Why Communication Matters

Only through communication can human life hold meaning.– Paulo Freire

Kids talking in group - chscorg.wordpress.com

Welcome to the blog for Cleveland Hearing & Speech Center (CHSC). As the premier provider of hearing, speech-language and deaf programs, services and advocacy, CHSC will keep you updated as to the latest information, tips, resources, research and more related to all things communication-based. If you are wondering how important the gift of communication can be – consider these

Top 10 Reasons Why Communication Matters

Cleveland hearing & Speech Center (CHSC) is dedicated to our vision – a community where everyone communicates effectively. The choice as to the form communication takes is a personal one.  Hearing and speaking are the most common forms of communication. Some people may use American Sign Language (ASL) Still others may choose captioning or lip reading. Communication by definition is the transmitting of, or interchange of, thoughts, opinions, or information by speech, writing, or signs. But, without question, the loss of the ability to communicate can mean loss of quality of life.

Without the ability to communicate you…

  1. wouldn’t be able to get a job. All jobs – from ditch-digger to CEO – require the ability to convey information. Your effectiveness at work, including interpersonal skills, is rooted in your approach to communicating with people. Hearing what is being said by the client; conveying goals to your team; listening to your boss’ instructions; understanding your objectives – all require your ability to communicate effectively.
  2. wouldn’t be able to signal for help. You finally got to take that trip to Italy – only to find yourself lost in a strange town. How can you ask for help? Being unable to communicate a need can be scary, especially in unfamiliar surroundings.
  3. wouldn’t be able to learn. Who doesn’t love curling up with a good book? Reading, writing, and ‘rithmatic all require the ability to understand the meaning of letters, words and numbers. Literacy is tied to communication, as is all learning.
  4. wouldn’t be able to manage a bank account. Keeping your checkbook balanced may seem like an ongoing challenge – but imagine if you had no understanding of the complexities of deposits, withdrawals, and other bank-related formulas. The same is true of other complex issues – legal documents, contracts, warranties.
  5. wouldn’t be able to express your ideas or feelings. As recent politics showed us – people have strong opinions and ideas about what they want for themselves, their families, their futures. Everyone wants to feel their opinion matters. But first, they need to able to communicate that opinion.
  6. wouldn’t be able to socialize. Statistics show that people with hearing loss, aphasia (loss of language), or other communication challenges, tend to withdraw more and more from social situations. This creates a downward spiral where they feel  lonely and depressed. Statistics show that socializing with friends, family and groups not only keeps the brain sharp but improves overall health and wellbeing.
  7. wouldn’t be able to explain a problem. When the car engine starts making that weird noise, or the faucet won’t stop dripping – it’s time to schedule maintenance. This requires the ability to find the appropriate source of help, communicate the issue and arrange for repair.
  8. wouldn’t be able to call or text a friend. It’s true that communication isn’t always verbal – and texting is a form of communicating. But if you were both deaf and blind and had not been given alternate methods of communicating – you might never experience the simple pleasure of a friendly chat.
  9. wouldn’t be able to live independently. As we’ve mentioned, without the ability to communicate and understand complex ideas such as banking, living independently would be nearly impossible. Add to that the inability to navigate a bus schedule or pay utility bills and you would feel completely dependent on others for your life’s needs.
  10. wouldn’t be able to say “I love you.” Although hugs and kisses convey as much heartfelt meaning as the words “I love you” – it is not always possible to express feelings in a physical way, and not every relationship is a physical one. Communication is the greatest gift we have and can give to each other.

Most of us take our ability to communicate effectively for granted. Unless or until something changes our ability, we pay very little attention to it. But knowing that services and programs exist to help those who need it – when they need it – is key to the mission of Cleveland Hearing & Speech Center. Whether it is the family whose infant did not pass its hearing test at the hospital, or the child who stutters, or the stroke survivor who needs speech therapy, or the Deaf individual who needs an American Sign Language interpreter, or the Baby Boomer who is beginning to notice a hearing loss – these and many others find the help they need at CHSC.

If you or someone you know has a communication issue, please contact us for further information. We are happy to help you get the answers you need. You will find us at www.chsc.org or call 216-231-8787.


Prevent “Summer Slide” in Reading Skills

By Barbara Choudhury, SLP – Cleveland Hearing & Speech Center

Summer vacation isn’t all fun and games (even if it should be).  Research shows that summer can take a toll on a student’s knowledge and skills-from mathematics to reading development.  Summer learning loss (“summer slide”) contributes substantially to the achievement gap between low-income and high-income students.  Luckily many types of summer programs can help keep a child’s mind engaged over the summer.

Importance of Summer Reading

The value placed on literacy in the home, time spent reading with children, and the availability and use of reading materials have been identified as important elements in children’s reading success (Snow, Burns, & Griffin, 1998).  Supporting reading development over the summer months can be done in ways that activate a child’s interests and imagination.  It is not enough to simply tell parents that it is important to read to children.

Did you know?

