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All About Listening and Spoken Language – Episode 72 with Dr. Carol Flexer

Read the full transcript here

I’ve been learning- and unlearning!- a lot about integrating inclusivity and disability advocacy within audiology. Over the next few episodes, we’ll explore these ideas more. 

On today’s episode, you’ll hear from Dr. Carol Flexer. Dr. Flexer has been writing, teaching, and presenting for decades on the connection between hearing and the organization of the auditory brain. She is a distinguished professor emeritus at the University of Akron and Northeast, Ohio  (Northeast Ohio Au.D. Consortium (NOAC). Additionally, she is the author of many books.

Show Notes:

5:25 – Dr. Flexer initially wanted to be a nurse. She then decided to focus on public speaking. Within this major, she got hooked on a course that featured a two week lecture on audiology. She eventually worked with Doreen Pollack at University of Denver.  The rest is history!

14:00 – The decision regarding whether to communicate with your DHH child via Listening and Spoken Language (LSL) or through Sign Language, is a choice made by one’s parents. If you choose listening and spoken language, Dr. Flexer has put together a whole narrative on the logic chain of what system has to be in place, from understanding about the brain to the absolute must use of technology. Though on the flip side, she believes that if you want to communicate via sign language, you and everyone in your family needs to become fluent in sign language.

17:00 – DHH students, even with the use of hearing aids/ cochlear implants may experience language deprivation. It’s the responsibility of audiologists and educators to monitor the child’s progress.  

22:00 – The integration of primary and secondary auditory areas up through the midbrain is a process that occurs in early childhood, making early intervention crucial. 

26:00 –  Dr. Flexor explains acoustic access in the environment, saying “the ear is the doorway to the brain.”

31:00 – The specific communication method that parents choose for their child, whether through Sign Language or an auditory-verbal approach with the help of technological tools, needs to be implemented correctly and efficiently. ‘Although parents do not have control over the natural (or biological) outcome/s of their child’s diagnosis, it is up to the professionals to support the ways in which parents choose to communicate with their child.

To support the All About Audiology podcast, visit our Patreon website here:

For more resources and research visit:

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Check out Carol’s website here:

Listen Next/Related Episodes:

Ep 73: All The Things You Didn’t Learn in Your AUD Program with Mallorie Evans

Ep 15: All About Sign Language with Kimberly Sanzo from Language First

Ep 61: All About the Importance of the Parent-Audiologist Relationship –with Janet DesGeorges from Hands and Voices 

Ep 27: All About Auditory-Verbal Therapy (AVT)- with Elaine Matlow Tal-El, AV Israel


Dr. Carol Flexor: 

Ears don’t listen, brain listens. Ears are doorways.

Dr. Lilach Saperstein:

Welcome back to the All About Audiology podcast. I’m your host, Dr. Lilach Saperstein, and this is the show where we tackle all different elements and aspects of audiology and how it relates to your life, whether you are a parent or a professional, I’m so glad you’re here. And thank you for being a listener and supporter of the All About Audiology podcast. 

To learn more about supporting the podcast and becoming a patron visit And today we’re really tackling something huge. I have to be honest with you. I have gone back and forth on this upcoming episode. 

The thing that really gets a lot of people very engaged and very confused and very angry and all the things is something that has been framed as a controversy that is an either-or, with us or against us, over there with those people or over here with us. Right?

 This is a topic that we’ve discussed on the show before. And I really want to make space for us to have these conversations and listen to people from wherever they’re coming from, what their perspective is, and to learn from one another about this.  On one side, you have a very firm medicalized, um, interventionist, “auditory- verbal therapy,” “listening and spoken language” technology- at-all costs approach to essentially make the brain wired for hearing.

To encourage the development of a quote-unquote hearing brain, even in a child who is not typically hearing- who is hard of hearing or deaf. And that approach has led to some of the incredible advancements that we’ve seen in the use of cochlear implants and hearing aids in supporting individuals to become oral and to have access to sound in their lives. 

