A Paradigm Shift in Practice

Becky Clem

Do you ever have someone inquire, “Why did you decide to become a Speech-Language Pathologist (SLP)/Audiologist (Aud.)/Teacher of Children with Hearing Loss/Deafness (TOD)?”  I love to share that my dad’s profession as a reconstructive and plastic surgeon led me to speech-language pathology.  His work with children with cleft lip and palate and his belief that SLPs played a critical role in his patients’ speech and language development influenced my career decision early in high school. I loved meeting his patients, learning about the surgeries, and seeing his beautiful reconstructive work on these small children. He frequently remarked that the SLP’s role was essential in helping these children have excellent speech and communication quality without social and emotional challenges.

Along my career journey, my passion for children with hearing loss and deafness developed.  My graduate school, Wichita State, required all SLP graduate students to take the maximum number of audiology courses possible. We did extensive hearing tests; used giant audiometers by today’s standards, made earmold impressions, debated the pros and cons of Aural-Oral and Total Communication at a monthly dinner, and fully integrated our thinking into the world of hearing.   One of my first clients was a homeless adult diagnosed with neurological deficits. As it turns out, he had an undiagnosed moderate to severe sensorineural hearing loss. Once fit with hearing aids, he began to explore the world of sound with joy and abundance.

Beginning the journey towards certification as a Listening and Spoken Language Specialist with Auditory-Verbal Therapy Certification was nothing less than an upheaval to everything I thought I knew about working with children with speech, language, and hearing disorders. From the beginning of my career, I wanted to work with children and only children in the field. In the field of LSL, the focus is guiding and coaching parents. LSL intervention was not taking the child to the therapy room for 30 minutes, 2 times a week, leaving the parent in the waiting room reading, watching TV or perusing the Internet! Parents would be in the sessions fully participating? How would I teach parents? Instead of using the SLP requisite mirror and photo cards for articulatory mouth positions, we would be teaching speech through listening only!  How was that possible?

There was a monumental paradigm shift in practice from my role as a speech-language pathologist to an LSL Cert. AVT speech-language pathologist. That shift changed my practice as an SLP for all my patients with communication disorders.

What did I learn along the way? I learned to:

  • Be open to learning something totally new and different. Learn with a clear mind and open heart.
  • Be willing to try new skills and methods even when they are not comfortable.
  • Be willing to have someone else evaluate your clinical skills. Be willing to have them evaluate and help immediately in the moment. As a clinical supervisor myself, it was rather humbling to have someone else evaluate my clinical skills in therapy sessions.
  • Be more concerned about learning and improving than what it might look like to the parent/family to have someone help you during the session.
  • Engage parents and family in therapy sessions, as full participants. The results in patient progress will be far beyond therapist-child only sessions.
  • Have the parent participate even in ‘the child does better without the parent’ situations.  How can we expect progress without the parents’ involvement in the session learning and practicing strategies?
  • Be willing to make mistakes. It’s okay!
  • Practice AVT strategies and techniques in as many situations as possible with children who have other types of communication issues.
  • Read current research about how we learn to talk by what we hear – not by what we see.
  • Ask questions of other disciplines who work with children with hearing loss.
  • Ask audiologists and TODs to teach you about what they do.
  • Be respectful of what others do in the profession of paediatric hearing loss.

A Paradigm Shift in Practice

What changed in my own practice as an SLP? I now try to practice by:

  • Involving all parents of my speech-language patients fully in therapy sessions had a dramatic impact on the child’s outcomes.
  • By teaching parents specific strategies for carry over and helping figure out ways to carry over in a functional way at home, results in faster discharge from therapy.
  • Growing my skill set to include how to teach to various adult learning styles.
  • Developing my skills in mentoring and coaching for parents and professionals could positively affect the outcomes for children with hearing loss.
  • Teaching children speech through listening instead of through vision and articulatory placement cues (exclusive of those children with motor speech disorders) leads to more natural sounds speech at discharge.
  • Evaluating suprasegmentals and vowels as part of articulation testing and conversation evaluation changed my starting point and goals for intervention.  Goals target errors in suprasegmentals and vowels before error consonants.
  • Being open to constant changes in the hearing technology field and learning how it could improve access to speech through listening for my patients.
  • Collaborating with other professionals within my own program and outside led to failures and successes. Learning from all encounters and using that information for future collaborations provided some key changes in my thinking and practices.
  • Partnering with families of children with speech, hearing, and language disorders is not exclusive to the field of LSL-AVT and paediatric hearing loss.  The principles especially related to “guide and coach parents” and “parents are the primary language model” became part of all my therapy sessions – became part of my professional personality and mission.
  • Parents want to be part of their child’s success. By guiding and coaching them to be their child’s primary language model and teacher at home and in the community, successful outcomes for children with communication disorders of any type are possible.

I am joyously passionate about pediatric speech-language pathology and pediatric hearing loss!  Speech-Language Pathology is a marvelous profession.  Megan Hodge, a speech-language pathologist at the University of Alberta has a perfect quote for my thoughts in closing:  “….a career in speech-language pathology challenges you to use your intellect (the talents of your mind) in combination with your humanity (the gifts in your heart) to do meaningful work that feeds your soul.”

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/a-paradigm-shift-in-practice), as being the originator of the content.

Why we believe in continued education

Stephen Owen

Growing up I learned that one can get great lessons from parables. What may appear, at first blush, to be just a simple tale can many times have a profound impact on its hearer.

Allow me to share one such story that I think encapsulates why, at SoundIntuition, we do what we do.

A very strong woodcutter once asked for a job with a timber merchant, and he got it. His salary was really good and so were the working conditions. For that reason, the woodcutter was determined to do his very best.

His boss gave him an ax and showed him the area where he was supposed to fell the trees. The first day, the woodcutter brought down 15 trees.

” Congratulations,” the boss said. ” Carry on with your work!”

Highly motivated by the words of his boss, the woodcutter tried harder the next day, but he only could bring 10 trees down. The third day he tried even harder, but he was only able to bring down 7 trees.

Day after day he was bringing lesser number of trees down.

” I must be losing my strength”, the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on.

” When was the last time you sharpened your ax?” the boss asked.

” Sharpen? I had no time to sharpen my ax. I have been very busy trying to cut trees…”

Continued education is key and it’s why we offer this blog, it’s why we provide training and it’s the driving reason behind the conferences we host. We believe that good is not good when better is expected. We believe that sharpening our skills from time to time is the key to success.

The origin of the quoted parable is unknown.
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/continued-education), as being the originator of the content.

Register for the October 30th WESS conference in Toronto


Friday, October 30, 2015

Registration: 7:45 a.m.
Conference: 8:45 sharp – 4:00 p.m.