  • Without effective reading and literacy skills, people struggle academically, occupationally, and socially.
  • Research shows that greater exposure to language and reading each day is more likely to develop strong reading ability.
  • High-quality summer learning programs have been shown to also improve school attachment, motivation, and relationships with adults and peers.
  • Research suggests that three to four consecutive summers of high-quality learning beginning in pre-kindergarten can get kids reading on grade level by third grade, making them four times more likely to graduate from high school.

CHSC Summer Reading Camp

Cleveland Hearing & Speech Center’s Summer Reading Camp is designed to improve students reading ability through structured, multisensory reading instruction targeting the five key areas of reading instruction identified by the National Reading Panel in 2000 (phonemic awareness, the alphabetic principle, accuracy and fluency of reading, vocabulary, and comprehension) and consistent with the Common Core Standards for English Language Arts (CCS).  The CHSC Summer Reading Camp is unique because it is facilitated by a speech-language pathologist (SLP) who provides reading instruction using research-based methods to develop critical reading skills.  The reading instruction is paired with strengthening of oral language skills (which speech-language pathologists are specifically trained to do) to provide the foundation for reading and literacy.

The CHSC Summer Reading Camp is facilitated by Barbara Choudhury, a speech-language pathologist who coordinates the reading and writing services at Cleveland & Hearing and Speech Center.  She is certified as a Wilson Dyslexia Practitioner and has over 10 years experience using the Wilson Reading Program with children.

The sessions:

  • Run six consecutive weeks (June 14-July 19th, 2017)
  • Meet one time per week (either Wednesdays or Thursdays)
  • Daily sessions are two hours long
  • Grouped by grade level (entering 1st – 5th)
  • Small group instruction

Everything at CHSC Summer Reading Camp (stories, games, activities) involves letter or reading, as do the crafts or other hands on activities.  The children participate in a pre-test to determine their current skill levels and then a post-test is completed at the end of camp to see how much growth they have made in the 6 weeks.

Parent Involvement and Education

An important component of the program is to send home a note to parents explaining the skills their children are demonstrating in the camp activities.  The parent can then be aware of important aspects to work on with the child and learn how to help keep skills sharp once reading camp is over.  Some simple, recommended activities for the parents to do with their children are:

  • Read everything: point out words on signs, read instructions and captions out loud; encourage your child to help you cook or bake and read the instructions together.
  • Play word games like I Spy: as you talk with your child point out the names, colors, shapes of things. “I spy with my little eye, something that is a square and has lots of pages.” It’s a book.  This helps your child build vocabulary, which is key to sound out unknown words while reading (it’s much easier to sound out a word if you know that the word exists in the first place).
  • Go to the library to read books with your child. Then connect what you read with what happens in life (read about animals and take a trip to the zoo).
  • Have your child use a finger to trace a letter while saying the letter’s sound. Do this on paper, in sand, or on a plate of sugar.
  • Sing songs, read rhyming books, and say silly tongue twisters. These help kids become sensitive to the sounds in words.

Have a happy and healthy summer!  Be sure to read, read, and read some more!  Not only can we prevent the summer slide, we can help reading growth with hard work over the summer.  For more information, please contact Barbara Choudhury at the Cleveland Hearing & Speech Center  216-325-7532 or bchoudhury@chsc.org.


Testing Your Baby’s Hearing

By Dr. Bridgid Whitford Au.D. CCC-A

Director of Hearing Services, Cleveland Hearing & Speech Center

I remember the days my children were born clearly….well, kind of. Some moments are crystal clear and will be etched in my memory till the end of time “Your baby boy has red hair!” “It’s a girl!” In contrast; many of the details were a complete blur – countless nurses, doctors, aides, monitors and medications. There were informational videos to watch, and tearful meetings with lactation consultants. The constant hum of activity allowed for very little sleep.

Universal Newborn Hearing Screenings (UNHS)

As an audiologist, I know the importance of identifying hearing loss in children as early as possible. However, because my children were born in Ohio before 2004, only my son who was born with Down Syndrome received a hearing screening. My other two children had no risk factors and, thus, did not warrant a screening. Fortunately, this has changed. Today, Universal Newborn Hearing Screenings (UNHS) ensure that all children receive a hearing screening before they are discharged from the hospital. Fifty percent of children born with hearing loss have no risk factors. We are fortunate now to be able to identify children who may have otherwise not been diagnosed until developmental delays associated with hearing loss (like speech and language concerns) emerge.

Early Hearing Loss Detection and Intervention (EHDI) Program

The Early Hearing Loss Detection and Intervention (EHDI) Program has a clear goal of having every child receive a hearing screening by 1 month of age, a diagnostic hearing test (if the baby did not pass the hospital screening) by 3 months of age, and enrollment in early intervention (if hearing loss is identified)  by 6 months of age. These 1/3/6 month standards are nationwide. There is also a strong movement to meet these markers by a 1/2/3 month standard, as we know the earlier a child receives intervention for hearing loss the better the outcome.

