Choosing Communication Approaches

​​Deciding How to Communicate with Your Child

Have​ you just found out that your baby is deaf or hard of hearing, and you want to learn how to "talk" to  him? Are you wondering if it's better to speak or use sign language, or maybe both?  Read on to find out more…

Adults and children use language(s) (e.g., English, Spanish, French, American Sign Language, British Sign Language) to express their ideas and to communicate with others. Babies and parents share a common language so that they can understand each other. Hearing babies begin to pay attention to the language(s) around them in the first few months of life. Similarly, deaf babies who have deaf parents also begin to pay attention to their parents' use of sign language in the early months of life. These natural models in the home (spoken or signed) encourage the child to learn language.

When parents are hearing and their babies are deaf or hard of hearing, they need to find effective ways to communicate and model language for their babies.

  • The family must find forms of communication that everyone can understand.
  • Decisions about how to communicate in your family are very important to your child's early development.

Because each baby and family is different, decisions about how to communicate must be made carefully, based on your baby's and family's needs. Approaches vary in the amount of emphasis placed on listening, spoken language, and/or visual approaches. Sometimes one approach works for children. Sometimes combinations of communication styles are more appropriate. Decisions about how to communicate are not usually “either-or" (either this one or that one); many families combine various approaches in response to the child's needs over time.​​

The information in the following section was contributed by a team that developed a website for families focused on “raising deaf kids​" (see About Us​).  It may have been edited or updated from the original.

What is communication?

  • Communication is sharing ideas. Many people think it's just talking.
  • But real communication happens when you understand other people, and they understand you.
  • Communication is more than words.
  • You communicate by smiling, frowning and the expressions on your face. You also do it by the way you  stand, and by how you move your body.

How to choose ways to communicate

  • Accept that each family is different.
    There isn't a "right" choice for all children.
    Each child is different and needs different things.
    Parents are also different and have their own hopes for their children. Some families are able to do one thing.
    Some families are able to do another.
  • Be flexible.
    Follow your child's lead.
    You may feel stressed out over choosing from the various options that are available. Many parents find that the best choice is to follow their child's lead.
    Some parents even combine ways of communicating. It's important to be flexible.
    Children's needs change over time, and may families adjust approaches over time in response to those changing needs.
  • Ask yourself these questions:
    • How much can your child hear?
    • Does your child get mad quickly when you don't understand him?
    • Are you willing to learn a new language?
    • How much time can you give to help your child learn?
    • How important is it to you that your child learns to speak clearly?
    • Are there programs for the different options where you live?
    • What do other parents and professionals say about those programs?
  • ​There are many different ways of communicating.
  • Everychild is different. There is no one "right" way for all children.
  • Give one method your best shot. But if it doesn't  work, be opne to other options.​

Information in the following section was developed by the team (See About Us)

Any decisions will require commitment from you and from the professionals on your baby's team. You may see people refer to this as "communication modalities." This means whether communication will be through auditory, visual, or combined routes. The list of common communication approaches below is ordered from most auditory to most visual.


Auditory-to-Visual Communication Continuum


We often think of these approaches on a continuum from auditory (A) emphasis in learning to visual(V) emphasis in learning. By considering the child's unique learning strengths and needs, parents and communicators can use the best approach(es) for the child. Children might start at one place on the continuum and move to different points on it as their needs change.


  • A and Av: place a lot of emphasis on learning to listen through the auditory (hearing) sense. Promote reliance on hearing aids and/or cochlear implant technologies.
  • Av: A lot of listening practice with some visual support, like speech reading.
  • AV: Equal emphasis on auditory and visual learning. This might be a child who is learning spoken language with the support of Cued Speech, or learning sign language and spoken language.
  • VA and V: Some children learn best with more emphasis on visual communication. These might be children who mostly rely on sign language, but also benefit from some auditory stimulation (VA), or primarily learn through American Sign Language (V) or use American Sign Language and learn English through reading and written language (see Bi-Lingual Bi-Cultural section).

Communication Styles and Languages

Listening and Spoken Language (LSL)
(also known as auditory-verbal or auditory-oral)

  • This type of program focuses on maximum use of the child's hearing through use of well-fit hearing technologies (e.g., hearing aids, cochlear implants) as a route to the development of speech and language (spoken language).
  • The approach fosters the reliance on spoken language for communication and learning. The term auditory refers to listening; verbal to spoken language; oral refers to speaking.
  • Professionals seek specialty certification from the Alexander Graham Bell Association in Listening and Spoken Language. Certified teachers and therapists offer sets of techniques that help babies and young children who are deaf or hard of hearing learn spoken language through listening with their hearing aids or cochlear implants.
  • The A G Bell organization ( explains that whether you are working with a professional who follows the auditory-verbal approach (A-V) or the auditory-oral approach (A-O), the goal of Listening and Spoken Language (LSL) is the same: to combine early identification and intervention with appropriate hearing technology to enable a child who is deaf or hard of hearing to develop age-appropriate language skills by the time they enter first grade.
  • The A. G. Bell organization further explains that professionals who are certified in supporting families and children to develop listening and spoken language are known as Listening and Spoken Language Specialists (LSLSTM) and are designated as either LSLS Certified Auditory-Verbal Educators (LSLS Cert. AVEd) or LSLS Certified Auditory-Verbal Therapists (LSLS Cert. AVT.) These professionals support and coach parents and caregivers in your role as your child's most important teacher of language.