Location: Gibson Ballroom of Novotel (Hotel)
3 Park Home Avenue, North York M2N 6L3 Toronto, Ontario, Canada



*$275 (+HST) for professionals; $175 (+HST) student rate with code;
HST is already included in the price on the registration page

Get to know our speakers:

Dale Atkins     |    Dave Sindrey    |    Karen MacIver-Lux

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Click to download .pdf of conference poster

Dr. Dale AtkinsDale Atkins, Ph.D. 

The author of several books, textbook chapters, and articles in popular and professional journals, “Dr. Dale”, as she is widely known, is a highly regarded motivational and keynote speaker who lectures worldwide at business, health, educational, and social service venues. With a special gift for presenting complex psychological, sociological, and educational research in understandable terms she appeals to a wide variety of audiences.

Dr. Atkins frequently comments on NBC’s Today Show and CNN’s Headline News about social / relationship issues. Additionally, she is a consultant and on-screen expert for several award-winning documentaries, news programs, and educational training films. She serves on the Boards of several non-profit local and national organizations and educational institutions whose foci are literacy, tolerance, wellness, community action, and child protection. An active volunteer, she and her dog are a certified “dog therapy team.”

Dr. Atkins earned a Ph.D. at the University of California at Los Angeles in Educational Psychology (Early Childhood Education); an M.A. in Special Education (Deafness) from Teacher’s College at Columbia University; and a B.S. from New York University. She has a private psychology practice in New York City.


Dave SindreyDave Sindrey, S-LP, Cert. AVT

David has published numerous workbooks and resources to help children of all ages learn to listen.  He is both the author and illustrator of the material he produces. Some of those include Listening Games for Littles (1997, 2002) and the Cochlear Implant Auditory Training Guide (2004). Mr. Sindrey has also developed several online resources including the the ListeningRoom at Advanced Bionics,  Speechtree, Listeningtree, and Actividades de Audición for Programa Infantil Phonak in Spain. His listening activities have been translated to Dutch, German, Spanish, French and Korean.  Since 2012 he has designed and illustrated 9 apps on iTunes that help develop and/or assess listening skills for children with hearing loss. Mr. Sindrey is currently working on completing a combined Masters of Audiology and PhD in Hearing Science at the University of Western Ontario, in London Ontario Canada where he lives with his family.

Karen MacIver-LuxKaren MacIver-Lux, Aud, Cert. AVT

AVT® is the president of SoundIntuition where she oversees the development of online training programs and products for professionals engaged in serving individuals who have communication disorder(s).

Karen has held the position of Lecturer in the School of Human Communication Disorders at Dalhousie University, and is currently a consultant to WE Listen International Inc. She has given numerous presentations internationally, and provides mentorship to professionals.

From 1997-2007 Karen worked as an auditory-verbal therapist and coordinator of clinical services at the Learning to Listen Foundation (LTLF), North York General Hospital in Toronto. In addition, she worked as a clinical audiologist for several years.  She also served as a director of the board of Auditory-Verbal International, Inc.  Karen has a congenital severe to profound hearing loss and is a graduate of LTLF.

Karen was honored by Maclean’s magazine as one of the Top 100 young Canadians of 2000 and received the Who’s Who in Students of American Colleges and Universities Award in 1993.

Karen has made contributions to the literature including: How the Student with Hearing Loss Can Succeed in College (2nd ed.) (1996), 50 FAQs About AVT (2001), Songs for Listening! Songs for Life!(2003), Listen to This! – Volume I (2004), The Listener (2000, 2005), Listen to This!-Volume 2 (2006), Auditory-Verbal Therapy and Practice (2006), Perspectives on Audiology (2009), 101 FAQs of AVT (2012) and Cochlear Implants (2014).


Download .pdf of poster here

Help! Teachers Can’t Understand My Child’s Speech

Rebecca Siomra

In my time working as a Speech-Language Pathologist, I’ve come to believe that our ability to effectively and efficiently communicate with anyone we meet can have a great impact on how we feel about ourselves and the people around us. Our ability to communicate can also have an impact on how others perceive us.

In my clinical work with toddlers, preschoolers and even school-aged children, parents often report to me that they aren’t able to accurately judge the clarity of their child’s speech because they are accustomed to the way their child speaks.  True enough!  This is why it is so important for parents, caregivers and teachers, whether it’s preschool or elementary school, to foster open lines of communication.  Teachers are valuable, often new, observers of the student and should be seen as an extension of a child’s support team.

Parents have reported to me that they become stressed when their child’s speech is judged by others to be difficult to understand; especially when it’s coming from their child’s teacher.  Parents know that, no matter what the child’s grade or level in school, success can be impacted by the effectiveness with which a student and teacher are able to communicate with one another or how they can be understood by each other. On the other hand, many teachers have reported that it’s not easy for them to share their concerns about a student’s speech and language skills with the student’s parents.  When parents let teachers know that they are open to communicating about their child’s development — either out of concern or praise — new opportunities for collaboration are created.  When both parties begin to trust that the other is working in the child’s best interest, the conversation can become less stressful and more productive for everyone.

Before I get to the heart of the matter, let’s have a quick refresher on some common speech and language challenges in children and how it affects their communication skills.  Even children who are very verbal may be extremely difficult to understand. Some children may do beautifully in formal speech testing, which usually consists of single words, while in conversation they may speak so quickly that their motor planning is unable to keep up with their thoughts. This can lead to decreased clarity of speech. Speech production relates to the sounds that we use when we talk and how we move from one sound to another to form words and combine those words together into phrases and sentences.   In addition to having some errors in their speech production, other children may have a very weak vocabulary.  Some children, when they want to share information and are unsure of which word to say next, may fill the gap with a nonsense word or even a mumble.  This certainly can have a negative impact on the clarity of their message. This is not necessarily due to speech production difficulties, but rather, language production.  Language production refers to which words we choose to use and the way we organize them into phrases, sentences and stories.

Tips to Facilitate Dialogue and Effective Collaboration

When a teacher or parent approaches one another to express concerns about a child’s speech and language, there are a few tips to consider that will facilitate open and collaborative dialogue which may lead to positive change and outcomes for the child.

  1. We live in a society in which the majority of communication is through e-mail and other forms of technology, but live communication can feel more personal and a child’s communication skills is a very personal matter! Arranging a face-to-face meeting with the parent or concerned teacher, or at the very least, having a conversation over the phone is a wonderful way to communicate!
  2. Be ready to ask the concerned parent or teacher questions about the child’s communication effectiveness.  Questions such as, “How much of what the child says does the teacher/parent understand?, Is this difficulty impacting his or her ability to have their needs met though the day?, Can the teacher effectively evaluate/assess the child? and, If not, can the parent suggest other ways for the teacher to get the information they need?”
  3. Ask the teacher or parent how the child is coping at school or home when they have a difficult time conveying what they want to say.  Some children are very easy-going about repeating themselves and clarifying what they say, while others may become frustrated or may even withdraw.  If the child is struggling emotionally or socially, they may need a little extra support to cope as they continue to work on their speech or language production.
  4. Share information about services available to the child. What services is the child receiving?
    Explore the effective (and ineffective) strategies that are being used within the home and classroom that help the child develop clearer speech and spoken language. A communication book that can go back and forth between the parent and teacher is one way to effectively share information and continue a collaborative partnership.

