Role of speech language pathology center in speech

language therapy of HI (hearing impaired) children

What is a hearing impairment?

Hearing impairment and deafness are not necessarily the same thing. Hearing loss greater
than 90 decibels is generally categorized as deafness, but any impediment to hearing –
whether temporary, permanent or fluctuating – impacts not only a child’s experience in the
classroom but their social and emotional development, literacy skills and speech and
language abilities.

What types of hearing impairment are there?

According to the National Deaf Children’s Society there are over 50,000 children and
young people in the UK with hearing impairments, but this does not mean that they all have
the same conditions or needs. There are three main types of hearing impairment that you
may come across in children

Sensorineural deafness A permanent hearing loss in the inner ear usually caused by the cochlea not
(nerve deafness) working effectively

Auditory Neuropathy
A problem occurring more deeply within the ear, where sounds are received
Spectrum Disorder   
normally by the cochlea, then become disrupted as they travel to the brain
(ANSD)
Usually temporary, sometimes permanent. Sound can’t pass effectively   
through the outer and middle ear to the inner ear. Caused by blockages such
Conductive deafness
as wax or fluid. The latter is known as glue ear — can last for up to three
months and very common in pre-school children
How to spot signs of hearing impairment in a child?
While hearing impairments are often identified in babies, they may not develop or make
themselves known for several years. This means that it’s important to keep an eye out for
the signs of hearing impairment in the classroom, particularly in young children – as at
some point in your career you could find that you are teaching a child with an undiagnosed
hearing impairment. 

Here are some of the common signs of hearing impairments that you can look for in young
children:

 Not responding when their name is called 

 Problems with concentration, excessive tiredness and frustration with work that starts to affect
their behavior
 Watching your lips intently as you speak
 Speaking too loudly or too quietly
 Watching others do something before attempting it themselves
 Becoming increasingly withdrawn from others in the classroom
 Delayed speech and communication development
 Mishearing or mispronouncing words
 Not being able to hear what’s happening if there is any background noise
 Making minimal contributions to classroom discussion
 Difficulty with reading and linking it to speech

Screening and Diagnosis

 For newborns, routine hearing screening tests
 For older children, a doctor's evaluation and tympanometry
 Imaging tests

Because hearing plays such an important role in a child’s development, many

doctors recommend that all newborns be tested for hearing impairment by the age of
3 months.

Most states require that newborns undergo routine screening tests  to detect hearing
impairment. Newborns are usually screened in two stages. First, newborns are tested
for echoes produced by healthy ears in response to soft clicks made by a handheld
device ( evoked otoacoustic emissions testing ). If this test raises questions about a
newborn’s hearing, a second test is done to measure electrical signals from the brain
in response to sounds (the auditory brain stem response test, or ABR). The ABR is
painless and usually done while newborns are sleeping. It can be used in children of
any age.
If results of the ABR are abnormal, the test is repeated in 1 month. If hearing loss is
still detected, children may be fitted with hearing aids and may benefit from
placement in an educational setting responsive to children with impaired hearing.

If doctors suspect the child has a genetic defect, genetic testing can be done.

In older children, several techniques are used to diagnose hearing impairment:

 Asking a series of questions to detect delays in a child’s normal development

or to assess a parent’s concern about language and speech development
 Examining the ears for abnormalities
 For children aged 6 months to 2 years, testing their response to various sounds
 Testing the response of the eardrum to a range of sound frequencies
( tympanometry), which may indicate whether there is fluid in the middle ear
 After age 2 years, asking children to follow simple commands, which usually
indicates whether they hear and understand speech, or testing their responses to
sounds using earphones

Imaging tests are often done to identify the cause of hearing loss and guide
prognosis. Magnetic resonance imaging  (MRI) is done for most children. If doctors
suspect bone abnormalities, computed tomography  (CT) is done

How does hearing impairment affect learning? 

Hearing-impaired children struggle at every stage of their education .. Hearing and learning
go hand-in-hand, so the impairment of this function means much more for a child than
simply struggling to hear. Any hearing impairment which is not handled effectively has an
adverse effect on a child’s development, preventing them not only from taking in new
information but learning to interact, relating to others and making friends.

A child whose hearing impairment negatively affects their learning is likely to withdraw
further into themselves throughout their education, which has a knock-on effect throughout
the rest of their life. The frustration of being unable to express themselves and
communicate both inwardly and outwardly is highly damaging and can impact future
employment and their relationships with both others and themselves.

Everyday frustrations in the classroom are not as simple as an absence of individual

attention from the teacher. A child with a hearing impairment does not necessarily require
constant additional help but rather a mindful and sensitive approach to teaching the whole
class – not facing the whiteboard to speak, minimizing background noise and using visual
aids as much as possible. 
Effect of Hearing Loss on Speech and Language Development

Language acquisition is very much dependent on the hearing capacity of the child.
Hence, the various factors affecting the speech and language development in a child
with hearing impairment include age of onset of hearing loss, the severity, early
intervention and accompaniment of other disabilities in the individual. Since the child
is not able to hear speech and listen to the language, the earlier the onset of hearing
loss, the more is the delay in language acquisition. However, if the hearing loss is
identified early and intervention is begun, the language can be learnt on time. The
intervention can be started even with a newborn child diagnosed as hearing impaired.

