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Services for children who are Deaf or hard of hearing

Children born Deaf or hard of hearing, or who develop permanent hearing loss while they are very young, are at risk for delayed language development.

Research shows that delay in language development can affect cognitive, emotional and social development: how well a young child's language is developing is related to whether that child will be ready to learn when he or she starts school. The earlier a child's hearing loss is identified, and the sooner the child can receive support, the better opportunity that child will have to succeed in school.

The Ontario Infant Hearing Program (IHP)

The Infant Hearing Program is dedicated to serving the needs of children who are Deaf or hard of hearing and their families.

The Infant Hearing Program:

1. Offers universal hearing screening for all newborns, in order to identify infants who are born deaf or hard of hearing, or who are at risk for developing hearing loss in early childhood.
2. Provides services for infants and young children who are Deaf or hard of hearing, and their families, to support language development.

When you know your child is Deaf or hard of hearing

Your audiologist has told you that your baby is Deaf or hard of hearing. Now it's time to find out about the services offered through the Infant Hearing Program for your child and for your family. Making full use of these services, and continuing to use them as your child grows, is important to your child's future. The Infant Hearing Program will support your child's healthy development and preparation for success in school when he or she enters Grade 1.

Audiology services: hearing re-assessment

All babies referred from hearing screening have their hearing assessed by an audiologist.

Audiologists are specialists in the assessment of hearing and in working with technology such as hearing aids to help improve communication for people with hearing loss. The Infant Hearing Program audiologists have received advanced training in the latest methods, techniques and equipment for assessing the hearing of infants and young children.

Hearing assessment of infants is based on electrophysiological measures, which use special equipment and a number of tests. An assessment may take several hours to complete, because of the amount of information the audiologist needs to determine hearing levels. Babies usually sleep through the entire process.

The assessment provides:

• information about your child's type of hearing loss and about the degree of hearing loss
• information about how your child's hearing loss could affect language development
• information that will allow for a hearing aid to be fitted if that is the family's choice

As children grow older, other assessment techniques are used to monitor hearing over time. Ongoing audiology reassessment is important because it allows changes in hearing over time to be identified. Hearing aids can be adjusted and changes in services can be made as appropriate.

Audiology services: amplification

When parents know that their child has a permanent hearing loss, they may choose for their baby to use a hearing aid or other device used to improve hearing. Infant Hearing Program audiologists have specialized training in selecting and fitting hearing aids for infants. The audiologist will do an evaluation, and will select a device based on information about the child's hearing loss and other needs.

The audiologist – or a hearing instrument specialist who has been trained by the Infant Hearing Program – will show parents how to use and care for the hearing aids.

Your child's hearing will continue to be monitored, and adjustments will be made to the hearing aids as needed. These frequent services are provided by audiologists and hearing instrument specialists located as close to home as possible.

Infants who meet certain criteria will be eligible for the province's Cochlear Implant Program. Audiologists from the Infant Hearing and Cochlear Implant programs work together to assess the needs of the infant, and to decide whether an implant might be an option.

If your family chooses a cochlear implant for your child, you can become involved with one of the province's three pediatric cochlear implant programs as soon as possible after the identification of hearing loss. Your audiologist can help with a referral.

Language development: services to support you and your child

You will receive information about the services and supports for communication development that are available to you and your baby from your audiologist. These include:

• American Sign Language (ASL)
• Auditory Verbal Therapy (AVT) – an approach to help children who are Deaf or hard of hearing to learn to listen and to talk
• speech language pathology
• other services available in the community

Specially trained service providers, including speech language pathologists and ASL and literacy consultants, will give you ongoing language development services and support:

• An American Sign Language (ASL) consultant is a specially-trained Deaf adult who instructs families who have chosen American Sign Language as their communication method.
• Auditory-Verbal Therapy helps a deaf or hard of hearing child learn to listen and to talk. The provider may have a background in speech language pathology, audiology or education of children who are Deaf or hard of hearing.
• A speech language pathologist is a professional who works with children who have language delays or disorders, and their families. Because children with hearing impairment are at risk for language delay, the speech language pathologist works with the family to help their child learn language. The speech language pathologist will support the family in nurturing the child's communication development.
• Other service providers, such as teachers of the Deaf and hard of hearing, may support your family as the child develops.

As your child grows older, Infant Hearing Program professionals will continue to assess and monitor his or her language development, and may recommend changes in service delivery or approach. It will always be possible for families to choose different approaches to language development, different service providers, or additional supports, depending on the needs of their child.

