Who does what on your child's team?

The appointments begin, and nobody hands you a map: audiologist, ENT, SLP, teacher of the deaf. Here's who does what, and the question you should ask every one of them.

August 17, 20266 min readWorking with your team

It started with a quiet worry about your child's hearing. Then began the appointments. You met with an audiologist and an ENT. They diagnosed the hearing loss, recommended that you see a therapist or visit a school for deaf children. Suddenly all these new people were people you talked to and heard from every week, every month!

A boy wearing a hearing aid looks at a picture book with his mother and his speech-language pathologist, who points at the page. — Ordinary moments. Extraordinary opportunities.

Helping a DHH child learn to listen and speak takes a team. Depending on where you are in the world, your team might be all in one place funded through the government or they might be all in different places. Sometimes, the specialist you need to see is in a city far away.

You, the parent, are the captain of this team and have to figure out how you all can work together to support your child.

Who does what on your child's team

Here's what each professional contributes.

The pediatric audiologist specializes in working with children. They measure how your child hears, fit and program the hearing aids or cochlear implant processors so that speech (all of it, down to the quietest sounds) actually reaches your child's brain. Expect frequent visits in the first year; the settings are tuned and re-tuned as your child grows.

The ENT physician (otologist) covers the medical side: examining the structures of the ear, reviewing scans, performing surgery when a cochlear implant is the right choice. Once the medical work is done, this usually settles into a yearly check.

The early interventionist helps you in the birth-to-three years, often working with you in your home, with your routines, on whatever your child needs the most.

The speech-language pathologist (SLP) works on listening, speech, language, and conversation: the skills your child builds on top of what the devices deliver. The SLP might be an early interventionist specializing in working with 0-3 year olds and their families. You might see them at their center or they may come to your home.

The teacher of the deaf might also specialize in working with 0-3 year olds and their families in their homes. In the preschool and school years, teachers of the deaf work with your child in small groups or individually. They help build listening and spoken language skills that become foundations for reading, writing, and future school success.

The Listening and Spoken Language Specialist (LSLS) is a credential, not a separate profession. An SLP, a teacher of the deaf, or an audiologist can earn it by completing three to five years of mentored practice (900 hours) focused entirely on children who are learning to listen and talk, then passing a rigorous exam. Auditory-Verbal Therapists (LSLS Cert. AVT) coach families one-on-one; Auditory-Verbal Educators (LSLS Cert. AVEd) usually work in classrooms.

So who runs this team? You do. As the team at Listening Together puts it, "parents are always the captains of this team." Each professional contributes a piece, then hands the week back to you.

Are your team members "experienced" or just "qualified"?

Different countries have different requirements for professional training and licensure. For example, licensed speech language pathologists in the US and India are qualified to work with all children with communication challenges, including those who are deaf or hard of hearing. In South Africa, most special education teachers are not trained to teach DHH children specifically, but learn through additional on-the-job training.

You want to know if your professional is not just qualified but also experienced because it makes a difference. A study by Rosenzweig and Smolen surveyed 132 professionals (SLPs, teachers of the deaf, audiologists, early interventionists) about 19 evidence-informed auditory-verbal strategies. The general-purpose techniques were nearly universal: everyone waits for a response, everyone expands what the child says. The gaps were exactly where listening expertise matters. Strategies that require knowing speech acoustics and the auditory brain, like whispering to spotlight quiet high-pitched consonants, speaking in parentese (the melodic, stretched-out way adults naturally talk to babies), or asking "what did you hear?" to repair a breakdown through listening, were used most by certified LSLS professionals and least by professionals without that training.

None of this means a professional without the credential can't be excellent. Certified LSLS are scarce (under a thousand worldwide at the end of 2020, with only 270 outside the US), so many superb clinicians are mid-certification, or practicing where no mentor exists. What it does mean: you can ask. How many children with cochlear implants have you worked with? Are you LSLS certified, or working toward it? What listening and spoken language training have you done since your degree? A professional worth having will welcome every one of those questions.

Green flags, Red flags, and Truths to hold on to

Parent and professional leaders in the field agree that children do best when professionals work in genuine partnership with the family, coaching you rather than delivering therapy at your child. Here's what that looks like in the room, and what its absence looks like.

Green flags:

They coach you as much as your child. The session is built around your actual routines (mealtime, bedtime, the drive to daycare), you practice while they watch, you leave knowing what to do this week.
They ask before they tell. Your priorities, your home languages, your culture shape the plan. When you decline a suggestion, that's treated as your call to make. Because it is.
They connect you outward. To other parents, to DHH adults, to the rest of your child's team. Confident professionals build bridges; they don't need to be your only source.

Red flags:

You only get to watch. Therapy happens across a small table while you sit on the couch, or worse, outside the room.
Every family gets the same program. Same worksheets, same goals, same order, whatever your routines, language, or culture.
Your questions change the temperature in the room. Vague answers about their experience with hearing devices, defensiveness about certification, or a brush-off when you report what you've noticed at home.

Always remember:

However skilled the therapist, a child spends nearly 99% of their waking week outside that room. If they're not coaching you to make the most of the in-between, they're doing a disservice to you and your child.
Family-centered practice starts by learning about your family. It adapts to your family on an ongoing basis. It doesn't come out of a one-size-fits-all binder.
You know your child best. A good team treats your observations as data, because you are the expert on the child.

How SparkMinds fits in the larger picture

Your child's support team works in sessions and appointments. But your child learns language all week. SparkMinds helps you carry your team's goals into the everyday moments in between sessions, and helps you arrive at each appointment with better information (we've written about the in-between and how we support your team).

Still assembling your team? You can start with SparkMinds today. We can help you find the right people.

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