1. CSD 5400 REHABILITATION PROCEDURES FOR THE HARD OF HEARING
Language and Speech of Deaf and Hard-of-Hearing
Characteristics and Concerns
Speech Development

2. Some Preliminary Remarks
The first intelligible word usually occurs at 1 year
Discrimination of important phonetic contrasts occur much earlier (receptive)
Normal speech development occurs concurrently with language development
Consistent exposure to conversations with adults is necessary
Normal hearing is necessary
Altho a child’s first intelligible words don’t occur until about 12 months of age, infants are born able to discriminate the important phonetic contrasts of the world’s languages
Recall the categorical perception studies of the 1970s and 1980s that demonstrated newborns able to categorically perceive important phonetic contrasts like voice onset times (able to differentiate a voiceless from a voiced stop consonant, for example) at birth.
Normal hearing allows for this speech discrimination ability, which ultimately is reflected in speech development and production. Remember that speech development occurs concurrently with receptive language development.
What happens when HL is present at birth. Well, it’s clear that the development of speech sounds and other expressive language characteristics will be affected to some degree. Lots of variables affect how much speech will be affected. The two major variables appear to be degree of HL (more severe the HL, the more speech is affected) and age of identification/remediation (early id, better speech characterisitics later on)
In fact there are some reports to suggest that children ident by 6 months had normal speech by age 5--recall some of the deaf kids in oral programs shown in “Sound and Fury”
First we will review normally hearing speech development characteristics and then talk about hard-of-hearing/deaf kids

3. Newborns Primary form of communication is through their cry
Newborns and young infants--birth to 6 mo
A newborn’s primary way of communicating is thru it’s cry.
While crying can seem foreign and overwhelming at first, parents soon learn to distinguish different kinds of cries for the different purposes they serve.

4. Newborn Communication
Communication intents though crying:
Pain or discomfort
Hunger
Overload
Baby’s cries generally indicate that something is wrong--hungry, wet, cold, tired, lonely.
Soon, parent will be able to recognize which need their baby is expressing and respond accordingly.
Babies also cry when he is overwhelmed by overstimulation of sight and sound. Sometimes they cry for no apparent reason.
Crying can be a way of shutting down, if they are overloaded.
Believe it or not, infants reorganize themselves (reset, if you will) by a good cry.

5. Newborn Speech Skills Primarily reflexive sounds at birth
Oral reflexes
Crying
Status of Speech Skills:
At birth, babies produce predominantly reflexive sounds (gulping, breathing with vocalization, smacking during feeding, etc)
Newborns have a number of oral reflexes--like the rooting one, but also gagging that may also be associated with vocalizations.
Crying--very early on, cry during both inhalation and exhalation.
Quickly moves to just crying during exhalation--which is what we do during the production of speech sounds.

6. Changes in Speech Increased development and use of non-distress sounds
Some productions of vowel sounds and back consonants /g/ and /k/
By 3 months, vocalization in response to caregiver’s vocalizations
Changes in speech
Increased development and use of nondistress sounds--cooing
some productions of vowel sounds and back consonants /g/ and /k/
by 3 mo, infants will vocalize in response to other vocalizations

7. Babbling Emerges at around 4 months Random sound play
Extremely important landmark of infant development
Single syllable units of CV or VC construction
At around 4 months--babbling emerges.
Babbling is random sound play and becomes more complex as the child gets older.
It is an extremely important landmark of infant development.
You can imagine babbling as the raw data from which language emerges.
At four months, babbling usually consists of single syllable units of CV or VC construction.
What you also will hear is changes in pitch and intonation and tone similar to language.
As the babbling progresses with age, English syllable structure is also imitated.

8. Changes in Speech
By 6 months, see evidence of more complex sound combinations
Labial sounds like /m/ and /p/ are produced more often
Stop consonants (p,t,b,k,g,d), nasal consonants (m, n, ing) and vowels comprise about 80% of sounds produced
Evidence of reduplicated babbling
Emergence of imitative behavior
As the child approaches 6 mo,
the produce increasingly more complex phonemic combinations.
Labial sounds like /m/ and /p/ are produced (babbled) more frequently.
Staps, nasals, vowels comprise about 80% of the consonants produced.
Also at this time, infants demonstrate reduplicated babbling, which contains long strings of CV syllable repetitions or self-imitations.
They may practice this for long periods of time, but attach no real meaning to these sounds.
Babies will start to imitate caregivers speech productions including individual speech sounds, pitch, and intonation.

