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Children With Hearing Loss
Developing Listening and Talking, Birth to Six

Third Edition
Elizabeth B. Cole, Carol Flexer
486 pages, Illustrated (B/W), Softcover, 6 x 9"
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The third edition of Children With Hearing Loss: Developing Listening and Talking, Birth to Six provides updated information from the previous two editions for both professionals and parents facilitating spoken language through listening (auditory brain access, stimulation, and development) in infants and young children with hearing loss. Also addressed is auditory brain development, audiologic technologies, auditory skill development, spoken language development, as well as family-focused intervention for young children with hearing loss whose parents have chosen to have them learn to listen and talk.

Additionally, this new edition is expanded to reflect important and rapidly evolving changes that have developed in the past five years, including:

  • Application of neuroscience research to our knowledge of the foundations of listening and talking (Chapter 1)
  • Current information on vestibular function in infants and young children (Chapters 2 and 3)
  • Essential technology updates (Chapter 5)
  • Expansion of the discussion of types of services a child with age-appropriate skills needs to sustain a positive academic trajectory (Chapter 6)
  • Discussion of the use and efficacy of coaching and other parent guidance strategies (Chapter 10)
  • Updated resources (Appendix 6)

This text is intended for undergraduate- and graduate-level training programs for professionals who work with children who have hearing loss and their families. This third edition is also a valuable resource for parents, listening and spoken language specialists (LSLS), speech-language pathologists, audiologists, early childhood instructors, and teachers. Furthermore, much of the information in Chapters 1 through 5 and Chapter 7 is beneficial to individuals of all ages with hearing loss, especially newly-diagnosed adults.

Two appendices from the book are also available for individual purchase:
"Targets for Auditory/Verbal Learning"
"Explanation for Items on the Framework"

These two key assessments are downloadable PDFs which can be printed to use with each of your clients. Click here to order.

Praise for the Previous Edition

This is a timely and a much needed textbook on a new population of children with hearing loss where our level of knowledge, at least in some areas, is relatively low and where we need to increase our understanding in order to promote the best possible conditions for the development of auditorily-based spoken language. It is a textbook that is easy to read also for those outside the field of aural rehabilitation. The intended audience of the book is graduate students in training programs or professionals who work with children. The book is a valuable resource for this group of students and it will also be of great interest to undergraduate students, particularly in psychology and speech-language-hearing programs
--Bjorn Lyxell, in International Journal of Audiology 2 (2011)

In the world of audiology and speech language pathology, there is seldom an area of practice that brings the two careers together as the aural habilitation of infants, toddlers, and children who are deaf and hard of hearing. Children With Hearing Loss: Developing Listening and Talking, Birth to Six by Elizabeth Cole and Carol Flexer offers a comprehensive overview of the auditory system, the importance of early identification and diagnosis, amplification, and intervention. The authors have divided their book into two areas that benefit both audiologists and speech language pathologists. In the world of listening and spoken language habilitation, the audiologist is the gatekeeper of auditory access. To develop competent spoken language, a child must have adequate hearing technology. Without aggressive and appropriate auditory technology, the listening and spoken language interventionist will not be able to facilitate optimal outcomes for child. The authors use of charts, lists, examples, and appendices makes this a practical text to use in any audiology or listening and spoken language practice. The text offers an extensive explanation of auditory neural development and a model of hearing loss as an invisible acoustic filter, which changes the reception and perception of sound by the brain.
--Kelly S. Teegardin, M.S.,CCC-SLP, LSLS Cert AVT,in Ear & Hearing (Vol. 34, No. 2, 2013)

I want to commend the authors for developing this wonderful resource! In my opinion, parents, educators and clinicians will find very helpful guidance from this book. I especially appreciated the integration of child language concepts and the integrated approach to listening development. This is a must-read.
--Mary Pat Moeller, PhD, Director, Center for Childhood Deafness, Boys Town National Research Hospital, Boys Town National Research Hospital, (May 2011)

This detailed book looks at the skills and knowledge needed to promote the development of spoken language through listening in young children and babies with a hearing loss. Despite its length it is very readable. Each chapter's 'key points' give a clear and concise explanation of the information to come. The comprehensive contents page makes it quick and easy to look up specific information. Early chapters provide a good overview of hearing loss, with information on terminology, technology, the structure and function of the ear, and causes. It includes data on good language learning environments and early language development. Later chapters look at intervention and are more practical, exploring strategies and activities for working with families. The appendices provide some interesting frameworks and checklists. Whilst the book refers to American terms and systems, the information is still useful. ...I would recommend it as a detailed reference for students, a good resource for those new to the field and a refresher for more experienced clinicians, particularly with its discussion around recent research.
--Rachel Millward, Speech-Language Therapist, in Speech & Language Therapy in Practice, (Winter 2011)


