Archive for the ‘Hearing Loss’ Category
I’ve mentioned the Captioned Media Program before, but it’s a topic that bears revisiting. Now called the Described and Captioned Media Program, this organization is funded by the U.S. Department of Education. Its mission is "to promote and provide equal access to communication
and learning for students who are blind, visually impaired, deaf, hard of hearing, or deaf-blind." The DCMP maintains a clearinghouse for information about all aspects of life with these disabilities and a huge lending library of videos and DVDs on all topics—captioned for the deaf and hard of hearing, or on audio for the blind. Many of the materials are also available online as streaming video.
If any member of your family is blind, deaf, or hard of hearing, your family qualifies for membership in the program and may check out library materials at no charge. Even the postage is covered by the program. I believe classroom teachers with qualifying students may also apply for membership.
We have checked out several good ASL instructional DVDs from DCMP in the past, and now I see that many of these (and others) can be viewed online as well. I’m thrilled; this is just what we need to carry us the next step down the road in our ASL studies.
Still trying to tidy up my archives. Here are the most substantive posts I’ve written about Wonderboy’s hearing loss:
The Speech Banana (hearing loss diagnosis)
Getting Ear Molds Made (a photoessay)
Practicing for Hearing Tests (games to help preschoolers in the sound booth)
Speech Therapy at Home
Newborn Hearing Test Advice
Sign Language (how awesome it is)
Learning ASL as a Family
Fun with FM (heh heh)
Expressive and Receptive Language
This Lilting House post gets more search-engine hits than anything else I’ve written. Every week I am amazed by how many people land on my blog via a search for “speech banana” and related terms. I thought it might be helpful if I reposted it here. This post was written in June of 2006. More recent posts on related subjects can be found in the hearing loss archive, including a photo essay about getting ear molds for hearing aids and advice regarding the newborn hearing screen.
Wonderboy’s hearing loss came as a shock to us. Sure, we knew he’d failed the newborn hearing test. Three times. But those rounds of testing were administered in the NICU where there is always a humming and beeping of background noise, and the tech had told us that ambient noise could skew the test results. We had more pressing things to worry about: his (minor) heart defect; his recovery from omphalocele repair surgery; the genetic testing necessary to determine whether he had a potentially serious chromosomal syndrome; the fact that he was going home on oxygen. At least he was going home, and we tucked the hearing-test business to the back of our minds and focused on the immediate business of keeping him alive.
Every month the health department sent us a letter reminding us to have the hearing screen repeated. Sure thing, we said, just as soon as things slow down a bit. We were constantly having to take him to some specialist or another. The chromosome study came back negative: his medical issues were not due to a genetic syndrome. He was just one of those babies for whom something goes slightly awry early on in utero, resulting in a number of physical abnormalities down the line. An MRI had shown brain abnormality, but what its effects would be, no one could say: time will tell, they said. (They are still saying that.) He had extremely high muscle tone (hypertonia) and could not stretch out his arms and legs very far. His fists were tightly clenched. He started physical therapy at four months of age. He required emergency surgery to repair a double hernia with incarcerated bowel. The cardiologist was still keeping a close eye on his heart. The hearing test would just have to wait.
Besides, we told ourselves, we know he isn’t deaf. He startled to loud noises. Of all the things there were to worry about, we really didn’t think hearing loss was one of them.
But by six months, we had suspicions. He wasn’t babbling. He didn’t turn his head at the sound of my voice, lighting up with recognition before even seeing me, as our other children had. We took him back for another hearing screen.
The audiologist said something about a “mild” hearing loss, and I thought that didn’t sound too bad. “Oh, no,” she told me, hastening to set me straight. “It isn’t like a ‘mild’ fever. ANY hearing loss is serious. Most speech sounds fall at the bottom of the scale, so if you have any hearing loss at all, you’re going to have trouble with speech.”