Apparently, my son Jamie, who has Down Syndrome, received a hearing screening in the days after his birth. I have no idea when (so much was a blur at that time). But, I do clearly recall talking with the nurse because he did not pass the screening. This meant we needed to bring him back for further testing. Given my profession, I was fortunate to understand that time was of the essence. The Auditory Brainstem Response (ABR) testing that they needed to complete to know how well my son was hearing required Jamie to be fully asleep. A newborn will sleep naturally and the testing can usually be completed quickly in the audiologist’s office.  However, if we waited months to go back, there was a high likelihood that he would have to be sedated to get an accurate test. I definitely would have sedated had it been necessary, but was glad that was not the case. I knew that I needed to be sure that my son could hear, or if not, how much hearing loss there was and how to arrange to get help for him. How could I expect he would learn to talk, if he could not hear?

Like every mother, I wanted to do everything possible to help my baby. I quickly scheduled a follow up hearing test. When he was just a few weeks old, my husband and I brought Jamie back to the hospital for the diagnostic ABR testing. He slept in my arms as the audiologist taped wires (electrodes) to his forehead and behind his ears. Then the audiologist put little headphones on him that made noises and watched his brain’s response to those sounds. Jamie slept the entire time! It was easy, and I was thankful to learn that Jamie had normal hearing.  However, given his diagnosis of Down Syndrome, the audiologist suggested frequent (every 6 month) tests to monitor his hearing.

Jamie also enrolled in early intervention through Help Me Grow.  Jamie was eligible due to his Down Syndrome diagnosis, however, this is the same program that children who are identified with hearing loss are eligible for. It was wonderful! We had a specialist who came to our home and helped our family work with Jamie to meet the goals we decided were important to us.  The best part was that it was absolutely free.  It did not matter what insurance (if any) we had. It is free to everyone.

Cleveland Hearing & Speech Center has early interventionists that specialize in hearing loss.  We work as part of the Help Me Grow team and go to a family’s home to help them understand their child’s hearing loss and how it may impact their child’s development. We help families identify outcomes important to them and help them achieve those outcomes.  Every family is unique and has their own strengths and own dreams. Some families want to learn sign language and meet members of the Deaf community.  Some families need more information about technology such as hearing aids or cochlear implants.  Some families want strategies on how to encourage language within their home.  We know that babies and toddlers learn best in their natural environment so our goal is not to teach the baby, but to coach the parents so that they may be their child’s best teacher.  Learning happens in every day routines and situations.  We help families recognize and maximize those opportunities.

Cleveland Hearing & Speech Center also has a team of audiologists.  We conduct hearing testing at all 3 of our locations (University Circle, Broadview Heights, South Euclid), although we do not have the equipment to test a newborn. It is typically the large hospital systems that have the ABR equipment.  However, our audiologists can test children from 9 months of age and up and we also fit hearing aids on people of all ages, including infants.  If a child has a hearing loss, we hope to have hearing aids fit by 3 months of age. Access to sound is important as children are learning language.  Children are like sponges and they spend the better part of the first year listening and taking it all in, and it is not typically until the second year of life that the words they heard begin to come back out. It is important that all babies have the opportunity to develop language.

Every baby’s journey is unique; however, all parents need to know how well their baby hears in order to provide him/her with a language rich environment. If you have questions about your child’s hearing or about hearing loss, please contact Cleveland Hearing & Speech Center at 216-231-8787.

How to Prevent Noise Induced Hearing Loss

Ok. I have to be real about this.

Back in the day, before I became an audiologist, I did some really unkind, unhealthy things to my hearing.  Pretty please, promise you won’t tell my 14 year old.  You know, as the saying goes  “do as I say not as I did.”

I attended some REALLY loud indoor concerts – Nine Inch Nails, Bowie, Pink Floyd.

In college I would lay on the floor with my head sandwiched between speakers and play Genesis’s entire Trick of the Tail album. Loud.  Then some Crosby Stills Nash & Young. Loud. And, oh yeah, can’t forget, Prince’s epic 1999 (still can’t believe he’s gone). That was even louder.

I remember leaving one show at the old Coliseum in Richfield and feeling as if my hearing was muffled and laughing as I asked friends, “huh, what did you say?”

Summer meant Blossom Music Center. One summer: 17 concerts on the lawn. Loud, but not quite as loud as the indoor shows.

If I only knew then what I know now.

I now know that temporarily reduced hearing after loud sound exposure has a name – Temporary Threshold Shift (TTS). I didn’t know that TTS can be a precursor to a permanent threshold shift ( PTS) in hearing.  I didn’t know that tinnitus or ringing in the head or ears is most commonly associated with hearing loss.  I didn’t know that time of exposure + overall loudness can prove to be a dangerous combination for my hearing. In high school, when my parents would holler upstairs to “TURN IT DOWN”, I just thought they were being uncool.

As a young (don’t even go there) audiologist, I began to respect my ears and hearing more. I saw how hearing loss impacted lives, jobs, and relationships.  I saw that although hearing aids offer many people with hearing loss significant benefit, the best plan was to protect my hearing.  It just mattered to me more. So, when portable music (remember the old Walkman radios and CD players?) first became popular, I developed the Safe Sound (now known as Sound Choices) hearing conservation program for elementary aged children. Originally presented to classrooms, the student and teacher materials are now available on our website: www.chsc.org/soundchoices

Fast-forward to MP3 players. Today, it is not uncommon to see a smartphone in the hands of young children. Music, movies, and videos are more accessible, portable, devices have longer run times, and speakers are commonly worn IN THE EARS.

