By Jana Ziegberman, Au.D., CCC-A

Parents make decisions for their families every day. What school should my daughter attend? Do we need a bigger home? Should my son join karate or Boy Scouts?

When parents learn that their child has a hearing loss, they face new decisions. One of the most important decisions is how their child will communicate, which can be a difficult choice.

Searching online for “communication options for hearing loss,” you will discover blogs, research articles, websites, books, and pamphlets that not only describe the options, but also debate which one is best. The following is a list of the most common communication options available:

Auditory-Verbal Approach

This approach emphasizes listening skills and is an option for children with varying degrees of hearing loss. One-on-one therapy with an auditory-verbal therapist begins after the child is fit with the appropriate amplification, which may either be a hearing aid or a cochlear implant.

The therapist will work with the parents, child and family to teach listening in a natural environment. Speech reading or any sensory cues are not encouraged with this method. With this approach, the primary goal is to enroll the child in a mainstream school setting.

Auditory Oral Approach

This approach works with spoken language and face-to-face communication for children with varying degrees of hearing loss. A child is fit with a hearing aid and/or cochlear implant and then is immersed in an intensive language-rich classroom environment with other children with hearing loss.

The child also learns speech reading which can be used in combination with listening. The result is enhanced communication skills. When considering this approach, it is important to know that one of the primary goals is to prepare the child for success in a mainstream setting.

Cued Speech

This approach includes speech reading with the assistance of hand shapes. Hand shapes are used to help communicate sounds that a child cannot see by speech reading.

Specifically when using English, there are eight hand shapes that differentiate consonant phonemes; four locations near the mouth differentiate vowel phonemes. Cued speech can be used with 55 different languages and dialects throughout the world. By using these hand shapes, confusion of difficult sounds can be decreased and therefore, speech discrimination can be improved.

This method can be chosen for children with all degrees of hearing loss and children with or without amplification.

Total Communication

Total communication is comprised of a combination of whatever works best for the child during different contexts and can include sign language, spoken language, speech reading, and gestures. When using sign language and speech simultaneously, it is called Sign Supported English. The signs are consistent with the English sentence structure, unlike American Sign Language (ASL).

All strategies are not intended to be used equally or simultaneously, but rather available to the child as needed.

Total Communication is often known as TC or Combined Option and can be used with children with all degrees of hearing loss, or for children who wear hearing aids and/or cochlear implants.

American Sign Language (ASL)

ASL is a visual modality and consists of hand signs, body movements, facial expressions, and gestures. American
Sign Language (ASL) is a language that is used primarily in deaf communities in America and English speaking parts
of Canada. Throughout these communities there will be different dialects, just like the many accents be found throughout the United States. ASL has its own grammatical system, similar to French, and cannot be used in exact correlation to English.

Just as a hearing child is born to parents who also are hearing, and communicate through spoken language, a child who is born to parents who already communicate through ASL will typically learn ASL. However, if a deaf child deaf is born to hearing parents, the child, parents and family may learn ASL and become involved in the deaf culture.

For both children, English will be the second language when learning to read and write.

There are many different communication options and the decision- making process may be overwhelming. Parents need to know that their child, degree of hearing loss and family dynamics is unique. What works best for one family may not work for another. Parents should also be aware that whichever route they choose to travel, it does not have to be the only option. What a parent may think is the most appropriate choice initially may change as they proceed with their child’s care. Parents should also voice their concerns and ask questions of their child’s audiologist, pediatrician, therapists, and other family members that are involved in the child’s life.

Understanding all the available options is important for parents and other family members. These are important building blocks in the child’s ability to communicate.


Anderson, K. (2011). Ways to Communicate with a Child with Hearing Loss

National Institute of Health. (April 2000). Communication Options for Children Who Are Deaf or Hard-of-Hearing.

Gravel, J., & O’Gara, J. (2003). Communication options of children with hearing loss. Mental Retardation and Developmental Disabilities Research Reviews, 9, 243-251.