As it turned out, Wonderboy’s loss was a bit more serious than the audiologist first thought. Further testing placed him at the “moderate” level on the scale of mild—moderate—severe—profound. Unaided, Wonderboy’s ears can’t detect sounds softer than 50 decibels. Most speech sounds fall in the 20-decibel-or-lower range. Our little guy can hear vowel sounds, the louder middles of words, but few of the consonants that shape sound into speech. For Wonderboy, people probably sound a lot like Charlie Brown’s teacher. Wah-WAH-wah-wah-waahh-wah. We learned about the speech banana: the area on a graph that shows where speech sounds fall in the decibel and frequency ranges. Wonderboy can’t hear sounds above the horizontal 50 line on that chart.
(More or less. He has a sloping loss which is slightly better at the lower frequencies.)
By his first birthday he was wearing hearing aids, and what a huge difference we could see! Aided, he tests around the 20-decibel range. He hears and understands a great deal of what we say. He is two and a half years old now, and he is finally beginning to add some consonant sounds to his verbal speech. Daddy used to be “Ah-ee” and now he is “Gaggy.” (This cracks me up. You can get a lot of mileage out of calling your husband Gag.) Grandpa is Amp-Ha. Wonderboy’s baby sister is “Gay-gee.” As you can see, he doesn’t have a B sound yet. His M is perfect, though; I have been Mommy, clear as a bell, for over a year.
But Wonderboy’s verbal speech is only part of the picture. His actual vocabulary is enormous, thanks to sign language. He uses a combination of sign and speech; we all do. Although it appears he will be primarily a verbal person as he gets older, sign language will always be an important second language for him. Hearing aids, incredible as the technology is nowadays, don’t do you any good at the swimming pool. Just for instance.
Hard of hearing. It used to be a phrase that conjured up in my mind the image of a grizzled old man with an ear trumpet. What? What’d ye say? Speak up, lad! (Apparently he is a grizzled old Scotsman.) Now it applies to my son. Words pop up on a TV screen, “closed captioned for the deaf and hard of hearing,” and I’ll give a little mental jump: Oh! That means Wonderboy!
Watching our children learn to speak is one of the great delights of parenthood. We mothers tend to collect their funny pronunciations, their experimentation with the meanings of words. This time around, my joy has been doubled, for I get to see communication unfold in two languages. His funny little toddler signs are just as endearing as any “helidopter” or “oapymeal” ever uttered by a two-year-old. (“Oapymeal” was one of Jane’s. It meant oatmeal. I served it often just to hear her say it.)
I put some links in my sidebar for American Sign Language resources. I can’t say enough about the wonders and benefits of ASL, not just for deaf and hard of hearing children, but for all babies and toddlers, especially those with any type of speech delay. ASL is a beautiful, nuanced language, a visual poetry. I count myself privileged to have been put in the way of learning it. Jane is determined to certify as an interpreter someday, and I have to admit I’m a little jealous. I wish I’d learned at her age.
Wonderboy makes a fist and touches a knuckle to his cheek, wiggling the hand. “Ah-hul!” he shouts. Apple, in two languages. The speech banana? We’ll get there, one way or another.
*Audiogram image courtesy of GoHear.org.
• Signing Time DVDs
• More about Signing Time
• Rilla Signs
• Unsolicited Signing Time Commercial
• Signing with Babies, My Favorite Topic
As I’ve mentioned before, mommyspeechtherapy.com is a good source of tips for how to work on specific speech sounds with your children.
As I work (and play) with Wonderboy, I’ve come up with a few games of my own that are helping him practice the new sounds he is learning to produce. One particularly sweet one is how we practice the p sound, which is still relatively new for him. I thought it might help if he could feel it, feel how the air explodes from one’s lips during the puh sound. I touch my lips to his cheek, like a kiss, and say words like piano, pizza, apple, emphasizing the p. He has begun to reciprocate, pressing his little face to my cheek and puhracticing his puhlosives. It’s so cute, I want to eat him up, like pizza or an apple.
We also use the Visual Phonics signs to help make consonant sounds pop for him. Since sign is Wonderboy’s other language, having signs connected with sounds makes a lot of sense to him. If I make the visual phonics sign for the first sound in a word, and then follow with the whole word, both in English and ASL, he gets that the sound itself is something that can be broken out of the word and made on its own. So: buh, buh, baby. The "buh" is the Visual Phonics sign for the sound made by the letter b: you hold the ASL sign for b up to your mouth, and as you say "buh," you move the b sign rapidly away. That’s the phoneme sign.