And at the other side, as if on the other side, there is this cultural identity of deafness, of being part of a deaf world that communicates primarily through sign language. A very different approach of accepting and celebrating deafness and advocating and championing access and accessibility and the reduction of ableism and audism in the world. 

And it’s as if there is a clear divide between these two approaches.  And I think it’s really important for us to have these conversations and to learn from one another.

A couple of episodes that I recommend to continue this conversation is actually to go back to an early conversation I had with Kimberly Sanzo from Language First. That conversation was very impactful for me in my re-education and learning a lot of things that I hadn’t necessarily been exposed to or knew about. And I’m constantly learning more and understanding more about the need for access to language and the dangers of language deprivation.

All of these will be linked in the show notes at I highly recommend you also listen to the conversation I had with Janet DeGeorge from Hands and Voices about the idea of choice and about the decisions. That a family needs to make when they learn that their child is deaf or hard of hearing.

I’ve also been learning a lot about the illusion of choice and how for many people, the choice is not really a choice,  given the source of where they get their information and what resources are presented. So in light of all of this, I really hope that you’ll listen to my conversation with today’s guest and understand that everyone comes from their approach and their understanding.  We all want to do the best for our children, for our patients, and for our community. And that can only come if we are all engaging and learning from one another.

Come with patience and context and understanding and nuance. That is what I aim for with the podcast. So let’s begin. 

Today’s esteemed guest is Dr. Carol Flexer who has been writing and teaching and presenting for decades on the topic of the brain. Dr. Carol Flexer is a distinguished professor  emeritus at the University of Akron and Northeast, Ohio  (Northeast Ohio Au.D. Consortium (NOAC)) 

She is the author of many, many books,  writer, presenter, speaker, and incredibly warm. And as you’ll hear, incredibly articulate about the goal of many of our interventions. I really look forward to hearing your feedback from our conversation and what your thoughts are on some of the controversies we touched on.

So you can always send me a DM on Instagram @allaboutaudiologypodcast or through the website where you will find full transcripts of today’s conversation at And I would love to invite you to the upcoming H.E.A.R retreat, which is all about finding your confidence and learning advocacy skills. It is a free seven-day virtual retreat, and you can sign up over at  and without further ado, welcome Dr. Flexer to the show.

How did you get into the field? What attracted you to this work, a little about your background. Magnum Opus, the brain here, if you will. [both laugh]


Just, I just by accident. By accident! 




 I started out. I wanted to be a nurse.

So I was at the University of Colorado studying nursing. It was a five-year bachelor’s program. This was in the sixties. So, um, that’s how old I am. Um, actually I’m very young. I started when I was three [sarcastic], so I was in nursing school then. About the second and a half years, two and a half years, I decided I didn’t want to be a nurse.

I’d rather be a physician. So, um, I looked around for that, and then, that just seemed, that seemed more intense than I wanted to. So I started searching around for majors and then I settled on broadcast journalism. This is how I learned a lot about what I do now in public speaking about using my voice, about microphone management, all of that. Within broadcast journalism. This was at the University of Colorado. So there was no broadcast journalism bachelor’s major. It had to be a speech major. So as a speech major, I had to take a class in speech pathology. Well, I had heard of speech pathology and, and that course, that semester was really interesting.

As part of the course, there was a two-week lecture on audiology. I had never heard of it. Never, ever, ever. I didn’t know any child with hearing loss, there was no personal connection at all. None of it. I knew old people with hearing loss, but that was it. And I fell in love with audiology. Why? It has medicine, it has talk, it has mic technology. It has, um, taking care of people. Absolutely, I fell totally in love in that week. Totally completely in love.  Just dropped everything, finished my speech degree. And then I got a full scholarship to the University of Denver, which no longer has a program, but at the time, and guess who I got to do externships with Marion Downs  Jerry Northern, um, Doreen Pollack.

