First let’s begin with the beginning.
It has become largely known that when a baby is born a hearing screening is beneficial in detecting a hearing loss as early as possible. Every state in the U.S. has created a program designed for Early Hearing Detection and Intervention (EDHI) in hopes to support children and their families through their journey from Newborn Hearing Screening (Mandated in almost all states, Guam, Puerto Rico, and The District of Columbia) to follow up screenings, audiology appointments, amplification options and Early Intervention services.
A newborn hearing screening can include two types of hearing tests. An Otoacoustic Emissions Test (OAE) tests the outer hair cells inside the cochlea which is located in the inner ear and responsible for transmitting sound waves into neural messages for the brain to process. A small earbud like probe is placed in the ear and a stimulus is presented. The response is measured based off of the echo of the stimulus presented. The second test is an Auditory Brainstem Response (ABR) also known as an Auditory Evoked Potential (AEP). This involves small electrodes that are placed on the babies head while a stimulus is presented and measures how the inner ear and the brain process sound.
If a baby fails a Newborn Hearing Screening it is not to say that he or she absolutely has a hearing loss, but it is also not something to brush off. The follow up screening is very important to finalize the results of the initial screening. Some babies have trouble being quiet and still for the test which can result in failing the screening. Others may have blockage in the ear canal or in the middle ear which can result in a failed screening.
“Loss to follow up” is one of the biggest struggles at this time as many hearing losses are still going undetected for longer periods of time when the family does not keep the follow up appointment after a failed Newborn Hearing Screening. The follow up appointment will help finalize hearing screening results and plan next steps if needed. This is where Early Intervention comes into play.
Next Step – Early Intervention
Once child is diagnosed the family should be pointed in the direction of Early Intervention Services. The overall goal of Early Intervention services for children who have hearing loss is to learn communication skills. The first years of a child’s life are critical in learning about and obtaining communication skills. This is true for both Auditory/Verbal communication and Sign Language. Even though a child is not talking or signing themselves until a little later, the time before they begin speaking/signing is critical for absorbing and observing as they are training their auditory pathways and learning to listen. Babies begin hearing in the womb up to four months prior to birth and continue to stimulate their auditory pathways after birth while they watch and listen to those around them. Here they will make a transition from “hearing” which is the physical presence of sound waves traveling through the auditory system and being processed by the brain to listening which involves understanding what is being heard. If the child has a hearing loss during this “language learning window” it is important that the hearing loss be identified as soon as possible so plans can be made to acquire language in whichever way possible and preferred by the family. Amplification may be utilized to gain access to sound or sign language learning may be the solitary focus of the family’s next steps. (In my opinion sign language is beneficial for all children- typically developing hearing or not. More on this later!)
What is the Purpose of Early Intervention?
When I worked as an Early Interventionist, my main goal was to help support the family both emotionally and educationally so that they felt confident in their ability to make decisions and work on teaching the child the needed skills to learn to communicate. Hearing loss is reported as one of the top birth defects yet it is something that not a lot of people know about. I think it is essential that the parents/caregivers be educated on the etiology of the hearing loss, the type and degree, and to understand what that means for their child as far as affecting their day to day life in respect to communication, education, family life, and social emotional development. If the parent/caregiver feels knowledgeable about these aspects of their baby’s life they will feel more confident when facing decisions such as sign language and/or verbal communication, educational placement, amplification options, and how to teach the child to communicate wants and needs and interact with the family.
The Early Interventionist is not….
One misconception about Early Intervention services is that the Intervention Therapist will come to the house with their bag of materials and plans for lessons and spend their time one on one with the child, magically instilling skills during their one hour a week and poof! The child can listen, talk, hear etc. exactly as their typically hearing peers. While the one-on-one session with planned lessons is a model that has existed in the past, we have learned that with that set up the child is getting exposure to those strategies and skill work activities only during that one hour a week. This is very limited exposure to very important skill work during a very crucial learning window in the child’s life. Now the standard practice is to work off of the lead of the family meeting their most pressing concerns first and supporting the child by teaching the parent simple and easy strategies or tasks that can easily be built into daily routines. This way, the child is getting exposure to the skill work on a daily basis and the parent doesn’t feel like they have “homework” to make time for.
The Early Interventionist may Provide Services for:
An Early Interventionist that specializes in children who have hearing loss is knowledgeable and prepared to discuss and support the family in a variety of subjects such as:
- Reading the audiogram and understanding the child’s hearing loss.
- Working through and handling emotions regarding hearing loss.
- Support in making decisions regarding communication, amplification, and education.
- Amplification options/maintenance/function/strategies to encourage use.
- Communication modality options.
- Auditory skill development.
- Speech development.
- Language Development – Verbal and Manual.
- Educational Placement.
- Transition Services – school age.
- Individualized Education Plan (IEP) Concerns.
- Resources/Groups/Community Involvement
Some things to remember about Early Intervention for children who are Deaf and Hard of Hearing:
- It is critical to begin services as early as possible to begin working on skill development that may have been missed before diagnosis or that may require more direct teaching than children with typically developing hearing. (Children with hearing loss often times require more direct teaching as they may struggle to learn specific skills by overhearing as many other children do.)
- It requires a team effort from the Early Intervention team, Audiologist and the family for the child to gain communication skills.
- The Early Intervention Therapist is there to help in any way possible – Don’t be afraid to ask questions or voice concerns.
- The Intervention Therapist understands that you are the expert of your child and they are the experts in skill development – work together to create the most successful learning environment for your child.
- Be confident in your ability to learn, grow, and make decisions with and for your baby!