We do this over and over, all through the day. Guh guh go, kuh kuh car, puh puh pizza. (Yes, more pizza. If you spend much time at my house, you know that we are all about the pizza here. I don’t cook for people. I invite them over for pizza. Can’t make it? Eh, we’ll order that pizza anyway.)
We’re working on developing his listening differentiation skills with a game we play with Rilla. Wonderboy thinks he is teaching things to Rilla (and he is), and this makes it loads of fun for him. He doesn’t realize he’s making big leaps himself.
We have a stack of pictures of objects with sounds we’re working on. Right now it’s the f sound, so we have fish, frog, fire, phone, etc. I lay out two or three of the cards and give Wonderboy or Rilla a block to hold. Then I’ll say the name of one of the items on the cards, and the child whose turn it is puts the block on the right card. It’s a very simple game and both the little ones eat it up.
For Wonderboy, what the game is doing is helping him hear the subtle differences between similar-sounding English words. With his hearing aids, he can hear a good deal of speech, but not everything—not some of the soft, unvoiced consonant sounds. So I lay out pictures of phone and bone, or fish and dish, and the game—which is great fun, especially because of the antics of little miss Rilla—hones his listening skills.
I think he is doing a lot of lip-reading. He’s a crackerjack at the game when he can see my mouth, and has more difficulty if I hide my lips behind a hand. When he sits beside me and chatters away, as is happening almost constantly these days, he cups my chin with one determined little hand, turning my face toward his. This is indescribably sweet, I have to say. At a birthday party a couple of weeks ago, a friend’s mother was watching Wonderboy talk to me, and she said, "That is so dear! The way he studies your face! He can’t take his eyes off you."
It is dear. It’s a good idea, though, to help hone his listening skills without visual clues when we can. So we play another game, also with Rilla, in which each child hold a little ball up to his or her ear, and I cover my mouth and make a sound. The game is simple: when the child hears the sound, he or she drops the ball into a container. We use an empty tennis ball canister. The main purpose of this game is to get Wonderboy into the groove of what happens in a hearing test when we go to the audiologist. In order to accurately test his hearing (and therefore ensure that his hearing aids are calibrated correctly, in the way that will give him the best possible amplification), we need him to respond to each sound he hears. The ball-in-canister game is one we can easily duplicate in the sound booth.
It’s also great fun. Rilla thinks it’s a hoot! Her excitement is infectious, and Wonderboy and I are usually in giggles the whole time. They hold the balls up to their ears just to reinforce that they are going to listen. Wonderboy thinks Rilla jumps the gun a lot; he doesn’t realize that she is hearing sounds that don’t exist for him. He doesn’t seem to hear S or SH at all.
I will repeat what I just wrote in an email to a fellow ClubMom blogger whose toddler son, the delicious Noah (over whom I have drooled in person), is going through the same Early Intervention evaluation process Wonderboy went through a couple of years ago. Noah has been diagnosed with speech delay, and I feel a bizarre and probably obnoxious urge to welcome Amy to the club. She mentioned on her blog that although they think hearing loss is not likely in his case, Noah will be undergoing a diagnostic hearing screen soon, to be safe.
And that prompted me to spout forth a great deal of unsolicited advice about how to get most out of a toddler hearing screen. Then it occurred to me that that’s what ClubMom is paying me for, to spout forth unsolicited advice on this here blog. So spout I shall.
When Wonderboy was an infant, his hearing tests were the auditory brainstem kind I wrote about here. But once he was a year old and had his hearing aids, his periodic testing shifted to a sound booth. Kids with aids need testing on a regular basis, to make sure the settings are right. As the child gets older and more responsive in the booth, the audiologist can better fine-tune the settings.
