MacDonald & Gilletter, 1989; Menyuk, 1977; Ross, 1990; Estabrooks, 1994
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What it Takes: Communication & Language Development
Sensory Pathways�Visual / Auditory
�Options for amplification technology
�Sustained effort towards development
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What it Takes: Communication & Language Development
Language Input
�Complete, fluent language
�Meaningful, relevant� Abundant
�Contextual
� Repetitive
� Intentional
� Developmentally appropriate
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What it Takes: Communication &
Language Development
Consistent�Use
�Meaningful repetition
�Expectation(s)
�Access to other users of the language
�Developmental appropriateness
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Underlying Assumptions
� Anything is possible
� Every option is open to almost every child and family
� Parents as decision-makers: “Captain of the ship”
� Team is the “crew”: help you meet your goals for
your child and family
� Preferred Option may change
�Child’s skills and functional abilities can be positively
influenced by intentional interaction
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Receptive Communication Continuum
AVA VA AvV
Nussbaum, D., Scott, S., Waddy-Smith, B., Koch, M. (2006, abril). Spoken Languageand Sign: Optiminzing Learning for childrenwith Cochlear Implants. Paper presentedat Laurent Clerc National Deaf EducationCenter, Washington, D.C.
Fully VisualCommunicator
Mostly VisualCommunicator
Mostly
AuditoryCommunicator
Fully AuditoryCommunicator
Receptive Communication• V Depends on visual information from signs / ASL
• VA Depends on signs / ASL; gets some benefit from auditory information• VA Able to understand both signs / ASL and spoken language at high levels of fluency
• Av Depends on spoken language with some signs or gestures (often for larification)
• A Depends on auditory information through spoken language
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Expressive Communication Continuum
OSo SO OsS
Nussbaum, D., Scott, S., Waddy-Smith, B., Koch, M. (2006, abril). Spoken Languageand Sign: Optiminzing Learning for childrenwith Cochlear Implants. Paper presentedat Laurent Clerc National Deaf EducationCenter, Washington, D.C.)
Fully SignCommunicator
Mostly SignCommunicator
Mostly Oral Communicator
Fully Oral Communicator
Expressive Communication• S Uses signs / ASL only
• So Uses signs / ASL with some oral communication• SO Able to use both sign and oral communication at high levels of fluency
• Os Uses spoken language with some signs or gestures (often for clarification)
• O Uses spoken language only
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Initial Considerations for Parents
� How does your child communicate now?
� How do you envision your child
communicating in the future?
�Movement on the continuum is possible.
Functioning can be positively influenced
by intentional interaction
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Considerations for Parents
�What are your long-term goals for your
child/family?
�Do you know anything about any of the
communication options?
�What kind of school experience do you
want for your child?
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American Sign Language (ASL)
and English as a 2nd Language
Cued Speech Total Communication Auditory Oral Auditory Verbal
“Listening and Spoken Language”
Also known as Bilingual / Bicultural
“Bi – Bi”
Simultaneous Communciation
“SimCom” or “TC”
“Oral” “AV Therapy”
DEFINITION •ASL is the language of the Deaf community and an important part
of their culture and identity
•ASL has its own distinct grammar
and does not match spoken English
•ASL is a fluid, rich language with
slang, idioms, etc.
• A sound-based hand
supplement to speech
reading
• 8 handshapes used in 4
locations (“cues”)
• Cues are used
simultaneously while
speaking to make help
distinguish sounds that
look the same on the
mouth of spoken
language look visually
different
• A philosophy using a
combination of methods
including: sign language system,
finger spelling, body language,
speech, speech reading, listening
and amplification.
