There are different approaches to teaching language to a child who is deaf. No one approach is appropriate for every child with hearing loss. Rather, the parents, with the guidance of speech-language pathologists, audiologists, educators, and other professionals, should make the decision about how to teach their child language (Goldberg, 1996, pp. 288-289).

Manual Communication: Signing

One way of teaching language to a child with hearing loss is through the use of sign language. Different types of sign language exist, including American Sign Language (ASL). ASL is the language of the deaf culture (Gannon, 1996) and has its own grammar, semantics, and syntax (Gallimore & Woodruff, 1996). Words are represented by the hands’ movements and shape (Martin, 1997). Since ASL has its own grammatical, syntactical, and semantic rules, ASL is considered to be a language (Martin, 1997).

Another form of sign language is Manually Coded English (MCE) which follows English grammar, but typically uses the ASL lexicon (Martin, 1997). There are different forms of MCE such as Signed English, Seeing Essential English (SEE), Signing Exact English (SEE-2), and Linguistics of Visual English (LOVE) (Goldberg, 1996; Martin, 1997).

Total Communication

Total Communication was developed in the 1970s (Bodner-Johnson, 1996). This particular approach uses “every and all means to communicate” (Goldberg, 1996). To further elaborate, the individual with hearing loss and his or her communication partners typically use Manually Coded English, speech, gestures, speechreading, audition, and fingerspelling (Bodner- Jones, 1996). By using all these learning strategies, the child can choose how he or she can best communicate. As a result, the child may decide to use spoken language in one situation, but may decide to use a combination of speech and sign in a different situation (Bodner-Jones, 1996).

The Auditory-Oral Approach

The auditory-oral approach is based on the concept that society communicates largely through spoken language (Gatty, 1996). The goal of the auditory-oral approach is for the child to learn spoken language and to be able to communicate verbally (Martin & Noble, 1994). The children can look at the speaker’s face and mouth in order to lipread (Goldberg, 1996). Some children who follow the oral approach are fitted with hearing aids and use hearing to aid their speechreading (Gatty, 1996). Ling (1986) stated that those who are successful followers of the auditory-oral approach “usually have a good knowledge of spoken language, make use of both verbal and nonverbal contexts to provide cues on the intent of the message, and are able to synthesize the partial patterns perceived into a meaningful whole” (p. 25).

Cued Speech

Cued speech was developed by Dr. R. Orin Cornett in 1966 in order to make it easier for those with hearing loss to understand what was being said (Williams-Scott & Kipila, 1996). Since approximately 30% of speech can be understood when speechreading is the primary source of information (Gatty, 1996), Cornett developed eight hand cues which are placed at four different spaces near the mouth or throat. These particular hand cues represent phonemes which can be difficult to hear (Nicholls & Ling, 1982). The hand cues also differentiate between homophenous sounds (Goldberg, 1996). For instance, several phonemes such as /m, b, p/ look alike when spoken; when a cue corresponding to each phoneme is given, the sound is clarified. The hand shapes and positions are “always used in conjunction with speaking” (Williams-Scott & Kipula, 1996, p. 121).

The Auditory-Verbal Approach

The auditory-verbal approach is a philosophy where the child is taught spoken language auditorily. The auditory-verbal approach differs from auditory training in that auditory-verbal is a way of life; in contrast, auditory-training is often a supplement to other cues such as lipreading or signing (Pollack, Goldberg, & Caleffe-Schenck, 1997). The success of the auditory-verbal approach is dependent upon early diagnosis of hearing loss as well as early intervention (Auditory-Verbal International, 1991). Early diagnosis and intervention of hearing loss is crucial because the critical language and speech learning years take place during infancy and the preschool years (Pollack et al., 1997, p. 189). The child is fitted with hearing aids or a cochlear implant and is enrolled in individualized auditory-verbal therapy (Estabrooks, 1994a).

Auditory-verbal therapy is a family-centered approach, where the parents are active partners in the teaching process (Flexer & Richards, 1998). Additionally, the auditory-verbal therapist provides guidance to the parents, teaching them how to utilize and integrate the principles of auditory-verbal therapy into their lives (Estabrooks, 1994). There are nine principles of auditory-verbal practice which are integrated into the lives of auditory-verbal families. The principles are as follows: early detection, identification, and management of hearing loss; appropriate amplification; a parent partnership with the auditory-verbal therapist; total integration of listening into the child’s personality; one-on-one therapy; acoustic feedback; the following of an auditory hierarchy; teaching which is continually diagnostic; and the implementation of mainstreaming as appropriate (Auditory-Verbal International, 1991).

The auditory-verbal approach is diagnostic; that is, each therapy session evaluates the progress of the parents and the child (Estabrooks, 1994a). Since the goal of auditory-verbal therapy is that the children “grow up in typical listening and learning environments that enable them to become independent, participating, and contributing citizens in mainstream society” (Goldberg, 1996, pp. 290-291), the auditory-verbal approach “integrates listening into the child’s total personality” (Auditory-Verbal International, 1991, p. 15). Since the auditory-verbal approach stresses that the child grow up to be a part of mainstream society, the child is typically mainstreamed in his or her local school (Estabrooks, 1996).

The child is “stimulated with sound all the time” (Pollack et al., 1997, p. 143). In order for the child to focus on the auditory sense, the auditory-verbal therapist and parents often make use of a hand cue. The parent or therapist will briefly cover his or her mouth while speaking; this signals that the child needs to listen (Estabrooks, 1994b; Natural Communication, Inc., 1998). An additional aspect of auditory-verbal therapy is that normal patterns of development are followed (Natural Communication, Inc., 1998). The children can develop fluent spoken language skills and have a good grasp of the rules that guide spoken communication and language (Robertson & Flexer, 1993).

The focus on audition is not without reason. Stewart, Pollack, and Downs (1964) stated that “no amount of lipreading or kinesthetic training can develop normal skills of vocal usage; these must be heard to be reproduced” (p. 153). An additional benefit of this focus on audition is that children who follow the auditory-verbal approach have “normal inflection patterns and a pleasing voice in contrast to the ‘deaf’ voice quality usually associated with severe hearing impairments” (Pollack et al., 1997, p. 63). Documentation has shown that 95% of children with hearing loss have residual or remaining hearing (Rhoades, 1982). If this hearing is not utilized during the critical language learning years, the ability to comprehend auditory information deteriorates because of physiological factors such as the deterioration of auditory pathways (Goldberg, 1993).