Clarity of Speech

Tips to Facilitate Improved Speech and Language Production 

Parents and teachers jointly share the responsibility of helping the child reach his/her highest spoken communication and academic potential. Here are a few tips that can help bring about positive changes in the clarity of child’s speech and language.

  1. Even though the primary concern is the child’s level of speech clarity, arrange for a referral to a Speech-Language Pathologist for a speech-language assessment AND with an Audiologist for a hearing assessment. A hearing assessment provided by an Audiologist will let the parent and teacher know if the child has good hearing access (auditory access) to spoken language (primary speech signal). If auditory access to the primary speech signal is weak or inconsistent, speech and language development will be at risk. Even a minimal hearing loss (e.g. ear infections) can cause sound to be muffled to the child.  Within a noisy setting such as a classroom, in order to learn effectively, children need the primary speech signal (teacher’s voice) to be significantly louder than the background noise. Even if the child has already passed a hearing screening test, it is recommended that the hearing is screened annually. Hearing thresholds (levels) can change over time, and a child may hear differently today than they did a year ago.
  2. Ask ‘yes/no’ or choice questions to ease communication stress.  When answers are limited in this way there is a greater chance that the response will be interpreted correctly and clearly understood.
  3. Ask the child to ‘show’ you what he/she is talking about.  This can create a way to clarify a message that was not understood.  Some ideas are:  pointing to a picture, photo, person, or object or using gestures and facial expressions.
  4. Have the child write the message. For those children who are old enough, they can write/type out a message, when the teacher needs clarification.
  5. Get down to the child’s level and ask him/her to ‘say it again’.  It is important for children to know that what they are trying to say is important.  The parent or teacher may catch the message the second time, or the child may rephrase in a way that is easier to understand.  Keep in mind that not all children will tolerate this strategy, and even if they do, they may only tolerate it to varying degrees.  Some children will be comfortable repeating once, and become frustrated with future repetitions while others will happily try over and over again until their message is understood.

When parents, caregivers, teachers and other professionals in the community reach out to one another and work together as a team to uncover and find solutions for a child’s communication challenge, they may be opening up new doors for that child and their future.  Communicating effectively and easily, gives the opportunity to develop friendships, learn, or tell others about ‘that funny thing that happened today’.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/teachers-cant-understand-my-childs-speech), as being the originator of the content.

Hearing Screenings for Home birth Babies

Shannon Palmer

Imagine a family anxiously anticipating the birth of their child. Mom gives birth to a healthy baby girl in a hospital in Michigan. Michigan is a state that has implemented universal newborn hearing screening. The baby’s hearing is screened and they are immediately referred to an audiologist. Hearing tests reveal that the baby has a permanent hearing loss. The baby is fit with hearing aids and the family is enrolled in an early intervention program to help the baby learn to listen, understand and use spoken language.

For many parents of children born with hearing loss, this is a common scenario due to the ability to identify children with hearing loss at a young age that is made possible by universal newborn hearing screening.

According to the Joint Committee on Infant Hearing (2007), when a baby with permanent hearing  is identified and enrolled in an early intervention program by 6 months of age, that baby will have the potential to develop age appropriate listening and spoken language skills. For this reason, universal newborn hearing screening programs have been implemented in all 50 states of the United States and early intervention is a reality for many children born with hearing loss. However, there is a population of children who are routinely missing out on this opportunity—children born at home.

Families choose home births for many reasons: proximity to a hospital, religious reasons, a desire for limited medical interventions, or cultural reasons. Unfortunately, these families often face obstacles when trying to obtain a newborn hearing screening for their babies and, therefore, do not get a hearing screening (American Academy of Pediatrics (2011). The obstacles faced by home birth families are often specific to the population of home birth families and the region where they live. In discussion of potential obstacles with home birth families in MI, several common barriers arose.

The first obstacle is simply making and getting to an appointment at a hospital or clinic for the screening. It may be difficult or inconvenient to travel to an outside appointment shortly after the birth of a baby. This is especially true for Amish families who must arrange a ride from someone in their community to travel to the nearest audiology facility. The family may also prefer to avoid hospitals or other medical offices to prevent exposure of their baby to those environments.

Families may also encounter a financial barrier when trying to get a hearing screening for their baby. When a baby is born in a hospital, the cost of the newborn hearing screening is often bundled in with the other services provided and covered by their insurance coverage. If it is not bundled with routine infant care, insurance may or may not cover the cost. Outpatient hearing screening can often result in a higher charge to the parent. Paying for this testing, out of pocket, may not be feasible or be deemed unimportant for many home birth families.

Midwives who attend home-births and provide routine care to these families are in a unique position to help overcome these barriers and obstacles. Midwives are trained healthcare providers who have an expertise in prenatal care, natural childbirth, and postpartum care. They provide care for mothers and their babies, often in the family’s home. It has been concluded that training midwives to complete newborn hearing screening would remove the barriers of time and travel. Further, if midwives were to include the cost of the hearing screening in the price of their services, the financial barrier would be reduced as well.

Unfortunately, most midwives have not been previously trained in how to complete this type of testing and they, typically, do not own the equipment necessary to do a hearing screening. The cost of an automated auditory brainstem response (AABR) unit can be up to $15,000USD and most home birth midwives would not be able to afford this equipment on their own. In the state of Michigan, efforts have been underway making important changes, to ensure that this becomes standard procedure independent of where births take place.

Nan Asher, from the Michigan Early Hearing Detection and Intervention Program, Wendy Switalski from Audiology Systems, and I have been working together to provide AABR equipment to midwives across the state of Michigan. Funded by a grant from the Carls Foundation through the Michigan Coalition for Deaf, Hard of Hearing, and DeafBlind People, fifteen AABR units have been purchased and distributed them around the state. Midwives who will be using this equipment have completed an online newborn hearing screening training module and have received hands-on training with the screening equipment. The training module was created by the MI Early Hearing Detection and Intervention program for all providers who will be completing newborn hearing screening. This module covers information about hearing and hearing loss, risk factors for hearing loss, the type of screening tests that are done, and how to complete and report the results of the screening. The midwives completed this online training on their own time before attending a hands-on training session. The hands-on sessions showed the midwives how to use the equipment, how to report the screening results, and what to tell parents about the results of the screening. Midwives were then able to complete a practice screening using the equipment and a baby doll with a simulated hearing loss.

