hearSAY Teaching Children with CIs to Speak More than One Language

M E D - E L’ S E D U C AT I O N A L N E W S L E T T E R - I S S U E 7
Teaching Children with CIs to
Speak More than One Language
• Teaching Children with CIs to Speak
More than One Language
The United States population experiences a steady immigration growth with more
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than 40 languages being spoken by over 55 million people. Furthermore, neonatal
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hearing loss is particularly prevalent among Hispanic-Americans and those from
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low-income householdsi As a result; many speech-language pathologists, deaf
educators, and audiologists are serving an increasing number of children with
cochlear implants who come from families that do not speak English. Since English
is the language of the public schools in the United States, bilingualism will become
a necessity for many families, including those who have children with cochlear
However, the concern that learning a second language can interfere with the
mastery of the majority language and cause language impairment has historically
led clinicians and educators to discourage second language learning; especially
among pediatric cochlear implant users. In contrast, there is no data to support
the impression that there is a higher incidence or more severe presentation of
language impairment in children learning two spoken languages versus one1.
Language impairment found in bilingual children with typical hearing is not because
of the simultaneous acquisition of two languages but rather a problem in the
child’s innate ability to acquire language2,3,4,5. In addition, research with typical
Michael Douglas, MA, CCC-SLP, LSLS, Cert AVT
hearing children who are learning English as a second language indicates that they
Michael Douglas is a speech-language
pathologist and a certified AuditoryVerbal Therapist. He is an adjunct
professor in the University of Houston’s
communication sciences and disorders
department and lectures annually at
Texas A&M and The University of
Texas Health Science Center. As the
Director of Intervention Services at
The Center for Hearing and Speech,
he is responsible for clinical practice,
program development, mentoring
and supporting current and aspiring
therapists in the Greater Houston
Area, and serving as a member of
CHS’ Cochlear Implant Team.
should receive skilled intervention in their primary language when a language
disorder is diagnosed6,7. Results of therapy outcome studies on bilingual
children with typical hearing who have language impairment have indicated that
language intervention provided in both languages can yield the same results as
monolingual children8.
For bilingual and monolingual families who have children with cochlear implants,
facilitating their child’s successful integration into the family and the majority society
also requires intervention designed to increase performance in both spoken
languages. This has been possible with the implementation of mandated hearing
screenings, early identification, and special treatment for infants with hearing
loss9,10,11,12,13. Such results are being seen across North America for some children
with cochlear implants when compared to their monolingual hearing impaired
peers’ intervention ages14.
Though agencies may not have adequate bilingual staff to
It is well known that children with cochlear implants benefit from
accommodate for the variety of language backgrounds on any
rich linguistic environments. When a child is regularly exposed
one caseload, there are ways to compensate for these shortages.
to a language other than the majority language, and when that
Current family-centered, spoken language intervention models
minority language is recommended for intervention, careful
offer hope and opportunity for children with hearing impairments
investigation of center-based programs that can also provide
to develop multiple spoken languages on par with their auditory-
intense immersion in the majority language is necessary19. When
oral, hearing impaired peers even when the home language is
selecting intervention models, efforts need to ensure that the
not English. The pathway to such success is paved by supporting
targeted input will be meaningful or learning will not occur20.
bilingual development through appropriate assessment and
To facilitate bilingualism, Pearson21 reports that previous studies
intervention, as well as hiring bilingual support staff and service
found participants should spend a minimum of 20% (15 hours
a week) in the minority language. Other researchers specify
Ideally, assessment and intervention should be conducted
in the language of the home by a skilled bilingual service
provider proficient in that language. In cases where this is not
spending up to 30% or more of the children’s time (25 hours a
week) in the minority language.
