Auditory Verbal Parents

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Accommodations – Why They Are Not Always a Good Thing

Amy: Melissa, recently we saw a study confirming that children learn much language from peers in the preschool years.  (Click here for study) This just adds confirmation to what I believe regarding children who have  cochlear implants– that they do not need special “placements” when  implanted young.  My hearing kids didn’t; so if my goal is normal speech and language for my implanted children, why would I seek a ”placement” of a special school or classroom for them?  My kids were on-par by age 2, but even if they weren’t quite there by the preschool years, I doubt I would have changed my course.  It’s so important to have normal language models for kids for whom the goal is listening and speaking.  And, I have always avoided treating my implanted children as more “different” or “special” than my hearing kids.  I think it would send the wrong message to them both.  We have always taught them to be self-reliant whenever possible, and for them it is definitely possible!  This is not a “sink or swim” philosophy– we made sure they were well equipped for typical school classes before we sent them off.

That being said, there are certain accommodations I MIGHT use for various reasons:  FM system (in certain classrooms, or with particular teachers), choosing a carpeted classroom, and sitting in the front of the room/close to the teacher for testing situations, particularly if instructions are an integral part of the test (spelling tests or state testing are times when that would come into play).  Would I need an IEP for those?  Probably not.  If we couldn’t afford an FM system, we might, but I think it is more likely that we would prefer to own it (and thus have control over taking it home for troubleshooting, etc).  The list could be longer for other kids, depending on their circumstances, age of implantation, and other disabilities.  So no one size fits all…

But, I just don’t “get” why some parents become so involved in the needs of their children that they don’t realize how capable they are.  And, by relying on special help, they often actually hamper their real education.  By real education, I mean learning the things that normally are learned, rather than speech related education.  As a parent, that is “extra curricular,” in my book.  All therapy was to take place with us, as a family, not as a part of their school day.  Also, I would never have considered a long bus ride, longer school day or more days in school for my preschooler simply for hearing-related issues.  My kids attended a regular, 3-morning-a-week preschool at the typical age.  I think it’s dreadful when kids are gone every day (unless it’s necessary for other reasons) and can’t benefit from their most important role-model and speech teacher: their parents.

Money is another thing to consider.  When thinking about the cost to society, it is no small thing to accommodate with special schools, special teachers, special bussing, etc.  I think we all have a moral obligation to only request what is absolutely necessary, because it comes from the taxes we all pay!  And, there are certainly those who really need it due to grave physical conditions and developmental disabilities.  It reminds me of the difference between flying business class and regular seats– when you think about the real costs to your business, and if you do it infrequently, the reality is that you are better off choosing the “right” thing rather than the “most comfortable.”  Unless you are paying yourself, you still need to think of the moral obligations you have to those who share your workplace.  Things aren’t “free” just because they are provided.  They have a real cost, which is shouldered by every family.  I think we have a moral obligation to consider those beside ourselves, and in doing so we create children who understand the value being independent and compassionate, at the same time.  And if they ever do need help, the funds will be there for them.

Melissa: You know this is a pet peeve of mine for all of the reasons that you mentioned but, in particular, because, in choosing to provide accommodations before there is a demonstrated need, parents could very well actually end up doing more harm to their children than good.  When a child is a toddler or in preschool, it is very difficult to think about the future when that child is grown and goes off on his/her own to college.  I am reminded of a parent I know whom I always thought of as way too involved and overprotective.  Her daughter had gone away to college, and the mother was complaining to me about a situation her daughter had with a professor that she thought was unfair.  She then exclaimed to me, “If her college was closer, I’d go there and yell at that professor myself.”  We might all laugh at that because we know how embarrassing it would be for that college student if her mother really did that, and we know that, by college age, she should be capable of handling this situation on her own.  This story is very relevant to accommodations for children who are hearing impaired.  Part of raising our kids is not just to ensure that they learn how to hear and speak well and master the English language but also to ensure that they grow up as independent adults who are fully capable of adapting to and coping with less than ideal situations, including hearing situations.  They must learn to listen when background noise is present because most situations in life don’t come with FMs or soundfields.  They must learn how to speak up for themselves when they can’t hear clearly and need to change their seat or ask for repetition.