A baby having their infant hearing screening done by a midwife. (photo: Martin Lux)

A baby having their infant hearing screening done by a midwife. (photo: Martin Lux)

Each AABR unit was given to a midwife or birthing center in a different region of the state and the equipment is being shared among all midwives in that area who have completed both phases of the training. The equipment was distributed based on need — areas with busier midwives received more AABR units. Generally, areas with more the 5-6 midwives or more than 2-3 midwifery practices were considered busy. Annual calibration and refresher training will be provided to make sure that all equipment is functioning correctly, and any problems or questions from the midwives can be answered.

So far, this project has been very successful: 50 midwives*, doulas, and midwifery students have completed the entire training process. Prior to the implementation of these training sessions and equipment, only 19% of home birth babies in Michigan were getting a hearing screening. As of September 2014, that number has increased to 66% — a huge increase! Although we would like to get the number closer to what is seen in hospital births (97% in Michigan), this has been a great start. The midwives we have talked to have been very interested and supportive. They have reported that many of the families they work with have also been open and enthusiastic about having their babies screened.

Typically, Michigan midwives complete the initial hearing screening at their 1 week check-up appointment and if the baby refers in either or both ears, they are re-screened at a subsequent visit. This allows the midwives to meet the Early Hearing Detection and Intervention Program’s goal of completing the newborn hearing screening by one month of age. Babies that refer in either or both ears on the re-screen are referred to an audiologist in their community for a diagnostic auditory brainstem response (ABR) test.

A similar project has been conducted in the state of Utah. From 2007-2013 Utah purchased 23 Otoacoustic Emissions (OAE) screening units and distributed them to midwives in their state. Following implementation of their program the rate of newborn hearing screening for out of hospital births has increased from 2.5% in 1999 to 80.6% in 2013 (Smith, S., Wnek, S., & Badger, K., 2015).

The success of both the Michigan and Utah programs demonstrate several important things.

  1. Many midwives are open to the idea of performing hearing screenings for their clients — Many of the midwives that participated in the Michigan project expressed excitement about being able to provide a service that is routinely offered in a hospital, in the comfort of a family’s own home. Midwives want to provide the best possible care for their clients and by conducting hearing screenings they are able to provide truly comprehensive postnatal care.
  2. Home birth families are open to the idea of having their baby’s hearing screened — Families that choose a home birth are not always opposed to traditional medical care. Regardless of the reason for choosing a home birth, these parents want the best possible care for their babies.
  3. Providing the hearing screening in the family’s home or at a local midwife’s office overcomes many of the barriers of travel or aversion to hospitals — Training and providing midwives with the needed equipment allows them to conveniently conduct hearing screenings as part of their routine follow-up care. Families will no longer be required to make a separate trip to complete the hearing screening.

So what can you do in your own community?

  1. Contact your local midwives. Talk to them about their needs, level of interest in performing hearing screenings, barriers in place for their clients, etc. This will give you a good idea of the current situation that they are facing. Find out if there are other ways to overcome some of the obstacles. These solutions could include some educational materials for midwives and their clients, a better referral process for a hearing screening or transportation assistance.
  2. Identify some funding agencies that would be interested in providing hearing screening equipment to midwives and find out what their requirements are to obtain funding.
  3. Gain a good understanding of the current climate in your area you may be able to come up with some creative solutions that will make a difference.

Before the implementation of universal newborn hearing screening, the average age of identification for children with hearing loss was two years old meaning that children born with hearing loss missed out on two years of sound. This can have a profound impact on speech and language development. Hospital-based newborn hearing screening programs, have brought the average age of identification to six months. The implementation of newborn hearing screening program for home birth babies can allow children born at home to take advantage of the same opportunities provided to children born in a hospital.


* Midwives are not licensed in the state of Michigan

Reference: American Academy of Pediatrics [AAP] (Feb, 2011). Reducing Lost to Follow-Up Rates in Out-Of-Hospital Birth Populations.  EHDI E-Mail Express. Accessed November 15, 2014.

Smith, S., Wnek, S., & Badger, K. (2015). Out of hospital midwives: Improving compliance with hearing screening in Utah. The National Early Hearing Detection & Intervention Meeting. Louisville, KY.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/hearing-screenings-for-home-birth-babies), as being the originator of the content.

A Global Effort to Help Children With Hearing Loss in Vietnam Learn to Listen and Talk


The sounds of children laughing and chatting on the playground are what first greet visitors approaching the gates of the early intervention building at Thuan An Center in Vietnam. One would think this was a typical playground scene found anywhere in the world, and it is, save for one extraordinary element. These young children, vocally communicating with each other and their parents, are all deaf or hard of hearing. This is one example of success resulting from the hard work that has been done in Vietnam over the last several years to make it possible for such young children with hearing loss to learn to listen and speak.

Thuan An Center is a residential school for the deaf established in the 1800’s by a French priest. The grounds with its colonial buildings have retained much of its old-world flair. About 200 boys and girls older than 7 years of age who are deaf come here from provinces around South Vietnam to board and acquire a sign language-based education. In the late 1990’s, the director of Thuan An Center, Nguyen Thanh Thu Thuy, took part in a training program in Europe that taught about the benefits of early intervention in helping young children with hearing loss learn to listen and talk. She learned that all children develop language in the first years of life. And, that it is critical to introduce sound to children who are deaf or hard of hearing through hearing aids or cochlear implants as soon as possible and provide early intervention services to foster their listening and spoken language abilities. Thuy returned to Thuan An Center determined to establish such early intervention services at her center for toddlers and children under 6 years of age with hearing loss. She struggled at first because it was a challenging undertaking in a country that lacked the necessary knowledge and expertise to make such a venture successful.


My first visit to Thuan An Center was in 2008 as part of a volunteer assignment to teach English. Thuy had never met an adult such as myself who was born with hearing loss and yet communicates solely through listening and spoken language. Upon introductions, Thuy immediately led me into her office, sat me down, and asked me to share my background. I told her about how I was identified with severe to profound hearing loss at 11 months of age and fit with hearing aids while my family was living in England as expatriates. I shared with her the audiology and early intervention services that I and my family received in those first years in both England and in the United States. That early support enabled me to enroll into mainstream schools throughout my academic career starting at kindergarten. After earning a Master’s degree, I held various marketing positions, including at Fortune 100 companies, for several years.

I knew that services for children with hearing loss in low and middle income countries such as Vietnam were not at the same level as in the United States and other higher income countries. However, I was still touched by Thuy’s intense interest and marveling reaction to my life experiences that derived as a result of the early support I received. As I engaged with the children at Thuan An Center over the next several weeks and learned from their teachers about their limited future education and employment prospects, it struck a chord with me. It did not seem right that these children would have reduced opportunities in their lives simply because of the lack of awareness and resources for pediatric hearing loss that exists where they were born.