The vocabulary development is much slower in a child with hearing loss than a
normal hearing child. Concrete words like ball, dog, table, etc. are understood more
easily than abstract words like jealous, equal, etc. Functional words like articles,
prepositions, conjunctions are also difficult to understand and more formal training is
required for the rules to be incorporated in their language. Words with multiple
meanings could be confusing for the hearing impaired child. For example, "star" could
mean the star of the night sky or a reference to a celebrity.

The speech clarity of a child with hearing impaired is often different from a hearing
child. These children do not hear the sounds they speak. Quiet speech sounds like ‘f’,
‘k’, ‘sh’ and‘s’ are not heard by them. So, the word “stake” and “take” seem similar to
them. Pronouncing these sounds may also be affected and consequently their speech
may not sound clear. The loudness levels may not be appropriate and the speech may
sound monotonous without the required stress on particular words, the right
intonations and slow rate of speech flow.

The sentence structure of a child with hearing impairment may usually be shorter and
simpler than those of a hearing child. They may have difficulty in understanding
complex sentences and thus the writing skills will also be affected. They may have
difficulty in hearing sounds in words ending with –ed or –s. This can affect the use of
words describing past tense, plurals, subject-verb agreement and also possessives.

Speech and Language Intervention in a Child with Congenital Hearing Loss

The first step in introducing the hearing-impaired child towards speech and language
is identifying the severity of hearing loss and determining the residual hearing
capacity, and eventually fitting with the right kind of hearing aid. Cochlear implants
can be recommended to those who can benefit from it. There are various approaches
to help with speech and language acquisition for children fitted with hearing aids and
cochlear implants. Training them and their parents to use and maintain the hearing
aids is a must for the effectiveness of the intervention program.

Based on the severity of the hearing loss, the residual hearing capacity of the child can
be used to the maximum possible extent. The child needs to be trained to identify
sounds, discriminate background from the speech sounds and also understand
differences in the sounds that appear alike. Training the child in Speech reading or Lip
reading can help the child to pick up the skills in a better way and also communicate
well in the talking world. The child must be made aware of the sounds, pronunciation,
intonation patterns used and also use the right kind of voice quality and intensity. The
child must also learn conversational skills like waiting for their turn to talk,
maintaining the context, initiating and maintaining conversations, responding to
questions or situations, facial expressions and maintaining eye contact.
Professional help in Identification and Intervention for a Child with Hearing
Impairment

The parents may be advised by the family physician to seek a specialist’s help when
the doctor is in doubt of a proper diagnosis regarding the hearing loss.
The Otolaryngologist or the ENT specialist can help to identify and assess the hearing
impairment and assess the possibility of repairing any damage. The parents are then
guided by the Audiologist about the extent of hearing impairment, who also
determines the amount of residual hearing ability and the right kind of hearing aid for
the child. The Speech therapist now takes over and a long process of speech and
language therapy along with auditory training follows. The candidates suitable for a
cochlear implant can be surgically fitted with the same by the ENT surgeon and the
follow-up auditory and speech training is carried on with the qualified Audiologist
and Speech Therapist.

Speech and language is not the only management required for the child with hearing
loss. The overall development includes improving cognitive skills, dealing with the
feelings of odd-one out, emotional development, social skills and many other related
areas. The programme must be such that it helps the child to be more confident,
expressive and feel integrated into the talking world.

Speech therapist
Speech therapist or speech-language pathologists are trained personnel who work with children having speech-
related disorders. They also provide screening, consultation, assessment, diagnosis, treatment, management
and counseling services for children with special needs. Speech therapy plays an important role towards the
holistic development in a child with autism spectrum disorder. It improves overall communication, enhances
social skills, enables to cope up better with the society and function in day-to-day life. It should be started as
early as diagnosis is made.

Role of speech therapist

Speech therapist does much more than simply teaching a child to correctly pronounce words. In fact, a speech
therapist working with an autistic child may work on a wide range of skills including:

 Speech articulation: by oromotor exercises of lip and facial muscles, the way a child moves mouth
while saying certain words and sounds.
 Communication: This includes teaching gestural communication, or training with PECS (picture
exchange cards), electronic talking devices, and other non-verbal communication tools.
  Comprehension: The speech therapist engages the child in a functional language activities that
involve cognition and social interaction.
 Speech pragmatics: Use of speech to build social relationships.
 Conversation skills: Self Talk, parallel talk, sentence elongation, situational talk
 Conceptual skills: Big and small concept, left & right concept, color concept, body parts concepts,
yes and no concept

Speech therapy center

Speech therapy center work directly with children, their families, and other education professionals
to develop personalized strategies to support a child's individual needs. They also provide training to
education professionals so they can identify the signs of speech, language and communication needs and
support them appropriately.