Current educational models for typical hearing children with
feasible, bilingual support personnel can
language disorders who speak more than
assist service providers in delivering the
one language employ expert professionals
appropriate instruction. If trained properly,
who immerse and shape children’s oral
this arrangement can be effective in
communicative behaviors22. These models
implementing instructional activities and
are also consistent with auditory-oral
help skilled providers accommodate families
programs implemented by educators of the
and children with special needs . Bilingual
deaf. In both instances, skilled manipulation
support personnel are not responsible
of the rate of instruction, cueing hierarchies,
for designing assessment tools and making
and specific strategies are used during
educational placement decisions, and are
fun and meaningful activities with rich,
not considered specialists. They perform
comprehensible linguistic input in quiet
their well-defined duties under the direct
environments during individual, small, and
supervision of a monolingual listening and
large group sessions23,24.
spoken language specialist, speech-language
pathologist, certified teacher of the deaf,
audiologist, or psychotherapist trained and knowledgeable in
multi-lingual learning issues16. Bilingual support personnel who
are biliterate can also be recruited to develop much needed
learning material in other languages.
For children with cochlear implants whose
home language is not English, parents can
work within the framework of an established language/speech/
audition plan developed by a listening and spoken language
specialist. In individualized sessions, therapists teach parents
strategies to facilitate the attainment of weekly goals at home.
Professionals who understand the expected course of both
The idea is to maximize the family’s capacity to help their child
monolingual and bilingual language acquisition will be better
learn spoken language through listening25. These sessions can be
prepared to analyze pertinent data crucial for facilitating each
done with a trained interpreter, a trained paraprofessional who
individual child’s success. Integrating issues related to hearing
speaks the home language, or a bilingual therapist who speaks the
impairment with matters relevant to the typical and atypical
home language26. Meanwhile, the child is immersed in English-
development of children without hearing impairment who speak
speaking spoken language programs at school on a daily basis.
another language will aid in the development of an appropriate
Ideally, these programs are implemented by skilled professionals
treatment plan. A discussion of assessment procedures that
with expertise in hearing loss, including educators of the deaf,
combine these issues is beyond the scope of this article and the
speech-language pathologists, and audiologists27,28.
reader is referred to Goldstein17 and Austin18 for further reading
and understanding of bilingual development and related issues.
The same teaching strategies used for any monolingual, Englishspeaking family who has a child with a hearing impairment
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are effective for coaching parents who do not speak English.
When working with these families,
interventionists will need to prepare themselves to effectively connect culturally with each family while
MED-EL Multilingual Resources
paying extra attention to their body language and how things are said29. Intervention provided in the
home language with trained bilingual personnel or trained interpreters begins with education on the
hearing loss, treatment options, and the establishment of a good parent-child relationship. For those
who choose a spoken language approach, initial counseling is followed by a clear and simple plan for the
consistent use of hearing technology and development of listening skills in the home language.
Strategies that facilitate spoken language development can be implemented and shared with family
LittlEARS Auditory Questionnaire
members in any language with appropriate personnel under the guidance of the managing specialist.
These may include shared book reading, “observe, wait, listen, and speak” (OWLS), modeling and
imitation, recasting, choral speaking, expansions, and extensions.
There are resources available in other languages that are designed to help professionals effectively teach
families strategies to develop listening skills. These include the Oral Deaf Education website (http://
www.oraldeafed.org), Learn to Talk Around the Clock30 (Rossi, 2003) and a variety of materials available
from MED-EL (see sidebar). Lessons at no cost to parents are also available in 50 languages online
and/or through traditional mail from the John Tracy Clinic in Los Angeles, California (http//:www.jtc.org).
Murat Reader Series
Bilingual children’s songs in English and other languages are available on CD at http//:www.sara-jordan.
Bilingual therapists or monolingual therapists with their interpreters can also use resources as a
reference tool when translating talking points during therapy such as My Baby and Me: A book about
teaching your child to talk31 . When resources are available in English and other languages such as You
Make the Difference32, It Takes Two to Talk33, and the John Tracy Clinic Distance Education Course for
Parents34, monolingual English-speaking therapists can use both materials in tandem to convey and
practice strategies with families. Bilingual children’s books are also available in English and 40 other
Mellie Storybook
languages on http://www.languagelizard.com.
