Most parents celebrate their baby’s first “Mama” or “Dada” but rarely consider how much goes into this speech milestone. For a child with hearing loss, those utterances may not be a given.
So when Tiffany Lim’s first assigned case, a four-year-old with hearing loss who had spent most of his childhood in a world of silence, called out to his mother and grandparents for the first time, it meant everything to her.
“Up until then, he was in his own bubble,” she recalled.
The 26-year-old is an auditory-verbal habilitationist (AVH) at KK Women’s and Children’s Hospital’s (KKH) Audiology Service. She works in a niche field, helping children and babies with hearing loss develop listening and language skills after they are fitted with hearing devices.
The work is deeply family-centred, with parents coached to support listening and language development both during sessions and at home.
In Singapore, around one in 1,000 newborns has significant hearing loss, according to KKH.Auditory-verbal therapy is recommended to monitor the child’s hearing device use and their spoken language development, said Lim.
On average, the KKH Audiology Service attends to 2,500 to 3,000 patients with hearing loss each year.The service sees children from around six months up to 18 years old. Some are born with hearing loss; others lose their hearing later due to acquired infections or medical conditions.
Lim, who has a degree in psychology with a focus on child development, always wanted to be in a helping profession. She found herself drawn to the interactive, hands-on aspect of working with children during an internship at an early intervention centre.
In each auditory-verbal therapy session, Lim engages the child through play, songs and reading. (Photo: KK Women’s and Children’s Hospital)
As an older sister, she naturally slipped into a caregiving role from a young age, looking out for her younger brother and helping with the younger children at church activities.
“I realised that I genuinely enjoyed not just playing with them, but guiding, encouraging, and supporting them in their learning and behaviour,” she said.
“What stands out to me is how the world can feel overwhelming for young children, and how important it is for adults to create a safe and supportive environment to equip them with the skills they need.”
She found her direction after learning about the work of a family friend, who is one of the few certified Listening and Spoken Language Specialist (LSLS) Auditory-Verbal Therapist (AVT), in Singapore. Sitting in on a playgroup session for children with hearing loss sealed Lim’s decision.
The session revolved around a birthday celebration theme. She recalled a birthday “cake” made of playdough, pretend candles, singing, conversations and laughter filling the room. Lim was struck by how much language could be woven into one activity.
The connection between the children and their parents also moved her. “Seeing the smiles and conversations between the children and their parents warmed my heart,” she said.
During auditory-verbal therapy sessions, Tiffany also guides and coaches caregivers to check and manage their child’s hearing technology daily. (Photo: KK Women’s and Children’s Hospital)
She is especially drawn to how auditory-verbal therapy places parents at the heart of the process. “I felt that this is very special, very different,” Lim recalled. “I wanted to be involved in such an environment, helping families to grow and learn together.”
KKH’s Audiology Service comprises two AVHs, two AVTs, along with audiologists and audiological technicians.
Lim is currently working towards becoming a certified Listening and Spoken Language Specialist (LSLS) Auditory-Verbal Therapist, which is awarded by the Alexander Graham Bell Academy in the United States.
The certification is a rigorous three-to-five-year journey, which includes specialised coursework, supervised clinical hours, and passing the certification examination. The certification also needs to be renewed every two years with required credit units, she added.
Even though Lim is currently working towards the certification, she said the clinical work of an AVH and AVT – assessing the children, treatment, monitoring progress and coaching parents – is similar.
Babies in Singapore all undergo a Universal Newborn Hearing Screening soon after birth. If a baby does not pass the screening, they’re referred to an ear, nose and throat clinic and audiology team for further testing, said Lim.
“Once hearing loss is confirmed, we aim to fit hearing aids as early as possible, no later than six months of age. About 40 per cent of infants with hearing loss have co-existing health conditions which may need to be prioritised before addressing hearing, and that is why at times they are fitted later,” she added.
Activities in auditory-verbal therapy are carefully designed to develop listening and spoken language skills in an engaging and developmentally appropriate way. (Photo: KK Women’s and Children’s Hospital)
Some children may be fitted with cochlear implants, surgically implanted electronic devices that stimulate the hearing nerve directly.
But these devices do not magically solve everything, even though they provide access to sound. Once a child is well fitted and wearing their devices consistently, Lim’s work begins – by teaching them to connect sound to meaning.
It is a common misconception to link hearing solely to one’s ears. In reality, it is also about how the brain interprets sounds, said Lim.