For a child under four, the big challenge of the sound booth hearing test is understanding what the audiologist wants him to do. Typically, the child will be in the booth with a parent or the audiologist’s assistant. The audi is behind a window, pushing buttons on her fancy machine. The child (or his helper) holds a toy or block up to his ear, and he’s
wearing little earplugs that pipe in sound, and when he hears a sound
he’s supposed to put the block in a basket or something. Then a little
monkey* in the corner bangs a toy drum and FREAKS HIM OUT. At
least that’s how it goes with Wonderboy. The drum-banging is supposed to be the payoff
for responding to the sound but Wonderboy suspects the monkey wants to eat
*(Sometimes the monkey is a rabbit.)
I don’t know why they never tell you in advance, but you can help this test go
much better by doing some prep work. You can play the
hold-the-block-to-your-ear-and-slam-dunk-it-when- I-go-beep game at home to get
him used to how the whole thing works. It’s good to hold a card or
something in front of your
mouth so he has to listen for the beep instead of watching you open
your mouth. Also try it with shhhh and ssss sounds, and clicks, and whispering of all sorts.
The first time we did this kind of hearing screen, it was a
big waste of time because Wonderboy didn’t know what to do. The audiologist
told me no worries, the first time is mainly to train the child to do
the test and we should come back next week. I wanted to scream because Scott had lost half a day of work to take care of the other kids so I could go to this appointment, and now
we were going to have to repeat the whole process. I would have had Wonderboy practice, had I but known. (Had I but known Google Reader.)
Say! I don’t think I ever showed you my snazzy blue ear molds. And after my nutty mother made you look at all those How Ear Molds Are Made pictures and everything!
You know how enthusiastically I recommend the Signing Time DVDs as a resource for developing expressive and receptive language skills in young children, even those whose hearing is normal.
I’ve written, too, about how useful I am finding the Visual Phonics program as an aide to helping Wonderboy (3 1/2 years old, moderate hearing loss) expand the range of consonant sounds he can make.
I’m always on the lookout for useful resources, and this website looks promising: Mommy Speech Therapy. Posts range from practical advice for helping a child work on specific sounds to informative discussions about working with speech professionals, getting a diagnosis, and when to be concerned about things like lisps, pacifiers, and thumb-sucking.
OK, so I’m 15 months late making this little PSA. I’ve been meaning to share this advice since the day Rilla was born—the day she failed her newborn hearing test.
Yup, that’s right, she failed. Just like her brother had failed, three years earlier.
Hearing loss can run in families, you know. When the hearing-screen tech gave me the news, it came as a bit of a blow. To be perfectly honest, the first thing that passed through my mind was: Oh dear God, where are we going to come up with another five grand for hearing aids?
(Did you know that most insurance companies do not cover hearing aids, even for children? Don’t get me started.)
But then I managed to collect my wits, or at least enough of them to ask some questions. Had she done the test in the newborn nursery? Yes, she had. Aha.
I had learned from our experience with Wonderboy that many newborns don’t pass the initial screen in the nursery, especially in a NICU (as with Wonderboy, but not with Rilla) where there is so much ambient noise. Wonderboy was tested three separate times on his discharge day before they gave up trying and sent us home with instructions to have him re-tested as soon as possible, but not to worry, it was highly unlikely he really did have hearing loss, it was just all the background noise in the NICU mucking up the test results.
"Ask for the newborn hearing test to be administered in the quiet of the mother’s room."
OK, in his case, it turned out NOT to be the ambient noise skewing the results; the kid really does have hearing loss. But still, that didn’t mean Rilla’s test had necessarily been accurate, and I wanted confirmation before leaping to conclusions.
I asked the tech if she could re-do the test, right there in my hospital room, where it was nice and quiet. I didn’t even have a roommate.
The tech was kind and sympathetic, but doubtful. "Honey," she said gently—they always call me honey, these hospital personnel about to deliver potentially upsetting news—at least, the female ones above age forty always seem to—"I’m willing to give it a try, but this is a brand new machine, state of the art, and it’s especially designed to NOT be affected by ambient noise. And with hearing loss in the family…"
"I know," I said. "But I think it’s worth our time to try."
"Well, what you need to do is have her re-tested in one month."
I sighed and explained that my HMO would make me go all the way to Richmond, 80 miles away, for further testing (this I knew from prior experience), and it would be a big pain in the neck, and if there was any chance today’s test wasn’t 100% accurate, it would be a huge help to me to give it another try.
