The choice of communication and educational methodology for children who are deaf can be a very heated and emotional issue. The debate about “oral” vs. “manual” methods goes back over 150 years to the days of Thomas Hopkins Gallaudet and Alexander Graham Bell. Each method has many parents, educators, advocates, and others promoting it.
Ultimately, the choice of communication methodology is an intensely personal one that each family makes for itself. There is no one approach to language and educational development that is best for all children or families. Each family’s decision is based on preferences, priorities, and beliefs that are unique to them, as well as the resources and support available in their area and other factors.
The choices can feel daunting, but there is every reason to be hopeful! It is important to remember that there are many children (including children whose parents are part of the CI Circle Community) who are THRIVING using all of the different communication options. There are many paths to a full, happy, independent, wonderful life for your child! Also bear in mind that no choice is forever and that you can always adjust your approach if your child’s and family’s needs change.
Here is a brief overview of some of the most prevalent approaches to communication and education for children with severe-profound hearing loss.
AUDITORY-VERBAL: The Auditory-Verbal approach stresses the use of listening alone (with appropriate amplification, usually cochlear implant(s)) for the development of language. Visual supports (such as gestures, signs, and speech-reading) are not usually used and speech-reading may be actively discouraged/prevented during therapeutic activities by the adult covering their mouth, positioning themselves behind or beside the child, or by using distractions such as games and toys. Structured therapy activities stress the development of auditory discrimination and other listening skills, as well as receptive and expressive language development. The Auditory-Verbal method, which practitioners often refer to as the “A-V lifestyle” also emphasizes parental involvement in the therapy process, carryover of therapy targets into everyday activities, and education with typical, hearing peers. Some families choose to work with an AV therapist and apply many of the AV principles while also using a visual communication method at home and/or school.
AUDITORY-ORAL: The Auditory-Oral approach also emphasizes listening (with amplification) and spoken language, without the use of sign language or other systematic visual supports. Unlike in the A-V approach, speech reading is not discouraged and may be actively taught, based on the child’s need. Most families and therapists report that children with cochlear implants, especially those implanted in infancy/early childhood, do not rely on speech-reading to understand speech, although they may use it in noisy situations or when their equipment is off. Most “oral deaf education” programs, both private schools and public-school based programs, use the auditory-oral approach.
CUED SPEECH: Cued Speech is a system of hand-shapes and positions designed to facilitate speech reading by representing sounds. The use of the hand signals helps the listener distinguish between sounds (like /b/ and /p/) that look identical on the lips. Cued Speech is NOT a language; it is a method of representing spoken English (or any spoken language). The advantage of Cued Speech is that it gives the “listener” access to all the phonological information of spoken English whether or not she can hear them, which may help with both language and literacy development. Compared to sign language, Cueing can be learned very quickly, and any word (including proper names, words in other languages, etc) that can be spoken can be cued. Cued Speech never entered into wide-spread usage, although some individuals and their families achieved a great deal of success with the method and advocate it enthusiastically. Most cochlear implant users are able to access the phonological information of spoken language without the visual support of cueing, but it remains an option that families may want to explore.
American Sign Language: ASL is a distinct and complete language, with its own vocabulary and syntax not closely related to that of spoken English. It is the first and primary language of many Deaf adults and children (as well as the first language of some hearing children who have Deaf parents) and has a rich history and culture (with poetry, storytelling, etc). For most hearing parents of deaf children, of course, it is an unfamiliar foreign language that they will need to learn from scratch if they want to teach it to their child. Having evolved for communication among Deaf people, ASL (and other sign languages – there are many) is a visual-spatial language that uses movement, location, facial expression, and many other features to carry meaning.
It is very difficult to speak grammatical English and sign grammatical ASL at the same time (the neurologist Oliver Sachs, in his interesting if now somewhat dated book on Deafness, described it as “like trying to speak English and write Chinese at the same time.”) There are also systems that use manual signs (many of them borrowed or adapted from ASL) as well as invented signs and markers to depict spoken English manually – the most widely used of these is called Signing Exact English 2. These convey the grammatical information of English but can be challenging to learn and use. Most people (hearing and Deaf) sign somewhere along the continuum, using whatever combination of ASL and SEE signs and grammatical features they feel comfortable with (this is sometimes referred to as Pidgin Sign English, PSE).
There are many different ways that families can use sign in communicating with their deaf children. A few are described below. The label “total communication” (TC) is used to describe any approach that combines spoken language and signs. When considering a school program described as “TC,” parents should observe it carefully to determine what approach is used.
(Note: We have included this video to provide a visual representation of total communication in a school, we are not advertising in any way the school represented in this video)
KEYWORD SIGNING/SIGN SUPPORTED SPEECH – When they learn their child is deaf, many parents explore signing as a communication option. Those who opt to make signing, as well as cochlear implants and spoken language, part of their child’s communication experience have several options. One approach is referred to as “keyword signing” or “sign-supported speech,” among other labels. Families using this strategy use spoken English (or another spoken language) as their primary method of communication, but add some signs to support their child’s emerging language use and provide a “bridge” to spoken language. The number of signs learned and used is usually fairly limited (from a handful to a few hundred), representing some of the most important concepts and objects in a young child’s life.
Signs are always combined with speech, and usually only the most important words in the sentence are signed (e.g., a parent might say “Get your shoes” while signing SHOES or “I want another cookie please” while signing “WANT COOKIE PLEASE.”) Most families using this approach gradually fade the signs over time as the child’s spoken language develops, although some continue to use signs when the child’s implant is off (e.g., in the bathtub or at bedtime). This approach is very similar to the “Baby Signs” strategy popular with some families who use signs to “jumpstart” communication with their hearing babies and ward off frustration while speech is developing, although families with deaf children often learn more signs and use them more systematically.
SIMULTANEOUS COMMUNICATION – In the simultaneous communication (sim-com) approach, spoken and signed language (usually a manual English system like SEE2) are used at the same time. All messages are spoken and signed in order to convey the information both auditorally and visually. While some people are able to become very proficient in signing and speaking at the same time, others find it difficult and may simplify their sign, their speech, or both.
BI-LINGUAL/BICULTURAL -- The Bilingual-Bicultural (or Bi-Bi) approach aims to develop fluency in both ASL and English and allows children to function as members of both the hearing and Deaf communities. The philosophy of Deaf education developed a number of years ago and initially focused on fluency in ASL and written English, but the advent of cochlear implants makes bilingual fluency in spoken English an achievable goal as well. The Bi-Bi method stresses the integrity and separation of the two languages, so sim-com is rarely used, although one language may be used to explain vocabulary, structure, and concepts of the other. Many, but certainly not all, parents who choose this approach are Deaf themselves or have previous experience with Deafness. Learning ASL from “scratch” and teaching it to your child is a challenge, but one that some parents, drawing on support from schools for the Deaf and Deaf adults in their communities, have embraced.
By Marny Helfrich, M. Ed. As an early childhood special educator by training, I had the privilege of working with young children with hearing loss and their families for five years in an inclusive, open-minded, spoken-language focused program. In that time, I was lucky enough to get to know families using a wide range of communication strategies, from strictly AV to Bi-Bi, and to see their children growing and thriving!