During typical intervention with young children who are hearing-impaired and learn one language,
parents learn easy strategies to accomplish weekly goals in the context of daily routines. The idea of
learning two languages, especially one the parent does not know, can be overwhelming for caregivers.
Therefore, additional strategies will need to be considered to simplify this process. As parents immerse
their child in an English-speaking program, the choice of strategies will depend on the goals and what
language resources are available. It is important to remain flexible in teaching day-to-day language
behaviors35. With consistency and gentle persistence, parents can learn to facilitate the development of
Let’s Get Started
the minority language or English as a second language during daily activities through the use of strategies
such as the following:
• Minority Language at Home ([email protected]) -the minority language is
spoken at home while English is used in the community.
• One Parent One Language (OPOL) - one caregiver speaks
English; another caregiver speaks the minority language.
•Time and Place (T&P) - a mixture of OPOL and [email protected]
These are implemented while accommodating for different linguistic environments during different times
Music and Young Children with CI’s
of the week or in different places. For example, the child may be exposed to Spanish on Wednesday at
a grandparent’s house, English with an aunt on Wednesday at the grocery store, Spanish at home with
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a caregiver the rest of the week, as well as English with another caregiver in the evening and during school.
In her book, Raising a Bilingual Child, Pearson36 provides parent-friendly explanations of these strategies and their use. She also provides
self-evaluation tools to reference when counseling parents, helping them to decide on a strategy that will fit their lifestyle, or discovering
solutions for common questions and obstacles.
In order to maximize the listening and spoken language skills of infants and children with cochlear implants who are or will be constantly
exposed to more than one language, a team of professionals will need to focus their attention on designing an intervention program
intended to implement positive change in the languages the children will need to be successful in their lives. This situation presents
exciting challenges that can be mitigated through the enhancement of current intervention models for children with cochlear implants, the
employment of multilingual professionals and the publication of more teaching resources in other languages.
A comparison of strategies for developing bilingualism in bilingual, monolingual, and minority-language speaking families is provided in Table 1. A list
of strategies for English immersion programs is provided in Table 2.
Table 1. Facilitating Bilingualism through Skilled Intervention
Bilingual – Majority and Minority
Language Speaking Families
Home Mutual strategizing for home
intervention – ex. Use English in the
community, minority language at home.
Therapy Individual therapy in the majority
language with active parent
participation – parent uses the
strategies in the minority language at
School English immersion through an
auditory-oral or mainstream preschool.
Extra-curricular Parent may enroll the child in
additional, individualized minority
language training.
Monolingual Minority Language
Speaking Families
Minority language is spoken at home
and in the neighborhood.
Individual therapy is provided in the
minority language (with bilingual
therapist/assistant or monolingual
therapist and an interpreter). Parent
uses the strategies at home.
English immersion through an
auditory-oral preschool program.
Parent may enroll the child in
additional, individualized majority
language training.
Table 2.
Strategies for Educational Environments
• Assure a 20-30 dB signal to noise ratio
• Pause often
• Repeat, rephrase, and restate information between pauses; utilize all effective evidenced-based
strategies that encourage listening and speaking
• Use shorter sentences and pause between them without ruining the natural rhythm and syntax of
connected speech
• Use a multi-modal spoken language approach to learning – incorporate body movements
• Try to teach new information in as quiet an environment as possible
• Use preparatory sets to inform students what is about to happen
• Use gestures and facial expressions to supplement the meaning
• Allow extra processing time by waiting (longer than a pause) for the child to answer questions
• Use student’s name to get their attention
• For learners first exposed to a new language, a silent period may last up to two years
• Emphasize key words through acoustic highlighting
• Initially focus on comprehension while gently encouraging production
• Work in small groups so they can see and hear the teacher easily
(Pearson, 2008; Rhoades, et. al, 2008; Roseberry-McKibbin, 2001)
Bibliography for this article is located on page 8
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Music and MED-EL
MED-EL has recently released several new resources for music therapy and
music enjoyment for children using cochlear implants.