Christine Yoshinaga-Itano was one of my teachers. I mean, I was like in the best part at 1976 at the University of Denver.  So I got this degree and because I was working with Doreen Pollack who had the Acoupedic method, which is one of the beginners of auditory verbal, had a program at Porter’s Memorial hospital in Denver. But this was way before implants. And she was, at that time we were putting a body aid on children with a Y cord meeting, a split cord from, one big device going to each ear.

Doreen Pollack said, no, you put two powerful body aids on this child. One to each side to be at the residual hearing. And when I went to her clinic, I saw kids listening and talking and this one child, I just didn’t believe her. And she said, Carol, take him into the sound room, test him yourself. I said this child sounds like they have a mild hearing loss.

They can’t be profoundly deaf. That’s not possible. I tested him. Yeah, he was. He was. So when I saw what she could do, I thought that’s what I want to do. This is it. I want to have children listen and talk, but you know, we didn’t talk about the brain then, ever. We talked about, like, it’s the ear. We want to teach this ear to listen, want to teach both ears to listen. 

Ears don’t listen, the brain listens. Ears are doorways. I mean, there are amazing doorways, but they are receptacles they capture and direct and they do change information to neural energy. just a sidebar, all of our senses capture different types of environmental data, whether it’s optic wavelengths, um, olfactory molecules, I’m pointing to my nose, optic wavelengths- I’m pointing to my eyes. Or vibrations. The peripheral ear. It’s just vibration. These are all different types of environmental data and these magical senses transduce their various environmental data to neural impulses because the brain can only read- process neural data. So that’s what this auditory system does, but we, again, never talked about it like that.

We never talked about the brain until even though we had to know, of course, we knew. I had classes in neurology, but somehow our study of the brain was in the scientific realm but was not taken into a counseling narrative or into a practical application of explaining what hearing is. Hearing is a neural analysis of environmental data that is given meaning to exposure and practice in language.

Right? But we talked about ears and audiologists. We still mess people up because we say, well, what is the speech perception in your right ear? And the speech perception in your left ear? There is no speech perception in ears. What we’re testing is the capacity of this. When we do speech testing is, and I’m pointing to my ears is the organic capacity of this auditory doorway to manage vibrations from the environment and transmit those vibrations. How much of the vibration, in what way to the brain, to all the different transduction points. So we’re never testing ears. It’s always the brain, but when we talk about ears, it puts people, I think, going down the wrong track. You see?

So our job is to get through the doorway and develop a hearing brain. So going back to how I got into this and we were all about teaching ears. Um, but now, of course, we’re, and I’m not the only one who thought about the brain. I mean, we all talk about the brain, but what I feel that I’ve, I’ve attempted to do for the last years, is transform our neurological information into a practical counseling narrative that explains how, this sense- how this auditory doorway works with vibratory environmental data. And then what that means to neural management. And so, as I got into the field, I got more and more captured by the relationship of neurology and medicine and technology and human interaction and caregiving and family support and communication. How all of that came together for me and still does. So that’s how I am, where I am.


Really has that intersection from everything you wanted to be doing. And it’s like, oh, it’s technology and it’s diagnostic and it’s puzzles.


Don’t you love that? You know, every child is different. Every family, cause you always have to be thinking and you also have to keep changing, you know, as information.

I mean, who knew we would be recommending implants for single-sided deafness. I mean, I remember when we wouldn’t even think of implants until you were so profoundly deaf and we waited so long because we didn’t have information about what is possible. And then we only recommend one. We recommend two implants, see what we have to keep changing what, what we know. I mean, as information emerges, as we know more, we should do more. Right? We should take in this information, we don’t need to be having a 1950 or 1960 conversation. We should be having a 2021  conversation based on what we know now about how the brain works and what’s possible for children.


Oh, yes. That’s why I am very glad that you’re, have come on the podcast and doing a very different medium. I’m sure that all the conferences and writings and, and the traditional way we disseminate knowledge. Now we have listeners all over the world and I’m excited that we’ve had the opportunity to hear from you. And then, um, I would like to touch on controversy if you’re open to it.

