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What We Mean by Communication Access

By Kate E. Salvatore, M.D., and John F. Stanton, J.D.

Teens Looking at Phones

Dr. Alexander Graham Bell’s most celebrated student, Helen Keller, believed that “deafness is a much worse misfortune” than blindness. Keller reasoned that the inability to hear hindered the free exchange of ideas, opinions and feelings that connect people to each other on a personal level.

Communication access, the various tools and methods through which people receive and exchange information, has a profound impact on nearly every aspect of life for individuals with hearing loss and their families. From infancy, many children with hearing loss depend on hearing aids or cochlear implants to receive auditory information. Later, the language and educational development of children who are deaf or hard of hearing depend, in part, on access through accommodations such as assistive listening devices and Computer Assisted Realtime Translation (CART).

The issue of communication access has legal, technological and social implications and should be identified and defined in these contexts. For individuals with hearing loss, communication access helps to bridge societal and environmental barriers. Most importantly, it offers individuals who are deaf or hard of hearing equal access to the classroom, workplace and public venues, as well as critical services and other life experiences. Understanding these different contexts is the key to maximizing access.


Legally speaking, communication access requires that individuals with hearing loss have a way to express, as well as receive and understand, auditory information. The first law to address communication access for individuals with hearing loss was the Captioned Films Act of 1958, in which Congress appropriated federal funds to lease films, provide captions and then distribute them through appropriate state agencies such as state schools for the deaf. This program was enormously popular among people with hearing loss and, over time, Congress increased appropriations to provide captioning for more movies and television programming.

Other laws that affect communication access include Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Individuals with Disabilities Education Act of 1990 and the Television Decoder Circuitry Act of 1990. Pursuant to these laws, schools must provide interpreting and/or assistive listening devices to students who are deaf. Televisions and movie theaters must be equipped with captioning devices. Service establishments and public entities must provide telephone access to individuals with hearing loss. Public accommodations must provide emergency information and access. And, employers must provide all necessary accommodations to ensure that individuals who are deaf or hard of hearing can perform their job responsibilities.

As a result, these laws have helped reinforce individual independence, improve quality of life, ensure safety and improve educational and employment opportunities for people with hearing loss. It is important, however, that laws keep pace with developing technologies. For example, it is uncertain whether today’s laws require captioning access of video messages over the Internet. New laws requiring access may be necessary as the Internet grows as a communications medium. (Editor’s Note: Since publication in 2007, there have been advancements in captioning technology especially in online videos via services like YouTube and streaming services like Netflix.)


Technology’s impact on communication access is closely related to the law: The focus is on improving the way individuals who are deaf or hard of hearing comprehend aural information. Because communication needs vary based on the type and degree of a person’s hearing loss, appropriate accommodations also differ from person to person.

It is one of history’s great ironies that Dr. Alexander Graham Bell, a teacher of the deaf, is best known for inventing the telephone, which was completely inaccessible for people with hearing loss for many decades. Since then, improvements in technology have allowed users to communicate over the telephone using telecommunications devices for the deaf (TDDs), internet relay services, CapTel and compatible t-coils for hearing aids and cochlear implants. Other technological innovations such as e-mail and text  messaging have allowed people with hearing loss to obtain equal access in other ways.

On the interpreting front, perhaps no other invention has had as profound an impact on individuals with hearing loss as CART. CART technology, which provides instantaneous translation of spoken word into text, is often used in schools, on the job, at conferences and in other settings. In many situations, CART has come closest to “equalizing” the field for individuals with hearing loss in the workplace and at school. It is not a coincidence that more individuals with hearing loss have succeeded at the highest academic levels since CART became available.

Finally, advances in technology have significantly improved the quality of hearing aids and cochlear implants for recent generations of people with hearing loss. Even if cochlear implants and hearing aids do not entirely restore hearing, the benefits these devices offer in maximizing access to auditory information for individuals who are deaf or hard of hearing is undeniable.