  • Lois Grant, Audiology Now (2016):
    "With the availability of newborn hearing screening, the landscape of pediatric audiology and communication development has changed and continues to evolve. This book provides concepts that integrate knowledge and practice from audiological and educational perspectives….[Cole & Flexer’s] book, intended for both parents and professionals, is written with enthusiasm from their experience about maximizing spoken language outcomes for families and their children with hearing loss. The language, illustrations and layout would be accessible to a wide audience. The book is very well referenced with over 36 pages of journal articles and texts for further reading…. Much attention is given to meaningful interaction and communication with discussion of parent-child attachment, shared attention (joint reference), turn-taking and communicative intent. Strategies to enrich the language environment for the child involve analysis of characteristics of caregiver talk, but also sensitive awareness of the emotional state of parents and understanding the preferred learning styles of parents. This is useful for parents and professionals to consider together"

  • James Harrison, Clinical Lead Paediatric Audiology, Sherwood Forest Hospitals Trust UK, ENT & Audiology News (Jan/Feb 2017):
    "Each chapter features small anecdotal inserts or sketched-style images which help break down the science. The book recognises the changes that have occurred in audiology following the advent of universal newborn hearing screening. Furthermore, it recognises that while outcomes for children with hearing impairments are improving, professionals still have a changing landscape ahead of them - this book is a useful reference point."


Chapter 1.Neurological Foundations of Listening and Talking

Typical Infants: Listening and Language Development
Auditory Neural Development
New Context for the Word Deaf
Hearing Versus Listening
A Model of Hearing Loss: The Invisible Acoustic Filter Effect
Think about Hearing Loss as a Doorway Problem
Summary: The “Essential Question” That Drives Technological and Intervention Recommendations

Chapter 2. The Audiovestibular System

The Nature of Sound
Unconscious Function
Signal Warning Function
Spoken Communication Function
Audibility Versus Intelligibility of Speech
The Ling 6-7 Sound Test: Acoustic Basis and Description
Audiovestibular Structures
Data Input Analogy
Outer and Middle Ear
Inner Ear to the Brain
The Vestibular System: The Sensory Organs of Balance

Chapter 3. Hearing and Hearing Loss in Infants and Children

Degree (Severity): Minimal to Profound
Timing: Congenital or Acquired
General Causes: Endogenous, Exogenous, or Multifactorial
Genetics, Syndromes, and Dysplasias
Connexin 26
Inner Ear Dysplasias
Medical Aspects of Hearing Loss
Conductive Pathologies and Hearing Loss
Sensorineural Pathologies and Hearing Loss
Mixed, Progressive, Functional, and Central Hearing Losses
Synergistic and Multifactorial Effects
Auditory Neuropathy Spectrum Disorder (ANSD)
Vestibular Issues

Chapter 4. Diagnosing Hearing Loss

Newborn Hearing Screening and EHDI Programs
Test Equipment and Test Environment
Audiologic Diagnostic Assessment of Infants and Children
Test Protocols
Pediatric Behavioral Tests: BOA, VRA, CPA, Speech ::Perception Testing
Electrophysiologic Tests: OAE, ABR/ASSR, and Immittance
The Audiogram
Configuration (Pattern) of Thresholds on the Audiogram
Formulating a Differential Diagnosis
Sensory Deprivation
Ambiguity of Hearing Loss
Measuring Distance Hearing

Chapter 5. Hearing Aids, Cochlear Implants, and FM Systems

For Intervention, First Things First: Optimize Detection of the Complete Acoustic Spectrum
Listening and Learning Environments
Distance Hearing/Incidental Learning and S/N Ratio ::ANSI/ASA S12.60-2010: Acoustical Guidelines for Classroom Noise and Reverberation
Talker and Listener Physical Positioning
Amplification for Infants and Children
Hearing Aids/Hearing Instruments
Bone Anchored Hearing Aid Implants (BAI) for Children
Wireless Connectivity
Hearing Assistance Technologies (HATs) for Infants and Children: Personal-Worn FM and Sound-Field FM and IR (Classroom Amplification) Systems
Cochlear Implants
Auditory Brainstem Implant (ABI)
Measuring Efficacy of Fitting and Use of Technology
Equipment Efficacy for the School System

Chapter 6. Intervention Issues

Basic Premises
Differentiating Dimensions Among Intervention Programs
Challenges to the Process of Learning Spoken Language
Late to Full-Time Wearing of Appropriate Amplification or Cochlear Implant(s)
Disabilities in Addition to the Child’s Hearing Loss
Ongoing, Persistent Noise in the Child’s Learning Environment
Multilingual Environment
Educational Options for Children with Hearing Loss, Ages 3 to 6