CF: Which one, which controversy! [laughs]


Perfect. Okay. I guess the, uh, the staunch, over-application of LSL to the detriment of sign language, perhaps, where some people feel very isolated and alienated and not accepted.

There’s a lot of that online, at least online. In the Facebook groups, there’s a lot of drama. You know each one is slinging to the other. If you don’t XYZ, then you’re abusing your children. And it’s both sides saying the same. So I would be interested in hearing that, like, kind of a history of that. And what is your take on how people can do what’s right?

For their family, which is always the view on the podcast is there’s no one right way. If there was we’d we’d all be doing it. 


 Well, it’s all about parent choice. It’s what, what outcome does the parent want and what does it take to get to that outcome? And the fact that we know about 95% of children with hearing loss are born to hearing, speaking parents.

And many parents, like you, speak several languages. So the child, if the parent would like listening and spoken language, they probably want their child to know several spoken languages, which is entirely possible if we do what it takes. So we have to do what it takes. 

So it’s up to the parents. What language or languages do they know? What language or languages do they want their child to know? Um, how do they want this all to turn out? Who do they want their child to be able to communicate with? And this is 2021. So we’re in a whole new context and have been since the mid-nineties. It’s just that we have a lot more information now of what we can do.

So parents’ desired outcome. If they want listening and spoken language, I know what to do about that. If they want sign language, I refer them to someone who knows what to do about that. Um, to say that that, um, I have the skills for everything is absolutely not so. I’m very skilled in listening and spoken language. Even though I had four years of sign language, I would never try and teach someone that because I’m not skilled in it. 

A parent has every right to make that choice. And so, but what I explain to parents is every choice requires something of them. I mean, kids require a lot of a parent, period. So, um, if you want listening and spoken language, I’ve put together this whole narrative on the logic chain of what system has to be in place, from understanding about the brain to the absolute most use of technology to listening and spoken to really enrich.

If you want sign language, family, you, and everyone in your family needs to become fluent in sign language. Not just a hundred signs, but thousands. Everyone, and not just you or your child will communicate with only one person. Is that a member of your family? So it’s completely up to you to choose sign language but really get what that’s going to take. If you really want it. 

So I have really straight talks with families. And then if they say what we still want, sign language, that’s fine. Your choice. Here’s some people, or here’s some agencies that you might want to take a look at to see who you’re comfortable working with. 


That’s right.


 That’s how I go about it.


That’s beautiful. And I’m, I’m really appreciating that answer because you’re not sugar-coating in any place. Whatever you do is going to be hard. Going to take effort. 




So then the question would be about, well, what about all these kids with language deprivation that, you know, get to third and fifth and eighth grade, and then, oh, the hearing aids aren’t really working out by the way we have delayed L1 one and these children who are deaf did not benefit from their technology the way we hope they would. And now we’re dealing with a whole other issue. 


Well, we should have – well, then that’s on us. The professionals messed up. It’s on us. So it’s up to professionals to keep track of the doorway, to keep track of the technology, and to do diagnostics therapy, to know how the child is progressing. We shouldn’t wake up when they’re 10 and say, oh, you know what? They don’t know anything. We should have known at age one.

 So this is 2021, every child who has a severe to profound loss, anything worse than 70 DB should have implants before they’re 12 months of age if the desired outcome is listening and spoken language. So there is no language deprivation if we get on it right away.

And even if you have hearing aids for the first part, for the first few months, there is, if we maximize those low frequencies, you can still get an enormous amount of auditory enrichment and neural growth in the brain. And the parent can learn how to provide auditory input. So there should be minimum deprivation, minimum.

And if there’s more that’s on a crummy system. That means the professionals didn’t know what they were doing. Period. In my view, because we know better. We know better. And if that child didn’t get implants or hearing aids till they were older then the system messed up. Then what happens is the child is messed up.