There are no audiology degree programs in Vietnam. Most of the teachers and therapists working with children with hearing loss have undergraduate degrees in special education. There are no advanced degrees in deaf education. Only in recent years has a speech pathology certificate program been established.

During that first visit to Vietnam, I did teach English. However, it soon became clear that my purpose was going to be much broader. Thuy brought me with her to various meetings with colleagues and academics. She would nudge me, “Paige, just say something. Say anything.” I would say a few words and she would point at me with eyebrows raised. Her eyes dancing in excitement, she remarked to anyone who would listen, “See! See what is possible for someone born with a severe to profound hearing loss?”

I asked Thuy what would be most useful in her efforts to develop services for children with hearing loss in her country. She could have focused on her own school and the needs of her own fledging early intervention program. Instead, she expressed an urgent wish for a training program that would educate teachers, therapists, and other professionals throughout her country about how to help children 0-6 years of age with hearing loss learn to listen and talk. A training program would transfer essential knowledge to the Vietnamese so they could provide direct service to the children and also prepare them to train others in the country. The whole system of early education for these children could then improve and become more widely available to families. It was a powerful vision and one that I immediately got behind.


After returning to Seattle, Thuy and I communicated via email to develop a proposal for a multi-year program to bring training in audiology, early intervention, auditory-verbal practice, and speech pathology to Vietnam. I shared our vision with professionals in my city working in audiology and auditory-verbal practice and they volunteered to lend their expertise to the effort. We worked together to develop a curriculum that they and others in their respective fields would teach in Vietnam.

As I sought funding and support from organizations to bring our proposal to life, I recognized an opportunity to develop an alternative model to what currently existed to address pediatric hearing loss in developing countries. The Global Foundation For Children With Hearing Loss was established in 2009 with this model in mind.

The Global Foundation For Children With Hearing Loss takes a comprehensive, long-term view to the issue of pediatric hearing loss. Our approach is to collaborate with local partners across education and hearing health care in a developing country to identify and address gaps in the country’s support system for babies and young children with hearing loss learning to listen and talk. We promote early identification of hearing loss. We provide training to professionals and families about best practices in audiology, early intervention, and auditory-verbal practice. We help establish new processes. We work to raise awareness about pediatric hearing loss and how it can be addressed.

Our Vietnam Program launched in July, 2010 with a Summer Training Program involving 95 teachers and therapists representing 35 schools across 20 provinces in South Vietnam. In 2011, we added our audiology training program for audiology technicians. Soon after, we started a hospital program to train medical professionals and ENT doctors. We also initiated training sessions to parents of children with hearing loss so they could learn how to support their child’s listening and spoken language development. Today, our Vietnam Program touches over 250 education and healthcare professionals working in hospitals, clinics, and schools across North and South Vietnam who collectively serve over 1,000 children with hearing loss and their families.

We provide hearing aids to children in need as part of the clinical aspect of our audiology training efforts to give the Vietnamese opportunities to practice what they are learning. The children are then supported ongoing by the technicians we train. Our curriculum is taught by a team of about 40 Global Foundation For Children With Hearing Loss volunteer professionals in speech pathology, audiology, otolaryngology, and auditory-verbal practice from the United States and other countries. They volunteer their expertise and time to this effort throughout the year.

A key tenant of our program is to prepare the Vietnamese participants to not only do the work themselves, but then to train others, making the benefits exponential and sustainable. Our program has created a network of support across audiology, otolaryngology, auditory-verbal therapy, and deaf education that is strengthening the system for families of children with hearing loss in Vietnam.

Moving forward, the Global Foundation For Children With Hearing Loss plans to establish regional audiology centers and provide additional training to address the need for more accessible pediatric audiology care in the provinces. In July 2015, the Global Foundation will graduate a group of Vietnamese therapists and teachers from its program. These teachers and therapists will be involved in future training of additional Vietnamese professionals in Global Foundation programs in Vietnam.

The Global Foundation For Children With Hearing Loss has received attention from other developing countries for its successful model. We are currently exploring opportunities to expand our work to other developing countries that have requested our support.


Back at Thuan An Center, an early intervention building was constructed on school grounds in 2011. Thuy chose a bright yellow for the façade as a “symbol of hope and promise for families”. Today, the center’s 70 students range between 1.5 to 6 years of age who are all fit with hearing aids and cochlear implants and are learning to listen and talk. The Global Foundation has been training all of their early intervention teachers and therapists as part of its program over the years. The center recently established an audiology booth that is staffed by a technician we trained. In each year since its inception, growing numbers of children have “graduated” out of the Thuan An Center early intervention program to attend the local mainstream school.

The collaboration between the Vietnamese and the Global Foundation For Children With Hearing Loss is a demonstration of what is possible when a committed group of caring professionals and families across the world share a vision and work together to make positive change.

Paige Stringer,
Founder and Executive Director Global Foundation For Children With Hearing Loss

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/learning-to-listen-and-talk-in-vietnam), as being the originator of the content.

Red Flags for Apraxia in Children

Rebecca Siomra Red flags for Apraxia in Children:
hat should therapists or parents do if they suspect their child has Apraxia.

Every now and then, a very concerned, often nervous-looking, parent tentatively asks me, “Do you think my child has Apraxia?”  In my life as a Speech-Language Pathologist (S-LP) working with preschoolers, parents put a lot of faith in my clinical judgement to help their children become better communicators.  I need to honour that trust by being truthful with them and by giving them the best information and guidance that I can.

I need to start off by being clear that, as an S-LP in Ontario, it is beyond my scope of practice to make, or confirm, this diagnosis – that needs to come from a medical doctor – however, I am very happy to talk with parents about apraxia, to educate them and, to the best of my ability,  support them in their journey.

When parents ask about Apraxia – more specifically called Childhood Apraxia of Speech (CAS) with this population – I like to ask them what are they seeing from their children and why they suspect that diagnosis. Their answers often include, “Well, when I googled my child’s speech patterns that’s what kept coming up.”

Now, I love internet searches as much as the next person, but, unfortunately, they don’t often ask questions to help fine-tune what you are looking for.  Parents report reading that some children with CAS never learn to speak clearly and this scares them; they worry for their own child’s future.  Common concerns parents report to me include:

• his words are so hard for me to understand; sometimes I just have to pretend that I understand
• all of his words sound the same
• her mouth/tongue doesn’t seem to move very much when she speaks
• he just can’t seem to get his words out
• I’m the only person who knows what she’s trying to say – what will happen at school?
• he hardly makes any speech sounds at all but uses lots of gestures to be understood

Here’s the thing about the term ‘apraxia’. It is only one part of the motor speech disorder family, but is often used to describe any part of that group.  Truth be told, CAS is actually quite uncommon, relative to other speech disorders.  Some research estimates 0.1-0.2% of the general population1 has CAS (for reference, approximately 10% of the general population is estimated to have a speech and/or language disorder).  In spite of this low percentage, the terms ‘apraxia’ and ‘childhood apraxia of speech’ are sometimes used quite liberally in the community.