The centers will test child’s speech and language skills and decide if child needs treatment. Each
center has a process to get services started.
Thechild may get speech and language services alone or in a small groups in the centers. The
centers may go into your child’s classroom and work with his teacher. The centers will work
with child on what she is learning in class. The goal of speech and language services is to help
child do well in school.
Speech and language problems do not have to keep child from doing well in school. Therapy
centers can help.
Speech therapy centers mission is to provide a diverse and affordable program of quality diagnostic, rehabilitative
and supportive services to meet the unique challenges of children and adults who are deaf or hard of hearing, or
have other communication needs, and to serve as an information and referral source for these populations and the
general public.

Auditory capabilities directly impact communication skills. Speech therapists can assess and treat patients
with individualized plans that fit their lifestyles and goals

The ASHA (American Speech-Language-Hearing Association) Scope of Practice states that the
practice of speech-language pathology (SLP) includes providing services for individuals with
hearing loss and their families/caregivers. The Preferred Practice Patterns are statements that
define universally applicable characteristics of practice. It is required that SLPs who practice
independently in this area hold the ASHA Certificate of Clinical Competence. SLPs must also
abide by the ASHA Code of Ethics, including Principle of Ethics II Rule B, which states:
“Individuals shall engage in only those aspects of the profession those are within their
competence, considering their level of education, training, and expertise.”

Table of Contents
 Specialized Roles of Speech-Language Pathologists
 Specialized Roles of Teachers of Children Who Are Deaf and Hard of Hearing
 Collaborative Responsibilities
 Service Delivery Models
 Recommendations
 References

The teachers of children who are deaf or hard of hearing, other educational administrators and
personnel, as well as others on the role of SLPs and Teachers in facilitating the development of
communicative competence (the ability to understand and use one or more languages effectively
in a variety of sociocultural contexts). SLPs and Teachers are uniquely qualified to provide
services to children who are deaf or hard of hearing in the development of communicative
competence and have specific as well as overlapping roles in this area.