So, so I think our, what we need to do is get our act together as a system, as audiologists, as interventionists, as people who manage technology as doing a diagnostic intervention, as getting that we are developing a brain and we don’t have any time to waste, and we know how to do that. 

Um, it’s difficult for parents who don’t know sign language to build a comprehensive language structure in sign language. It’s like saying, you know, would you like to raise your children in Swedish Do you know Swedish? Well, you know, half a dozen words. Well, that’ll be enough. You know, you learn as you go along. So I think when parents who don’t sign think they need to sign, that puts a huge barrier in their way. 

Number one, they don’t know how to sign. And number two, knowing a few signs does not help your child at all. I mean, you might as well gesture. Gestures are great. Oh my, baby signs are gestures. Baby signs are not a language. Just gestures. Nothing wrong with gestures, gestures are useful. So I think we have to be clear about what it takes.

What is the responsibility of the system, meaning professionals, what is it that families need to know? And there is no excuse for any child getting to a point where people are shocked of what they know or don’t know or shocked that the equipment is, or isn’t working. Shame on us. That should never happen. That’s my view.


I’m gonna push back a little and ask, you know, because if I was talking to a sign language expert, I would push them on, on there because that’s what I do. So, what about when we don’t know that a child in a year or two will, present with an autism presentation and maybe now they have an additional diagnosis, or we don’t know if a child has a language disorder on top of, or in addition to their hearing loss or children who come from different countries or, you know, you can have all these other elements of, of, we’re not, we can’t control the system. So what’s the net that’s keeping those kids actually having any access? And you have an LSL methodology that essentially ties your hands, like do not sign whatsoever, even cover your mouth. Like those extreme things that we see sometimes implemented can make people very anxious and turn them off from LSL thinking that it’s anti deafness and there’s that, you know, a bad taste in people’s mouth is what I’m saying.


I say they totally misunderstand. See, what is good for a baby is good for a baby. And what’s good for a child is good for a child. Humans are designed to listen and talk. That’s how we’re powerfully wired. And so, provided, we can get to the brain and provide the right social linguistic environment. That’s why we need professionals.

And if we don’t develop and integrate that auditory brain early on, we don’t get a do-over. No do-overs on that. So if a parent even thinks at some point, maybe they’ll want to listen. You better start right now because you cannot do it later. You cannot integrate the primary and secondary auditory areas up through the midbrain. That can only happen in those early, early months and years of life. Otherwise, you may get some sound awareness, but you will never go beyond that. So, the only way your child will have a choice of using audition is if you make that brain available now. There’s no do-overs to that.

And I’m very clear about that because I’ve seen too many kids or families, and they’ll not, not in this day and age so much. Uh, but that would come and say, okay, my child’s 10. I think we want to talk. Too late. Sorry, should’ve thought about-  well, you know what, we thought any time- we’ll let them make the decision.

There is no decision. If you don’t teach listening and spoken language early, your child can never decide to do it. Never. You’ve taken that decision completely away from them. So there’s a big misunderstanding about how the auditory brain works and how critical auditory engagement is to integrate it with the rest of the brain, including especially the prefrontal cortex.

So, um, even if a child has problems later and they might, it’s powerful to integrate and develop that auditory brain for receptive information. Powerful.  So I would never say, well, we’re not going to develop these critical and integrate these critical auditory centers because you might have problems later that we don’t know about.

Well, you may or may not. Your child might. My grandchildren might. I’m not going to tell my grandchildren, well, don’t talk to your children because they might get older and might not be able to do what later. 

I think we start with how humans are designed and we integrate and develop those auditory centers. And we do listening and talking. It’s whatever you would do with your child with typical hearing, but about 20 to 30% more of the same thing, not different things. I do barrier games and I sit beside the child. But it’s all about developing that auditory brain that networks with every other part of the brain.