I have read often parents asking other parents about using an FM at home with a toddler, including in the car.  The parents’ rationale is that it will provide the child with optimal hearing all the time and so result in better access to language and speech.  What this actually will do, instead, is create a child who is dependent upon the FM who will not learn to listen in everyday listening situations and whose distance hearing will suffer.  I drive a minivan.  My girls would often sit in the back row, and so riding in the car was not an optimal listening situation.  I viewed it, instead, as a different sort of learning environment, one where they could learn to listen despite the less than optimal acoustics, and they did.  We hold conversations just fine even with my back to them while driving, the engine noise, and them seated two rows behind me.  Occasionally, I have to repeat, but that’s okay.  Learning to listen in noise is part of learning to listen.  Similarly, at home, they can hear me if I call to them upstairs (unless Rachel is plugged into her iPod!).  This is because we didn’t use an FM when they were home but, instead, let them learn to listen at a distance.

Accommodations in school is another topic.  Part of the issue for me is geographic.  In the southeast, schools just do not provide what they do in the northeast and elsewhere.  The money isn’t there, and Georgia, my state, is consistently ranked 47th to 50th in the nation for education for a reason.  Thus, the accommodations my girls have gotten over the years consist of preferential seating, tennis balls on the chair legs when the classroom had a tile floor, a portable soundfield system, and, when classes became more lecture based in high school and college, a student notetaker or, in a few instances, CART reporting.  Here’s the thing, though – I would never have asked for anymore!  In fact, when Rachel first started kindergarten at our local elementary school, we didn’t even ask for anything.  She didn’t even have an IEP, and, guess what?  She did fine!  In fact, most of the children who go through the Auditory-Verbal Center of Atlanta as my girls did do not have IEPs or accommodations.  When Rachel was in first grade, her teacher used each week’s spelling lists to teach phonics.  Thus, her early lists consisted of “at” words, such as mat, bat, rat, sat, etc, and “et” words, such as met, bet, set, get, etc.  The teacher would give the test walking around the classroom.  For Rachel, who only had one CI at the time, this became an impossible task.  The teacher recognized this and asked the classroom aide to give her the spelling test one-on-one in the cafeteria.  She was also fine with Rachel getting up and moving to another seat if she needed to in order to hear better.  She let Rachel know that it was fine for her to just get up and move, that she didn’t have to ask permission.

When Rachel entered 4th grade, she moved to a new school.  It was a private school with two full teachers and a class of about 20 students.  Often, one teacher would teach one half of the class while the other students worked at a few different centers with the other teacher overseeing that group.  Rachel had difficulty hearing the teacher over the noise of the kids talking at the centers.  Thus, we purchased a soundfield system for her, which helped greatly.  We opted to purchase the soundfield because Rachel demonstrated a need for additional help, and we responded promptly.

Another issue is special ed.  As Amy mentioned, children learn much language from their peers in preschool.  Furthermore, when they learn language from their peers, they do so naturally.  In addition to the language, they learn normal speech inflection, idioms, and social interaction. If they are placed instead, in a self contained classroom, much of the benefit of language learning from their normally hearing peers is taken away.  If they are pulled out for lots of speech therapy, they also lose some of this.  In addition, having seen Auditory-Verbal therapy vs. traditional speech therapy firsthand, I can say that much of how they learn speech in traditional speech therapy often does not result in natural sounding speech.  There are absolutely times when speech therapy is necessary.  It was with Jessica who had apraxia and with Rachel who had weak tongue muscles and so had to have a deviate swallow corrected, which was also affecting her tongue tip sounds.  However, we were quick to put each sound back into the auditory once it was mastered.  While we all want our children to have clear, natural sounding speech, we need to recognize that most children born with normal hearing develop clear speech through listening and exposure.  Our goal, then, should be to teach our children how to hear and listen optimally plus good role models of their peers with normal hearing so that they, too, can develop speech naturally.

My girls, especially Rachel, were implanted at much older ages than children are being implanted today, and they started with older technology.  Yet, they have managed not just to keep up with school but to succeed beautifully.  I think that, before parents start requesting acoustical tiles on floors and ceilings, carpeting, lots of speech therapy, etc., they need to sit back and look at their child and ask themselves what their child really needs.  Asking for everything and anything simply because it’s available isn’t the best strategy and could very well backfire and produce negative results.  Believe in your children and what they are capable of with their CI or residual hearing.  They can and will amaze you and they deserve a chance to do so and, more importantly, to enjoy childhood and their time in school as freely and as normally as possible.