Specialized Roles of Speech-Language Pathologists

SLPs have the specialized preparation, experiences, and opportunities to address communication
effectiveness, communication disorders, differences, and delays due to a variety of factors
including those that may be related to hearing loss. SLPs provide services to a wide range of
persons with communication needs. These services can be delivered in a variety of settings
including a clinic, school, or the person's home. SLPs in educational settings contribute to
students' communicative competence and academic achievement including literacy
SLPs have the knowledge and skills to address the complex interplay of the areas of listening,
speaking, signing, reading, writing, and thinking. Furthermore, they understand how skill
expansion in one of these components enhances performance in another area ultimately
contributing to the overall development of literacy and learning.
The document Knowledge and Skills Required for the Practice of Audiologic/Aural
Rehabilitation indicates that SLPs providing services to individuals who are deaf or hard of
hearing should have knowledge of and skills that include, but are not limited to, the following
areas of expertise :
 normal communicative development and the effects of hearing loss on communicative
development;
  the assessment of communicative skills and intervention with individuals with hearing
loss; and
 the prevention of communicative issues
The scope of practice in speech-language pathology (ASHA, 2002b) encompasses
responsibilities that include, but are not limited to the following communication disorders
conditions found in the general population as well as the population with hearing loss:
1. Providing prevention, screening, consultation, assessment and diagnosis, treatment,
intervention, management, counseling, and follow-up services for disorders of:
 speech (i.e., articulation, fluency, resonance, and voice including aeromechanical
components of respiration); language (i.e., phonology, morphology, syntax,
semantics, and pragmatic/social aspects of communication) including
comprehension and expression in oral, written, graphic, and manual modalities;
 language processing; preliteracy and language-based literacy skills, including
phonological awareness; and
 swallowing or other upper aerodigestive functions, cognitive aspects of
communication, sensory awareness related to communication, swallowing, or
other upper aerodigestive functions.
2. Establishing augmentative and alternative communication techniques and strategies
including developing, selecting, and prescribing of such systems and devices.
3. Providing services to individuals with hearing loss and their families/caregivers, (e.g.,
auditory training; speechreading; speech and language intervention secondary to hearing
loss; visual inspection and listening checks of amplification devices for the purpose of
troubleshooting, including verification of appropriate battery voltage).
4. Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy,
computer technology) to observe, collect data, and measure parameters of communication
and swallowing, or other upper aerodigestive functions in accordance with the principles
of evidence-based practice.
5. Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for
communication, swallowing, or other upper aerodigestive functions.
6. Collaborating in the assessment of central auditory processing disorders and providing
intervention where there is evidence of speech, language, and/or other cognitive-
communication disorders.
SLPs have modified and expanded their role in the education setting over the last 75 years in
response to populations in need of their expertise and services in the areas of speech, language,
cognitive-communication, voice, fluency, swallowing, and hearing loss.
Specialized Roles of Teachers of Children Who Are Deaf
and Hard of Hearing
Teacher education programs prepare teachers to plan and deliver the child's educational program,
including the development of communicative competence within a variety of social, linguistic
and cognitive/academic contexts. Teachers provide educational programming to children in
center schools for deaf or hard of hearing children as well as in schools and programs that serve
hearing, deaf, and hard of hearing children. These settings include self-contained classrooms,
resource rooms, general education classrooms, and itinerant, home, or community-based settings.
A planned sequence of educational coursework and practica (i.e., observation, participation and
student teaching, prepare teachers for assessing, planning, implementing and evaluating
educational outcomes in the developmental, communicative, linguistic and academic domains).
Teachers are familiar with child development from infancy through adolescence. In addition to a
common core of knowledge required to teach deaf or hard of hearing children, Teachers have a
foundation of knowledge in a professional specialization (CED, 2001). Teachers with
specialization in parent/infant education are prepared to work with families and very young
children as part of an interdisciplinary team of professionals (Joint Committee of ASHA-CED,
1994). Specialization in early childhood addresses the development and educational needs of
children and their families in the pre-primary years. Teachers specializing in elementary
education typically are prepared to instruct in all academic areas and work collaboratively with
parents and other professionals in elementary education settings. Teachers with specialization in
multiple disabilities have an understanding of the concomitant effects of hearing loss and
atypical developmental, social, emotional, motor, and physical conditions. Secondary education
specialists have extensive knowledge in an educational content area and adolescent development.
The teacher preparation program's curriculum consists of planned learning experiences in the
following components of the joint CED CEC Knowledge and Skills Essential to Beginning
Special Education Teachers of Students who are Deaf or Hard of Hearing:
 Philosophical, Historical, and Legal Foundations of Special Education, including the
Education of Students who are Deaf or Hard of Hearing
 Characteristics of Learners
 Assessment, Diagnosis, and Evaluation
 Instructional Content and Practice
 Planning and Managing the Learning Environment
 Managing Student Behavior and Social Interaction Skills
 Communication and Collaborative Partnerships
 Professionalism and Ethical Practice
The preparation of Teachers addresses the acquisition and development of communicative
competence with an understanding of the linguistic, cultural, cognitive, developmental, familial,
visual, auditory, tactile, and motor influences. Coursework and field experiences with children
who are deaf or hard of hearing prepare teachers to:
 1. Establish a classroom or other learning environment to meet the physical, cognitive,
cultural, linguistic, and communicative needs of the child;
2. Plan and utilize strategies, appropriate materials, and resources for implementing
educational experiences that support the development of communicative competence;
3. Provide consistent comprehensible language(s) appropriate to the needs of the child
regardless of the modality or form;
4. Apply first and second language teaching strategies to teaching English (e.g., through
ASL appropriate to the needs of the child and consistent with the program philosophy);
5. Facilitate and support communication among deaf and hard of hearing children and
adults, hearing children and adults, including family/caregivers;
6. Monitor and evaluate the child's communicative competence on a regular basis in
academic and nonacademic contexts including the child's use of signs, cues, speech,
and/or assistive technologies;
7. Provide instruction and/or support for effective use of communication supports such as
interpreting, transliteration, note-taking, real-time captioning, telecommunications, and
computing.
Teachers are knowledgeable about both general education including the natural and behavioral
sciences and humanities and pedagogy. Teachers are prepared to educate children who exhibit a
range of learning abilities, challenges, and styles. Coursework and practica integrate cultural,
linguistic, and socio-economic perspectives including the socio-cultural and linguistic
phenomena associated with deafness. In addition, teacher preparation programs direct teachers to
promote the child's sense of identity by collaborating with adults and peers who are social,
cultural, and linguistic role models (Christensen, 2000; Cohen, 1997; Cohen, 1993; Cohen,
Fischgrund, & Redding, 1990).
Teachers plan for and educate children who are deaf or hard of hearing with varying
backgrounds, abilities, and characteristics. Regardless of setting, Teachers—in collaboration
with other professionals—provide, facilitate, monitor, and evaluate the development of
communicative competence and literacy of children who are deaf or hard of hearing. Working
closely with families, Teachers support family involvement and facilitate communication within
the family. Teachers who have earned CED certification are prepared to provide educational and
communicative experiences that are developmentally and individually appropriate.
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Collaborative Responsibilities
Children who are deaf or hard of hearing constitute a heterogeneous population (JC ASHA/CED,
1998) whose abilities and needs may require the SLP and the Teacher to combine their expertise
toward the development of communicative competence for these children. In addition, as the age
and abilities of the child change over time, the professionals may also have to modify their roles.
Collaborative responsibilities may include the following:
  Consider relevant background information (family history, medical information, previous
assessments, reports, and observations) for the purposes of program planning;
 Obtain a comprehensive description of communicative and linguistic abilities and needs
of the child, history of communication modalities and languages (signed and/or spoken)
used and/or tried, family preferences, and concerns related to communication.
 Administer and interpret appropriate formal and informal, standardized and
nonstandardized assessments of all areas of communicative competence.
 Develop communicative competence goals and objectives that address the general
curriculum for the child; incorporating recommendations and findings of the family and
interdisciplinary team;
 Identify individuals responsible for the design and implementation of an instructional
program and related services to assist the child in achieving the identified goals and
objectives;
 Evaluate the child's progress as related to the goals;
 Evaluate the program or related services provided;
 Provide progress reports to families on a regular basis and other professionals as
consistent with IDEA Parts B and C (IDEA, 1999);
 Determine the effectiveness of assistive technologies for the child in collaboration with
the family and interdisciplinary team;
 Facilitate the development of social aspects of communication;
 Provide consultation, guidance, and education to children and young adults who are deaf
or hard of hearing and to their families;
 Provide consultation and support to and or collaborate with professionals and
paraprofessionals involved in the habilitation/educational program of the child;
 Consider overall learning strengths, weaknesses, differences, and/or delays which may be
unrelated to hearing status for appropriate referral and/or educational planning;
 Collaborate with families and children regarding communicative and linguistic strengths
and needs in planning appropriate educational, vocational, and/or career transitions;
 Assist families in receiving appropriate access to communicative and linguistic services
for the child;
 Assist students in developing the skills and knowledge necessary for self-advocacy.
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Service Delivery Models