Now it was her turn to sigh, and you could see her thinking thoughts about how you have to humor these post-partum mothers, and she shrugged and said, "All right. We’ll try. I’ll go get the machine."
She wheeled in the contraption and attached the little sensors to Rilla’s head, and stuck the thingamajig in her right ear. Then, while the test started running, the tech popped back into the nursery for a chart she’d left behind. When she returned five minutes later, she took one look at her State of the Art Machine and gasped.
"It’s finished already! It took me 20 minutes to get a finish before!"
Me: "Finished, good?"
But already I knew it HAD to be good, because the way this test works is the machine sounds little clicks into the baby’s ear, and the sensors record how many times a nerve twitches or something like that, in response to the clicks. You need a certain number of clicks within a certain window of time to get a "hearing is normal" result. If the twitches aren’t happening, the machine will keep on sounding clicks until a biggish chunk of time has passed, and then you get a "hearing is not normal" report like the one Rilla had already been given.
A finish in five minutes meant the machine had already counted enough nerve-twitches to know that Rilla’s right ear was working just fine.
The tech was openly flabbergasted. This is where this becomes a really satisfying story, because it is one of those rare times that an expert admits frankly, and with pleasure, that she was mistaken.
"I’m stunned," she said. "It’s not supposed to be affected by ambient noise, but obviously it is."
I could have kissed her.
She tested the other ear, and that side too yielded A-OK results in under five minutes. Rilla’s hearing was pronounced normal, and the stern document instructing us to take steps X, Y, and Z toward further testing was removed from her chart, ripped in half, and pitched into the wastebasket.
Of course, it’s possible for a child who passes a newborn hearing screen to show signs of hearing loss later in life, and sometimes it is years before a parent realizes there is a problem. If Rilla had been diagnosed with hearing loss at birth, or six months later like her brother was, or at any point in the future, we would deal with it, and it would be fine. The point of my pushing the tech to re-test, and the point of this story, has simply to do with a tip that can save parents time and unnecessary anxiety. When the hospital wants to administer a hearing test to your newborn, request that it be done in the relative quiet of the mother’s room or some other isolated place, not in the nursery.
The tech seemed somewhat dazed, but she was awfully sporting about it. She told me, "This is really going to change things for me. It usually takes me up to an hour to test each baby. I think you’ve just saved me a ton of time."
I can’t tell you how much I appreciated those words!
But I appreciated being spared the drive to Richmond, and the stress of putting baby Rilla through further testing (stress on her, I mean), and the month or more of back-of-the-mind worry we’d have had to deal with while waiting for the next test, even more. I was able to take her home without any questions gnawing at me, and when I think back to that peaceful, happy babymoon,
I’m terribly grateful the tech was willing to honor my request.
It’s been a while since I wrote about Signing Time, but it occurred to me that I ought to mention it for new readers.
The Signing Time DVDs are a wonderful series of half-hour shows designed to teach American Sign Language (ASL) to children. Adults who happen to be in the room will find they can’t help but learn as well. The shows are delightful, with catchy songs, cute kids, and practical ASL vocabulary.
Here’s an excerpt of what I wrote about Signing Time two years ago:
It’s hard for me to imagine our lives without Signing Time. Rachel Coleman, the creator, and her daughter Leah, who is deaf, and Leah’s cousin Alex, who is hearing, are practically part of our family. “Rachel says” and “Leah says” are regular utterances around here. When Wonderboy watches the videos, he looks back and forth from me to Rachel, or from his sisters to the children, in awed delight. His hands soar through the air, mimicking his beloved Rachel. He understands the spoken words “Signing Time” even without his hearing aids in. (This is significant. He probably hears something like “eye-ee-eye,” but he sure knows what it means.)
Rachel’s songs have become my personal highway belt-it-out favorites (along with Marie Bellet and Bruce Springsteen), because she *gets it* so completely. Leah was a year old when her parents learned she was deaf. Rachel’s family’s love and occupation is music, and my hat is off to Rachel Coleman for finding a way to so beautifully combine her old life with her new one. Next to the joy she has brought my children, my favorite thing about Rachel Coleman is her honesty in lyrics. Her song, “The Good,” expresses my understanding of motherhood better than anything I’ve ever written: “Maybe we won’t find easy, but baby we’ve found the good.”
