Communication Disorders

• Conductive Hearing Loss
  • Tends to be temporary 
  • Caused by an interference of progress of sound across the ear canal and middle ear 
  • Foreign bodies: blockage 
  • Malformed ear canal: outer ear; some are born without 
  • Otitis media: damage to the middle ear; glue ear 
• Sensori-Neural Hearing Loss 
  • Inner ear damaged
  • Caused by defects in the fine structure of the inner ear or auditory pathways to the brain 
  • Prenatal causes; inherited/rubella 
  • Perinatal 
  • Postnatal; trauma/meningitis
  • Toxic causes; pregnancy drugs 
  • Genetics; prenatal mal development 
  • No cure; permanent

• Hearing is tested across a range of sounds from low tones to high tones
• Test uses five frequencies - Hertz

Low Frequency : 25-500 Hz; 'a' as in hat, 'oo' as in food, 'ow' as in tow

Middle Frequency : 500-2000 Hz; 'ay' as in play, 'ee' as in see, 'd' as in dog

High Frequency : 2000-8000 Hz; 's' as in sun, 'f' as in face, 'h' as in horse, 'th' as in thin 

• The loudness of any particular frequency is measured in decibels 

• 6 months: babbling is different 
• Non target forms can occur with all sounds 
• Smaller vocabulary - less accidental learning 
• Poor/poorer grammar - unstressed elements 
• Articulation 
  • Vowels are particularly difficult but errors can occur with all sounds 
  • Substitutions and deletions are most common
• Suprasegmental 
  • Unusual prosody, intonation and nasality 
• Voice pitch and quality
  • Problems in breath control and speaking 
  • Sounds different 
• Intelligibility 
  • Markides 1983
    • Speech of the large majority of severely and profoundly deaf children is unintelligible 
    • Struggle to understand what they are saying 

• Reading 
  • Inner speech mediates reading by the silent understanding and rehearsal of symbols and words 
  • Also assists in the production of symbols and words in writing 
  • If children have problems with oracy, also likely to experience problems with literacy 
• Difficulties with Reading 
  • Missed early experience 
  • Deficit in verbal language 
  • Cant rely on phonological coding 
  • Problems in percieving the written words as reflecting the language code 
  • Visual coding is comparitively poor
• Reading Achievment 
  • Children with hearing impairment as a result of chronic middle ear infections may have difficulties in beginning reading 
  • Young children with only a mild sensori-neural hearing loss may show reduced performance in vocabulary acquisition and reading comprehension
  • Those with a signficant loss rarely read beyond the ability of a 9-10 year old 

• No cognitive issue 
• Can story tell, know narrative structure 
• Spelling is fine - not dyslexic 
• Immature grammar 
• Lack of function words 
• Shorter sentences 
• Jerky text 
• SVO order is telegraphic 
• Lack of inflections 
• Lack of auxiliaries 
• Non fluent text 
• Writing without visual feedback did not affect the writing skills of hearing impaired children 
• Webster 1986
  • No advantage of the feedback mechanism 
• Spelling is good 
• Invisible pen task
  • Deaf children perform better as they dont rely on visual feedback 
  • No advantage of feedback mechanism 

• Age at onset of deafness is a crucial variable 
• Children who are deaf at birth and those who are deafened after the acquisition of language form distinclty different groups 

• Identification
  • Webster and Wood 1989
    • THe sooner a hearing loss is detected, the sooner the impact of deafness can be reduced at source
  • Deaf people have no native disposition to speak
  • Powerful disposition to sign 
  • Sign language 
    • Equal status to speech, recognised as languages 
  • Earlier we are aware, more choices
  • Age and onset of loss is crucial - different needs 

• Distraction Tests
  • 7-18 months 
  • Present sounds baby cant see or feel
  • Failure doesnt mean deaf 
  • Could not be interested enough 
• Cooperative Tests
  • 0-3 years
  • Follow instructions 
• Booth Tests 
  • Older children/adults 
  • Headset
  • Involves pressing buttons

• Language characteristics as a result of a Conductive hearing loss (mild hearing loss)
  • Delayed language 
  • Poorer vocabulary 
  • Weaker grasp of grammar 
  • Slower reading 
  • Disorders of phonology 
• Language characteristics of Sensori-Neural hearing loss 
  • 2-3 children in 5000 
  • Severe deafness
  • Permanent damage 
  • 1 in 10 children have deaf parents from whom they acquire sign language
  • Sign language is unique in that its major cultural transmission is carried out by others 

• Body Worn Aids
  • Worn on chest with a harness
  • Not discrete 
  • Most powerful
• In the Ear Aid 
  • Not for children 
• Bone Conductor
  • Vibrates to stimulate cochlea 
  • For those with no ear canal or prone to infection 
• Post Aural Aid
  • Sits in the ear
  • DIal behind ear
  • Improving all the time 
  • Less powerfuk 
  • Feedback problems
• Cochlear Implants - new in the last 15-20 years 
  • Mechanical electrical device buried into the skull to replace inner ear
  • Stimulates auditory nerve
  • Used for those with profound loss, with a good memory of language 

• Oralism 
  • Want them to speak 
• Make best of residual hearing and lip reading skills
• Sign language is excluded 
• No reason to support continuing dedication to oralism
• No evidence that sign language inhibits speech development 
• Unanimous consensus that the deaf young child exposed to spoken language is extremely impoverished 
• Children feel recussing frustration: dampened curiosity about the world: deaf child is aloof, immature, dissociated
• Acquisition of deaf speech is painfully slow
• No feeling of natural growth in deaf childrens spoken language 
• Children exposed to early manual or simultaneous manual-oral input appear to develop adequate inner language with no reduction in their ability to use speech and reading for communication than do children not so exposed  

• Language of the home is a combination of signed and spoken language 
• This is often the preferred method of a hearing family of a deaf child: total communication
• Communication occurs through a combination of speech, lip reading, amplification and the simultaneous use of one of several manual sign systems 
• Intergration vs segregation 

• Deaf parents often want deaf children so that they are fully part of deaf culture 
• Seen as their first language
• Generally against cochlear implants 
• Seen as an attack on language and culture

• Sign Language 
  • Deaf children of deaf parents using sign as their first language make their first signs when they are about 6 months and have considerable sign fluency by the age of 15 months 
  • They will often have 100 signs at the age when hearing children will have no more than 50 words 
  • In spite of the difference in modality the milestones of language development may be the same in sign for deaf children as it is in speech for hearing chilldren