9. In Summary… By six months, most babies: Make a lot of different sounds
React appropriately to different voices
Turn and look for sounds
Babble with purpose
Respond to their name
Try to imitate sounds and vocalizations
In summary then, by age 6 mo, most babies make lots of different sounds.
They laugh, gurgle, coo with familiar people.
The react appropriately to loud, angry and friendly voices.
They turn and look to novel sounds. They babble for attention.
They can respond to their own name--they recognize it
They frequently use syllables ba, da, ka, and others
they pay attention to their own vocalizations and those of others.
They try to imitate sounds and vocalizations.

10. Landmarks in Speech Development by One Year
The use of one or more words with meaning
Typical first words include “mama”, “dada”, other nouns important in the child’s life
Concept words come next
Babbling development gets the child to this point
Speech development and landmarks at this time:
By the end of the first year, a 1 year old child will use one or more words WITH MEANING—and this is the really important point.
A word—not necessarily the “right” one will be used by the child to signify an object—usually the first words represent nouns
“mama” and “dada” are common first words.
Other nouns used—names of pets, cup or bottle, juice, milk, name of favorite toy or tv character (Barney)
Soon, words representing basic concepts are included: come, go bye-bye, go outside, eat, etc..
Getting to this point, tho, is a continuation of babbling development

11. Stages of Babbling During this Time
Echolalia--imitation
Varigated babbling--syllables aren’t identical
Jargon
Phonetically consistent forms
Representation
Stages and kinds of babbling/speech behaviors:
Echolalia—imitation of another speaker’s utterances.
At first, babies will/can only imitate sounds or strings they have already produced spontaneously.
At this time, tho, they can imitate structures they haven’t spontaneously produced yet.
This use of imitation helps them to expand and modify their speech repertoire
Varigated babbling—adjacent and successive syllables aren’t identical.
Ie pada instead of papa
Evidence of jargon—long strings of speech sounds (not meaningful) but with adult-like intonation and pitch.
Basically, this is babbling that sounds like real speech.
And finally, at the conclusion of this time, the baby develops Phonetically consistent forms (PCFs) which function as “Words” for the infant.
They usually approximate the correct English word and parents will help shape that approximation—but at this point the child has illustrated Representation.
This is the process of having one thing stand for another.
Learning to represent and to symbolize is VERY Strongly related to cognitive abilities.

12. Affect of Hearing Loss on Early Speech Development and Behavior
The effects of hearing loss on speech development are very subtle
Generally, even subtle differences sometimes aren’t apparent until after the first birthday
Emergence of canonical babbling is a major clue
Presence of HL doesn’t become noticeable until months, as far as differences in speech development and characteristics.
Realize that the nature of the HL (degree, uni- or bilateral) will really affect when differences are noticeable and the magnitude of differences
But even children who are deaf won’t show evidence of this until nearly 1 year--that’s why speech development differences haven’t ever been an effective way to id HL.
What differences do we start seeing and when??
Quality and quantity of vocalizations are pretty similar between normally hearing and deaf babies thru about the first year.
The most consistent trend is when canonical (reduplicative) babbling emerges for each group. For normal hearing babies, parents report evidence of this kind of babbling between 6-10 months (this is considered a normal range).
Deaf babies showed evidence of this kind of babbling between 11 and 25 months. Notice that even the most precocious deaf baby didn’t show evidence of this kind of babbling within the normal range
This is from Oller and Eilers, 1988

13. Variables Affecting Later Speech Intelligibility
Age of identification/remediation
We already talked about this
Degree of impairment
Focus more on aided thresholds
Communication mode
Oral programs tend to develop speech intelligibility best
So how predictable is a child’s ultimate level of speech intelligibility based on characteristics of the HL
Well, we already mentioned age of ident/remed. The earlier the better
The degree of impairment (in terms of the PTA in the better ear) has long been the gold standard as the best predictor of eventual speech intelligibility. Research and experience has long held 70 dB HL average HL as the major dividing line.
We know need to revise this in terms of the average aided thresholds from Has or Cis. Some researchers (Osberger, et al) at NTID report really favorable overall speech intell results from kids with average thresholds at dB HL with appropriate amplification and a rigorous auditory/verbal program.
Communication mode--how does the child’s preferred communication affect overall speech intell?? Does the use of primarily a manual communication system bode poorly for intelligible speech development?? Some argue it will
Osberger (1994) found that kids with cochlear implants using total communication approach had significantly poorer speech intelligibility compared to kids with cochlear implants using oral communication
Most likely due to the fact that only oral programs really focus on speech use, development, and intelligibility.

