Hard of Hearing Children and Dual Language Learning: Guidelines for Interpreters

There’s certainly a lot to be careful about, but in the end it’s an amazing experience to witness the journey of a child who faces the challenge of learning two languages while having hearing loss.

Learning a language is an admirable feat for anyone. It’s amazing to watch how easily children seem to learn their first language at such an early age. This process can become more difficult, however, if the child has hearing loss. In some cases, there’s another added challenge: learning two languages at once!

Interpreters play a key role for these hard of hearing future multilinguals as they receive services from audiologists and speech-language pathologists (SLPs). We’re also instrumental to their families when communicating with school systems so they can ensure their child receives the services to which they’re entitled.

How can interpreters complement and aid other professionals in their tasks? How do we help families along this journey without making it our own? Here’s some advice that stems from my experience and that of other professionals in the field.

What to Know

In the areas of knowledge and terminology, here are a few things with which you need to be familiar:

    • Procedures and Tests Used in the Field: It’s important to be familiar with audiology tests and procedures commonly used in speech and language evaluations (e.g., auditory brainstem response tests), devices, and assistive technology (e.g., types of hearing aids, cochlear implants, etc.). The Centers for Disease Control and Prevention website is a good place to start getting oriented regarding the types of tests used.1 To learn more about cochlear implants, for example, providers such as Cochlear2 or Med-El3 are good resources, and sometimes offer information in several languages.
    • How the Family Communicates: It’s important for the child to receive the same linguistic input at home and during therapy. This means interpreters have to learn the family’s “dialect.” This includes their nonverbal communication (Do they shake hands? How do they greet each other?) and the terminology the family uses to discuss everything from medical conditions to everyday objects.
    • The Family’s Cultural Beliefs: Sometimes a family has different beliefs about gender roles, medical interventions, or child rearing. It’s important to know as much as possible about a family’s beliefs so we can better respond to their needs and facilitate mutual understanding with other professionals working with them.
    • Federal and State Laws about Hearing Loss: Ideally, you should not advocate for the family. In case you do, and in order to better interpret the information that families receive at school and at medical offices, it’s important to know what rights and obligations the family has under the law in your state. There may be a situation in which a family needs a certain resource that you know where to find or how to approach. My suggestion is to always discuss this information with the provider first.

There are also other aspects of this field that aren’t critical but that you might want to be acquainted with.

  • Phonetic Transcription: This is the visual representation of speech sounds by means of written symbols. The most common type of phonetic transcription uses a phonetic alphabet, such as the International Phonetic Alphabet, which was developed to accurately represent the pronunciation of languages.4 This type of transcription can be useful to indicate to the therapist or audiologist when the patient has produced or missed a sound during an evaluative test.
  • Dialectal Variation and Nonverbal Communication: These are aspects that may vary in different cultures. As I mentioned earlier, it’s best to focus on the pragmatics of each particular family, but always be aware of cultural differences. You may need to work with families from various cultural groups and observe different norms.

Some Practical Advice

Children who have hearing loss are no less smart! They become very resourceful at communicating in other ways, especially in a visual manner. This has some implications for interpreters:

  • If other people are covering their mouths to speak, do the same when you interpret for the child. Of course, the advent of the mask era has made this much easier!
  • When you hear a noise in the background, don’t react to it. Act as if you heard nothing. If the child sees your reaction, they might imitate it and “trick” the audiologist or SLP into thinking that they heard the stimulus.
  • We might also be asked to participate in an activity during testing. For example, we may be required to receive a toy when the professional asks the child to give it to us. These interventions on our part are minor and should not lead to us taking over the interaction. (See the discussion on ethical considerations below.)

Where the interpreter is placed in the room can make a difference. In some cases, the professional will want to position the interpreter as close as possible to the child or their assistive technology. In other cases, especially for testing purposes, they might want the interpreter a little farther away. As you can imagine, the pandemic changed things a bit. The interpreter couldn’t be too close to the child, and we had to adapt along with the professionals and families to ensure that children were receiving as much auditory input as possible in a safe manner. As an interpreter, I haven’t provided services in this specific situation via video, but I imagine that this is a route that some providers have taken.

In this and other aspects, it’s key to be flexible and open to learning from the professionals we work with. Interpreters must establish a relationship of trust between the audiologist or SLP and the patient. For example, knowing the goals that the provider has for each session can help guide our performance. When our services adjust to what the provider wants to accomplish, they begin to see us as team members with a specific task. In this way, they can better understand the limitations of our role and we can collaborate, within these role constraints, to accommodate the needs of these professionals, and especially, of the patient.

