An Educational Audiologist’s Take on Communication Mode

I have always been passionate about education and supporting children’s abilities to learn in whatever modality is best suited for each person. For many years, I considered becoming a classroom teacher and I absolutely enjoyed student teaching, peer mentoring and tutoring over the years. At the same time, I was a science enthusiast and considered a career in medicine. My interest in science was always of a practical nature- how can this knowledge help me understand my own experience of the world in a more complex way and help others. The field of audiology is a wonderful area of healthcare in this way; it is necessarily related to how we communicate and engage with the world. One of my favorite aspects of being an audiologist is sharing my knowledge to help a patient/parent understand their circumstances, in other words, teaching!

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Now, I am an educational audiologist at School for the Deaf in New York, combining all my passions. What does an educational audiologist do? Let me tell you more about our school and about my responsibilities in the school.

Population: Most of our ~65 students have either cochlear implants or hearing aids. And many of the students have additional co-morbidities, including cognitive impairment, Autism Spectrum Disorder, visual impairment, physical disabilities, and medical issues. Some of the classes have a special education designation and have a 6:2:1 ratio, meaning up to six children, with two assistants and 1 teacher. Other classrooms have a 6:1:1 ratio.

Communication Mode: We are a “Total Communication” (TC) school, which means teachers sign and speak together in a mix of signed English and American Sign Language (ASL). ASL is a distinct and unique language with its own syntax, structure, culture etc. Signed Exact English is different in that each individual morpheme is also signed to mimic English. For example:

“The mother prepared lunch for her children.”

In ASL, this may be signed using a combination of the signsΒ  /prepare/ /lunch/ /mother/ /for/ /children/, and the order of signs is not necessarily set.

Whereas, in Signed Exact English, the signs would be in the exact word order of the sentence and would include designated sign for the article /the/ and to signify past tense /-ed/.

This is my understanding of a complex topic since being exposed to ASL and Deaf culture at the school. So, at our school, there is a mix that is dependent on each students’ and staff members’ communication mode, fluency, and ability. For example, there are several staff members who are Deaf and use ASL exclusively, while other hearing staff use the TC mode. Similarly with the students among whom there is a great range of language ability, proficiency, and a diversity of modes.

Students use ASL, communication boards, iPad devices, Picture-exchange Communication System (PECS) and spoken language/voice.

What I have learned is that audiologists must support language development in any mode, above the goal of auditory/oral development, taking into account the context of each individual child. There are students who are implanted but due to their cognitive ability, language comprehension, late implantation age, parental preference etc. are not on route to develop auditory/oral language skills. They must be given a way to express their needs, to reduce their frustration, to interact with their caregivers, service-providers, and peers. Whatever mode of language and communication will work for them is individually approached.

This is in contrast to the auditory/oral model of communication which places hearing and speaking orally as the primary goal. For children that have any degree of hearing loss who are able to have access to sound via hearing aids or cochlear implants, the auditory/oral model may be most appropriate for them. In an auditory/oral approach, intensive auditory rehabilitation and speech therapy are provided to promote auditory skills of listening and discriminating sounds, as well as producing and articulating speech sounds. Many times, teachers/therapists/parents will cover their mouths when interacting with children so they must rely on their auditory skills for detection, discrimination, and comprehension of speech. In this approach, signed support and even lip-reading may be viewed as a crutch.

Again, each person can make decisions that take into account their needs, abilities, community, resources, and preferences.

The modern miracle of cochlear implants is truly remarkable and has allowed countless people to access the ‘hearing world.’ Most children who are born with hearing loss are born to hearing parents who are either unfamiliar or uninterested in Deaf culture and ASL, and want to do everything for their child to be like them, to speak their language and support them.

My responsibility is to keep our students “in sound,” that is, to ensure all equipment is up and running, with fresh batteries, working components and clean! I call manufacturers for replacement parts/repairs and am responsible for purchasing and maintaining all equipment, including hearing aids, molds, FM systems, diagnostic equipment and various “loaner” or spare charging stations/batteries/cables.

I perform annual hearing tests and performance reviews for our current students as well as intake evaluations for incoming students. One of my favorite things about the intake process is getting a packet of previous reports, reviews, IEPs, medical information about a child to get a picture of their history– and then meeting them and sometimes seeing a completely different child than what I expected based solely on previous professional reports. The more I learn, the more I realize that noting the individuality of each and every child is inherent to their success.

A major aspect of working in a school that is so gratifying for me is the interdisciplinary nature of school work. There’s a team in place for each student that includes their classroom teacher and staff, various therapist (speech-language, occupational, physical), teacher of the visually impaired, administration/supervisors, social worker, nurse, and me, the audiologist,- all on site. There is communication about students’ needs and goals across the board. I feel incredibly lucky to have supportive and engaged colleagues; there is an air of genuine care for our students.


Do you have any questions or comments? Let’s discuss, learn and grow together!


Dr. Lilach Saperstein








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