For optimal service delivery, the SLP and Teacher will engage in a collaborative team approach
to facilitate the development of communicative competence using one or a combination of
service delivery models (ASHA, 1999, 2001). Service delivery is a dynamic concept varying
according to the abilities and needs of the child as well as family preference. It is necessary for
professionals to employ service delivery models that are most appropriate for the child and are
based on the child's Individualized Family Service Plan (IFSP) or Individualized Education
Program (IEP). The following are examples of current models: consultation; classroom-based
integrated instruction and/or intervention; pull-out instruction and/or intervention; community-
based intervention.
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Recommendations
These recommendations are intended to provide the SLP and Teacher with a framework for
resource allocation based on collaboration that optimizes the development of linguistic and
communicative competence of children who are deaf or hard of hearing.
To promote the success of the child who is deaf or hard of hearing, ASHA and CED recognize
that collaboration among professionals is critical. ASHA, CED, Teachers, and SLPs need to
work with program administration to facilitate the following recommendations:
 Promote a culture of professional collaboration and exchange of knowledge.
 Ensure adequate planning and preparation time among team members for collaborative
efforts.
 Ensure that professionals have the specialized knowledge and skills to work with children
who are deaf or hard of hearing at the child's developmental and chronological age, using
the child's preferred communication modalities and language(s), and with an
understanding of the child's unique needs.
 Ensure that professionals have specialized knowledge and skills to provide family-
centered, community-based, culturally competent, integrated services.
 Recruit and hire qualified professionals
 Ensure ongoing evaluation of program and child outcomes to enhance program
effectiveness.
 Encourage and support ongoing professional development.
 Provide interdisciplinary educational programs for SLPs and Teachers.
 Ensure that future research addresses the educational, linguistic, and communicative
needs of children who are deaf or hard of hearing with concomitant disabilities
(Gallaudet University Center for Assessment and Demographic Study, 1998; Baker-
Hawkins & Easterbrooks, 1994; Cherow, Matkin, & Trybus, 1985).
  Provide information on current research, technology, and approaches for developing
communicative competence.
 Offer information and education on delivering integrated services that are family-
centered, community-based, and culturally responsive.
 Address the changing demographics of the population of children who are deaf and hard
of hearing to accommodate multicultural and multilingual considerations (Fischgrund,
1982; Harston & Smith, 1983; Delgado, 1984; Heath, Plett, & Tibbetts, 1987; Farrell,
1989; McNeil, 1990; Dodd & So, 1994; Hodgson & Montgomery, 1994; Cohen,
Fischgrund, & Redding, 1990; Christensen & Delgado, 1993; Cohen, 1997; Christensen,
2000).
 Promote access to appropriate communicative and linguistic services and assistive
technologies for children who are deaf or hard of hearing.
 Promote access to family-centered, community-based, culturally-responsive services for
children who are deaf or hard of hearing.
 Design and conduct studies that assess models of collaboration between SLPs and
Teachers.
 Design collaborative, applied research to investigate the efficacy of models and strategies
to develop communicative competence.
 Promote resources for research, evaluation, and program development.

SLP Roles with Patients with Hearing

Impairments
June 1, 2020 
Hearing loss affects people of all ages and backgrounds. Here are some hearing loss
statistics, according to the Hearing Loss Association of AmericaExternal
link:open_in_new:
 Roughly 48 million Americans have some level of hearing loss. 
 Out of every 1,000 children born in the U.S., two to three have hearing loss in one or
both ears. 
 Approximately one in five American teens experience hearing loss.
 The most prevalent service-related disability of American veterans is hearing loss.