In my practice, I prefer to talk with families about the specific challenges their child is facing and address those, without worrying about labels.  Frustrating perhaps for some, but I have my reasons.  When I meet a child with a suspected motor speech challenge, I must first determine if it is a delay, or an impairment.  In the case of a delay, skills emerge in a typical developmental order, with somewhat predictable errors, but simply later than expected.  When there is an impairment, errors are unpredictable, often differ from typical development and/or may show extremes of typical speech movements.

Red Flags for Apraxia in Children

Impairments can occur in several areas. Developmental Dysarthria is characterized by impaired muscle tone (too tight/tense or too loose/floppy), but word and sound productions are fairly consistent.  With CAS, there are challenges with volitional control in the planning, sequencing and organizing of muscle sequences for speech.  That is to say, the child might be unable to figure out how to get their mouth to produce a specific sound, or sequence of sounds, reliably.  Areas impacted by CAS include any of, range, direction, coordination and timing of movements.

Tell-tale feature of Childhood Apraxia of Speech are:

• inconsistent errors in repeated attempts of the same word;
• disordered prosody (that’s the tune or melody of our speech);
• challenges with transitions between speech sounds.

As mentioned, ‘true’ CAS is not common, and most children with motor speech challenges present with a mixture of the types of speech characteristics mentioned above.  This is why, as a S-LP, I feel it is so important to focus on supporting children to work through their specific error patterns, rather than worrying about how to label the disorder.  When there is a motor speech disorder present, talking is HARD for a child, and they need encouragement and help, from a S-LP, and, through coaching, from their parents and other caregivers.  Parents are encouraged to contact their local S-LP provider if they suspect their child needs therapy.

Some indicators of when to suspect a motor speech disorder:

• speech may sound ‘flat’ or choppy
• accuracy/clarity decreases as words/phrases become longer
• groping is observed (e.g., a child moves their mouth around in an attempt to figure out how to say a sound/word)
• inconsistent errors when the same word is repeated multiple times
• limited lip movements
• sliding of the jaw during speech
• excess or restricted jaw opening during speech
• drooling
• open jaw at rest

For a parent, it can be heartbreaking to watch your child struggle in any area of development.  Support to address motor speech difficulties, whether a delay or, an impairment, should be sought from a S-LP. A S-LP is able to evaluate a child’s articulation/phonology skills (which sounds are made and in which positions of words), as well as their neuromotor skills (how their mouth moves in speech), either informally or with structured testing.  With this more specific, and appropriate, information, they will be able to determine any areas of weakness and to set suitable goals. Motor speech therapy can be intense for some children and families, not only due to frequency of sessions, but also because this is hard work.  Re-training the motor speech system takes a lot of repetition, and careful goal selection, just as with learning any other motor task, from playing the violin, to cake-decorating, to learning play soccer. The intervention recommended to any child should be determined based on their age, maturity, nature and degree of speech/language challenge, as well as other developmental needs.

In my opinion, the first step in helping the family of a child with a motor speech difficulty is to educate and help them to understand where the breakdown is happening in their child’s communication system. Helping them to understand ‘the lingo’ and goals will help them be a more effective partner in therapy sessions,  follow-through with homework between sessions and, if they must, to tackle the internet with a little more direction and specific questions.  Parents and clinicians must have faith in each other, and be able to trust that they are both working in the best interest of the child.

1 Shriberg, l., Aram, D., Kwiatkowki, J. (1997) Developmental apraxia of speech: 1. Descriptive and theoretical perspectives. Journal of Speech, Language, Hearing Research, 40, 273-285.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/blog/red-flags-for-apraxia-in-children), as being the originator of the content.

Listen to me now: A letter from the future

Mikaeel Valli

Dear Mom and Dad,

You are probably both wondering who this person is who is writing to you. It’s me, your son, Mikaeel writing this letter from the future as a 21 year old, but for now, you both know me as your young four year old, being raised beside my bustling older brother, Talib. Raising two young boys and balancing your work demands has, without a doubt, been keeping you both very busy. Raising us to adults as we are today, you both deserve a lot of credit for your hard work. Trust me, it will be worth it, though admittedly, we will have driven you nuts and given you splitting headaches many, many times.

I can only imagine how hard it was for you to learn that I have a severe to profound hearing loss. A deafening echo of ‘deaf’ must still be going through your minds and it has no doubt left you wondering what the future holds for me. Will I ever listen and communicate like any normalchild — especially like Talib? Even deeper echos running through your minds will probably be whether you will ever be able to communicate your thoughts to me or even for me to communicate my thoughts to you. The truth is, it will all happen! Rest assured that though it will be difficult in the beginning as you are now experiencing, over time I will gradually improve with my communication and listening skills to a point that these fears you are having will become non-existent.

As with many parents both of your minds must be racing as to what I  feel being that I am hard of hearing (HOH), especially once I reach an age of understanding. The reality is that I never felt any resentment over being HOH. I feel life is too short to dwell on things that cannot be changed. I believe we need to progress forward, focusing on the blessings we have, always being positive, no matter what. Rest assured that the cochlear implant has opened a tremendous floodgate of opportunities for me to such an extent that I don’t feel HOH (when wearing the cochlear implant, of course!). My listening and articulation capabilities are, at this point, very similar to individuals with typical hearing in many listening situations.

Currently, all you see is “little Mikaeel” being so quiet, and generally having a difficult time grasping the ability to learn to talk. You and your therapist wonder if I’ll ever talk myself out of my shell of shyness. Therapists and teachers have expressed concern and wonder if they are doing everything they can to help me. Both of you are convinced, however, that I just need more time. I want to assure you that you are absolutely right! There is a great misconception that upon cochlear implantation, recipients will automatically have the ability to hear and speak, but clearly you both understand that that’s not exactly accurate. It not only takes appropriate hearing technology and intervention, but time.  Along with the professionals, you have all done a tremendous job! Now, it’s time to wait for me to continue to learn, grow and express myself.

