Sensori-Neural hearing impairments and their affects on language development in children

The focus of this study is to discuss language difficulties in relation to children with sensor-neural hearing impairments. It will also include how practice can be organised to facilitate the development of oracy skills, which is the development of speaking and listening.

Language difficulties can affect different aspects of language. These include expressive, receptive and central difficulties.

Expressive difficulty is when children find it difficult to put words together to make sense even though they have understood what has been said to them.

Receptive difficulty is when children can easily make themselves understood but find it difficult to understand what is said to them.

Central difficulty is when children have difficulty communicating with others as well as understanding what is said to them but are able to show by their non-language skills that they have a good ability.

M. Warnock in Special educational Needs defines ‘Children with speech and language difficulties’ as

“Children whose language development is delayed, those who have severe problems of articulation, those who are dsyphasic and those who have other communication difficulties”

(Warnock: 1978 Pg 218)

As stated in the Handbook for Pre-school SEN Provision

“Speech and language difficulties refer to expressive language and comprehension as well as the ability to communicate in a variety of settings.

(C.Spencer and K Schnelling 1998: Pg 62)

Sensori-neural hearing impairments occur when the inner ear fail to respond to sound or the hearing nerve fails to carry information to the brain. Sensori-neural hearing loss is the most common type of hearing loss and is the most serious. This is because once damaged they cannot be repaired, only alleviated at least partially by hearing aids, although hearing aids only restore the missing loudness and do not restore missing clarity. Most children will benefit from a hearing aid with a sensori-neural hearing impairment, although a cochlea implant is available for some that do not gain benefit from conventional hearing aids.

Sounds are not affected equally with a sensori neural hearing loss. Hearing high-pitched sounds is far more difficult than low-pitched sounds. A child with sensori neural hearing impairment will hear a distorted version of the sound as well as a reduced ability to hear. The high frequencies are usually associated with consonants of speech and the low frequency sounds are the vowels. A. Freeland in his book ‘Deafness: The facts’ states “If hearing consonants is reduced, speech discrimination is poor” (A.Freeland 1991 Pg. 21)

With sensori-neural hearing impairments, important high-frequency components are unable to be heard, a child will not be able to follow more complex language.

This is shown in an example of a Nursery Rhyme in R.Guilford and G. Upton’s book ‘Special Educational Needs’

H_mpt_ D_mpt_ s_t _n _ w_ll

_ _i__ e_a_ _ or_er_a_i_ a o_der

(R.Guillford.1992 Pg. 133

As seen, the vowels are missing from example one, and the rhyme is quite easy to distinguish although in example two all the consonants have been removed and it is impossible to distinguish. This shows how difficult it must be for a child with a hearing impairment to understand speech. This is when a child may have difficulties in using speech themselves. If they can not hear the correct sounds, a child may not be able to say them.

Sensori-neural hearing impairments are often linked with recruitment. This is when sounds become distorted and occasionally painful when a voice is raised. If recruitment does occur with children extra care must be taken with their hearing aid.

Tinnitus is also linked to sensori-neural hearing impairments. Tinnitus can be defined as a subjective experience of noise when there is no external stimulation. The causes of tinnitus are caused by the pathological alterations in the cells of the cochlea sensory system and the physical distortion of the cochlea sensory system, which is why it is linked to sensori neural hearing impairments.

Sensori-neural hearing impairments are permanent and depending on the extent of the damage to the cochlea will depend on what the individual can hear. With a sensori-neural hearing loss, a hearing aid will only help improve hearing slightly and not restore their hearing to normal.

There are many types of hearing aids available; they are designed to improve the auditory signals experienced in everyday life. Unfortunately many hearing aids amplify all the sounds in a room which is likely to result in a high level of interference, especially in a classroom.

It could be said that treatment can prevent serious long-term hearing loss and if treatment is not provided, the child may be left with a continuing difficulty which may affect school progress. If a hearing impairment provides no result, the other alternative with a hearing impairment is a cochlea implant. This involves a series of electronic channels that are threaded into the non-functioning cochlea. Although a cochlea implant does not restore the hearing totally, it allows the child to have access to sound stimuli at the level of a child with a slightly less profound hearing loss. In all cochlea implants, an external microphone collects the sounds which are then passed to a speech processor after they have been converted to electrical signals. The speech processor passes on the signals to an electrode within the cochlea implant.