“Musical Ears” is a comprehensive music therapy program for children with
cochlear implants. Numerous therapy activities, musical instruments and a
Music Evaluation form are included.
“Music and Young Children with CIs” is a free resource to help parents get
started with music activities at home. A Musicality rating scale is included.
Available as a download in English and Spanish at www.medel.com
“The Farmer’s Cheese” is a special musical composed for
Children with CIs. This original piece was composed by
Oliver Searle and based on a children’s story written
by Geoff Plant. A colorful hardback story book with both a
CD and DVD of the musical concert makes up the Farmer’s
Cheese package.
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“Mellie and Her Cochlear Implants” storybook is now available in Spanish.
“Mellie goes to nursery school”, a delightful new story is available as a free
download at www.medel.com
“The LittlEARS Diary” has been revised to include additional activities for parents.
Additional diaries are available as a free download from www.medel.com
“A How to Guide, Getting Connected” and “Taking Steps to Enjoying Music
with your Cochlear Implant” are two new resources to help your students
connect to a variety of ALD’s and improve their music enjoyment.
For more information on these new resources contact [email protected]
hearSAY : : M E D - E L’ S E D U C AT I O N A L N E W S L E T T E R - I S S U E 7
COMING ATTRACTIONS: Workshops and conferences
13th Symposium on Cochlear Implants in Children - followed by the US debut of “The Farmer’s Cheese” musical
July 14-16
Sheraton Hotel, Chicago Illinois
Children’s Memorial’s 2011 Listening and Spoken Language Summer Programs
Symposium: August 1-4;
Practicum: August 5 and August 8 -12
Who should attend: Early interventionists, classroom teachers, audiologists, teachers of the deaf, speechlanguage pathologists, program and school administrators, therapists working with children who are deaf and
hard of hearing
Location: The Children of Peace School, home of the Holy Trinity Deaf Program in Chicago.
For further information & to download an application visit:
hearSAY is a publication of MED-EL’s BRIDGE to Better
Communication program. BRIDGE is a program developed by
MED-EL Corporation especially designed for education and
rehabilitation professionals, implant users and parents to help BRIDGE
the gap between implantation and the rapid development of improved
listening skills and spoken communication. The BRIDGE program
consists of a wide variety of products, resources and materials for adult
and pediatric habilitation, assessment, and device management.
For more information contact us at
[email protected] or call
hearSAY : : M E D - E L’ S E D U C AT I O N A L N E W S L E T T E R - I S S U E 7
Keamy, D.G., Roland D. Eavey, R.D., & Mehra, S. (2009) The Epidemiology of Hearing Impairment in the United States in the US: Newborns, Children, and Adolescents.
Otolaryngology – Head and Neck Surgery, 140, 461-472.
Waltzman, S.B., Robbins, A.M., Green, J., Cohen, N. (2003). Second oral language capabilities in children with cochlear implants. Otol Neurotol, 24(5):757:763.
Goldstein, B. (2004). Bilingual language development and disorders in Spanish – English speakers, Baltimore, Maryland: Paul H. Brookes Publishing Co.
Comeau, L. & Genesee, F. (2001). Bilingual children’s repair strategies during dydadic communication. In Cenoz J, Genessee, F., (Eds.) Trends in Bilingual Acquisition (pp. 231-56) Amsterdam: John
Deuchar, M. & Quay, S. (2000). Bilingual Acquisition: Theoretical Implications of a Case Study. Oxford: Oxford University Press.
Paradis, J., Nicoladis, E. & Genesee, F. (2000). Early emergence of structural constraints on code-mixing: evidence from French-English bilingual children. Bilingual Language and Cognition, 3:34852.
Genesee, F. (2003) Bilingualism and language impairment. In Kent R. ed. MIT Encyclopedia of Communication Disorders. Cambridge, Mass: The MIT Press.
Goldstein (2004). Ibid.
Waltzman et al. (2008). Ibid
Thomas, E., El-Kashlan, H., Zwolan, T.A. (2008). Children with Cochlear Implants Who Live in Monolingual and Bilingual Homes. Otology and Neurotology, 29, 230-234.