For helpful information on the LSL approach, visit:

Cued Speech

  • This approach is also called Cued Language; it is a visual way to make spoken language clear for children who are deaf or hard of hearing by supplementing spoken language with systematic cues near the mouth.
  • The Cued Speech approach is designed to support effective communication, language development and literacy (reading development) in children who are deaf or hard of hearing.
  • This is a visual approach to communication that uses handshapes and placements in combination with the mouth movements of speech to make the sounds of spoken language look different from each other. For example, look in a mirror – if you turn off your voice and say "mom, pop, or Bob," you cannot tell these apart on the lips. Cued Speech adds visual information to make these and many other confusable sound combinations clear.
  • Many sounds look alike on the face. Cued speech is a way of showing spoken language clearly. 
  • Systematic cues are available to support multiple spoken languages.

For helpful information on the Cued Speech approach, visit:

Combined Approaches (Speaking and Signing)

  • Sometimes called Total Communication, these approaches combine a focus on listening, speaking, and signing as a route to language development.
  • Some approaches use invented sign systems that were developed to represent English. These sign systems are called Manually Coded English (MCE). Users of MCE speak and sign at the same time. 
  • Manually Coded English is a way of using specific signs and signed word endings to represent the English language on the hands. Signs are used in combination with spoken English.
  • Some families use a manual code of English as a tool for their children to learn English grammar.

For more information, visit: 

American Sign Language (ASL)

  • American Sign Language (ASL) is the predominant sign language of the Deaf Community in the United States.
  • ASL is a complete and natural language. ASL has a complex grammar system that differs from spoken language, but it shares many of the other properties of spoken languages.
  • Any idea that can be expressed in English can be completely expressed visually in ASL. Ideas are expressed through signs, fingerspelling, facial expression, and movement of signs in visual space.
  • Parents who want to learn ASL benefit from meeting and interacting with people who are fluent in ASL.

For helpful information on ASL, visit:

*The information in the following section was contributed by the team that developed a website website for families focused on “raising deaf kids”​ (see About Us).  It may have been edited or updated from the original.

  • The word bilingual means being able to communicate in 2 languages. The word bicultural means being part of 2 cultures, or 2 communities.
  • Bilingual-bicultural approaches include an emphasis on ASL, learning English, and learning about Deaf cultural traditions and perspectives.
  • In a Bi-Bi approach, children use 2 languages and   learn about 2 cultures:
    • Children learn American Sign Language (ASL) as a first language. They learn ASL as their main way of communicating with other people.
    • They learn English as a second language.
      They use English mainly for reading and writing.
      They may also learn spoken English.
    • Children often benefit from bilingualism and learning about various cultures, such as Deaf culture, is another benefit.
    • Children may learn about and become part of Deaf culture and the Deaf community.
    • They are also still part of their family's culture and their family's community.
    • The National Association for the Deaf supports bilingualism: the development and use of American Sign Language and English in the home and at school for infants and children who are deaf or hard of hearing.

Bilingual-biculturalism (bi-bi) is based on the idea that deaf children need access to a  language they can see. It is also believed that once children learn one language, they can pick up other languages with greater ease. For helpful information on the Bilingual-Bicultural approach, visit:

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A Lot Depends on the Learning Needs of Your Child

Information in this last section was developed by the team (See About Us)

Sometimes families will find a single form of communication works best, and other families may use more than one form. For example:

  • One family may choose listening and spoken language methods for a child who is going to receive a cochlear implant at one year of age. Another family in this situation may sign to the baby until the implant is received, and then transition to spoken language approaches. Others may sign before and after the cochlear implant.
  • A baby with both deaf and hearing family members may learn sign language while also relying on hearing to develop spoken language.
  • Another child may speak clearly but do best with a sign language/educational interpreter in noisy settings, like in school.
  • It is important to remain flexible and observe whether or not the approaches you are using are working well for your child. Ongoing evaluation can guide modification of approaches as needed.



*McConkey Robbins, A. (2001). A sign of the times: Cochlear implants and total communication. Advanced Bionics Loud & Clear (4)2, 1-7.

*Nussbaum, D., Scott, S., Waddy-Smith,B., & Koch, M. (2004). Spoken language and sign: Optimizing learning for children with cochlear implants. Paper presented at Laurent Clerc National Deaf Education Center, Washington, DC.​​​