Wood et al (1986) says

“Hearing Impaired children can have problems learning spoken language and written representations of such language, because they here little (or nothing) of what people say”

(As cited in J. Pockerall & D. Messer: 1999 Pg. 95)

Pitner (1928) as cited in J. Bamford and E. Saunders (1991) researched sensori-neural hearing impairments linked to the use of nouns and verbs. It was found that children with hearing impairments used less verbs than a child without a hearing impairment, at the same age, also that children with a hearing impairment used a greater percentage ...

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Wood et al (1986) says

“Hearing Impaired children can have problems learning spoken language and written representations of such language, because they here little (or nothing) of what people say”

(As cited in J. Pockerall & D. Messer: 1999 Pg. 95)

Myklebust (1960) found a large number of children with hearing impairments who used only nouns. It was said that their sentences were “short, simple and telegraphic”

(As cited in J.Bamford and E.Saunders:1991)

“Those born with sensori-neural deafness or develop it prior to speech development there are serious implications for the development of speech”

(A. Freeland 1991 Pg. 29)

Myklebust (1940) cited in J. Bamford et al (1991) researched the language of children with hearing impairments compared to children without a hearing impairment. It was found that:- Sentence structure is more often than not simpler, the style of language is inflexible and stereotyped, content words were overused and function words were under used, also frequent errors of word order was used.

Children with a hearing impairment, do babble, vocalise and cry like a child without a hearing impairment would, although it is known that babies with hearing impairments produce a reduced range of sounds. When this has become apparent, speech rhythms, vowel distortion, omission of consonants and slow laboured speech is also noted.

All the above research shows that hearing impairments have a great impact on the development of language. They can result in a complete inability to understand language and a related inability to speak. Delays in language development caused by hearing impairments can last from several months to several years. A break of understanding may occur which will be come apparent from failure to grasp linguistical-based concepts, which are associated with new learning.

Gregory and Mogford (1981) suggest that children with a hearing impairment develop using the same process as children without hearing impairments just at different rates.

(As cited D.Wood 1989)

Quigley et al (1976) carried out studies of syntactic structures. Children aged ten to nineteen years with hearing impairments were tested on a wide range of sentence forms. This included the use of pronouns, question forms and verb processes. It was found that the children made slow progress although it was as a consistent rate.

(As cited D.Wood 1989)

The Hearing Speech and Deafness Centre state

“Special Educational Treatment is required for children with serious sensori-neural hearing impairments as they have difficulty learning speech and language”

(http://www.hsdc.org/cu-hearing.htm)

For a statutory assessment to be appropriate there is a great deal to be taken into account. Below are a few aspects, which are looked at for children with speech and language difficulties: -

If the child has a specific language difficulty which is linked by another learning difficulty, if the child shows difficulty in using language to communicate effectively and if it is likely that the child will require support from a special school, resource base or the service for Sensory Impairment.

The same is for children with Hearing Impairments: -

The child has a significant permanent hearing loss, the child has communication difficulties where speech and language is delayed and if there is a requirement for building adaptations.

Some would argue integration is the most important factor concerning children with special Education Needs. For children with a hearing impairment, it is a great advantage for them to be educated in a mainstream school. This is because they will be in a verbal/vocal environment, which gives them maximum exposure to spoken language.

It is unlikely that a mainstream school teacher will have sufficient skills, in communicating and enabling all National Curriculum subjects are followed and to be able to promote language acquisition.

This is linked to the development of oracy skills. Oracy is an important element in schools and the National Curriculum includes a whole attainment target to speaking and listening.

“This recognition of the place of oracy in children’s learning reflected how important the spoken word is within the language opportunities which should be provided for young children.”

(S. Clipson-Boyles 1996 Pg.21)

When considering oracy and children with hearing impairments, children should be given plenty of opportunities to learn to speak, to understand speech and learn through spoken language in school. Speech is the most acceptable form of communication for those who can hear and for children with a hearing impairment how they can access to the acoustic and/or articulatory codes that involve the acquisition and use of the spoken language could prove very difficult.