Amy: Once that harm is done and time has passed (by sequestering a deaf child), it often becomes “too late.”  It becomes too late to learn to listen, too late to become fluent in the language of the peers and community at large, and too late to catch up to same-aged peers educationally.  In reports about special schools (both oral or ASL based), it becomes clear that a huge portion of the day is about the topic of language, rather than simply about the things which other kids are learning… math, literacy, science, social studies, etc.  Every hour that is spent on speech therapy  is an hour taken away from content learning.  It’s no wonder that kids in deaf schools routinely score very low on state testing.  Proponents of those schools complain that it’s not done in “their language” or that it uses oral instruction which is difficult, but isn’t that what ALL OF LIFE will be like?  It will not get easier when one is in college or employed.  Becoming comfortable with real life and the language of the community is crucial to being well-educated and employed.  Perhaps some parents don’t have those goals; they are two of the top goals which I have for mine, along with being a kind, ethical person.

At this very moment, my hearing, 12 year old son is playing with his 3 year old, implanted brother… here is what they are doing:

Starting in the bed, Alex declares that there is a FIRE!

He says, “When there is a fire, you Stop, Drop and Roll.”  (12 year old drops to the carpeting, showing his brother.)

Oliver, excited, drops to the carpet and imitates his brother.

“Then, you crawl out of the room, like this, so the fire won’t hurt you…”

Oliver squeals with delight, and says “Let’s do it again!”

(They talk about it, and perform the act again.)

How many life lessons do my deaf children learn every day from their siblings and friends?  What ones are crucial?  Can you put a price-tag on the important information which they convey?  Never!

Melissa: One caveat to this is, of course, those children who are diagnosed as deaf at a later age or who don’t receive a cochlear implant until a later age.  Certainly, these children are not going to have language that is caught up to their peers by kindergarten, and, thus, more accommodations may be necessary.  However, these accommodations should still not interfere with their developing their learning to listen skills.  Rachel was one such child.  She entered kindergarten with a 4-year-old language level, and yet we still only asked for and received those accommodations for which there was a demonstrated need.

(ADDED 5/28)

Additional research which mentions benefit of mainstreaming:

Audiol Neurootol. 2009 May 15;15(1):7-17. [Epub ahead of print]
Earlier Intervention Leads to Better Sound Localization in Children with Bilateral Cochlear Implants.

Van Deun L, van Wieringen A, Scherf F, Deggouj N, Desloovere C, Offeciers FE, Van de Heyning PH,Dhooge IJ, Wouters J.
ExpORL/Department of Neurosciences, KU Leuven, Belgium.

We present sound localization results from 30 children with bilateral cochlear implants. All children received their implants sequentially, at ages from 6 months to 9 years for the first implant and 1.5-12 years for the second implant, with delays of 10 months to 9 years. Localization was measured in the sound field, with a broadband bell-ring presented from 1 of 9 loudspeakers positioned in the frontal horizontal plane. The majority of the children (63%) were able to localize this signal significantly better than chance level. Mean absolute error scores varied from 9 to 51 degrees (root mean square error scores from 13 to 63 degrees ). The best scores were obtained by children who received their first implant before the age of 2 years and by children who used hearing aids prior to implantation for a period of 18 months or longer. Age at second implantation was important in the group of children who did not use a contralateral hearing aid during the unilateral implant period. Additionally, children who attended a mainstream school had significantly better localization scores than children who attended a school for the deaf. No other child or implantation variables were related to localization performance. Data of parent questionnaires derived from the Speech, Spatial and Qualities of Hearing Scale were significantly correlated with localization performance. This study shows that the sound localization ability of children with bilateral cochlear implants varies across subjects, from near-normal to chance performance, and that stimulation early in life, acoustically or electrically, is important for the development of this capacity. Copyright © 2009 S. Karger AG, Basel.