A young Mikaeel in an auditory-verbal therapy session with his auditory-verbal therapist

A young Mikaeel in an auditory-verbal therapy session with his auditory-verbal therapist

Dad, your determination to consistently take me to Auditory Verbal Therapy (AVT) sessions every Wednesday morning along with the time Mom takes to watch each of the taped AVT sessions along with your combined determination to enforce the lessons taught during those sessions will prove to be the recipe for my success. I certainly feel that, beside the decision for a cochlear implant, enrolling in AVT (and you both taking it seriously) are the best decisions that you both made. Without a shadow of doubt, I would never have achieved my current level of articulation and listening skills with it. The determination, love and work ethic you both possess is unmatched.

There is an expression that says, “No pressure. No diamond.” You both are placing a good amount of pressure on creating the conditions that will lead to the polishing of me — your diamond. Your tenacity of continual pressure for your children to attain their highest possibilities; having high expectations, will have diamonds descending onto your laps — guaranteed.

Continue going with the flow, even when the going gets tough. Many doors of opportunities will open up along the way for both Talib and I. These doors, however, will open when you least expect it. Talib will become a very confident young adult who will eventually meet a wonderful wife who brings a vibrant perspective to our family. He will earn great success in his career. I will mature quickly and, admittedly, I am very surprised at myself for this when I look back! You have encouraged me to focus and this has led me to pursue and develop my career from a relatively young age.

Mom and Dad, always continue to work together as team of two in supporting each other, sharing comforting and reassuring thoughts with each other and always continue to ensure there is a line of communication between the two of you as well as with your children. Continue to strive to integrate your boys together and treat your journey with Mikaeel as a holistic package involving everyone in the family. One possible way is to incorporate Mikaeel into Talib’s activities and vice versa as much as possible. Consider bringing Talib along to a few of my AVT sessions. I bet Talib would find it a lot of fun to play with the abundance of colourful toys in the therapist’s room. It would certainly make Talib feel part of this journey to a greater level and would encourage me to mimic Talib, using him as my model. You could do the reinforcement of AVT lessons at home together with the two siblings as well. This will give prime opportunity in re-enforcing your conviction that everyone has a valuable role to play within the home and that everyone needs to feel included.

I know you both are very determined that Talib and I achieve an education and you are probably wondering how we both will do in school. Talib will become a proficient academic performer especially in high school where he will earn honor rolls throughout the four years. As for me, it will take time for me to gradually catch on, adjust to different listening situations and to effectively understand and communicate language properly in the earlier years of elementary mainstream school. But don’t worry. I will catch on, especially when I reach mainstream high school where I also will achieve honor rolls in all four years. I speculate that my continual exposure to children with typical hearing in my age group in mainstream elementary school was the driving force pushing me toward success. I believe that being assimilated has led to my ability to communicate effectively.

As I have already spilled the beans on your children’s school accomplishments, you are probably on the edge of your chair wondering what happens next after high school for both of us. Well, I have to say that patience is a virtue and that you will have to wait until prime time in about ten plus years! I just would like to let you know that as an adult, life is very positive and I am very happy just the way it is. This is thanks to the lessons and mindset that you instilled in us right from the very beginning. Your dedication has brought forth rewards that I think will surpass your wildest dreams.

You both are still probably wondering who I am and how I can say such decisive things. The reality is, once again, I am speaking from the future and you will be with this person through to the future and much further. I need to let you know that, along with the excellent family support received especially from your sister (in-law), Zainab and her family, you are both doing a fantastic job! All of you ought to be very proud of your accomplishments for molding Talib and I into our full potential in being happy and healthy.

Warmest regards from your old (and more behaved) son,


As an adult, whenever possible, Mikaeel enjoys spending time with Warren Estabrooks and Karen MacIver-Lux

As an adult, whenever possible, Mikaeel enjoys spending time with Warren Estabrooks and Karen MacIver-Lux

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/what-hearing-loss), as being the originator of the content.




Do You T.H.I.N.K When Providing Intervention?

Karen MacIver-Lux

Auditory-verbal therapists spend a lot of time coaching, providing feedback and engaging in collaborative discussions with parents. Speech-language pathologists, audiologists, teachers and other early intervention professionals (professionals) are no exception. Effective communication is recognized as a priority across the health care continuum because it directly affects the quality of patient care, safety, medi-care outcomes and patient satisfaction (1995).

Occasionally, professionals may need to deliver news or feedback that can difficult for a parent/child (client) to hear. Some professionals dread having these conversations because, despite their best intentions, the information gets lost in translation and clients can end up feeling unnecessarily frustrated, discouraged or even angry. As a result, rather than putting into action a plan for care, valuable time can be spent recovering from the shock of the news.

In her book The Now Impact, Elisha Goldstein describes the T.H.I.N.K. strategy, which can be used when preparing to provide feedback or information so that the message is clear and concise. This strategy can also be used when communicating and engaging with young clients, particularly during behavior management.

Before engaging and communicating with clients, it is a good idea to T.H.I.N.K. by asking ourselves if what we’re about to do or say is:


When discussing treatment plans/options, try to ensure that the information shared is accurate and current. When sharing observations, try to accurately describe what was observed, remembering to include multiple examples/evidence. When the answer is unknown or unclear, say so. Then work together with the client to find the answers. If the client requests additional information about a topic or intervention approach we’re not familiar with, refer them to the appropriate source(s) or professional(s).

During my years working with children, I’ve learned to say what I mean and mean what I say. Body language and follow-through are as equally important as the message.  If I say I’m going to do something, I need to do it.  When working with clients, I need to walk the talk, truthfully.

Many years ago, I saw Jack (not his real name), an adorable three year-old boy who noticed every delicate décor accessory in the clinic. Jack would have these in his hands before his mother or I can move them out of reach.  One day, he looked at a flower vase, and reached out to touch it.  I smiled cheerily and said in the nicest voice I could muster, “No, no, Jack. Don’t touch the vase! If you touch it, it will break!” Well, guess what? Jack touched the vase and it didn’t break. My voice and body language did not match the message and the verbal consequences I presented didn’t make sense. Nor was it the truth.

The next time Jack walked by the vase, he reached out to touch it and looked back at me. This time, I didn’t smile and I used a quiet but firm voice and said, “No, Jack. Don’t touch the vase. If you touch the vase, I won’t be happy and there will be no bubbles.” He touched the vase, so we didn’t play with the bubbles during our session.

The next time Jack walked by the flower vase, he didn’t touch it and as a result the beloved bubbles stayed in our session plan. My body language matched the clear boundaries I set and the consequences were realistic and truthful.


As professionals, we are accustomed to providing recommendations and suggestions and we expect the children and their parents to follow them. At times, however, due to a family’s circumstances, the recommendations may be easier said than done.

Consider the following case of a family whose baby, Molly, was fitted behind-the-ear hearing aids one month prior. During their follow-up visit with the audiologist, the parents reported that Molly had adjusted well to the hearing aids and is wearing then during all waking hours. Upon reviewing the data logging, however, the audiologist noticed a discrepancy that suggested that the hearing aids were only being used four hours a day.