Lately, Wonderboy has been re-immersed in these DVDs, asking for them daily. They are the ONLY television show he has ever shown any interest in watching, ever. When his sisters watch other shows, even cartoons, Wonderboy pays no attention. But for Signing Time, he is always all eyes and ears.
He has learned a ton of vocabulary from them, including (just lately) words like “remember,” “learn,” and “smart.” I wrote a post for Bonny Glen last night about what a big deal it is that he is now beginning to grasp abstract concepts (such as remember, learn, and smart!). I really think ST has a great deal to do with that.
Rilla (she is 15 months now) is also enchanted by ST and enchants the rest of us with her perfectly scrumptious signing…when she signs “More,” her daddy is putty in her plump little hands.
I also think the DVDs spurred Beanie along the path to reading when she was four and five years old. The English words for each sign appear on the screen before the signs are demonstrated, and those were some of the first words she learned how to read.
The shows are now being aired on PBS, so you can check your listings to see if it’s playing in your area. But the DVDs are a worthy investment (and they make great gifts). (And no, I don’t get a commission on these materials! I just love them.)
The first three volumes are simpler, younger, than later editions. Volumes 4-6 are my family’s favorites, except for Wonderboy, who prefers, ironically, the “Welcome to School” disk.
I see on the website there are two new “Practice Time” DVDs—I haven’t seen those yet.
We seem to have lost Volume 11, “My Neighborhood,” somewhere along the trail during our cross-country trip. I’m thinking about re-ordering it, because I know Wonderboy would be very into the whole police- officer-firefighter theme right now.
There is also a Signing Time blog and forum.
• Signing Time DVDs
• Rilla Signs
• Unsolicited Signing Time Commercial
• Signing with Babies, My Favorite Topic
Monday morning, early. Wonderboy and I are off to speech therapy in a few minutes. His sessions have been going wonderfully well, and he is now regularly saying B and P sounds. This is huge progress; two months ago his only consonants were M, hard G, K, N, and an occasional H (as in "Huh moni!"—that’s "Good morning" to you conventionally annunciating types).
He loves Miss Tammie, the speech therapist, and our fun half-hours in her room, playing games, singing (okay, listening to Miss Tammie sing), putting the buh buh baby and the puh puh popcorn on the buh buh bus, and the puh puh puppy goes in the buh buh box.
His astonishing and rapid progress is due in large part, I believe, to Tammie’s use of something called "Visual Phonics." This language development program is actually new to Tammie, and we are more or less learning it together. The concept is truly brilliant. In Visual Phonics, a hand sign is assigned to every single sound. It’s like taking the sign language alphabet (with which Wonderboy is already quite familiar, though he does not sign it himself yet—when he was two, his favorite way to fall asleep was to watch my hand while I signed and sang the ABCs) one step further.
For example, there a sign for the B sound (buh). You use the ASL sign for B, a flat hand, fingers together and pointing up, thumb folded over the palm, and you hold that handshape up by your mouth, moving the B away from your lips as you say "Buh."
Not all the Visual Phonics signs are based on the ASL alphabet; the P has your fingers sort of exploding away from your lips. Really, it hardly matters WHAT the signs are; the brilliant innovation was in attaching signs to these small units of sound. There are signs for every speech sound, including consonant blends and all the vowel sounds, including diphthongs.
Wonderboy GETS sign language; he knows how to connect a sign to a spoken word to a thing or idea. He clicked with the concept of buh and puh immediately, just as soon as we turned the sounds into Real Things for him by giving them signs.
I missed a chance to go to a Visual Phonics training session last month, but I’ll share more about the program as I learn about it. It is primarily intended to help kids struggling with reading, but Gallaudet and other institutions have recognized its immense value in both reading and speech instruction for deaf/hard-of-hearing kids. I imagine Visual Phonics is going to be a big part of our lives these next few years, first in helping my boy learn to speak English, and later in helping him learn to read.
Buh buh brilliant. Also, buh buh bye—I’ve got to run or we’ll be late!