Working with SLP patients with hearing impairments is one of many fulfilling speech
language pathology career paths. Speech pathologists use speech therapy to help
clients with hearing impairments improve their quality of life. They work on interventions
for speech disorders related to voice, articulation, fluency, resonance and other factors.
They also collaborate with audiologists to create treatment plans for patients. 
How Speech Therapists Help People with Hearing
Loss
Speech therapists work with clients whose communication disorders occur from a
variety of causes, including stroke, brain injury and developmental delay. According to
the American Speech Language-Hearing AssociationExternal link:open_in_new (ASHA),
speech pathologists have the knowledge and skills to evaluate communication
disorders, differences, delays and effectiveness, which may be affected by or related to
hearing loss. SLP responsibilities and roles slightly change when working with clients
with hearing loss. In fact, ASHA states that SLPs working with individuals with hearing
impairments should have specific education and training related to this population. 
ASHA reports the following as appropriate SLP roles:

 Understand how hearing loss affects communication development.

 Work with SLP patients with hearing impairments to assess communication skills
and treatment.
 Prescribe and choose appropriate communication techniques and strategies.
 Provide speech therapy services to hearing-imparied SLP patients, their families and
caregivers, including auditory training, listening checks, speechreading and more.
 Observe and measure communication parameters using instrumentation informed
practices.
 Evaluate and establish appropriate communication devices.

Working with a speech therapist can help people with hearing loss learn how to more
effectively cope with communication issues. SLP patients with hearing impairments
come from a variety of populations, including children, adults and older adults.

How SLPs Help Babies and Children with Hearing

Loss
Infants, toddlers and children who have permanent hearing loss can benefit from
speech language services. In her report, “The SLP and Early Intervention with Infants
and Toddlers with Hearing LossExternal link:open_in_new,” Amy McConkey Robbins,
MS, CCC-SLP, discusses unique SLP roles and responsibilities when working with
children with hearing loss and their families. She identifies the following clinical needs of
SLP patients with hearing impairments in this population:
 Help parents manage hearing aids or cochlear implants: Hearing aids and
cochlear implants help babies, toddlers and children gain access to sound. This is
important because brains are still developing in children. While an audiologist will fit
the device and monitor hearing loss, the speech pathologist helps parents insert
devices if they come out and helps families work toward full-time use of the devices. 
 Select appropriate speech treatment materials for the child’s age: Babies,
toddlers and children will benefit from different types of speech therapy materials.
One of many SLP roles is to recommend the best materials to stimulate infants’ and
 children’s. If the child is interested in the materials and enjoys interacting with them,
the speech therapy will be more effective.  
 Counsel families regarding communication options: Every child and family is
different. Speech therapists need to be prepared to discuss communication
recommendations based on the hearing aids or cochlear implants a child has, what
the child’s treatment plan is, and the child’s future, which may include cochlear
implant surgery. Speech therapists need to be sensitive to what works for the family
and will need to make recommendations for communication treatments, like the use
of American Sign Language. Empathy and sensitivity to patients and their families
are important SLP responsibilities. 
 Offer flexible treatment: Children, toddlers and infants are unpredictable in the type
of energy and focus they’ll bring to treatment sessions. Speech therapists have to be
flexible in how they approach each session. They also need to be supportive
counselors to parents who bring new concerns and questions to sessions. Having
this kind of flexibility can aid patients’ long-term progress.

Early intervention for babies, toddlers and children can be instrumental in helping these
populations achieve communication success later in life. Speech therapists provide both
treatment and counseling to help families cope with hearing loss in a child and use
speech therapy to navigate daily challenges.

SLPs and Patients with Hearing Loss Beyond Early

Childhood
ASHA reports that beyond early childhood, noise and aging are the primary causes of
hearing loss in adultsExternal link:open_in_new. In fact, in the North American World
Health Organization subregion, 9% of adult-onset hearing impairment is likely caused
by occupational noise, ASHA states. For example, hearing loss could be caused by
prolonged exposure to loud noises on construction sites or at concerts. These kinds of
hearing impairments can lead to communication disorders. 
Some other causes of hearing loss after early childhood, as noted by ASHA, include:

 Ear canal infection

 Swimmer’s ear
 Benign tumors
 Genetic disorders
 Ototoxicity drugs, such as those used in chemotherapy 
 Head injury or trauma 
 Bacterial infections
 Vascular deficiencies

According to the Center for Hearing and CommunicationExternal link:open_in_new,

speech therapy can help adults with hearing loss improve their relationships, self
confidence, and mental health, and establish heightened independence and security.
During speech therapy for teen and adult patients with hearing loss, speech therapists
may focus on treatment that improves voice production and articulation. 
SLPs and Patients with Hearing Loss in Older Adults
Hearing loss is common in older adult populations. According to the National Institute on
Deafness and Other Communication Disorders (NIDCD), one in three people 65 to 74
years old have hearing lossExternal link:open_in_new. NIDCD also reports that almost
half of individuals older than 75 have difficulty hearing. A study published by the
National Library of Medicine shows that voice changes nearly always happen after the
age of 60External link:open_in_new. Aging can affect communication in ways including
voice pitch, intensity and quality. 
Hearing loss in older adults makes it more difficult to communicate with friends, family
and doctors. It can impact relationships, confidence and even safety. SLPs help them
embrace strategies that alleviate some of these burdens. Speech pathologists can help
older adult patients improve their communication through speech improvement, speech
and lip reading, and hearing aid instruction interventions.