• Signs used are not ASL but rather
signs borrowed from ASL layered
over English to follow English
grammar and word order
• A therapy approach
emphasizing teaching child to
use his/her hearing, speech
reading and visual cues to
understand and use spoken
language
• A therapy approach which
guides and coaches parents to
teach their child spoken
language through maximal
development of listening skills
• Uses natural developmental
patterns of language learning,
listening and cognition
• Requires a certified Auditory
Verbal Therapist or Auditory
Verbal Educator
GOALS &
OUTCOMES
• The child learns ASL as his/her
primary language and learns
English as a second language
through reading
• To appreciate the differences
between the hearing & Deaf
communities
• Richer understanding of and
participation in Deaf culture
• To access the basic,
fundamental properties of
spoken languages
through the use of vision
• Has been adapted to 60+
languages and dialects
• To use any available tool to help
the child communicate
depending on the situation and
conversational partner
• To develop listening and
spoken language skills to the
child’s best potential
• To integrate listening and
spoken language into all
aspects of the child’s life
• To promote education in
neighborhood schools with
typically-hearing peers
HOW LANGUAGE
IS UNDERSTOOD
•Child interacts with other ASL users
and develops understanding of ASL
through rich language exposure
• English is taught as a second
language after child has strong
foundation in ASL
• Child learns to understand
language using
amplification and “read”
speech through cues
which represent different
sounds
•Child learns to understand
language (spoken, signed or
both) through rich language
exposure to spoken language, a
formal signed system and speech
reading
• Child learns to understand
spoken language through
(aided) listening and speech
reading
• Child learns to understand
spoken language through
(aided) hearing
• Does not rely on speech
reading or visual cues for
understanding
HOW LANGUAGE
IS EXPRESSED
•ASL
•Written English (or other)
•Varying proficiency may occur
within both language systems
• Spoken language (with
cues)
• Written English (or other)
• Spoken language
• Sign language (not ASL)
• Fingerspelling & written English (or
other)
• Varying proficiency may occur
within both language systems
• Spoken language
• Written English (or other)
• Spoken language
• Written English (or other)
AMPLIFICATION(HEARING AIDS, COCHLEAR
IMPLANTS, FM SYSTEMS, ETC.)
•Use of amplification is not a
requirement for success
• Maximal use of remaining
hearing is strongly
encouraged
• Maximal use of remaining
hearing is strongly encouraged
• Early and consistent and
maximal use is critical
• Early, consistent and maximal
use is critical
WHAT IT TAKES • Parents and family must become proficient in ASL if they are not
already
• Access to Deaf and/or hearing
adults fluent in ASL
• Parents and family are the
primary teachers of cued
speech to their child
• Parents must cue at all
times while speaking
• Must learn to cue fluently
• Parents and family must learn the
sign system
• Parents must encourage full-time
use of amplification
• Families should consider a
language plan to ensure
adequate exposure to both
signed and auditory systems
• Parent and family must
integrate therapeutic
techniques and strategies into
daily routines
• Parents must encourage full-
time use of amplification
• Parents and family must
integrate therapeutic
techniques and strategies into
daily routines
• Parents must encourage full-
time use of amplification
SCHOOL – AGE
CONSIDERATIONS
• Bilingual-bicultural approaches are
most commonly found in residential
schools for the Deaf
• Child may require a
transliterator: a proficient
cuer who cues what the
teacher(s) and peers say
• Placement options vary by district
• Class would typically be taught
by Teacher of the Deaf & HOH
• Placement options vary by
district
• Class would typically be
taught by Teacher of the
Deaf & HOH
• Ultimate goal is mainstream
classroom setting with typically
hearing peers
• May continue to receive
support in and out of classAdapted from NC Beginnings (www.ncbeginorg)
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Receptive Communication Continuum
AVA VA AvV
Nussbaum, D., Scott, S., Waddy-Smith, B., Koch, M. (2006, abril). Spoken Languageand Sign: Optiminzing Learning for childrenwith Cochlear Implants. Paper presentedat Laurent Clerc National Deaf EducationCenter, Washington, D.C.