And I use gestures. I do. It’s hearing first. So I might say something like, oh, where’s your cup? Where’s your cup? Here’s your cup! There’s your cup. Hear it, and then see it. I point all the time, but never first. Where’s your glasses? Ooh, glasses? Here are my glasses. They’re right here. These are my glasses. Okay. 


 And then you point to your glasses. 


Actually, that’s my point. Exactly.   But you hear it and then see it. So I don’t point, show me my glasses and say, oh, here, look, here are my glasses. No, you need to hear it. Think about it. And then you can see them and play with them.

And once you know what glasses are, I don’t need to point to them anymore.


 Right. Okay. Amazing. So I’ll tell you more because when you say that humans are designed this way and our brain is wired for it, all of that you know is true, but maybe in the gentle 2021 version of acceptance, inclusivity, and disability advocacy.

That also is existing much more prominently. There is a flavor of audism ableism of like there’s a right way. And then children who are born deaf are not built correctly or needs to be fixed like that. There’s that element that people hear that tells him like, wait a minute, are the professionals that are working with my kid think there’s something wrong with them? And that’s where there’s that uncomfortable belly feeling. 


I don’t know. Would you wear glasses if you couldn’t see well? “oh, there’s something wrong with you. You have glasses on. Oh, you’re damaged. Your damage or you have braces on your teeth or is there something wrong with you that you’re doing that?

Oh my goodness. You have special shoes on. There’s something wrong with you? … NO! Hearing is a sense. We have five senses. Humans are designed to function with five senses, and this is a doorway for sound. This is a doorway for vision. This is a- they’re all doorways. The understanding occurs in the brain. So when I diagnose a hearing loss, what I say to the families is “well, what we have is a doorway problem, here.”

What we have is an issue getting sound from the environment through this doorway, into the brain. And the treatment is technology. Just like the treatment for visual problems is a technology treatment. It’s glasses that, although it’s not the exact same thing, the treatment for an auditory problem is hearing aids.

Why is that a treatment? Because the goal, the only goal of technology is to get auditory information to the brain. And we can do that now. We can do that and create and integrate a hearing brain. That’s the only reason.

 Yeah. There’s a doorway problem. You fix it. Or you deal with it and you allow the person’s brain to function with all senses. See, in the olden days, you couldn’t do that. We couldn’t get through this. If you had a closed doorway- game over. You couldn’t get to the auditory brain. Now we can, we can get to the auditory brain. We can in 98% of the cases, why would we not? Why would we not?

And I talk to, because when people say, what do you do? And I explain what I do and about the doorway and the brain. I have never had a hearing person say, oh, Well, I don’t think I really want my child to hear. I think it’s okay.

Because, you know, and, and if they had a vision problem, I wouldn’t want them to see. I mean, because that’s, there’s, there’s nothing wrong with them. They, they just can’t see. So there’s no reason to take these cataracts off of them. I mean, I accept them for who they are. Maybe I’m a visualist if I insist that they are able to see. 


I, I, I think that what people, um, come up against is that one person’s decision for their child is somehow a threat to the decisions that other people make for themselves or their children. And it’s certainly not. 


It’s not. Nope. Don’t feel it’s their own personal decision. Absolutely. Absolutely. They just, I want to make sure they know what they’re deciding. I still run across people who say, well, no one said a deaf child could talk. No one ever said that was possible. How come no one ever told me that? I mean, that is unethical to not tell someone. That yes, if we do what it takes, it’s highly likely your child will listen and talk and maybe several languages.

If we do what it takes, this is 20 21, or 19 or 2000. Highly likely. And yet there are people who think that isn’t so. , I mean, if people have full information and then I encourage them, look online, talk to people, and visit programs. Then you make an informed decision and you can change your mind.

People change their minds and the saddest thing is, and this didn’t happen too long ago, a family came to me and they realized their child had Usher Syndrome that wasn’t diagnosed at birth. What did they do? Sign language.




 They now know when they’re 14, that child has Ushers. Oh, now they need to hear.

