Early Intervention

Early identification of hearing impairment
Early habilitation & auditory-neural development
The best technology - working well

Early Identification

My passion for improving services for young deaf children began when studying for my first degree in Developmental Psychology. It was then that I began examining the way in which normally hearing babies and toddlers learned to listen and speak and relating this to the typically delayed language acquisition of deaf children.

I followed with enthusiasm the techniques being developed to screen newborn infants for hearing impairment and raised the funds to study the consequences of very early identification and amplification for deaf babies and their families. My doctoral research at Cambridge University made a significant contribution to the evidence base required to initiate Newborn Hearing Screening across the UK. My work provided evidence that:

Identification of deafness within the first few months of life, along with earlier amplification and earlier habilitation significantly benefited severely and profoundly deaf infants learning to listen and speak (Robinshaw 1993)

Deaf infants who are taught to really use their hearing aids within the first months and years of life can be helped to follow the same path of development in learning to listen and speak as their normally hearing peers (Robinshaw, 1996)

Rate of progress in learning to listen and speak is affected by severity of hearing impairment, but early habilitation techniques can help even profoundly deaf young children catch up with their normally hearing peers (Robinshaw 1995)

I have worked with infants identified through newborn hearing screening programmes (NHSP) and trials since 1988. The implementation and benefits of NHSP still remain a high priority for me both on a national level and at an individual level.

Why? Because early identification and amplification give us the opportunity to stimulate the child's auditory brain development during the critical period of language acquisition: We have the best chance ever to develop the auditory skills that your child will need to participate fully in social and work activities throughout childhood and beyond.

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Early Habilitation

The vast majority of infants who are born deaf have a problem within their middle or inner ear. Most deaf infants still have a working auditory nerve and still have the capacity to develop the auditory cortex of the brain. The marvel of early identification of deafness is that it enables us to tap into the normal process of auditory brain development within the normal, critical period of language development. Alternatively, it enables us to assess for auditory-neural damage or complications and begin a slightly more intense package of rehabilitation early.

The first two to three years of a child's life are the most significant period for the acquisition of auditory and speech skills. The younger the infant, the greater the neural-plasticity, which means the more readily the auditory pathways and cortex will adapt. So the more we can stimulate auditory neural activity in the brain, the more normal the development of speech and language skills will be. Making the most of the way that the brain develops therefore requires prompt intervention that includes both:

Good use of hearing aids or cochlear implants and personal FM systems

And

An individually tailored programme designed to exploit the auditory development of the brain.

"Because of technology and neuroplasticity, today's infants represent a new and different generation of children who are deaf. We are in the position to provided to the world, a new and expanded vision of hope and possibility regarding intervention outcomes". Carol Flexer PhD Distinguished Professor of Audiology, University of Akron.

Hearing aids and cochlear implants are the tools that enable us to begin to stimulate and "rewire" those neural connections in the brain. Initially most parents need support in learning how to use hearing aids, cochlear implants and personal FM systems to best effect. High quality guidance in learning how to stimulate and develop the neural connections that enable a child to develop good listening skills (within their everyday playful activities) is also crucial for parents.

This approach guides parents in how to develop their child's "auditory brain power" and listening

skills by:

Getting the best from the best technology available
Using a diagnostic approach on a weekly/fortnightly basis
Using auditory-verbal techniques

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The Best Technology

Getting the most out of the best technology is fundamental to developing good listening skills and clear speech.

As yet, we cannot "fix" sensori-neural hearing impairment, but we can use technology to help bypass some of the problems it causes. Technological advances in digital signal processing hearing aids (DSP HAs) and in Cochlear Implants (CIs) mean that most severely and profoundly deaf infants and young children can:

Learn to talk through listening
Respond to speech, music and environmental sounds through listening alone
Use sound as the primary channel for learning and making their world meaningful.

The basis for any deaf child learning to listen is to make sure that from infancy they have the best technology, maintained to the highest standard, that is used to maximum effect throughout their daily life - and that you are comfortable with it all.

This approach makes sure that you as parents know:

About the hearing aids, cochlear implants and FM systems available to help your child
How your child's audiogram and aided hearing relates to the intelligibility of speech, environmental sounds and music
How to maintain your child's technology to the highest standard on a daily basis
How to trouble shoot technological hitches
The questions to ask your specialist audiology team
The knowledge that you have that will help your audiology team
Techniques for establishing good hearing aid use with babies, toddlers and young children
Signs of progress for both new hearing aid or implant users and for more experienced listeners
How to promote your child's listening skills using auditory-verbal techniques.
How to monitor and evaluate your child's progress in auditory skill acquisition based on objective research based evidence and video recorded clips.

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