Fraser (1990) states there are three modes of communication, which have all been used in the education of children with hearing impairments. They are Oral, Sign Language and Total Communication. (R.Guillford 1992 pg. 140)

The Oral mode is split into two main approaches, the ‘traditional oral’ and ‘Auditory oral. The traditional method is focused on the development of language through lip-reading. The auditory method focuses on the hearing aid, the child is listening although there is no attempt to teach language skills.

“Early and consistent use of residual hearing will enable the child to develop listening experience which will facilitate the acquisition of the language experience and cognitive skills necessary for the interpretation of spoken language”

(R.Guillford and G.Upton 1992 Pg. 141

Sign Language is used by many that have a hearing impairment. It is now a recognised language and is used in its own right. Children with hearing impairments may use Sign Language as their first language and then go onto learn their mother-tongue as their second language.

The only draw back in the above is that the child may be ‘fluent’ in Sign Language and the child’s parents/guardians may not understand Sign Language at all. This may prove difficult in speaking to a child and also the child may not be able to communicate to his/her peers which may prove frustrating and the child feeling lonely. Although on the other hand if the child’s parents do sign, the child will obviously benefit from this and communication will be enhanced between them.

Some feel that Sign Language is not necessary, this very much depends on the individual, there are many different ways to communicate. It could be said that Sign Language is inferior and could discourage development of speech although Sign Language has its own vocabulary and grammatical structure. It gives a child the chance to communicate, to talk and to listen. The most obvious point which results in the above is that perhaps a variety of Sign and Oral language is essential. A child may use Sign Language when he is in a Hearing Impairment community and speak the best he/she can when not.

Most children with a hearing impairment will lip-read to listen. Lip-reading does not just consist of watching people’s lips, the child is likely to watch the whole face to understand more by watching expressions and body language. A child will look for contextual clues to make sense of what is being said.

Total communication is used to provide the child with many ways to access language. This includes, speech, signing, spelling out words on fingers and providing optimal use of a child’s hearing aid. This could be classed as the most important form of communication as it gives a child the chance to use different forms of communication.

“Many children, regardless of their degree of hearing impairment achieve high levels of speech intelligibility and learn effectively through the spoken language”

(D.Ling 1984 pg. 9)

This does not suggest that all children with a hearing impairment achieve high levels of speech. It states that the only way to access the codes of language is through oral education.

The National Curriculum has one component comprising both talking and listening. The Attainment Target for Oracy proposes the following aim;

“The development of pupils understanding of the spoken word and the capacity to express themselves effectively in a variety of speaking and listening activities, matching style and response to audience and purpose”

(S.Tann 1996 Pg. 43)

To develop speaking and listening skills in children, knowledge of the different ranges of talk is necessary. This helps to stimulate and support their development. To ensure oracy skills are being developed ‘Supporting Language and Literacy’ suggests there are five types of intervention that a teacher may use, These are:- initiation, information, feedback, prevention and response (S.C Boyles Pg 23)

Whilst children are in a mainstream setting they are close to children speaking which in turn may help them and develop their oral skills to the best of their ability. However, children can develop their own thought and language systems using Sign Language without being restricted to whatever they are able to hear and speak orally.

As a teacher who has a child with a hearing impairment in their class there are many different strategies that need to be taken into account to ensure that the child is included into everything possible. It is likely that a mainstream teacher will have some support or can speak to somebody who works with children who have hearing impairments on a full time basis.

Children with a hearing impairment may have a Speech Language Pathologist they specialise in the diagnoses and treatment of speech, language and related difficulties in children and adults. As already stated a mainstream teacher will have insufficient skills to develop and promote language so a speech pathologist is used. They are likely to treat articulation, phonological problems and a variety of language delays. If a child has a speech language pathologist, it is important that close contact is made between the teacher and the pathologist and the child’s parents’/guardians.

The most important aspect of having a child with a hearing impairment to ensure they develop oracy skills is to treat them the same as the rest of the class as much as possible. A child with a hearing impairment is more likely to benefit if they are sat near the front of the class. This way they will be able to lip-read easier without straining their eyes too much. Whilst a child is lip-reading it is important that teachers do not move around too much whilst talking. It is important to remember that as the child is concentrating on watching you all the time, to see what you are saying they may become tired. However, they should be expected to complete all work set whilst in the classroom.