Some people erroneously think that it is only rock music that will cause damage. Admittedly, rock and roll is often played loud, but ANY music (country, gospel, orchestra) can cause damage if loud enough and you listen long enough.

We also now know that loud sound can impact hearing differently in some people. Some ears just seem to be more tender and fragile than others.  The problem that remains is that we don’t know who that is ahead of time.

I am more concerned than ever about the hearing of future generations. Parents and other authority figures have a hard time monitoring risky hearing behavior.  But just like we teach our children to use sunscreen to protect their skin and to brush their teeth twice a day to prevent cavities, we need to talk to them about hearing loss related to loud sound exposure. The younger they start practicing good habits, the better. And, as parents, remember to model good hearing hygiene habits when you are with them.

Noise Induced Hearing Loss (NIHL) is completely and 100% preventable.

To conserve what you have, some easy tips:

  • Limit time of exposure
  • Limit overall loudness
  • Use noise canceling earphones
  • Look for loudness limiting parental controls in devices
  • Limit noisy toys or remove the batteries
  • If someone is  arms reach away and can hear your music, it is too loud
  • In noisy places, If you have to raise your voice to be heard, it is too loud
  • Sound that causes ringing in the ears or a temporary reduction in hearing is too loud
  • Use earplugs or muffs when operating a lawnmower, snow blower or leaf blower
  • ALWAYS use hearing protection when hunting or shooting

Facts About Noise

Although the definition of “noise” may be interpreted on a personal basis, it can be described simply as unwanted sound. Unwanted sound, or noise, can result in hearing loss, which is known as noise-induced hearing loss. Noise-induced hearing loss (NIHL) can be instantaneous and caused by just one single exposure to a very loud sound (like a firecracker or gunshot). NIHL can also be caused by cumulative exposure to loud sounds which gradually build over time to cause the hearing loss. So, even though hearing loss due to loud sound may not always be evident immediately, NIHL may be present later, in teenagers or adulthood. Any reduction in the overall lifetime noise “dose” will be good for hearing in later years.

  • Noise is one of the leading causes of hearing loss
  • Noise-induced hearing loss is permanent – but preventable
  • Continuous exposure to noise can lead to physiological changes in blood pressure, sleep, digestion, and other stress-related disorders
  • Noise-induced hearing loss typically occurs gradually and without pain
  • Continued exposure to noise above 85 decibels will eventually harm one’s hearing
  • In general, the louder the sound, the less time required before damage occurs

How Noise Affects Hearing

The cochlea is the organ of hearing.  It is shaped like a snail and is approximately the size of a nickel.  Inside the cochlea are thousands of tiny nerve endings called hair cells.  These hair cells are surrounded by fluid.  When you hear a sound, the sound vibrations cause the fluid to ripple through the cochlea and bend the hair cells, thereby activating the nerve endings.  If the sounds are very loud, the vibrations, in turn, are very strong and cause the hair cells to not only bend, but to break.  Once a hair cell is damaged in this fashion, it cannot be repaired, renewed, or replaced.

Knowing When It’s Too Loud

As a general rule, if you must raise the volume of your voice above the noise level to carry on a conversation, the noise is too loud.

Noise and Hearing Conservation

  • According to the National Center of Disease Statistics, 5.2 million children between the ages of 6-19 years have hearing loss directly related to noise exposure.
  • The Occupation Safety and Health Administration estimates that nearly 5 million Americans work in levels of noise that are potentially harmful to their hearing.

What should you do if you suspect a Noise Induced Hearing Loss (NIHL)?  The audiologists at CHSC can assess your hearing to determine if a loss is present and make recommendations regarding hearing protection and conservation including customized noise earplugs.  To schedule an appointment with an audiologist, please contact us at 216-231-8787.


How “Clear Speech” Helps Those with Hearing Loss

As audiologists at Cleveland Hearing & Speech Center, we are best known for rehabilitating hearing loss.  However, we don’t stop at evaluating your hearing.  We care about communication.  When you come to one of our audiologists for a diagnostic hearing evaluation, we discuss with you your lifestyle and your communication needs.  We talk to you about how your specific hearing loss impacts your ability to communicate in a wide range of listening environments.  Just as important— we work with family, friends, and other communication partners to help them better understand how to communicate with a loved one who has hearing loss.  During May – Better Hearing and Speech Month – we want to discuss how Clear Speech can lead to better hearing.  The following strategies can help you improve your communication with family and friends who have a hearing loss.

What is Clear Speech?

Clear Speech is a method of speaking in which the speaker makes a concerted effort to express every word, sentence, and idea in a very precise, accurate, and deliberate way.  When you practice Clear Speech with a friend or family member, you don’t shout at them or speak in unnatural ways – like exaggerating sounds, or speaking in a monotone or “sing-song” voice.  Rather, you speak slowly and clearly at a slightly elevated – but not strained – volume.  It is a way of conveying your message in a clear, purposeful way to help a person with a hearing loss better understand what you said AND avoid the need for repetition.