How awful, how awful, how dare we? Now we can, you can do genetic testing and we would have that information and oh, you really go for those implants, those implants immediately, depending on what the degree of hearing loss is, progressive, whatever. Because there’s different types. Right. But you see there’s huge repercussions to not accessing that and integrating that auditory brain for that child’s whole life.

Because we don’t know what else is in there. We don’t know. Yeah, that’s true.


 Yeah. And I think another very important piece that you’re bringing up is that it’s not just the technology. It’s the technology plus a very directed intervention that is, you know, all waking hours, and people need to know that investment.


 But here’s the thing. Um, what you’re doing with your child is the same thing you would do with any child. You are talking, you’re reading, you’re singing, you’re more intentional and you’re more often. I mean, do you read to your children? Do you sing to them? Of course, you do.

Would you do that if you had a child with hearing loss? Yes. Even more so, but you have to have that technology on and you have to wear the technology. So the extra is being intentional and I use remote microphones at home all the time. You use that, that mic, that mic accessory because we have a brain to build here.

And so parents need to be informed. They should be informed anyway. I mean, that’s for their own sake and their child’s. Whatever they decide to do needs an information base. And there, they do need to be aware of where they are, in terms of distance and noise. So there is stuff to know, but is this like different stuff you would never ever think of doing with your other children?

No, it’s the same thing. Same thing. More intentional, more often, but different? Like, I would, I would never sing to my children. I would never read to them. I would never take them for a walk. I wouldn’t, you know, Oh, yeah. Use that microphone. So, uh, a lot of the instruction is also, which I’m sure you’re finding is how do you use that technology?

How to make sure it’s working. How does implementation use that mic accessory? Why do you use it at home and how do you use it at home? What does that mean for your child’s brain development? What does that mean for their prefrontal cortex and executive function development? You know, we tie this all together in an advocacy format.


I’m thinking about all the parents who talk about their baby, pulling out their hearing aid 82 times in 10 minutes, 


 Then you put in 85 times in 10 minutes. 


[chuckles] That’s right. And they’re, you know, they’re putting the mold in their mouth and they’re worried about the battery, even though they’ve got the child lock on it.

Um, and it makes sense. Like that’s where I mean that there’s the extra. The difference.


Yes. Yes, yes, yes. The technology. Parents have to get that. And of course, if the baby’s pulling it out as audiologists, we want to make sure there’s no reason. In other words, there’s no pain, there’s no discomfort, the physical feel of it.

And then, the technological, the acoustic, all of that needs to be verified. But once it is, once it is, if you want listening and spoken language, it is as serious as you do not let your child play in traffic. You don’t let them stick their finger in the fire. That’s how serious this technology is serious.

Because you can’t have the outcome without the technology. You just can’t. And we have to be clear about that. Um, and when parents say, well they wore it for a couple of hours… 12 hours a day, 10 to 12. Now it’s an infant when they’re awake, but by the time they’re a year or two years of age, they’ve got to have it on.

Otherwise, you’re not getting to the brain. You won’t get the outcome. This is as serious as putting your hand in the fire. So if they take it (hearing technology) out 10 times, you put it in 11, they take it out 400, you put it in 401. That’s how serious this is. See, I think that professionals aren’t really serious in how they talk directly to parents about the outcome.

You want sign language, you’ve got to learn sign language, or your child will know nothing because your job is their teacher. And so, you’re teaching them what you know. How can you teach them what you don’t know? Which means you better know it. So real clear about that. You know, knowing 10 signs is not a language and that will not help your child. Having a hearing aid and putting it in one hour a day will not help your child.

You won’t get that outcome. What outcome do you want? And this is what it takes. 


Excellent. We really need this. 


And people can disagree, they can’t really disagree about what it takes because we know what it takes.  They have every right to choose their outcome. And it’s up to we the professionals to make sure the family knows what it takes to get that outcome.