Speech Language Pathologist Assessment of Patients

with Hearing Loss
Speech pathologists need to know how to perform thorough hearing screenings and
interpret audiometric data to help SLP patients with hearing impairments. Sometimes,
when it’s in their scope of practice, SLP roles will include interpreting or performing
audiological procedures. However, a speech therapist doesn’t diagnose medical
conditions or hearing impairments; that’s the role of the audiologist. 

During an assessment, it’s the speech therapist’s role to identify risk factors or interpret
results to prepare effective speech language treatment. A speech pathologist will need
to:

 Diagnose communication and swallowing disorders.

 Determine the patient’s or parents’ goals and willingness to use hearing devices.
 Analyze the patient’s everyday environments—acoustics, classmates, activities, etc.
—and how those will affect interventions.
 Prepare reports and treatment plans that address patients’ needs.

Speech Language Pathologist Treatment of Patients

with Hearing Loss
The goal of speech pathology treatment for patients with hearing impairment is to
improve speech, communication, listening and language skills. There are a variety of
speech therapy techniques speech therapists can use in intervention. Some types of
speech therapy treatmentExternal link:open_in_new, noted by Nationwide Children’s
Hospital, include:
 Listening and spoken language therapy: Also known as “auditory-verbal therapy,”
to help patients develop listening skills so they can better their speaking skills.
 Auditory-oral or auditory-based speech therapy: Teaches lip reading and visual
cues to learn language by watching.
 Total communication speech therapy: A combination of spoken and sign
communication using visual cues, sign language and spoken input.

Speech therapists assess patients’ fluency, speech production, language, cognition,

voice, resonance and lifestyle to create individual treatment plans. The use of hearing
aids or cochlear implants will also impact treatment.

How Speech Pathologists and Audiologists Work

Together
Audiologists and speech pathologists have different roles, but they often collaborate for
the benefit of the patient. An audiologist focuses on diagnosing hearing impairment and
providing access to sound and assistive listening devices. A speech therapist focuses
on implementing auditory-cognitive training to improve communication. Together, an
audiologist and speech therapist will provide counseling, set expectations, identify
communication strategies and be advocates for their clients.

Ways audiologists and speech therapists might collaborate include:

 Establish hearing-related goals.

 Develop a comprehensive care plan.
 Share resources and knowledge.
 Manage expectations.
 Provide device and accessory assistance.
 Provide communication counseling and auditory training.
 Track patient progress and make adjustments to therapy or hearing devices.

Speech pathologists and audiologists work together to help SLP patients with hearing
impairments improve communication success and hearing-related quality of life. They’ll
work with patients and their families to understand communication goals, identify
challenges, develop action plans and create strategies to put those plans into action.
Collaboration between audiologists and speech pathologists is common and
instrumental in helping patients improve communication. 

Speech Therapists Can Improve the Quality of Life for

Patients with Hearing Loss
Auditory capabilities directly impact communication skills. Speech therapists can assess
and treat patients with individualized plans that fit their lifestyles and goals. For those
interested in helping people regain communication after hearing loss, there should be
ample opportunities as the Bureau of Labor Statistics reports a 27% increase in
employment of speech-language pathologistsExternal link:open_in_new from 2018 to
2028. This is much faster than the average growth rate across all occupations, which is
5%.
Information updated June 2020

https://www.ndcs.org.uk/information-and-support/language-and-communication/spoken-language/
speech-and-language-therapy/
Speech and language therapy

Communication development starts from the moment a child is born and is a process
that never stops.  Developing language in the early years is particularly crucial because
without good language skills, deaf children will struggle to develop in the same way as
other children, to access education and to become independent. Speech and language
therapy aims to help all children to communicate as well as possible. 

What is speech and language therapy?

Speech and language therapy aims to help all children to communicate as well as
possible, and develop their speech and language skills. A speech and language therapist
will work as part of a team with your child’s audiologist, Teacher of the Deaf, teaching
assistants and other professionals to help your child.

A speech and language therapist can:

 assess how well your child’s speech, language and communication skills are
developing
 identify if your child is experiencing any difficulties and the reasons why
 develop a plan to address those difficulties and work with you to carry out the
plan
 give advice on your child’s progress and the next steps
 work with teaching staff to support language-based aspects of the curriculum.

