174 Chapter 9
Three variables directly affect aural habilitation and rehabilitation in children. First, some
hearing losses and types of deafness are congenital, that is, apparent at birth. “Youngsters with
congenital deafness should generally be served through early- intervention programs, which
include parent- infant and preschool programs” (Moeller, Schow, & Johnson, 2002, p. 279).
Second, some hearing losses and types of deafness may occur after birth, but before or during
the major speech and language acquisition period. In these cases, the age at which the disorder
takes place and the child’s level of speech and language acquisition dictate the nature and type of
aural rehabilitation ser vices provided. The child can be seen in early- intervention programs, in
the school, and in other clinical settings. Third, some hearing loss and deafness may occur after
speech and language development, roughly after the age of 8 years. According to the Individuals
with Disabilities Education Act (IDEA), children with hearing loss must receive free, appropriate
educational ser vices in the least restrictive environment. Although vocabulary and pragmatics are
learned throughout life, most children have learned language and phonemes by age 7 or 8 (Tanner,
Culbertson, & Secord, 1997; Tanner, Lamb, & Secord, 1997).
According to Nicolosi, Harryman, and Kresheck (2004), all aural habilitation and rehabilitation
is based on two methodologies: analytic and synthetic. The analytic, or formal, method empha-
sizes learning the parts of speech reading (lip reading) before addressing them holistically. In this
method, the clinician teaches the hard- of- hearing or deaf person to recognize the speech sounds
in isolation, later progressing to words, phrases, sentences, and longer units. In this approach to
speech reading, the prosodic aspects are emphasized (Jena method), including rapid and rhythmic
drills (Mueller– Walle method) and close observation of the movement of the lips from one sound
position to another (Bruhn method). The synthetic, or informal, method addresses the meaning
of whole paragraphs before breaking them into smaller units. This approach to speech reading
emphasizes the intuition, quickness, concentration, and alertness of the speech reader in dealing
with larger units prior to addressing words and sentences (Nitchie method).
Moeller et al. (2002) describe auditory skills for children. Attending and detection involve
focusing on environmental sounds, voices, and distinct speech sounds. Recognizing and locat-
ing entail recognizing objects and events from their sounds and locating them in space. Distance
and levels require localizing sound sources at increasing distances and “above and below.”
Environmental discrimination, identification, and comprehension consist of repeated stimulation
with meaningful sounds to improve comprehension. Vocal discrimination, identification, and
comprehension involve giving the child natu ral opportunities to distinguish onomatopoeic gross
vocal sounds, words, and phrases. Speech discrimination, identification, and comprehension pro-
vide the child with opportunities to use these be hav iors with meaningful fine speech sounds in
words and in dif fer ent situations. According to Moeller et al., these seven skills are not necessarily
discrete stages; they form a general hierarchy with individual variations.
Articulation therapy for children with hearing loss requires special adaptations. The sensorim-
otor method is required rather than the phonological pro cesses approach to articulation therapy
for children with hearing loss (Waldowski & Wilkes, 2003). According to Waldowski and Wilkes,
seven strategies can be used to improve articulation in children with hearing loss: working from
the known to the unknown, using facilitating contexts, teaching by analogy, establishing a set,
listening, analyzing errors, and providing specific feedback. After the child receives a hearing aid
or cochlear implant, the feedback system provides a way of remembering sounds and connecting
them to hearing.
School- age children who are deaf or hard of hearing require several adaptations in inclu-
sive educational settings (Moeller et al., 2002). First, each child’s communication strengths
and weaknesses should be comprehensively evaluated. Second, intervention should address
functioning in the classroom and those be hav iors that lead to successful classroom listen-
ing. Third, new vocabulary words should be linked to existing knowledge. Fourth, narration
focusing on organ ization and self- expression should be used to improve both oral and written