Regardless of the approach chosen by families, the goal is for children who are Deaf or hard of hearing to develop language that is age-appropriate by the time they begin school, so that they will have the same opportunity as other children for academic success.

Family support

The Infant Hearing Program provides support services to parents as they adjust to the knowledge that their child is Deaf or hard of hearing. These services are provided by trained specialists, called family support workers. Family support workers are social workers who have received additional information on hearing loss, and on the implications of hearing loss on language development. Your family support worker will help to connect your family with the service providers you wish to meet. He/she will connect you with other community agencies, and will help to ensure that all of your needs as a family are met.

Developmental milestones in American Sign Language (ASL)

Listed below are some of the milestones that mark the progress of young children as they learn to communicate in American Sign Language (ASL). Also listed are some suggestions for what you can do to help.

Most children learn language in a predetermined order. Research indicates that children using ASL as a first language pass through the same stages of language development as hearing children using spoken language. You can look for these milestones as your child learns and grows.

Sign Language milestones

Birth to 3 months

• looks around with alertness
• is attracted to any human movement
• looks attentively at a person's face
• responds to smiles by smiling back
• enjoys cuddling and holding
• plays with hands and fingers and enjoys hand plays

What you can do

• look at your baby when feeding, bathing or changing him or her
• sign to your baby
• play with handshapes and use lots of facial expression when playing with your baby
• place fun, colourful pictures of ASL and the finger-spelled alphabet in your baby's room
• place a mirror in your baby's room, positioned so he or she can see you entering and leaving the room
• hold your baby while bouncing or dancing
• share picture books

3 to 6 months

• smiles, makes eye contact and laughs
• likes to be held facing out, towards any action that is happening
• laughs when seeing fingers approaching to tickle
• turns eyes to a flashing light
• turns towards vibrations when the door bell or phone rings
• is attracted to moving and coloured objects
• plays with hands and fingers and enjoys hand plays

What you can do

• smile and laugh with your baby
• sign with your baby to say what you are doing when you feed, bath and dress him or her
• show interest in the handshapes and facial expressions your baby makes and repeat them back
• hold your baby while using body rhythm or body movement

6 - 9 months

• enjoys hand babbling - repetitive hand movements such as opening and closing hands in a rhythm without associated leg movements
• turns head to locate moving objects, and to watch sign movements used to communicate
• looks at common objects and family members when named in ASL
• understands simple ASL words

What you can do

• point to people, pictures and common objects, sign their names and use simple ASL grammar
• watch signed children's videotapes with your baby
• look at books, point to the pictures and name them in ASL
• play games such as peek-a-boo with signs
• show interest in the signs your baby makes and repeat them back
• Do ASL nursery rhymes with your baby

9 - 12 months

• Begins hand babbling with varied patterns
• Begins to use simple movements with handshapes, such as straight forward or up and down
• points to self and things
• signs first ASL words using simple handshapes, such as "mine", "more", "milk", "mommy"
• has a vocabulary of 10 signs

What you can do

• comment on things you and your child are doing by signing about them
• learn what hand babbling looks like
• acknowledge and expand hand babbling by repeating it
• look for first signs and repeat and expand on what your child signs
• share ASL children's literature with your child
• play with your child using ASL rhymes and rhythms and have fun

12 - 18 months

• begins to combine ASL words into simple two-sign sentences, such as "eat more", "ouch fall"
• uses touch and gesture to summon parents and to indicate needs
• asks questions, such as: "yes" or "no" with eyebrows raised along with a sign such as "mine" to say, "Is it mine?"
• "what" or "where" with frowned eyebrows
• points, and can sign some letters of the alphabet
• uses negation – a headshake alone or with negative sign "no" or "can't"
• uses up to 40 signs, but understands many more

What you can do

• respond to what your child is signing rather than how he or she signs it
• accept and expand your child's sign attempts and respond naturally with adult signs
• sign ASL stories
  • with books
  • without books
  • with made up stories about pictures
• handshape stories
• show your child sign story videotapes and ASL poetry videotapes for children
• have a conversation by signing back when your child signs to you
• play games using toys and objects that your child enjoys

18 - 24 months

• uses 20 or more ASL words at 18 months
• combines two or more ASL words, such as "bath upstairs," "bye bye daddy," "stroller outside," "baby cry"
• linguistically points to self and others
• begins to tell stories about the here and now
• loves ASL stories and stories from books
• copies actions and facial expressions of characters in a story
• takes turns talking back and forth with you
• By 24 months, may have a vocabulary of more than 200 words

What you can do

• use a variety of signs and facial expressions when you have a conversation with your child
• recognize and respond to the meaning that's conveyed in your child's facial expressions
• act out stories with your child
• encourage your child to play with other children who use ASL, such as play groups, ASL story circle times
• have fun playing with your child and communicating about everything in his or her and your world!