Speech and language therapists can help with different aspects of communication,
including:

 pragmatics – using and understanding language in social situations

 verbal skills – understanding and using spoken language
 non-verbal skills – communicating using signs and gestures, body language,
turn-taking
 expressive skills – getting a message across, verbally or non-verbally
 comprehension or receptive skills – understanding of spoken language and sign
 voice skills – controlling volume, quality and pitch
 speech – pronouncing sounds and words
 literacy – developing an awareness of letter-sounds and language skills that are
specifically related to reading, spelling and to understanding written text.

Some speech and language therapists will have done extra training to work with deaf
children, and/or may also be able to communicate in sign language. These specialists
can be employed by local services/charities or can be contacted through the Royal
College of Speech & Language Therapists. These specialists may help the local
therapists to plan therapy programmes for the child, or, in some cases, they may see
the child themselves.

Some highly specialised speech and language therapists also support children with
eating and drinking, particularly if your child has difficulties with swallowing, for
example, if your child has additional needs as well as deafness.

There are over 13,000 speech and language therapists working in the UK. Many of
them are employed by the NHS, but some work for education authorities, individual
schools, charities or privately.

How can a speech and language therapist help your child?

The speech and language therapist will spend some time assessing your child.
Assessment involves collecting information about your child’s communication
development, their hearing needs, your family and the environment. This helps the
therapist to discuss with you what happens next and then decide an action plan.

Assessments can be informal or formal. Informal assessments involve the therapist

watching your child playing and interacting, as well as asking you and any other adults
who know your child well for information. Formal assessments use tests to compare
your child’s communication to that of other children.

The best assessments should give you a complete picture of your child’s strengths and
needs, and an idea of how you can help. Your wishes and the wishes of your child, (if
they are old enough), should be taken into account when planning actions.

The speech and language therapist will write a report describing the findings of their
assessments. Ask for a copy of this report and don’t be afraid to ask if you’re not quite
sure what things mean.

Examples of questions that you might ask

  Where is my child up to? (How are they doing?)
 What will they do next?
 What do other professionals working with my child need to do? How will they
know?
 What can I do to help? Are there any activities I can do at home to support my
child’s speech and language development?

Download and pass on our resource for education professionals on the different

assessments that is available for assessing and monitoring the progress of deaf children
and young people in communication, language and listening.

Examples of support from speech and language therapy

Speech and language therapy comes in different shapes and sizes to suit your child’s
needs. Some examples are:

 assessment and advice, plus programmes for school staff and parents to carry
out
 regular reviews at home or school with the speech and language therapist,
updating targets and strategies following discussions with the family and
teachers
 a course of intensive speech and language therapy to work on specific targets,
carried out by a speech and language therapist or a specially trained speech and
language therapy assistant
 group or paired sessions with other children – children can really benefit from
group sessions to help them to learn to listen, take turns and take part in
discussions with other children. Your therapist should already have taken steps
to make sure that your child will be able to understand the contributions of
others
 parents invited to attend a course about communication development and how
to help
 support and coaching for parents to build targets and strategies into everyday
routines
 ongoing speech and language therapy at school, particularly if your child is in a
special school or a mainstream school with specialist provision for deaf children.

For children who go to school or nursery, the speech and language therapist should be
working closely with all education professionals, for example, the Teacher of the Deaf,
support assistants and class teachers, to make sure that speech and language therapy
targets are built into school work and everyday activities, both at home and out and
about, to give the child as many opportunities as possible to learn and practise.

Working with your child’s speech and language therapist

  Let the speech and language therapist know about your child’s likes and dislikes,
hobbies and interests – they may be able to include them into therapy.
 Share important events that may encourage conversation. Let the therapist know
about the happy and sad events which may affect your child.
 Ask your therapist questions about your child’s communication and the targets
for therapy.
 Get involved in your child’s therapy sessions, and ask the therapist for games
and activities you can use in everyday life.

Remember, you’re the most important person when it comes to developing your child’s
speech and language skills and communication; there are a lots of different things you
can do at home to support them. Download or order our booklets for ideas and tips.

How does the role of a speech and language therapist differ from
what a Teacher of the Deaf?
How does the role of a speech and language therapist differ from
what a Teacher of the Deaf?
All Teachers of the Deaf will have had training on supporting deaf children’s language
development and will be able to give you advice on what you can do at home to make
sure your child makes good progress. They’ll also be able to advise staff working in any
early years settings that your child goes to.

A speech and language therapist will have had more specialist training on speech and
language. In particular, they will be able to provide specialist advice if your child is
struggling with their speech or language beyond what would normally be expected, or if
your child isn’t responding to any of the actions taken by your Teacher of the Deaf.
They may also be able to carry out more specialist assessments of your child’s speech
and language needs.

Teachers of the Deaf and speech and language therapists work together closely to meet
the needs of deaf children and, in some areas, they work together in the same team in
the local authority.
https://www.listeningears.in/speech-language-therapy/