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Resource Guide: Early Hearing Detection and Intervention

Early Hearing Detection and Intervention

Early identification and early intervention are the keys to successful language development. If not detected early, studies have shown that children who are born Deaf or hard of hearing can have delays in speech, language, social skills, and academic achievement. It is important that all infants and young children have a hearing screening, which helps find children who are deaf.

Early Hearing Detection and Intervention (EHDI) programs are designed to help families identify whether their child is deaf. Most infants have a hearing screening soon after birth, usually before they leave the hospital. This procedure is often called the Universal Newborn Hearing Screening (UNHS). That means every newborn is screened. The procedure is safe and painless, and can be done while your infant is asleep.

It is important to remember that the UNHS is just a screen. Some infants’ hearing status can change later due to a number of factors. Factors can include family history, illness, injury, and/or certain medications. As always, if you have any concerns about your child’s hearing, have your child’s hearing tested by an audiologist. Your pediatrician can refer you to an audiologist.

If an infant or child is found to be Deaf or hard of hearing, the child’s family and doctors can make sure the child gets necessary services at an early age. Often times, steps include getting audiological evaluations and participating in early intervention services. By intervening early and getting the appropriate services, the child can develop language that will last a lifetime.

The Maryland Infants and Toddlers Program

The Maryland Infants and Toddlers Program directs a statewide system of early intervention for eligible children and their families, coordinating services from health care, educational, and social service agencies, and private providers.

When an infant or toddler is suspected of having a developmental delay, the child is referred by a parent or professional to the designated contact point for his/her county. This process is called the Single Point of Entry. A service coordinator or case manager will then help arrange for an evaluation and assessment of the child, free of charge, to determine if the child is eligible for early intervention services.

For more information, please see:


American Sign Language Milestones Checklist[i] 

Birth to 3 months:

  • Looks around with alertness.
  • Is attracted to any human movement.
  • Looks attentively at a person’s face.
  • Responds to smiles by smiling back.
  • Enjoys cuddling and holding.
  • Plays with hands and fingers and enjoys hand plays.

What you can do:

  • Comment on things you and your children are doing by signing about them.
  • Learn what hand babbling looks like.
  • Acknowledge and expand hand babbling by repeating it.
  • Look for first signs and repeat and expand on what your child signs.
  • Share ASL children’s literature with your child.
  • Play with your child using ASL rhymes and rhythms and have fun.

3 to 6 months:

  • Smiles, makes eye contact and laughs.
  • Likes to be held facing out, towards any action that is happening.
  • Laughs when seeing fingers approaching tickle.
  • Turns eyes to a flashing light.
  • Turns towards vibrations when the door bell or phone rings.
  • Is attracted to moving and coloured objects.
  • Plays with hands and fingers and enjoys hand plays.

What you can do:

  • Respond to what your child is signing rather than how he or she signs it.
  • Accept and expand your child’s sign attempts and respond naturally with adult signs.
  • Sign ASL stories: with books; without books; with made up stories about pictures;hand shape stories.
  • Show your child sign story videotapes and ASL poetry videotapes for children.
  • Have a conversation by signing back when your child signs with you.
  • Play games using toys and objects that your child enjoys.

6 to 9 months:

  • Enjoys hand babbling – repetitive hand movements such as opening and closing hands in rhythm without associated leg movements.
  • Turns head to locate moving objects, and to watch sign movements used to communicate.
  • Looks at common objects and family members when named in ASL.
  • Understands simple ASL words.

What you can do:

  • Use a variety of signs and facial expressions when you have a conversation with your child.
  • Recognize ad respond to the meaning that’s conveyed in your child’s facial expressions.
  • Act out stories with your child.
  • Encourage your child to play with other children who use ASL, for example, at play groups or ASL story circle times.
  • Have fun playing with your child and communicating about everything in his or her and your world!

9 to 12 months

  • Begins hand babbling with varied patterns.
  • Begins to use simple movements with hand shapes, such as straight forward or up and down.
  • Points to self and things.
  • Signs first ASL words using simple hand shapes, such as “mine”, “more”, “milk”, “mommy”.
  • Has a vocabulary of 10 signs.

What you can do:

  • Look at your baby when feeding, bathing or changing him or her.
  • Sign to your baby.
  • Play with hand shapes and use lots of facial expressions when playing with your baby.
  • Place fun, colourful pictures of ASL and the finger-spelled alphabet in your baby’s room.
  • Place a mirror in your baby’s room, positioned so he or she can see you entering and leaving the room.
  • Hold your baby while bouncing or dancing.
  • Share picture books.

12 to 18 months:

  • Begins to combine ASL words into simple two sign sentences, such as “eat more”, “ouch fall”.
  • Uses touch and gesture to summon parents and to do indicate needs.
  • Asks questions, such as:
  • -“Yes” or “No” with eyebrows raised along with a sign such as “mine” to say, “Is it mine?”.
  • -“What” or “where” with frowned eyebrows.
  • Points and can sign some letters of the alphabet.
  • Uses negation – a head shake alone or with negative sign “No” or “Can’t”.
  • Uses up to 40 signs, but understands many more.

What you can do:

  • Smile and laugh with your baby.
  • Sign with your baby to say hat you are doing when you feed, bath and dress him or her.
  • Show interest in the hand shapes and facial expressions your baby makes and repeat them back.
  • Hold your baby while using body rhythm or body movement.

18 to 24 months:

  • Uses 20 or more ASL words at 18 months.
  • Combines two or more ASL words, such as “Bath upstairs”, “Bye bye daddy”, “Stroller outside”, “Baby cry”.
  • Linguistically points to self and others.
  • Begins to tell stories about here and now.
  • Loves ASL stories and stories from books.
  • Copies actions and facial expressions of characters in a story.
  • Takes turns talking back and forth with you.
  • By 24 months may have a vocabulary of more than 200 words.

What you can do:

  • Point to people, pictures and common objects, sign their names and use simple ASL grammar.
  • Watch signed children’s videotapes with your baby.
  • Look at books, point to the pictures and name them in ASL.
  • Play games such as peek-a-boo with signs.
  • Show interest in the signs your baby makes and repeat them back.
  • Do ASL nursery rhymes with your baby.

Hearing Milestones Checklist[ii]

Birth to 3 months:

  • Blinks or jerks to loud noises.
  • Quiets and watches parents face when talked to.
  • Coos and gurgles.

3 to 6 months:

  • Looks to see where sounds come from.
  • Likes rattles, noise-making toys.
  • Smiles and babbles when talked to.

6 to 9 months:

  • Turns and looks at you when you talk.
  • Looks at right person when words “Mommy” and “Daddy” are said.
  • Uses sound (not crying) to get your attention.
  • Makes sounds like: da, ba, and ma.

9 to 12 months:

  • Knows names of favorite toys and can point to them when asked.
  • Follows directions: (open your mouth, give me the ball).
  • “Dances” and makes sounds to music.
  • Makes “b,” “d,” “g,” “m,” and “n” sounds when “talking.”
  • Jabbers when being talked to, changing loudness of voice.

12 to 18 months:

  • Points to body parts when asked.
  • Brings objects to you when asked.
  • Hears sounds coming from another room.
  • Imitates new sounds and words.
  • Says 10-20 words.

18 to 24 months

  • Understands simple phrases like: “in the cup” and “under the table.”
  • Likes to be read to and points to pictures when asked.
  • Says own first name.
  • Says two word sentences: “my shoes,” “go bye-bye,” “more juice.”