Filed under: Amy,Melissa — Melissa Chaikof @ 4:19 pm


  1. It’s funny that you mentioned this: “I am reminded of a parent I know whom I always thought of as way too involved and overprotective. Her daughter had gone away to college, and the mother was complaining to me about a situation her daughter had with a professor that she thought was unfair. She then exclaimed to me, “If her college was closer, I’d go there and yell at that professor myself.” We might all laugh at that because we know how embarrassing it would be for that college student if her mother really did that, and we know that, by college age, she should be capable of handling this situation on her own. ”

    A professor at SCAD today was talking about how SCAD has a STRICT policy about parents contacting professors. Because of the FERPA law, professors and parents are NOT allowed to speak to each other unless the student has signed a written agreement with the school that the parents and the professors can talk to each other. Otherwise, it’s OFF-LIMIT!

    Comment by Rachel — May 27, 2009 @ 11:00 pm

  2. Don’t forget though that there are plenty of dirt poor families who can’t afford a private preschool. For these kids the choice is often a school special-ed program or substandard daycare which wouldn’t even be a good language environment for a hearing child.

    While it would be lovely if all families could afford speech therapy, soundfields, etc, I know many kids who only got their implants because of Medicaid and their parents work two jobs each. The parents can barely afford groceries, much less private school.

    Comment by Monica — May 28, 2009 @ 12:45 am

  3. Monica,

    I don’t know about all states, but Georgia now has public preschool options.

    Comment by Melissa Chaikof — May 28, 2009 @ 1:48 pm

  4. Monica, the problems of families such as you describe are not limited to hearing impaired children, and certainly it would be great if all kids had the option to attend whatever school was most appropriate for them. I have always been a proponent of school choice and vouchers, and your comment makes me think of that. But, again, the state preschool options are a possibility in many areas, as Melissa suggests. By mainstreaming, I am certainly not suggesting that private school is the answer; rather, we are suggesting that being with hearing peers is a good way to stimulate normal development– public or private. Being in public situations would be good, in fact, for families which are strapped for cash, because it would allow them to utilize the IEP (no gasping– we aren’t opposed to them!) to obtain speech therapy or an FM system, when needed. And, it could even allow them to obtain preschool funds.

    Comment by Amy — May 28, 2009 @ 2:12 pm

  5. Not all oral schools are self-contained settings, as you describe. Our oral school has, since the early 1980s, included 10-12 hearing kids and just 2-4 hearing impaired kids in each classroom, from preschool through 5th grade. Many of our hearing impaired children do not need an IEP, but parents choose this as their mainstream option because of small class sizes, person fms provided by the school, soundfield systems used by each teacher and an audiologist and cochlear implant mapping center on site.

    Comment by Anne — May 29, 2009 @ 9:09 pm

  6. Monica,

    You’re right it would be nice IF…..however, what I learned from my own parents, who were pretty close to dirt poor for most of their lives, is that where there is a will there is a way. I will be the first to admit that AV isn’t for every family. BUT don’t ever say it’s not an option or that we’re wrong for choosing it for our children. I think these moms here are just letting those who are “up for it,” know about AV and it’s wonders. It is what it is. AV works when followed for most children. I laugh thinking back to the fact that my son’s first scholarship was at 18 months of age…..for AV therapy. It helped cover what our insurance would not. Every parent can pursue what we did. As for the private school issue, in my state we have a preschool program for all children…free. Again, scholarships also can help pay for private preschool. Where there is a will!!

    Comment by Debbie — June 1, 2009 @ 2:33 am

  7. Nice article. Its true that children learn much language from peers in the preschool. Make your child confident, give him love, teach him to be positive and he will make wonders.

    Comment by Glenn Fernandes — June 1, 2009 @ 6:49 am

  8. Just a note about accomodations. When our daughter first got her hearing aids (with only a mild-moderate loss), all the professionals tried to push the FM system on us – telling us, as Melissa stated, that our daughter needed an optimal listening environment, all of the time.

    We considered purchasing one, but on my own, I decided to see how she would do first. And what a great learning experience it was to see how see would do in which environments – and she did learn how to best listen even in noise (not talking about school here). I am so relieved that I didn’t take their advice – what a disservice I would have done to my child to take away her ability to adapt to her environment and learn to handle different situations.

    Similar to Melissa, my daughter and I talk in our minivan all the time, despite the noise, the music, and my baby’s cries, and I feel good knowing that I’m replicating a real-life environment for her, one that she knows she can handle.

    Comment by Deganit — June 12, 2009 @ 2:46 pm

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