What is the goal of Clear Speech?

Hearing loss impairs communication by filtering out certain speech sounds, so the individual with hearing loss only hears a portion of the sounds spoken to them.  Different types and degrees of hearing loss filter out different speech sounds and different amounts of speech information.  The goal of Clear Speech is for the communication partner to employ good speech techniques to help the individual with hearing loss to compensate for the speech sounds filtered out by their hearing loss.

How can I practice Clear Speech?

  • Articulate sounds precisely and accurately
  • Speak more slowly
  • Take clear pauses between phrases and thoughts. This gives the individual with hearing loss time to process key ideas before you continue with your thoughts.
  • Increase volume – but only slightly, and avoid speaking where you are straining. When you strain to speak loudly, you are distorting your speech sounds and the way your lips are moving (thus impairing visual lipreading cues).

Examples of Clear Speech:

You may be reading this thinking “I speak clearly, what more can I do?”  What many people don’t realize, though, is that English speakers actually don’t speak very clearly – even when we think we are!  We often blur words together and blend speech sounds of neighboring words in a sentence.  Take a look at the following examples of typical spoken English and the transformation into Clear Speech (Kricos, 2005).

  • “She leffer the store onabus”
    • Using Clear Speech, the speaker would say – at a modestly elevated vocal volume – “She left for the city   on a bus.”  The pauses give the individual with hearing loss time to process what has been said – and to understand the meaning of key ideas before the speaker adds further detail.  Also Clear Speech avoids blending of sounds like “leffer” in this particular example.
  • “The kids ‘r swim’n inthepool.”
    • The Clear Speech version would be: “The kids     are swimming    in the pool.”  Once again, strategic pauses in key places help the individual with hearing loss to follow ideas in the sentence.  Also, by not blending words and sounds together, you make your ideas more easily understandable to a family or friend with hearing loss.
  • “Yermother’ll haftagotothe denistomorrow”
    • With Clear Speech, you would say “Your mother will have to go to the   dentist tomorrow.”  Words like “hafta” are common in spoken English, but they are difficult for the individual with hearing loss.  With Clear Speech, you avoid familiar sayings like this to make sure your speech is clear and understandable.  It may take some effort to avoid speaking like this, but if you do, you may avoid having to repeat yourself!
  • Another Clear Speech tip is to take a pause before and after very important words in a sentence. For example, if you want to ensure an individual with hearing loss hears the correct name in a sentence, take a pause before and after saying the person’s name.  The same goes for any very important word in a sentence.

Other Communication Strategies:

In addition to Clear Speech techniques, there are numerous strategies for improving your communication with friends and family members with hearing loss.  Below are some ideas:

  • Make sure you get the individual’s attention before speaking. This could mean saying his/her name and waiting until he/she makes eye contact with you.  Or it could mean gently tapping the person on the shoulder.
  • Don’t try to communicate from different rooms in the house! We hear this one a lot  when see patients.  We know it may feel more convenient to try shouting from another room, but individuals with hearing loss can’t communicate this way!
  • Reduce background noise and distractions when communicating. Background noise is very detrimental for individuals with hearing loss.  Even background noise that you perceive as soft may make speech understanding more difficult for an individual with hearing loss
  • Make sure the individual with hearing loss can see your face. Speak face-to-face with good lighting.  Visual cues help a lot!
  • If an individual with hearing loss asks for repetition, consider using different words/phrasing when you repeat. Some words are difficult for an individual with hearing loss to hear, so repeating in different words may help.
  • Check for understanding.  When expressing ideas, you may need to step back to check that the listener is on the same page before continuing on with other ideas.
  • Most importantly, be patient! Listening with a hearing loss is hard work.

If you suspect a friend or family member has hearing loss, we want to help!  The above tips are a general guide for communicating with a friend or family member with hearing loss, but only a diagnostic hearing evaluation performed by a licensed audiologist can provide individualized recommendations.  Call Cleveland Hearing & Speech Center at 216-231-8787 to schedule a consult with one of our experienced audiologists.  In the meantime, we encourage you to practice Clear Speech with friends and family members who have hearing loss.  This month, better speech is better hearing!


How to Respond to Communication-Related Tantrums

by Megan Ahlman, M.A. CCC-SLP at Cleveland Hearing & Speech Center

Communicating can be frustrating for both parents, and toddlers!  Toddlers often know what they want, but are not yet able to express their wants accurately to caregivers.  Communication breakdowns happen when toddlers point or whine, sending an unclear message to the adult they’re communicating with.

Remember – it’s normal for toddlers to communicate this way!  Toddlers are exposed to new words every day, and they need to hear and try new words many times before using them consistently.

But, when tension builds and frustration mounts due to a communication breakdown, toddlers may completely lose their cool!  Your toddler may cry, scream, run away from you, shut down, or even hit and pinch when you offer comfort.  Toddlers can become overwhelmed with their emotions, which can turn into a full-blown tantrum.