14. Speech Characteristics and Therapy Goals
Children with mild/moderate degree of impairment
Children with profound impairment
Acquired hearing loss
We will structure our discussion of the specific types of speech problems based on the degree of hearing loss since this seems to be the major variable determining the degree and type of speech concerns the client will bring to the therapy setting.

15. Speech Characteristics With Mild/Moderate Hearing Loss
What’s normal
Vowel production, voice quality, suprasegmental features
Intelligibility
What’s not normal
Articulation of single consonants and consonant blends
Substitutions, distortions, omissions
Speech characteristics based on degree of HL:
mild/moderate: vowel production, voice quality and suprasegmental features will be normal
Primary errors related to articulation of single consonants or consonant blends
Mostly of consonants characterized by reduced intensity, high freq, and short duration.
Most involve errors of substitutions, followed by distortions. Omissions are infrequent

16. Speech Characteristics with Mild/Moderate Hearing Loss
Phonologically, these children look like normally-hearing kids of a younger age
These children develop and use speech sounds in the same order as normally hearing kids
phonological analyses of samples from these kids suggest they produce errors comparable to younger normal hearing kids.

17. Speech Management of Mild/Moderate Hearing Loss
Amplification is a must
Clear understanding of the child’s aided hearing thresholds
Articulation and phonological management can generally be approached in the same way as a normally hearing child but
Don’t rely on auditory feedback cues
Rely more on visual, tactile, and/or kinesthetic cues
Be mindful of the developmental order of speech sound acquisition
therapy:
Keep in mind when working on these consonants, complexity of formation, visibility, and developmental order of acquisition.
consider heightening use of visual, tactile and kinesthetic cues to compensate for reduced auditory input.
Knowledge of child’s audiogram (aided and unaided) is crucial

18. Speech Characteristics of Deaf Children
What’s normal
Nothing
What’s not normal
Respiration, phonation, resonance, articulation, and suprasegmentals
Intelligibility averages about 20%, but extremely variable on a case-by-case basis

19. Characteristics of Respiration
Basic problems related to a general in- coordination of respiration and phonation
Few syllables/breath
Inhalation at inappropriate times
Abnormally high airflow rates during phonation
Breathy quality

20. Characteristics of Resonance
Hyponasality
Hypernasility

21. Characteristics of Phonation
Inadequate vocal fold adduction
Breathy voice quality
Voiceless sound substitutions for voiced sound
Inadequate control of vocal fold vibration
Abnormally high pitch
Pitch change is restricted across utterances
Inadequate control of laryngeal activity
Speech intensity too high or too low
Lack of loudness variation and control across utterances
Breathiness or glottal resistance

22. Characteristics of Articulation
Individuals are extremely variable in the number and type of articulation errors seen
Vowel errors
Vowel neutralization, diphthong and vowel confusions, nasalization of vowels
Consonant errors
Errors of voicing, omission and distortion of consonants, omission of consonant blends, nasalization of consonants
Impaired coarticulation movements

23. Characteristics of Suprasegmentals
Slower than normal speaking rates (1.5-2 times)
Individual phonemes prolonged
Lengthy pauses within utterances
Pauses are more numerous and longer than normal
Abnormal intonation patterns
One of the biggest variables determining overall intelligibility
Suprasegmental features communicate emotional intent, urgency of the message, and linguistic stress

24. Increasing Speech Production and Intelligibility
Maximizing residual hearing
Appropriate amplification is a must
Anatomical and pictorial monitoring
Picture representations of tongue placement during phoneme production
Visual stimulation and feedback
Mirrors
Feedback devices
Visipitch, SpeechViewer, palatometers

25. Speech Characteristics of Acquired Hearing Loss
Extremely variable effects
Usually the degree of hearing loss has to be very significant, especially in the high frequencies
Decline in intelligibility is gradual and due to loss of auditory feedback
Typical errors
Production of siblants, final consonants, voice quality, loudness control, rhythm
Speech characteristics of acquired HL
very little information on them
generally the decline is gradual and extremely variable.
typical errors might include--production of sibilants, final consonants, voice quality, loudness control, and rhythm.