loss on this development, we will review briefly the extensive literature on the development of speech and language in children with normal hearing. Although the ages at which certain development milestones occur may vary, the sequence in which they occur is usually constant (Menyuk, 1972).

This chapter discusses the nature of the emergence of communication skills in normally hearing children as well as the unique effects of early hearing loss and deafness on this process for infants and children. We give details of the special nature of assessments and rehabilitation strategies appropriate for infants and children with hearing loss and finally discuss how considerations for disability determination need to be tailored to the special needs of this population.

DEVELOPMENT OF PERCEPTION, SPEECH PRODUCTION, AND LANGUAGE

Children with Normal Hearing

Speech Skills

Infants begin to differentiate among various sound intensities almost immediately after birth and, by 1 week of age, can make gross distinctions between tones. By 6 weeks of age, infants pay more attention to speech than to other sounds, discriminate between voiced and unvoiced speech sounds, and prefer female to male voices (Nober and Nober, 1977).

Infants begin to vocalize at birth, and those with normal hearing proceed through the stages of pleasure sounds, vocal play, and babbling until the first meaningful words begin to occur at or soon after 1 year of age (Bangs, 1968; Menyuk, 1972; Quigley and Paul, 1984; Stark, 1983). Speech-like stress patterns begin to emerge during the babbling stages (Stark, 1983), along with pitch and intonational contours (Bangs, 1968; Quigley and Paul, 1984; Stark, 1983).

According to Templin (1957), most children (75 percent) can produce all the vowel sounds and diphthongs by 3 years of age; by 7 years of age, 75 percent of children are able to produce all the phonemes, with the exception of “r.” Consonant blends are usually mastered by 8 years of age, and overall speech production ability is generally adult-like by that time (Menyuk, 1972; Quigley and Paul, 1984).

Language Skills

Language studies have described vocabulary and grammatical development of children with normal hearing. Studies of grammatical devel-



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