McConkey-Robbins et al. (2004). Ibid.
Svirsky, M.A., Teoh, S.W., & Neuburger, H. (2004). Development of language and speech perception in congenitally, profoundly deaf children as a function of age at cochlear implantation.
Audiology & Neurotology, 9(4), 224-233.
McConkey Robbins, A., Green, J.E., & Waltzman, S.B. (2004). Bilingual oral language proficiency in children with cochlear implants. Archives of Otolaryngology Head and Neck Surgery, 130(5),
Rhoades, E.A., Perusse, M., Douglas, W.M., & Zarate, C.M. (2008). Auditory Based Bilingual Children in North America: Differences and Choices. Volta Voices, September/October Issue; 20-22.
Kohnert, K., & Derr, A. (2004). Language intervention with bilingual children. In B. Goldstein, (Ed). Bilingual language development and disorders in Spanish-English speakers (pp. 311-338). Baltimore: Paul H. Brookes.
Mattes, L.J. & Garcia-Easterly, I. (2007). Bilingual speech and language intervention resource: Lists, forms, and instructional aides for Hispanic students. Oceanside, CA: Academic Communication
Associates, Inc.
Goldstein. (2004). Ibid
Austin, L., Glover, G., Aoyama, K., Stubbe Kester, E., Cárdenas, N., Valles, B., Fernandez, M.R., Fernandes, B., Limon-Ordoñez, M., and Lopez, J. (2005). Linguistically Diverse Populations: Considerations and Resources for Assessment and Intervention. Available on line: http://www.txsha.org/Diversity_Issues/index.asp.
Stallings, L.M., Kirk, K.I., Chin, S. B., & Gao, S. (2002). Parent word familiarity and the language development of pediatric cochlear implant users (Monograph). The Volta Review, 102, 237-258.
Mattes and Garcia-Easterly. (2007). Ibid.
Pearson, B.Z. (2008). Raising a Bilingual Child. New York: Random House.
Kohnert & Derr. (2004). Ibid.
Kohnert & Derr. (2004). Ibid.
Moog, J.S. & Stein, K.K. (2008). Teaching Deaf Children to Talk. Contemporary Issues in Communication Sciences and Disorders, 35, 133-142.
Cole, E. & Flexer, C. (2007). Children with Hearing Loss Developing Listening and Talking Birth to Six. San Diego, CA: Plural Publishing.
Kohnert & Derr. (2004). Ibid.
American Speech-Language-Hearing Association. (2007). Executive summary for JCIH year 2007 position statement: Principles and guidelines for early hearing detection intervention programs. Retreived from http://www.asha.org.
Moog & Stein. (2008). Ibid.
Hammer, C.S., Miccio, A.W., &Rodriguez, B.L. (2004). Bilingual Language Acquisition and the Child Socialization Process. In B. Goldstein, (Ed). Bilingual language development and disorders in
Spanish-English speakers (pp. 21-50). Baltimore: Paul H. Brookes.
Rossi, K. (2003). Learn to talk around the clock: A professional’s early intervention toolbox for use with families of children who are deaf or hard of hearing, birth to three. Washington, DC: Alexander
Graham Bell Association for the Deaf and Hard of Hearing.
©2011 MED-EL Corporation, USA MKT 23039
Brooks, B.M. (2002). My baby and me: A book about teaching your child to talk. Saint Louis, MO: Moog Center for Deaf Education.
Manolson, A., Ward, B., & Dodington, N. (1996). You make the difference. Toronto, Ontario: The Hanen Centre. Available in English, Spanish, French, Chinese, and Aboriginal-Native American.
Manolson, A. (2004). It takes two to talk. Toronto, Ontario: The Hanen Centre. Available in English, Spanish, French, and Dutch.
John Tracy Distance Education: http://www.jtc.org/parent-child-services/distance-education-courses-parents
Pearson. (2008). Ibid.
Pearson. (2008). Ibid.
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