Listen, Look, Link: Adapting AAC for Children with Hearing Loss

Abstract

Because communication for deaf and hard-of-hearing (DHH) children is never ‘one-size-fits-all,’ intervention must accommodate complex individual needs. While modern screenings catch hearing loss earlier, 95% of these infants are born to hearing families, and 30–40% present with co-occurring behavioral, developmental, or genetic diagnoses that further impact language acquisition (Gallaudet Research Institute, 2013; Richlin, B et al., 2022). Navigating these compounding variables requires flexible tools and specialized expertise. This session frames how clinicians can collaborate with families to build tailored, multi-modal communication plans that optimize functional communication outcomes at any age. One approach to consider is the utilization of a Total Communication (TC) approach, including low-, mid-, and high-technology AAC and/or sign language in conjunction with spoken language (Hall et al., 2017). While TC is universally applicable, implementing it for the DHH population requires distinct clinical considerations that honor both technology needs and the unique cultural and linguistic components of the Deaf community. While typically hearing children utilize TC to reinforce spoken language, DHH children rely on it as a primary gateway to sensory and linguistic access. Within this framework, specific Listening and Spoken Language (LSL) strategies, such as Creating a Listening Sandwich, Acoustic Highlighting, and Auditory Bombardment, can be implemented in any setting, regardless of the child’s expressive modality. This foundational pairing of auditory and TC strategies establishes the clinical scaffolding necessary to select and implement the low- and high-tech assistive technology and AAC options detailed in the second half of this session.

When introducing an AAC system for a child with hearing loss, it is important to consider accommodations that may support their language and device skills. Accommodations for low-tech, mid-tech, and high-tech AAC will be discussed in this presentation. For example, real pictures and pictures of sign language signs can be incorporated in low-tech choice boards or core boards. Mid-tech AAC accommodations for this population include visual and/or tactile feedback when pressing the switch button and adding picture icons to buttons. There are a variety of options to support children with hearing loss who use high-tech AAC. Some devices allow the user to stream the auditory feedback directly to their hearing aids via Bluetooth while allowing the speaking voice output to come through the device speaker. Visuals can be incorporated to support user comprehension, such as adding symbols in the speech bar, changing button icons to include sign language icons, real picture icons, or video icons. Clinicians can program self-advocacy language, such as “too loud/too quiet,” “ears (hearing aids) on/ears off,” “I can’t hear you,” “help with ears,” etc. Rather than relying on auditory feedback for icon selections, visual and tactile feedback may be added via changing the color of the selected icon or programming haptic feedback. Three case studies will highlight opportunities to support children with hearing loss using low-tech and high-tech AAC with a variety of language abilities and communication needs.