Positioning is very important in a classroom, not only for the teacher and the child but for other adults as well. The child needs to be away from direct light, ensure they can see you clearly and other pupils in the class. If this is possible, it is also important to ensure the child with a hearing impairment knows who is talking. As a teacher, it is necessary to ensure the child is looking at you before you speak.

Once it is known that a child with a hearing impairment can see you and others as much as possible, the issue of whether the child understands needs to be thought of. To help any visual aids that could be used, to support what you are saying. Although it may be time-consuming to write everything down, pointing at a certain word may just help a child to understand a little bit better.

The classroom is another issue, classrooms can be very noisy places which can be very distracting for a child wearing a hearing aid. The problem with hearing aids can be adjusted slightly by fitting a child with a radio hearing aid and the teacher with a small microphone. From doing this, the teacher’s voice is amplified instead of all the other noises or voices.

Other issues in a classroom involves adapting the classroom as much as possible, for example carpeting the classroom to stop chairs scraping on the floor which will be amplified with a hearing aid, or putting plastic studs on the bottom of all chairs. Curtains can also help reduce sound, walls that have acoustic tiles and any soft furnishings added to a classroom which will help reduce speech perception needs to be taken into account.

Communication is another issue, which could be considered the most important when discussing oracy skills. Children model the language adults use, they learn how to say words on what they hear and what an adult says. When considering a child with a hearing impairment, speech needs to be a at a natural pace and clear articulation is very important. It is also important to remember that there are many words which sound very alike and especially when lip-reading will prove even harder for example words such as ‘bat’ and ‘mat’. When considering the above, it is not suggested that speech is mouthed with exaggerated lip patterns.

“Hearing impaired children need to hear colloquial and idiomatic uses if language in order to a acquire these for themselves”

(E. Andrews 1994 Pg. 69)

Sentences must not be long and complex, as a child would not be able to grasp all of it. Repetition is important especially when it is clear that a child has misunderstood what was said. Although sometimes they may have heard what was said just not understood. In this case a teacher would need to rephrase what was said. In the above case, a teacher must not assume that the child did not hear. A teacher will get to know the level of sentence complexity that the child can understand confidently.

When issuing a child with a variety of instructions, it may be necessary to ask the child to repeat what they are. This way as a teacher it will be known that the child has understood and the child will be clear of what they are expected to do.

A Language for Life states “The teacher’s own speech is a crucial factor in developing that of his pupils” (A. Bullock 1975. Pg 145)

Children in a classroom have plenty of opportunities for speech, whether it is on a one to one basis or in a group. Children should be encouraged to ask questions as well as provide answers although some children may not get the opportunity to do this. In this case group work is an advantage, it provides security for those who feel they cannot speak out in a classroom in front of everybody. The different audiences can help children, they make different social demands and each audience discussed above demand a range of speaking and listening styles.

As well as the points discussed above which involve classroom strategies other issues which need to be taken into account when considering children with hearing impairments is planning, this involves the preparation of subject material, presentation of information to pupils and interaction between children to develop learning. It may be possible to prepare the child for the lesson beforehand, different strategies to ensure that the lesson material has been though through and carefully detailed in order for the child to understand and follow everything through whilst in class.

When considering speech and language difficulties, it is important that teachers are clear about the learning objectives, they know what language skills they are trying to develop as with all activities. An important issue includes the importance of their language and how they communicate to the children.

As seen above, sensori-neural hearing impairments affect language development and children may find it difficult to communicate and develop language. Early identification is necessary when a child has a hearing impairment, this way depending on the severity, the child can be helped in the best way possible. If a hearing impairment is detected early, effective teaching and the use of hearing aids/cochlea implants can help language acquisition.

The teacher’s role is to help any child as much as possible and despite the disability, the teacher is there to make the most of a child’s education.

As the majority of children with hearing impairments have ‘hearing’ parents, it seems that the oral method is the most preferred, this is linked to the view that if a child learns to talk, they will be part of a ‘hearing’ community.

A child with a hearing impairment who has the ability to learn to speak and to understand speech in theory should be given the opportunity to do so.

Which way to communicate with a hearing impairment very much depends on the child, every child is unique with his/her needs, desires and personality. The most important factor is facilitating communication in the best way possible and to ensure the child has a variety of tools to communicate.

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