Contents

• Introduction
• Total Communication
• Sign Bilingualism
• Auditory Oral
• Choosing Options
• References

The Auditory-Oral Approach

The moral and practical issues associated with a sign bilingual approach seem as great as those associated with the use of an oral-only approach in the past. Disillusion with oral practice and oral outcomes in the 1960s and 1970s did not, however, result in universal rejection of the oral approach. In Britain and in N. America an auditory-oral approach continues to be considered by many to be the approach which offers the deaf child the greatest potential for linguistic, social and educational development. Now, more than ever before, oralists believe that technological advances have secured for even the profoundly deaf child a hearing, speaking future.

The case for an auditory-oral approach

The ideological position behind the present-day auditory-oral approach is, as it has been with any oral approach at any time, that verbal communication, particularly spoken communication, is the predominant medium of social exchange.

Deaf people are surrounded most of the time by normally hearing people, and the demands of everyday life necessitate a considerable amount of exchange with people who speak and do not sign. Without the ability to speak and understand the speech of others, the individual's links with the wider society are severely restricted.

Those who currently advocate an auditory-oral approach argue that it is not only desirable but now possible to enable even severely and profoundly deaf children to talk and to acquire language through the medium of spoken exchange, thanks largely to new knowledge and advancing technologies.

Things have changed and the poor educational attainments reported during the 1960's reflect an era when hearing aids were not as effective or readily available; when even severe or profound hearing loss might not be identified until two years or later; when cochlear implants were not available to deaf children; when professionals and parents were not as competent at managing hearing aids as they are today nor as knowledgeable about promoting language growth.

Where the auditory-oral method is practised competently, where available technology is used to its potential and where parents receive well-informed, sensitive support in managing linguistic interaction with their deaf child, then the educational achievements of orally educated deaf children are much closer to what we would like them to he.

Research studies of auditory-oral practice

Studies of children and young people educated consistently through an auditory-oral approach from the USA (Note 41) and from the UK (Note 42) give heartening evidence of more positive educational outcomes in relation to academic achievements.

For example, the study by Lewis and Hostler, (1998), on behalf of the Ewing Foundation, involved complete populations of severely and profoundly deaf young people in five LEAs in England and provide encouraging data on GCSE results.

All the 28 young people had received a natural aural education in mainstream schools.

The GCSE examination results for 1995-7 indicated that 5O% of the deaf pupils achieved five or more GCSE grades A-C or above compared with the national average of 45% for those years. Furthermore, taking into account "school" and "home environment" factors, 22 out of the 28 achieved the same or better than their peers and 12 out of 16 achieved as well as or better than siblings. The sample is small, too small for sweeping generalizations to be made. However, the 28 deaf children whose overall GCSE results surpassed those of the "normal" population in mainstream schools did represent 10% of their entire age group of severe/profoundly deaf pupils in English mainstream schools at that time. So, although the numbers are small, they nonetheless represent a significant sample.

Furthermore, there were high levels of self-reported happiness at school and friendships with peers (Note 43). There was no evidence that "good" academic results were achieved at the expense of a healthy self-image amongst this group.

Advances in knowledge

Knowledge in the areas of child language acquisition, acoustic phonetics, learning behaviours and audiological technology has been advancing steadily from the days of reported "oral failure". Educational practices in deaf education have reflected these advances. Those advocating an auditory-oral approach claim that the fruits of improved knowledge, technology and educational practice can already be seen in the outcomes reported by the Ewing Study (Note 44).

The pleasing GCSE results of the Ewing young people reflect excellent specialist support, appropriate involvement of parents and effective linguistic and audiological management. However, the technology when these young people were growing up, though improving, was not as advanced as it is today in exploiting and augmenting residual hearing.

None of the young people featuring in the Ewing research had the benefit of digital signal processing hearing aids during their education. None had received a cochlear implant.

And none were diagnosed as newborns - in fact the average age of diagnosis of the group was 28 months, with a range from 6 months to 61 months. So the majority of these severely and profoundly deaf children had not been diagnosed by the end of their second year - a remarkable tribute to their later educational management.

There have been enormous technological break­throughs over the last five or so years and oralists today argue that technology, if used effectively, can minimize the negative consequences of deafness. The current auditory-oral position stakes its claim on the fact that with the aid of modern technology and our improved knowledge of, for example, language learning, the deaf child's hearing can be enhanced to provide the child's brain with sufficient auditory and linguistic information to permit speech perception and spoken language production. "Oral failure", it is claimed, is a thing of the past.

Recent technological advances

The major breakthroughs that give the present-day oralist so much confidence are:

Digital, programmable, "smart" hearing aids which give a clear speech signal, which reduce background noise and which are customized to suit the needs of an individual hearing loss (Note 45).

