Consultation for a 3-yr-old with Hearing Aids and Pacifier Use

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I have a child on my caseload (aged 3) who has moderate high frequency hearing loss, hemiparesis and oromotor impairment. He has started using gesture (mainly pointing) and vocalizations (mainly /u:/) to communicate with adults. He doesn’t play with other children yet but I think that he’s overwhelmed by the noise of the childcare center as he only goes twice a week and doesn’t get to wear his hearing aids much at home (about 3 hours a week). He is often using a dummy at home. I would love some advice around where to start with this child and how to get the parents on board with hearing aid use and using strategies at home. The childcare center staff are on board and willing to implement strategies to facilitate the child’s speech and language development. Most of the work I am employed to do is consultative rather than 1:1 therapy so I need strategies that I can train the adults around the child to use. The parents are not willing to use signs and he would have trouble with them anyway due to his left-sided weakness. Thanks!

First Priority: The Aids!

The child will not learn to speak if he never hears speech.  Ok, so yes there are some exceptions to that but in all honesty, being able to hear the words spoken around him will make the most difference for him so I would start there.

You’re definitely going to need to do some parent education to make sure that they are on board with getting him to wear them more.  3 hours per week plus twice at daycare is just not enough.  Check out these tips for helping a child wear his hearing aids more.  https://www.speechandlanguagekids.com/when-a-child-wont-wear-his-hearing-aids/

Second Priority: Responding to Gestures

While the parents are working on the hearing aids situation and the child is getting more used to that, teach the family and childcare workers how to respond appropriately to his gestures.  That is the closest thing he has right now to language so everyone needs to respond as though he had spoken a real word.  Don’t pretend you didn’t understand in hopes that the child will then say a real word.  He probably won’t at this point.  Train everyone to acknowledge that they understand what he said but saying the word out loud and then following through.

For example, if the child points to the box of cookies and says “uh”, the adult also points to the box and says “Coookie. You want a cookie.  Cookie.” and then gives the child the cookie.  This will help the child feel the power of communication but also provide him with excellent models of the words he could be saying (especially if he’s wearing those aids!).

Third Priority: Ditch the Dummy/Pacifier

Really, this is usually one of my first priorities but since we’re introducing the aids as our first priority, we don’t want to overwhelm him by also taking away his source of comfort at the same time.  Once he’s used to wearing his aids frequently, start working on getting rid of the pacifier.

Fourth Priority: Consider AAC

If the child has been hearing with his aids for a while and doesn’t seem to be improving any from hearing all of those good single-word models, consider adding a form of AAC.  If the parents won’t do sign, that’s fine.  Look for other options that will work such as picture exchange or pointing to pictures.

If the family is on a budget, try a cheap option like this cookie sheet communication board: https://www.speechandlanguagekids.com/how-to-make-a-communication-board-out-of-a-cookie-sheet-for-autism-apraxia-and-aphasia/