“Hearing loss is an access problem. If sounds cannot reach the brain clearly, understanding speech becomes difficult. Hearing devices such as hearing aids or cochlear implants can help re-open that access, but the brain still needs practice to make that sound-to-meaning connection,” she explained. An example is associating the word “cow” with “moo”.
“In therapy, this looks like helping the child learn to notice sounds, tell them apart, understand words and sentences, and use listening as their main way of learning language.
“Over time, we strengthen the brain’s auditory pathways – that’s what ‘listening with the brain’ really means,” Lim added.
Because therapy centres on parent coaching, sessions are meaningful even before a baby starts talking, Lim said.
“Listening and language grow in everyday moments – feeding, playing, cuddling – and parents shape all of that. When parents feel confident using strategies at home, progress happens much faster,” she said.
“Hearing loss is an access problem: if sounds cannot reach the brain clearly, understanding speech becomes difficult,” says Lim. (Photo: KK Women’s and Children’s Hospital)
With infants as young as six or seven months old, therapy
“We build goals around everyday routines so parents can naturally support listening and language at home,” Lim said.
“Even simple things like changing a diaper – “Now your diaper is dirty, let’s take it off and then we can change it’ – can be a learning opportunity. When you think about how many times you change a diaper, there are so many opportunities to use that as a learning moment.”
With toddlers, a simple water play activity with toy boats provides opportunity for listening and language. When boats go in and out of the water, for example, parents can layer in sounds and words – describing the way a boat moves and the sound it makes all help children connect sound to meaning.
Lim is drawn to how auditory-verbal therapy is family-focused, with parents as active participants. (Photo: Eveline Gan)
Beyond using the appropriate techniques, Lim believes that children learn best in moments when they feel warmth and love.
“We often say children hear love, and when parents turn those loving interactions into listening opportunities, that is when the biggest gains happen,” she said.
Returning to the first family she supported, Lim pointed to the big difference that intervention and family involvement can make.
“This child has such a supportive and motivated family. From no words to single words to now beginning to have longer sentences to express his thoughts – and all in a span of a year. When people say it takes a village to raise a child, it really does,” she said.
More than a year into her work, Lim still finds herself moved by the little moments that most people take for granted.
“Many parents are thrilled when their babies detect a sound or say a sound or word for the first time. Their eyes light up when their child calls them ‘Papa’ and ‘Mama’,” she said.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...
So when Tiffany Lim’s first assigned case, a four-year-old with hearing loss who had spent most of his childhood in a world of silence, called out to his mother and grandparents for the first time, it meant everything to her.
“Up until then, he was in his own bubble,” she recalled.
The 26-year-old is an auditory-verbal habilitationist (AVH) at KK Women’s and Children’s Hospital’s (KKH) Audiology Service. She works in a niche field, helping children and babies with hearing loss develop listening and language skills after they are fitted with hearing devices.
The work is deeply family-centred, with parents coached to support listening and language development both during sessions and at home.
In Singapore, around one in 1,000 newborns has significant hearing loss, according to KKH.Auditory-verbal therapy is recommended to monitor the child’s hearing device use and their spoken language development, said Lim.
On average, the KKH Audiology Service attends to 2,500 to 3,000 patients with hearing loss each year.The service sees children from around six months up to 18 years old. Some are born with hearing loss; others lose their hearing later due to acquired infections or medical conditions.
FINDING HER CALLING
Lim, who has a degree in psychology with a focus on child development, always wanted to be in a helping profession. She found herself drawn to the interactive, hands-on aspect of working with children during an internship at an early intervention centre.
In each auditory-verbal therapy session, Lim engages the child through play, songs and reading. (Photo: KK Women’s and Children’s Hospital)
As an older sister, she naturally slipped into a caregiving role from a young age, looking out for her younger brother and helping with the younger children at church activities.
“I realised that I genuinely enjoyed not just playing with them, but guiding, encouraging, and supporting them in their learning and behaviour,” she said.
“What stands out to me is how the world can feel overwhelming for young children, and how important it is for adults to create a safe and supportive environment to equip them with the skills they need.”
She found her direction after learning about the work of a family friend, who is one of the few certified Listening and Spoken Language Specialist (LSLS) Auditory-Verbal Therapist (AVT), in Singapore. Sitting in on a playgroup session for children with hearing loss sealed Lim’s decision.
The session revolved around a birthday celebration theme. She recalled a birthday “cake” made of playdough, pretend candles, singing, conversations and laughter filling the room. Lim was struck by how much language could be woven into one activity.
The connection between the children and their parents also moved her. “Seeing the smiles and conversations between the children and their parents warmed my heart,” she said.
