Even hearing babies don’t talk at this age. Why does a child with hearing loss need “speech”?
I hear this from strangers, parents, grandparents, doctors, and state early intervention coordinators alike. Most people can understand audiology appointments for a child with hearing loss, and maybe some general “developmental therapy” checkups to make sure the baby is globally on track. But speech? Why?
Because it’s more than speech. “Speech therapy” is a very misleading name for what we do. Communication involves many factors, of which verbal output is just one. Helping a baby learn to communicate also means focusing on auditory development, cognition, play skills, and the social aspects of language (pragmatics).
Because speech doesn’t just happen. Yes, it’s true that typically hearing babies also don’t say their first words until around their first birthdays. But they’re not silent until then, either. There are many stages of vocalization, vowel and consonant production, and babble that come before that first precious word. Children with hearing loss, who cannot hear themselves well without technology, are at risk for decreased vocal output. When language happens normally, we don’t think twice about it. Most people spend their whole lives assuming that communication just “happens,” and are clueless about all of the microsteps in between. Early therapy can help parents learn more about these “baby steps” and how to help their child along the way.
Because no matter how early you identify, you’re making up for lost time. Babies with typical hearing develop their auditory sense about 20 weeks before birth. That means before they even take their first breath, their brains are forming around an auditory signal. Remember, it’s all about the brain. Thanks to the miracles of newborn hearing screening, we can identify hearing loss and get a child hearing aids within a few weeks of birth, but we’re still in a race against time to get that auditory input in and build strong neural connections.
Because parents are drowning in a sea of information. Discovering that your child has hearing loss can be a whirlwind. Appointments with the audiologist or ENT are once every few months, but weekly check-ins with the child’s therapist allow a constant contact for parents, a safe, comfortable space to sit and unpack all the new information they are learning, a chance to ask as many questions as possible, always with the promise that more can be discussed next week. By helping parents fully understand their child’s hearing loss, we can increase family buy-in and participation in therapy. This is crucial for the child’s success.
Because no one should walk this journey alone. Families should not be left alone to deal with the tsunami of emotion that comes along with the realization that their child has a hearing loss. More than “speech” therapy, early intervention is family therapy. Helping parents cope with the changes in their lives and build positive relationships with their baby and with each other is the greatest gift we can give to families. Speech skills, grammar proficiency, and audiological thresholds mean nothing if a child is not safe and secure in her world. A good therapist can serve as a listening ear, a shoulder to cry on, and a light to guide the way in those first scary months. It is our great privilege as therapists to partner with families to help them be happy, whole, and successful in meeting this new challenge in their lives.
Because babies don’t come with a manual. Parenting in general is hard. Parenting a baby with hearing loss when just a few months ago ABR, HA, CI, ANSD would have read like alphabet soup to you is even harder. Nothing I do in therapy is magic or something parents can’t do at home, but they need some coaching. For a child with hearing loss, we just have to “supercharge” our interactions with their baby to make up for any lost auditory input due to time waiting for hearing aids, or the child’s reduced ability to overhear.
Because we want to stack the deck in the child’s favor. A strong early start gives the child fewer chances to fall behind. Regular communication between family and therapist allows for constant monitoring of progress, so we can work as a team to eliminate delays and maximize potential before things even become an issue. The time parents invest in the early years can seem staggering, but it’s far better than finding out at age eight that your child is falling behind his peers. Remember that approximately 90% of what young children learn is incidental. We have to provide more input to give children with hearing loss more chances, through either focused or incidental learning, to get the same information as their hearing peers.
Because we want a running start. Early therapy with a baby who is profoundly deaf can sometimes feel like an endless waiting game until cochlear implant surgery. While implantation before the FDA’s current [but outdated!] guideline of twelve months has been shown to be both safe and effective, regardless of how early you implant, there is still going to be some lag time between identification and implantation. There is still much that can be done. Time in therapy while waiting for the cochlear implant does not have to be wasted time. If therapists can help parents master basic therapy skills (how to perform a Ling Six Sound Check, auditory-first presentation, parentese, etc.) and help the child develop basic communication foundations (joint attention, cognitive development, preventing the extinction of vocal play we sometimes see in infants with hearing loss), they will be ready to take off once they receive full access to sound through their CIs. If a family only starts therapy after cochlear implant activation, they are starting out behind.
Because parents need to “learn how to look.” Babies are really incredible little people, and if you know what to look for, they’re actually doing a lot more communicating than we give them credit for! One of the big parts of early intervention is teaching parents and caregivers to observe their baby, to read his pre-communicative signals, to know how to look for reactions to sound, to build opportunities for joint attention and turn-taking. I cannot tell you how many times a parent has said to me, “Wow! I didn’t know my baby could do that!” … all because they learned how to look.
Because early intervention pays off. Big time. A practical consideration in all of this is that we know that early intervention has serious, tangible benefits to both families and society. If we invest in children early, we improve their quality of life and reduce the negative impact on society (through reduced education levels and work productivity) for a lifetime. (For more studies, see HERE and HERE.)