Toddlers also learn how to push limits as their need to experience independence grows.  As toddlers attempt to make their own decisions – open the refrigerator, dress themselves, decide they want to go outside to play – communication breakdowns may occur.  This can be exhausting and irritating for parents, who feel frustration with their toddler’s growing desire to do things on their own.  Again, remember- this is a normal behavior for toddlers!

How should a parent respond when a toddler can’t communicate what they want?
Here are a few tips to keep in mind:

Don’t Take It Personally

Every parent can remember a time when their child pushed the limits.  Toddlers constantly gauge what they can (and cannot) get away with.  The playground, kitchen table, and grocery store are only a few places where they may test their boundaries.  It’s important to remember that toddlers are impulsive and easily swayed by their emotions.  As they attempt to control the world around them, their actions may seem defiant.  In reality, children are learning what is (and is not) allowed.  Remind yourself that your child is learning, and maintain your patience rather than viewing his actions as a personal attack.

Respond Consistently

Show your child that you are not affected by their behavior.  Dealing with a tantrum and emotions that are running rampant can quickly become challenging, but remember to keep your composure.  You are the parent, and you are in charge.  Do not allow your child to control a situation by using their emotions to get your attention.  Parents may become embarrassed when their child throws a tantrum, but it’s a normal part of toddler’s growth of their emotional knowledge.  Respect their emotions, but don’t give in.  Respond calmly- don’t threaten or punish your child for feeling strong emotions.  Instead, recognize their feelings, and help your child work through their emotions.  Tell your child what you would like for them to do.  Instead of saying “No, don’t throw the ball in the house!” say “I see you’re angry.  We throw balls outside.  Please go outside so you can throw it.”

Remove The Pressure – Accept & Listen

When a child is trying to tell you something, he may feel pressured to use words to say what he wants.  Parents can remove this pressure by accepting the means of communication their child is using.  Let your toddler point or gesture.  Using words can be hard for toddlers, so they should be encouraged to communicate with others in a comfortable way.  Using gestures is still a good way for your child to get his point across, and gestures can be combined with sounds for emphasis.  If your child is trying to use words, you may hear approximations, distorted or shortened words.  This is expected for toddlers, and parents should encourage the use of approximations even though they may be difficult to understand.

Give your toddler time to get his message across.  Slow down the pace of the interaction, and continue the conversation in an un-hurried way.  If your child is attempting to use words, make sure you take time to truly listen to what your child is saying.

Model How You Want Them To Talk

You may hear a lot of “No, no, NO!” from your toddler, especially when you’re trying to help them and figure out what they want!  Toddlers may not have the words to ask for a favorite toy, a snack, or to go to the bathroom.  In order to help your child and avoid a potentially exasperating situation, model the way you would like your child to ask for things during play or daily routines.  Saying “my turn” while pointing at your chest may encourage your child to point to his chest when he wants something.  You can say “I want cereal.  Do you want cereal?”  Then, help your child ask appropriately, modeling “I want…”  If your child is using approximations, encourage them to keep talking by taking your child’s approximations and modeling the correct way to say it.  For example, if you child says “doo,” parents can reply “Oh, you want juice!”  If your child says “doe ow-sigh” while pointing to the door, model “Go outside!  I see you pointing.”

Provide Choices

Toddlers are developing independence and may become upset if they feel like they’re being ordered around.  You may be able to “trick” your toddler into thinking they are in charge of a situation by offering them choices.  Asking the question “What do you want for breakfast?” may result in an answer like “Cupcakes!” or simply no response if your child doesn’t have the vocabulary to answer you with what he wants.  Instead, phrase your question as a choice, saying “Do you want cereal or eggs for breakfast?”  This allows your child to still feel in control, while ensuring they will make an appropriate suggestion and avoid frustration.

Offer an Alternative Activity

If your child’s tantrum becomes out of control, take a break from the activity or reason for the communication breakdown.  Remove your child from the situation and remain close to them, in case they attempt to communicate with you.  Try going for a walk, eating a snack, or sitting quietly together.

Toddlers expect their parents to know exactly what they want at all times, and sometimes parents do!  Avoid situations in which you know your child may be primed for a communication breakdown.  For example, if you schedule a doctor’s appointment during your child’s typical nap time, you’ll likely experience an emotion-laden toddler who is difficult to communicate with.
These tips may help parents keep their cool while helping their child through a communication-related tantrum.  If parents find that they are unable to understand their toddler’s verbalizations of their wants and needs more than 50% of the time, a licensed speech-language pathologist (SLP) may be able to help!  SLPs can help parents learn strategies to make communicating with toddlers easier, and ultimately less frustrating. If you have questions or concerns about your child’s speech or language development, contact the Cleveland Hearing & Speech Center at 216-231-8787.


Developing Social Skills in Young Children

Social skills are the ways we use our language skills in social situations. Social communication is important in developing effective interpersonal skills and is critical to various aspects of our daily life. Social skills are important in childhood and adulthood. What is the relationship between social skills and speech-language skills/disorders?