Developmental milestones in spoken language

Listed below are some of the milestones that mark the progress of young children as they learn to communicate in spoken language.

These milestones are based on a child's hearing age – the length of time the child has been consistently wearing hearing aids and/or a cochlear implant.

Based on hearing age and other variables, children will pass through the same stages of listening, speech, language and cognitive development as children with typical hearing.

By 6 months

• turns to source of sounds
• startles in response to sudden, loud noises
• makes different cries for different needs – I'm hungry, I'm tired
• watches your face as you talk
• smiles and laughs in response to your smiles and laughs
• imitates coughs or other sounds – ah, eh, buh

By 9 months

• responds to his/her name
• responds to the telephone ringing or a knock at the door
• understands being told "no"
• gets what he or she wants through sounds and gestures, for example, reaching to be picked up
• plays social games with you, for example, peek-a-boo
• enjoys being around people
• babbles and repeats sounds – babababa, duhduhduh

By 12 months

• follows simple one-step directions – "sit down"
• looks across the room to something you point to
• uses three or more words
• uses gestures to communicate – waves "bye bye", shakes head "no"
• gets your attention using sounds, gestures and pointing while looking at your eyes
• brings you toys to show you
• "performs" for attention and praise
• combines lots of sounds as though talking – abada baduh abee
• shows interest in simple picture books

By 18 months

• understands the concepts of "in and out", "off and on"
• points to several body parts when asked
• uses at least 20 words
• responds with words or gestures to simple
• questions – "Where's teddy?", "What's that?"
• demonstrates some pretend play with toys – gives teddy a drink
• makes at least four different consonant sounds – b, n, d, g, w, h
• enjoys being read to and looking at simple books with you
• points to pictures using one finger

By 24 months

• follows two-step directions – "Go find your teddy bear and show it to Grandma"
• uses 100 or more words
• uses at least two pronouns – "you", "me", "mine"
• consistently combines two or more words in short phrases – "daddy hat", "truck go down"
• enjoys being with other children
• begins to offer toys to peers and imitates other children's actions and words
• people can understand his or her words 50 to 60 per cent of the time
• forms words and sounds easily and effortlessly
• holds books the right way up and turns pages
• "reads" to stuffed animals or toys
• scribbles with crayons

By 30 months

• understands the concepts of size (big/little) and quantity (a little, a lot, more)
• uses some adult grammar – "two cookies", "bird flying", "I jumped"
• uses more than 350 words
• uses action words – run, spill, fall
• begins taking short turns with other children, using both toys and words
• shows concern when another child is hurt or sad
• combines several actions in play – feeds doll then puts her to sleep; puts blocks in train then drives train and drops blocks off
• puts sounds at the start of most words
• produces words with two or more syllables or beats – "ba-na-na", "com-pu-ter", "a-pple"
• recognizes familiar logos and signs – McDonald's golden arches, stop sign
• remembers and understands familiar stories

Babies like it when you:

• Get down to their level so they can see your face. This tells them that you're interested in what they're doing and saying. It makes it easier to interact with you.
• Repeat the sounds they make. Babies enjoy making noises, and like it when you imitate them over and over.
• Sing and laugh, especially when you are feeding, bathing, and changing them. Remember to talk to your baby throughout the day about things you do and see – "Mommy's putting on her coat", "That's a big truck."
• Tell them the names of the objects they are looking at and playing with. Babies are interested in exploring and learning about new things, and like to hear what things are called.

Toddlers like it when you:

• Let them touch and hold books while you point to and name the pictures.
• Use real words instead of baby talk – "give me" instead of ta ta or "bottle" instead of baba.
• Take the time to listen to them – they want you to hear all of their new sounds, words and ideas.
• Give them simple directions to follow – "Go find your red boots".
• Use lots of different words when you talk to them – opposite words like up/down, in/out; action words like "running", "splashing", and descriptive words like "happy", "big", "little", "clean", "dirty".
• Encourage them to play with other children – at the library, play groups, park.