Although tempted to question the parents about the discrepancy, the audiologist refrained. Instead he said, “I see that your baby is getting an average of four hours a day of hearing aid use.  This is a great start!  Our goal is to have the hearing aids on during all waking hours. How do you think we can achieve this goal with Molly? Is there anything I can do to help?” The parents showed surprise and responded that they are certain that the hearing aids are being used at all times except during rides in the car, bath time and sleep .

After the audiologist waited for a few minutes allowing time for self reflection, the parents suggested the possibility of the hearing aids not being used while Molly was at daycare. Later that evening, the parents discovered that the daycare staff were uncomfortable handling the hearing aids and were fearful of losing or breaking them. In addition, the other children were pulling Molly’s hearing aids off and placing them in their mouth. As a result, fearful for all the children’s safety, the staff weren’t always diligent in putting the hearing aids back on.

With this information at hand, the audiologist and the parents developed a plan of action to help ensure that the hearing aids would be worn during the baby’s entire time at daycare (e.g. a pilot cap and an in-service for the staff on the handling and care of the Molly’s hearing aids). Adopting a helpful attitude and supportive language is what often sets the stage for progress.


When I was 13 years of age, I decided that I wanted to become an audiologist.  It did cross my mind, however, that given the severity of my hearing loss the job may be difficult to do. How would I be able to do listening checks on a hearing aid? Was my speech good enough to do speech discriminations tests?

The list of questions grew longer and my dream drifted further and further away until I met Jeff Float.

As team captain in the men’s 4×200-meter freestyle relay, Jeff Float was the first legally deaf athlete from the United States to win an Olympic gold medal. Impressed by his story and example, I realized that if he could start a relay race, then so could I.

Meeting Jeff Float gave me the inspiration to pursue my dreams with dogged determination.

When parents are faced with their child’s diagnosis of a communication challenge, they are usually uncertain of what the future holds. In all honesty, so are the professionals.  Professionals however, have the advantage of having the skill set and knowledge to develop an intervention plan to help the child reach his/her highest communication potential. It’s important for  professionals to remember that parents not only need a plan of action, but that they need some inspiration as well. The same goes for young children, teenagers and adults with communication disorders.

  1. Arrange appointments so that clients have the opportunity to meet other others with similar communication challenges. Partner “new parents” with parents who have been through the process.
  2. Present opportunities for children with communication challenges (e.g. hearing loss, dysfluencies, cerebral palsy, auditory neuropathy spectrum disorder, etc.) to meet adults with similar communication challenges.
  3. Encourage children and young teenagers to join peer support groups of similar communication challenges (e.g. LOFTHitIt, etc.).
  4. Use language that is respectful of other professionals and communities who have embraced alternative communication approaches.

A good dose of inspiration goes a long way for those who have communication challenges and paves the way for the achievement of dreams and beyond. Encourage clients to aspire by introducing them to those who inspire.



When my mother found out about my hearing loss when I was four years old, the doctor firmly told her that I would never hear or be able to speak.  He also added that I would never go beyond grade three, and that I would be severely limited in my vocational choices. He explained that it was necessary for my mother to adjust her expectations of me because of my mild to profound hearing loss. He then left the room to attend to another patient. Did my mother adjust her expectations? No, but she did feel devastated by his words and it took her some time to recover and move forward to find out what I really was capable of.  She later discovered that the doctor not only provided inaccurate information at the time (e.g. I could hear her voice even without hearing aids because I have a mild to profound hearing loss) but I also achieved outcomes beyond his expectations. To this day, my mother remembers his words and is still angered by them. Unfortunately, similar interactions still occur today unnecessarily causing parents grief and aggravation.

Each case is unique and professionals need to gauge the type and amount of information to provide. It is best to avoid making predictions about outcomes. Instead, listen to the parents’ dreams and desired outcomes for their children. Professionals should provide research data on outcomes and variables that can be controlled (e.g. hearing technology). Parents should be directed to resources so that they can do their own research. When parents’ dreams for their children have been heard and understood by professionals, parents will be more open to developing a plan of action in a collaborative fashion and following it.

Be mindful of when and how we share information.  Is it necessary to call a parent on a Friday afternoon to recommend a cochlear implant candidacy investigation when your next appointment with them is on Monday? Is it necessary to tell a parent of a one year old child to work on producing “s’ in words?  Is it necessary to provide parents of a newly diagnosed infant with a thick binder of information on hearing loss?  Is it necessary to tell a child that he’s a good boy when he hears a clock ticking?

When we take the time to consider the necessity of the information we provide to parents and children, chances are they will be more open to listening and moving forward with a plan of action.


Kindness is not just about being polite or generous; it’s also about having and demonstrating empathy.

Unfortunately in today’s world, kindness and empathy are sometimes regarded as signs of weakness. Often, the perception is that kind and empathetic professionals are either too timid to be effective or that they rely on their “niceness” in place of knowledge and the ability to effectively treat or impact clinical outcomes. Additionally, there seems to be a fear among some in the “helping” profession that empathy will lead to “burn out” early in their careers, and they develop a persona of polite indifference to protect their mental health and livelihood.

Clients who engage with professionals who behave with indifference, understandably, lose trust in the professional and their treatment plan, and progress for positive change is disrupted or grinds to a halt (2014).

Kindness and empathy is demonstrated by adopting body language that clearly shows that the professional is truly listening and by providing feedback the professional confirms that the client/patient was heard and understood.

It’s important for the professional to remember, that they need to move quickly from empathy toward developing a plan of action in collaboration with the client/patient.  Such collaboration will lead to the client/patient acquiring greater knowledge, trust, and motivation during the intervention process.

Remember Molly’s audiologist?  Her parents were given the opportunity to take the time to think about why her hearing aids were not being used as often as they thought. How?  Making sure to keep his arms uncrossed and open, leaning forward and providing good eye contact, making sure that his legs are uncrossed as the audiologist waits and allows the parents to self-reflect. Adopting such body language conveys that he is open to hearing whatever they have to say and that he’s open to being helpful.

When planning your next session, celebrate your professional strengths and challenges and T.H.I.N.K. before doing and saying. When we T.H.I.N.K., communication and collaboration will lead to better understanding, collaboration, client satisfaction and outcomes.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/do-you-THINK-when-providing-intervention), as being the originator of the content.


Stewart, M. (1995) Effective physician patient communication and health outcomes: a review. Canadian Medical Association Journal. 1995;152(9):1423n1433. 261
Back, A.L. & Arnold, R.M. (2014). “Yes It’s Sad, But What Should I Do?”: Moving from Empathy to Action in Discussing Goals of Care. Journal of Palliative Medicine 17(2):141-4.