With regard to the social aspects of deafness, communication access generally means an ability to understand and use language effectively in a variety of social contexts. For children who are prelingually deaf, this needs to start as early as possible so they have the best chance to be on equal footing with their hearing peers. Research shows that undetected and unmanaged hearing loss in infants negatively impacts speech and language acquisition, academic achievement and social and emotional development. Universal newborn hearing screening and subsequent immediate enrollment into auditory therapy (intervention) is one way to close this gap.

For school-age children, however, grasping the nuances and subtleties of everyday peer conversation can be an arduous task. How children who are deaf or hard of hearing respond to these types of challenging situations can depend on biological predispositions, personality traits (i.e., a child who is “quiet” can have a harder time socializing with peers), medical issues and social issues such as poverty or divorce. Whenever possible, age-appropriate information about hearing loss and communication options should be provided to the hearing peers of classmates with hearing loss to reduce the risk of ostracization and to promote understanding of differences among children – a very difficult task given that children don’t want to be seen as “different.”

The elements governing social interaction for individuals with hearing loss are different for one-on-one conversations versus group conversations. Specifically, each setting has its own communication challenges. One-on-one conversations are generally easier to manage since variables such as lighting, noise, acoustics and lip-reading are better controlled. In addition, the pace and flow of conversation can be better regulated. Group exchanges, on the other hand, are more difficult to master due to unique dynamics – the individual with hearing loss must juggle multiple speakers and conversation styles, spontaneous interjections, “off-hand” jokes and “background noise” to name just a few.

Both types of social interaction (especially the latter) can be challenging for individuals with hearing loss at any age. For younger children, parents often need to take on a more active role to ensure their children learn the appropriate cues to follow conversation around them. Parents also must advocate on behalf of their children to ensure optimal communication access beginning with diagnosis of their child’s hearing loss. This involves partnering with teachers, speech-language pathologists, audiologists and other service providers to make sure their child has the best chance for success in the mainstream. Parents and educators also must be aware of and take action to reduce problems that can develop in children as a result of poor communication such as oppositional or acting out behaviors, social isolation/withdrawal, depression and/or anxiety.

On the other hand, older children and teenagers must become self-reliant and learn to advocate for themselves if they are to be successfully mainstreamed in our culture. Daily interaction requires multisensory adaptation, physical energy, patience and education on the part of the individual with hearing loss to communicate effectively.

Although this is intended to be empowering, it can also pose unique challenges for teenagers with hearing loss. For one, deafness is an invisible disability that lacks concrete expectations for actions between two parties. For example, if someone in a wheelchair has trouble opening a door, it is clear to observers what the problem is and what measures can be taken to help that person. But if someone has a hearing loss, only that individual knows what he or she is “missing.” Communication breakdowns can create confusion, resentment and frustration for both parties.

In addition, older children and teenagers are expected to “fit in” at all costs. For the individual with hearing loss, this can lead to social bluffing (Link to Social Bluffing article), fatigue and frustration. Eventually denial, anger, withdrawal, depression and/or anxiety can set in with this age group as well.
Social activities have a vital presence in the lives of all people, especially individuals with hearing loss, because these activities “de-pathologize” the experience of the individual with hearing loss. Because being different is often not a virtue, children who are deaf or hard of hearing especially can benefit from these activities. This, in turn, creates empowerment, strength and confidence to more effectively overcome barriers in our society.

Helen Keller also said, “Hearing is the soul of knowledge and information of a high order. To be cut off from hearing is to be isolated indeed.” Understanding the contexts of communication access offers people with hearing loss the opportunity to seek out ways to maximize their own access to information and achieve success in school, work, social and familial settings. As organizations like AG Bell continue to raise awareness of and advocate for laws promoting communication access, we improve access for individuals today with hearing loss and create a legacy for future generations.

Source: Volta Voices, January/February 2007