Navigating social interactions is one of the most complex tasks in which human beings participate. Social communication involves many psychological systems, such as visual and auditory perception, receptive and expressive language and problem-solving skills. These systems develop throughout childhood into adulthood and are influenced by our personality (nature) and the environment and interactions around us (nurture). When these systems do not function properly, social exchanges may not go smoothly. For example, a child with a language deficit affecting social communication may not be able to understand or respond to verbal or nonverbal social cues such as when to end a conversation or how to change topics during discussion.

There are many different types of social skills deficits. Some examples include children with Autism Spectrum Disorders (ASD), who tend to have deficits in understanding another person’s perspectives. Many individuals with ASD do indeed desire social involvement; however, these individuals typically lack the necessary skills to interact effectively. Children with the hyperactive and impulsive subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD) tend to have poor impulse control and social problem-solving skills. Socially anxious children are overly cautious, in part due to fears of what others will think of their actions, which may result in avoiding social situations.

Research presented at the 2007 meeting of the Society for Research in Child Development by a team of Michigan State University researchers indicate that a child’s social skills at age 3 could predict his or her future social and academic performance. Important social skills in early childhood include emerging abilities to manage feelings and behaviors, recognize social cues from others and engage in positive interactions with peers.

Young children who experience problems with social-behavioral adjustment often have co-existing deficits in early language and literacy skills. These deficits may compound the challenges they face and place prospects for success in school and in positive social relationships at risk (Bos, Coleman, & Vaughn, 2002; Hinshaw, 1992; Kaiser, Car, Hancock, & Foster, 2002; McGee, Prior, Williams, Smart, & Sanson, 2002; Tomblin, Zhang, Buckwalter, & Catts, 2000).

What do social skills include?

Social skills include:

  • using eye contact
  • greeting others
  • taking turns in conversations
  • starting and ending conversations appropriately, not abruptly
  • staying on topic or appropriately changing topics
  • using the correct tone of voice for the situation
  • using the appropriate facial expressions and hand gestures
  • sending the message as it was meant (e.g., was it a joke or a request or a way to disagree)

How are social skills evaluated?

Evaluating a child’s social skills is best done by observing a child in a variety of contexts or having the caregiver report about their skills, as well as some formalized testing and checklists. A speech-language pathologist (SLP) will observe a child during a speech-language assessment and record his/her responses. These responses are then reviewed and analyzed for accuracy and appropriateness of each of the skills listed above. The SLP may also ask the parent to complete a checklist of skills the child has demonstrated or to describe difficulties the child has when interacting with others.

How are social skills disorders treated?
Social skills disorders are best treated in a group setting to provide a variety of partners and situations to practice learned skills. Our groups provide direct instruction through a variety of teaching techniques that include modeling, role-play activities, coaching and games. Group lessons address specific goals identified for the group members, such as paying attention to others, holding a conversation, understanding turn-taking, interviewing, problem solving of daily issues, compromise and self-evaluation. A successful group includes plans for generalization and maintenance of newly learned skills outside the training environment. We use group activities to create opportunities to practice real-life skills, and homework is assigned to increase the generalization of skills beyond the group session. Parents and teachers should be involved to ensure carryover of skills to natural settings.

Social skills options at Cleveland Hearing & Speech Center (CHSC)

CHSC is able to design a social skills group based on a client’s age and skill set.  Please contact Barbara Choudhury at (216) 325-7532 or Linda Lange at (216) 325-7531 for more information.

Over the Counter Hearing Aids: the Real Story

“Do I really need a hearing aids?”

“Is my hearing that bad?”

“I am only here because my kids think I need a hearing aid”

Audiologists hear comments like this throughout their day.

Unfortunately, hearing aids have not gained the same mainstream popularity and fashion forward statement that eyeglasses have. Despite the fact that 360 million people worldwide have hearing loss and that nearly 50% of people over 75 years of age have hearing loss, there is still wide spread resistance to trying hearing aids.

Significant research supports the use of hearing aids for people with even a mild hearing loss. Untreated hearing loss can have considerable negative social, psychological, cognitive and health effects.

Studies* have linked untreated hearing loss effects to:

  • Irritability, negativism and anger
  • Fatigue, tension, stress and depression
  • Avoidance or withdrawal from social situations
  • Social rejection and loneliness
  • Reduced alertness and increased risk to personal safety
  • Impaired memory and ability to learn new tasks
  • Reduced job performance and earning power
  • Diminished psychological and overall health

*Better Hearing Institute

However, the resistance to getting hearing help continues and hearing aid adoption rates are low, especially for those with mild hearing loss. The reasons why are numerous and include:

  • Denial: Not understanding (or believing) you have a hearing loss, but instead feeling as if others are mumbling.
  • Vanity: Not liking the look of the hearing aid, or believing it makes you look older.
  • It’s a hassle: Everyone seems to know someone who has hearing aids but still seem to struggle to hear.
  • Finances: Unable to afford the cost of a hearing aid.