Fully VisualCommunicator
Mostly VisualCommunicator
Mostly
AuditoryCommunicator
Fully AuditoryCommunicator
Receptive Communication• V Depends on visual information from signs / ASL
• VA Depends on signs / ASL; gets some benefit from auditory information• VA Able to understand both signs / ASL and spoken language at high levels of fluency
• Av Depends on spoken language with some signs or gestures (often for larification)
• A Depends on auditory information through spoken language
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Expressive Communication Continuum
OSo SO OsS
Nussbaum, D., Scott, S., Waddy-Smith, B., Koch, M. (2006, abril). Spoken Languageand Sign: Optiminzing Learning for childrenwith Cochlear Implants. Paper presentedat Laurent Clerc National Deaf EducationCenter, Washington, D.C.)
Fully SignCommunicator
Mostly SignCommunicator
Mostly Oral Communicator
Fully Oral Communicator
Expressive Communication• S Uses signs / ASL only
• So Uses signs / ASL with some oral communication• SO Able to use both sign and oral communication at high levels of fluency
• Os Uses spoken language with some signs or gestures (often for clarification)
• O Uses spoken language only
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American Sign Language (ASL)
� ASL is a full, complete language with its own syntax
and grammar system
� Provides access to the Deaf community
� Requires parental knowledge of and fluency in ASL
� No written form
� ASL users learn written English as a second language
� Bilingual / Bi-Cultural specialized programs exist, including most state schools for the Deaf
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Total Communication /
Simultaneous Communication
� Philosophy involving the use of a signed language system and spoken English simultaneously
� Requires parental knowledge of and fluency in signed system
� Child asked to process two sensory stimuli simultaneously
� May provide the child the opportunity to be bilingual
� In school:
� Variability exists in implementation of TC/SimComprograms
� Classmates generally have hearing loss and use same mode
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Cued Speech
� Handshapes are used as symbols to clarify phonemes that look the same on the mouth when produced
� Not a language but rather a symbolic system of speech phonemes
� Requires family members learn to cue� Can be a supplement to residual hearing and use of amplification
� Widely used in some areas of the country and hardly used in others
� In school:� May need staff who can cue to facilitate comprehension in classroom
� Peers and classmates may or may not cue for themselves
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Auditory Oral Approach
� Promotes listening skills and spoken language
� A therapy approach emphasizing teaching child to use his/her hearing, speech reading and visual cues to understand and use spoken language
� Speech reading, natural gestures and facial expressions are also promoted
� In school
� AO classrooms promote listening skills and spoken language; classmates often also have hearing loss
� Teachers of the Deaf and Hard of Hearing
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Auditory-Verbal Therapy
� Promotes development of spoken language and communication skills through listening
� Uses optimal amplification to guarantee access to sound
� A developmental, comprehensive therapeutic approach coaching caregivers / parents
� Parents become the primary facilitators of their child’s spoken language development
� Providers hold LSLS certification designated as
LSLS AVT or LSLS AVEd
� In school:
� Goal: mainstream classroom with typically hearing peers
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Complex Issue
� Age of Identification
� Onset of Hearing loss
� Degree of Hearing loss
� Benefit from Hearing Aids
� Family Dynamics:
� Siblings & Extended Family
� Lifestyle
� Bilingual issues
� Culture & Values
� Attitude & Commitment
� Finances
� Multiple Issues or Labels
� Family Support System
� Urban or Rural
� Availability of Resources
� Technology
� Parents can choose sound
� Validity of testing
� Society issues
� Beliefs about Disability
� Social Isolation
� Child’s Innate Abilities: learning style, personality, development, inclinations
� Peers & Social Outlets
� Educational Options
� Long term Goals
� Validity of information
� Flexibility and fluidity of choice-making process
Let the child leadCopyright © 2006 Hands & Voices
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Parent / Family Opportunities
� FamilyLink Activities
� Monthly outing
� Pizza Party Orientation
� Community Partnerships
� Annual Events for current and past families
� Program Specialists
� State GBYS
� State Deaf Mentor Program
� Wisconsin Families for Hands & Voices
� Wisconsin chapter of AG Bell
� Wisconsin Statewide opportunities via WESPDHH Outreach
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Ultimate Goal for ALL
Children
� Well-adjusted, self confident child who uses
language to successfully interact with others
� Child with the necessary foundational skills to be
ready to learn at school entry