The prospect in the very near future in the UK of universal newborn screening for hearing loss (Note 46). This means that sensori-neural hearing loss can be detected at birth and hearing aids fitted within the first month after detection. The importance of amplifying the hearing of severely and profoundly deaf children during the first year of life cannot be underestimated: the first months of life have been shown by scientists to be crucial to the development of the auditory processing mechanisms of the brain (Note 47). If the deaf child's auditory mechanisms can be activated during this early period, when hearing aid rejection is unlikely, then the foundations for speech discrimination are laid in a similar way to those of hearing children. Indeed, research from the USA on the speech perception and speech production of deaf children diagnosed and fitted with hearing aids before six months offers the remarkable but welcome finding that age-appropriate spoken language reception and production can be expected for most deaf children (Note 48). In other words, very early diagnosed deaf children can make progress with speech and language in the early years similar to that made by children with normal hearing.

The growth in availability of cochlear implantation for young deaf children and the consistent trend towards a reduction in age of implantation  (Note 49). The success of cochlear implantation in significantly improving the hearing capacity of deaf adults and older deaf children has led to greater confidence in the use of this surgical procedure with young children: implantation is now widely available to profoundly deaf children in the UK at the age of two years or less (Note 50). Lutermann (1999), writing in the USA, claims "cochlear implants... are producing a new kind of child... the hearing deaf child". Furthermore, deaf children with additional disabilities, who until recently have been excluded from the process of cochlear implantation, are now being considered for implantation and this should greatly improve the educational and communication prospects for these children.

If deaf children can be enabled to hear from an early age and are offered sensitive spoken language input then they should be able to acquire spoken language during the language sensitive first five years (Note 51).

They should, with appropriate, expert support both for new technology and for language acquisition, be able to attend their local mainstream school and achieve according to their intellectual potential.

Whilst new technology is crucially important, according to current auditory-oral thinking, hearing aids and implants remain complex, fiddly devices which are capable of breaking down.

However, in Britain the expectations of standards of audiological management required of professionals continue to rise (Note 52) and this includes enabling parents and deaf children themselves to take responsibility for good audiological care. It is perhaps more crucial than ever before that professionals working in the health services, particularly in audiology, work closely with professionals in education, if the potential benefits to deaf children of current technology are to be realised.

Will sign language survive?

According to Luterman (1999) the “technological revolution we are currently experiencing.., will tip the balance in favour of the auralists”. He believes that the “bilingual/bicultural movement” will decline in influence and popularity because:

“They are fighting yesterday’s wars”. However, this does not mean that there is no need for sign language in a deaf individual’s life nor that a signing Deaf Community has no place.

Orally educated deaf young people may derive strength from their affiliations at Deaf Clubs and many learn signs during the latter years at school or on leaving school (Note 53).

Furthermore, success in spoken language and education does not guarantee deaf children a future which is problem-free. A deaf individual, however successful in acquiring verbal language, intelligible speech and literacy remains deaf. The deaf child and the deaf adult who resides in the mainstream of the hearing-speaking world will experience day-in, day-out problems in grasping all that is said, particularly in informal social situations. It takes strength and a high degree of self-confidence to know and accept the real limitations of a substantial hearing loss and rise above them.

A deaf child might have that confidence as a child when supported and protected by their families and schools. However, that same deaf individual in the less protected world of adulthood may lose confidence. As Ross (1992) has insightfully commented: “deaf audiologic successes might eventually come to an identity crisis which they must painfully resolve”.

Which option offers most opportunities?

The pure auditory-oral approach is not, then, without its problems but advocates would argue that it is the best option “on balance” and the one which offers the deaf individual the greater opportunities and choice in life.

“There is more to life than being deaf”, so it is argued, and the use of an auditory-oral approach allows the deaf individual participation in the wider society and all the very many cultural and interest groups that exist within a diverse society such as Britain.

There are plenty of opportunities for deaf individuals to become part of the “Deaf World” if they want to do so. No-one is stopping deaf children/young people learning sign language or joining the local Deaf Club when they are of all age to make that choice for themselves.

Deaf children reared and educated in environments where sign language predominates, however, are in danger of losing for ever the opportunity to understand and produce speech (Note 54). Deaf children, especially those with more substantial hearing losses, who have sign language selected for them as a first language may not have much choice as adults except to have a social identity as a Deaf person.

Will all deaf children benefit from an auditory-oral approach?

Whilst “achievement according to potential” during the school years can, by and large, be predicted for most deaf children through an auditory-oral approach, this does not mean that all parents will opt for all oral approach at all stages of education.

Some parents, whether themselves deaf or hearing, may prefer their deaf child to have access to a signing Deaf culture from an early age in order to establish their child’s right to a Deaf identity.

At the secondary and post-16 stage of education, for some deaf pupils in some teaching contexts, it might be more effective to deliver information through sign language than through spoken language.

For reasons of physiology, not all deaf children can have cochlear implants and for reasons not yet known, a tiny minority of deaf children appear to gain no benefits to audition having had an implant (Note 55).