childhood hearing loss and the development of spoken language

Childhood hearing loss and the development of spoken language

Sordità e svilluppo del linguaggio parlato

Arthur BoothroydPresented during short course onChildhood Deafness and Language

Amplifon Center for Research and StudyMilan, October 2012

Director: Edoardo ArslanUniversity of Padua

Acknowledgements

• Dr. Janice Gatty: Colleague and co-author• Office of development, the Clarke Schools for

the Deaf: provided many pictures

Premises1. Deaf children 90% have hearing,

speaking parents

Premises2. Aids & implants viable hearing

Premises3. Hearing deficits intervention

Premises4. Intervention mostly via parents

Premises5. Spoken language:

Speech only a mediumCognition the basisSocial cognition the need

Premises1. Deaf children 90% have hearing,

speaking parents2. Aids & implants viable hearing 3. Hearing deficits intervention4. Intervention mostly via parents5. Spoken language:

Speech only a medium Cognition the basis Social cognition the need

Child development.Nature or Nurture?

Child development

NurtureNature

?

Child development -

NurtureNatureInter-action

- nature/nurture interaction

Child development Environment

Social

Child

LanguagePhysical

Development

ReactionAction

Sensori-motor

PerceptualCognitive

SocialLinguistic

ChildDevelopment

CognitiveSocial

LinguisticSensori-motor

Perceptual

ChildDevelopment

CognitiveSocial

Linguistic

Speech without language? Language without cognition?Language without social cognition?

Meaningless

Impossible

Useless

Sensori-motor

Perceptual

Child development -

NurtureNatureInter-action

Hearing loss is a deficit of nature

NurtureNatureInter-action

Aids/implants remove the deficit

NurtureNature Inter-action

Residualhearing deficit

reduce

Compensation for residual deficit requires enhanced nurture

NurtureNature Inter-action

Residualhearing deficit

Aural habilitation 1. Best hearing capacity2. Best hearing skill3. Best use of hearing for:

Cognitive developmentSocial developmentLanguage development

Cognitive, social-cognitive, and linguistic development

The child as “scientist”

Scientific method

Observation

Theory

Prediction

Experiment

Results

Yes

No As Predicted

?

Growing knowledge

Prediction

Theory

Child development

Experiment

Results

Yes

No As Predicted

?

Prediction

Theory

Observation

Cognition, social cognition, language

Experiment

Results

Yes

No As Predicted

?

Prediction

Theory

Observation

Cognition, social cognition, language

Child development

Nature

EnhancedNurture

The many layers of spoken

language

Spoken Language

Physical, Social, Language ContextTalker intent

Surface meaningSentences

WordsSounds

Phonology

Vocabulary

Grammar

Semantics

Pragmatics

Purpose

Language Cognition Social CognitionSensorimotor

function

Speech withoutlanguage?

Language withoutcognition?

Language withoutsocial-cognition?

Meaningless

Impossible

Useless

Language

The infant’s learning environment

Early child development Environment

Social

Child

LanguagePhysical

DevelopmentSensori-motor

PerceptualCognitive

SocialLinguistic

FamilyHome Language

Child

Indirect intervention

Therapist/teacher Family

Direct Intervention

Indirect Intervention

Direct Intervention

Audiologist ParentAudiologist Parent

What you sayThe tests show that Mary has a hearing loss. Our

best estimate is that the loss is around 85dB which puts her in the severe category. Things

could be much worse. There’s a good chance she will do well with hearing aids. If it turns out that

the hearing loss is more serious, you needn’t worry because she can always be fitted with cochlear implants and we have been seeing

amazing results with children. Some of them seem almost like they have normal hearing.

Would you like me to explain the audiogram?

What they hear

DEAF

0

Indirect intervention

Information

EducationDemonstrationCoaching

Empower-ment

Evaluation

Explanation

Observation

Listening

SupportDiagnosis

Direct intervention:Associations and connections

Sounds

Events

ObjectsMove-ment

Concepts

WordsSent-ences

Direct interventionTherapist child Parent child

MovingFeelingSeeing

HearingSound-event association

Sensorimotor, Perceptual,Cognitive, Linguistic

Cognition and language

Social cognition

Video here

CognitionGeneral Social

LanguageKnowledge Use

SpeechHearing Producing

Role of positive feedback

Self

Hearing deficit

CognitionGeneral Social

LanguageKnowledge Use

SpeechHearing Producing

Self

CognitionGeneral Social

LanguageKnowledge Use

SpeechHearing Producing

Enhanced nurture

Self

Messages1. Aids/implants Best hearing capacity2. Early intervention + Capacity + Nurture

Natural development3. Enhanced nurture individual differences4. General + Social Cognition Language5. Language + hearing skill Spoken language6. Audiologist assess/assist7. Interventionist assess/guide/adapt8. Both assess outcome and communicate

Grazie