Chapter 7. Auditory “Work”

The Primacy of Audition
The Acoustics-Speech Connection
The Effect of Hearing Loss on the Reception of Speech
A Historical Look at the Use of Residual Hearing
The Concept of Listening Age
Auditory “Skills” and Auditory Processing Models
Theory of Mind and Executive Functions
How to Help a Child Learn to Listen in Ordinary, Everyday Ways
Two Examples of Auditory Teaching and Learning
Scene I: Tony
Scene II: Tamara
Targets for Auditory/Linguistic Learning
A Last Word

Chapter 8. Spoken Language Learning

What’s Involved in “Talking”?
How Does a Child Learn to Talk?
Relevance for Intervention Decisions
How Should Intervention Be Organized?

Chapter 9. Constructing Meaningful Communication

The Affective Relationship
The Child’s Development of Interactional Abilities
Joint Reference, or Joint Attention
Turn-Taking Conventions
Signaling of Intention
Characteristics of Caregiver Talk
1. Content: What Get’s Talked About?
2. Prosody: What Does Motherese Sound Like?
3. Semantics and Syntax: What About Complexity?
4. Repetition: Say It or Play It Again
5. Negotiation of Meaning: Huh?
6. Participation-Elicitors: Let’s (Keep) Talk(ing)
7. Responsiveness
Issues About Motherese
How Long Is Motherese Used?
Motherese: Why?
Motherese: Immaterial or Facilitative?

Chapter 10. Interacting in Ways That Promote Listening and Talking

The Emotional Impact of a Child’s Hearing Loss on the Family
Adult Learning
What Parents Need to Learn
Components of Intervention for Babies and Young Children with Hearing Loss
When to Talk with Your Child and What to Talk About
A Framework for Maximizing Caregiver Effectiveness in Promoting Auditory/Linguistic Development in Children with Hearing Loss
Background and Rationale
Structure of the Framework
Getting a Representative Sample of Interacting
Discussing the Framework with Parents
Ways of Addressing Parent-Chosen Targets
Instructional Targets and Sequence
Teaching Through Incidental and Embellished Interacting
Teaching Through Incidental Interacting
Embellishing an Incidental Interaction
Teaching Spoken Language Through Embellished Interacting
Teaching Listening (Audition) Through Embellished Interacting
Teaching Speech Through Embellished Interacting
Preplanned Parent Guidance Sessions or Auditory-Verbal Therapy Sessions
Components to Be Accomplished in a Typical Preplanned Session
Sample Preplanned Scenario
About the Benefits and Limitations of Preplanned Teaching
What does the Research Say?

Appendix 1. How to Grow Your Baby’s/Child’s Brain

Appendix 2. Application and Instructions for the Ling 6-7 Sound Test

Appendix 3. Targets for Auditory/Verbal Learning

Appendix 4. Explanation for Items on the Framework

Appendix 5. Checklist for Evaluating Preschool Group Settings for Children With Hearing Loss Who Are Learning Spoken Language

Appendix 6. Selected Resources

Appendix 7. Description and Practice of Listening and Spoken Language Specialists: LSLS Cert. AVT and LSLS Cert. AVEd

Appendix 8. Principles of LSLS Practice

Appendix 9. Knowledge and Competencies Needed by Listening and Spoken Language Specialists (LSLSs)

Appendix 10. Listening and Spoken Language Domains Addressed in This Book


About The Authors

Elizabeth B. Cole

Elizabeth B. Cole, EdD, is the director of Soundbridge, a program of the Capitol Region Education Council in Connecticut. Soundbridge is a statewide public school program that provides a wide variety of services to more than 700 children (birth through secondary school) whose parents want their children with hearing loss to use spoken language to communicate and learn.

Carol Flexer

Carol Flexer, PhD, received her doctorate in audiology from Kent State University in 1982. She was a distinguished professor of audiology in the School of Speech-Language Pathology and Audiology at the University of Akron for 25 years. Her special areas of expertise include pediatric and educational audiology. Dr. Flexer continues to lecture extensively nationally and internationally about pediatric audiology issues, and has authored more than 155 publications. She has coedited and authored thirteen books: Handbook of Acoustic Accessibility; Children with Hearing Loss: Developing Listening and Talking, Birth to Six (first and second edition); Pediatric Audiology: Diagnosis, Technology, and Management (first and second edition); Pediatric Audiology Casebook; The Sound of Learning: Why Self-Amplification Matters; How the Student with Hearing Loss Can Succeed in College (first and second edition); Sound Field Amplification: Applications To Speech Perception And Classroom Acoustics (first and second edition); and Facilitating Hearing and Listening in Young Children (first and second edition).