It’s all about them. Listening and spoken language early intervention is family therapy. It’s not about the child. Everything is on the family. In fact, all interventions should be about the family, because if we think anything, we do a few hours a week makes any difference. We’re delusional. 


Yeah, very right. And I also feel the importance of that if there is native deaf signers in the family and the baby is exposed to sign, that’s a very different story, then. 


Absolutely! Absolutely, you’re absolutely right, because the child really, and here, that’s where we get to multiple languages. The child has to know the home language.

They have to know it. So, um, that’s why many have to know several spoken languages, right? Because the home language might not be the school language. Well, it’s the same with sign language. If the home language is sign language, of course, the child has to know that. But they’re with a proficient person who has a whole language base and you can still do auditory.

You just have to be very intentional. If there’s no one in the house who uses their voice, you have to make sure that child gets that. 


Okay, it’s actually refreshing to hear you be so firm on what it takes because there’s a lot of wishy-washiness. I myself have been in that space also. It’s like, you can do this or that. I mean, let’s like, see what you want. 


You can’t do this or that. Whatever you do, you have to be full steam ahead, full steam ahead. Because the brain, whatever you do, the brain needs a lot of practice and a lot of input.

It can’t dibble, dabble, dibble dabble because you won’t get brain development from that. You won’t, I don’t mean you, but one will not. 


Oh my gosh. Okay. In your last piece of advice for any of our listeners that are both families, professionals, students. What is, one thing you hope everyone holds on to from you? 


Oh, the hearing is about the brain. Just like vision is about the brain and smelling is about the brain. The knowing of the meaning of all environmental events occurs in the brain through exposure and practice, and that what hearing problems are is a doorway problem. What vision problems are? It is a doorway problem. You know, anytime there’s something in the doorway, what happens is information is corrupted or kept from getting to the brain. And the only purpose of technologies, there’s only one purpose, whether it’s a hearing aid or a bone anchor device, a remote microphone, a cochlear implant, their only purpose is to get information through that doorway to the brain where the knowing and the learning occurs. 


Excellent. May there be a lot of knowing and learning. [both laugh] That’s going to be the new blessing for you. I’m very, very grateful for your time and for sharing so much of your wisdom with us. 


And thank you for everything that you’re doing. Thank you for being there and reaching out to people and supporting them and, and, and yeah, and, and it is a shame. This is about that, that parents feel they have to defend their decision. They don’t, it’s their decision, you know, it’s like, we don’t have to defend how we raise our children, but, you know, just, I just hope that they know why they made the decision, but once there’s no defending it.


Right. Well, I think, I think actually it’s a symptom of a much bigger parenting conundrum of modern parenting, which is you do have to defend, are you breastfeeding or, you know, That is a very different world. 


Yeah. That’s a good point. That is a good point. Yeah. Where people want to know what you’re doing and why are you doing that?


Yeah. Yeah. I mean, people comment on if my children wear sandals too early in the season. It’s still cold. Why are they not wearing socks? It’s not cool. You know what I mean?


It’s been a while since I’ve been a parent of a young child. So yeah, I haven’t had to deal with that, but I guess there would be a lot of pressure on parents for all sorts of decisions.

Yeah. Yeah. I can see where there would be. Yeah. So I shouldn’t have been so cavalier…about ‘just do what you want to do.’ Wish we could, right? Yeah.


 And that’s where my advocacy training and the work I’m doing is, is very focused on the parent getting their own confidence first. 




So that’s what we’re doing.


Definitely. And just one last, one more word about that is confidence. And self-advocacy comes from knowing what’s going on, which means I think a primary purpose we have is providing information, uh, technical and otherwise, and then directing them for more. Cause you can’t advocate. If you don’t really know what’s going on, you know, you can’t get confidence. If you have no idea, what’s really happening. So I, I think that we, what you’re doing and what we’re doing is providing information that gives the parent confidence to reach out and look further and do further. 


Knowledge is Power! 


 Yes, it is! [laughs]



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