What Not to Do

Michael Douglas, a speech-language pathologist who served as principal of the Mama Lere Hearing School at Vanderbilt University, has described some of the main issues he has encountered when working with interpreters.5 These include:

The interpreter says more or less than what’s being said. We know how important accurate and transparency are in our profession. The family cannot afford to miss out on any of the information being shared, so omit nothing. When it comes to adding information, neutrality comes into play. We have to remember that this is not our message to transmit, and we should not make it ours or take over by adding to it.

The interpreter takes the leading role instead of remaining neutral. It’s one thing to manage the flow of conversation, but an entirely different thing to make ourselves the center of this conversation. Remember, the family needs to establish a relationship with the professional assisting them, not with us.

The interpreter the family brought doesn’t agree with the professional. As I’ve already mentioned, professional interpreters leave their opinions at the door. Allow me to repeat this: it’s not our conversation, our relationship, or our story. The best way to empower the family is to place ourselves in the background and facilitate them taking over the situation and making the choices that only they can make for their child.

The Ethical Issue

When working with hard of hearing children who are bilingual and bicultural, sticking to our professional ethical principles is especially important. Here are some ethical tenets to keep in mind:

  • Accuracy: We need to learn terminology (medical and non-medical) so that we can be as accurate as possible. As mentioned previously, we need to focus on not changing the message we’re conveying.
  • Professionalism: As with other aspects in our field, it’s essential to devote ourselves to professional development. Hearing technology continues to evolve and so do tests and methods of intervention. Stay abreast of this evolution and be open to learning more from the professionals and families you work with. We’re not required to know it all, but we’re expected to always be willing to learn.
  • Impartiality and Neutrality: We will not always agree with the decisions families make for their children, but these are their decisions. We may be frustrated by what we consider a lack of understanding on their part, but let’s not underestimate our patients. If we’ve done our job correctly, they’ll have the information they need. It’s also true that sometimes we get attached to a patient, especially if we get to work with them through many appointments in their journey. This is a completely natural thing, and we don’t necessarily need to suppress it or be ashamed. The key is not to let this attachment show outwardly. We need to treat all patients the same, regardless of who we like best. On this same token, remember that, as far as patients and professionals are concerned, we have no opinions.
  • Role Boundaries: In connection with impartiality, we need to remember that as interpreters, our main job is to interpret. If we’re doing something else, we need to ask ourselves if we should be there at all. Beyond minor participation, we’re not a part of the conversations being had or the decisions being made.
  • Confidentiality: Some appointments will be emotional and take a toll on us. In these instances, we’ll need to debrief with a colleague or talk to a friend or family member. Please remember to always protect the information of the family. Don’t mention any protected health information. If necessary, make up a name for the child and the professional with whom you’re working.

A Very Rewarding Experience

There’s certainly a lot to be careful about, but in the end it’s an amazing experience to witness the journey of a child who faces the challenge of learning two languages while having hearing loss. There’s no doubt that these children and their families work extra hard for communication, and we’re there to facilitate that. This gives us a “superhero” feeling and makes us very aware of the importance of our role. Let’s live up to this wonderful opportunity to empower these very special children!

Additional Resources

American Speech-Language-Hearing Association

(Nonprofit that helps parents understand hearing loss and the needs of children who are deaf and hard of hearing)

International Medical Interpreters Association
IMIA Guide to Ethical Conduct

  1. “Hearing Loss and Children,” Centers for Disease Control and Prevention, https://bit.ly/CDC-hearing-loss-children.
  2. Cochlear, www.cochlear.com/us/en/home.
  3. Med-El, www.medel.com.
  4. International Phonetic Alphabet, www.internationalphoneticalphabet.org
  5. Douglas, Michael. Dual-Language Learning for Children with Hearing Loss (Med-El, 2014).

María Baker, CT received her MA in Spanish and teaching English to speakers of other languages at West Virginia University in 2013. Passionate about professional development, she has nine years of experience in interpreting and translation. She became a certified medical interpreter in 2014 and a certified health care interpreter in 2018. She became an ATA-certified English>Spanish translator in 2021. She has conducted training for health care providers on interpreting and delivered workshops for interpreters. She is vice president of the Interpreters and Translators Association of Alabama. She is a former editor of Caduceus, the newsletter of ATA’s Medical Division, volunteers on the Social Media Committee of ATA’s Spanish Language Division, and is a member of the Professional Development Committee. info@maria-baker.com

1 Responses to "Hard of Hearing Children and Dual Language Learning: Guidelines for Interpreters"

  1. Alberta Giraldo says:

    This was quite an interesting introduction to me as this specialty is of interest to me. I believe the article was well written and just the right amount of information for those with a beginner’s curiosity. I hope to continue investigating the possibility of study in the vocabulary of the definition of terms and the treatment of Hard of Hearing Children. Thank you so much.

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