In October 2015, The President’s Council on Science and Technology (PCAST) released a report on hearing aids and determined that hearing aids in the current marketplace are not easily accessible to consumers. PCAST believed cost  to be a major issue. They offered recommendations to the President that included the Food and Drug Administration (FDA) creating an “over the counter” (OTC) hearing aid category. The purpose of this is to allow entrepreneurs to be able to bring innovative products to market quickly, without having to go through the red tape currently required to bring a hearing aid, which is classified as a medical device, to market. This should result in innovative products being available more quickly, and at a lower cost, to consumers. In addition, the PCAST suggested that Personal Sound Amplifier Products (PSAPs) – which are currently available and often seen online and in infomercials – to be allowed to make truthful claims about their capabilities, such improving hearing or understanding in situations where environmental noise or crowded rooms might interfere with speech intelligibility. Currently PSAPs may only be marketed to those with normal hearing.  Cleveland Hearing & Speech Center has a high-quality PSAP available to those who may benefit from it.

In November 2016, the Food and Drug Administration voiced their commitment to making OTC hearing aids a reality and Rep. Elizabeth Warren introduced the “Over the Counter Hearing Aid bill of 2016” which would allow for the sale of OTC hearing aids.  Although the bill was not passed prior to the end of the congressional session, it is likely that a similar one will be introduced in the future as the legislation had great support, including the National Academy of Science (NAS), the American Academy of Audiology (AAA), the Academy of Doctors of Audiology(ADA) and the American Speech Language Hearing Association(ASHA).

The support of these professional organizations has come with some caveats including safeguards they recommend the FDA put into place such as:

  • Establish limited gain and output thresholds for these hearing aids
  • Ensure that OTC hearing aids are only available for adults
  • Establish a means for collecting information on consumer safety and other potential complaints
  • Require labeling that strongly recommends seeking audiologic diagnostic and rehabilitative services
  • Require labels that provide consumers with warning signs for conditions that require medical treatment such as tinnitus, dizziness, drainage from the ear, sudden hearing loss, asymmetric hearing, foreign body in the ear, cerumen impaction, pain, congenital or traumatic deformity of the ear.
  • Ensure that current insurance coverage of hearing aids is not undermined. Currently, some states mandate that insurers, including Medicaid, provide coverage for hearing aids for adults. The U.S. Department of Veterans Affairs and the Federal Employees Health Benefits Program also provide coverage for hearing aids. Any new OTC model should not be seen as a substitute for hearing aid benefits under third-party plans.

An overarching reason given for support of legislation for OTC hearing aids is the goal of increasing access to affordable hearing aids and the desire to increase hearing aid adoption rates. However, there is some debate as to whether or not moving to an OTC model will, in fact, accomplish this. EuroTrak and JapanTrak 2012 – 2015 and MarkeTrak 8 and 9 found that Japan, which offers OTC hearing aids has significantly lower levels of adoption than both the UK and the United States which do not currently allow OTC hearing aids sales. (Hearing Aid Adoption rates:  Japan 13%, United Kingdom 41%,  United States 30%.) In addition, levels of satisfaction with hearing aids are lower in Japan (39%) compared to the United States (81%) and the UK (70%).

These lower scores in adoption and satisfaction call into question if improved financial access alone is enough to gain positive outcomes in hearing aid adoption and if moving to an OTC model is in the best interest of public health. This is an area that remains to be proven in the United States. It is safe to say that these changes make for an uncertain time in audiology and hearing healthcare. There is anxiety from professionals and consumers alike about what this will mean and how it will impact them personally and professionally.

As audiologists and providers of hearing healthcare, we know that the professional services that we provide make a difference to the success of our patients. At Cleveland Hearing & Speech Center we track outcomes.  96% of our fittings meet their targeted outcomes as demonstrated by Real Ear testing and we have a 100% satisfaction rate two weeks post-fitting. We feel confident that this would not be the case without our professional services. It is our deep understanding of hearing, hearing loss and the products we dispense that result in successful fittings. CHSC will continue to offer a full range of hearing aids from a variety of manufacturers and the complete package of services to support the consumer. However, we are also committed to ensuring that the hearing aids, even those that are purchased OTC, are fit appropriately and lead to an increased quality of life for the consumer. CHSC is prepared to support consumers who choose to purchase hearing aids or hearing related product from a different vendor, including other audiology practices and retail/online/establishments. Services we will be able to offer include:

  • Diagnostic audiologic testing to determine the type and severity of hearing loss and a person’s ability to understand speech in quiet and noise.
  • Guidance in choosing an OTC hearing aid or accessories/ couplers for OTC hearing aids that will best meet the needs of the patient and the patient’s hearing loss.
  • Customizing OTC hearing aid’s features to best meet the patients hearing loss as able by product.
  • Providing custom ear impressions.
  • Educating patient on proper use and care of OTC hearing aids or any hearing related product.
  • Performing repairs and modifications to hearing aids.
  • Completing outcome and verification measures to document successful fittings of hearing aids including Real Ear measurements, aided testing and questionnaires to gauge patient perception of outcomes and satisfaction.

In Feb 2017, Consumer Reports acknowledged that there is a place in the market for less expensive products however, “… it’s best to see a licensed, reputable hearing specialist first, to make sure the devices are right for your needs.” We could not agree more.

If you have questions for our CHSC Audiologists concerning your hearing health or hearing aids, please call 216-231-8787 or visit www.chsc.org.