During auditory-verbal therapy sessions, Tiffany also guides and coaches caregivers to check and manage their child’s hearing technology daily. (Photo: KK Women’s and Children’s Hospital)
She is especially drawn to how auditory-verbal therapy places parents at the heart of the process. “I felt that this is very special, very different,” Lim recalled. “I wanted to be involved in such an environment, helping families to grow and learn together.”
KKH’s Audiology Service comprises two AVHs, two AVTs, along with audiologists and audiological technicians.
Lim is currently working towards becoming a certified Listening and Spoken Language Specialist (LSLS) Auditory-Verbal Therapist, which is awarded by the Alexander Graham Bell Academy in the United States.
The certification is a rigorous three-to-five-year journey, which includes specialised coursework, supervised clinical hours, and passing the certification examination. The certification also needs to be renewed every two years with required credit units, she added.
Even though Lim is currently working towards the certification, she said the clinical work of an AVH and AVT – assessing the children, treatment, monitoring progress and coaching parents – is similar.
HELPING CHILDREN “LISTEN WITH THEIR BRAINS”
Babies in Singapore all undergo a Universal Newborn Hearing Screening soon after birth. If a baby does not pass the screening, they’re referred to an ear, nose and throat clinic and audiology team for further testing, said Lim.
“Once hearing loss is confirmed, we aim to fit hearing aids as early as possible, no later than six months of age. About 40 per cent of infants with hearing loss have co-existing health conditions which may need to be prioritised before addressing hearing, and that is why at times they are fitted later,” she added.
Activities in auditory-verbal therapy are carefully designed to develop listening and spoken language skills in an engaging and developmentally appropriate way. (Photo: KK Women’s and Children’s Hospital)
Some children may be fitted with cochlear implants, surgically implanted electronic devices that stimulate the hearing nerve directly.
But these devices do not magically solve everything, even though they provide access to sound. Once a child is well fitted and wearing their devices consistently, Lim’s work begins – by teaching them to connect sound to meaning.
It is a common misconception to link hearing solely to one’s ears. In reality, it is also about how the brain interprets sounds, said Lim.
“Hearing loss is an access problem. If sounds cannot reach the brain clearly, understanding speech becomes difficult. Hearing devices such as hearing aids or cochlear implants can help re-open that access, but the brain still needs practice to make that sound-to-meaning connection,” she explained. An example is associating the word “cow” with “moo”.
“In therapy, this looks like helping the child learn to notice sounds, tell them apart, understand words and sentences, and use listening as their main way of learning language.
“Over time, we strengthen the brain’s auditory pathways – that’s what ‘listening with the brain’ really means,” Lim added.
THE POWER OF FAMILY INVOLVEMENT
Because therapy centres on parent coaching, sessions are meaningful even before a baby starts talking, Lim said.
“Listening and language grow in everyday moments – feeding, playing, cuddling – and parents shape all of that. When parents feel confident using strategies at home, progress happens much faster,” she said.
“Hearing loss is an access problem: if sounds cannot reach the brain clearly, understanding speech becomes difficult,” says Lim. (Photo: KK Women’s and Children’s Hospital)
With infants as young as six or seven months old, therapy
“We build goals around everyday routines so parents can naturally support listening and language at home,” Lim said.
“Even simple things like changing a diaper – “Now your diaper is dirty, let’s take it off and then we can change it’ – can be a learning opportunity. When you think about how many times you change a diaper, there are so many opportunities to use that as a learning moment.”
With toddlers, a simple water play activity with toy boats provides opportunity for listening and language. When boats go in and out of the water, for example, parents can layer in sounds and words – describing the way a boat moves and the sound it makes all help children connect sound to meaning.
Lim is drawn to how auditory-verbal therapy is family-focused, with parents as active participants. (Photo: Eveline Gan)
Beyond using the appropriate techniques, Lim believes that children learn best in moments when they feel warmth and love.
“We often say children hear love, and when parents turn those loving interactions into listening opportunities, that is when the biggest gains happen,” she said.
Returning to the first family she supported, Lim pointed to the big difference that intervention and family involvement can make.
“This child has such a supportive and motivated family. From no words to single words to now beginning to have longer sentences to express his thoughts – and all in a span of a year. When people say it takes a village to raise a child, it really does,” she said.
More than a year into her work, Lim still finds herself moved by the little moments that most people take for granted.
“Many parents are thrilled when their babies detect a sound or say a sound or word for the first time. Their eyes light up when their child calls them ‘Papa’ and ‘Mama’,” she said.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...